Fernando de Ory

Instituto de Salud Carlos III, Madrid, Madrid, Spain

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Publications (158)375.38 Total impact


  • No preview · Article · Aug 2015 · Revista Española de Salud Pública
  • Fernando de Ory · Teodora Minguito · Pilar Balfagón · Juan C Sanz
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    ABSTRACT: In the context of measles elimination, the identification of recent infections is important for clinical laboratories. Serological diagnosis is achieved by detecting specific IgG and IgM. Recently an automated chemiluminescent immunoassay (CLIA) (Liaison, DiaSorin, Italy) has been used to quantify the measles antibody. The aim of this study was to compare this assay with Enzygnost ELISA (Siemens, Germany), with final classification of discrepancies by indirect immunofluorescence (Euroimmun, Germany). For measles IgM, 204 sera were analyzed: 50 IgM-positive, 104 IgM-negative/IgG-positive, and 50 from other viral infections (B19V, rubella, mumps, CMV, and EBV). For the measles IgG assay, 162 samples were tested: 106 were positive and 56 were negative. For measles IgM, the sensitivity and specificity of CLIA against ELISA were 94% (95% CI: 83.2-98.6) and 100% (95% CI: 97.1-100), respectively; the corrected figures after the final classification of discrepancies were 100% (95% CI: 91.0-100) and 99.4% (95% CI: 96.1-100), respectively. In relation to IgG, the sensitivity and specificity of CLIA against ELISA were, respectively, 97.2% (95% CI: 91.7-99.4) and 92.9% (95% CI: 82.5-97.7), and 95.5% (95% CI: 89.5-98.3) and 100% (95% CI: 91.8-100) after the final classification. CLIA showed excellent sensitivity and specificity in detecting measles IgG and IgM antibodies, eliminating the need to aliquot specimens before carrying out the assay. © 2015 APMIS. Published by John Wiley & Sons Ltd.
    No preview · Article · Jul 2015 · Apmis
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    ABSTRACT: The invasive mosquito Aedes albopictus, with proven vectorial ability to transmit European autochthonous cycles of dengue and chikungunya virus, has currently colonized every coastal department of Eastern Spain. The main objective of the study was to define the epidemiological and clinical characteristics as well as the trends of these two arboviral diseases in a European area heavily colonized by Ae. albopictus. A voluntarily-based, prospective and multicenter surveillance study was performed in all medical units of the North Metropolitan area of Barcelona (406,000 inhabitants, Catalonia; Spain) with diagnostic capability from 2009 to 2013. Since any possible increase in arboviral cases could be justified by changes in traveling behaviors along the study period (especially longer trips) the trend showed by these two arboviral diseases was compared with that displayed by malaria cases during the same period. 38 out of 52 (73.1%) suspected cases could be serologically confirmed (IgM+): dengue 34/38 (89.5%) and chikungunya 4/38 (11.5%). No autochthonous cases were identified. The overall incidence of both arboviruses was 0.19 cases/10,000 inhabitants-year (95% CI: 0.07-0.3); dengue = 0.17 cases/10,000 inhabitants-year (95% CI: 0.05-0.3), and chikungunya = 0.02 cases/10,000 inhabitants-year (95% CI: 0.001-0.03). The Incidence Relative Risk of arboviral disease between 2009 and 2013 shown a significant trend (IRR = 1.27. IC 95%: 1.01-1.59; p = 0.043) when compared with that displayed by malaria (IRR = 1.04. IC 95%: 0.924-1.192). If no unexpected circumstances concur, the arboviral disease incidence tax would equal that of malaria about 2021-2022. The incidence of dengue and chikungunya is steadily increasing in the North Metropolitan area of Barcelona, a region densely colonized by Ae. albopictus, at the entire expense of imported cases (especially Visiting Friends and Relatives travelers). To date, no secondary autochthonous cases have been identified and, thus, they have not taken part in this rise. Copyright © 2015. Published by Elsevier Ltd.
