ABSTRACT
Introducción: Recientemente se ha aprobado en Europa y en España el uso de nirsevimab, un anticuerpo monoclonal (AcM) para la prevención de la enfermedad por virus respiratorio sincitial (VRS). Objetivos: Facilitar unas recomendaciones para la administración de nirsevimab para la prevención de la enfermedad por VRS. Métodos: Para la elaboración de estas recomendaciones, se decidió realizar una revisión crítica de la literatura, utilizando la metodología Delphi y la metodología GRADE. Se definió un grupo de expertos. Se realizaron tres rondas para definir las preguntas, manifestarse a favor o en contra, graduar la recomendación, y definir el acuerdo o el desacuerdo con las conclusiones. Resultados: En la población general de recién nacidos, se recomienda administrar rutinariamente nirsevimab para reducir la enfermedad y la hospitalización por bronquiolitis y enfermedad de vías bajas por VRS. Se recomienda administrar nirsevimab a todos los lactantes que nazcan en la estación de alta incidencia de VRS y aquellos que cuando esta comience, tengan menos de seis meses de edad. En los pacientes prematuros de 29 a 35 semanas de edad gestacional, en los lactantes con cardiopatía hemodinámicamente significativa y lactantes con enfermedad pulmonar crónica se recomienda rutinariamente administrar nirsevimab para reducir la enfermedad y la hospitalización por bronquiolitis y enfermedad de vías bajas por VRS. En los pacientes con indicación actual de palivizumab, se recomienda sustituir palivizumab por nirsevimab para reducir la carga de enfermedad de bronquiolitis. Conclusiones: Se recomienda administrar rutinariamente nirsevimab a todos los recién nacidos menores de seis meses nacidos en la estación de VRS o que tengan menos de seis meses cuando entran en la estación invernal, para reducir la carga de enfermedad y la hospitalización por bronquiolitis. (AU)
Introduction: Nirsevimab, a monoclonal antibody for the prevention of disease caused by respiratory syncytial virus (RSV), has recently been approved for use in Europe and Spain. Objectives: To provide recommendations for the administration of nirsevimab for prevention of RSV disease. Methods: The approach chosen to develop these recommendations involved a critical review of the literature and the use of the Delphi and GRADE methods. An expert group was formed. The group engaged in three rounds to define the questions, express support or opposition, grade recommendations and establish the agreement or disagreement with the conclusions. Results: In the general neonatal population, routine administration of nirsevimab is recommended to reduce the frequency of illness and hospitalisation for bronchiolitis and RSV lower respiratory tract infection. Nirsevimab is recommended for all infants born in high-incidence RSV season and infants aged less than 6 months at the season onset. In infants born preterm between 29 and 35 weeks of gestation, with haemodynamically significant heart disease or with chronic lung disease, routine administration of nirsevimab is recommended to reduce the incidence of disease and hospitalisation due to bronchiolitis and RSV lower respiratory tract infection. In patients in whom palivizumab is currently indicated, its substitution by nirsevimab is recommended to reduce the burden of bronchiolitis. Conclusions: Routine administration of nirsevimab to all infants aged less than 6 months born during the RSV season or aged less than 6 months at the start of the winter season is recommended to reduce the burden of disease and the frequency of hospitalization due to bronchiolitis. (AU)
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Antibodies, Monoclonal/administration & dosage , Antibodies, Monoclonal/therapeutic use , Respiratory Syncytial Viruses , Respiratory Syncytial Virus Infections/drug therapy , Respiratory Syncytial Virus Infections/prevention & control , BronchiolitisABSTRACT
INTRODUCTION: Nirsevimab, a monoclonal antibody for the prevention of disease caused by respiratory syncytial virus (RSV), has recently been approved for use in Europe and Spain. OBJECTIVES: To provide recommendations for the administration of nirsevimab for prevention of RSV disease. METHODS: The approach chosen to develop these recommendations involved a critical review of the literature and the use of the Delphi and GRADE methods. An expert group was formed. The group engaged in three rounds to define the questions, express support or opposition, grade recommendations and establish the agreement or disagreement with the conclusions. RESULTS: In the general neonatal population, routine administration of nirsevimab is recommended to reduce the frequency of illness and hospitalisation for bronchiolitis and RSV lower respiratory tract infection. Nirsevimab is recommended for all infants born in high-incidence RSV season and infants aged less than 6 months at the season onset. In infants born preterm between 29 and 35 weeks of gestation, with haemodynamically significant heart disease or with chronic lung disease, routine administration of nirsevimab is recommended to reduce the incidence of disease and hospitalisation due to bronchiolitis and RSV lower respiratory tract infection. In patients in whom palivizumab is currently indicated, its substitution by nirsevimab is recommended to reduce the burden of bronchiolitis. CONCLUSIONS: Routine administration of nirsevimab to all infants aged less than 6 months born during the RSV season or aged less than 6 months at the start of the winter season is recommended to reduce the burden of disease and the frequency of hospitalization due to bronchiolitis.
