Guillain-Barré syndrome following the 2009 pandemic monovalent and seasonal trivalent influenza vaccination campaigns in Spain from 2009 to 2011: outcomes from active surveillance by a neurologist network, and records from a country-wide hospital discharge database.
Identifieur interne : 000144 ( Main/Exploration ); précédent : 000143; suivant : 000145Guillain-Barré syndrome following the 2009 pandemic monovalent and seasonal trivalent influenza vaccination campaigns in Spain from 2009 to 2011: outcomes from active surveillance by a neurologist network, and records from a country-wide hospital discharge database.
Auteurs : Enrique Alcalde-Cabero [Espagne] ; Javier Almazán-Isla [Espagne] ; Fernando J. García L Pez [Espagne] ; José Ram N Ara-Callizo [Espagne] ; Fuencisla Avellanal [Espagne] ; Carlos Casasnovas [Espagne] ; Carlos Cemillán [Espagne] ; José Ignacio Cuadrado [Espagne] ; Jacinto Duarte [Espagne] ; María Dolores Fernández-Pérez [Espagne] ; Scar Fernández [Espagne] ; Juan Antonio García Merino [Espagne] ; Rosa García Montero [Espagne] ; Dolores Montero [Espagne] ; Julio Pardo [Espagne] ; Francisco Javier Rodríguez-Rivera [Espagne] ; María Ruiz-Tovar [Espagne] ; Jesús De Pedro-Cuesta [Espagne]Source :
- BMC neurology [ 1471-2377 ] ; 2016.
Descripteurs français
- KwdFr :
- Adulte (MeSH), Adulte d'âge moyen (MeSH), Bases de données factuelles (MeSH), Espagne (épidémiologie), Facteurs temps (MeSH), Femelle (MeSH), Humains (MeSH), Incidence (MeSH), Mâle (MeSH), Neurologues (MeSH), Pandémies (MeSH), Sous-type H1N1 du virus de la grippe A (immunologie), Sujet âgé (MeSH), Surveillance de la santé publique (MeSH), Surveillance épidémiologique (MeSH), Syndrome de Guillain-Barré (épidémiologie), Vaccins antigrippaux (effets indésirables), Études prospectives (MeSH), Études rétrospectives (MeSH).
- MESH :
- effets indésirables : Vaccins antigrippaux.
- immunologie : Sous-type H1N1 du virus de la grippe A.
- épidémiologie : Espagne, Syndrome de Guillain-Barré.
- Adulte, Adulte d'âge moyen, Bases de données factuelles, Facteurs temps, Femelle, Humains, Incidence, Mâle, Neurologues, Pandémies, Sujet âgé, Surveillance de la santé publique, Surveillance épidémiologique, Études prospectives, Études rétrospectives.
English descriptors
- KwdEn :
- Adult (MeSH), Aged (MeSH), Databases, Factual (MeSH), Epidemiological Monitoring (MeSH), Female (MeSH), Guillain-Barre Syndrome (epidemiology), Humans (MeSH), Incidence (MeSH), Influenza A Virus, H1N1 Subtype (immunology), Influenza Vaccines (adverse effects), Male (MeSH), Middle Aged (MeSH), Neurologists (MeSH), Pandemics (MeSH), Prospective Studies (MeSH), Public Health Surveillance (MeSH), Retrospective Studies (MeSH), Spain (epidemiology), Time Factors (MeSH).
- MESH :
- chemical , adverse effects : Influenza Vaccines.
- epidemiology : Guillain-Barre Syndrome, Spain.
- immunology : Influenza A Virus, H1N1 Subtype.
- Adult, Aged, Databases, Factual, Epidemiological Monitoring, Female, Humans, Incidence, Male, Middle Aged, Neurologists, Pandemics, Prospective Studies, Public Health Surveillance, Retrospective Studies, Time Factors.
Abstract
BACKGROUND
Studies have shown a slight excess risk in Guillain-Barré syndrome (GBS) incidence associated with A(H1N1)pdm09 vaccination campaign and seasonal trivalent influenza vaccine immunisations in 2009-2010. We aimed to assess the incidence of GBS as a potential adverse effect of A(H1N1)pdm09 vaccination.
METHODS
A neurologist-led network, active at the neurology departments of ten general hospitals serving an adult population of 4.68 million, conducted GBS surveillance in Spain in 2009-2011. The network, established in 1996, carried out a retrospective and a prospective study to estimate monthly alarm thresholds in GBS incidence and tested them in 1998-1999 in a pilot study. Such incidence thresholds additionally to observation of GBS cases with immunisation antecedent in the 42 days prior to clinical onset were taken as alarm signals for 2009-2011, since November 2009 onwards. For purpose of surveillance, in 2009 we updated both the available centres and the populations served by the network. We also did a retrospective countrywide review of hospital-discharged patients having ICD-9-CM code 357.0 (acute infective polyneuritis) as their principal diagnosis from January 2009 to December 2011.
