Flu is transmitted from an ill person to another person through droplets expelled when coughing and sneezing. The transmission period starts from the day before symptoms appear and persists for five days afterwards.

It is estimated that seasonal flu may affect between 5% and 20% of the general population, and that approximately 25% of febrile respiratory processes may be produced by the flu. This increased morbidity gives rise to a large number of medical consultations and absences from work as a consequence of the disease. Moreover, some people, such as older people, those with chronic illnesses, immuno-suppressed people and pregnant women, among others, may suffer more from the illness and it is common for them to experience complications during its evolution. Flu thus continues to be a major public health issue.

Symptoms 

Flu presents heightened fever, dry cough, headache and neck ache, muscle pain and general illness. It can also cause diarrhoea, nausea and vomiting, especially in young children. In most cases, people recover in 7-10 days.

Who is affected by the condition?

Flu may affect anyone, but the most vulnerable to suffering complications are children under the age of 2, people aged 60 or above, pregnant women, morbidly obese people and people of any age who suffer from one of the following types of illness: cardiovascular, pulmonary (including bronchopulmonary dysplasia, cystic fibrosis and asthma), neurological, neuromuscular, metabolic (including diabetes mellitus), kidney failure, immunosuppression, cancer, chronic liver diseases, asplenia and iron deficiencies.

Diagnosis

Flu diagnosis is normally clinical and does not require laboratory tests. Despite that fact, microbiological diagnosis is fundamental to be able to obtain aetiological confirmation in patients with risk factors and those with serious illnesses. The detection of the virus in respiratory samples can be done using cultures, antigen detection techniques and molecular methods.

Typical treatment

There is no specific treatment for flu. Treatment with analgesics and antipyretics (paracetamol) is recommended to alleviate or treat some of the symptoms associated with flu, such as fever or headache.

Antibiotics do not cure the flu. Only in cases where there is an overlying bacterial infection, such as pneumonia, or in those with chronic illnesses, may preventive antibiotic treatment be indicated to avoid complications.

Antivirals, such as oseltamivir or zanamivir, may be indicated in people at high risk of complications to reduce the duration of the flu and the possibility of complications, but they should begin to be taken within 48 hours from the outbreak of symptoms.

Prevention

The best way of protecting yourself from the flu is vaccination and following good hygiene practices to prevent the spread of the virus. The purpose of anti-flu vaccination each year is to generate protection against the flu viruses that circulate in the flu season. Health authorities and scientific associations around the world unanimously recommend seasonal anti-flu vaccination for people at high risk. Anti-flu vaccinations are very safe and well-tolerated with effectiveness that ranges from 30% to 70% to prevent hospitalisation due to flu and pneumonia. In older people living in institutions, vaccinations have proven to be between 50% and 60% effective to prevent hospitalisation or pneumonia, and 80% to prevent death by flu.

This is a frequently transmitted disease and in most cases it does not result in any pathology. It can, however, release a benign disease in the form of warts, or less commonly, different types of cancer. In women, HPV can cause cervical cancer.

What is HPV?

HPV is spread via direct skin to skin contact during sex, and not through fluids. In around 90% of cases it disappears spontaneously, but it can be transmitted whilst the virus is present.

HPV is classified in terms of whether or not there is a risk of cancer developing:

• Low risk: may cause benign genital warts or condyloma.
• High risk: up to 14 different types of high risk or congenital HPV have been described, of which the most common are types 16 and 18. These are responsible for 70% of cancers caused by this virus.

It should be said that it is possible to be infected with more than one type of HPV. In addition, persistent infection can result in developing cancer of the cervix, vulva, penis, anus or oropharynx.

Specifically, the virus initiates dysplastic changes in the epithelial cells which continue to evolve until they produce an invasive cancer. This is a progressive process and the time from infection until developing the disease can be up to twenty years.

Symptoms

Genital warts or small protuberances or groups of different sizes and shapes may appear in the area of the genitals.

In the case of cancer, there are no symptoms until it is very advanced. In the case of cervical cancer, symptoms show up as:

• Abnormal vaginal bleeding
• Pain in the lower abdomen, pelvis, back and legs
• Weight loss
• Pain during sexual intercourse

Who is affected by HPV?

In Catalonia, cancer of the womb occurs in 7.2 out of every 100,000 women per year (2003-2007). This represents 2.8% of all female cancers. Between the ages of 35-64 this figure rises to 16.1 cases for every 100,000 women. Furthermore, the risk of developing this disease for women who live to 75 is one in 106.

Anal cancer has an annual incidence rate of 1.8 cases for every 100,000 people, but in the case of men engaging in same-sex relations and infected with HIV, this rises to 70 or 128 cases for every 100,000.

