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y si la vacunaci&#243;n se asoci&#243; a una menor ocurrencia de s&#237;ndrome gripal&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">M&#233;todos</span><p id="par0015" class="elsevierStylePara elsevierViewall">Estudio transversal realizado con trabajadores sanitarios en 18 hospitales de Andaluc&#237;a&#44; Castilla-La Mancha&#44; Catalu&#241;a&#44; Madrid y Pa&#237;s Vasco&#46; Se dividieron por servicios&#58; urgencias&#44; &#225;rea m&#233;dica &#40;medicina interna&#44; neumolog&#237;a&#44; pediatr&#237;a&#41;&#44; &#225;rea quir&#250;rgica &#40;cirug&#237;a general y anestesia&#41; y no adscritos&#59; y por categor&#237;as&#58; m&#233;dicos&#44; enfermeras&#44; auxiliares de enfermer&#237;a&#44; celadores y administrativos&#46; Entre noviembre de 2009 y enero de 2010 respondieron un cuestionario autocumplimentado sobre s&#237;ntomas &#40;fiebre&#44; tos&#44; disnea&#44; rinorrea&#44; mialgias&#44; neumon&#237;a&#44; 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en los que s&#237;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#41;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Entre los que no recibieron la vacuna frente al virus A&#47;California&#47;7&#47;2009&#47;H1N1&#44; 70 presentaron s&#237;ndrome gripal &#40;6&#44;4&#37;&#41;&#44; frente a cinco de los que recibieron la vacuna &#40;2&#44;6&#37;&#44; p para la comparaci&#243;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;031&#41;&#44; sin diferencias significativas en el caso de la vacunaci&#243;n frente a la gripe estacional &#40;6&#44;3&#37; en los que la recibieron frente a 4&#44;4&#37; en los que no la recibieron&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">En el modelo de regresi&#243;n log&#237;stica se incluyeron como variables independientes la presencia de casos en el n&#250;cleo familiar&#44; la comunidad aut&#243;noma de origen&#44; recibir la vacuna frente al virus A&#47;California&#47;7&#47;2009&#47;H1N1&#44; el sexo&#44; la categor&#237;a profesional y el servicio&#46; Se asociaron a una mayor prevalencia de s&#237;ndrome gripal el trabajar en la Comunidad de Madrid &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8&#44;31&#59; IC95&#37;&#58; 1&#44;05-65&#44;39&#41;&#44; los casos previos en el n&#250;cleo familiar &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44;84&#59; IC95&#37;&#58; 1&#44;41-5&#44;73&#41; y no haberse vacunado frente a la gripe A &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44;68&#59; IC95&#37;&#58; 1&#44;05-6&#44;82&#41;&#44; como se muestra en la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discusi&#243;n</span><p id="par0065" class="elsevierStylePara elsevierViewall">Hallamos una prevalencia de diagn&#243;stico de s&#237;ndrome gripal del 5&#44;8&#37;&#44; similar a la de estudios previos<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a>&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Una limitaci&#243;n de nuestro estudio es que en el cuestionario de salud se preguntaba si se hab&#237;a recibido el diagn&#243;stico de gripe por parte de alg&#250;n m&#233;dico&#44; sin exigir la toma de muestras microbiol&#243;gicas&#46; Sabemos que s&#243;lo en torno al 20&#37; de los s&#237;ndromes gripales corresponden a verdaderos casos de gripe&#44; que son aquellos sobre los que cabe esperar alg&#250;n efecto de la vacuna&#46; El hecho de que los casos fueran autodeclarados y los participantes voluntarios constituye otra debilidad&#58; posiblemente los participantes sean el personal m&#225;s sensibilizado en relaci&#243;n a la gripe&#44; con caracter&#237;sticas diferentes&#44; por ejemplo&#44; en el grado de cumplimiento de las recomendaciones higi&#233;nicas o de autoprotecci&#243;n frente al virus&#46; En cualquier caso&#44; este extremo no puede ser confirmado por nuestro trabajo&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Llaman la atenci&#243;n las diferencias geogr&#225;ficas encontradas&#46; La evoluci&#243;n de la pandemia no fue similar en toda Espa&#241;a&#44; con tasas de ataque diferentes en cada comunidad aut&#243;noma&#46; De todos modos&#44; el hecho de que nuestro estudio no fuera representativo de las plantillas de cada centro debe hacernos ser prudentes a la hora de analizar este hecho&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">La vacunaci&#243;n frente a la gripe A se asoci&#243; a una menor prevalencia de s&#237;ndrome gripal&#46; Revisiones de estudios previos ponen en duda la efectividad de la vacuna antigripal en los trabajadores sanitarios para evitar los casos de gripe documentada microbiol&#243;gicamente en los mayores de 60 a&#241;os&#44; pero s&#237; la apoyan en t&#233;rminos de s&#237;ndrome gripal&#46; De igual forma&#44; no hay evidencias de que la vacunaci&#243;n de los trabajadores sanitarios redunde en menos d&#237;as de baja laboral<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#8211;7</span></a>&#46; La interpretaci&#243;n en t&#233;rminos de mortalidad es bastante m&#225;s dificultosa por los muchos sesgos que suelen presentar estos estudios<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Otro factor asociado al diagn&#243;stico fue la presencia de casos previos en el n&#250;cleo familiar&#46; En otros estudios realizados con sanitarios se reconoce como fuente de contagio la extrahospitalaria<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#46; No se recogi&#243; la conformaci&#243;n familiar por franjas de edad&#44; lo que hubiera sido &#250;til para determinar si los contagios se hab&#237;an dado a partir de ni&#241;os o j&#243;venes&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">En resumen&#44; en torno a uno de cada veinte trabajadores sanitarios que participaron en el estudio fueron diagnosticados de s&#237;ndrome gripal&#44; con diferencias geogr&#225;ficas y relacionado con no haber sido vacunado contra la gripe A y haber tenido casos previos en el entorno familiar&#46;<elsevierMultimedia ident="tb0005"></elsevierMultimedia></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Contribuciones de autor&#237;a</span><p id="par0105" class="elsevierStylePara elsevierViewall">Concepci&#243;n y dise&#241;o del trabajo&#58; J&#46; Olalla&#44; F&#46; de Ory&#44; I&#46; Casas y J&#46; Garc&#237;a-Alegr&#237;a&#46; Escritura del art&#237;culo&#58; J&#46; Olalla&#44; F&#46; de Ory e I&#46; Casas&#46; Revisi&#243;n cr&#237;tica&#58; J&#46; Garc&#237;a-Alegr&#237;a&#46; Aprobaci&#243;n final&#58; J&#46; Olalla&#44; F&#46; de Ory&#44; I&#46; Casas y J&#46; Garc&#237;a-Alegr&#237;a&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Financiaci&#243;n</span><p id="par0110" class="elsevierStylePara elsevierViewall">Proyecto financiado por el Instituto de Salud Carlos III a trav&#233;s del CIBER de Epidemiolog&#237;a y Salud P&#250;blica&#46; C&#243;digo del proyecto GR09&#47;0038&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicto de intereses</span><p id="par0115" class="elsevierStylePara elsevierViewall">Ninguno&#46;</p></span></span>"