    Full-text · Article · Jun 2015 · Travel Medicine and Infectious Disease
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    ABSTRACT: Chikungunya virus (CHIKV) is currently spreading in the Caribbean and America. Lymphadenopathy, described in infections with other alphaviruses, is not commonly reported in CHIKV infections. Painful lymphadenopathy was found in three of the first six CHIKV infections from the current outbreak diagnosed at a reference center in Madrid, Spain. © 2015 International Society of Travel Medicine.
    Full-text · Article · Apr 2015 · Journal of Travel Medicine
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    ABSTRACT: Dengue is endemic to the tropics and subtropics, and the most frequent of arthropod-borne viral diseases. Reliable diagnosis of dengue infection is important not only in clinical care but also in disease surveillance, the control of outbreaks, and the development of new vaccines. The diagnosis of dengue infection is usually established by a variety of commercial or in-house serological protocols. The European Network for the Diagnostics of Imported Viral Diseases (ENIVD) recognized the need to survey the accuracy of dengue serological diagnostics in current use, and organized an external quality assurance (EQA) study of dengue serological practice in diagnostic laboratories. A 15-sample panel, consisting of sera reactive against dengue plus specificity and negative controls, was sent to 48 laboratories for serological testing. The results returned by the participating laboratories were anonymized, scored, and subjected to comparison and statistical analysis. Ten laboratories rated all samples correctly with regard to IgM, and only three achieved the full score for IgG detection. The main handicaps in assay performance were suboptimal sensitivity of in-house IgM detection protocols by comparison with better-performing commercial ELISA tests, and the presence of IgG cross-reactivity with heterologous flaviviruses. Differences of detail in the methodology of dengue IgG antibody detection appear to underlie the disparities in accuracy observed between laboratories. This EQA study demonstrates that there is room for many laboratories to improve sensitivity in the detection of anti-dengue virus IgM antibodies, against the benchmark set by commercial antibody capture ELISA tests. The EQA shows also that cross-reactivity is a continuing issue, and IgG detection protocols must be optimized to increase their specificity.
    Full-text · Article · Apr 2015 · BMC Infectious Diseases
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    ABSTRACT: Non-immune neonates and non-immune pregnant women are at risk of developing rubella, measles and mumps infections, including congenital rubella syndrome. We describe the seroepidemiology of measles, mumps and rubella (MMR) in neonates and pregnant women in Catalonia (Spain). Anti-rubella, anti-measles and anti-mumps serum IgG titres were assessed using enzyme-linked immunosorbent assay (ELISA) tests in 353 cord blood samples from neonates of a representative sample of pregnant women obtained in 2013. The prevalence of protective antibody titres in neonates was 96 % for rubella IgG (≥8 IU/ml), 90 % for measles IgG (>300 IU/ml) and 84 % for mumps IgG (>460 EU/ml). Slightly lower prevalences of protective IgG titres, as estimated from the cord blood titres, were found in pregnant women: 95 % for rubella IgG, 89 % for measles IgG and 81 % for mumps IgG. The anti-measles and anti-mumps IgG titres and the prevalences of protective IgG titres against measles and mumps increased significantly (p < 0.001) with maternal age. The prevalence of protective anti-measles IgG titres decreased by 7 % [odds ratio (OR) = 0.15, p < 0.001), the prevalence of protective anti-rubella IgG titres increased by 3 % (OR = 1.80, p < 0.05) and the MMR vaccination coverage (during childhood) in pregnant women increased by 54 % (OR = 2.09, p < 0.001) from 2003 to 2013. We recommend to develop an MMR prevention programme in women of childbearing age based on mass MMR vaccination or MMR screening and vaccination of susceptible women to increase immunity levels against MMR.
