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1.
N Engl J Med ; 388(5): 427-438, 2023 02 02.
Article in English | MEDLINE | ID: mdl-36724329

ABSTRACT

BACKGROUND: In September 2015, the four-component, protein-based meningococcal serogroup B vaccine (4CMenB; Bexsero) became available for private purchase in Spain. METHODS: We conducted a nationwide matched case-control study to assess the effectiveness of 4CMenB in preventing invasive meningococcal disease in children. The study included all laboratory-confirmed cases of invasive meningococcal disease in children younger than 60 months of age between October 5, 2015, and October 6, 2019, in Spain. Each case patient was matched with four controls according to date of birth and province. 4CMenB vaccination status of the case patients and controls was compared with the use of multivariate conditional logistic regression. RESULTS: We compared 306 case patients (243 [79.4%] with serogroup B disease) with 1224 controls. A total of 35 case patients (11.4%) and 298 controls (24.3%) had received at least one dose of 4CMenB. The effectiveness of complete vaccination with 4CMenB (defined as receipt of at least 2 doses, administered in accordance with the manufacturer's recommendations) was 76% (95% confidence interval [CI], 57 to 87) against invasive meningococcal disease caused by any serogroup, and partial vaccination was 54% (95% CI, 18 to 74) effective. Complete vaccination resulted in an effectiveness of 71% (95% CI, 45 to 85) against meningococcal serogroup B disease. Vaccine effectiveness with at least one dose of 4CMenB was 64% (95% CI, 41 to 78) against serogroup B disease and 82% (95% CI, 21 to 96) against non-serogroup B disease. With the use of the genetic Meningococcal Antigen Typing System, serogroup B strains that were expected to be covered by 4CMenB were detected in 44 case patients, none of whom had been vaccinated. CONCLUSIONS: Complete vaccination with 4CMenB was found to be effective in preventing invasive disease by serogroup B and non-serogroup B meningococci in children younger than 5 years of age.


Subject(s)
Meningococcal Infections , Meningococcal Vaccines , Neisseria meningitidis, Serogroup B , Child , Humans , Infant , Case-Control Studies , Meningococcal Infections/microbiology , Meningococcal Infections/prevention & control , Meningococcal Vaccines/therapeutic use , Neisseria meningitidis , Spain
2.
Clin Infect Dis ; 78(2): 476-483, 2024 02 17.
Article in English | MEDLINE | ID: mdl-37864849

ABSTRACT

BACKGROUND: With more than 7500 cases reported since April 2022, Spain has experienced the highest incidence of mpox in Europe. From 12 July onward, the modified vaccinia Ankara-Bavaria Nordic (MVA-BN) smallpox vaccine was offered as pre-exposure prophylaxis for those receiving pre-exposure prophylaxis for human immunodeficiency virus (HIV-PrEP). Our aim was to assess the effectiveness of 1 dose of MVA-BN vaccine as pre-exposure prophylaxis against mpox virus (MPXV) infection in persons on HIV-PrEP. METHODS: National retrospective cohort study between 12 July and 12 December 2022. Individuals aged ≥18 years receiving HIV-PrEP as of 12 July with no previous MPXV infection or vaccination were eligible. Each day, we matched individuals receiving a first dose of vaccine and unvaccinated controls of the same age and region. We used a Kaplan-Meier estimator, calculated risk ratios (RR) and vaccine effectiveness (VE = [1 - RR]x100). RESULTS: We included 5660 matched pairs, with a median follow-up of 62 days (interquartile range, 24-97). Mpox cumulative incidence was 5.6 per 1000 (25 cases) in unvaccinated and 3.5 per 1000 (18 cases) in vaccinated. No effect was found during days 0-6 post-vaccination (VE, -38.3; 95% confidence interval [CI], -332.7 to 46.4), but VE was 65% at ≥7 days (95% CI, 22.9 to 88.0) and 79% at ≥14 days (95% CI, 33.3 to 100.0) post-vaccination. CONCLUSIONS: One dose of MVA-BN vaccine offered protection against mpox in most-at-risk population shortly after the vaccination. Further studies need to assess the VE of a second dose and the duration of protection over time.