Subject(s)
Bronchiolitis , Communicable Diseases , Respiratory Syncytial Virus Infections , Respiratory Syncytial Virus, Human , Respiratory Tract Infections , Infant, Newborn , Infant , Humans , Child , Antiviral Agents/therapeutic use , Respiratory Syncytial Virus Infections/prevention & control , Respiratory Tract Infections/drug therapy , Respiratory Tract Infections/prevention & control , Bronchiolitis/drug therapy , Bronchiolitis/prevention & controlABSTRACT
The influenza virus has accompanied humans since time immemorial, in the form of annual epidemics and occasional pandemics. It is a respiratory infection with multiple repercussions on people's lives at an individual and social level, as well as representing a significant burden on the health system. This Consensus Document arises from the collaboration of various Spanish scientific societies involved in influenza virus infection. The conclusions drawn are based on the highest quality evidence available in the scientific literature and, failing that, on the opinion of the experts convened. The Consensus Document addresses the clinical, microbiological, therapeutic, and preventive aspects (with respect to the prevention of transmission and in relation to vaccination) of influenza, for both adult and pediatric populations. This Consensus Document aims to help facilitate the clinical, microbiological, and preventive approach to influenza virus infection and, consequently, to reduce its important consequences on the morbidity and mortality of the population.(AU)
El virus de la gripe ha acompañado al ser humano desde tiempo inmemorial, en forma de epidemias anuales y pandemias ocasionales. Se trata de una infección respiratoria con múltiples repercusiones sobre la vida de las personas a nivel individual y social, así como una importante sobrecarga para el sistema sanitario. El presente documento de consenso surge de la colaboración de diversas sociedades científicas españolas implicadas en la atención de la infección por virus de la gripe. Las conclusiones extraídas se han fundamentado en las evidencias de mayor calidad disponibles en la literatura científica y, en su defecto, en la opinión de los expertos convocados. En el documento de consenso se abordan los aspectos clínicos, microbiológicos, terapéuticos y preventivos (respecto de la prevención de la transmisión y con relación a la vacunación) de la gripe, tanto para población pediátrica como para adultos. Este documento de consenso pretende ayudar a facilitar el abordaje clínico, microbiológico y preventivo de la infección por virus de la gripe y, consecuentemente, a disminuir sus importantes consecuencias sobre la morbimortalidad de la población.(AU)
Subject(s)
Humans , Influenza, Human/diagnosis , Influenza, Human/drug therapy , Influenza Vaccines , Vaccination , Influenza, Human/prevention & control , Consensus , Consensus Development Conferences as Topic , Spain , Respiratory Tract InfectionsABSTRACT
The influenza virus has accompanied humans since time immemorial, in the form of annual epidemics and occasional pandemics. It is a respiratory infection with multiple repercussions on people's lives at an individual and social level, as well as representing a significant burden on the health system. This Consensus Document arises from the collaboration of various Spanish scientific societies involved in influenza virus infection. The conclusions drawn are based on the highest quality evidence available in the scientific literature and, failing that, on the opinion of the experts convened. The Consensus Document addresses the clinical, microbiological, therapeutic, and preventive aspects (with respect to the prevention of transmission and in relation to vaccination) of influenza, for both adult and pediatric populations. This Consensus Document aims to help facilitate the clinical, microbiological, and preventive approach to influenza virus infection and, consequently, to reduce its important consequences on the morbidity and mortality of the population.