    Full-text · Article · Feb 2015 · European Journal of Clinical Microbiology
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    ABSTRACT: Immunoblot (IB) techniques using different Epstein-Barr virus (EBV) antigens have been applied for detecting specific antibodies, making possible to obtain EBV seroprofiles in a single determination. The aim of this study was to evaluate a commercial IB for the detection of EBV-specific IgG (Euroimmun, Lübeck, Germany). A total of 117 samples classified as EBV primary recent infections (n = 70), past infections (n = 29), or not infected (n = 18) have been used. The samples were characterized by immunofluorescence, by testing EBV capsid antigens IgM and IgG (using indirect approaches) and EBV nuclear antigen (by anticomplement technique; Meridian Bioscience Inc.). Using the cut-off value as defined by the IB manufacturer, the concordance, relative sensitivity, and relative specificity were 85.5 (100/117), 94.3% (66/70), and 72.3% (34/47), respectively. If a corrected cut-off value was considered to classify the samples, the corresponding corrected figures were 89.7, 88.6, and 91.5%, respectively. Being a useful serological diagnostic tool, IB for testing EBV IgG seems to be an adequate approach to define EBV seroprofiles. However, efforts to better define the cut-off value should be made in order to improve the performance of the assay in evaluation.
    Preview · Article · Jan 2015 · Journal of Clinical Laboratory Analysis
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    ABSTRACT: The aim of the European Sero-Epidemiology Network 2 (ESEN2) project was to estimate age-specific seroprevalence for a number of vaccine-preventable diseases in Europe. To achieve this serosurveys were collected by 22 national laboratories. To adjust for a variety of laboratory methods and assays, all quantitative results were transformed to a reference laboratory's units and were then classified as positive or negative to obtain age-specific seroprevalence. The aim of this study was to assess the value of standardization by comparing the crude and standardized seroprevalence estimates. Seroprevalence was estimated for measles, mumps, rubella, diphtheria, varicella zoster and hepatitis A virus (HAV) and compared before and after serological results had been standardized. The results showed that if no such adjustment had taken place, seroprevalence would have differed by an average of 3·2% (95% bootstrap interval 2·9–3·6) although this percentage varied substantially by antigen. These differences were as high as 16% for some serosurveys (HAV) which means that standardization could have a considerable impact on seroprevalence estimates and should be considered when comparing serosurveys performed in different laboratories using different assay methods.
    Full-text · Article · Nov 2014 · Epidemiology and Infection
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    ABSTRACT: Introduction: Measles virus (MeV) causes a highly contagious disease that is currently targeted for a National Plan Elimination in our country since 2001. The MV genotyping and phylogenetic analysis are an essential part to trace the chains of transmission and to determine the elimination of the virus. The genotype D4 caused massive outbreaks in Europe (2010-2012). This study is focused on updating the molecular epidemiology of this genotype in Spain from 2008 to 2012. Methods: The phylogenetic analysis was based on the 450 nucleotides encoding the C-terminal end of the viral nucleoprotein (N-450). A total of 1640 sequences obtained from GenBank and MeaNS databases were analyzed, 680 from Spain. They were aligned (BioEdit v.7.0.5), haplotypes were described (DNAsp v.5) and their genetic distance analyzed (MEGA v.6). The phylogenetic trees were constructed by maximum likelihood (RaxML v.7 y PhyML v.3). Results: We found 41 Spanish haplotypes, grouped in 18 phylogenetic clusters, belonged to prevalent European variants during these years: 11 haplotypes (182 sequences) related to MVs/Enfield.GBR/14.07/-variant (D4-Enfield); 2 haplotypes (16 sequences) related to the sub-variant MVs/Hamburg.DEU/03.09/-variant (D4-Hamburg) and 14 haplotypes (251 sequences) related to the sub-variant MVs/Manchester.GBR/10.09/-variant (D4-Manchester). Furthermore there were 2 sub-variants from D4-Machester (Mvs/Marmande.FRA/43.11/2/ and MVs/Maramures.ROU/3.11/) in minority-way and we described a new one: MVs/Madrid.ESP/46.10-variant (D4-Madrid) with 10 different haplotypes (126 sequences). We denoted 2 strains older than the reference strains of the D4-Enfield (Mv/Raichur.IND/38.06/1) and D4-Manchester (MVs/Lisieux.FRA/27.07/1) variants. In 2008 the variant D4-Enfield was detected in Spain in a low incidence rate as in the next year 2009. During 2010 the measles incidence increased and the variants D4-Hamburg and D4-Manchester replaced D4-Enfield. The highest incidence of measles was in 2011, mainly due to the D4-Manchester variant and sub-variants related to this, which were also detected during the 2012 but with lower number of cases. Discussion: The pattern of measles genotype D4 circulation in Spain during the period of study was the same that in the rest of Europe. Our results suggest the existence of different events of importation instead of continuous circulation. In addition we described a new variant D4-Madrid that had a wide distribution in our country which caused local outbreaks during years 2011 and 2012 and was further detected in Rumania and United Kingdom. The existence of 2 identical strains older than the reference strains D4-Enfield and D4-Manchester determine an older origin of the variants in India and France, respectively.
