Since 2004 an electronic epidemiological surveillance system (AVE) has been developed and implemented for infectious diseases in the autonomous region of Valencia that allows data collection from notifiable diseases in real time concerning outbreaks and alerts, as well as analysis and dissemination of the information. Within the autonomous region of Valencia, the system is used by 17 epidemiology units, which act as the first level of specialized surveillance. The electronic surveillance system is used by all these units, as well as by physicians working in primary and specialized care, who can introduce information from the ambulatory information system while the patient is in the practice room. The system is able to capture the demographic data from the patient and the physician can add any other information that is considered important for the case detected. The system receives new laboratory test results overnight from the Microbiological Surveillance Network (RedMIVA). AVE can record outbreaks of notifiable diseases as well as any unusual clusters or changing patterns of any disease. The department of epidemiology has access to the whole system for analysis of the information and for quality control of the epidemiological surveillance. The system provides timely and comprehensive information to facilitate public health action in individual cases of infectious disease.

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At present, epidemiological surveillance in Spain remains focused on the communicable diseases included in the list of notifiable diseases. However, there has been a change in epidemiological pattern that predominated until the last few decades of the twentieth century. Infectious diseases, which used to be the leading causes of morbidity and mortality, have given way to a predominance of chronic diseases. In this regard, progress has been made in the drafting and adoption of specific legal regulations on public health monitoring. However, Spain has yet to develop this legislation which, among other elements, includes the mandate to organize the surveillance of non-communicable diseases in Spain. This article aims to describe some points that should be considered in the development of a national surveillance system linked to existing strategies for the prevention and control of chronic diseases.

te llón.(2) Cen tro Na cio nal de Epi de mio lo gía, Insti tu to de Sa lud Car los III.(3) La bo ra to rio de Mi cro bio lo gía, Hos pi tal Ge ne ral de Cas te llón. RESUMENFun da men to: A par tir de la de cla ra ción de va rios ca sos en un cen tro es co lar se ini cia el es tu dio de bro te con el ob je ti vo de ca rac te ri zar éste des de el pun to de vis ta de per so na, lu gar y tiem po; se cal cu la la efec ti vi dad de la va cu na, y se es tu dia la con cor dan cia en tre los ca sos y el re sul ta do po si ti vo del es tu dio se ro ló gi co.Mé to dos: Se de fi ne caso a la per so na que pre sen ta tos persis ten te de dos se ma nas de du ra ción. Se rea li za es tu dio de la difu sión de la en fer me dad a tra vés de la cur va epi dé mi ca, y de la efec ti vi dad de la do sis de re fuer zo de la va cu na an ti per tus sis. La con cor dan cia en tre los ca sos y la se ro lo gía po si ti va se evalúa por el ín di ce Kappa.Re sul ta dos: Entre los alum nos de va rios cen tros es co la res y sus con vi vien tes se en cues ta a 130 per so nas, de los que 94 entran en la de fi ni ción de caso. La me dia de edad de los ca sos es 10,5 años, un 42,6% son va ro nes, el 84% es co la res, el 71,3% mues tra sig nos de in fec ción re cien te (IgM po si ti va), y el tiempo me dio des de la úl ti ma do sis de va cu na an ti per tus sis es de 8,25 años. La efec ti vi dad de la do sis de re fuer zo de la va cu na es del 66%. La con cor dan cia en tre los ca sos y el re sul ta do po si tivo de la se ro lo gía mues tra un Kappa igual a 0,45. No se ais ló B. Per tus sis en las 25 mues tras de fro tis fa rín geo.Con clu sio nes: Las au las y el me dio fa mi liar son un fac tor de di fu sión de la en fer me dad. La in clu sión de una do sis de refuer zo a los 18 me ses me jo ra la efec ti vi dad de la va cu na an tiper tus sis. El ais la mien to de la B. Per tus sis es poco fre cuen te, y la se ro lo gía, pue de ser una al ter na ti va ante la sos pe cha clí ni ca de la en fer me dad.Pa la bras cla ve: Tos fe ri na. Bro te epi dé mi co. Tos pa ro xís ti ca.

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