Subject(s)
Communicable Diseases , Influenza, Human , Orthomyxoviridae , Adult , Child , Humans , Influenza, Human/diagnosis , Influenza, Human/prevention & control , Public Health , Community Medicine , VaccinologyABSTRACT
El virus de la gripe ha acompañado al ser humano desde tiempo inmemorial, en forma de epidemias anuales y pandemias ocasionales. Se trata de una infección respiratoria con múltiples repercusiones sobre la vida de las personas a nivel individual y social y supone una importante sobrecarga para el sistema sanitario. El presente documento de consenso surge de la colaboración de diversas sociedades científicas españolas implicadas en la atención de la infección por el virus de la gripe. Las conclusiones extraídas se han fundamentado en las evidencias de mayor calidad disponibles en la literatura científica y, en su defecto, en la opinión de los expertos convocados. En el documento de consenso se abordan los aspectos clínicos, microbiológicos, terapéuticos y preventivos (respecto de la prevención de la transmisión y en relación con la vacunación) de la gripe, tanto en población pediátrica como en adultos. Este documento de consenso aspira a contribuir a facilitar el abordaje clínico, microbiológico y preventivo de la infección por el virus de la gripe y, consecuentemente, a disminuir sus importantes consecuencias sobre la morbimortalidad de la población. (AU)
The influenza virus has accompanied humans since time immemorial, in the form of annual epidemics and occasional pandemics. It is a respiratory infection with multiple repercussions on people's lives at an individual and social level, as well as representing a significant burden on the health system. This Consensus Document arises from the collaboration of various Spanish scientific societies involved in influenza virus infection. The conclusions drawn are based on the highest quality evidence available in the scientific literature and, failing that, on the opinion of the experts convened. The Consensus Document addresses the clinical, microbiological, therapeutic, and preventive aspects (with respect to the prevention of transmission and in relation to vaccination) of influenza, for both adult and pediatric populations. This Consensus Document aims to help facilitate the clinical, microbiological, and preventive approach to influenza virus infection and, consequently, to reduce its important consequences on the morbidity and mortality of the population. (AU)
Subject(s)
Humans , Antibiotic Prophylaxis , Influenza, Human/diagnosis , Influenza, Human/drug therapy , Spain , SocietiesABSTRACT
The influenza virus has accompanied humans since time immemorial, in the form of annual epidemics and occasional pandemics. It is a respiratory infection with multiple repercussions on people's lives at an individual and social level, as well as representing a significant burden on the health system. This Consensus Document arises from the collaboration of various Spanish scientific societies involved in influenza virus infection. The conclusions drawn are based on the highest quality evidence available in the scientific literature and, failing that, on the opinion of the experts convened. The Consensus Document addresses the clinical, microbiological, therapeutic, and preventive aspects (with respect to the prevention of transmission and in relation to vaccination) of influenza, for both adult and pediatric populations. This Consensus Document aims to help facilitate the clinical, microbiological, and preventive approach to influenza virus infection and, consequently, to reduce its important consequences on the morbidity and mortality of the population.
Subject(s)
Communicable Diseases , Influenza, Human , Orthomyxoviridae , Adult , Child , Humans , Influenza, Human/diagnosis , Influenza, Human/prevention & control , Influenza, Human/drug therapy , Public Health , Community Medicine , VaccinologyABSTRACT
The inï¬uenza virus has accompanied humans since time immemorial, in the form of annual epidemics and occasional pandemics. It is a respiratory infection with multiple repercussions on people's lives at an individual and social level, as well as representing a signiï¬cant burden on the health system. This Consensus Document arises from the collaboration of various Spanish scientiï¬c societies involved in inï¬uenza virus infection. The conclusions drawn are based on the highest quality evidence available in the scientiï¬c literature and, failing that, on the opinion of the experts convened. The Consensus Document addresses the clinical, microbiological, therapeutic, and preventive aspects (with respect to the prevention of transmission and in relation to vaccination) of inï¬uenza, for both adult and pediatric populations. This Consensus Document aims to help facilitate the clinical, microbiological, and preventive approach to inï¬uenza virus infection and, consequently, to reduce its important consequences on the morbidity and mortality of the population.