    No preview · Conference Paper · Sep 2014
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    ABSTRACT: Background: Infections because of Bordetella pertussis still occur in infants and adults in European countries, despite vaccination coverage against pertussis being high. Methods: IgG antibody titers to pertussis toxin (anti-PT) were assessed using an enzyme-linked immunosorbent assay test (Serion ELISA classic) in 353 cord blood samples from neonates of a representative sample of pregnant women obtained in Catalonia (Spain) in 2013. Neonates with anti-PT titers ≤ 40 international units (IU)/mL were considered to be unprotected against pertussis. IgG-PT titers >100 IU/mL in umbilical cord samples were considered to be indicative of a current or recent pertussis infection (12 months) in pregnant women. The age-standardized prevalence of recent pertussis infection obtained in this study was compared with the prevalence obtained in 2003. Results: The mean anti-PT titer in neonates was 10.8 IU/mL and 89.8% of neonates were unprotected against pertussis. The prevalence of unprotected neonates as defined by cord blood anti-PT ≤ 40 IU/mL was 90%. The prevalence of recent pertussis infection in pregnant women as defined by cord blood anti-PT >100 IU/mL was 2%. The diphtheria-tetanus-pertussis vaccination coverage during childhood in pregnant women was 75%. The age-standardized prevalence of recent pertussis infection in pregnant women observed in this study (2.2%) was slightly higher than the prevalence obtained in 2003 (1.5%), with an odds ratio = 1.45 (95% confidence intervals: 0.5-3.9), although differences were not statistically significant. Conclusions: Most neonates are unprotected against pertussis and pertussis infections are frequent in pregnant women in Catalonia. Infants and pregnant women should be the priority population groups for pertussis prevention programs in Catalonia.
    Full-text · Article · May 2014 · The Pediatric Infectious Disease Journal
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    ABSTRACT: Mumps virus (MuV) was detected in the cerebrospinal fluid (CSF) of 6 of 158 patients with meningitis or encephalitis in absence of clinical mumps in the context of mumps epidemics. Our results suggest the need for the study of MuV RNA in the CSF of neurological patients in this context.
    No preview · Article · Mar 2014 · Diagnostic microbiology and infectious disease
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    ABSTRACT: : Study Design: Case report.Objective: To report this rare Varicella Zoster Virus (VZV) complication in a multiple sclerosis patient.Summary of Background Data: Longitudinally extensive transverse myelitis (LETM) is a spinal cord lesion that extends over 3 or more vertebral segments. A common feature in neuromyelitis optica, LETM can also occur in several other diseases.Methods: A 15 year-old boy with relapsing-remitting Multiple Sclerosis, who has been treated with immunomodulators for 6 months, developed a subacute left brachio-crural hemiparesis with ipsilateral decreased sensation in the trunk and limbs. This was interpreted as a new relapse, and was treated consequently. During the evolution, the patient developed a cutaneous rash in the left C8 metameres followed by asymmetric tetraparesis.Results: MRI demonstrated an extensive cervical-thoracic medullar lesion. Cerebrospinal fluid (CSF) analysis revealed 17 leukocytes /μL (95% mononuclear), protein 41 mg/dL, negative VZV-DNA by polymerase chain reaction, but elevated anti-VZV IgG CSF/serum index, with a normal albumin CSF/serum index, all of which were consistent with intrathecal synthesis of anti-VZV antibody. We were able to rule out all other causes included in the differential diagnosis, namely, vascular disease, tumor, and autoimmune conditions, especially those associated with NMO spectrum disorders.Conclusions: Awareness of the potentially varied presentation of VZV myelitis can enable earlier recognition and specific treatment.