RESULTS
Among 141 confirmed of 148 notified cases of GBS or Miller-Fisher syndrome, Brighton 1-2 criteria in 96 %, not a single patient was identified with clinical onset during the 42-day time interval following A(H1N1)pdm09 vaccination. In contrast, seven cases were seen during a similar period after seasonal campaigns. Monthly incidence figures did not, however, exceed the upper 95 % CI limit of expected incidence. A retrospective countrywide review of the registry of hospital-discharged patients having ICD-9-CM code 357.0 (acute infective polyneuritis) as their principal diagnosis did not suggest higher admission rates in critical months across the period December 2009-February 2010.
CONCLUSIONS
Despite limited power and underlying reporting bias in 2010-2011, an increase in GBS incidence over background GBS, associated with A(H1N1)pdm09 monovalent or trivalent influenza immunisations, appears unlikely.
DOI: 10.1186/s12883-016-0598-z
PubMed: 27206524
PubMed Central: PMC4875759
Affiliations:
Links toward previous steps (curation, corpus...)
Le document en format XML
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Research Institute (Institut d'Investigació Biomèdica de Bellvitge/IDIBELL), L'Hospitalet de Llobregat, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Neuromuscular Unit, Neurology Department, Bellvitge University Hospital, Bellvitge, Biomedical Research Institute (Institut d'Investigació Biomèdica de Bellvitge/IDIBELL), L'Hospitalet de Llobregat</wicri:regionArea><wicri:noRegion>L'Hospitalet de Llobregat</wicri:noRegion></affiliation></author><author><name sortKey="Cemillan, Carlos" sort="Cemillan, Carlos" uniqKey="Cemillan C" first="Carlos" last="Cemillán">Carlos Cemillán</name><affiliation wicri:level="3"><nlm:affiliation>Neurology Department, Severo Ochoa University Hospital, Leganés, Madrid, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Neurology Department, Severo Ochoa University Hospital, Leganés, Madrid</wicri:regionArea><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName></affiliation></author><author><name sortKey="Cuadrado, Jose Ignacio" sort="Cuadrado, Jose Ignacio" uniqKey="Cuadrado J" first="José Ignacio" last="Cuadrado">José Ignacio Cuadrado</name><affiliation wicri:level="1"><nlm:affiliation>Epidemiology Department, Regional Ministry of Health, Madrid Autonomous Region, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Epidemiology Department, Regional Ministry of Health, Madrid Autonomous Region</wicri:regionArea><wicri:noRegion>Madrid Autonomous Region</wicri:noRegion></affiliation></author><author><name sortKey="Duarte, Jacinto" sort="Duarte, Jacinto" uniqKey="Duarte J" first="Jacinto" last="Duarte">Jacinto Duarte</name><affiliation wicri:level="1"><nlm:affiliation>Neurology Department, General Hospital, Segovia, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Neurology Department, General Hospital, Segovia</wicri:regionArea><wicri:noRegion>Segovia</wicri:noRegion></affiliation></author><author><name sortKey="Fernandez Perez, Maria Dolores" sort="Fernandez Perez, Maria Dolores" uniqKey="Fernandez Perez M" first="María Dolores" last="Fernández-Pérez">María Dolores Fernández-Pérez</name><affiliation wicri:level="1"><nlm:affiliation>Neurology Department, Virgen de las Nieves University Hospital, Granada, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Neurology Department, Virgen de las Nieves University Hospital, Granada</wicri:regionArea><wicri:noRegion>Granada</wicri:noRegion></affiliation></author><author><name sortKey="Fernandez, Scar" sort="Fernandez, Scar" uniqKey="Fernandez " first=" Scar" last="Fernández"> Scar Fernández</name><affiliation wicri:level="1"><nlm:affiliation>Neurology Department, Carlos Haya University Hospital, Málaga, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Neurology Department, Carlos Haya University Hospital, Málaga</wicri:regionArea><wicri:noRegion>Málaga</wicri:noRegion></affiliation></author><author><name sortKey="Merino, Juan Antonio Garcia" sort="Merino, Juan Antonio Garcia" uniqKey="Merino J" first="Juan Antonio García" last="Merino">Juan Antonio García Merino</name><affiliation wicri:level="3"><nlm:affiliation>Neurology Department, Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Neurology Department, Puerta de Hierro University Hospital, Majadahonda, Madrid</wicri:regionArea><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName></affiliation></author><author><name sortKey="Montero, Rosa Garcia" sort="Montero, Rosa Garcia" uniqKey="Montero R" first="Rosa García" last="Montero">Rosa García Montero</name><affiliation wicri:level="1"><nlm:affiliation>Neurology Department, Virgen de la Salud Hospital, Toledo, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Neurology Department, Virgen de la Salud Hospital, Toledo</wicri:regionArea><wicri:noRegion>Toledo</wicri:noRegion></affiliation></author><author><name sortKey="Montero, Dolores" sort="Montero, Dolores" uniqKey="Montero D" first="Dolores" last="Montero">Dolores Montero</name><affiliation wicri:level="3"><nlm:affiliation>Spanish Medicines & Medical Devices Agency (Agencia Española de Medicamentos y Productos Sanitarios), Madrid, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Spanish Medicines & Medical Devices Agency (Agencia Española de Medicamentos y Productos Sanitarios), Madrid</wicri:regionArea><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName></affiliation></author><author><name sortKey="Pardo, Julio" sort="Pardo, Julio" uniqKey="Pardo J" first="Julio" last="Pardo">Julio Pardo</name><affiliation wicri:level="1"><nlm:affiliation>Neurology Department, University Teaching Hospital Clínico, Santiago de Compostela (Corunna), Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Neurology Department, University Teaching Hospital Clínico, Santiago de Compostela (Corunna)</wicri:regionArea><wicri:noRegion>Santiago de Compostela (Corunna)</wicri:noRegion></affiliation></author><author><name sortKey="Rodriguez Rivera, Francisco Javier" sort="Rodriguez Rivera, Francisco Javier" uniqKey="Rodriguez Rivera F" first="Francisco Javier" last="Rodríguez-Rivera">Francisco Javier Rodríguez-Rivera</name><affiliation wicri:level="3"><nlm:affiliation>Neurology Department, La Paz University Hospital, Madrid, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Neurology Department, La Paz University Hospital, Madrid</wicri:regionArea><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName></affiliation></author><author><name sortKey="Ruiz Tovar, Maria" sort="Ruiz Tovar, Maria" uniqKey="Ruiz Tovar M" first="María" last="Ruiz-Tovar">María Ruiz-Tovar</name><affiliation wicri:level="3"><nlm:affiliation>National Centre for Epidemiology, CIBERNED, Carlos III Health Institute, Madrid, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>National Centre for Epidemiology, CIBERNED, Carlos III Health Institute, Madrid</wicri:regionArea><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName></affiliation></author><author><name sortKey="De Pedro Cuesta, Jesus" sort="De Pedro Cuesta, Jesus" uniqKey="De Pedro Cuesta J" first="Jesús" last="De Pedro-Cuesta">Jesús De Pedro-Cuesta</name><affiliation wicri:level="3"><nlm:affiliation>National Centre for Epidemiology, CIBERNED, Carlos III Health Institute, Madrid, Spain. jpedro@isciii.es.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>National Centre for Epidemiology, CIBERNED, Carlos III Health Institute, Madrid</wicri:regionArea><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2016">2016</date><idno type="RBID">pubmed:27206524</idno><idno type="pmid">27206524</idno><idno type="doi">10.1186/s12883-016-0598-z</idno><idno type="pmc">PMC4875759</idno><idno type="wicri:Area/Main/Corpus">00130</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Corpus" wicri:corpus="PubMed">00130</idno><idno type="wicri:Area/Main/Curation">000130</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Curation">000130</idno><idno type="wicri:Area/Main/Exploration">000130</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Guillain-Barré syndrome following the 2009 pandemic monovalent and seasonal trivalent influenza vaccination campaigns in Spain from 2009 to 2011: outcomes from active surveillance by a neurologist network, and records from a country-wide hospital discharge database.</title><author><name sortKey="Alcalde Cabero, Enrique" sort="Alcalde Cabero, Enrique" uniqKey="Alcalde Cabero E" first="Enrique" last="Alcalde-Cabero">Enrique Alcalde-Cabero</name><affiliation wicri:level="3"><nlm:affiliation>National Centre for Epidemiology, CIBERNED, Carlos III Health Institute, Madrid, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>National Centre for Epidemiology, CIBERNED, Carlos III Health Institute, Madrid</wicri:regionArea><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName></affiliation></author><author><name sortKey="Almazan Isla, Javier" sort="Almazan Isla, Javier" uniqKey="Almazan Isla J" first="Javier" last="Almazán-Isla">Javier Almazán-Isla</name><affiliation wicri:level="3"><nlm:affiliation>National Centre for Epidemiology, CIBERNED, Carlos III Health Institute, Madrid, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>National Centre for Epidemiology, CIBERNED, Carlos III Health Institute, Madrid</wicri:regionArea><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName></affiliation></author><author><name sortKey="Garcia L Pez, Fernando J" sort="Garcia L Pez, Fernando J" uniqKey="Garcia L Pez F" first="Fernando J" last="García L Pez">Fernando J. García L Pez</name><affiliation wicri:level="3"><nlm:affiliation>National Centre for Epidemiology, CIBERNED, Carlos III Health Institute, Madrid, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>National Centre for Epidemiology, CIBERNED, Carlos III Health Institute, Madrid</wicri:regionArea><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName></affiliation></author><author><name sortKey="Ara Callizo, Jose Ram N" sort="Ara Callizo, Jose Ram N" uniqKey="Ara Callizo J" first="José Ram N" last="Ara-Callizo">José Ram N Ara-Callizo</name><affiliation wicri:level="1"><nlm:affiliation>Neurology Department, Miguel Servet University Hospital, Zaragoza, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Neurology Department, Miguel Servet University Hospital, Zaragoza</wicri:regionArea><wicri:noRegion>Zaragoza</wicri:noRegion></affiliation></author><author><name sortKey="Avellanal, Fuencisla" sort="Avellanal, Fuencisla" uniqKey="Avellanal F" first="Fuencisla" last="Avellanal">Fuencisla Avellanal</name><affiliation