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          "titulo" => array:5 [
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            0 => "Abstract"
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          "titulo" => "Introducci&#243;n"
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          "identificador" => "sec0045"
          "titulo" => "Conflicto de intereses"
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          "identificador" => "xack12270"
          "titulo" => "Agradecimientos"
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        12 => array:1 [
          "titulo" => "Bibliograf&#237;a"
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    "pdfFichero" => "main.pdf"
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    "fechaRecibido" => "2011-10-14"
    "fechaAceptado" => "2012-01-29"
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec29479"
          "palabras" => array:3 [
            0 => "Trabajadores sanitarios"
            1 => "Gripe A &#40;H1N1&#41; 2009"
            2 => "Vacuna"
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec29480"
          "palabras" => array:3 [
            0 => "Healthcare workers"
            1 => "Influenza A &#40;H1N1&#41; 2009"
            2 => "Vaccination"
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      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Describir la prevalencia de s&#237;ndrome gripal en el invierno de 2009 y los factores asociados a su ocurrencia&#46;</p> <span class="elsevierStyleSectionTitle">M&#233;todo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio transversal en 18 hospitales espa&#241;oles&#46; Los voluntarios respondieron un cuestionario de salud&#44; informando sobre si hab&#237;an sufrido s&#237;ndrome gripal y su estado vacunal&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Participaron 1289 trabajadores sanitarios&#44; y de ellos&#44; 72 &#40;5&#44;6&#37;&#41; refirieron gripe en su familia&#44; 195 &#40;15&#44;1&#37;&#41; se vacunaron frente al virus A&#47;California&#47;7&#47;2009&#47;H1N1 y 75 &#40;5&#44;8&#37;&#44; intervalo de confianza del 95&#37; &#91;IC95&#37;&#93;&#58; 4&#44;5-7&#44;1&#41; sufrieron s&#237;ndrome gripal&#46; Hubo diferencias entre comunidades aut&#243;nomas&#46; En el an&#225;lisis de regresi&#243;n log&#237;stica&#44; se asoci&#243; a s&#237;ndrome gripal trabajar en la Comunidad de Madrid &#40;<span class="elsevierStyleItalic">odds ratio</span> &#91;OR&#93;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8&#44;31&#44; IC95&#37;&#58; 1&#46;05-65&#46;39&#41;&#44; tener casos de gripe en la familia &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44;84&#44; IC95&#37;&#58; 1&#44;41-5&#44;73&#41; y no estar vacunado frente a la gripe A &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44;68&#44; IC95&#37;&#58; 1&#44;05-6&#44;82&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La presencia de casos en la familia y la comunidad donde se trabaja determinaron una diferente prevalencia de s&#237;ndrome gripal&#46; La vacuna se asoci&#243; a una menor prevalencia de la enfermedad&#46;</p>"
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      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Objectives</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To describe the prevalence of influenza-like syndrome in winter 2009 and the factors associated with its occurrence&#46;</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A cross-sectional study was carried out in 18 hospitals in Spain&#46; Volunteers completed a health questionnaire in which they reported the occurrence of influenza-like syndrome and vaccination and demographic status&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">A total of 1&#44;289 healthcare workers participated&#46; Of these&#44; 72 &#40;5&#46;6&#37;&#41; reported influenza in their family&#44; 195 &#40;15&#46;1&#37;&#41; had been vaccinated against the A&#47;California&#47;7&#47;2009&#47;H1N1 virus and 75 &#40;5&#46;8&#37;&#44; 95&#37;CI&#58; 4&#46;5-7&#46;1&#37;&#41; had been diagnosed with influenza like-syndrome&#46; There were differences among regions&#46; In logistic regression analysis&#44; the following factors were associated with a higher prevalence of influenza-like syndrome&#58; working in Madrid &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8&#46;31&#44; 95&#37;CI&#58; 1&#46;05-65&#46;39&#41;&#44; the occurrence of cases of influenza in the family &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#46;84&#44; 95&#37;CI&#58; 1&#46;41-5&#46;73&#41; and not having been vaccinated against influenza A &#40;H1N1&#41; &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#46;68&#44; 95&#37; CI&#58; 1&#46;05-6&#46;82&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Differences in the prevalence of influenza-like syndrome were due to the occurrence of familiar cases and region&#46; Vaccination against influenza A &#40;H1N1&#41; was associated with a lower prevalence of the disease&#46;</p>"
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            "apendice" => "<p id="par0130" class="elsevierStylePara elsevierViewall">Javier Garc&#237;a-Alegr&#237;a&#44; Alfonso del Arco&#44; Javier de la Torre&#44; Jos&#233; Luis Prada&#44; Miguel Marcos&#44; Daniel Urdiales&#44; Fernando Fern&#225;ndez&#44; Marta Aranda&#44; Manuel Vergara&#44; Juan Carlos Toribio&#44; Jos&#233; Antonio Rodr&#237;guez y Paola P&#233;rez &#40;Hospital Costa del Sol&#41;&#59; Antonio Jes&#250;s N&#250;&#241;ez&#44; Jos&#233; Javier Santos y Francisco Pozo &#40;Hospital de Antequera&#41;&#59; Jos&#233; Mar&#237;a Quintana&#44; Susana Garc&#237;a y Carlota Las Hayas &#40;Hospital de Gald&#225;cano&#41;&#59; Antonio Escobar&#44; Juan Carlos Fern&#225;ndez y Mar&#237;a Garc&#237;a &#40;Hospital de Basurto&#41;&#59; Jos&#233; Ram&#243;n S&#225;enz&#44; Emilio P&#233;rez-Trallero y Diego Vicente &#40;Hospital de Donosti&#41;&#59; Ignacio S&#225;nchez Arcilla&#44; Marina Fern&#225;ndez y Magdalena Muedra &#40;Hospital