[Meningococcal C conjugate vaccine: Impact of a vaccination program and long-term effectiveness in Navarra, Spain, 2000-2014]. / Vacuna conjugada frente al meningococo C: impacto del programa de vacunación y efectividad a largo plazo en Navarra, 2000-2014.

BACKGROUND: Since 2000, when the meningococcal serogroupC conjugate vaccine (MenCC) was introduced in the childhood immunization schedule in Spain, several changes in the schedule and catch-up campaigns have been performed. We aim to estimate the impact and effectiveness of this vaccine in Navarra up to 2014. METHODS: The impact of the vaccination program was analysed by comparing incidence, mortality and lethality rates of disease before (1995-1999) and after (2004-2014) the introduction of the MenCC. Vaccine effectiveness was estimated using the screening method (Farrington) and the indirect cohort method (Broome). Data on cases were obtained from the active surveillance of meningococcal disease. RESULTS: During 1995-1999 the mean annual incidence of meningococcalC disease was 1.32 per 100,000, and 7.18 per 100,000 in children younger than 15years. The fall of meningococcalC disease incidence was significant in cohorts targeted for vaccination from the beginning and progressive in the general population. No cases were reported between 2011 and 2014. The estimated vaccine effectiveness was 96% by the screening method, and 99% by the indirect cohort method. CONCLUSION: The MenCC vaccination program has been successful in decreasing the incidence rate of serogroupC meningococcal disease in Navarra, and schedule changes have maintained high vaccine effectiveness throughout the study period.

[Post-mortem microbiology analysis]. / Análisis microbiológico post mórtem.

Post-mortem microbiology is useful in both clinical and forensic autopsies, and allows a suspected infection to be confirmed. Indeed, it is routinely applied to donor studies in the clinical setting, as well as in sudden and unexpected death in the forensic field. Implementation of specific sampling techniques in autopsy can minimize the possibility of contamination, making interpretation of the results easier. Specific interpretation criteria for post-mortem cultures, the use of molecular diagnosis, and its fusion with molecular biology and histopathology have led to post-mortem microbiology playing a major role in autopsy. Multidisciplinary work involving microbiologists, pathologists, and forensic physicians will help to improve the achievements of post-mortem microbiology, prevent infectious diseases, and contribute to a healthier population.

Advances with vaccination against Neisseria meningitidis.

In the last decade, meningococcal serogroup C conjugate vaccination programs have been demonstrated to be hugely successful with a truly impressive public health impact. In sub-Saharan Africa, with the implementation of an affordable serogroup A conjugate vaccine, it is hoped that a similar public health impact will be demonstrated. Challenges still remain in the quest to develop and implement broadly protective vaccines against serogroup B disease. New, broad coverage vaccines against serogroup B are for the first time becoming available although little is known about their antibody persistence, effectiveness or effect on nasopharyngeal carriage. Enhanced surveillance following any potential vaccine introduction against serogroup B needs to be thoroughly implemented. The future now holds a distinct possibility, globally, for substantially decreasing meningococcal disease, regardless of infecting serogroup.

[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.

Pros and cons of vaccination against serogroup B meningococcal disease. / Pros y contras de la vacunación frente a la enfermedad por meningococo B.

A vaccine has recently been approved in the EU against meningococcal serogroup B, the main cause of meningococcal disease. There is a fierce debate about the decision regarding a universal vaccination in infants older than 2 months, as recommended by the majority of scientific societies. In western Europe the only country to have included the universal vaccination is the United Kingdom, with a lower incidence of the disease than Ireland. Other countries have also adopted it, such as the Czech Republic, Cuba and certain regions of Italy. Numerous cost-effectiveness studies have been published regarding the vaccination with different assumptions, which have supported the decision not to implant the universal vaccination because it exceeds the will to pay for a health benefit. We discuss the pros and cons of the universal vaccination against meningococcal B, recommended by the Sociedad Española de Pediatría (Spanish Society of Paediatrics), which as yet has not been implemented.

