Scientific letter
Reporting of human cystic echinococcosis in Spain: How effective is the epidemiological surveillance system?
Notificación de la hidatidosis en España: ¿hasta qué punto es eficaz el sistema de vigilancia epidemiológica?
David Carmenaa,b,
, Aitziber Benito-Pérez de Mendiolaa, Luisa P. Sánchez-Serranoc
Autor para correspondencia
a Department of Immunology, Microbiology and Parasitology, Faculty of Pharmacy, University of the Basque Country, Vitoria-Gasteiz, Spain
b MRC Clinical Sciences Center, Cellular Stress Group, Faculty of Medicine, Imperial College, Hammersmith Hospital, London, England
c CIBER Epidemiology and Public Health, National Center of Epidemiology, Institute of Health Carlos III, Madrid, Spain
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"apellidos" => "Sánchez-Serrano" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff3" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Department of Immunology, Microbiology and Parasitology, Faculty of Pharmacy, University of the Basque Country, Vitoria-Gasteiz, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] 1 => array:3 [ "entidad" => "MRC Clinical Sciences Center, Cellular Stress Group, Faculty of Medicine, Imperial College, Hammersmith Hospital, London, England" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] 2 => array:3 [ "entidad" => "CIBER Epidemiology and Public Health, National Center of Epidemiology, Institute of Health Carlos III, Madrid, Spain" "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff3" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Notificación de la hidatidosis en España: ¿hasta qué punto es eficaz el sistema de vigilancia epidemiológica?" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig1" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1140 "Ancho" => 1583 "Tamanyo" => 98842 ] ] "descripcion" => array:1 [ "es" => "<p class="elsevierStyleSimplePara elsevierViewall">Incidence of human cystic echinococcosis in Spain (1982–2007). Data are from the Compulsory Notifiable Diseases (CND) system.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p class="elsevierStylePara elsevierViewall">As in other Mediterranean countries, human cystic echinococcosis (HCE) is considered an endemic disease in Spain.<a class="elsevierStyleCrossRef" href="#bib1"><span class="elsevierStyleSup">1</span></a> The implementation of prevention and control programs for hydatidosis/echinococcosis in the 1980s led to a significant decrease in human incidence rates (<a class="elsevierStyleCrossRef" href="#fig1">fig. 1</a>); nonetheless, HCE remains one of the most important anthropozoonoses in Spain.<a class="elsevierStyleCrossRef" href="#bib2"><span class="elsevierStyleSup">2</span></a> The national epidemiological surveillance network is based on 3 interdependent systems: Compulsory Notifiable Diseases (CND), Outbreak Alerts (OA) and Microbiological Information (MI). All practicing doctors from both the public and private healthcare sectors are obliged to notify incident and suspected HCE cases to the CND, although since 1996, reporting is only required in those autonomous regions where the infection is considered endemic.<a class="elsevierStyleCrossRef" href="#bib3"><span class="elsevierStyleSup">3</span></a> Hence, the CND is regarded as the universal notification system in Spain, providing the official figures published in the Spanish Report on Trends and Sources of Zoonoses by the European Commission. The MI is based on voluntary weekly reporting of confirmed microbiological diagnoses of individual cases provided by a network of parasitology laboratories, mainly in hospitals. This system covers approximately 25% of the Spanish population, since only 5 of 19 autonomous regions in Spain currently report their cases. Because they have a lower coverage range and limited usefulness, the OA and MI systems generally play complementary and/or confirmatory roles. However, the effectiveness of the CND in HCE reporting may be seriously compromised by a number of factors derived from its operating design and the particular biological features of the disease: 1) errors and omissions made by overworked or poorly motivated