wicri:level="3"><nlm:affiliation>National Centre for Epidemiology, CIBERNED, Carlos III Health Institute, Madrid, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>National Centre for Epidemiology, CIBERNED, Carlos III Health Institute, Madrid</wicri:regionArea><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName></affiliation></author><author><name sortKey="Casasnovas, Carlos" sort="Casasnovas, Carlos" uniqKey="Casasnovas C" first="Carlos" last="Casasnovas">Carlos Casasnovas</name><affiliation wicri:level="1"><nlm:affiliation>Neuromuscular Unit, Neurology Department, Bellvitge University Hospital, Bellvitge, Biomedical Research Institute (Institut d'Investigació Biomèdica de Bellvitge/IDIBELL), L'Hospitalet de Llobregat, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Neuromuscular Unit, Neurology Department, Bellvitge University Hospital, Bellvitge, Biomedical Research Institute (Institut d'Investigació Biomèdica de Bellvitge/IDIBELL), L'Hospitalet de Llobregat</wicri:regionArea><wicri:noRegion>L'Hospitalet de Llobregat</wicri:noRegion></affiliation></author><author><name sortKey="Cemillan, Carlos" sort="Cemillan, Carlos" uniqKey="Cemillan C" first="Carlos" last="Cemillán">Carlos Cemillán</name><affiliation wicri:level="3"><nlm:affiliation>Neurology Department, Severo Ochoa University Hospital, Leganés, Madrid, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Neurology Department, Severo Ochoa University Hospital, Leganés, Madrid</wicri:regionArea><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName></affiliation></author><author><name sortKey="Cuadrado, Jose Ignacio" sort="Cuadrado, Jose Ignacio" uniqKey="Cuadrado J" first="José Ignacio" last="Cuadrado">José Ignacio Cuadrado</name><affiliation wicri:level="1"><nlm:affiliation>Epidemiology Department, Regional Ministry of Health, Madrid Autonomous Region, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Epidemiology Department, Regional Ministry of Health, Madrid Autonomous Region</wicri:regionArea><wicri:noRegion>Madrid Autonomous Region</wicri:noRegion></affiliation></author><author><name sortKey="Duarte, Jacinto" sort="Duarte, Jacinto" uniqKey="Duarte J" first="Jacinto" last="Duarte">Jacinto Duarte</name><affiliation wicri:level="1"><nlm:affiliation>Neurology Department, General Hospital, Segovia, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Neurology Department, General Hospital, Segovia</wicri:regionArea><wicri:noRegion>Segovia</wicri:noRegion></affiliation></author><author><name sortKey="Fernandez Perez, Maria Dolores" sort="Fernandez Perez, Maria Dolores" uniqKey="Fernandez Perez M" first="María Dolores" last="Fernández-Pérez">María Dolores Fernández-Pérez</name><affiliation wicri:level="1"><nlm:affiliation>Neurology Department, Virgen de las Nieves University Hospital, Granada, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Neurology Department, Virgen de las Nieves University Hospital, Granada</wicri:regionArea><wicri:noRegion>Granada</wicri:noRegion></affiliation></author><author><name sortKey="Fernandez, Scar" sort="Fernandez, Scar" uniqKey="Fernandez " first=" Scar" last="Fernández"> Scar Fernández</name><affiliation wicri:level="1"><nlm:affiliation>Neurology Department, Carlos Haya University Hospital, Málaga, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Neurology Department, Carlos Haya University Hospital, Málaga</wicri:regionArea><wicri:noRegion>Málaga</wicri:noRegion></affiliation></author><author><name sortKey="Merino, Juan Antonio Garcia" sort="Merino, Juan Antonio Garcia" uniqKey="Merino J" first="Juan Antonio García" last="Merino">Juan Antonio García Merino</name><affiliation wicri:level="3"><nlm:affiliation>Neurology Department, Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Neurology Department, Puerta de Hierro University Hospital, Majadahonda, Madrid</wicri:regionArea><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName></affiliation></author><author><name sortKey="Montero, Rosa Garcia" sort="Montero, Rosa Garcia" uniqKey="Montero R" first="Rosa García" last="Montero">Rosa García Montero</name><affiliation wicri:level="1"><nlm:affiliation>Neurology Department, Virgen de la Salud Hospital, Toledo, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Neurology Department, Virgen de la Salud Hospital, Toledo</wicri:regionArea><wicri:noRegion>Toledo</wicri:noRegion></affiliation></author><author><name sortKey="Montero, Dolores" sort="Montero, Dolores" uniqKey="Montero D" first="Dolores" last="Montero">Dolores Montero</name><affiliation wicri:level="3"><nlm:affiliation>Spanish Medicines & Medical Devices Agency (Agencia Española de Medicamentos y Productos Sanitarios), Madrid, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Spanish Medicines & Medical Devices Agency (Agencia Española de Medicamentos y Productos Sanitarios), Madrid</wicri:regionArea><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName></affiliation></author><author><name sortKey="Pardo, Julio" sort="Pardo, Julio" uniqKey="Pardo J" first="Julio" last="Pardo">Julio Pardo</name><affiliation wicri:level="1"><nlm:affiliation>Neurology Department, University Teaching Hospital Clínico, Santiago de Compostela (Corunna), Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Neurology