Meningite bacteriana: uma revisão / Bacterial meningitis: a review

A meningite bacteriana é uma inflamação das leptomeninges que envolvem o Sistema Nervoso Central. Essa patologia, que possui diversos agentes etiológicos, apresenta-se na forma de síndrome, com quadro clínico grave. Entre as principais bactérias que causam a meningite, estão a Neisseria meningitis e Streptococcus pneumoniae. A transmissão ocorre através das vias aéreas por meio de gotículas, sendo a corrente sanguínea a principal rota para as bactérias chegarem à barreira hematoencefálica e, a partir dessa, até as meninges. Atualmente existem vários métodos de diagnóstico precisos, onde a cultura de líquido cefalorraquidiano (LCR) é o método padrão ouro. Ademais, a melhora na qualidade do tratamento com beta-lactâmicos e a maior possibilidade de prevenção, devido à elevação do número e da eficácia de vacinas, vem contribuindo para redução dos casos da doença e de sua gravidade. Porém, apesar desses avanços, ainda há um elevado número de mortalidades e sequelas causadas por essa síndrome.

Bacterial meningitis is an inflammation of the leptomeninges that surround the Central Nervous System. This pathology, which has several etiological agents, is presented as a syndrome with a severe clinical scenario. The main bacteria causing meningitis include Neisseria meningitis and Streptococcus pneumoniae. It can be transmitted by droplets through the airways, with the bacteria using the bloodstream as the main route to reach the blood-brain barrier, and from there to the meninges. There are currently several accurate diagnostic methods, with CSF culture being the gold standard. In addition, the improvement in the quality of beta-lactam treatment and the greater possibility of prevention due to the increased number and effectiveness of vaccines have contributed to reducing the number of cases and severity of the disease. Nevertheless, despite these advances, this syndrome still presents a high number of mortalities and sequelae.

[The use of polymerase chain reaction in the diagnosis of invasive meningococcal disease]. / La reacción en cadena de la polimerasa en el diagnóstico de la enfermedad meningocócica invasiva.

INTRODUCTION AND OBJECTIVES AND AIMS: Invasive meningococcal disease (IMD) remains a serious public health problem. Although culture is the gold standard, previous antibiotic therapy reduces its sensibility. The aim of this study is the epidemiological analysis of IMD in our area, to assess the usefulness of polymerase chain reaction (PCR) to increase its diagnostic accuracy,and to show the association of antibiotic administration with the negative result of the culture. PATIENTS AND METHODS: A retrospective study was conducted on all children younger than 16 years with microbiologically (positive culture and/or PCR) confirmed IMD, admitted to our hospital between 2004-2012. RESULTS: Seventy-five patients were included, of whom 52% had sepsis, 30.7% meningitis, and 17.3% with both of them. PCR was positive in all samples, whereas a positive was seen 50.7% of the cultures. Previously administered antibiotic was documented in 40 patients (53.3%), and 40% of them were confirmed by PCR only. CONCLUSIONS: PCR was the only test providing evidence for IMD diagnosis and serogroup determination in almost 39% of cases.

Historia de la meningitis bacteriana en Cuba: siglo XIX al XXI

Introducción: La meningitis bacteriana aún constituye un importante problema de salud mundial. En Cuba hay limitadas investigaciones con una perspectiva histórica de esta temática. Objetivo: Describir el comportamiento de la meningitis bacteriana en Cuba (siglo XIX-XXI). Material y Métodos: Estudio descriptivo (corte histórico) entre finales de 1800 y 2017, utilizando el método histórico-lógico y un análisis deductivo-inductivo de múltiples fuentes bibliográficas. Desarrollo: La primera alusión a la meningitis bacteriana en Cuba data de 1877. También se sugiere su probable importación por el ejército de ocupación norteamericano en 1899. En 1901 se aisló el meningococo de Weichselbaum del líquido cefalorraquídeo, lo que constituye, probablemente, su primera notificación en Cuba. Iniciado el siglo XX, se reportan casos aislados y brotes hasta 1976 cuando inicia la mayor epidemia de Enfermedad Meningocócica (serogrupos C y B). En 1979 se vacuna contra el C. En 1980 se implementa una vigilancia epidemiológica especial. Se desarrolla la vacuna cubana VA-MENGOC-BC® (1984) que se usa masivamente (1987) y se contribuye al control, incluyéndose en el Programa Nacional de Inmunizaciones (1991). Haemophilus Influenzae pasa a ser la principal bacteria causante de meningitis bacteriana hasta 1999 en que se aplican vacunas (Vaxem-Hib® y QuimiHib®) y se controla. Su nicho ecológico es ocupado por neumococo hasta ahora. Conclusiones: Desde fines del siglo XIX hasta la segunda mitad del XX la meningitis bacteriana en Cuba se manifestaba como casos aislados y brotes. Durante y después de una gran epidemia, se implementan estrategias preventivas efectivas, incluidas dos vacunas cubanas contra estas enfermedades, que revierten el comportamiento a endemia muy baja hasta la actualidad.