Subject(s)
HIV Infections , Mpox (monkeypox) , Vaccines , Vaccinia , Humans , Adolescent , Adult , Vaccinia/prevention & control , Cohort Studies , Retrospective Studies , Vaccinia virus , Vaccination , Monkeypox virus , HIV Infections/epidemiology , HIV Infections/prevention & control
3.
Epidemiol Infect ; 150: e163, 2022 08 22.
Article in English | MEDLINE | ID: mdl-35993492

ABSTRACT

This study aimed to assess the impact of the introduction of pneumococcal conjugate vaccine 13 (PCV13) on the molecular epidemiology of invasive pneumococcal disease (IPD) in children from Andalusia. A population-based prospective surveillance study was conducted on IPD in children aged <14 years from Andalusia (2018-2020). Pneumococcal invasive isolates collected between 2006 and 2009 in the two largest tertiary hospitals in Andalusia were used as pre-PCV13 controls for comparison of serotype/genotype distribution. Overall IPD incidence rate was 3.55 cases per 100 000 in 2018; increased non-significantly to 4.20 cases per 100 000 in 2019 and declined in 2020 to 1.69 cases per 100 000 (incidence rate ratio 2020 vs. 2019: 0.40, 95% confidence interval (CI) 0.20-0.89, P = 0.01). Proportion of IPD cases due to PCV13 serotypes in 2018-2020 was 28% (P = 0.0001 for comparison with 2006-2009). Serotypes 24F (15%) and 11A (8.3%) were the most frequently identified non-PCV13 serotypes (NVT) in 2018-2020. Penicillin- and/or ampicillin-resistant clones mostly belonged to clonal complex 156 (serotype 14-ST156 and ST2944 and serotype 11A-ST6521). The proportion of IPD cases caused by PCV13 serotypes declined significantly after the initiation of the PCV13 vaccination programme in 2016. Certain NVT, such as serotypes 24F and 11A, warrant future monitoring in IPD owing to invasive potential and/or antibiotic resistance rates.


Subject(s)
Pneumococcal Infections , Child , Humans , Molecular Epidemiology , Pneumococcal Infections/epidemiology , Pneumococcal Vaccines , Prospective Studies , Spain/epidemiology , Streptococcus pneumoniae , Vaccines, Conjugate
4.
J Pediatr Hematol Oncol ; 40(6): e348-e349, 2018 08.
Article in English | MEDLINE | ID: mdl-29620683

ABSTRACT

Severe combined immunodeficiency is an inherited disease with profoundly defective T cells, B cells, and natural killer cells. X-linked severe combined immunodeficiency is the most common form. In this report, we describe a 4-month-old male infant who was admitted to our hospital with progressive breathlessness and abdominal mass. He was diagnosed with hepatoblastoma and presented a pneumocystis jirovecii pneumonia at the beginning of chemotherapy. Definitive diagnosis of X-linked severe combined immunodeficiency was established by DNA analysis of the interleukin 2 receptor gamma chain gene. This case is the first report which describes an X-linked severe combined immunodeficiency patient with hepatoblastoma.


Subject(s)
Hepatoblastoma , Liver Neoplasms , Pneumocystis carinii , Pneumonia, Pneumocystis , X-Linked Combined Immunodeficiency Diseases , Hepatoblastoma/diagnosis , Hepatoblastoma/drug therapy , Humans , Infant , Liver Neoplasms/diagnosis , Liver Neoplasms/drug therapy , Male , Pneumonia, Pneumocystis/diagnosis , Pneumonia, Pneumocystis/drug therapy , X-Linked Combined Immunodeficiency Diseases/diagnosis , X-Linked Combined Immunodeficiency Diseases/drug therapy
5.
Pediatr Int ; 60(10): 943-947, 2018 Oct.
Article in English | MEDLINE | ID: mdl-30074664

ABSTRACT

BACKGROUND: Apnea is a life-threatening complication of pertussis, now a re-emerging cause of infant hospitalization worldwide. The incidence of apnea during pertussis ranges widely. The aim of this study was therefore to determine the incidence of apnea in hospitalized infants diagnosed with pertussis and to identify relevant risk factors for apnea. METHODS: This was a retrospective analytical study. We included children hospitalized with pertussis at a tertiary hospital during a 5 year period from 2010 to 2015. Nasopharyngeal aspirates (NPA) were obtained in all subjects. Real-time polymerase chain reaction was used to test NPA samples for Bordetella pertussis. The daily charts were assessed to identify inpatients with apnea. Multivariable logistic regression was performed to identify independent risk factors for inpatient apnea. RESULTS: Inpatient apnea was identified in 51 of 147 infants with pertussis confirmation (34.7%: 95%CI: 27-42%). Maternal smoking during pregnancy was the only statistically significant, independent predictor of inpatient apnea (OR: 4.48; 95%CI: 1.35-14.8). No statistically significant association was found with gender, corrected age; birthweight, caregiver smoking; lactation, weight at admission <3rd percentile, or hematological parameters. CONCLUSIONS: The incidence of pertussis apnea was nearly one in three hospitalized infants, and was fourfold more frequent in infants whose mothers smoked during pregnancy.


