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Diezma-Martín, M.I. Morales-Casado, L. Jiménez-Díaz, J.D. Navarro-López, B. Mondéjar-Marín, J. Parra-Serrano, A. Vadillo-Bermejo, C. Marsal-Alonso, P. Beneyto-Martín" "autores" => array:9 [ 0 => array:2 [ "nombre" => "A.M." "apellidos" => "Diezma-Martín" ] 1 => array:2 [ "nombre" => "M.I." "apellidos" => "Morales-Casado" ] 2 => array:2 [ "nombre" => "L." "apellidos" => "Jiménez-Díaz" ] 3 => array:2 [ "nombre" => "J.D." "apellidos" => "Navarro-López" ] 4 => array:2 [ "nombre" => "B." "apellidos" => "Mondéjar-Marín" ] 5 => array:2 [ "nombre" => "J." "apellidos" => "Parra-Serrano" ] 6 => array:2 [ "nombre" => "A." "apellidos" => "Vadillo-Bermejo" ] 7 => array:2 [ "nombre" => "C." "apellidos" => "Marsal-Alonso" ] 8 => array:2 [ "nombre" => "P." "apellidos" => "Beneyto-Martín" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S001425652400153X" "doi" => "10.1016/j.rce.2024.07.003" "estado" => "S200" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S001425652400153X?idApp=WRCEE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S225488742400122X?idApp=WRCEE" "url" => "/22548874/unassign/S225488742400122X/v1_202410160428/en/main.assets" ] "itemAnterior" => array:17 [ "pii" => "S2254887424001103" "issn" => "22548874" "doi" => "10.1016/j.rceng.2024.08.001" "estado" => "S200" "fechaPublicacion" => "2024-08-28" "aid" => "2233" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Soluble receptor for advanced glycation end-products positively correlated to kidney injury with coronary heart disease" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "El receptor soluble para productos finales de glicación avanzada se correlacionó positivamente con la lesión renal con la enfermedad coronaria" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1825 "Ancho" => 3341 "Tamanyo" => 319191 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Correlation analysis between sRAGE and uACR in CHD patients (A), and ROC analysis of sRAGE, UMA, eGFR, SCr, UCr, Albumin and BUN with uACR ≥ 30 mg/g in CHD patients (B).</p> <p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Each dot represents an individual patient. BUN: blood urea nitrogen; CHD: coronary heart disease; eGFR: estimated Glomerular Filtration Rate; ROC: receiver operating characteristic; SCr: serum creatinine; sRAGE: soluble receptor for advanced glycation end products; uACR: urinary albumin to creatinine ratio; UCr: urine creatinine; UMA: urine microalbumin.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Lu Chen, Xiang-Jun Zeng, Xin-Ying Guo, Jian Liu, Feng-He Du, Cai-Xia Guo" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Lu" "apellidos" => "Chen" ] 1 => array:2 [ "nombre" => "Xiang-Jun" "apellidos" => "Zeng" ] 2 => array:2 [ "nombre" => "Xin-Ying" "apellidos" => "Guo" ] 3 => array:2 [ "nombre" => "Jian" "apellidos" => "Liu" ] 4 => array:2 [ "nombre" => "Feng-He" "apellidos" => "Du" ] 5 => array:2 [ "nombre" => "Cai-Xia" "apellidos" => "Guo" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0014256524001498" "doi" => "10.1016/j.rce.2024.06.016" "estado" => "S200" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256524001498?idApp=WRCEE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887424001103?idApp=WRCEE" "url" => "/22548874/unassign/S2254887424001103/v1_202408280421/en/main.assets" ] "en" => array:16 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Brief Original</span>" "titulo" => "Measles outbreak transmission in the ER waiting room: the role of vaccination" "tieneTextoCompleto" => true "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "A. Hernández-Aceituno, I. Falcón García, E. Marrero Marichal, D. Sanabria Curbelo, Á. Torres Lana, E. Larumbe-Zabala" "autores" => array:6 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Hernández-Aceituno" "email" => array:1 [ 0 => "anahdez989@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "I." "apellidos" => "Falcón García" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "E." "apellidos" => "Marrero Marichal" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "D." "apellidos" => "Sanabria Curbelo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "Á." "apellidos" => "Torres Lana" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "E." "apellidos" => "Larumbe-Zabala" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Epidemiología y Prevención, Dirección General de Salud Pública, Santa Cruz de Tenerife, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FCIISC), Santa Cruz de Tenerife, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Transmisión de un brote de sarampión en la sala de espera de urgencias: el papel de la vacunación" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Measles is one of the most contagious infectious diseases, with a secondary attack rate of over 90% in susceptible populations.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Elimination requires interruption of endemic transmission through high levels of population immunity.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> However, in many countries, routine childhood measles vaccination against is below the level recommended to achieve and maintain measles elimination. Less than half of EU/EEA countries have achieved ≥95% coverage with the first dose of measles-containing vaccine, and very few achieved ≥95% coverage with the second dose.