Introduction: Bacterial meningitis remains an important health problem worldwide. In Cuba, there are limited research studies about this issue from a historical perspective. Objective: To describe the behavior of this disease in Cuba (19th - 21st centuries). Material and Methods: A descriptive historical study was carried out between the ends of 1800-2017, using the historical-logical method and a deductive-inductive analysis of multiple bibliographical sources. Development: The first reference to bacterial meningitis in Cuba was made in 1877. The probable introduction of the disease by the US occupation army in 1899 is also considered. In 1901, the meningococci of Weichselbaum was isolated from cerebrospinal fluid, which was probably it first report in Cuba. At the beginning of the 20th century, isolated cases and outbreaks were reported until 1976, when the biggest and larger invasive meningococcal disease began (serogroups C, B). Vaccination against serogroup C started in 1979. In 1980, a special epidemiological surveillance was implemented. The Cuban vaccine VA-MENGOC-BC® against the disease was developed in 1984, which was massively used in 1987. The vaccine contributed to the control of the disease and was included in the National Immunization Program in 1991. Haemophilus Influenzae became the main causative bacterial agent of meningitis until 1999, when the implementation of massive vaccination (Vaxem-Hib® and QuimiHib®) controlled disease. Up to the present, its ecological niche is occupied by pneumococci. Conclusions: From the end of the 19th century to the second half of the 20th century, bacterial meningitis in Cuba behaved as isolated cases and outbreaks. Effective preventive strategies were implemented during and after a huge epidemic, including Cuban vaccines against the disease, that pass on its behavior to a very low endemic disease up to the moment.

Vigilancia de laboratorio de enfermedad meningocóccica invasora en Chile, 2006-2012 / Laboratory surveillance for invasive meningococcal disease in Chile, 2006-2012

Background: Laboratory surveillance of Invasive Meningococcal Disease (IMD) is performed by the Institute of Public Health of Chile. It confirms identification, classifies in serogroups and analyzes the genetic profiles of Neisseria meningitidis isolates from laboratories throughout the country. Aim: To show the results of this surveillance from 2006 to 2012. Methods: A descriptive data analysis of the confirmed cases of IMD and serological characterization, susceptibility and genetic profiles of the isolates. The analysis was disaggregated by serogroup, age and region. Results: From 2006 to 2012, 486 isolates of N. meningitidis were confirmed. In 2011 a rise in IMD rates was observed due to an increase in W serogroup cases, mainly affecting children aged 5 years or less. Serogroup W became the most prevalent during 2012 (58.3%), replacing the historically prevalent serogroup B. Predominating strains belonged to ST-32 complex/ET-5 complex (40, 4% of strains) and ST-41/44 complex/ Lineage 3 (45, 9% of strains). Conclusions: Laboratory surveillance has allowed the early detection of increasing IMD caused by serogroup W, which is emergent in Chile. This information has reinforced the daily monitoring of new cases, in collaboration with all the clinical laboratories of the country.