Subject(s)
Communicable Diseases , Influenza, Human , Orthomyxoviridae , Child , Adult , Humans , Influenza, Human/diagnosis , Influenza, Human/prevention & control , Public Health , Community Medicine , VaccinologyABSTRACT
The influenza virus has accompanied humans since time immemorial, in the form of annual epidemics and occasional pandemics. It is a respiratory infection with multiple repercussions on people's lives at an individual and social level, as well as representing a significant burden on the health system. This Consensus Document arises from the collaboration of various Spanish scientific societies involved in influenza virus infection. The conclusions drawn are based on the highest quality evidence available in the scientific literature and, failing that, on the opinion of the experts convened. The Consensus Document addresses the clinical, microbiological, therapeutic, and preventive aspects (with respect to the prevention of transmission and in relation to vaccination) of influenza, for both adult and pediatric populations. This Consensus Document aims to help facilitate the clinical, microbiological, and preventive approach to influenza virus infection and, consequently, to reduce its important consequences on the morbidity and mortality of the population.(AU)
El virus de la gripe ha acompañado al ser humano desde tiempo inmemorial, en forma de epidemias anuales y pandemias ocasionales. Se trata de una infección respiratoria con múltiples repercusiones sobre la vida de las personas a nivel individual y social, así como una importante sobrecarga para el sistema sanitario. El presente documento de consenso surge de la colaboración de diversas sociedades científicas españolas implicadas en la atención de la infección por virus de la gripe. Las conclusiones extraídas se han fundamentado en las evidencias de mayor calidad disponibles en la literatura científica y, en su defecto, en la opinión de los expertos convocados. En el documento de consenso se abordan los aspectos clínicos, microbiológicos, terapéuticos y preventivos (respecto de la prevención de la transmisión y en relación con la vacunación) de la gripe, tanto para población pediátrica como para adultos. Este documento de consenso pretende ayudar a facilitar el abordaje clínico, microbiológico y preventivo de la infección por virus de la gripe y, consecuentemente, a disminuir sus importantes consecuencias sobre la morbimortalidad de la población.(AU)
Subject(s)
Humans , Influenza A virus , Influenza, Human , Diagnosis , Therapeutics , Disease Prevention , Influenza Vaccines , Communicable Diseases , Spain , ConsensusABSTRACT
The influenza virus has accompanied humans since time immemorial, in the form of annual epidemics and occasionalpandemics. It is a respiratory infection with multiple repercussions on peoples lives at an individual and sociallevel, as well as representing a significant burden on the health system. This Consensus Document arises from thecollaboration of various Spanish scientific societies involved in influenza virus infection. The conclusions drawn arebased on the highest quality evidence available in the scientific literature and, failing that, on the opinion of theexperts convened. The Consensus Document addresses the clinical, microbiological, therapeutic, and preventiveaspects (with respect to the prevention of transmission and in relation to vaccination) of influenza, for both adult andpediatric populations. This Consensus Document aims to help facilitate the clinical, microbiological, and preventiveapproach to influenza virus infection and, consequently, to reduce its important consequences on the morbidity andmortality of the population.(AU)
El virus de la gripe ha acompañado al ser humano desde tiempo inmemorial, en forma de epidemias anuales ypandemias ocasionales. Se trata de una infección respiratoria con múltiples repercusiones sobre la vida de las personasa nivel individual y social, así como una importante sobrecarga para el sistema sanitario. El presente documentode consenso surge de la colaboración de diversas sociedades científicas españolas implicadas en la atención de lainfección por virus de la gripe. Las conclusiones extraídas se han fundamentado en las evidencias de mayor calidaddisponibles en la literatura científica y, en su defecto, en la opinión de los expertos convocados. En el documento deconsenso se abordan los aspectos clínicos, microbiológicos, terapéuticos y preventivos (respecto de la prevención dela transmisión y en relación con la vacunación) de la gripe, tanto para población pediátrica como para adultos. Estedocumento de consenso pretende ayudar a facilitar el abordaje clínico, microbiológico y preventivo de la infecciónpor virus de la gripe y, consecuentemente, a disminuir sus importantes consecuencias sobre la morbimortalidad dela población.(AU)
