Enfermedad meningocócica invasiva por serogrupo C en la era posvacunal y fallos vacunales / Serogroup C invasive meningococcal disease in the post-vaccine era and vaccine failures

INTRODUCCIÓN: La incidencia de la enfermedad meningocócica invasiva (EMI) por serogrupo C ha disminuido desde la introducción de la vacunación sistemática el año 2000. El objetivo de este estudio es determinar los casos de EMI diagnosticados desde entonces y los fallos vacunales en los casos por serogrupo C. PACIENTES Y MÉTODOS: Análisis retrospectivo de pacientes diagnosticados de EMI confirmada por cultivo o reacción en cadena de la polimerasa, en un hospital infantil de tercer nivel de Barcelona, entre 2001 y 2018. Se analizó el número de dosis de vacuna recibidas y la edad, recogidos de la historia clínica y del carnet de vacunaciones. RESULTADOS: Se confirmaron 128 casos de EMI (7,1 casos/año; 70,3% en < 5 años). Se estudió el serogrupo en 125 casos (97,6%): 103 fueron B (82,4%), 10 fueron C (8%), uno fue 29E (0,8%) y uno fue Y (0,8%); solo 10 (8%) no fueron serogrupables. De los 10 pacientes con serogrupo C, 4 no estaban vacunados y en 3 la pauta fue incompleta en cuanto a número de dosis; 3 de ellos recibieron la pauta completa según la edad y el calendario vacunal vigente, por lo que se consideran fallos vacunales. Fallecieron 6 pacientes (tasa de letalidad: 4,7%): 5 por serogrupo B (letalidad: 4,8%) y uno por serogrupo C (letalidad: 10%). CONCLUSIONES: El serogrupo C representó solo el 8% de los casos de EMI en el periodo de estudio y los fallos vacunales de este serogrupo fueron del 30%

INTRODUCTION: The incidence of serogroup C invasive meningococcal disease (IMD) has decreased since the introduction of systematic vaccination in 2000. The aim of this study is to determine the number of serogroup C IMD cases diagnosed since then and the vaccine failures. PATIENTS AND METHODS: A retrospective analysis was performed on patients diagnosed with IMD by culture or polymerase chain reaction (PCR) in a maternity and childhood hospital in Barcelona between 2001 and 2018. An analysis was made of the number of vaccine doses and the age received, as well as on the medical records and vaccine cards. RESULTS: There were 128 confirmed cases of IMD (7.1 cases/year; 70.3 in < 5 years). The serogroup was studied in 125 (97.6%) cases, in which 103 (82.4%) were B, 10 (8%) were C, one (0.8%) was 29E, and one (0.8%) was Y, and only 10 (8%) were not able to be serogrouped. Of the 10 patients with serogroup C, 4 were not vaccinated, and in 3, the course was not complete as regards the number of doses. The other 3 received the complete course according to age and current calendar, and thus were considered vaccine failures. A total of 6 patients died (mortality rate: 4.7%), 5 due to serogroup B (mortality: 4.8%), and one due to serogroup C (mortality: 10%). CONCLUSIONS: Serogroup C only represented 8% of IMD cases in the period studied, with 30% of cases due to this serogroup being vaccine failures

[Serogroup C invasive meningococcal disease in the post-vaccine era and vaccine failures]. / Enfermedad meningocócica invasiva por serogrupo C en la era posvacunal y fallos vacunales.

INTRODUCTION: The incidence of serogroup C invasive meningococcal disease (IMD) has decreased since the introduction of systematic vaccination in 2000. The aim of this study is to determine the number of serogroup C IMD cases diagnosed since then and the vaccine failures. PATIENTS AND METHODS: A retrospective analysis was performed on patients diagnosed with IMD by culture or polymerase chain reaction (PCR) in a maternity and childhood hospital in Barcelona between 2001 and 2018. An analysis was made of the number of vaccine doses and the age received, as well as on the medical records and vaccine cards. RESULTS: There were 128 confirmed cases of IMD (7.1 cases/year; 70.3 in <5 years). The serogroup was studied in 125 (97.6%) cases, in which 103 (82.4%) were B, 10 (8%) were C, one (0.8%) was 29E, and one (0.8%) was Y, and only 10 (8%) were not able to be serogrouped. Of the 10 patients with serogroup C, 4 were not vaccinated, and in 3, the course was not complete as regards the number of doses. The other 3 received the complete course according to age and current calendar, and thus were considered vaccine failures. A total of 6 patients died (mortality rate: 4.7%), 5 due to serogroup B (mortality: 4.8%), and one due to serogroup C (mortality: 10%). CONCLUSIONS: Serogroup C only represented 8% of IMD cases in the period studied, with 30% of cases due to this serogroup being vaccine failures.

Malaltia per coronavirus 2019. Una nova pandèmia: reflexions des de casa / No disponible

No disponible

Multidisciplinary, evidence-based consensus guidelines for human papillomavirus (HPV) vaccination in high-risk populations, Spain, 2016.