Ram&#243;n y Cajal&#41;&#59; Consol Serra&#44; Roc&#237;o Villar y Josefina Pi-Sunyer &#40;Hospital del Mar&#41;&#59; Pilar Varela&#44; Victoria Oliver y Ana Vileilla &#40;Hospital Cl&#237;nic de Barcelona&#41;&#59; Carlos Pereda y Mar&#237;a Angeles Herrer&#237;a &#40;Hospital de Santa B&#225;rbara&#41;&#59; Carmen Valero&#44; Luc&#237;a Fern&#225;ndez y Mar&#237;a Angustias Romera &#40;Hospital de Santa Ana&#41;&#59; Pedro Gonz&#225;lez y Jos&#233; Mar&#237;a Jover &#40;Complejo Hospitalario de Ja&#233;n&#41;&#59; Manuel Zarzuela&#44; Jos&#233; Guti&#233;rrez y Mar&#237;a Carmen Lozano &#40;Hospital Puerta del Mar&#41;&#59; Fernando Y&#233;lamos&#44; Manuel Rodr&#237;guez y Jos&#233; Ram&#243;n Maldonado &#40;Hospital de Torrec&#225;rdenas&#41;&#59; Mar&#237;a Carmen Ubago&#44; Amelia Fern&#225;ndez y Dolores Torres &#40;Hospital Virgen de las Nieves&#41;&#59; Salvador O&#241;a&#44; Juan Arcos y Dolores Lerma &#40;Hospital Materno Infantil de M&#225;laga&#41;&#59; David Sadia y Jos&#233; Bascu&#241;ana &#40;Hospital Infanta Leonor&#41;&#59; Berta Moyano y El&#237;as Rodr&#237;guez &#40;Hospital del Tajo&#41;&#59; Francisco Martos &#40;Facultad de Medicina&#44; Universidad de M&#225;laga&#41;&#59; Antonio Daponte &#40;Escuela Andaluza de Salud P&#250;blica&#41;&#59; Mar&#237;a Jos&#233; P&#233;rez&#44; Encarnaci&#243;n Rom&#225;n&#44; Carmen Escassi y Eduardo Briones &#40;Hospital de Valme&#41;&#59; Jos&#233; Mar&#237;a Mayoral &#40;Direcci&#243;n General de Salud P&#250;blica&#44; Consejer&#237;a de Salud de la Junta de Andaluc&#237;a&#41;&#59; M&#243;nica Gonz&#225;lez Esguevillas&#44; Isabel P&#233;rez Grajera y Jes&#250;s Mar&#237;a de la Fuente &#40;Centro Nacional de Microbiolog&#237;a&#44; Instituto de Salud Carlos III&#41;&#46;</p>"
            "etiqueta" => "Anexo"
            "titulo" => "Grupo de trabajo para el estudio MARBEGRIP"
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Castilla-La Mancha&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">&#40;98&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#40;1&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Catalu&#241;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">106&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;89&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;10&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#44;038&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Andaluc&#237;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;95&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pa&#237;s Vasco&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">168&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;92&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#40;7&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Comunidad de Madrid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">164&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">&#40;93&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">&#40;6&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Servicio</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Urgencias&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">515&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#40;94&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#40;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#193;rea m&#233;dica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">307&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;93&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;6&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#44;878&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#193;rea quir&#250;rgica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">311&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;94&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#40;5&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No adscritos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;95&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#40;4&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Categor&#237;a profesional</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>M&#233;dico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">332&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;93&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Enfermera&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Auxiliar&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Administrativo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&#40;4&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Celador&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&#40;92&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">&#40;7&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Sexo</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Masculino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&#40;94&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Femenino&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Media &#40;DE&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">41&#44;7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#40;9&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">40&#44;4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#40;10&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Contagios previos</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">1153&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#40;94&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">64&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#40;5&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">61&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;052&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t">306&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#40;95&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;257&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  "referenciaCompleta" => "Harryman K&#44; Rosenberg J&#44; Bernier B&#44; et al&#46; Novel influenza A &#40;H1N1&#41; virus infections among health-care personnel - United States&#44; April-May 2009&#46; MMWR&#46; 2009&#59; 58&#58;641-5&#46;"
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Original breve
Casos autodeclarados de síndrome gripal en trabajadores sanitarios españoles durante la pandemia de gripe A (H1N1) 2009
Self-reported cases of influenza among Spanish healthcare workers during the 2009 influenza A(H1N1) pandemic
Julián Olallaa,b,
Autor para correspondencia
julianos@hcs.es

Autor para correspondencia.