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> In the last year, 30 EU/EEA Member States collectively reported a total of 10,887 measles cases.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Of the cases with known vaccination status, 87.2% were unvaccinated.</p><p id="par0010" class="elsevierStylePara elsevierViewall">In Spain, since 2012, the recommended schedule for measles vaccination has been the administration of the first dose at 12 months and the second dose at 3–4 years of age. As a result, the World Health Organization (WHO) declared Spain free of endemic measles transmission in 2017. In the Autonomous Community of the Canary Islands, which are 1,000 km away from the mainland, the last reported cases of measles occurred in 2019. However, recent measles outbreaks have been reported in Spain, with 106 confirmed cases from January 1 to June 11, 2024.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><p id="par0015" class="elsevierStylePara elsevierViewall">We present a descriptive study of an outbreak that occurred in the pediatric emergency room of a tertiary level hospital on the island of Tenerife (Canary Islands) in April 2024, in which a health care worker (HCW) was infected despite proper vaccination.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0020" class="elsevierStylePara elsevierViewall">Between April 23 and May 12, 2024, four PCR-confirmed measles cases were identified, resulting in 407 contacts in healthcare center waiting rooms. On May 5, 2024, the microbiology laboratory of a hospital in Tenerife notified the Epidemiology Service of the Public Health system of a suspected case of measles in an unvaccinated 2-year-old girl with positive IgM antibodies. The girl had exhibited symptoms on April 23 and developed exanthema on April 28. Between April 25 and 30, she visited multiple health centers, generating 113 contacts at the primary care center and 157 at the hospital emergency department. Of these, 27 children were not vaccinated (22 of whom were less than one year old).</p><p id="par0025" class="elsevierStylePara elsevierViewall">Two unvaccinated children, aged 10 and 6 months, who had coincided with the primary case in the same emergency waiting room on April 27, began exhibiting symptoms on May 10 and 11. The 10-month-old child was hospitalized for pneumonia. These children generated 57 and 80 contacts, respectively, at the health center and hospital emergency department. Serum, pharyngeal exudate and urine samples from the three cases were sent to the National Microbiology Center, where they were confirmed positive for the D8 genotype by PCR.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Contact tracing was conducted for all cases, irrespective of whether the cases were vaccinated or unvaccinated. The primary care centers and the hospital admission service were requested to provide a list of patients who had coincided with the confirmed cases in the waiting rooms. Upon examination of the vaccination schedules, the vaccine was recommended for unvaccinated children older than nine months. For children under nine months of age, the pediatrician was contacted for follow-up and parental notification. The hospital’s occupational risk prevention service was contacted to ascertain the health status of the HCWs who had attended the aforementioned cases.</p><p id="par0035" class="elsevierStylePara elsevierViewall">On June 13, the hospital’s microbiology laboratory reported another case with symptoms consistent with the disease. The case involved a 26-year-old male nurse who had been properly vaccinated with two doses of measles, mumps, and rubella (MMR) vaccine during infancy. Although he did not directly attend the primary case, he worked in the pediatric emergency department during the period the girl was in the hospital. The nurse began to experience symptoms on May 7, the day he took a two-hour flight. On May 10, the day of his return flight to Tenerife, he had a fever, and on May 11 the exanthema started. The diagnosis was confirmed by PCR at the national microbiology center on May 21.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Between May 7 and May 10, the nurse lived with nine people during his trip. None of the individuals with whom he traveled and lived showed symptoms. Of the nine individuals, only four were aware that they had been correctly vaccinated in childhood. No evidence of infection has been identified among the passengers and crew of the two flights (179 passengers and 6 crew members on the outbound flight and 148 passengers and 6 crew members on the return flight).</p><p id="par0045" class="elsevierStylePara elsevierViewall">Given the notifications of cases among HCWs, and the infections that occurred in the waiting room during this outbreak, it was decided to inform the directors of the hospitals and primary care centers, as well as the Occupational Risk Prevention and Preventive Medicine Department. Letters were issued informing about the situation and recommending the revision and updating of the vaccination schedule for workers. In light of the notification of cases in adults who had been properly vaccinated as children, the use of airborne and contact precautions was recommended in the care of suspected cases, according to the recommendations of the Spanish National Center of Epidemiology.