Diana Toledo

Background: Seasonal influenza, especially in persons with underlying medical conditions, is a substantial global burden. Influenza vaccination effectiveness (VE) varies annually, requiring continuous evaluation due to evolving viruses and vaccination coverages. Our aim was to investigate influenza VE in preventing hospitalization for confirmed influenza among people aged 15–64 years with underlying medical conditions. Methods: We conducted a multicentre case–control study across 17 Spanish hospitals in hospitalized patients aged 15–64 years with underlying medical conditions in three influenza seasons. Influenza VE was estimated using two types of controls: test‐negative controls and non‐acute respiratory infection controls. Data on demographics, underlying medical conditions, vaccination status and clinical outcomes were collected. Adjusted VE was analysed using multivariable logistic regression models. Results: Recruited were 1220 hospitalized adults with underlying medical conditions, of whom 25.2% were vaccinated. VE varied by season, age group, and virus subtype. Statistically significant protection was observed for all seasons jointly against influenza A(H3N2) subtype, whereas VE estimates for specific seasons and subtypes were not significant. Conclusions: These findings underscore the importance of continuous VE monitoring and tailored vaccination strategies to protect adults with underlying medical conditions and highlight low seasonal influenza vaccination coverage in this population. Influenza seasonal vaccination should be improved in people aged 15–64 years with underlying medical conditions.

Measles is a highly contagious infectious disease. The importance of vaccinating healthcare workers (HCW) and medical students as future HCW is underlined

Objective: The aim was to describe the history of sexually transmitted infections (STIs) among adult mpox men cases and to analyse sociodemographic and epidemiological characteristics according to the presence or absence of any STI diagnosed 1 or 6 months previous to mpox diagnosis during the 2022 outbreak in Spain. Methods: A cross‐sectional study was conducted as part of a multicentre study in seven Spanish regions. Mpox patients were enrolled by the epidemiological surveillance services from June 2022 to January 2023. We conducted descriptive and bivariate analyses to compare sociodemographic, epidemiological and clinical characteristics of mpox according to the presence of a previous STI diagnosis. Associations were assessed using logistic regression to estimate crude odds ratio (OR) and adjusted odds ratio (aOR) with 95% confidence intervals (95% CI). Results: A total of 1202 mpox individuals were included (96.4% were men); 36% (417/1159) of males had previous STI during the 6 months previous to mpox diagnosis. Chemsex practice (aOR 1.66, 95% CI: 1.11–2.47), practicing sex in leisure places (aOR 1.68, 95% CI: 1.12–2.51), having HIV diagnosis (aOR 1.91, 95% CI: 1.32–2.77) and using pre‐exposure prophylaxis (PrEP) (aOR 4.43, 95% CI: 3.05–6.45) were more frequent among males with a history of STI in the 6 months previous to mpox diagnosis. No statistical differences were found in mpox clinical manifestations and hospitalization according to STI history. Conclusions: Overlapping risk behaviours and shared transmission routes contributed to the high prevalence of STI history in mpox cases. Epidemiological characteristics studied in mpox cases with previous STI may help identify target populations and planning an integrated prevention strategy.

Community-acquired pneumonia (CAP) is a leading cause of morbidity in adults with chronic conditions. Although pneumococcal vaccine effectiveness (VE) has

While measles‐mumps and rubella vaccines (MMR) have reduced mumps incidence, outbreaks continue to occur in developed countries. The aim of the study was to evaluate the serological status against mumps and its association with vaccination history among medical students in Catalonia (Spain). A cross‐sectional study was conducted during 2023–2025 among medical students attending four university teaching‐units. Participants completed a questionnaire and provided blood samples for mumps IgG testing. Associations between positive serology and vaccination status and the independent variables were assessed calculating adjusted OR (aOR) and 95% confidence interval (CI) after adjustment for age, sex, and degree year. Among 235 participants, 94.5% had received 2‐MMR doses, and 94.9% had been vaccinated more than 15 years earlier. Complete vaccination was associated with being a 5th‐year student (aOR 5.45; 95%CI: 1.38–21.50); 80.4% showed positive IgG, being higher in women (aOR 2.52; 95%CI: 1.20–5.30). Seropositivity declined with increasing time since last vaccination. Although the proportion of students serologically protected is acceptable, more than 15 years have passed since the last vaccine dose in most of the students and waning immunity is expected. The recommendation of a third MMR dose for medical students and healthcare workers in mumps outbreak settings should be considered.