professionals can lead to underreporting, and 2) the system is inadequately adapted to reporting diseases characterized by slow progression rates, long asymptomatic periods, and late diagnosis, as is the case of HCE. Indeed, the sensitivity of the CND in estimating the incidence of HCE was found to be 47% to 57% in the autonomous regions of Aragon<a class="elsevierStyleCrossRef" href="#bib4"><span class="elsevierStyleSup">4</span></a> and the province of Salamanca<a class="elsevierStyleCrossRef" href="#bib5"><span class="elsevierStyleSup">5</span></a> by the capture-recapture method and active search of hospital records, respectively. These findings clearly illustrate the need for new epidemiological data sources to help improve the low sensitivity of the CND.</p><elsevierMultimedia ident="fig1"></elsevierMultimedia><p class="elsevierStylePara elsevierViewall">Computerized hospital discharge records, particularly the minimum basic data set (MBDS), have been increasingly used to retrieve scientific evidence over the last 20 years in Spain. The MBDS is a nationwide medical-administrative database, approved in 1987 by the National Health System Interterritorial Council and based on recommendations of the European Union. The system uses clinical codes (CIE-10-MC) according to the International Classification of Diseases, tenth revision, Clinical Modification, and in 1998 it covered an estimated 97% of public hospitals in Spain.<a class="elsevierStyleCrossRef" href="#bib6"><span class="elsevierStyleSup">6</span></a> The quality and consistency of the MBDS relies on meticulous recording of data in hospital discharge reports and coding of the variables considered. Errors and omissions in these 2 key procedures have been reported frequently in the literature<a class="elsevierStyleCrossRefs" href="#bib7"><span class="elsevierStyleSup">7–9</span></a> and indicate considerable differences in the quality of data between hospitals and regions. Because of its wide coverage, convenience and relatively low cost, the MBDS is a potentially powerful resource for epidemiological and research purposes, although it is important to bear in mind that the system was not set up as an instrument to promote diagnostic accuracy. Considered together, these observations indicate that the MBDS, like any other methodological tool, must be adequately validated as a research resource. In the last few years the MBDS has also been used to estimate the incidence of HCE in the province of Salamanca<a class="elsevierStyleCrossRef" href="#bib10"><span class="elsevierStyleSup">10</span></a> and the autonomous region of Madrid.<a class="elsevierStyleCrossRef" href="#bib11"><span class="elsevierStyleSup">11</span></a> Both surveys found relevant epidemiological data showing higher incidence rates than those expected or provided by the CND, confirming the lack of sensitivity of the CND reported previously. However, the reliability of the MBDSs investigated was not determined in either of the surveys (for example validating the data obtained against individual patient case reports), a fact that sheds doubts on the degree of accuracy of the figures presented.</p><p class="elsevierStylePara elsevierViewall">In conclusion, it is now clear that the CND alone is insufficient for estimating the incidence of HCE in Spain. This task requires complementary epidemiological data sources, including the MI and the MBDS. However, the MBDS must be evaluated prior to its use in order to guarantee the quality and accuracy of the data provided.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig1" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1140 "Ancho" => 1583 "Tamanyo" => 98842 ] ] "descripcion" => array:1 [ "es" => "<p class="elsevierStyleSimplePara elsevierViewall">Incidence of human cystic echinococcosis in Spain (1982–2007). 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 4 | 1 | 5 |
| 2024 Octubre | 8 | 3 | 11 |
| 2024 Septiembre | 12 | 7 | 19 |
| 2024 Agosto | 13 | 1 | 14 |
| 2024 Julio | 12 | 4 | 16 |
| 2024 Junio | 10 | 4 | 14 |
| 2024 Mayo | 9 | 4 | 13 |
| 2024 Abril | 11 | 5 | 16 |
| 2024 Marzo | 14 | 8 | 22 |
| 2024 Febrero | 16 | 5 | 21 |
| 2024 Enero | 22 | 1 | 23 |
