BackgroundA large and unsuspected tuberculosis outbreak involving 18.7% of the total of the tuberculosis cases studied, was detected in a population-based molecular epidemiological study performed in Zaragoza (Spain) from 2001 to 2004.MethodsThe Mycobacterium tuberculosis drug-susceptible strain, named MTZ strain, was genetically characterized by IS6110-RFLP, Spoligotyping and by MIRU-VNTR typing and the genetic patterns obtained were compared with those included in international databases. The characteristics of the affected patients, in an attempt to understand why the MTZ strain was so highly transmitted among the population were also analyzed.ResultsThe genetic profile of the MTZ strain was rare and not widely distributed in our area or elsewhere. The patients affected did not show any notable risk factor for TB.ConclusionThe M. tuberculosis strain MTZ, might have particular transmissibility or virulence properties, and we believe that greater focus should be placed on stopping its widespread dissemination.

In July 2008 an onychomadesis outbreak in a nursery setting was reported in Saragossa (Spain). Some of the cases had previously suffered from hand, foot and mouth disease (HFMD). In order to study the outbreak and to determine the relation between the two diseases, two epidemiological studies were conducted: a descriptive study focused on cases and a retrospective cohort study. Samples from stool, pharynx and nails were obtained from cases for microbiological analysis. During the study period, 27 children fulfilled the case definition. The average age was 1.8 years. A case shed on average four nails (minimum one maximum twelve). Twenty-four of the 27 cases had previously presented with HFMD which started an average of 40 days before the onset of onychomadesis (relative risk: 14). Unidentified non-polio enterovirus (n=10), coxsackie B1 (n=4) and coxsackie B2 virus (n=3) were isolated in 28 specimens obtained from 14 cases. The analysis showed a strong association between HMFD and onychomadesis. Microbiological results have not been conclusive; consequently more studies are necessary to determine the causal agent of infectious onychomadesis.

On 6 February 2002, a cluster of pneumonia cases was reported to the Sección de Vigilancia Epidemiológica del Servicio Aragonés de Salud (epidemiological surveillance unit, health services of Aragon) in Zaragoza, Spain; all patients were residents of a nursing home for elderly people. The residents in the home were aged 56-102 years, the median age was 86.

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We highlight the importance of evaluation of the ESS, based on its results. nMM due to S. pneumoniae represent an important group of diseases and their case fatality is high. The completeness of the ESS in Saragossa was over 80% when the mandatory reporting system and the MBDS were combined. Incorporating the MBDS into surveillance would facilitate the estimation of the real incidence of various diseases subject to mandatory reporting.