Introducción: La vigilancia de laboratorio de enfermedad meningocócica invasora (EMI) que realiza el Instituto de Salud Pública de Chile, confirma, seroagrupa y estudia el perfil genético de las cepas de Neisseria meningitidis provenientes de los laboratorios del país. Objetivo: En este artículo se muestra los resultados de esta vigilancia entre los años 2006 a 2012. Materiales y Métodos: Se realizó un análisis descriptivo de los casos confirmados de EMI, caracterización serológica, el análisis de susceptibilidad antimicrobiana y el estudio de subtipo genético de la cepa. El análisis se desagregó por serogrupo, edad y región. Resultados: En el período 2006-2012 fue confirmado un total de 486 cepas de N. meningitidis. A partir del año 2011 se observó un alza en la tasa de EMI dado por el número de casos del serogrupo W, afectando principalmente a niños bajo 5 años de edad. El W se transformó en el serogrupo prevalente el año 2012 (58,3%), desplazando al serogrupo B, el cual históricamente había sido prevalente. Predominaron principalmente las cepas pertenecientes al complejo clonal ST-32 complex/ET-5 complex (40,4% de las muestras) y el ST-41/44 complex/Lineage 3 (45,9% de las muestras). Conclusiones: El sistema de vigilancia de laboratorio ha permitido la identificación del serogrupo W, emergente en Chile. Esta información nos ha obligado a estar en permanente alerta y monitoreo de casos diarios, mediante la participación activa de todos los laboratorios clínicos del país.

Enfermedad invasiva por Neisseria Meningitidis, alerta epidemiológica / Neisseria Meningitidis invasive disease, epidemiological alert

En países que han incorporado vacunas conjugadas contra Streptococcus pneumoniae y Haemophilus influenzae, la Neisseria meningitidis es el principal patógeno bacteriano causante de enfermedad invasiva. La enfermedad invasiva por meningoco se asocia con una alta tasa de letalidad. Objetivos. Describir una agregación inesperada de casos de enfermedad invasiva por Neisseria meningitidis en los Municipio Salmeron Acosta y Sucre, Estado Sucre,Venezuela. Metodos. Cohorte de inicio. Casos con diagnóstico definido o probable de infección por Neisseria meningitidis. Se registraron datos pertinentes acerca del paciente, de su enfermedad, del agente causal y del medio ambiente. Se determinó la tasa de incidencia por grupos de edad y municipio de residencia, serogrupos de Neisseria meningitidis, y patron de susceptibilidad a antibióticos. Resultados. Entre las semanas epidemiológicas 1-41 de 2012 se detectaron 15 casos de enfermedad invasiva por meningococo en niños menores de 15 años con residencia en el Estado Sucre, Venezuela. La tasa de incidencia para los Municipios Cruz Salmerón Acosta y Sucre del Estado Sucre fue 33,7 x 105 y 6,7 x 105 niños <15 años respectivamente. La enfermedad muestra mayor dispersión en la tasa de ataque de niños de 5-14 años, agregación en espacio y tiempo así como tendencia cíclica. Los casos confirmados fueron 10 de 15, Neisseria meningitidis serogrupo B, 4 casos y Neisseria meningitidis serogrupo C, 6 casos. La letalidad observada fue 6 de 15; se observaron secuelas en un tercio de los sobrevivientes. Conclusiones. Se describe una frecuencia inesperada de enfermedad invasiva por Neisseria meningitidis en los Municipio Salmeron Acosta y Sucre, Estado Sucre,Venezuela. La información generada puede orientar el diseño de medidas de intervención y control.

In countries were conjugate vaccines against Streptococcus pneumoniae and Haemophilus influenzae, have been incorporated, Neisseria meningitidis is the major bacterial pathogen causing invasive disease. Invasive meningococcal disease is associated with a high mortality rate. Objectives. To describe unexpected aggregation of invasive meningococcal disease. Methods. Inception cohort: Definite or probable cases of infection with Neisseria meningitidis. Information about the patient and his disease, the causative agent and the environment was registered. Incidence rate by age and municipality of residence, serogroups of Neisseria meningitidis, and antibiotic susceptibility pattern were determined. Results. Between the epidemiological weeks 1-41 of 2012, 15 cases of invasive meningococcal disease in children under 15 years of age, living in the state of Sucre, Venezuela were identified. The incidence rate for Cruz Salmerón Acosta and Sucre municipalities was 33.7 x 105 and 6.7 x 105 children <15 years of age, respectively. The disease shows greater dispersion in incidence by age group, aggregation in space and time and a cyclical trend. Confirmed cases were 10 of 15, 4 cases of Neisseria meningitidis serogroup B and 6 cases of Neisseria meningitidis serogroup C. Overall mortality rate was 6 of 15; sequelae were present in one third of the survivors. Conclusions. This study describes an unexpected frequency of invasive meningococcal disease in the Sucre and Salmeron Acosta Municipalities, Sucre State, Venezuela. This information may be useful to guide intervention measures design.