Department, University Teaching Hospital Clínico, Santiago de Compostela (Corunna)</wicri:regionArea><wicri:noRegion>Santiago de Compostela (Corunna)</wicri:noRegion></affiliation></author><author><name sortKey="Rodriguez Rivera, Francisco Javier" sort="Rodriguez Rivera, Francisco Javier" uniqKey="Rodriguez Rivera F" first="Francisco Javier" last="Rodríguez-Rivera">Francisco Javier Rodríguez-Rivera</name><affiliation wicri:level="3"><nlm:affiliation>Neurology Department, La Paz University Hospital, Madrid, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Neurology Department, La Paz University Hospital, Madrid</wicri:regionArea><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName></affiliation></author><author><name sortKey="Ruiz Tovar, Maria" sort="Ruiz Tovar, Maria" uniqKey="Ruiz Tovar M" first="María" last="Ruiz-Tovar">María Ruiz-Tovar</name><affiliation wicri:level="3"><nlm:affiliation>National Centre for Epidemiology, CIBERNED, Carlos III Health Institute, Madrid, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>National Centre for Epidemiology, CIBERNED, Carlos III Health Institute, Madrid</wicri:regionArea><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName></affiliation></author><author><name sortKey="De Pedro Cuesta, Jesus" sort="De Pedro Cuesta, Jesus" uniqKey="De Pedro Cuesta J" first="Jesús" last="De Pedro-Cuesta">Jesús De Pedro-Cuesta</name><affiliation wicri:level="3"><nlm:affiliation>National Centre for Epidemiology, CIBERNED, Carlos III Health Institute, Madrid, Spain. jpedro@isciii.es.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>National Centre for Epidemiology, CIBERNED, Carlos III Health Institute, Madrid</wicri:regionArea><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName></affiliation></author></analytic><series><title level="j">BMC neurology</title><idno type="eISSN">1471-2377</idno><imprint><date when="2016" type="published">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult (MeSH)</term><term>Aged (MeSH)</term><term>Databases, Factual (MeSH)</term><term>Epidemiological Monitoring (MeSH)</term><term>Female (MeSH)</term><term>Guillain-Barre Syndrome (epidemiology)</term><term>Humans (MeSH)</term><term>Incidence (MeSH)</term><term>Influenza A Virus, H1N1 Subtype (immunology)</term><term>Influenza Vaccines (adverse effects)</term><term>Male (MeSH)</term><term>Middle Aged (MeSH)</term><term>Neurologists (MeSH)</term><term>Pandemics (MeSH)</term><term>Prospective Studies (MeSH)</term><term>Public Health Surveillance (MeSH)</term><term>Retrospective Studies (MeSH)</term><term>Spain (epidemiology)</term><term>Time Factors (MeSH)</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Adulte (MeSH)</term><term>Adulte d'âge moyen (MeSH)</term><term>Bases de données factuelles (MeSH)</term><term>Espagne (épidémiologie)</term><term>Facteurs temps (MeSH)</term><term>Femelle (MeSH)</term><term>Humains (MeSH)</term><term>Incidence (MeSH)</term><term>Mâle (MeSH)</term><term>Neurologues (MeSH)</term><term>Pandémies (MeSH)</term><term>Sous-type H1N1 du virus de la grippe A (immunologie)</term><term>Sujet âgé (MeSH)</term><term>Surveillance de la santé publique (MeSH)</term><term>Surveillance épidémiologique (MeSH)</term><term>Syndrome de Guillain-Barré (épidémiologie)</term><term>Vaccins antigrippaux (effets indésirables)</term><term>Études prospectives (MeSH)</term><term>Études rétrospectives (MeSH)</term></keywords><keywords scheme="MESH" type="chemical" qualifier="adverse effects" xml:lang="en"><term>Influenza Vaccines</term></keywords><keywords scheme="MESH" qualifier="effets indésirables" xml:lang="fr"><term>Vaccins antigrippaux</term></keywords><keywords scheme="MESH" qualifier="epidemiology" xml:lang="en"><term>Guillain-Barre Syndrome</term><term>Spain</term></keywords><keywords scheme="MESH" qualifier="immunologie" xml:lang="fr"><term>Sous-type H1N1 du virus de la grippe A</term></keywords><keywords scheme="MESH" qualifier="immunology" xml:lang="en"><term>Influenza A Virus, H1N1 Subtype</term></keywords><keywords scheme="MESH" qualifier="épidémiologie" xml:lang="fr"><term>Espagne</term><term>Syndrome de Guillain-Barré</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adult</term><term>Aged</term><term>Databases, Factual</term><term>Epidemiological Monitoring</term><term>Female</term><term>Humans</term><term>Incidence</term><term>Male</term><term>Middle Aged</term><term>Neurologists</term><term>Pandemics</term><term>Prospective Studies</term><term>Public Health Surveillance</term><term>Retrospective Studies</term><term>Time Factors</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Adulte</term><term>Adulte d'âge moyen</term><term>Bases de données factuelles</term><term>Facteurs temps</term><term>Femelle</term><term>Humains</term><term>Incidence</term><term>Mâle</term><term>Neurologues</term><term>Pandémies</term><term>Sujet âgé</term><term>Surveillance de la santé publique</term><term>Surveillance épidémiologique</term><term>Études prospectives</term><term>Études rétrospectives</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>BACKGROUND</b></p><p>Studies have shown a slight excess risk in Guillain-Barré syndrome (GBS) incidence associated with A(H1N1)pdm09 vaccination campaign and seasonal trivalent influenza vaccine immunisations in 2009-2010. We aimed to assess the incidence of GBS as a potential adverse effect of A(H1N1)pdm09 vaccination.