Subject(s)
Humans , Consensus , Influenza A virus , Influenza, Human/microbiology , Influenza, Human/prevention & control , Infections , Microbiology , Indicators of Morbidity and Mortality , Delivery of Health Care , Public Health , Preventive Medicine , SpainABSTRACT
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/epidemiologyABSTRACT
No disponible
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Young Adult , Adult , Middle Aged , Pharyngitis/diagnosis , Pharyngitis/drug therapy , Tonsillitis/diagnosis , Tonsillitis/drug therapy , Consensus Development Conferences as Topic , Acute Disease , Pharyngitis/complications , Tonsillitis/complications , Practice Guidelines as TopicABSTRACT
An update of the Spanish consensus document on the diagnosis and treatment of acute tonsillopharyngitis is presented. Clinical scores should not be used to prescribe antibiotics, unless microbiological tests are not available or there is a child at risk of rheumatic fever. There is no score better than those set out in the previous consensus. Microbiological tests are recommended in proposed cases, regardless of the result of the scores. Penicillin is the treatment of choice, prescribed twice a day for 10 days. Amoxicillin is the first alternative, prescribed once or twice a day for the same time. First-generation cephalosporins are the treatment of choice in children with non-immediate reaction to penicillin or amoxicillin. Josamycin and midecamycin are the best options for children with immediate penicillin allergic reactions, when non-beta-lactam antibiotics should be used. In microbiological treatment failure, and in streptococcal carriers, the treatments proposed in the previous consensus are still applicable.
Subject(s)
Anti-Bacterial Agents/administration & dosage , Pharyngitis/therapy , Tonsillitis/therapy , Acute Disease , Child , Humans , Pharyngitis/diagnosis , Spain , Tonsillitis/diagnosisABSTRACT
Introducción: La gripe es una enfermedad generalmente benigna, pero en ocasiones puede ocasionar complicaciones graves. Existe controversia sobre los beneficios del tratamiento con antivirales. Objetivos: Proporcionar unas recomendaciones sobre el tratamiento con oseltamivir en pacientes pediátricos con gripe, basadas en los mejores datos disponibles y válidas en nuestro medio. Métodos: El Grupo de Infecciones Respiratorias de la Sociedad Española de Infectología Pediátrica llevó a cabo una revisión de la bibliografía. Los hallazgos se analizaron mediante la metodología GRADE, y se elaboraron unas recomendaciones. Resultados: No se recomienda el uso sistemático de pruebas diagnósticas para la gripe en el ámbito ambulatorio y en urgencias hospitalarias en pacientes inmunocompetentes con un cuadro clínico compatible. No se recomienda el uso de antivirales a la gran mayoría de los pacientes sanos y asmáticos con gripe o sospecha de gripe estacional, si el objetivo es prevenir eventos graves. No se recomienda el uso de oseltamivir de forma sistemática en pacientes hospitalizados con gripe. Se recomienda tratar con oseltamivir a los pacientes con gripe y neumonía o enfermedad grave o a los pacientes críticos, especialmente durante las primeras 48 h de enfermedad. Se recomienda el tratamiento de los pacientes con factores de riesgo, teniendo en cuenta su enfermedad de base. La vacunación antigripal, junto a las medidas básicas de evitación, continúan siendo la principal herramienta en la prevención de la gripe. Conclusión: En algunas situaciones hay datos suficientes para emitir recomendaciones claras. En otras situaciones los datos son incompletos y solo permiten hacer recomendaciones débiles
Introduction: Influenza is a generally a benign disease, but occasionally it can cause serious complications. There is controversy about the benefits of antiviral treatment. Objectives: To provide some recommendations on the treatment with oseltamivir in paediatric patients with influenza, based on the best data available and valid in our environment. Methods: The Respiratory Infections Group of the Spanish Society of Paediatric Infectious Diseases carried out a review of the literature. The findings were analysed using the GRADE methodology, and recommendations were made. Results: The systematic use of diagnostic tests for influenza in the outpatient setting, or in the emergency room, in immunocompetent patients with a compatible clinical picture is not recommended. If the aim is to prevent serious events, the use of antivirals is not recommended for the vast majority of healthy and asthmatic patients with influenza or suspected seasonal flu. The systematic use of oseltamivir in patients admitted to hospital with influenza is not recommended. Oseltamivir treatment is recommended in any patients with influenza and pneumonia or severe illness, and critically ill patients, especially during the first 48 hours of illness. The treatment of patients with risk factors is recommended, considering their underlying disease. Influenza vaccination, together with basic isolation measures, continue to be the main tool in the prevention of influenza. Conclusion: In some situations, there are sufficient data to issue clear recommendations. In other situations, the data are incomplete, and only allows weak recommendations