INTRODUCTION: Although human papillomavirus (HPV) routine vaccination programmes have been implemented around the world and recommendations have been expanded to include other high-risk individuals, current recommendations often differ between countries in Europe, as well as worldwide. AIM: To find and summarise the best available evidence of HPV vaccination in high-risk patients aiding clinicians and public health workers in the day-to-day vaccine decisions relating to HPV in Spain. METHODS: We conducted a systematic review of the immunogenicity, safety and efficacy/effectiveness of HPV vaccination in high-risk populations between January 2006 and June 2016. HPV vaccination recommendations were established with levels of evidence according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. RESULTS: A strong recommendation about HPV vaccination was made in the following groups: HIV infected patients aged 9-26 years; men who have sex with men aged 9-26 years; women with precancerous cervical lesions; patients with congenital bone marrow failure syndrome; women who have received a solid organ transplant or hematopoietic stem cell transplantation aged 9-26 years; and patients diagnosed with recurrent respiratory papillomatosis. CONCLUSIONS: Data concerning non-routine HPV vaccination in populations with a high risk of HPV infection and associated lesions were scarce. We have developed a document to evaluate and establish evidence-based guidelines on HPV vaccination in high-risk populations in Spain, based on best available scientific evidence.

Diez años de vacunación frente al virus del papiloma humano. De la dermatología a la oncología a través de la infectología / Ten years of human papillomavirus vaccination. From dermatology to oncology via infectology

El virus del papiloma humano (VPH) se identifica en primer lugar en dermatología y posteriormente se demuestra que es una causa necesaria para el desarrollo de cáncer de cuello uterino y de otros tumores, tras una infección persistente por alguno de sus genotipos oncogénicos. Desde hace 10 años, las infecciones y neoplasias más frecuentes relacionadas con el VPH pueden prevenirse mediante la inmunización con 2 vacunas, una bivalente y otra tetravalente, y acaba de comercializarse una nonavalente. Durante el periodo 2007-2008 se incluyó la vacuna frente al VPH en el calendario de las comunidades autónomas y es la segunda vacuna, después de la de la hepatitis B, que previene el cáncer. En estos 10 años de disponibilidad de estas vacunas se ha progresado en su conocimiento y se han producido avances importantes en las estrategias de vacunación y en las indicaciones y las recomendaciones: adelanto de la edad de vacunación en el calendario, pautas de 2 dosis desde los 9 hasta los 13-14 años, vacunación sistemática del varón en algunos países, inmunización de la mujer más allá de la adolescencia, implementación de programas de vacunación en países en desarrollo, prevención de otras neoplasias, recomendaciones de vacunación para poblaciones de riesgo elevado de infección por el VPH, evidencia científica del impacto y la efectividad de la vacunación, y confirmación de la seguridad de estas vacunas, con más de 270 millones de dosis administradas, como ya se había observado en los ensayos clínicos. El papel de los profesionales de la salud es fundamental para alcanzar y mantener coberturas vacunales elevadas

Human papillomavirus (HPV) was first identified in dermatology, and it was subsequently demonstrated that is was required for the development of uterine cervical cancer and other tumours, after a persistent infection by any of its oncogenic genotypes. Ten years ago, the most common infections and cancers associated with HPV could be prevented by immunisation with 2vaccines, one bivalent, and another tetravalent, and having just marketed a nonavalent one. During the period 2007-2008, the HPV vaccine was included in the Autonomous Communities vaccination calendar, and it is the second vaccine, after that of Hepatitis B, that prevents cancer. In these 10 years that these vaccines have been available the knowledge has progressed and there have been significant advances in vaccination strategies, as well as in the indications and recommendations. These include, lowering the age in the vaccination schedule, prescribing of 2doses at 9 years and at 13-14 years, systematic vaccination of the male in some countries, immunisation of the woman after adolescence, implementation of vaccination programmes in developed countries, prevention of other cancers, recommendations for vaccinations for populations at high risk of HPV infection, scientific evidence on the impact and effectiveness of vaccination, and confirmation of the safety of these vaccines, with more than 270 million doses administered, as has already been observed in clinical trials. The role of health professionals is essential to achieve and maintain high vaccine coverage

[Ten years of human papillomavirus vaccination. From dermatology to oncology via infectology]. / Diez años de vacunación frente al virus del papiloma humano. De la dermatología a la oncología a través de la infectología.

Human papillomavirus (HPV) was first identified in dermatology, and it was subsequently demonstrated that is was required for the development of uterine cervical cancer and other tumours, after a persistent infection by any of its oncogenic genotypes. Ten years ago, the most common infections and cancers associated with HPV could be prevented by immunisation with 2vaccines, one bivalent, and another tetravalent, and having just marketed a nonavalent one. During the period 2007-2008, the HPV vaccine was included in the Autonomous Communities vaccination calendar, and it is the second vaccine, after that of Hepatitis B, that prevents cancer. In these 10 years that these vaccines have been available the knowledge has progressed and there have been significant advances in vaccination strategies, as well as in the indications and recommendations. These include, lowering the age in the vaccination schedule, prescribing of 2doses at 9 years and at 13-14 years, systematic vaccination of the male in some countries, immunisation of the woman after adolescence, implementation of vaccination programmes in developed countries, prevention of other cancers, recommendations for vaccinations for populations at high risk of HPV infection, scientific evidence on the impact and effectiveness of vaccination, and confirmation of the safety of these vaccines, with more than 270 million doses administered, as has already been observed in clinical trials. The role of health professionals is essential to achieve and maintain high vaccine coverage.