</p></div><div type="abstract" xml:lang="en"><p><b>METHODS</b></p><p>A neurologist-led network, active at the neurology departments of ten general hospitals serving an adult population of 4.68 million, conducted GBS surveillance in Spain in 2009-2011. The network, established in 1996, carried out a retrospective and a prospective study to estimate monthly alarm thresholds in GBS incidence and tested them in 1998-1999 in a pilot study. Such incidence thresholds additionally to observation of GBS cases with immunisation antecedent in the 42 days prior to clinical onset were taken as alarm signals for 2009-2011, since November 2009 onwards. For purpose of surveillance, in 2009 we updated both the available centres and the populations served by the network. We also did a retrospective countrywide review of hospital-discharged patients having ICD-9-CM code 357.0 (acute infective polyneuritis) as their principal diagnosis from January 2009 to December 2011.</p></div><div type="abstract" xml:lang="en"><p><b>RESULTS</b></p><p>Among 141 confirmed of 148 notified cases of GBS or Miller-Fisher syndrome, Brighton 1-2 criteria in 96 %, not a single patient was identified with clinical onset during the 42-day time interval following A(H1N1)pdm09 vaccination. In contrast, seven cases were seen during a similar period after seasonal campaigns. Monthly incidence figures did not, however, exceed the upper 95 % CI limit of expected incidence. A retrospective countrywide review of the registry of hospital-discharged patients having ICD-9-CM code 357.0 (acute infective polyneuritis) as their principal diagnosis did not suggest higher admission rates in critical months across the period December 2009-February 2010.</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSIONS</b></p><p>Despite limited power and underlying reporting bias in 2010-2011, an increase in GBS incidence over background GBS, associated with A(H1N1)pdm09 monovalent or trivalent influenza immunisations, appears unlikely.</p></div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" IndexingMethod="Curated" Owner="NLM"><PMID Version="1">27206524</PMID><DateCompleted><Year>2016</Year><Month>12</Month><Day>19</Day></DateCompleted><DateRevised><Year>2018</Year><Month>12</Month><Day>02</Day></DateRevised><Article PubModel="Electronic"><Journal><ISSN IssnType="Electronic">1471-2377</ISSN><JournalIssue CitedMedium="Internet"><Volume>16</Volume><PubDate><Year>2016</Year><Month>May</Month><Day>21</Day></PubDate></JournalIssue><Title>BMC neurology</Title><ISOAbbreviation>BMC Neurol</ISOAbbreviation></Journal><ArticleTitle>Guillain-Barré syndrome following the 2009 pandemic monovalent and seasonal trivalent influenza vaccination campaigns in Spain from 2009 to 2011: outcomes from active surveillance by a neurologist network, and records from a country-wide hospital discharge database.</ArticleTitle><Pagination><MedlinePgn>75</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1186/s12883-016-0598-z</ELocationID><Abstract><AbstractText Label="BACKGROUND" NlmCategory="BACKGROUND">Studies have shown a slight excess risk in Guillain-Barré syndrome (GBS) incidence associated with A(H1N1)pdm09 vaccination campaign and seasonal trivalent influenza vaccine immunisations in 2009-2010. We aimed to assess the incidence of GBS as a potential adverse effect of A(H1N1)pdm09 vaccination.</AbstractText><AbstractText Label="METHODS" NlmCategory="METHODS">A neurologist-led network, active at the neurology departments of ten general hospitals serving an adult population of 4.68 million, conducted GBS surveillance in Spain in 2009-2011. The network, established in 1996, carried out a retrospective and a prospective study to estimate monthly alarm thresholds in GBS incidence and tested them in 1998-1999 in a pilot study. Such incidence thresholds additionally to observation of GBS cases with immunisation antecedent in the 42 days prior to clinical onset were taken as alarm signals for 2009-2011, since November 2009 onwards. For purpose of surveillance, in 2009 we updated both the available centres and the populations served by the network. We also did a retrospective countrywide review of hospital-discharged patients having ICD-9-CM code 357.0 (acute infective polyneuritis) as their principal diagnosis from January 2009 to December 2011.</AbstractText><AbstractText Label="RESULTS" NlmCategory="RESULTS">Among 141 confirmed of 148 notified cases of GBS or Miller-Fisher syndrome, Brighton 1-2 criteria in 96 %, not a single patient was identified with clinical onset during the 42-day time interval following A(H1N1)pdm09 vaccination. In contrast, seven cases were seen during a similar period after seasonal campaigns. Monthly incidence figures did not, however, exceed the upper 95 % CI limit of expected incidence. A retrospective countrywide review of the registry of hospital-discharged patients having ICD-9-CM code 357.0 (acute infective polyneuritis) as their principal diagnosis did not suggest higher admission rates in critical months across the period December 2009-February 2010.