, Fernando de Oryb,c, Inmaculada Casasb,d, Javier García-Alegríaa, Francisco Rivas-Ruizb,e, en representación del Grupo de Trabajo para el Estudio MARBEGRIP
a Unidad de Medicina Interna, Hospital Costa del Sol, Marbella (Málaga), España
b CIBER de Epidemiología y Salud Pública (CIBERESP), España
c Servicio de Microbiología Diagnóstica, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda (Madrid), España
d Laboratorio de Gripe y Virus Respiratorios, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda (Madrid), España
e Unidad de Investigación, Hospital Costa del Sol, Marbella (Málaga), España
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">En junio de 2009&#44; la Organizaci&#243;n Mundial de la Salud declaraba la pandemia por virus de la gripe A&#47;California&#47;7&#47;2009&#47;H1N1<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#46; En su inicio se comunic&#243; que el 12&#37; de los sanitarios que atendieron a pacientes infectados por dicho virus desarrollaron s&#237;ndrome gripal o s&#237;ntomas respiratorios<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#46; Los sanitarios son un colectivo al cual se supone especialmente sensibilizado hacia las medidas de protecci&#243;n frente a las enfermedades emergentes&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">En este trabajo pretendemos determinar el porcentaje de trabajadores sanitarios que recibieron la vacuna frente al virus A&#47;California&#47;7&#47;2009&#47;H1N1 en una muestra de voluntarios&#44; y si la vacunaci&#243;n se asoci&#243; a una menor ocurrencia de s&#237;ndrome gripal&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">M&#233;todos</span><p id="par0015" class="elsevierStylePara elsevierViewall">Estudio transversal realizado con trabajadores sanitarios en 18 hospitales de Andaluc&#237;a&#44; Castilla-La Mancha&#44; Catalu&#241;a&#44; Madrid y Pa&#237;s Vasco&#46; Se dividieron por servicios&#58; urgencias&#44; &#225;rea m&#233;dica &#40;medicina interna&#44; neumolog&#237;a&#44; pediatr&#237;a&#41;&#44; &#225;rea quir&#250;rgica &#40;cirug&#237;a general y anestesia&#41; y no adscritos&#59; y por categor&#237;as&#58; m&#233;dicos&#44; enfermeras&#44; auxiliares de enfermer&#237;a&#44; celadores y administrativos&#46; Entre noviembre de 2009 y enero de 2010 respondieron un cuestionario autocumplimentado sobre s&#237;ntomas &#40;fiebre&#44; tos&#44; disnea&#44; rinorrea&#44; mialgias&#44; neumon&#237;a&#44; diarrea&#44; v&#243;mitos&#44; cefalea&#44; malestar general&#41;&#44; comorbilidad asociada a mal pron&#243;stico de la gripe A&#44; vacunaci&#243;n frente a la gripe estacional y pand&#233;mica&#44; casos de gripe A confirmada por reacci&#243;n en cadena de la polimerasa &#40;PCR&#41; nasal en la familia y diagn&#243;stico de s&#237;ndrome gripal&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Se realiz&#243; un an&#225;lisis descriptivo&#46; En el an&#225;lisis bivariado se tom&#243; como variable principal la presencia o ausencia de s&#237;ndrome gripal&#46; Para la comparaci&#243;n de subgrupos en las variables continuas se aplic&#243; el test de la U de Mann-Whitney&#44; y para las categ&#243;ricas el test de &#967;<span class="elsevierStyleSup">2</span>&#46; Se construyeron modelos de regresi&#243;n log&#237;stica m&#250;ltiple por pasos hacia delante&#44; incluyendo aquellas variables que en el an&#225;lisis bivariado obtuvieron p &#60;0&#44;1&#46; No se incluyeron los s&#237;ntomas que presentaban los trabajadores en el momento de la encuesta de salud aunque se asociaran a la presencia de s&#237;ndrome gripal&#44; por ser expresiones residuales de &#233;ste&#46; Se ofrecen los valores de <span class="elsevierStyleItalic">odds ratio</span> &#40;OR&#41; y los intervalos de confianza del 95&#37; &#40;IC95&#37;&#41;&#46; El nivel de significaci&#243;n estad&#237;stica se estableci&#243; en p &#60;0&#44;05&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Resultados</span><p id="par0025" class="elsevierStylePara elsevierViewall">Fueron reclutados 1289 participantes&#44; de los cuales 935 &#40;72&#44;5&#37;&#41; eran mujeres&#46; La edad media fue de 41&#44;63 a&#241;os &#40;IC95&#37;&#58; 41&#44;09-42&#44;17&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">El servicio que m&#225;s voluntarios aport&#243; fue urgencias &#40;548&#44; 42&#44;5&#37; del total&#41;&#44; seguido de las &#225;reas m&#233;dica y quir&#250;rgica &#40;cada una con 328&#44; 25&#44;4&#37;&#41; y 85 participantes no adscritos &#40;6&#44;6&#37;&#41;&#46; La categor&#237;a profesional m&#225;s representada fue enfermer&#237;a &#40;36&#44;7&#37;&#41;&#46; Estos datos se detallan en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Por comorbilidad&#44; 13 &#40;1&#44;3&#37;&#41; refer&#237;an enfermedad cardiovascular previa&#44; 41 &#40;3&#44;2&#37;&#41; enfermedad pulmonar cr&#243;nica&#44; 22 diabetes &#40;1&#44;7&#37;&#41;&#44; 70 obesidad &#40;5&#44;4&#37;&#41; y 15 embarazo &#40;1&#44;2&#37;&#41;&#46; En el momento de la encuesta de salud&#44; 8 participantes presentaban fiebre &#40;0&#44;6&#37;&#41;&#44; 138 tos &#40;10&#44;7&#37;&#41;&#44; 17 dificultad respiratoria &#40;1&#44;3&#37;&#41;&#44; 117 rinorrea &#40;9&#44;1&#37;&#41;&#44; 75 dolor de garganta &#40;5&#44;8&#37;&#41;&#44; 14 diarrea &#40;1&#44;1&#37;&#41;&#44; 3 v&#243;mitos &#40;0&#44;2&#37;&#41;&#44; 32 cefalea &#40;2&#44;5&#37;&#41; y 15 mialgias &#40;1&#44;2&#37;&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Setenta