    No preview · Article · Sep 2013 · Spine
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    ABSTRACT: The aim of this study was to evaluate enzyme immunoassays (EIA) (Euroimmun, Lübeck, Germany) and chemiluminiscent immunoassays (CLIA) (Diasorin, Saluggia, Italy) in their application to detect B19V-IgM and -IgG. For this purpose, one hundred and ninety samples were studied. Of them, 101 came from recent infection cases (B19V-specific IgM (86) and/or PCR (87), 42 from past infections, 18 from non-infected, and 29 from other viral recent infections (Epstein-Barr virus, measles, and rubella). Samples were characterized by capture (for IgM), or indirect (for IgG) EIA (Biotrin, Dublin, Ireland); indeterminate samples were classified by indirect immunofluorescence (IIF) (Biotrin). All the samples were used for testing IgM assays, and all but the cases from other viral infections were used for IgG tests. For IgM, CLIA, and EIA identified 76 and 62 of 86 IgM positives, respectively (sensitivity 88.4% and 72.1%). Considering B19V IgM negative samples, negative result was obtained in 95 and 92 of 104, being the specificity values of CLIA and EIA 91.3% and 88.5%, respectively. For IgG, CLIA and EIA identified correctly 114 and 115 of the 122 positive samples (sensitivity 93.4% and 94.3%, respectively), and 39 and 36 of 39 negative samples (specificity 100% and 92.3%). As conclusion, CLIA methods can be used in clinical laboratories as adequate alternatives to the well-established Biotrin EIAs.
    No preview · Article · Jun 2013 · Apmis
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    ABSTRACT: Objectives To describe the prevalence of influenza-like syndrome in winter 2009 and the factors associated with its occurrence.MethodsA cross-sectional study was carried out in 18 hospitals in Spain. Volunteers completed a health questionnaire in which they reported the occurrence of influenza-like syndrome and vaccination and demographic status.ResultsA total of 1,289 healthcare workers participated. Of these, 72 (5.6%) reported influenza in their family, 195 (15.1%) had been vaccinated against the A/California/7/2009/H1N1 virus and 75 (5.8%, 95%CI: 4.5-7.1%) had been diagnosed with influenza like-syndrome. There were differences among regions. In logistic regression analysis, the following factors were associated with a higher prevalence of influenza-like syndrome: working in Madrid (OR = 8.31, 95%CI: 1.05-65.39), the occurrence of cases of influenza in the family (OR = 2.84, 95%CI: 1.41-5.73) and not having been vaccinated against influenza A (H1N1) (OR = 2.68, 95% CI: 1.05-6.82).Conclusions Differences in the prevalence of influenza-like syndrome were due to the occurrence of familiar cases and region. Vaccination against influenza A (H1N1) was associated with a lower prevalence of the disease.
    Full-text · Article · Mar 2013 · Gaceta Sanitaria
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    ABSTRACT: Abstract Toscana virus (TOSV), an arthropod-borne phlebovirus, is an important agent of acute meningitis and meningoencephalitis in the Mediterranean area. The epidemiology of the infection in humans in Catalonia is at present unknown. In this study, we found a seroprevalence of infection of 6%, and 2 clinical cases were detected by serology and/or PCR.
    Full-text · Article · Feb 2013 · Vector borne and zoonotic diseases (Larchmont, N.Y.)