Salut, estils de vida i condicions laborals dels pediatres a Espanya / Salud, estilos de vida y condiciones laborales de los pediatras en España / Health, life style, and working conditions of pediatricians in Spain

Fonament: la salut, els estils de vida i els hàbits dels pediatres, així com les característiques sociodemogràfiques del lloc de treball, les condicions laborals i els factors de risc psicosocial, són aspectes poc estudiats. Objectiu: conèixer la situació de salut, estil de vida i condicions laborals dels pediatres a Espanya. Mètode: enquesta adreçada a pediatres de tot Espanya, amb una mostra final de 1.028 professionals i una taxa de resposta total del 18,5%. Resultats: s'observa un augment de la feminització, amb un 59% de dones. El 71% dels pediatres treballa en atenció primària. La jornada de treball predominant és contínua pels matins, amb contracte estatutari, amb més precarietat en les dones i els joves, i una mitjana de 45 hores de treball setmanals. El 64,7% estan satisfets amb les condicions la-borals. El risc psicosocial és alt, amb una taxa de trastorns d'ansietat i depressió més alta que en la població general. Conclusions: s'observa una tendència a la feminització i un alt nivell de formació amb subespecialitat o doctorat. La majoria dels pediatres treballa en el sector públic en atenció primària, com a assalariats, amb poques perspectives de promoció i amb horaris inestables i jornades extenses. Hi ha riscos psicosocials relacionats amb la càrrega de treball i amb la baixa participació en les decisions. Els preocupa l'impacte de la crisi sobre la seva pràctica mè-dica i els seus pacients, més que sobre el seu salari, que com a conseqüència s'ha vist reduït. S'han observat estils de vida saludables i una bona salut autopercebuda, tot i presentar un risc elevat de mala salut menta

Fundamento. La salud, los estilos de vida y los hábitos de los pediatras, así como las características sociodemográficas del lugar de trabajo, las condiciones laborales y los factores de riesgo psicosocial, son aspectos poco estudiados. Objetivo. Conocer la situación de salud, estilos de vida y condiciones laborales de los pediatras en España. Método. Encuesta dirigida a pediatras de toda España, con una muestra final de 1.028 profesionales y una tasa de respuesta total del 18,5%. Resultados. Se observa un aumento de la feminización con el 59% de mujeres. El 71% de los pediatras trabaja en atención primaria. La jornada de trabajo predominante es continua por las mañanas, con contrato estatutario, mayor precariedad en las mujeres y los jóvenes, y una media de 45 horas de trabajo semanales. El 64,7% están satisfechos con las condiciones laborales. El riesgo psicosocial es alto, con una tasa de trastornos de ansiedad y depresión más alta que en la población general. Conclusiones. Se observa una tendencia a la feminización y un alto nivel de formación con subespecialidad o doctorado. La mayoría de los pediatras trabaja en el sector público en atención primaria, como asalariados, con pocas perspectivas de promoción y con horarios inestables y jornadas extensas. Existen riesgos psicosociales relacionados con la carga de trabajo y con la baja participación en las decisiones. Les preocupa el impacto de la crisis sobre su práctica médica y sus pacientes, más que sobre su salario que como consecuencia se ha visto reducido. Se han observado estilos de vida saludables y una buena salud autopercibida, a pesar de presentar un riesgo elevado de mala salud mental (AU)

Background. Health, life style, habits, working conditions, sociodemographic characteristics of the work place, and psychosocial risks of pediatricians in Spain has been poorly studied. Objective. To evaluate the health status, life style, and working conditions of pediatricians in Spain. Method. We constructed a multiple-choice survey addressed to pediatricians in Spain, with a final sample of 1,028 professionals (response rate of 18.5%). Results. There was a preponderance of females (59%), and primary care providers (71%). The predominant working day model was as continuous morning shift under statutory contract, which was more precarious for young practitioners and women, with an average of 45 hours per week. The working conditions were satisfactory for 64.7% of the pediatricians. The psychosocial risk was high; the proportion of professionals suffering anxiety and depression disorders was higher than among the general population. Conclusions. We observed a trend towards the increase of females and of individuals with subspecialty or doctorate. Most pediatricians work in the public sector in primary care, with limited options for promotion, and with unstable schedules and long shifts. There are significant psychosocial risks related to the workload and the low participation in decision making, along with concerns about the impact of the financial crisis on their practice and their patients, rather than on their own salaries. Despite the high risk for poor mental health, the pediatricians indicate having a healthy life style and good health (AU)

Etiología bacteriana de la otitis media aguda en España en la era de la vacuna neumocócica conjugada / Bacterial etiology of acute otitis media in Spain in the post-pneumococcal conjugate vaccine era