y dos trabajadores &#40;5&#44;6&#37;&#41; refer&#237;an casos previos de gripe en la familia&#46; Se vacunaron frente al virus A&#47;California&#47;7&#47;2009&#47;H1N1 195 trabajadores &#40;15&#44;1&#37;&#41;&#44; y frente a la gripe estacional 320 &#40;24&#44;8&#37;&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Fueron diagnosticados de s&#237;ndrome gripal 75 trabajadores &#40;5&#44;8&#37;&#41;&#46; La prevalencia de s&#237;ndrome gripal oscil&#243; entre el 0&#37; del Hospital del Tajo y el 16&#44;2&#37; del Hospital de Gald&#225;cano&#46; Hubo diferencias por comunidades aut&#243;nomas&#44; con un m&#225;ximo en Catalu&#241;a &#40;10&#44;9&#37;&#41;&#44; seguida del Pa&#237;s Vasco &#40;7&#44;2&#37;&#41;&#44; Comunidad de Madrid &#40;6&#44;3&#37;&#41;&#44; Andaluc&#237;a &#40;5&#37;&#41; y Castilla-La Mancha &#40;1&#44;3&#37;&#41;&#44; que fueron significativas &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;038&#41;&#46; No hubo diferencias significativas por servicios del hospital&#44; sexo &#40;5&#44;4&#37; de los hombres&#44; 6&#37; de las mujeres&#41; ni edad&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Los celadores fueron los que m&#225;s declararon haber sufrido s&#237;ndrome gripal &#40;7&#44;6&#37;&#41;&#44; seguidos de los m&#233;dicos &#40;7&#37;&#41;&#44; auxiliares de enfermer&#237;a &#40;5&#44;4&#37;&#41;&#44; enfermeras &#40;4&#44;9&#37;&#41; y administrativos &#40;4&#44;8&#37;&#41;&#44; sin diferencias significativas&#46; Ninguna comorbilidad se asoci&#243; a una mayor prevalencia de s&#237;ndrome gripal&#46; S&#237; se asociaron la tos &#40;p &#60;0&#44;0005&#41; y la dificultad respiratoria &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#46; Haber tenido casos previos en el n&#250;cleo familiar se asoci&#243; a una mayor prevalencia de s&#237;ndrome gripal &#40;5&#44;3&#37; en los que no los tuvieron frente a 15&#44;3&#37; en los que s&#237;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#41;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Entre los que no recibieron la vacuna frente al virus A&#47;California&#47;7&#47;2009&#47;H1N1&#44; 70 presentaron s&#237;ndrome gripal &#40;6&#44;4&#37;&#41;&#44; frente a cinco de los que recibieron la vacuna &#40;2&#44;6&#37;&#44; p para la comparaci&#243;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;031&#41;&#44; sin diferencias significativas en el caso de la vacunaci&#243;n frente a la gripe estacional &#40;6&#44;3&#37; en los que la recibieron frente a 4&#44;4&#37; en los que no la recibieron&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">En el modelo de regresi&#243;n log&#237;stica se incluyeron como variables independientes la presencia de casos en el n&#250;cleo familiar&#44; la comunidad aut&#243;noma de origen&#44; recibir la vacuna frente al virus A&#47;California&#47;7&#47;2009&#47;H1N1&#44; el sexo&#44; la categor&#237;a profesional y el servicio&#46; Se asociaron a una mayor prevalencia de s&#237;ndrome gripal el trabajar en la Comunidad de Madrid &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8&#44;31&#59; IC95&#37;&#58; 1&#44;05-65&#44;39&#41;&#44; los casos previos en el n&#250;cleo familiar &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44;84&#59; IC95&#37;&#58; 1&#44;41-5&#44;73&#41; y no haberse vacunado frente a la gripe A &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44;68&#59; IC95&#37;&#58; 1&#44;05-6&#44;82&#41;&#44; como se muestra en la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discusi&#243;n</span><p id="par0065" class="elsevierStylePara elsevierViewall">Hallamos una prevalencia de diagn&#243;stico de s&#237;ndrome gripal del 5&#44;8&#37;&#44; similar a la de estudios previos<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a>&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Una limitaci&#243;n de nuestro estudio es que en el cuestionario de salud se preguntaba si se hab&#237;a recibido el diagn&#243;stico de gripe por parte de alg&#250;n m&#233;dico&#44; sin exigir la toma de muestras microbiol&#243;gicas&#46; Sabemos que s&#243;lo en torno al 20&#37; de los s&#237;ndromes gripales corresponden a verdaderos casos de gripe&#44; que son aquellos sobre los que cabe esperar alg&#250;n efecto de la vacuna&#46; El hecho de que los casos fueran autodeclarados y los participantes voluntarios constituye otra debilidad&#58; posiblemente los participantes sean el personal m&#225;s sensibilizado en relaci&#243;n a la gripe&#44; con caracter&#237;sticas diferentes&#44; por ejemplo&#44; en el grado de cumplimiento de las recomendaciones higi&#233;nicas o de autoprotecci&#243;n frente al virus&#46; En cualquier caso&#44; este extremo no puede ser confirmado por nuestro trabajo&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Llaman la atenci&#243;n las diferencias geogr&#225;ficas encontradas&#46; La evoluci&#243;n de la pandemia no fue similar en toda Espa&#241;a&#44; con tasas de ataque diferentes en cada comunidad aut&#243;noma&#46; De todos modos&#44; el hecho de que nuestro estudio no fuera representativo de las plantillas de cada centro debe hacernos ser prudentes a la hora de analizar este hecho&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">La vacunaci&#243;n frente a la gripe A se asoci&#243; a una menor prevalencia de s&#237;ndrome gripal&#46; Revisiones de estudios previos ponen en duda la efectividad de la vacuna antigripal en los trabajadores sanitarios