title: Mediterranean spotted fever in Spain, 1997-2014: Epidemiological situation based on hospitalization records.
abstract: BACKGROUND
  Mediterranean spotted fever (MSF) is a zoonotic disease caused by Rickettsia conorii. In Spain, deficiencies in the official reporting result in misreporting of this disease. This study aims to describe the clinical and temporal-spatial characteristics of MSF hospitalizations between 1997 and 2014.
  
  
  METHODS
  We performed a retrospective descriptive study using the Hospitalization Minimum Data Set (CMBD). All CMBD's hospital discharges with ICD-9 CM code 082.1 were analyzed. Hospitalization rates were calculated and clinical characteristics were described. Spatial distribution of cases and their temporal behavior were also assessed.
  
  
  RESULTS
  A total of 4,735 hospitalizations with MSF diagnosis were recorded during the study period, out of which 62.2% were male, mean age of 48. Diabetes mellitus, alcohol dependence syndrome, and chronic liver disease occurred in 10.8%, 2.4% and 2.8% hospitalizations, respectively. The median annual hospitalization rate showed a decreasing trend from a maximum of 12.9 in 1997 to a minimum rate of 3.1 in 2014. Most admissions occurred during the summer, showing a significant annual seasonal behavior. Important regional differences were found.
  
  
  CONCLUSIONS
  Although MSF hospitalization rates have decreased considerably, it remains a public health problem due to its severity and economic impact. Therefore, it would be desirable to improve its oversight and surveillance.
authors.affiliation: National Centre for Tropical Medicine, Health Institute Carlos III (ISCIII in Spanish), Madrid, Spain.|Network Biomedical Research on Tropical Diseases (RICET in Spanish), Madrid, Spain.
authors.forename: Zaida
authors.identifier: http://orcid.org/0000-0002-6508-3818
authors.initials: Z
authors.lastname: Herrador
authors.affiliation: National Centre for Tropical Medicine, Health Institute Carlos III (ISCIII in Spanish), Madrid, Spain.|Network Biomedical Research on Tropical Diseases (RICET in Spanish), Madrid, Spain.
authors.forename: Amalia
authors.initials: A
authors.lastname: Fernandez-Martinez
authors.affiliation: Network Biomedical Research Centre in Epidemiology and Public Health (CIBERESP in Spanish), Madrid, Spain.|National Centre of Epidemiology, Health Institute Carlos III (ISCIII in Spanish), Madrid, Spain.
authors.forename: Diana
authors.initials: D
authors.lastname: Gomez-Barroso
authors.affiliation: Network Biomedical Research Centre in Epidemiology and Public Health (CIBERESP in Spanish), Madrid, Spain.|National Centre of Epidemiology, Health Institute Carlos III (ISCIII in Spanish), Madrid, Spain.
authors.forename: Inmaculada
authors.initials: I
authors.lastname: León
authors.affiliation: Network Biomedical Research on Tropical Diseases (RICET in Spanish), Madrid, Spain.|Unidad de Investigación Enfermedades Infecciosas y Tropicales (e-INTRO), Instituto de Investigación Biomédica de Salamanca-Centro de Investigación de Enfermedades Tropicales de la Universidad de Salamanca (IBSAL-CIETUS), Facultad de Farmacia, Universidad de Salamanca, Salamanca, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Vieira
authors.affiliation: Network Biomedical Research on Tropical Diseases (RICET in Spanish), Madrid, Spain.|Unidad de Investigación Enfermedades Infecciosas y Tropicales (e-INTRO), Instituto de Investigación Biomédica de Salamanca-Centro de Investigación de Enfermedades Tropicales de la Universidad de Salamanca (IBSAL-CIETUS), Facultad de Farmacia, Universidad de Salamanca, Salamanca, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Muro
authors.affiliation: National Centre for Tropical Medicine, Health Institute Carlos III (ISCIII in Spanish), Madrid, Spain.|Network Biomedical Research on Tropical Diseases (RICET in Spanish), Madrid, Spain.
authors.forename: Agustín
authors.initials: A
authors.lastname: Benito
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000453:epidemiology; D001907:Boutonneuse Fever / Q000175:diagnosis / Q000453:epidemiology* / Q000821:virology*; D002908:Chronic Disease; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006753:Hospital Records / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data*; D054884:Host-Pathogen Interactions; D006801:Humans; D038801:International Classification of Diseases; D016014:Linear Models; D008107:Liver Diseases / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data; D012189:Retrospective Studies; D020114:Rickettsia conorii / Q000502:physiology*; D013030:Spain / Q000453:epidemiology; D013577:Syndrome; D055815:Young Adult