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0050" class="elsevierStylePara elsevierViewall">In the outbreak reported in the Canary Islands in April 2024, HCW who had been correctly vaccinated in childhood was infected with measles in the hospital emergency room, despite not directly attending the primary case. He presented a mild clinical presentation and short duration. Although he lived with nine other people for four days during his infectious period and traveled on two airplanes with more than three hundred passengers, no secondary cases were reported.</p><p id="par0055" class="elsevierStylePara elsevierViewall">According to Markowitz et al. there is a more rapid decline in measles antibodies in populations that have had no re-exposure to wild virus compared to populations where measles was prevalent.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Mossong et al. estimated that the average duration of vaccine-induced protection in the absence of reexposure is 25 years.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Rota et al. reported two cases of well-vaccinated physicians who were infected and cared for patients with an atypical clinical course, duration and severity. Despite the fact that they continued to see patients during their infectious period, including unvaccinated infants, no cases of spread were detected.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Although measles cases in vaccinated individuals shed virus on average for a shorter period than unvaccinated individuals, and transmission in vaccinated cases is uncommon, it is necessary for public health services to conduct an aggressive search for cases, identify contacts, and, in potentially susceptible individuals, administer vaccine or immunoglobulin after exposure.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7,8</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">A number of studies have shown the pivotal role that healthcare settings play in the transmission of infections and the generation of cases.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9–14</span></a> In Hiller’s study, during an outbreak, 10 HCWs in a hospital contracted measles despite having no direct contact with the index patient. The majority of infected HCWs in this outbreak were unvaccinated.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> According to the study by de la Cuerda et al., 89% of HCWs from five Spanish university hospitals had protective antibodies against measles. Of the non-immune, more than 80% had been vaccinated, suggesting that HCWs, including those previously vaccinated, are currently at risk of measles.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Adegboye et al. posit that the spread of infectious diseases will increase, particularly due to the interruption of childhood immunization. Many developing countries face structural and economic weaknesses in their vaccination programs, while on the other hand, developed countries are facing an increase in anti-vaccine movements.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> Many of the foreigners residing in Spain come from countries that may not have incorporated any of the vaccines included in the childhood vaccination schedule or have done so recently and with low coverage, so there may be a considerable pool of the population vulnerable to communicable diseases.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17,18</span></a> The index case of this study was a girl whose parents came from a country with endemic transmission. Although the source of infection could not be identified and they did not report recent travel, the lack of previously reported cases in the Canary Islands, together with the identification of the D8 genotype currently circulating in Europe,<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> suggested that the case was secondary to an imported case.</p><p id="par0070" class="elsevierStylePara elsevierViewall">In order to prevent the transmission of measles in hospitals and to avoid new outbreaks, public health authorities in the Canary Islands contacted hospitals and primary care services to report the occurrence of cases and to urge the importance of reviewing and updating the vaccination schedules of HCWs, as well as pediatric patients. In addition, contacts were asked to identify themselves as such when they went to a health center so that they would be isolated and would not be in contact with the other patients in the waiting room.</p><p id="par0075" class="elsevierStylePara elsevierViewall">The outbreak began with an unvaccinated girl who likely infected two children not old enough to be vaccinated and to a nurse. However, the nurse, who had been properly vaccinated in infancy, did not infect anyone despite continued close contact. The course of this outbreak underscores the need to renew efforts to vaccinate all children with two doses of the vaccine, to protect young infants who cannot yet be vaccinated and to continue progress toward measles elimination. This finding suggests that vaccination may help not only prevent infection but also transmission of measles, although further studies are needed to better understand the role of vaccination in measles transmission.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflict of interests</span><p id="par0080" class="elsevierStylePara elsevierViewall">No potential conflict of interest was reported by the authors.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Funding</span><p id="par0085" class="elsevierStylePara elsevierViewall">The authors received no financial support for the research, authorship, and/or publication of this article.