para evitar los casos de gripe documentada microbiol&#243;gicamente en los mayores de 60 a&#241;os&#44; pero s&#237; la apoyan en t&#233;rminos de s&#237;ndrome gripal&#46; De igual forma&#44; no hay evidencias de que la vacunaci&#243;n de los trabajadores sanitarios redunde en menos d&#237;as de baja laboral<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#8211;7</span></a>&#46; La interpretaci&#243;n en t&#233;rminos de mortalidad es bastante m&#225;s dificultosa por los muchos sesgos que suelen presentar estos estudios<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Otro factor asociado al diagn&#243;stico fue la presencia de casos previos en el n&#250;cleo familiar&#46; En otros estudios realizados con sanitarios se reconoce como fuente de contagio la extrahospitalaria<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#46; No se recogi&#243; la conformaci&#243;n familiar por franjas de edad&#44; lo que hubiera sido &#250;til para determinar si los contagios se hab&#237;an dado a partir de ni&#241;os o j&#243;venes&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">En resumen&#44; en torno a uno de cada veinte trabajadores sanitarios que participaron en el estudio fueron diagnosticados de s&#237;ndrome gripal&#44; con diferencias geogr&#225;ficas y relacionado con no haber sido vacunado contra la gripe A y haber tenido casos previos en el entorno familiar&#46;<elsevierMultimedia ident="tb0005"></elsevierMultimedia></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Contribuciones de autor&#237;a</span><p id="par0105" class="elsevierStylePara elsevierViewall">Concepci&#243;n y dise&#241;o del trabajo&#58; J&#46; Olalla&#44; F&#46; de Ory&#44; I&#46; Casas y J&#46; Garc&#237;a-Alegr&#237;a&#46; Escritura del art&#237;culo&#58; J&#46; Olalla&#44; F&#46; de Ory e I&#46; Casas&#46; Revisi&#243;n cr&#237;tica&#58; J&#46; Garc&#237;a-Alegr&#237;a&#46; Aprobaci&#243;n final&#58; J&#46; Olalla&#44; F&#46; de Ory&#44; I&#46; Casas y J&#46; Garc&#237;a-Alegr&#237;a&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Financiaci&#243;n</span><p id="par0110" class="elsevierStylePara elsevierViewall">Proyecto financiado por el Instituto de Salud Carlos III a trav&#233;s del CIBER de Epidemiolog&#237;a y Salud P&#250;blica&#46; C&#243;digo del proyecto GR09&#47;0038&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicto de intereses</span><p id="par0115" class="elsevierStylePara elsevierViewall">Ninguno&#46;</p></span></span>"
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          "titulo" => "Palabras clave"
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        2 => array:2 [
          "identificador" => "xres36195"
          "titulo" => array:5 [
            0 => "Abstract"
            1 => "Objectives"
            2 => "Methods"
            3 => "Results"
            4 => "Conclusions"
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        3 => array:2 [
          "identificador" => "xpalclavsec29480"
          "titulo" => "Keywords"
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        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introducci&#243;n"
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        5 => array:2 [
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          "titulo" => "M&#233;todos"
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          "titulo" => "Resultados"
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          "identificador" => "sec0020"
          "titulo" => "Discusi&#243;n"
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        8 => array:2 [
          "identificador" => "sec0035"
          "titulo" => "Contribuciones de autor&#237;a"
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        9 => array:2 [
          "identificador" => "sec0040"
          "titulo" => "Financiaci&#243;n"
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        10 => array:2 [
          "identificador" => "sec0045"
          "titulo" => "Conflicto de intereses"
        ]
        11 => array:2 [
          "identificador" => "xack12270"
          "titulo" => "Agradecimientos"
        ]
        12 => array:1 [
          "titulo" => "Bibliograf&#237;a"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2011-10-14"
    "fechaAceptado" => "2012-01-29"
    "PalabrasClave" => array:2 [
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec29479"
          "palabras" => array:3 [
            0 => "Trabajadores sanitarios"
            1 => "Gripe A &#40;H1N1&#41; 2009"
            2 => "Vacuna"
          ]
        ]
      ]
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec29480"
          "palabras" => array:3 [
            0 => "Healthcare workers"
            1 => "Influenza A &#40;H1N1&#41; 2009"
            2 => "Vaccination"