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    ABSTRACT: The aim of the study was to determine the incidence of viruses causing aseptic meningitis, meningoencephalitis, and encephalitis in Spain. This was a prospective study, in collaboration with 17 Spanish hospitals, including 581 cases (CSF from all and sera from 280): meningitis (340), meningoencephalitis (91), encephalitis (76), febrile syndrome (7), other neurological disorders (32), and 35 cases without clinical information. CSF were assayed by PCR for enterovirus (EV), herpesvirus (herpes simplex [HSV], varicella-zoster [VZV], cytomegalovirus [CMV], Epstein-Barr [EBV], and human herpes virus-6 [HHV-6]), mumps (MV), Toscana virus (TOSV), adenovirus (HAdV), lymphocytic choriomeningitis virus (LCMV), West Nile virus (WNV), and rabies. Serology was undertaken when methodology was available. Amongst meningitis cases, 57.1% were characterized; EV was the most frequent (76.8%), followed by VZV (10.3%) and HSV (3.1%; HSV-1: 1.6%; HSV-2: 1.0%, HSV non-typed: 0.5%). Cases due to CMV, EBV, HHV-6, MV, TOSV, HAdV, and LCMV were also detected. For meningoencephalitis, 40.7% of cases were diagnosed, HSV-1 (43.2%) and VZV (27.0%) being the most frequent agents, while cases associated with HSV-2, EV, CMV, MV, and LCMV were also detected. For encephalitis, 27.6% of cases were caused by HSV-1 (71.4%), VZV (19.1%), or EV (9.5%). Other positive neurological syndromes included cerebellitis (EV and HAdV), seizures (HSV), demyelinating disease (HSV-1 and HHV-6), myelopathy (VZV), and polyradiculoneuritis (HSV). No rabies or WNV cases were identified. EVs are the most frequent cause of meningitis, as is HSV for meningoencephalitis and encephalitis. A significant number of cases (42.9% meningitis, 59.3% meningoencephalitis, 72.4% encephalitis) still have no etiological diagnosis. J. Med. Virol. © 2012 Wiley Periodicals, Inc.
    Full-text · Article · Dec 2012 · Journal of Medical Virology
  • X. Herranz · A. Negredo · F. de Ory · Ll. Sànchez

    No preview · Article · Nov 2012 · Revista Clínica Española
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    ABSTRACT: Se han evaluado ensayos de fluorescencia ligada a enzima (VIDAS EBV VCA IgM, VIDAS EBV VCA/EA IgG y VIDAS EBV EBNA IgG (Biomérieux, Francia) para la determinación de marcadores de infección por el virus Epstein Barr, así como para el establecimiento de perfiles de anticuerpos, comparándolos con ensayos de inmunofluorescencia como referencia. Los ensayos evaluados han mostrado buenas características de sensibilidad, especificidad y coincidencia porcentual de resultados, lo que les hace adecuados para su aplicación en laboratorios de diagnóstico clínico.
    No preview · Article · Jul 2012 · Enfermedades Infecciosas y Microbiología Clínica
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    ABSTRACT: Mumps outbreaks have recently been recorded in a number of highly vaccinated populations. We related seroprevalence, epidemiological and vaccination data from 18 European countries participating in The European Sero-Epidemiology Network (ESEN) to their risk of mumps outbreaks in order to inform vaccination strategies. Samples from national population serum banks were collected, tested for mumps IgG antibodies and standardized for international comparisons. A comparative analysis between countries was undertaken using age-specific mumps seroprevalence data and information on reported mumps incidence, vaccine strains, vaccination programmes and vaccine coverage 5-12 years after sera collection. Mean geometric mumps antibody titres were lower in mumps outbreak countries [odds ratio (OR) 0·09, 95% confidence interval (CI) 0·01-0·71)]. MMR1 vaccine coverage ⩾95% remained protective in a multivariable model (P<0·001), as did an interval of 4-8 years between doses (OR 0·08, 95% CI 0·01-0·85). Preventing outbreaks and controlling mumps probably requires several elements, including high-coverage vaccination programmes with MMR vaccine with 4-8 years between doses.
    Full-text · Article · Jun 2012 · Epidemiology and Infection

  • No preview · Article · Mar 2012 · European Journal of Internal Medicine