Subject(s)
Humans , Child , Adolescent , Antiviral Agents/administration & dosage , Influenza, Human/drug therapy , Oseltamivir/administration & dosage , Age Factors , Antiviral Agents/adverse effects , Critical Illness , Influenza, Human/complications , Influenza, Human/diagnosis , Oseltamivir/adverse effects , Risk Factors , Time FactorsABSTRACT
INTRODUCTION: Influenza is a generally a benign disease, but occasionally it can cause serious complications. There is controversy about the benefits of antiviral treatment. OBJECTIVES: To provide some recommendations on the treatment with oseltamivir in paediatric patients with influenza, based on the best data available and valid in our environment. METHODS: The Respiratory Infections Group of the Spanish Society of Paediatric Infectious Diseases carried out a review of the literature. The findings were analysed using the GRADE methodology, and recommendations were made. RESULTS: The systematic use of diagnostic tests for influenza in the outpatient setting, or in the emergency room, in immunocompetent patients with a compatible clinical picture is not recommended. If the aim is to prevent serious events, the use of antivirals is not recommended for the vast majority of healthy and asthmatic patients with influenza or suspected seasonal flu. The systematic use of oseltamivir in patients admitted to hospital with influenza is not recommended. Oseltamivir treatment is recommended in any patients with influenza and pneumonia or severe illness, and critically ill patients, especially during the first 48hours of illness. The treatment of patients with risk factors is recommended, considering their underlying disease. Influenza vaccination, together with basic isolation measures, continue to be the main tool in the prevention of influenza. CONCLUSION: In some situations, there are sufficient data to issue clear recommendations. In other situations, the data are incomplete, and only allows weak recommendations.
Subject(s)
Antiviral Agents/administration & dosage , Influenza, Human/drug therapy , Oseltamivir/administration & dosage , Adolescent , Age Factors , Antiviral Agents/adverse effects , Child , Critical Illness , Humans , Influenza, Human/complications , Influenza, Human/diagnosis , Oseltamivir/adverse effects , Risk Factors , Time FactorsABSTRACT
INTRODUCTION: Influenza infection in infants and children has been classically underestimated due to its non-specific symptoms, which sometimes overlap those of other respiratory viruses. Infants under 24 months are a risk group and school-aged children are a major source of influenza infection. The aim of this study was to describe the clinical and epidemiological characteristics of children hospitalized for flu, including co-infections and the differences as compared to other respiratory viruses. The effectiveness of a test for rapid diagnosis of this condition was assessed. MATERIAL AND METHODS: Prospective, descriptive study in children < 5 years of age hospitalized from 1 December 2003 to 28 February 2004 with respiratory processes or fever of unknown origin. Polymerase chain reaction (PCR) testing for influenza A (IA) and B, respiratory syncytial virus A (RSV-A) and B, and parainfluenza 1, 2 and 3 was performed in nasopharyngeal aspirate, as well as a test for rapid diagnosis of influenza. RESULTS: A total of 203 samples were included. PCR was positive for influenza in 11.3% (23/203); IA in 21 cases (20 H3N2, 1 H1N1). Co-infections were frequent (10/23), mainly IA with RSV-A. The rapid diagnostic test had a sensitivity of 45.5%. Median age of patients with flu was 4.87 months (5 days-3.5 years); 69.5% were < 24 months. Gastrointestinal symptoms were associated with fever and respiratory symptoms more often than in other viral infections (P < 0.05). Only 2.9% of patients with a recommendation for flu vaccination had received the vaccination. CONCLUSIONS: Flu is a major cause of hospitalization in infants and children, particularly those aged < 24 months. Early diagnosis of this condition may avoid unnecessary use of additional tests and antibiotics. Vaccination coverage is low; vaccination between 6 and 24 months seems advisable.