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        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Describir la prevalencia de s&#237;ndrome gripal en el invierno de 2009 y los factores asociados a su ocurrencia&#46;</p> <span class="elsevierStyleSectionTitle">M&#233;todo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio transversal en 18 hospitales espa&#241;oles&#46; Los voluntarios respondieron un cuestionario de salud&#44; informando sobre si hab&#237;an sufrido s&#237;ndrome gripal y su estado vacunal&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Participaron 1289 trabajadores sanitarios&#44; y de ellos&#44; 72 &#40;5&#44;6&#37;&#41; refirieron gripe en su familia&#44; 195 &#40;15&#44;1&#37;&#41; se vacunaron frente al virus A&#47;California&#47;7&#47;2009&#47;H1N1 y 75 &#40;5&#44;8&#37;&#44; intervalo de confianza del 95&#37; &#91;IC95&#37;&#93;&#58; 4&#44;5-7&#44;1&#41; sufrieron s&#237;ndrome gripal&#46; Hubo diferencias entre comunidades aut&#243;nomas&#46; En el an&#225;lisis de regresi&#243;n log&#237;stica&#44; se asoci&#243; a s&#237;ndrome gripal trabajar en la Comunidad de Madrid &#40;<span class="elsevierStyleItalic">odds ratio</span> &#91;OR&#93;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8&#44;31&#44; IC95&#37;&#58; 1&#46;05-65&#46;39&#41;&#44; tener casos de gripe en la familia &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44;84&#44; IC95&#37;&#58; 1&#44;41-5&#44;73&#41; y no estar vacunado frente a la gripe A &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44;68&#44; IC95&#37;&#58; 1&#44;05-6&#44;82&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La presencia de casos en la familia y la comunidad donde se trabaja determinaron una diferente prevalencia de s&#237;ndrome gripal&#46; La vacuna se asoci&#243; a una menor prevalencia de la enfermedad&#46;</p>"
      ]
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Objectives</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To describe the prevalence of influenza-like syndrome in winter 2009 and the factors associated with its occurrence&#46;</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A cross-sectional study was carried out in 18 hospitals in Spain&#46; Volunteers completed a health questionnaire in which they reported the occurrence of influenza-like syndrome and vaccination and demographic status&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">A total of 1&#44;289 healthcare workers participated&#46; Of these&#44; 72 &#40;5&#46;6&#37;&#41; reported influenza in their family&#44; 195 &#40;15&#46;1&#37;&#41; had been vaccinated against the A&#47;California&#47;7&#47;2009&#47;H1N1 virus and 75 &#40;5&#46;8&#37;&#44; 95&#37;CI&#58; 4&#46;5-7&#46;1&#37;&#41; had been diagnosed with influenza like-syndrome&#46; There were differences among regions&#46; In logistic regression analysis&#44; the following factors were associated with a higher prevalence of influenza-like syndrome&#58; working in Madrid &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8&#46;31&#44; 95&#37;CI&#58; 1&#46;05-65&#46;39&#41;&#44; the occurrence of cases of influenza in the family &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#46;84&#44; 95&#37;CI&#58; 1&#46;41-5&#46;73&#41; and not having been vaccinated against influenza A &#40;H1N1&#41; &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#46;68&#44; 95&#37; CI&#58; 1&#46;05-6&#46;82&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Differences in the prevalence of influenza-like syndrome were due to the occurrence of familiar cases and region&#46; Vaccination against influenza A &#40;H1N1&#41; was associated with a lower prevalence of the disease&#46;</p>"
      ]
    ]
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          0 => array:4 [
            "apendice" => "<p id="par0130" class="elsevierStylePara elsevierViewall">Javier Garc&#237;a-Alegr&#237;a&#44; Alfonso del Arco&#44; Javier de la Torre&#44; Jos&#233; Luis Prada&#44; Miguel Marcos&#44; Daniel Urdiales&#44; Fernando Fern&#225;ndez&#44; Marta Aranda&#44; Manuel Vergara&#44; Juan Carlos Toribio&#44; Jos&#233; Antonio Rodr&#237;guez y Paola P&#233;rez &#40;Hospital Costa del Sol&#41;&#59; Antonio Jes&#250;s N&#250;&#241;ez&#44; Jos&#233; Javier Santos y Francisco Pozo &#40;Hospital de Antequera&#41;&#59; Jos&#233; Mar&#237;a Quintana&#44; Susana Garc&#237;a y Carlota Las Hayas &#40;Hospital de Gald&#225;cano&#41;&#59; Antonio Escobar&#44; Juan Carlos Fern&#225;ndez y Mar&#237;a Garc&#237;a &#40;Hospital de Basurto&#41;&#59; Jos&#233; Ram&#243;n S&#225;enz&#44; Emilio P&#233;rez-Trallero y Diego Vicente &#40;Hospital de Donosti&#41;&#59; Ignacio S&#225;nchez Arcilla&#44; Marina Fern&#225;ndez y Magdalena Muedra &#40;Hospital Ram&#243;n y Cajal&#41;&#59; Consol Serra&#44; Roc&#237;o Villar y Josefina Pi-Sunyer &#40;Hospital del Mar&#41;&#59; Pilar Varela&#44; Victoria Oliver y Ana Vileilla &#40;Hospital Cl&#237;nic de Barcelona&#41;&#59; Carlos Pereda y Mar&#237;a Angeles Herrer&#237;a &#40;Hospital de Santa B&#225;rbara&#41;&#59; Carmen Valero&#44; Luc&#237;a Fern&#225;ndez y Mar&#237;a Angustias Romera &#40;Hospital de Santa Ana&#41;&#59; Pedro Gonz&#225;lez y Jos&#233; Mar&#237;a Jover &#40;Complejo Hospitalario de Ja&#233;n&#41;&#59; Manuel Zarzuela&#44; Jos&#233; Guti&#233;rrez y Mar&#237;a Carmen Lozano &#40;Hospital Puerta del Mar&#41;&#59; Fernando Y&#233;lamos&#44; Manuel Rodr&#237;guez y Jos&#233; Ram&#243;n Maldonado &#40;Hospital de Torrec&#225;rdenas&#41;&#59; Mar&#237;a Carmen Ubago&#44; Amelia Fern&#225;ndez y Dolores Torres &#40;Hospital Virgen de las Nieves&#41;&#59; Salvador O&#241;a&#44; Juan Arcos y Dolores Lerma &#40;Hospital Materno Infantil de M&#225;laga&#41;&#59; David Sadia y Jos&#233; Bascu&#241;ana &#40;Hospital Infanta Leonor&#41;&#59; Berta Moyano y El&#237;as Rodr&#237;guez &#40;Hospital del Tajo&#41;&#59; Francisco Martos &#40;Facultad de Medicina&#44; Universidad de M&#225;laga&#41;&#59; Antonio Daponte &#40;Escuela Andaluza de Salud P&#250;blica&#41;&#59; Mar&#237;a Jos&#233; P&#233;rez&#44; Encarnaci&#243;n Rom&#225;n&#44; Carmen Escassi y Eduardo Briones &#40;Hospital de Valme&#41;&#59; Jos&#233; Mar&#237;a Mayoral &#40;Direcci&#243;n General de Salud P&#250;blica&#44; Consejer&#237;a de Salud de la Junta de Andaluc&#237;a&#41;&#59; M&#243;nica Gonz&#225;lez Esguevillas&#44; Isabel P&#233;rez Grajera y Jes&#250;s Mar&#237;a de la Fuente &#40;Centro Nacional de Microbiolog&#237;a&#44; Instituto de Salud Carlos III&#41;&#46;</p>"