INTRODUCCIÓN: La otitis media aguda (OMA) es común en niños menores de 3 años. En España hay disponible una vacuna neumocócica conjugada (VNC) (VNC7; Prevenar (Pearl River, NY), Pfizer/Wyeth, EE. UU.) desde 2001, habiéndose alcanzado una cobertura vacunal del 50-60% en niños menores de 5 años. MATERIALES Y MÉTODOS: Se reclutó a niños de 3 a 36 meses con OMA confirmada por especialista en otorrinolaringología en 7 centros españoles (febrero 2009-mayo 2012) (Proyecto GSK: 111425). Se obtuvieron muestras de exudado del oído medio mediante timpanocentesis o de otorrea espontánea, y se hizo cultivo para identificación bacteriana. En muestras con cultivos negativos se realizó análisis adicional mediante reacción en cadena de la polimerasa (PCR). RESULTADOS: De 125 episodios de OMA confirmados en 124 niños, se analizaron 117 (edad mediana: 17 meses [rango: 3-35]); 8 episodios de OMA fueron excluidos del análisis. En total, combinando resultados de cultivo y PCR, se identificaron uno o más patógenos bacterianos en el 69% (81/117) de los episodios; identificándose Haemophilus influenzae (Hi) en el 44% (52/117) y Streptococcus pneumoniae (Spn) en el 39% (46/117). En 77 de los 117 episodios se hizo cultivo para uno o más patógenos, resultando positivo en 63, con mayor frecuencia para Spn (24/77; 31%) e Hi (32/77; 42%). La PCR en episodios con cultivos negativos detectó Hi en el 48% y Spn en el 55% de las muestras. El serotipo de Spn más común fue el 19F (4/24; 17%) seguido del 19A (3/24; 13%); todos los episodios en los que se identificó Hi correspondieron a Hi no tipificable (HiNT). Un total de 81/117 episodios de OMA (69%) se presentaron en niños que habían recibido una o más dosis de vacuna antineumocócica. CONCLUSIONES: HiNT y Spn resultaron ser los principales agentes etiológicos de la OMA en España. Para conocer el impacto de la vacunación antineumocócica en la OMA en España harán falta estudios adicionales cuando se haya alcanzado un nivel de cobertura mayor

INTRODUCTION: Acute otitis media (AOM) is common in children aged <3 years. A pneumococcal conjugate vaccine (PCV) (PCV7; Prevenar, Pfizer/Wyeth, USA) has been available in Spain since 2001, which has a coverage rate of 50-60% in children aged <5 years. MATERIALS AND METHODS: Children aged greater than or equal to 3 to 36 months with AOM confirmed by an ear-nose-throat specialist were enrolled at seven centers in Spain (February 2009-May 2012) (GSK study identifier: 111425). Middle-ear-fluid samples were collected by tympanocentesis or spontaneous otorrhea and cultured for bacterial identification. Culture-negative samples were further analyzed using polymerase chain reaction (PCR). RESULTS: Of 125 confirmed AOM episodes in 124 children, 117 were analyzed (median age: 17 months (range: 3-35); eight AOM episodes were excluded from analyses. Overall, 69% (81/117) episodes were combined culture- and PCR-positive for greater than or equal to 1 bacterial pathogen; 44% (52/117) and 39% (46/117) were positive for Haemophilus influenzae (Hi) and Streptococcus pneumoniae(Spn), respectively. 77 of 117 episodes were cultured for greater than or equal to 1 bacteria, of which 63 were culture-positive; most commonly Spn (24/77; 31%) and Hi (32/77; 42%). PCR on culture-negative episodes identified 48% Hi- and 55% Spn-positive episodes. The most common Spn serotype was 19F (4/24; 17%) followed by 19A (3/24; 13%); all Hi-positive episodes were non-typeable (NTHi). 81/117 AOM episodes (69%) occurred in children who had received greater than or equal to 1 pneumococcal vaccine dose. CONCLUSIONS: NTHi and Spn were the main etiological agents for AOM in Spain. Impact of pneumococcal vaccination on AOM requires further evaluation in Spain, after higher vaccination coverage rate is reached

[Bacterial etiology of acute otitis media in Spain in the post-pneumococcal conjugate vaccine era]. / Etiología bacteriana de la otitis media aguda en España en la era de la vacuna neumocócica conjugada.

INTRODUCTION: Acute otitis media (AOM) is common in children aged <3 years. A pneumococcal conjugate vaccine (PCV) (PCV7; Prevenar, Pfizer/Wyeth, USA) has been available in Spain since 2001, which has a coverage rate of 50-60% in children aged <5 years. MATERIALS AND METHODS: Children aged ≥3 to 36 months with AOM confirmed by an ear-nose-throat specialist were enrolled at seven centers in Spain (February 2009-May 2012) (GSK study identifier: 111425). Middle-ear-fluid samples were collected by tympanocentesis or spontaneous otorrhea and cultured for bacterial identification. Culture-negative samples were further analyzed using polymerase chain reaction (PCR). RESULTS: Of 125 confirmed AOM episodes in 124 children, 117 were analyzed (median age: 17 months (range: 3-35); eight AOM episodes were excluded from analyses. Overall, 69% (81/117) episodes were combined culture- and PCR-positive for ≥1 bacterial pathogen; 44% (52/117) and 39% (46/117) were positive for Haemophilus influenzae (Hi) and Streptococcus pneumoniae (Spn), respectively. 77 of 117 episodes were cultured for ≥1 bacteria, of which 63 were culture-positive; most commonly Spn (24/77; 31%) and Hi (32/77; 42%). PCR on culture-negative episodes identified 48% Hi- and 55% Spn-positive episodes. The most common Spn serotype was 19F (4/24; 17%) followed by 19A (3/24; 13%); all Hi-positive episodes were non-typeable (NTHi). 81/117 AOM episodes (69%) occurred in children who had received ≥1 pneumococcal vaccine dose. CONCLUSIONS: NTHi and Spn were the main etiological agents for AOM in Spain. Impact of pneumococcal vaccination on AOM requires further evaluation in Spain, after higher vaccination coverage rate is reached.