| 2023 Diciembre | 25 | 2 | 27 |
| 2023 Noviembre | 18 | 6 | 24 |
| 2023 Octubre | 21 | 18 | 39 |
| 2023 Septiembre | 11 | 1 | 12 |
| 2023 Agosto | 14 | 3 | 17 |
| 2023 Julio | 21 | 7 | 28 |
| 2023 Junio | 8 | 0 | 8 |
| 2023 Mayo | 5 | 1 | 6 |
| 2023 Abril | 9 | 3 | 12 |
| 2023 Marzo | 12 | 4 | 16 |
| 2023 Febrero | 11 | 8 | 19 |
| 2023 Enero | 9 | 5 | 14 |
| 2022 Diciembre | 20 | 6 | 26 |
| 2022 Noviembre | 26 | 3 | 29 |
| 2022 Octubre | 21 | 11 | 32 |
| 2022 Septiembre | 22 | 16 | 38 |
| 2022 Agosto | 11 | 8 | 19 |
| 2022 Julio | 20 | 10 | 30 |
| 2022 Junio | 32 | 10 | 42 |
| 2022 Mayo | 13 | 9 | 22 |
| 2022 Abril | 33 | 15 | 48 |
| 2022 Marzo | 22 | 12 | 34 |
| 2022 Febrero | 23 | 10 | 33 |
| 2022 Enero | 12 | 11 | 23 |
| 2021 Diciembre | 19 | 11 | 30 |
| 2021 Noviembre | 16 | 8 | 24 |
| 2021 Octubre | 12 | 11 | 23 |
| 2021 Septiembre | 8 | 9 | 17 |
| 2021 Agosto | 18 | 4 | 22 |
| 2021 Julio | 35 | 6 | 41 |
| 2021 Junio | 21 | 10 | 31 |
| 2021 Mayo | 28 | 8 | 36 |
| 2021 Abril | 24 | 6 | 30 |
| 2021 Marzo | 19 | 6 | 25 |
| 2021 Febrero | 12 | 14 | 26 |
| 2021 Enero | 16 | 10 | 26 |
| 2020 Diciembre | 14 | 6 | 20 |
| 2020 Noviembre | 11 | 12 | 23 |
| 2020 Octubre | 11 | 8 | 19 |
| 2020 Septiembre | 20 | 11 | 31 |
| 2020 Agosto | 10 | 12 | 22 |
| 2020 Julio | 8 | 9 | 17 |
| 2020 Junio | 14 | 13 | 27 |
| 2020 Mayo | 14 | 4 | 18 |
| 2020 Abril | 9 | 8 | 17 |
| 2020 Marzo | 15 | 6 | 21 |
| 2020 Febrero | 12 | 12 | 24 |
| 2020 Enero | 19 | 12 | 31 |
| 2019 Diciembre | 17 | 23 | 40 |
| 2019 Noviembre | 16 | 6 | 22 |
| 2019 Octubre | 5 | 10 | 15 |
| 2019 Septiembre | 9 | 4 | 13 |
| 2019 Agosto | 8 | 6 | 14 |
| 2019 Julio | 7 | 15 | 22 |
| 2019 Junio | 41 | 13 | 54 |
| 2019 Mayo | 122 | 21 | 143 |
| 2019 Abril | 32 | 8 | 40 |
| 2019 Marzo | 5 | 5 | 10 |
| 2019 Febrero | 7 | 9 | 16 |
| 2019 Enero | 8 | 4 | 12 |
| 2018 Diciembre | 5 | 8 | 13 |
| 2018 Noviembre | 11 | 12 | 23 |
| 2018 Octubre | 10 | 5 | 15 |
| 2018 Septiembre | 23 | 3 | 26 |
| 2018 Agosto | 8 | 1 | 9 |
| 2018 Julio | 8 | 2 | 10 |
| 2018 Junio | 5 | 1 | 6 |
| 2018 Mayo | 5 | 0 | 5 |
| 2018 Abril | 6 | 2 | 8 |
| 2018 Marzo | 7 | 0 | 7 |
| 2018 Febrero | 10 | 1 | 11 |
| 2018 Enero | 6 | 0 | 6 |
| 2017 Diciembre | 7 | 0 | 7 |
| 2017 Noviembre | 15 | 1 | 16 |
| 2017 Octubre | 10 | 2 | 12 |
| 2017 Septiembre | 13 | 7 | 20 |
| 2017 Agosto | 14 | 7 | 21 |
| 2017 Julio | 6 | 6 | 12 |
| 2017 Junio | 12 | 12 | 24 |
| 2017 Mayo | 38 | 5 | 43 |
| 2017 Abril | 24 | 6 | 30 |
| 2017 Marzo | 18 | 29 | 47 |
| 2017 Febrero | 17 | 0 | 17 |
| 2017 Enero | 16 | 2 | 18 |
| 2016 Diciembre | 25 | 3 | 28 |
| 2016 Noviembre | 23 | 4 | 27 |
| 2016 Octubre | 59 | 6 | 65 |
| 2016 Septiembre | 55 | 6 | 61 |
| 2016 Agosto | 33 | 3 | 36 |
| 2016 Julio | 33 | 7 | 40 |
| 2016 Junio | 38 | 33 | 71 |
| 2016 Mayo | 36 | 10 | 46 |
| 2016 Abril | 34 | 20 | 54 |
| 2016 Marzo | 38 | 19 | 57 |
| 2016 Febrero | 33 | 15 | 48 |
| 2016 Enero | 31 | 17 | 48 |
| 2015 Diciembre | 25 | 10 | 35 |
| 2015 Noviembre | 37 | 8 | 45 |
| 2015 Octubre | 52 | 9 | 61 |
| 2015 Septiembre | 37 | 11 | 48 |
| 2015 Agosto | 29 | 13 | 42 |
| 2015 Julio | 27 | 9 | 36 |
| 2015 Junio | 6 | 2 | 8 |
| 2015 Mayo | 14 | 12 | 26 |
| 2015 Abril | 34 | 19 | 53 |
| 2015 Marzo | 28 | 10 | 38 |
| 2015 Febrero | 25 | 6 | 31 |
| 2015 Enero | 50 | 6 | 56 |
| 2014 Diciembre | 64 | 11 | 75 |
| 2014 Noviembre | 37 | 8 | 45 |
| 2014 Octubre | 65 | 10 | 75 |
| 2014 Septiembre | 56 | 7 | 63 |
| 2014 Agosto | 38 | 10 | 48 |
| 2014 Julio | 53 | 6 | 59 |
| 2014 Junio | 59 | 3 | 62 |
| 2014 Mayo | 37 | 4 | 41 |
| 2014 Abril | 51 | 6 | 57 |
| 2014 Marzo | 54 | 3 | 57 |
| 2014 Febrero | 47 | 3 | 50 |
| 2014 Enero | 48 | 8 | 56 |
| 2013 Diciembre | 38 | 5 | 43 |
| 2013 Noviembre | 42 | 6 | 48 |
| 2013 Octubre | 51 | 6 | 57 |
| 2013 Septiembre | 37 | 7 | 44 |
| 2013 Agosto | 55 | 7 | 62 |
| 2013 Julio | 29 | 2 | 31 |
| 2013 Junio | 3 | 0 | 3 |
| 2013 Mayo | 5 | 0 | 5 |
| 2013 Abril | 2 | 0 | 2 |
| 2013 Marzo | 2 | 0 | 2 |
| 2013 Febrero | 2 | 0 | 2 |
| 2013 Enero | 3 | 0 | 3 |
| 2012 Diciembre | 2 | 0 | 2 |
| 2012 Octubre | 2 | 0 | 2 |
| 2010 Mayo | 296 | 0 | 296 |
| 2010 Febrero | 775 | 0 | 775 |
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