            "etiqueta" => "Anexo"
            "titulo" => "Grupo de trabajo para el estudio MARBEGRIP"
            "identificador" => "sec0050"
          ]
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        "etiqueta" => "Tabla 1"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">DE&#58; desviaci&#243;n est&#225;ndar&#46;</p>"
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Comunidad de Madrid&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="6" align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Servicio</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Urgencias&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#40;94&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#40;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#193;rea m&#233;dica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">&#40;6&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;878&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#193;rea quir&#250;rgica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">&#40;94&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No adscritos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">81&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Categor&#237;a profesional</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>M&#233;dico&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#40;93&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Enfermera&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Auxiliar&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">&#40;5&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Administrativo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">40&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#40;95&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#40;4&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Celador&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">109&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#40;7&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Sexo</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Masculino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">330&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#40;94&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#40;5&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Femenino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">879&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#40;94&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">56&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#40;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#44;813&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Edad</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Media &#40;DE&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&#44;7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#40;9&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#40;10&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Contagios previos</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">64&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">61&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;84&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;15&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Vacuna gripe A</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1023&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;93&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;6&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">190&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;97&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;2&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;052&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">908&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;93&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">61&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;6&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">306&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;95&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#40;4&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;257&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Castilla-La Mancha&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Referencia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&#44;49 &#40;0&#44;47-25&#44;90&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5&#44;22 &#40;0&#44;67-40&#44;78&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;11&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pa&#237;s Vasco&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&#44;02 &#40;0&#44;50-31&#44;92&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8&#44;31 &#40;1&#44;05-65&#44;39&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Referencia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Referencia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#44;039&nbsp;\t\t\t\t\t\t\n
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