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres2271500" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1893402" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres2271499" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Antecedentes" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1893401" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Materials and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflict of interests" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Funding" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2024-07-03" "fechaAceptado" => "2024-07-25" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1893402" "palabras" => array:5 [ 0 => "Measles" 1 => "Outbreak" 2 => "Transmission" 3 => "Vaccine" 4 => "Waiting room" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1893401" "palabras" => array:5 [ 0 => "Sarampión" 1 => "Brote" 2 => "Transmisión" 3 => "Vacuna" 4 => "Sala de espera" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Measles is one of the most contagious infectious diseases. Spain was declared free of endemic measles transmission in 2017. However, less than half of EU/EEA countries have achieved vaccination coverage goals and measles outbreaks have been reported recently, some of them in healthcare facilities. The aim of this study was to present an outbreak in the pediatric emergency (ER) waiting room affecting a vaccinated healthcare worker.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Descriptive study of an outbreak whose transmission occurred in the pediatric ER waiting room of a tertiary level hospital on the island of Tenerife (Canary Islands) in April 2024.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Between April 23 and May 12, 2024, four PCR-confirmed measles cases were identified, resulting in 407 contacts in healthcare center waiting rooms. One of the cases was a 26-year-old male nurse who had been correctly vaccinated with two doses of measles, mumps, and rubella vaccine during childhood. Between May 7 and 10, during his infective period, he took two two-and-a-half-hour flights and lived together with nine people during a trip. No evidence of infection has been identified among the individuals with whom he lived neither the passengers and crew of the two flights.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">In the emergency waiting room, an unvaccinated girl gave measles to two infants who were not yet old enough to be vaccinated and to a nurse who had been properly vaccinated as an infant. Despite generating more than 300 close contacts, the nurse did not infect anyone, suggesting that vaccination may help prevent both infection and transmission of measles.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Antecedentes</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El sarampión es una de las enfermedades infecciosas más contagiosas. España fue declarada libre de transmisión endémica en 2017. Sin embargo, menos de la mitad de los países de la UE/EEE han alcanzado los objetivos de cobertura de vacunación y recientemente se han notificado brotes de sarampión. El objetivo de este estudio fue presentar un brote en urgencias pediátricas que afectó a un trabajador sanitario vacunado.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Método</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio descriptivo de un brote en una sala de espera de urgencias pediátricas de un hospital de tercer nivel en Tenerife (Canarias) en abril de 2024.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Entre el 23 de abril y el 12 de mayo de 2024 se identificaron cuatro casos de sarampión confirmados por PCR, que dieron lugar a 407 contactos en salas de espera de centros sanitarios. Uno de los casos era un enfermero de 26 años correctamente vacunado en la infancia. Entre el 7 y el 10 de mayo, durante su periodo infectivo, tomó dos vuelos de dos horas y media y convivió con nueve personas durante un viaje. No hubo indicios de infección entre sus convivientes, los pasajeros ni la tripulación de los vuelos.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">En la sala de espera de urgencias, una niña no vacunada contagió el sarampión a dos lactantes que aún no tenían edad para ser vacunados y a un enfermero correctamente vacunado. A pesar de generar más de 300 contactos, el enfermero no infectó a nadie, lo que sugiere que la vacunación puede ayudar a prevenir tanto la infección como la transmisión de sarampión.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Antecedentes" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:19 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "autores" => array:1 [ 0 => array:2 [ "colaboracion" => "Consejo Interterritorial del Sistema Nacional de Salud" "etal" => false ] ] ] ] "host" => array:2 [ 0 => array:1 [ "Libro" => array:3 [ "titulo" => "Plan estratégico para la eliminación del sarampión y la rubeola en España [Internet]" "fecha" => "2021" "editorial" => "Ministerio de Sanidad" ] ] 1 => array:1 [ "WWW" => array:1 [ "link" => "https://www.sanidad.gob.es/areas/promocionPrevencion/vacunaciones/sarampion-rubeola/docs/PlanEstrategico_SarampionyRubeola.pdf" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Progress toward measles elimination — worldwide, 2000–2022" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.A. 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