Subject(s)
Hospitalization/statistics & numerical data , Influenza, Human/epidemiology , Adolescent , Child , Child, Preschool , Comorbidity , Early Diagnosis , Female , Hospitals, Maternity/statistics & numerical data , Hospitals, Pediatric/statistics & numerical data , Humans , Infant , Influenza A Virus, H1N1 Subtype/isolation & purification , Influenza A Virus, H3N2 Subtype/isolation & purification , Influenza Vaccines , Influenza, Human/diagnosis , Influenza, Human/virology , Male , Nasopharynx/virology , Polymerase Chain Reaction , Prospective Studies , RNA, Viral/blood , Risk Factors , Spain/epidemiology , Vaccination/statistics & numerical data , Viremia/diagnosis , Viremia/epidemiology , Viremia/virologyABSTRACT
Introducción. La gripe en pediatría ha sido clásicamente infradiagnosticada, por su clínica inespecífica y solapable con otros virus respiratorios. Los menores de 24 meses constituyen un grupo de riesgo y los escolares son una fuente importante de contagio. El objetivo de este estudio es describir la clínica y epidemiología de niños ingresados por gripe, estudiando coinfecciones y comparando con otros virus respiratorios. Se valoró la efectividad de un test de diagnóstico rápido. Material y métodos. Estudio descriptivo prospectivo en menores de 5 años hospitalizados entre el 1 de diciembre de 2003 y el 28 de febrero de 2004 por cuadro respiratorio o fiebre sin foco aparente. Se realizó reacción en cadena de polimerasa (PCR) a virus de la gripe A (IA) y B, virus respiratorio sincitial A (VRS-A) y B y parainfluenza 1, 2 y 3 en aspirado nasofaríngeo y test de diagnóstico rápido de gripe. Resultados. Se incluyeron 203 muestras, siendo la PCR positiva a virus de la gripe en un 11,3% (23/203): IA 21 casos (20 H3N2, 1 H1N1). Las coinfecciones fueron frecuentes (10/23), destacando la asociación IA y VRS-A. El test de diagnóstico rápido tuvo una sensibilidad del 45,5%. La mediana de edad de los pacientes con gripe fue 4,87 meses (5 días-3,5 años); un 69,5% eran menores 24 meses. A la fiebre y síntomas respiratorios, asociaron síntomas gastrointestinales con más frecuencia que los otros virus (p < 0,05). Sólo un 2,9% de los pacientes con indicación de vacunación antigripal la había recibido. Conclusiones. La gripe es causa importante de hospitalización en pediatría, especialmente en menores 24 meses. Su diagnóstico precoz evitaría el uso innecesario de pruebas complementarias y antibióticos. Existe una baja cobertura vacunal. Sería interesante la vacunación entre los 6 y los 24 meses (AU)
Introduction. Influenza infection in infants and children has been classically underestimated due to its non-specific symptoms, which sometimes overlap those of other respiratory viruses. Infants under 24 months are a risk group and school-aged children are a major source of influenza infection. The aim of this study was to describe the clinical and epidemiological characteristics of children hospitalized for flu, including co-infections and the differences as compared to other respiratory viruses. The effectiveness of a test for rapid diagnosis of this condition was assessed. Material and methods. Prospective, descriptive study in children < 5 years of age hospitalized from 1 December 2003 to 28 February 2004 with respiratory processes or fever of unknown origin. Polymerase chain reaction (PCR) testing for influenza A (IA) and B, respiratory syncytial virus A (RSV-A) and B, and parainfluenza 1, 2 and 3 was performed in nasopharyngeal aspirate, as well as a test for rapid diagnosis of influenza. Results. A total of 203 samples were included. PCR was positive for influenza in 11.3% (23/203); IA in 21 cases (20 H3N2, 1 H1N1). Co-infections were frequent (10/23), mainly IA with RSV-A. The rapid diagnostic test had a sensitivity of 45.5%. Median age of patients with flu was 4.87 months (5 days-3.5 years); 69.5% were < 24 months. Gastrointestinal symptoms were associated with fever and respiratory symptoms more often than in other viral infections (P < 0.05). Only 2.9% of patients with a recommendation for flu vaccination had received the vaccination. Conclusions. Flu is a major cause of hospitalization in infants and children, particularly those aged < 24 months. Early diagnosis of this condition may avoid unnecessary use of additional tests and antibiotics. Vaccination coverage is low; vaccination between 6 and 24 months seems advisable (AU)