Subject(s)
Apnea/etiology , Prenatal Exposure Delayed Effects/etiology , Smoking/adverse effects , Whooping Cough/complications , Apnea/diagnosis , Apnea/epidemiology , Female , Hospitalization , Humans , Incidence , Infant , Infant, Newborn , Logistic Models , Male , Maternal Behavior , Pregnancy , Prenatal Exposure Delayed Effects/diagnosis , Prenatal Exposure Delayed Effects/epidemiology , Retrospective Studies , Risk Factors
6.
Pediatr Res ; 78(6): 603-8, 2015 Dec.
Article in English | MEDLINE | ID: mdl-26334989

ABSTRACT

BACKGROUND: Autoimmune lymphoproliferative syndrome (ALPS) is a primary immunodeficiency characterized by chronic lymphoproliferation, autoimmune manifestations, expansion of double-negative T-cells, and susceptibility to malignancies. Most cases of ALPS are caused by germline or somatic FAS mutations. We report the case of an ALPS patient due to a novel homozygous Fasligand gene mutation (ALPS-FASLG). METHODS: ALPS biomarkers were measured and FASLG mutation was identified. Functional characterization was carried out based on activation-induced cell death (AICD) and cytotoxicity assays. RESULTS: This report describes the cases of a patient who presented a severe form of ALPS-FASLG, and his brother who had died due to complications related to ALPS. Moreover, in another family, we present the first case of lymphoma in a patient with ALPS-FASLG. Functional studies showed defective Fasligand-mediated apoptosis, cytotoxicity, and AICD in T-cell blasts. Otherwise, expression of the FASLG gene and corresponding protein was normal, but the shedding of the Fasligand was impaired in T-cells. Additionally, analyzing Epstein-Barr virus (EBV)-transformed B-cells, our results indicate impaired AICD in ALPS-FASLG patients. CONCLUSION: Patients with autosomal recessive inheritance of ALPS-FASLG have a severe phenotype and a partial defect in AICD in T- and B-cell lines. The Fasligand could play a key role in immune surveillance preventing malignancy.


Subject(s)
Autoimmune Lymphoproliferative Syndrome/genetics , B-Lymphocytes/virology , Cell Transformation, Viral , Cytotoxicity, Immunologic , Fas Ligand Protein/genetics , Herpesvirus 4, Human/pathogenicity , Lymphoma/genetics , Mutation , Adult , Apoptosis , Autoimmune Lymphoproliferative Syndrome/diagnosis , Autoimmune Lymphoproliferative Syndrome/drug therapy , Autoimmune Lymphoproliferative Syndrome/immunology , B-Lymphocytes/immunology , B-Lymphocytes/pathology , Child, Preschool , Consanguinity , DNA Mutational Analysis , Fas Ligand Protein/immunology , Female , Genetic Predisposition to Disease , HEK293 Cells , Homozygote , Humans , Infant , Jurkat Cells , Lymphoma/immunology , Lymphoma/pathology , Male , Pedigree , Phenotype , T-Lymphocytes/immunology , T-Lymphocytes/pathology , Transfection
7.
Enferm Infecc Microbiol Clin ; 33(7): 476-9, 2015.
Article in Spanish | MEDLINE | ID: mdl-25459193