Brote de enfermedad neurológica aguda por enterovirus en niños en Cataluña, 2016 / No disponible

Durante el periodo de abril a junio de 2016 se ha producido entre la población pediátrica de Cataluña un brote de infección por enterovirus (EV) del serotipo A71 con complicaciones neurológicas del tipo de la rombencefalitis. Las infecciones por EV son frecuentes y benignas en la infancia, con un espectro clínico amplio y polimorfo, desde una afectación leve cutánea, como enfermedad exantemática, hasta la del sistema nervioso con predominio de la meningitis frente a las graves e infrecuentes formas encefalíticas. Los serotipos de EV se dividen en cuatro especies, denominadas A, B, C y D; clasificación que ha sustituido a la original de cuatro grupos: poliovirus, Coxsackievirus A y B, y Echovirus, ya que después empezaron a designarse con números consecutivos desde el EV68. Las enterovirosis tienen una amplia distribución mundial, con un comportamiento endémico y epidémico. El EV-A71 ha dado lugar a brotes de enfermedad boca-mano-pie con complicaciones neurológicas graves. La afectación del rombencéfalo ha sido la característica de los enfermos del brote de Cataluña, en el que más del 90% de los pacientes han presentado una buena evolución clínica. Las medidas para evitar la transmisión de la infección son el principal método preventivo (higiene de manos). Los brotes por EV-A71 de algunos países, con complicaciones graves y con letalidad, ha llevado a que se investiguen vacunas preventivas. Dos de estas vacunas frente al subgenotipo más circulante en China se han autorizado en este país en 2016, pero sus peculiaridades limitan su uso al control de brotes en determinadas áreas geográficas y solo por un subgenotipo

During the period from April to June 2016 there was an infectious outbreak by an enterovirus of the A71 serotype with neurological complications of the rhombencephalitis type among the pediatric population of Catalonia. EV infections are frequent and benign during infancy, with a wide and polymorphic clinical spectrum, from a mild cutaneous affectation, as an exanthema, to an affectation of the nervous system, with a predomination of the meningitis before the more serious and less frequent encephalitic conditions. The EV serotypes are divided in four species, named A, B, C and D, a classification which replaces the former, four group one: poliovirus, Coxsackievirus A and B and Echovirus, since they would be later labeled with consecutive numbers, starting with EV68. The enterovirus are widely spread across the globe, with an endemic and epidemic behavior. The EV71 has led to hand-foot-and-mouth disease outbreaks with grave neurological complications. The affectation of the hindbrain has been common in patients affected by the outbreak in Catalonia, where more than the 90% of these patients have shown a favorable clinical evolution. The main measures to avoid transmission of the viral infection are the main method of prevention (hand hygiene). The EV71 outbreaks in some countries, with serious complications and fatal outcomes, has led to the research of preventive vaccines. Two of these vaccines against the most frequent subgenotype occurring in China have been authorized in this country in 2016, but its peculiar nature limits its use to controlling outbreaks in specific geographic areas and with a single subgenotype

Vacuna de la tos ferina. Reemergencia de la enfermedad y nuevas estrategias de vacunación / Pertussis vaccine. Reemergence of the disease and new vaccination strategies

La tos ferina continúa siendo un problema de salud pública a pesar de la importante disminución de su incidencia debido a la vacunación sistemática porque se está observando una reemergencia en países que han mantenido altas coberturas vacunales. La vacunación es la medida preventiva más eficaz para su control, pero tanto la inmunidad natural como la artificial disminuyen con el tiempo, por lo que la protección que las actuales vacunas ofrecen no es duradera; además, las vacunas acelulares son menos efectivas. Se necesita, por una parte, implementar nuevas estrategias vacunales, y por otra, nuevas vacunas seguras y más efectivas. La vacunación de la embarazada es la estrategia más efectiva para prevenir la tos ferina en el lactante pequeño (edad en la que tiene mayor gravedad), y debe recomendarse junto con la estrategia del nido, es decir, la vacunación de los futuros contactos domiciliarios y extradomiciliarios del lactante, que son los que la contagian

Pertussis continues to be a public health problem despite the significant decrease in its incidence due to routine vaccination. Resurgence of the disease in countries that have maintained high vaccination coverage has been observed in recent years. Although vaccination is the most effective preventive control measure, both natural and artificial immunity wane over time, and thus the protection offered by current vaccines is not long-lasting. Furthermore, acellular vaccines are less effective. The implementation of new vaccine strategies is required. Vaccination of pregnant women is the most effective strategy for preventing pertussis in young infants, who are the most vulnerable, and should be recommended together with cocooning, ie vaccination of future household and extra-domiciliary contacts who are the main transmitters of the disease

[Pertussis vaccine. Reemergence of the disease and new vaccination strategies]. / Vacuna de la tos ferina. Reemergencia de la enfermedad y nuevas estrategias de vacunación.