Background/Objectives: The study’s goal is to assess the association between long-term statin therapy and influenza incidence, influenza severity, and all-cause mortality. Methods: Two population-based dynamic cohorts (exposed and unexposed to statins) were followed from 2010 to 2019. Participants were 60 years or older; frail patients were excluded. The primary outcomes were influenza incidence, influenza-related intensive care unit (ICU) admission as a proxy for severity, and all-cause mortality. The exposed cohort comprised new statin users with a minimum of two pharmacy invoices within 90 days of enrollment. Adjusted risk ratios (aRRs) for influenza incidence, ICU admission, and mortality rate were calculated using Poisson regression. Results: The initial study population of 639,564 individuals was evenly split into exposed (319,782) and unexposed (319,782) cohorts; mean age was 71 years (standard deviation: 8 years), and 57% were women. Compared to non-users, new statin users showed a higher influenza incidence [9.39 (95% confidence interval: 9.36–9.42) vs. 7.64 (7.61–7.66) per 1000 person-years], ICU admission [1.65 (1.65–1.66) vs. 1.36 (1.35–1.36) per 1000 person-years], and overall mortality rate [97.09 (96.75–97.43) vs. 94.15 (93.82–94.47) per 1000 person-years]. Adjusted analysis revealed no significant association between statin use and influenza incidence [aRR: 1.04 (0.98–1.10)] or influenza-related ICU admission [aRR: 1.03 (0.89–1.19)] and shifted the effect on mortality from harmful to beneficial [aRR: 0.88 (0.87–0.89)]. Conclusions: Despite new users’ greater vulnerability at the start of treatment, our findings indicate that statins do not influence influenza incidence or severity but reduce all-cause mortality, warranting further exploration of their anti-inflammatory properties.

Background/Objectives: The role of smoking in household SARS-CoV-2 transmission is controversial. The objective of this study was to analyze the impact of smoking on SARS-CoV-2 index cases and transmission to household contacts. Methods: Prospective cohort study of 227 index cases and 332 household contacts in Catalonia and Navarre (May 2022–December 2024). The primary outcome measure was SARS-CoV-2 infection in contacts, confirmed by rapid antigen and polymerase chain reaction testing. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) for the smoking-infection association were calculated using logistic regression, adjusting for age, vaccination, and previous infection. Results: The cumulative infection incidence in contacts was 38.6%, and was higher in people aged ≥65 years (60.6%) and in smokers (48.6%) vs. non-smokers (33.8%). In the multivariate analysis, index case vaccination (aOR = 0.27; 95%CI: 0.11–0.63) and previous contact infection (aOR = 0.49; 95%CI: 0.30–0.81) were associated with a lower probability of transmission, while smoking by household contacts (aOR = 2.09; 95%CI: 1.19–3.65) and age ≥ 65 years (aOR = 5.13; 95%CI: 2.18–12.09) were associated with an increased risk of infection. The index case smoking status was not statistically significant. Conclusions: Smoking by cohabitants and age ≥ 65 years increase the risk of SARS-CoV-2 infection. Index case vaccination and previous contact infection are associated with reduced intra-household transmission.