ABSTRACT

INTRODUCTION: Pertussis is a re-emerging disease that mostly affects infants. At this age, the severity can be affected by intercurrent infections such as respiratory syncytial virus (RSV). OBJECTIVES: To estimate the incidence of RSV infection during an epidemic period in patients hospitalized due to pertussis. The impact on the severity was also observed during hospitalization. PATIENTS AND METHOD: A descriptive study of cases diagnosed with pertussis admitted to a tertiary hospital over a 3year period, where the presence of co-infection with RSV was analyzed. The estimate of severity was estimated using the incidence of complications and the level of care required. RESULTS: From a total of 73 infants with pertussis, 34 occurred in a bronchiolitis season epidemic. A co-infection due to RSV was detected in 17 patients. The mean age was not significantly different compared to the non co-infected. The mean stay and the need for intensive care was similar in both groups. The need for oxygen therapy care and nutritional support was higher in the coinfected patients. CONCLUSIONS: Coinfection with RSV in infants hospitalized with pertussis occurred in ono in 2 patients during a RSV epidemic season, in infants of similar age. Severity in terms of stay, presence of apnea and admission to intensive care was similar, but more need for respiratory care and nutritional support was found.


Subject(s)
Respiratory Syncytial Virus Infections/complications , Whooping Cough/complications , Bronchiolitis/epidemiology , Coinfection , Comorbidity , Critical Care/statistics & numerical data , Disease Outbreaks , Female , Hospitalization , Humans , Incidence , Infant , Infant, Newborn , Length of Stay/statistics & numerical data , Male , Nutritional Support , Oxygen Inhalation Therapy , Respiratory Syncytial Virus Infections/epidemiology , Respiratory Syncytial Virus Infections/therapy , Tertiary Care Centers , Whooping Cough/epidemiology , Whooping Cough/therapy
8.
Enferm Infecc Microbiol Clin ; 31(4): 240-53, 2013 Apr.
Article in Spanish | MEDLINE | ID: mdl-23411362

ABSTRACT

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.


Subject(s)
Diphtheria-Tetanus Vaccine/administration & dosage , Diphtheria-Tetanus-acellular Pertussis Vaccines/administration & dosage , Whooping Cough/epidemiology , Whooping Cough/prevention & control , Adolescent , Adult , Bordetella pertussis/immunology , Child , Child, Preschool , Female , Health Personnel , Humans , Immunization Schedule , Immunization, Secondary , Incidence , Infant , Infant, Newborn , Male , Pertussis Vaccine , Pregnancy , Pregnancy Complications, Infectious/prevention & control , Spain/epidemiology , Vaccination , Whooping Cough/diagnosis , Whooping Cough/drug therapy
9.
Pediatr Pulmonol ; 58(4): 1201-1209, 2023 04.
Article in English | MEDLINE | ID: mdl-36653064

ABSTRACT

INTRODUCTION: Acute bronchiolitis is the main cause of hospitalization in children under 2 years of age, with a regular seasonality, mostly due to the respiratory syncytial virus. OBJECTIVES: To describe the epidemiology of bronchiolitis hospitalizations in our center in the last 12 years, and analyze the changes in clinical characteristics, microbiology, and adverse outcomes during the SARS-CoV-2 pandemic. METHODS: Observational study including patients admitted for bronchiolitis between April 2010 and December 2021 in a Spanish tertiary paediatric hospital. Relevant demographic, clinical, microbiological, and adverse outcome variables were collected in an anonymized database. The pandemic period (April 2020 to December 2021) was compared to 2010-2015 seasons using appropriate statistical tests. RESULTS: There were 2138 bronchiolitis admissions, with a mean of 195.6 per year between 2010 and 2019 and a 2-4-month peak between November and March. In the expected season of 2020, there was a 94.4% reduction of bronchiolitis hospitalizations, with only 11 cases admitted in the first year of the pandemic. Bronchiolitis cases increased from the summer of 2021 during a 6-month long peak, reaching a total of 171 cases. Length of stay was significantly shorter during the pandemic, but no differences were found in clinical and microbiological characteristics or other adverse outcomes. CONCLUSIONS: The SARS-CoV-2 pandemic has modified the seasonality of bronchiolitis hospitalizations, with a dramatic decrease in cases during the expected season of 2020-2021, and an extemporaneous summer-autumn peak in 2021 with longer duration but similar patient characteristics and risk factors.