Prevalência de sorogrupos de neisseria meningitidis causadores de doença meningocócica no estado da Bahia de 1998 a 2007 / Prevalence of neisseria meningitidis sorogroups that cause meningococcal disease in Bahia, from 1998 to 2007 / Prevalencia de serogrupos de n. meningitidis causadores de enfermedad meningocócica en el estado de la Bahia de 1998 a 2007

A Doença Meningocócica (DM), problema de saúde pública em razão da elevada morbidade e letalidade em nosso meio, tem preocupado devido à recente ascensão do sorogrupo C da N. meningitidis em detrimento do sorogrupo B, que apresenta maior potencial para causar epidemias, e ao possível surgimento de novo perfil epidemiológico da doença. O objetivo deste estudo é quantificar a prevalência dos sorogrupos de N. meningitidis causadores de DM no estado da Bahia nos últimos 10 anos. Este é um estudo descritivo que avalia casos notificados de DM na Bahia de 1998 a 2007, por sexo, idade, letalidade e sorogrupos causadores. Dos 2.070 casos de DM, foram sorogrupados 327 (34,4por cento). O sorogrupo B foi responsável por 71,9por cento dos casos e o C por 26,65por cento, entretanto foi verificada inversão da frequência a partir de 2006, com sorogrupo C representando 77,8por cento dos casos em 2007. Homens e menores de cinco anos foram mais acometidos e a letalidade em 2007 foi de 31por cento. Concluiu-se que, também na Bahia, ocorreu um aumento do sorogrupo C em detrimento do sorogrupo B, o que evidencia a mudança da prevalência do sorogrupo causador da doença meningocócica, fato que tem como consequencia a mudança no perfil epidemiológico da doença.

Meningococcal disease (MD) is a public health problem due to the high morbidity and mortality rate in our country. Recently, the rise of serogroup C of N. meningitidis serogroup B instead, worries due to the greater potential to cause epidemics of this group and the possible emergence of a new epidemiological pattern of disease. The aim of this study is to quantify the prevalence of serogroups of N. meningitidis causes of DM in the state of Bahia in the last 10 years. This is a descriptive study that evaluates reported cases of DM in Bahia from 1998 to 2007, by sex, age, cause lethality and serogroups. Of the 2,070 cases of DM were different serogroups 327 (34.4percent). The serogroup B accounted for 71.9percent of cases and 26.65percent for C, however the frequency was observed reversal from 2006, with serogroup C accounting for 77.8percent of cases in 2007. Men and children under five years were most affected and the mortality rate in 2007 was 31percent. It was concluded that, in Bahia, an increase of serogroup C at the expense of serogroup B, which shows the change in the prevalence of serogroup causing meningococcal disease, a fact that leads to change in the epidemiology of the disease.

Resumen La enfermedad meningocócica (ED) es un problema de salud pública debido a la alta morbilidad y mortalidad en nuestro medio. El reciente aumento del serogrupo C de N. meningitidis en detrimento del serogrupo B, ha despertado preocupación por su alto potencial de causar epidemias y al posible aparecimiento de un nuevo patrón epidemiológico. El objetivo de este estudio es cuantificar la prevalencia de los serogrupos de N. meningitidis causa de la ED en el estado de la Bahía, en los últimos 10 años. Es un estudio descriptivo que evalúa denuncias de casos de ED en la Bahía de 1998 a 2007, por sexo, edad, letalidad y serogrupos causadores de la enfermedad. De los 2.070 casos de ED, 327 (34,4por ciento) fueron seroagrupados. El serogrupo B representó el 71,9por ciento de los casos y el C, el 26,65por ciento, sin embargo, se observó reversión en la frecuencia a partir de 2006, con el serogrupo C representando el 77,8por ciento de los casos en 2007. 678 Los hombres y los niños menores de cinco años fueron los más afectados y la tasa de mortalidad en 2007 fue del 31por ciento. Se concluye que, también en el estado de la Bahía, hubo un aumento del serogrupo C, en detrimento del serogrupo B, lo que muestra el cambio en la prevalencia del serogrupo causador de la enfermedad meningocócica, hecho que tiene como consecuencia el cambio de patrón epidemiologico de la enfermedad.

