Publication: Epidemiología de la neumonía y legionelosis en España
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2021-07-19
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Universidad Complutense de Madrid
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Abstract
La neumonía es una enfermedad respiratoria originada por agentes biológicos. Presenta gran importancia en salud pública, por ser la principal causa individual de mortalidad infantil en todo el mundo, con distribución diferente en función del desarrollo de los países en los que acontece. Asimismo, la legionelosis es una enfermedad respiratoria con origen bacteriano que se presenta bajo dos diferentes formas clínicas: la infección pulmonar (Enfermedad del Legionario) y la forma no neumónica (Fiebre de Pontiac). Su agente inductor, la bacteria Legionella, es capaz de contaminar los sistemas antrópicos de agua partiendo desde reservorios naturales y asociarse a diferentes tipos de edificios, instalaciones y equipos; con la posibilidad de dispersarse a través de aerosoles. El objetivo de esta tesis es caracterizar la epidemiología por neumonía y legionelosis en España en las series 1992-2001 y 2005-2015. En particular, expresado según la tasa de altas, casos y mortalidad. En España la tasa ajustada de altas por neumonía (población europea, x 100.000 habitantes) se incrementa fundamentalmente a lo largo de los años en ambos sexos, con una gran variabilidad en casi todos los grupos etarios. La legionelosis tiene implicación en el ámbito comunitario, nosocomial y EWGLINET; afectando al número de casos en todos los ámbitos y, en especial, en los brotes y casos en los años 1997, 1998 y 2000 de la primera serie y un número mayor de casos notificados en los últimos años de la segunda. Respecto a la mortalidad por neumonía la primera serie muestra una tendencia relativamente estable y similar según sexo, afectando preferentemente al masculino. A pesar de que la mortalidad de la neumonía en España disminuye en ambos sexos en algunos grupos de edad (especialmente en < 5 años), en > 75 años permanece aproximadamente estable. En años recientes de la segunda serie la mortalidad por neumonía aumentó ostensiblemente. Para la legionelosis las defunciones tuvieron la misma relevancia que los casos en los años indicados en la primera serie, mientras que la mortalidad aumentó en el último periodo. Adicionalmente, la implementación nacional de la normativa no ha sido suficientemente eficaz en el control de la enfermedad. Se identifica una mayor mortalidad con un aumento de los años (series) por lo que, atendiendo a su epidemiología, la legionelosis sigue presentándose como un reto que superar en España. La conjunción de medidas de salud pública y comunicación del riesgo podría redundar en un incremento del conocimiento de los mecanismos de contención del agente, por lo que se mejoraría la prevención y control de la enfermedad; remarcando la importancia del marco legislativo como medio frente a la aparición de la legionelosis. Además, el análisis de las series temporales podría arrojar información relevante del comportamiento de la enfermedad y del ámbito de desarrollo del agente inductor de la misma. Por ello, se sugiere la instauración de estrategias para la disminución de la neumonía, con especial atención a los niños y personas de mayor edad; así como la mejora en el diagnóstico y el fomento de prácticas relativas a la prevención y el tratamiento.
Pneumonia is a respiratory disease caused by biological agents. It’s of great relevance in public health, as leading individual cause of infant mortality worldwide, with a different distribution depending on the development of the countries in which it occurs. Likewise, legionellosis is a respiratory disease with a bacterial origin and two different clinical forms: pulmonary infection (Legionnaires’ disease) and non-pneumonic form (Pontiac fever). It`s inducing agent, Legionella bacterium, can contaminate anthropic water systems from natural reservoirs and link with different types of buildings, facilities and devices; with the possibility of spreading through aerosols. The objective of this thesis is to characterize the epidemiology of pneumonia and legionellosis in Spain (1992-2001 and 2005-2015 time series). In particular, expressed according to discharge rate, cases and mortality. In Spain, pneumonia adjusted discharge rate (European population, x 100,000 inhabitants) fundamentally increases over the years in both sexes, with great variability in almost all age groups. Legionellosis impacts in community, nosocomial and EWGLINET settings; affecting the number of cases and, especially, outbreaks and cases in 1997, 1998 and 2000 of the first series and a greater number of reported cases in the last years of the second. With respect to pneumonia mortality, the first series shows a relatively stable and similar tendency according to sex, preferably affecting male. Although pneumonia mortatilty in Spain decreases in both sexes in some age groups (especially < 5 years), > 75 years remains approximately stable. In recent years of the second series, pneumonia mortality increased significantly. Legionellosis deaths had the same relevance as cases in the years indicated in the first series, while mortality increased in the last period. Additionally, national regulation compliance has not been sufficiently effective in the control of the disease. A higher mortality with an increase in the years (series) was identified. Therefore, according to the epidemiology, legionellosis continues as a challenge to overcome in Spain. The conjunction of public health measures and risk communication could result in a knowledge increase of mechanisms to contain the agent, so that the prevention and control of the disease would be improved; highlighting the relevance of the legislative framework as a barrier against legionellosis. In addition, time series analysis could show relevant information on the behavior of the disease and the agent development scope. Therefore, it’s suggested the establishment of strategies for the reduction of pneumonia, with special attention to children and the elderly; as well as the improvement in diagnosis and the promotion of practices related to prevention and treatment.
Pneumonia is a respiratory disease caused by biological agents. It’s of great relevance in public health, as leading individual cause of infant mortality worldwide, with a different distribution depending on the development of the countries in which it occurs. Likewise, legionellosis is a respiratory disease with a bacterial origin and two different clinical forms: pulmonary infection (Legionnaires’ disease) and non-pneumonic form (Pontiac fever). It`s inducing agent, Legionella bacterium, can contaminate anthropic water systems from natural reservoirs and link with different types of buildings, facilities and devices; with the possibility of spreading through aerosols. The objective of this thesis is to characterize the epidemiology of pneumonia and legionellosis in Spain (1992-2001 and 2005-2015 time series). In particular, expressed according to discharge rate, cases and mortality. In Spain, pneumonia adjusted discharge rate (European population, x 100,000 inhabitants) fundamentally increases over the years in both sexes, with great variability in almost all age groups. Legionellosis impacts in community, nosocomial and EWGLINET settings; affecting the number of cases and, especially, outbreaks and cases in 1997, 1998 and 2000 of the first series and a greater number of reported cases in the last years of the second. With respect to pneumonia mortality, the first series shows a relatively stable and similar tendency according to sex, preferably affecting male. Although pneumonia mortatilty in Spain decreases in both sexes in some age groups (especially < 5 years), > 75 years remains approximately stable. In recent years of the second series, pneumonia mortality increased significantly. Legionellosis deaths had the same relevance as cases in the years indicated in the first series, while mortality increased in the last period. Additionally, national regulation compliance has not been sufficiently effective in the control of the disease. A higher mortality with an increase in the years (series) was identified. Therefore, according to the epidemiology, legionellosis continues as a challenge to overcome in Spain. The conjunction of public health measures and risk communication could result in a knowledge increase of mechanisms to contain the agent, so that the prevention and control of the disease would be improved; highlighting the relevance of the legislative framework as a barrier against legionellosis. In addition, time series analysis could show relevant information on the behavior of the disease and the agent development scope. Therefore, it’s suggested the establishment of strategies for the reduction of pneumonia, with special attention to children and the elderly; as well as the improvement in diagnosis and the promotion of practices related to prevention and treatment.
Description
Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Salud Pública y Materno-Infantil, leída el 25/01/2021