Subject(s)
Bronchiolitis , COVID-19 , Respiratory Syncytial Virus Infections , Respiratory Syncytial Virus, Human , Humans , Infant , COVID-19/epidemiology , COVID-19/complications , Hospitalization , Hospitals, Pediatric , Pandemics , Respiratory Syncytial Virus Infections/epidemiology , Respiratory Syncytial Virus Infections/therapy , Respiratory Syncytial Virus Infections/complications , SARS-CoV-2
10.
Int J Antimicrob Agents ; 62(1): 106805, 2023 Jul.
Article in English | MEDLINE | ID: mdl-37019243

ABSTRACT

OBJECTIVES: Appropriate duration of antibiotic treatment is a key principle to reduce the emergence of bacterial resistance and antibiotic harm. The aim of this study was to document current clinical practice among Spanish paediatricians in terms of the duration of antibiotic therapy in both inpatient and outpatient settings, mapping the difference between practice and guidelines, and thus identifying opportunities to improve practice. METHODS: A national exploratory work survey was distributed in 2020 as a questionnaire about seven main infectious syndromes in children: genitourinary; skin and soft tissue; osteoarticular; ear, nose and throat; pneumonia; central nervous system; and bacteraemia. The answers were contrasted with current recommendations regarding the duration of antibiotic therapy. Demographic analysis was also performed. RESULTS: The survey was completed by 992 paediatricians in Spain, representing 9.5% of paediatricians working in the Spanish national health system. Hospital care clinicians accounted for 42.7% (6662/15590) of responses. The antibiotic duration used in practice was longer than recommended in 40.8% (6359/15590) of responses, and shorter than recommended in 16% (1705/10654) of responses. Only 25% (249/992) and 23% (229/992) of respondents indicated that they would prescribe antibiotics for the recommended treatment duration for lower urinary tract infection and community-acquired pneumonia (AI evidence). Among severe hospital-managed infections, a tendency towards longer courses of antibiotics was found for non-complicated meningococcal infections and non-complicated pneumococcal, Gram-negative and S. aureus bacteraemia. CONCLUSIONS: A noteworthy tendency towards prescribing antibiotics for longer than recommended among paediatricians was evidenced in this nationwide study, highlighting a wide range of opportunities for potential improvement.


Subject(s)
Infections , Humans , Male , Female , Anti-Bacterial Agents/therapeutic use , Child , Pediatricians , Surveys and Questionnaires , Spain , Infections/drug therapy
11.
An Pediatr (Engl Ed) ; 95(1): 4-10, 2021 Jul.
Article in English | MEDLINE | ID: mdl-34154986

ABSTRACT

INTRODUCTION: HIV infection was the main risk of suffering Pneumocystis jirovecii pneumonia (PJP). The clinical-epidemiological characteristics of PJP have currently changed, with there being few studies on this. METHODS: A retrospective observational study was carried out on paediatric patients diagnosed with PJP over a 17 year period in a third level hospital in Spain. RESULTS: A total of 23 patients were included, of whom 7/23 (47.8%) suffered a haematological disease, 5/23 (21.7%) a primary immunodeficiency, and 4/23 (17.4%) an HIV infection. Prophylaxis with trimethoprim-sulfamethoxazole (TMP-SMX) was received by 11/23 (47.8%) patients. All were treated with TMP-SMX and 18/23 (78.3%) with systemic glucocorticoids. There were six (26.1%) deaths, of which one of them (16.7%) suffered an HIV infection. A higher mortality was seen in the non-HIV patients with greater leucocytosis, greater CO2 retention, and a higher heart rate at onset, differences not observed in HIV patients. No differences were found in mortality in relation to the predisposing factor, use of pTMP-SMX, or treatment with glucocorticoids. CONCLUSIONS: Paediatric patients with haematological cancers are currently the main risk group of developing PJP in this age group. No differences were found in mortality between patients with or without HIV infection as predisposing factor. The mortality among non-HIV patients was higher in those that had greater leucocytosis, greater CO2 retention, and increased heart rate at onset. A better prognosis was not seen in patients that received prophylaxis with TMP-SMX prior to the development of the PJP, or in those that received glucocorticoids as part of the treatment.


