The situation of vaccines for the prevention of infections in adults: An opinion paper on the situation in Spain.

The childhood immunization schedule is well known and generally well implemented in developed countries. For various reasons, the same is not true of vaccines aimed at preventing infections in adults, in which vaccination coverage is incomplete and generally very deficient. In order to assess the situation of adult vaccination in Spain, the Fundación de Ciencias de la Salud has brought together a series of experts in different fields, including doctors, nurses, representatives of patient associations, health managers and economists, health authorities and journalists to deal with this issue. The format was that of a round table in which a series of questions previously formulated by the coordinators were to be answered and debated. The document presented is not an exhaustive review of the topic, nor is it intended to make recommendations, but only to give a multidisciplinary opinion on topics that could be particularly debatable or controversial. The paper reviews the main vaccine-preventable adult diseases, their clinical and economic impact, the possibilities of reducing them with vaccination programmes and the difficulties in carrying them out. The role of nursing, pharmacy services, patient associations and the health administration itself in changing the current situation was discussed. Prospects for new vaccines were discussed and we speculated on the future in this field. Finally, particularly relevant ethical aspects in decision-making regarding vaccination were discussed, which must be faced by both individuals and states. We have tried to summarize, at the end of the presentation of each question, the environment of opinion that was agreed with all the members of the table.

Coverage of human papillomavirus vaccination during the first year of its introduction in Spain.

The decision to introduce human papillomavirus (HPV) vaccination into the national immunisation programme in Spain was made in October 2007, recommending vaccination of girls aged between 11 and 14 years with three doses of HPV vaccine. All 19 regions of the country (17 Autonomous Communities and two Autonomous Cities) introduced HPV vaccination gradually into their immunisation programmes between November 2007 and the last school term of 2008. Eight regions administered the vaccine in healthcare centres and 11 in schools. In the first year of the introduction of HPV vaccination, coverage of the first and third doses was assessed, to determine the proportion of girls who did not complete the vaccination. On the basis of the available data, the Ministry of Health estimated that coverage for the first dose was 87.2% (range: 73.9­98.9%; 95% CI: 71.8 to 100) and 77.3% (range: 62.2­97.4%; 95% CI: 57.9 to 96.7) for the third dose. Higher uptake was observed when the vaccination was carried out in schools compared with healthcare centres, but the difference was not statistically significant. Negative messages in the media during implementation of the HPV vaccination programme may have had some influence on the attitudes of adolescent girls and/or their parents towards HPV vaccination and may be partly responsible for the observed vaccination dropout rate.

Understanding catalysed growth of single-wall carbon nanotubes.

Classical molecular dynamics simulations using a reactive force field, which allows simulation of bond-breaking and bond-forming, are carried out to investigate the several stages of a catalysed synthesis process of single-wall carbon nanotubes. The simulations assume instantaneous catalysis of a precursor gas on the surface of metallic nanoclusters, illustrating how carbon atoms dissolve in the metal cluster and then precipitate on its surface, evolving into various carbon structures, finally forming a cap which eventually grows to a single-wall nanotube. The results are discussed in the context of experimental synthesis results.

Characterization and expression of secA in Mycobacterium avium.

Mycobacterium avium is both a pathogen that infects several hosts such as humans, pigs, and birds, as well as a microorganism that is encountered in environmental sources (soil and water). Protein secretion by the bacterium is likely to influence its ability to overcome adverse and competitive conditions both within or outside the host. Using a combination of cloning and information available in the databank, we characterized the secA gene from M. avium, encoding for a major preprotein translocase subunit associated with the secretion system of prokaryotics. In addition, we cloned the secA promoter sequence in a reporter construct upstream of a promoterless gfp. It was determined that the secA of M. avium shares large homology with the secA of Mycobacterium tuberculosis but not with secA of Mycobacterium leprae. secA expression was determined to be greater at logarithmic growth phase although it was also expressed at low levels during the stationary phase. secA expression was also observed when the bacteria were incubated in water as well as within human monocyte-derived macrophages and in conditions that are associated with biofilm formation. Future evaluation of the sec pathway in M. avium might provide important information about secreted proteins that are required for survival in different environments.

Comparison of three methods for identification of Streptococcus milleri group isolates to species level.

A collection of 180 clinical isolates of Streptococcus milleri group were identified to species level using two phenotypic methods (a commercial system and the reference method based on differential phenotypic reactions) and a genotypic method (hybridisation of the 16S rRNA gene with species-specific probes) in order to evaluate the performance of the respective methods. A high level of agreement (80%) was observed between the results of the reference method and the genotypic method. The highest level of agreement was found for the species Streptococcus anginosus (83%), a high level of agreement (76%) also being achieved for Streptococcus constellatus and Streptococcus intermedius. The sensitivity of the commercial system compared to the genotypic method was 76% overall, but it was low (57.5%) for Streptococcus intermedius. Twenty-five strains belonged to the recently described CI strains.

Five-year analysis of antimicrobial susceptibility of the Streptococcus milleri group.

Susceptibility to 17 antibiotics was studied in 180 strains of the Streptococcus milleri group (88 Streptococcus anginosus, 63 Streptococcus constellatus, and 29 Streptococcus intermedius) isolated over a 5-year period. Minimum inhibitory concentrations of penicillin were in the intermediate range for 5.6% of the strains. Resistance to erythromycin and clindamycin was found in 17.1% and 16.6% of the isolates, respectively. A steady increase in the susceptibility to ciprofloxacin was observed over the study period. Imipenem was the most active beta-lactam agent tested. Glycopeptide antibiotics showed excellent activity. Only slight differences between the three species were found in terms of antibiotic susceptibility. Intermediate resistance to penicillin is appearing among the Streptococcus milleri group in our area; consequently, care must be taken when choosing a macrolide for the management of infections caused by these microorganisms.

[Phenotypic characterization of erythromycin resistance in strains of the genus Streptococcus isolated from clinical specimens]. / Caracterización fenotíouca de la resistencia a eritromicina en cepas del género Streptococcus aisladas de muestras clínicas.

There are presently two recognized mechanisms of resistance to macrolide antibiotics in species of the genus Streptococcus: target modification and efflux. Target modification occurs in the ribosomes through the production of a ribosomal methylase codified for the erm genes and it is phenotypically known as MLSB resistance. Expression of MLSB resistance can be inducible or constitutive. Active efflux has been recently described in S. pyogenes and S. pneumoniae, and its expression is known as M phenotype. We studied the susceptibility, by determining the MIC using agar dilution, to penicillin, erythromycin and clindamycin, of 295 strains of the genus Streptococcus clinically isolated from 1993 to 1996 (70 S. pyogenes, 81 S. pneumoniae, 37 viridans group, and 107 S. milleri). We also studied the phenotype pattern of erythromycin-clindamycin resistance in the strains resistant to erythromycin by using the double-disc test. We found a 17.2% resistance to erythromycin and a 12.5% resistance to clindamycin. The M phenotype, initially described in S. pyogenes, was also observed in 6.6% of our S. pneumoniae strains, 25% of S. viridans spp., and 4.8% in the S. milleri group.

Nosocomial septicemia caused by Serratia plymuthica.

We report a case of nosocomial septicemia in a 79-year-old patient caused by Serratia plymuthica with no evident focus of infection. The patient was treated with gentamicin (40 mg every 8 h) during 10 days; clinical resolution of the infection was obtained after the 10-day treatment period.