</AbstractText><AbstractText Label="CONCLUSIONS" NlmCategory="CONCLUSIONS">Despite limited power and underlying reporting bias in 2010-2011, an increase in GBS incidence over background GBS, associated with A(H1N1)pdm09 monovalent or trivalent influenza immunisations, appears unlikely.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Alcalde-Cabero</LastName><ForeName>Enrique</ForeName><Initials>E</Initials><AffiliationInfo><Affiliation>National Centre for Epidemiology, CIBERNED, Carlos III Health Institute, Madrid, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Almazán-Isla</LastName><ForeName>Javier</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>National Centre for Epidemiology, CIBERNED, Carlos III Health Institute, Madrid, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>García López</LastName><ForeName>Fernando J</ForeName><Initials>FJ</Initials><AffiliationInfo><Affiliation>National Centre for Epidemiology, CIBERNED, Carlos III Health Institute, Madrid, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Ara-Callizo</LastName><ForeName>José Ramón</ForeName><Initials>JR</Initials><AffiliationInfo><Affiliation>Neurology Department, Miguel Servet University Hospital, Zaragoza, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Avellanal</LastName><ForeName>Fuencisla</ForeName><Initials>F</Initials><AffiliationInfo><Affiliation>National Centre for Epidemiology, CIBERNED, Carlos III Health Institute, Madrid, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Casasnovas</LastName><ForeName>Carlos</ForeName><Initials>C</Initials><AffiliationInfo><Affiliation>Neuromuscular Unit, Neurology Department, Bellvitge University Hospital, Bellvitge, Biomedical Research Institute (Institut d'Investigació Biomèdica de Bellvitge/IDIBELL), L'Hospitalet de Llobregat, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Cemillán</LastName><ForeName>Carlos</ForeName><Initials>C</Initials><AffiliationInfo><Affiliation>Neurology Department, Severo Ochoa University Hospital, Leganés, Madrid, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Cuadrado</LastName><ForeName>José Ignacio</ForeName><Initials>JI</Initials><AffiliationInfo><Affiliation>Epidemiology Department, Regional Ministry of Health, Madrid Autonomous Region, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Duarte</LastName><ForeName>Jacinto</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>Neurology Department, General Hospital, Segovia, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Fernández-Pérez</LastName><ForeName>María Dolores</ForeName><Initials>MD</Initials><AffiliationInfo><Affiliation>Neurology Department, Virgen de las Nieves University Hospital, Granada, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Fernández</LastName><ForeName>Óscar</ForeName><Initials>Ó</Initials><AffiliationInfo><Affiliation>Neurology Department, Carlos Haya University Hospital, Málaga, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Merino</LastName><ForeName>Juan Antonio García</ForeName><Initials>JA</Initials><AffiliationInfo><Affiliation>Neurology Department, Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Montero</LastName><ForeName>Rosa García</ForeName><Initials>RG</Initials><AffiliationInfo><Affiliation>Neurology Department, Virgen de la Salud Hospital, Toledo, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Montero</LastName><ForeName>Dolores</ForeName><Initials>D</Initials><AffiliationInfo><Affiliation>Spanish Medicines & Medical Devices Agency (Agencia Española de Medicamentos y Productos Sanitarios), Madrid, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Pardo</LastName><ForeName>Julio</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>Neurology Department, University Teaching Hospital Clínico, Santiago de Compostela (Corunna), Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Rodríguez-Rivera</LastName><ForeName>Francisco Javier</ForeName><Initials>FJ</Initials><AffiliationInfo><Affiliation>Neurology Department, La Paz University Hospital, Madrid, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Ruiz-Tovar</LastName><ForeName>María</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>National Centre for Epidemiology, CIBERNED, Carlos III Health Institute, Madrid, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>de Pedro-Cuesta</LastName><ForeName>Jesús</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>National Centre for Epidemiology, CIBERNED, Carlos III Health Institute, Madrid, Spain. jpedro@isciii.es.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><CollectiveName>Spanish GBS Epidemiology Study Group</CollectiveName></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2016</Year><Month>05</Month><Day>21</Day></ArticleDate></Article><MedlineJournalInfo><Country>England</Country><MedlineTA>BMC Neurol</MedlineTA><NlmUniqueID>100968555</NlmUniqueID><ISSNLinking>1471-2377</ISSNLinking></MedlineJournalInfo><ChemicalList><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D007252">Influenza Vaccines</NameOfSubstance></Chemical></ChemicalList><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000328" MajorTopicYN="N">Adult</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000368" MajorTopicYN="N">Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D016208" MajorTopicYN="Y">Databases, Factual</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D062665" MajorTopicYN="Y">Epidemiological