Vacunas meningocócicas / Meningococcal Vaccines

La enfermedad meningocócica, aunque poco frecuente, es severa y puede causar la muerte en 10% de quienes la contraen, de allí la importancia de la inmunización para prevenirla. existen varias clases de vacunas, como las polisacáridas que aun cuando pueden inducir protección, no son inmunogénicas en niños menores de 2 años ni inducen inmunidad de rebaño. la administración de dosis de refuerzoproduce hiporespuesta. Las vacunas conjugadas pueden ser monovalentes como la serogrupo c que demostró una reducción en un 93% de la enfermedad en poblaciones con altas coberturas vacunales, y las tetravalentes Ac W135, y/d (conjugada al toxoide diftérico y A; c, W135, y/crM139 conjugada a una mutante no tóxica de toxina diftérica Ambas son inmunogénicas y seguras. estudios epidemiológicos con A; c; W135, y/d descartan aumento de riesgo al síndrome de Guillain Barre (sGB) posterior a su administración. se recomienda administrar dosis única a adolescentes más un refuerzo. el personal de alto riesgo a la enfermedad (Asplenia anatómica o funcional, alteración del complemento, déficit de Properdina, vIh) deben recibir dos dosis más refuerzos cada cinco años

Meningococcal disease is a rare but serious infection, up to 10% of persons who contract disease die, so it is very important to immunized for Meningococcal disease protection and prevention. there are two types of vaccine: Polysaccharides that even though induces protection ,is not immunogenic in children younger of 2 years, don’t induce herd immunity and produce hypo responsivenessto a booster dose. conjugate vaccines can be monovalent serogroup: c which demonstrated 93% reduction of serogroups c disease in population with high vaccine coverage. Also there are two quadrivalent serogroups A;c;W135;y vaccines one conjugate to d(difteric toxoid) and other to /crM 139(mutant no toxic of dfsteric toxin. studies showed their immunogenicity up to 55 years and boths are safes. epidemiological study with A;c;W135,y/d disproves any evidence of increased risk to sGB after its administration recommended schedule is to immunized all adolescent, with a dose plus a booster. high risk people of invasive meningococcal disease (anatomic or functional asplenia,terminal complement or prperdin deficiencies,hIv) should rereceived, 2 doses, plus boostersevery 5 years

Prevención / Prevention

En la actualidad, se cuenta con un grupo de vacunas desarrolladas para la prevención de infecciones bacterianas, incluso para realizar profilaxis. En la década de los 80 del siglo XX apareció la primera vacuna contra Haemophilus influenzae tipo b que redujo y prácticamente eliminó la enfermedad invasiva por esta bacteria. A inicios del año 2000 se observó una dramática reducción de enfermedad invasiva por neumococo, gracias a la introducción de la vacuna PCV-7 contra este germen. Sin embargo, surgieron serotipos no incluidos en esta vacuna, por lo cual se desarrollaron la PHiD-CV 10 y la PCV-13, con 10 y 13 serotipos, respectivamente. En contra del meningococo se han desarrollado vacunas polisacáridas que han demostrado efectividad, así como las conjugadas que pueden ser monovalentes y tetravalentes. La quimioprofilaxis se indica en casos específicos que se explican en forma detallada en este capítulo

Nowadays, several vaccines have been developed for the prevention of bacterial infections, and also for prophylaxis. In the 80's of the twentieth century came the first vaccine against Haemophilus influenzae type b, which reduced and virtually eliminated invasive disease by this bacterium. In early 2000, there was a dramatic reduction in invasive pneumococcal disease, with the introduction of PCV-7 vaccine against this germ. However, there were serotypes not included in the vaccine, which was developed by the Phido-CV 10 and PCV-13, 10 and 13 serotypes, respectively. Against meningococcus, polysaccharide vaccines have been developed that have demonstrated effectiveness, as well as the conjugate vaccines, which may be monovalent and tetravalent. Chemoprophylaxis is indicated in specific cases that are reviewed in detail in this chapter