Pertussis continues to be a public health problem despite the significant decrease in its incidence due to routine vaccination. Resurgence of the disease in countries that have maintained high vaccination coverage has been observed in recent years. Although vaccination is the most effective preventive control measure, both natural and artificial immunity wane over time, and thus the protection offered by current vaccines is not long-lasting. Furthermore, acellular vaccines are less effective. The implementation of new vaccine strategies is required. Vaccination of pregnant women is the most effective strategy for preventing pertussis in young infants, who are the most vulnerable, and should be recommended together with cocooning, ie vaccination of future household and extra-domiciliary contacts who are the main transmitters of the disease.

Uso de antibióticos carbapenémicos en enfermos pediátricos hospitalizados. Adecuación de su prescripción a un protocolo terapéutico / Carbapenem antibiotics in hospitalised paediatric patients. Adherence to a therapeutic protocol

OBJETIVO: Describir el uso de carbapenémicos en pacientes pediátricos hospitalizados fuera de las unidades de cuidados intensivos y oncohematología, y evaluar la adecuación de su prescripción a un protocolo terapéutico. PACIENTES Y MÉTODOS: Estudio retrospectivo observacional, entre enero de 2009 y diciembre de 2010, sobre la utilización de carbapenémicos en niños hospitalizados, por patología infecciosa comunitaria y relacionada con asistencia sanitaria, en el área infantil del Hospital Universitari Vall d'Hebrón, en Barcelona, excluyendo las unidades de cuidados intensivos, neonatología y oncohematología. Se recogieron datos clínicos y de consumo de antibióticos, facilitados por el Servicio de Farmacia. RESULTADOS: Cumplían los criterios de inclusión 51 episodios. En el 31,4% se indicó un carbapenémico como tratamiento empírico inicial; en el resto fue como tratamiento de rescate. Se adecúan a las indicaciones del protocolo el 70,6% de las prescripciones empíricas y el 87,5% de las dirigidas. Globalmente, el 77,6% de las prescripciones de un carbapenémico se ajustaron a las indicaciones del protocolo. En los pacientes con un ingreso previo o una enfermedad de base la prescripción empírica tiene una mejor adecuación. Factores como el diagnóstico al ingreso, la edad o la antibioterapia previa al ingreso no mostraron ninguna tendencia respecto a la indicación empírica de un carbapenémico. CONCLUSIONES: La existencia de un protocolo de indicaciones de tratamiento con carbapenémicos establecido desde 2007 en el hospital ha permitido unos resultados de adecuación de la prescripción significativamente superiores a los obtenidos en otros estudios

OBJECTIVE: To describe the use of carbapenems in children hospitalised outside intensive care and onco-haematology units, and assess adherence to a therapeutic protocol. PATIENTS AND METHODS: A retrospective observational study was conducted on the use of carbapenems between January 2009 and December 2010. The study included children with a community-acquired infectious disease or a health care-associated infectious disease, and who were admitted to paediatric areas of the Vall d'Hebron University Hospital (Barcelona, Spain), other than intensive care, neonatology and onco-haematology units. Clinical data were collected and antibiotic consumption data were provided by the Pharmacy Department. RESULTS: A total of 51 episodes fulfilled the inclusion criteria. Carbapenem as initial empirical treatment was indicated in 31.4%, and applied as rescue therapy in the remainder. The instructions of the protocol were adhered to in 70.6% of the empirical and 87.5% of the targeted prescriptions (77.6% overall). A better match was found for empirical carbapenem in patients with a previous admission or underlying condition. Factors such as diagnosis, age or antibiotic use prior to admission did not affect the empirical indication of carbapenem. CONCLUSIONS: The establishment of a treatment protocol with carbapenem indications in our centre since 2007 has yielded significantly better results on the appropriateness of the prescription than those obtained in other studies

Tos ferina en lactantes y niños bien vacunados. ¿Son necesarias nuevas estrategias de vacunación? / Pertussis in fully vaccinated infants and children. Are new vaccination strategies required?