Spain reported the highest cumulative incidence of mpox in Europe during the 2022 outbreak, which disproportionately affected people living with HIV (PLWH) and HIV-negative individuals using pre-exposure prophylaxis (PrEP). We conducted a multicentre cross-sectional study to analyze epidemiological, clinical, and disease progression characteristics of mpox among PLWH, HIV-negative individuals, and PrEP user cases and non-user cases in Spain. Data were collected from June 2022 to January 2023, including 1,158 men aged ≥ 18 years; 35.3% were PLWH and 42.7% of HIV-negative individuals were PrEP users. Adjusted OR and the 95% CI were calculated by multivariate logistic regression analysis. More frequently PLWH than HIV-negative cases were having sex only with men (aOR = 10.92;3.76–31.69), chemsex (aOR = 2.02;1.38–2.97), another type of immunosuppression (aOR = 2.57;1.07–6.21) and non-anogenital and non-oral exanthems (aOR = 1.64;1.23–2.19). More frequent in PLWH compared to PrEP user cases were lower education levels (aOR = 23.21;2.87–187.52), fever (aOR = 1.42;0.98–2.06), non-anogenital and non-oral exanthems (aOR = 2.40;1.67–3.45) and another type of immunosuppression (aOR = 9.32;1.16–75.16) and more frequent in PrEP user cases than in non-PrEP user cases were risk factors related to sexual activity and concurrent sexually transmitted infections. PLWH did not experience more severe mpox than HIV-negative persons. These findings underscore the need for tailored prevention and clinical approaches.

Background: Socioeconomic inequalities in cardiovascular risk persist despite declining mortality. We examined the prevalence of cardiovascular risk factors and lifestyle behaviors across educational levels in men and women from a Mediterranean population. Methods: Cross-sectional analysis of adults aged 35–74 years from a population-based sample in north-eastern Spain. Risk factors and lifestyle were assessed with standardized measurements and validated questionnaires. Educational attainment was categorized as primary, secondary, or university. Analyses were sex-stratified; age-adjusted linear and logistic regression models were applied. Results: We included 943 adults (52.3% women). Among men, secondary and university education (vs. primary) were associated with lower LDL-cholesterol [β –11.76 (95% CI –21.68 to –1.83) and –17.83 (–28.03 to –7.63) mg/dL], lower odds of hypercholesterolemia [OR = 0.43 (0.20–0.90) for both], smoking [OR = 0.57 (0.33–0.97) and 0.53 (0.30–0.95)], and higher odds of high Mediterranean diet adherence [OR = 2.08 (1.04–4.16) and 3.05 (1.51–6.14)]. Among women, secondary and university education (vs. primary) were associated with lower body mass index [β –1.81 (–2.85 to –0.77) and –2.52 (–3.63 to –1.40) kg/m2] and lower odds of overweight/obesity [OR = 0.47 (0.29–0.76) and 0.34 (0.20–0.56)]. Lower odds of hypertension [OR = 0.44 (0.22–0.87)] and high Mediterranean diet adherence [OR = 2.14 (1.12–4.09)] were also more likely in university-educated women. Conclusions: Higher educational attainment was associated with healthier lifestyles and more favorable cardiometabolic profiles. Educational gradients were broader in women—spanning adiposity, blood pressure, glycemia, and lipidemia—whereas, in men, they mainly affected lipidemia and diet.

Objectives: This study aims to evaluate the impact of chronic statin therapy on the incidence of community-acquired pneumonia (CAP) and the rate of intensive care unit (ICU) admissions associated with CAP. Methods: Two population-based dynamic cohorts, consisting of individuals exposed and unexposed to statins, were followed from 2010 to 2019. Participants were older than 60 years, with frail patients excluded. The primary outcomes were the incidence of CAP and ICU admissions due to CAP, serving as a proxy for complicated cases. The exposed cohort included new statin users with at least two pharmacy invoices within 90 days of the recruitment period. Adjusted risk ratios (aRRs) for CAP incidence and CAP-associated ICU admissions were calculated using Poisson regression. Results: This study analyzed a sample of 639,564 individuals, evenly divided into exposed (319,782) and unexposed (319,782) groups, with a mean age of 71 years (standard deviation of 8 years) and 57% women. New statin users had a higher incidence of CAP [42.1 (95% confidence interval: 41.9–42.2) vs. 36.6 (36.5–36.8) per 1000 person-years] and ICU admissions [11.5 (11.5–11.6) vs. 10.1 (10.0–10.1) per 1000 person-years] compared to non-users. The adjusted analysis indicated that statin treatment reduced CAP risk by 6% [aRR: 0.94 (0.91–0.96)] and ICU admission by 7% [aRR: 0.93 (0.88–0.98)]. Conclusions: Prior statin therapy was associated with a clinically significant reduction in the incidence of CAP and ICU admissions due to CAP, despite the greater vulnerability of new users at the start of treatment compared to non-users.