Subject(s)
HIV Infections , Pneumocystis carinii , Pneumonia, Pneumocystis , Child , HIV Infections/epidemiology , Humans , Pneumonia, Pneumocystis/drug therapy , Spain/epidemiology , Tertiary Care Centers
12.
Pediatr Infect Dis J ; 40(6): 525-530, 2021 06 01.
Article in English | MEDLINE | ID: mdl-33538542

ABSTRACT

BACKGROUND: Visceral leishmaniasis (VL) is an endemic in Southern Europe. However, details regarding disease burden, clinical presentations, laboratory markers, management and outcome in children are scarce. METHODS: Medical records of children (<14 years) admitted with VL to 10 pediatric units in Andalusia (2004-2019) were retrospectively reviewed. VL diagnosis was based on clinical presentation, serology, microscopy and molecular methods. Diagnosis of secondary hemophagocytic lymphohistiocytosis (sHLH) was established using the hemophagocytic lymphohistiocytosis-2004 criteria. RESULTS: A total of 127 patients were identified. Median age was 14.5 months; the main clinical presentations were fever and splenomegaly (95.3% each). Cytopenias were the most common laboratory abnormalities. Diagnostics as well as treatment regimens varied over time and the participating centers. Liposomal amphotericin B was prescribed in 97.6%; relapses as well as adverse events were rarely observed (3.1% each). Thirty-seven patients, diagnosed with sHLH required longer hospital admission (P = 0.001), an increased number of platelet (P < 0.006) and red blood cell (P = 0.0001) transfusions and pediatric intensive care unit admission (P = 0.007). Monocytopenia (P = 0.011) and high C-reactive protein levels (P = 0.031), variables not included in the hemophagocytic lymphohistiocytosis-2004 criteria, were associated with sHLH. One patient deceased in the context of the Leishmania infection. CONCLUSIONS: We report data on the largest pediatric VL cohort from Europe, commonly associated with sHLH. Raised C-reactive protein levels and monocytopenia appear to be associated with sHLH. The latter may help to identify these patients and to guide decisions regarding need of additional supportive clinical care and immunomodulatory therapies. The observed high rate of heterogeneity in terms of diagnosis and management warrants the establishment of appropriate guidelines.


Subject(s)
Laboratories , Leishmaniasis, Visceral/complications , Lymphohistiocytosis, Hemophagocytic/diagnosis , Lymphohistiocytosis, Hemophagocytic/pathology , Amphotericin B/therapeutic use , Antiprotozoal Agents/therapeutic use , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Leishmaniasis, Visceral/drug therapy , Leishmaniasis, Visceral/epidemiology , Lymphohistiocytosis, Hemophagocytic/drug therapy , Lymphohistiocytosis, Hemophagocytic/epidemiology , Male , Retrospective Studies , Spain/epidemiology
13.
Pediatr Dermatol ; 27(1): 105-6, 2010.
Article in English | MEDLINE | ID: mdl-20199430

ABSTRACT

We report the first case of lupus-like lesions in an infant with chronic granulomatous disease during the treatment with voriconazole for chronic invasive aspergillosis. The lesions disappeared with termination of the treatment.


Subject(s)
Antifungal Agents/adverse effects , Aspergillosis/drug therapy , Granulomatous Disease, Chronic/complications , Lupus Erythematosus, Discoid/chemically induced , Pyrimidines/adverse effects , Triazoles/adverse effects , Aspergillosis/complications , Biopsy , Humans , Infant , Lupus Erythematosus, Discoid/pathology , Male , Voriconazole
14.
Arch Bronconeumol (Engl Ed) ; 56(11): 725-741, 2020 Nov.
Article in English, Spanish | MEDLINE | ID: mdl-32534869

ABSTRACT

Community-acquired pneumonia (CAP) is a prevalent disease among children and is frequently associated with both diagnostic and therapeutic uncertainties. Consensus has been reached between SEPAR, SENP and SEIP, and their conclusions are as follows.


Subject(s)
Community-Acquired Infections , Pneumonia , Child , Community-Acquired Infections/diagnosis , Consensus , Humans , Pneumonia/diagnosis , Pyruvates , Uncertainty
15.
Int J Infect Dis ; 98: 194-199, 2020 Sep.
Article in English | MEDLINE | ID: mdl-32553718