OBJETIVO: Analizar el estado vacunal de los niños diagnosticados de tos ferina y comparar las manifestaciones clínicas de los bien vacunados y de los no vacunados o con vacunación incompleta. Métodos Se ha revisado la historia clínica y el carnet vacunal de los pacientes menores de 16 años visitados en el servicio de urgencias del Hospital Universitario Vall d'Hebron de Barcelona con tos ferina confirmada por estudio microbiológico. El periodo de estudio comprende del 1 de enero de 2009 al 31 de diciembre de 2011.ResultadosSe han investigado 212 casos: 35 en 2009, 28 en 2010 y 149 en 2011. La reacción en cadena de la polimerasa en tiempo real (RT-PCR) fue positiva en 210 pacientes, y el cultivo, en 73. Los lactantes menores de 6 meses representan el 36,8% de los casos. No estaban vacunados 44 (21,5%) pacientes. Cuarenta y cuatro (21,5%) tenían entre 2 y 5 meses de vida y habían recibido una o 2 dosis de vacuna. Habían completado la primovacunación y las dosis de recuerdo (3 a 5 dosis, según la edad) 117 niños (57%); el 76,9% (90 casos) había recibido la última dosis de vacuna hacía menos de 4 años. Al comparar las manifestaciones clínicas de los pacientes con vacunación completa y con vacunación incompleta o no vacunados, solo la cianosis se ha presentado con más frecuencia en el segundo grupo (p < 0,001). La probabilidad de hospitalización ajustada por la edad se asoció de forma significativa con la ausencia de vacunación (p = 0,001). La letalidad en los pacientes hospitalizados fue del 1,3%.ConclusionesEl número de casos de tos ferina atendidos en nuestro centro ha aumentado de forma importante en el último año. El 57% de los pacientes estaban bien vacunados y el 76,9% habían recibido la última dosis en los últimos 4 años. Se necesitan otras estrategias de vacunación (adolescentes, adultos y embarazadas, y estrategia del nido) para proteger a los lactantes menores de 6 meses de edad, así como vacunas más efectivas

OBJECTIVE: To analyse the vaccination status of children diagnosed with pertussis and to compare the clinical manifestations of fully vaccinated with unvaccinated, or incompletely-vaccinated, children. METHODS: The clinical histories and vaccination cards of patients under 16 years of age seen in the Emergency Room of the University Hospital Vall d'Hebron, Barcelona (Spain), for pertussis confirmed by a microbiological study were reviewed. The study period lasted from January 1, 2009 to December 31, 2011. RESULTS: Two hundred and twelve cases were studied: 35 in 2009, 28 in 2010 and 149 in 2011. RT-PCR was positive in 210 patients, and 73 had a positive culture. Infants under 6 months of age account for 36.8% of all cases. Forty-four patients (21.5%) were not vaccinated. Forty-four (21.5%) children were between 2 and 5 months of age and had received 1-2 vaccine doses. One hundred and seventeen (57%) children were fully vaccinated; 76.9% (90 cases) had received the last dose less than 4years ago. When clinical manifestations of the fully vaccinated patients were compared with those of the non-vaccinated or incompletely-vaccinated children, only cyanosis was found with a higher frequency in the latter group (P < .001). The age-adjusted probability of hospitalisation was significantly associated with non-vaccination (P = .001). The case mortality rate among inpatients was 1.3%. CONCLUSIONS: The number of pertussis cases seen in our centre has risen significantly in the last year. More than half (57%) of the patients were fully vaccinated, and 76.9% had received the last dose in the previous 4 years. Other vaccination strategies, such as vaccination of adolescents, adults, and pregnant women, as well as a cocoon strategy are required to protect infants under 6 months of age. More effective vaccines need to be developed

[Pertussis in fully vaccinated infants and children. Are new vaccination strategies required?]. / Tos ferina en lactantes y niños bien vacunados. ¿Son necesarias nuevas estrategias de vacunación?

OBJECTIVE: To analyse the vaccination status of children diagnosed with pertussis and to compare the clinical manifestations of fully vaccinated with unvaccinated, or incompletely-vaccinated, children. METHODS: The clinical histories and vaccination cards of patients under 16years of age seen in the Emergency Room of the University Hospital Vall d'Hebron, Barcelona (Spain), for pertussis confirmed by a microbiological study were reviewed. The study period lasted from January 1, 2009 to December 31, 2011. RESULTS: Two hundred and twelve cases were studied: 35 in 2009, 28 in 2010 and 149 in 2011. RT-PCR was positive in 210 patients, and 73 had a positive culture. Infants under 6months of age account for 36.8% of all cases. Forty-four patients (21.5%) were not vaccinated. Forty-four (21.5%) children were between 2 and 5months of age and had received 1-2vaccine doses. One hundred and seventeen (57%) children were fully vaccinated; 76.9% (90cases) had received the last dose less than 4years ago. When clinical manifestations of the fully vaccinated patients were compared with those of the non-vaccinated or incompletely-vaccinated children, only cyanosis was found with a higher frequency in the latter group (P<.001). The age-adjusted probability of hospitalisation was significantly associated with non-vaccination (P=.001). The case mortality rate among inpatients was 1.3%. CONCLUSIONS: The number of pertussis cases seen in our centre has risen significantly in the last year. More than half (57%) of the patients were fully vaccinated, and 76.9% had received the last dose in the previous 4years. Other vaccination strategies, such as vaccination of adolescents, adults, and pregnant women, as well as a cocoon strategy are required to protect infants under 6months of age. More effective vaccines need to be developed.

[Carbapenem antibiotics in hospitalised paediatric patients. Adherence to a therapeutic protocol]. / Uso de antibióticos carbapenémicos en enfermos pediátricos hospitalizados. Adecuación de su prescripción a un protocolo terapéutico.