Diagnosis

When there is evidence of warts, diagnosis is usually clinical or by biopsy. Cancer is detected by cytology tests, which allow anomalous changes in the cells to be seen before they develop. If the test comes back anomalous it can be complemented by a colposcopy that allows magnified examination of the cervix and samples to be taken.

HPV detection is the main component of a preventative strategy to detect the virus before it reaches the point of disease.

Typical treatment

There is no specific antiviral treatment for HPV.

In the case of warts, in most cases they can be eliminated through surgery, ointments or other treatments.

If cancer does develop, treatment will depend on the stage at which it is diagnosed. For example, if it is detected early in the cervix this can involve removing the damaged tissue, whilst in more advanced stages it may require a hysterectomy, radiotherapy or chemotherapy.

Prevention

The use of condoms is essential to prevent HPV. There is also highly effective vaccine used as a way to prevent cervical cancer. Regular cervical smear tests (Papanicolau test) are also carried out as a form of screening. This strategy, however, is changing due to the techniques used to detect the virus which, together with the smear test, are enabling the different stages of the disease to be monitored (acquisition, persistence, progression to precancerous lesions and invasion).

What is diphtheria?

The characteristic symptom of respiratory diphtheria is a greyish white membrane (pseudomembrane) covering the tonsils and pharynx. The membrane tends to be difficult to remove and in doing so the area bleeds easily.

Symptoms

The most common symptoms are:

• Fever, feeling generally unwell and respiratory obstruction.
• Neurological and cardiac complications in the most serious cases. These complications can lead to death.

Who does diphtheria affect?

Thanks to vaccination, there have been no cases diagnosed in Spain for over thirty years. In 2015, however, there was one case in a child who had not been vaccinated.

Diphtheria is transmitted through respiration or close physical contact with an infected person or a healthy person carrying the bacteria but who has never shown symptoms.

The incubation period is two to seven days and it can be spread from seven days before symptoms appear up to two or three weeks afterwards.

Diagnosis

Diagnosis is confirmed via microbial culture of clinical samples (swabs from the nasal mucosa, pharynx or pseudomembranes).

Typical treatment

Diphtheria antitoxin medication and an antibiotic such as penicillin G procaine must be given as soon as possible (in the first 48 hours after showing symptoms, without waiting for the laboratory diagnosis).

Prevention

Vaccination is the main measure to prevent diphtheria and is effective in 95% of cases. It must be periodically boosted as the effects of the vaccination do not last for ever.

Epidemiological monitoring and prophylaxis are essential to control the bacteria and to avoid secondary cases.

For the moment, the number of new cases has been reduced thanks to policies to eliminate the insect in countries where it is endemic, as well as thanks to screening programmes aimed at blood and organ donors and pregnant women. The future challenges to cure this disease are maintaining and increasing these measures in addition to developing new treatment evolution and response markers for patients in the chronic phase, and new drugs to treat the disease.

What is Chagas disease?

Chagas disease is endemic to Latin America and is a global health challenge due to migration from countries in the region. Transmission via insect is mainly found in Bolivia, which has the highest number of cases. There are also infections in north-west Argentina, Peru, Paraguay, Ecuador, Nicaragua and southern Mexico. Outside these areas it is more commonly transmitted from mother to child.

Symptoms

Most patients with Chagas disease do not show any symptoms, which makes it difficult to detect. The disease develops in two phases:

• Acute: there are no symptoms and this means it goes undetected or is confused with other diseases. After an incubation period of 7-10 days, the acute phase resembles a case of flu, so it usually goes unnoticed.
• Chronic: in 30-40% of cases the disease results in cardiac and/or gastrointestinal complications which may be serious and therefore require specific treatment.

Who is affected by Chagas disease?

This disease affects six to seven million people, but 60 million are estimated to be at risk of infection.  There are 11,000 cases in Catalonia.

Diagnosis

• In the acute phase (mainly in babies) the disease is diagnosed by detecting the parasite in the blood. Microscopy and molecular techniques (PCR) are used for this.
• In the chronic phase (when acquired in childhood), the disease is diagnosed by detecting antibodies in the serum. In this phase of the disease, molecular techniques work in cases where the disease has been reactivated or as a marker of the failure of a specific treatment.

Typical treatment

There are currently two drugs that are used to treat Chagas disease: Benznidazole and Nifurtimox. Specific treatment is needed to address any cardiac and/or gastrointestinal complications that may arise.

Prevention

Since 2011, Catalonia has implemented the “Protocol for screening and diagnosing Chagas disease in pregnant Latin American women and their babies”. This programme allows possible congenital cases to be detected, and at the same time actively screens blood and organ donations from donors.