ABSTRACT

INTRODUCTION: Community-Acquired Pneumonia (CAP) is one of the most frequent causes of hospital admission in children. Our objective is to measure the impact of the introduction of pneumococcal conjugate vaccines on the hospitalization of previously healthy children due to CAP. METHOD: From 2011 to 2016, a partially retrospective, prospective, and descriptive study was carried out on healthy pediatric patients (3 months-14 years old) with CAP, who required hospital admission. Clinical, epidemiological, and demographic characteristics were collected, and vaccination status was obtained from medical records. RESULTS: A total of 292 cases were included, with a mean age of 33.4 months, 54% males. There was a progressive and significant 42% decrease in the number of admissions each year, without significant changes in the annual percentage of parapneumonic pleural effusion (PPE). Fifty-six percent of patients were immunized with a pneumococcal conjugate vaccine (PCV). The percentage of children who were not vaccinated decreased by 14%, and the coverage with PCV-13 increased by 46%. This revealed a significant increase of PPE in vaccinated patients with PCV-7 (63%) compared with unvaccinated (45%) and with PCV-13 (57%), without association with the presence of severe PPE. Moreover, no significant differences in severity or hospital stay were observed in unvaccinated patients, compared to those who were vaccinated. In >2-year-olds, we observed a significant increase in PPE (59%) compared to 45% in younger children. CONCLUSIONS: The increase in vaccination coverage with PCV-13 resulted in a decrease in hospitalizations due to CAP and PPE. Vaccination with PCV-7 is associated in our sample with an increase in PPE but not with severe PPE nor an increase in the hospital stay. There was an epidemiological shift of severe forms of pneumonia and empyema at later ages (>2 years).


Subject(s)
Community-Acquired Infections/therapy , Pneumococcal Vaccines/administration & dosage , Pneumonia/therapy , Vaccines, Conjugate/administration & dosage , Adolescent , Child , Child, Preschool , Community-Acquired Infections/prevention & control , Female , Hospitalization , Humans , Immunization , Infant , Length of Stay , Male , Pleural Effusion/microbiology , Pneumococcal Vaccines/immunology , Pneumonia/prevention & control , Prospective Studies , Retrospective Studies , Vaccination , Vaccines, Conjugate/immunology
16.
Enferm Infecc Microbiol Clin (Engl Ed) ; 38(9): 438-443, 2020 Nov.
Article in English, Spanish | MEDLINE | ID: mdl-33161954

ABSTRACT

Primary immunodeficiencies (PIDs) are rare, undiagnosed and potentially fatal diseases. Clinical manifestations of PID can be fatal or leave sequelae that worsen the quality of life of patients. Traditionally, the treatment of PIDs has been largely supportive, with the exception of bone marrow transplantation and, more recently, gene therapy. The discovering of new affected pathways, the development of new molecules and biologics, and the increasing understanding of the molecular basis of these disorders have created opportunities in PIDs therapy. This document aims to review current knowledge and to provide recommendations about the diagnosis and clinical management of adults and children with PIDs based on the available scientific evidence taking in to account current practice and future challenges. A systematic review was conducted, and evidence levels based on the available literature are given for each recommendation where available.


Subject(s)
Immunologic Deficiency Syndromes , Primary Immunodeficiency Diseases , Adult , Bone Marrow Transplantation , Child , Consensus , Humans , Immunologic Deficiency Syndromes/diagnosis , Immunologic Deficiency Syndromes/therapy , Primary Immunodeficiency Diseases/diagnosis , Quality of Life
17.
J Allergy Clin Immunol Pract ; 8(10): 3342-3347, 2020.
Article in English | MEDLINE | ID: mdl-33161963

ABSTRACT

Primary immunodeficiencies (PIDs) are rare, undiagnosed and potentially fatal diseases. Clinical manifestations of PID can be fatal or leave sequelae that worsen the quality of life of patients. Traditionally, the treatment of PIDs has been largely supportive, with the exception of bone marrow transplantation and, more recently, gene therapy. The discovering of new affected pathways, the development of new molecules and biologics, and the increasing understanding of the molecular basis of these disorders have created opportunities in PIDs therapy. This document aims to review current knowledge and to provide recommendations about the diagnosis and clinical management of adults and children with PIDs based on the available scientific evidence taking in to account current practice and future challenges. A systematic review was conducted, and evidence levels based on the available literature are given for each recommendation where available.


Subject(s)
Immunologic Deficiency Syndromes , Primary Immunodeficiency Diseases , Adult , Bone Marrow Transplantation , Child , Consensus , Humans , Immunologic Deficiency Syndromes/diagnosis , Immunologic Deficiency Syndromes/therapy , Quality of Life
18.
Future Microbiol ; 14: 1429-1436, 2019 11.
Article in English | MEDLINE | ID: mdl-31498705

ABSTRACT

Influenza, an infectious disease of the respiratory system, represents a major burden for public health. This disease affects all age groups with different prognosis, being life threatening for vulnerable individuals. Despite influenza being a vaccine-preventable disease, the control of the infection needs annual vaccination campaigns and constant improvements. Herein, the main challenges of influenza in relation to the pathogenic agent, the available vaccines and the health impact identified during the Light on Vax event, an expert meeting organized by the Asociación Española de Vacunología [Spanish Vaccinology Association] (AEV), are reported. Further possible steps in the control of influenza are also suggested. Ideally, the development of innovative and universal vaccines that would confer life-lasting and broader-spectrum immunity is highly desirable.