Monitoring</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D020275" MajorTopicYN="N">Guillain-Barre Syndrome</DescriptorName><QualifierName UI="Q000453" MajorTopicYN="Y">epidemiology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D015994" MajorTopicYN="N">Incidence</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D053118" MajorTopicYN="N">Influenza A Virus, H1N1 Subtype</DescriptorName><QualifierName UI="Q000276" MajorTopicYN="Y">immunology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D007252" MajorTopicYN="N">Influenza Vaccines</DescriptorName><QualifierName UI="Q000009" MajorTopicYN="Y">adverse effects</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000072141" MajorTopicYN="Y">Neurologists</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D058873" MajorTopicYN="N">Pandemics</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D011446" MajorTopicYN="N">Prospective Studies</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D062486" MajorTopicYN="Y">Public Health Surveillance</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D012189" MajorTopicYN="N">Retrospective Studies</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D013030" MajorTopicYN="N">Spain</DescriptorName><QualifierName UI="Q000453" MajorTopicYN="N">epidemiology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D013997" MajorTopicYN="N">Time Factors</DescriptorName></MeshHeading></MeshHeadingList><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="N">Guillain-Barré syndrome</Keyword><Keyword MajorTopicYN="N">ICD-9-CM</Keyword><Keyword MajorTopicYN="N">Influenza A virus H1N1 subtype</Keyword><Keyword MajorTopicYN="N">Influenza vaccines</Keyword><Keyword MajorTopicYN="N">Public health surveillance</Keyword><Keyword MajorTopicYN="N">Safety</Keyword></KeywordList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2015</Year><Month>08</Month><Day>14</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2016</Year><Month>05</Month><Day>12</Day></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2016</Year><Month>5</Month><Day>22</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2016</Year><Month>5</Month><Day>22</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2016</Year><Month>12</Month><Day>20</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>epublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">27206524</ArticleId><ArticleId IdType="doi">10.1186/s12883-016-0598-z</ArticleId><ArticleId IdType="pii">10.1186/s12883-016-0598-z</ArticleId><ArticleId 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sort="Almazan Isla, Javier" uniqKey="Almazan Isla J" first="Javier" last="Almazán-Isla">Javier Almazán-Isla</name><name sortKey="Ara Callizo, Jose Ram N" sort="Ara Callizo, Jose Ram N" uniqKey="Ara Callizo J" first="José Ram N" last="Ara-Callizo">José Ram N Ara-Callizo</name><name sortKey="Avellanal, Fuencisla" sort="Avellanal, Fuencisla" uniqKey="Avellanal F" first="Fuencisla" last="Avellanal">Fuencisla Avellanal</name><name sortKey="Casasnovas, Carlos" sort="Casasnovas, Carlos" uniqKey="Casasnovas C" first="Carlos" last="Casasnovas">Carlos Casasnovas</name><name sortKey="Cemillan, Carlos" sort="Cemillan, Carlos" uniqKey="Cemillan C" first="Carlos" last="Cemillán">Carlos Cemillán</name><name sortKey="Cuadrado, Jose Ignacio" sort="Cuadrado, Jose Ignacio" uniqKey="Cuadrado J" first="José Ignacio" last="Cuadrado">José Ignacio Cuadrado</name><name sortKey="De Pedro Cuesta, Jesus" sort="De Pedro Cuesta, Jesus" uniqKey="De Pedro Cuesta J" first="Jesús" last="De Pedro-Cuesta">Jesús De Pedro-Cuesta</name><name sortKey="Duarte, Jacinto" sort="Duarte, Jacinto" uniqKey="Duarte J" first="Jacinto" last="Duarte">Jacinto Duarte</name><name sortKey="Fernandez Perez, Maria Dolores" sort="Fernandez Perez, Maria Dolores" uniqKey="Fernandez Perez M" first="María Dolores" last="Fernández-Pérez">María Dolores Fernández-Pérez</name><name sortKey="Fernandez, Scar" sort="Fernandez, Scar" uniqKey="Fernandez " first=" Scar" last="Fernández"> Scar Fernández</name><name sortKey="Garcia L Pez, Fernando J" sort="Garcia L Pez, Fernando J" uniqKey="Garcia L Pez F" first="Fernando J" last="García L Pez">Fernando J. García L Pez</name><name sortKey="Merino, Juan Antonio Garcia" sort="Merino, Juan Antonio Garcia" uniqKey="Merino J" first="Juan Antonio García" last="Merino">Juan Antonio García Merino</name><name sortKey="Montero, Dolores" sort="Montero, Dolores" uniqKey="Montero D" first="Dolores" last="Montero">Dolores Montero</name><name sortKey="Montero, Rosa Garcia" sort="Montero, Rosa Garcia" uniqKey="Montero R" first="Rosa García" last="Montero">Rosa García Montero</name><name sortKey="Pardo, Julio" sort="Pardo, Julio" uniqKey="Pardo J" first="Julio" last="Pardo">Julio Pardo</name><name sortKey="Rodriguez Rivera, Francisco Javier" sort="Rodriguez Rivera, Francisco Javier" uniqKey="Rodriguez Rivera F" first="Francisco Javier" last="Rodríguez-Rivera">Francisco Javier Rodríguez-Rivera</name><name sortKey="Ruiz Tovar, Maria" sort="Ruiz Tovar, Maria" uniqKey="Ruiz Tovar M" first="María" last="Ruiz-Tovar">María Ruiz-Tovar</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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