OBJECTIVE: To describe the use of carbapenems in children hospitalised outside intensive care and onco-haematology units, and assess adherence to a therapeutic protocol. PATIENTS AND METHODS: A retrospective observational study was conducted on the use of carbapenems between January 2009 and December 2010. The study included children with a community-acquired infectious disease or a health care-associated infectious disease, and who were admitted to paediatric areas of the Vall d'Hebron University Hospital (Barcelona, Spain), other than intensive care, neonatology and onco-haematology units. Clinical data were collected and antibiotic consumption data were provided by the Pharmacy Department. RESULTS: A total of 51 episodes fulfilled the inclusion criteria. Carbapenem as initial empirical treatment was indicated in 31.4%, and applied as rescue therapy in the remainder. The instructions of the protocol were adhered to in 70.6% of the empirical and 87.5% of the targeted prescriptions (77.6% overall). A better match was found for empirical carbapenem in patients with a previous admission or underlying condition. Factors such as diagnosis, age or antibiotic use prior to admission did not affect the empirical indication of carbapenem. CONCLUSIONS: The establishment of a treatment protocol with carbapenem indications in our centre since 2007 has yielded significantly better results on the appropriateness of the prescription than those obtained in other studies.

Tos ferina en España. Situación epidemiológica y estrategias de prevención y control. Recomendaciones del Grupo de Trabajo de Tos ferina / Whooping cough in Spain. Current epidemiology, prevention and control strategies. Recommendations by the Pertussis Working Group

En los últimos años se está observando una reemergencia de la tos ferina en los países con amplias coberturas vacunales, con la aparición de brotes importantes. Este aumento de la incidencia tiene una distribución por edades bipolar: en los lactantes menores de 6meses, que por su edad no han iniciado la vacunación o no han completado la primovacunación, y en los adolescentes y adultos por la disminución de su inmunidad, vacunal o natural, con el tiempo transcurrido desde la inmunización o el padecimiento de la enfermedad. Estos cambios epidemiológicos justifican la adopción de nuevas estrategias vacunales con la finalidad de proteger al lactante pequeño y disminuir la incidencia de la enfermedad en toda la población. La vacunación del adolescente y del adulto debería ser prioritaria; en el primer caso solo supone cambiar la vacuna dT por la dTpa, con un coste adicional pequeño. La vacunación del adulto puede ser más difícil de implementar, pero de la misma forma que en muchos países se revacuna cada 10años frente a la difteria y el tétanos (con la vacuna dT), debería hacerse también frente a la tos ferina (con la vacuna dTpa). La estrategia que puede tener un impacto más importante sobre la incidencia de la tos ferina en el lactante es la vacunación de las personas con quienes convive o va a convivir, lo que se conoce como estrategia del nido. Recientemente, en algunos países se ha introducido también la vacunación de la embarazada, a partir de las 20semanas de gestación, como la forma más efectiva para proteger al recién nacido (AU)

A large increase of pertussis incidence has been observed in recent years in countries with high vaccination coverage. Outbreaks of pertussis are increasingly being reported. The age presentation has a bipolar distribution: infants younger 6months that have not initiated or completed a vaccination schedule, and adolescents and adults, due to the lost of natural or vaccine immunity over time. These epidemiological changes justify the need to adopt new vaccination strategies in order to protect young infants and to reduce pertussis incidence in all age groups. Adolescents and adults immunization must be a priority. In the first group, strategy is easy to implement, and with a very low additional cost (to replace dT vaccine by dTap one). Adult vaccination may be more difficult to implement; dT vaccine decennial booster should be replaced by dTap. The immunization of household contacts of newborn infants (cocooning) is the strategy that has a most important impact on infant pertussis. Recently, pregnant women vaccination (after 20weeks of gestation) has been recommended in some countries as the most effective way to protect the newborn (AU)

[Whooping cough in Spain. Current epidemiology, prevention and control strategies. Recommendations by the Pertussis Working Group]. / Tos ferina en España. Situación epidemiológica y estrategias de prevención y control. Recomendaciones del Grupo de Trabajo de Tos ferina.

A large increase of pertussis incidence has been observed in recent years in countries with high vaccination coverage. Outbreaks of pertussis are increasingly being reported. The age presentation has a bipolar distribution: infants younger 6months that have not initiated or completed a vaccination schedule, and adolescents and adults, due to the lost of natural or vaccine immunity over time. These epidemiological changes justify the need to adopt new vaccination strategies in order to protect young infants and to reduce pertussis incidence in all age groups. Adolescents and adults immunization must be a priority. In the first group, strategy is easy to implement, and with a very low additional cost (to replace dT vaccine by dTap one). Adult vaccination may be more difficult to implement; dT vaccine decennial booster should be replaced by dTap. The immunization of household contacts of newborn infants (cocooning) is the strategy that has a most important impact on infant pertussis. Recently, pregnant women vaccination (after 20weeks of gestation) has been recommended in some countries as the most effective way to protect the newborn.

Cellulitis multifocal recurrent en una nena de 7 anys / No disponible

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