Subject(s)
Influenza Vaccines/immunology , Influenza, Human/immunology , Influenza, Human/prevention & control , Public Health , Adult , Child , Child, Preschool , Cost of Illness , Female , Humans , Influenza, Human/complications , Pregnancy , Risk Factors , Seasons , Vaccination
19.
Enferm Infecc Microbiol Clin (Engl Ed) ; 37(4): 251-255, 2019 Apr.
Article in English, Spanish | MEDLINE | ID: mdl-30100097

ABSTRACT

INTRODUCTION: Passive transplacental immunity against respiratory syncytial virus (RSV) appears to mediate in the protection of the infant for the first 6 months of life. Lower environmental exposure in pregnant women to RSV epidemic may influence the susceptibility of these infants to infection by lowering the levels of antibodies that are transferred to the fetus. OBJECTIVES: To contrast the risk of severe disease progression in infants with acute bronchiolitis by RSV, according to the mother's level of exposure to epidemic. METHOD: Retrospective cohort study of previously healthy infants with RSV-acute bronchiolitis during 5 epidemics was made. We compared the severity of the infection in those born during the period of risk (when is less likely the mother's exposure to epidemic and the transfer of antibodies to the fetus: October 15th-December 15th in our latitude) with the rest of acute bronchiolitis. Bivariate analysis was performed regarding birth in period of risk and the rest of variables, using the Chi-square test. Multivariate logistic regression analysis was performed to study possible classical confounding factors. RESULTS: 695 infants were included in the study. 356 infants were born during the period of risk. Of the 56 patients requiring admission to PICU, 40 of them (71.4%) were born in this period (p=0.002). In the multivariate analysis, the birth in the period of risk showed a 6.5 OR (95% CI: 2.13-19.7) independently of the rest of variables. CONCLUSIONS: The worst clinical disease progression of the acute bronchiolitis by the RSV in less than 6 months age is related to lower exposure of the pregnant woman to the RSV epidemic.


Subject(s)
Bronchiolitis, Viral/immunology , Bronchiolitis, Viral/virology , Immunity, Maternally-Acquired/immunology , Maternal Exposure , Pregnancy/immunology , Respiratory Syncytial Virus Infections/immunology , Respiratory Syncytial Virus, Human/immunology , Acute Disease , Cohort Studies , Female , Humans , Infant , Male , Respiratory Syncytial Virus Infections/epidemiology , Retrospective Studies , Severity of Illness Index
20.
An Pediatr (Engl Ed) ; 91(3): 205.e1-205.e7, 2019 Sep.
Article in Spanish | MEDLINE | ID: mdl-31288982

ABSTRACT

Rotavirus (RV) is the leading cause of severe acute gastroenteritis in infants worldwide. Most children are infected by RV by the age of 5years, and especially in the first 2years. Two oral attenuated vaccines against RV are licensed in industrialised countries, which have proven to be safe and effective against the disease. The main objective of these vaccines has been to reproduce the natural history of infection and protect against severe disease in the first months of life. Preterm infants are at higher risk of severe RV infection compared to full-term infants and infants with normal birth weight. Data collected on RV vaccination in preterm infants demonstrated that RV vaccines are effective and safe, compared with full-term infants, with a marginal risk of horizontal viral transmission and dissemination when vaccination is performed during hospitalisation. Preterm infants frequently require admission to hospital after the beginning of the 12th week of life, which suggests that they should receive RV vaccines during admission according to the official immunisation schedule.


Subject(s)
Rotavirus Infections/prevention & control , Rotavirus Vaccines/administration & dosage , Vaccination/methods , Gastroenteritis/prevention & control , Gastroenteritis/virology , Humans , Immunization Schedule , Infant, Newborn , Infant, Premature , Rotavirus Vaccines/adverse effects , Vaccines, Attenuated
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