Causas de ingresos no deseados tras la realización de procedimientos quirúrgicos de cirugía ortopédica y traumatología en cirugía mayor ambulatoria / Causes of unplanned admission after orthopedic procedures in ambulatory surgery

OBJETIVO: Los procedimientos de cirugía ortopédica y traumatología realizados en unidades de cirugía mayor ambulatoria ofrecen importantes ventajas que desaparecen cuando la recuperación postoperatoria no es la esperada y los pacientes precisan ingresar. El objetivo de este estudio es analizar las causas de ingresos no deseados tras intervenciones quirúrgicas de cirugía ortopédica y traumatología en una unidad de cirugía mayor ambulatoria en relación con variables como edad, riesgo anestésico, tipo de anestesia, procedimiento o duración. MÉTODOS: Estudio de cohorte ambispectivo sobre 5.085 pacientes intervenidos desde 1995 a 2017. Se analizaron 39 variables proporcionadas por la base de datos de la unidad que se abre al ingreso en la misma y se cierra el día 30 postoperatorio. RESULTADOS: El 98,2% de los pacientes fueron dados de alta de la unidad. Precisaron ingresar 74 (1,5%). Este porcentaje demostró diferencias significativas en relación con el tipo de procedimiento, el tipo de anestesia y la duración, que condicionaron el ingreso inmediato por mal control del dolor agudo postoperatorio, náuseas o alteraciones de la herida. Diecisiete pacientes (0,3%) precisaron un ingreso diferido por complicaciones surgidas en el domicilio, siendo la más frecuente la infección de la herida. CONCLUSIONES: Los ingresos no deseados se relacionan con mayor frecuencia con el empleo de anestesia general, con operaciones de mayor duración y con procedimientos como la cirugía artroscópica, las correcciones de hallux valgus o las retiradas de material de osteosíntesis, siendo las causas de ingreso más importantes el mal control del dolor agudo postoperatorio en los inmediatos y la infección de la herida en los diferidos

OBJECTIVE: Orthopaedic procedures performed in Day Surgery Units provide important advantages which disappear when patients require admission when postoperative recovery is not as expected. The aim of this study was to analyse the reasons for unplanned hospital admissions after orthopaedic procedures in a Day Surgery Unit and their relationship between variables such as patient age, anaesthetic risk and technique, procedure or duration. METHODS: Ambispective cohort study of 5,085 patients who underwent surgical orthopaedic procedures between 1995 and 2017. Thirty-nine variables provided by the Unit's database were analysed. The database was opened on the day of admission and closed the 30th postoperative day. RESULTS: Of the patients, 98.2% were discharged from the Unit. Seventy-four (1.5%) required overnight admission. This percentage showed significant differences in relation to the type of procedure, type of anaesthesia and duration, which conditioned overnight admission due to inadequate postoperative pain management, nausea or wound complications. Seventeen patients (0.3%) required readmission after discharge due to complications that arose at home, such as wound infection, which was the most common. CONCLUSIONS: Unplanned admissions are more frequently related to general anaesthesia, lengthy surgeries and procedures such as arthroscopy, hallux valgus corrections or removal of osteosynthesis material. The major reasons for unplanned admissions were inadequate postoperative pain management for overnight admissions and wound infection for admissions after discharge

Causes of unplanned admission after orthopedic procedures in ambulatory surgery. / Causas de ingresos no deseados tras la realización de procedimientos quirúrgicos de cirugía ortopédica y traumatología en cirugía mayor ambulatoria.

OBJECTIVE: Orthopaedic procedures performed in Day Surgery Units provide important advantages which disappear when patients require admission when postoperative recovery is not as expected. The aim of this study was to analyse the reasons for unplanned hospital admissions after orthopaedic procedures in a Day Surgery Unit and their relationship between variables such as patient age, anaesthetic risk and technique, procedure or duration. METHODS: Ambispective cohort study of 5,085 patients who underwent surgical orthopaedic procedures between 1995 and 2017. Thirty-nine variables provided by the Unit's database were analysed. The database was opened on the day of admission and closed the 30th postoperative day. RESULTS: Of the patients, 98.2% were discharged from the Unit. Seventy-four (1.5%) required overnight admission. This percentage showed significant differences in relation to the type of procedure, type of anaesthesia and duration, which conditioned overnight admission due to inadequate postoperative pain management, nausea or wound complications. Seventeen patients (0.3%) required readmission after discharge due to complications that arose at home, such as wound infection, which was the most common. CONCLUSIONS: Unplanned admissions are more frequently related to general anaesthesia, lengthy surgeries and procedures such as arthroscopy, hallux valgus corrections or removal of osteosynthesis material. The major reasons for unplanned admissions were inadequate postoperative pain management for overnight admissions and wound infection for admissions after discharge.

Desarrollo histórico de la traumatología y de la cirugía ortopédica a partir del siglo XV / Historical development of traumatology and orthopedic surgery from the XV century

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[Immunisation schedule of the Spanish Association of Paediatrics: 2016 recommendations]. / Calendario de vacunaciones de la Asociación Española de Pediatría (CAV-AEP): recomendaciones 2016.

The Advisory Committee on Vaccines of the Spanish Association of Paediatrics (CAV-AEP) annually publishes the immunisation schedule which, in our opinion, estimates optimal for children resident in Spain, considering available evidence on current vaccines. We acknowledge the effort of the Ministry of Health during the last year in order to optimize the funded unified Spanish vaccination schedule, with the recent inclusion of pneumococcal and varicella vaccination in early infancy. Regarding the funded vaccines included in the official unified immunization schedule, taking into account available data, CAV-AEP recommends 2+1 strategy (2, 4 and 12 months) with hexavalent (DTPa-IPV-Hib-HB) vaccines and 13-valent pneumococcal conjugate vaccine. Administration of Tdap and poliomyelitis booster dose at the age of 6 is recommended, as well as Tdap vaccine for adolescents and pregnant women, between 27-36 weeks gestation. The two-dose scheme should be used for MMR (12 months and 2-4 years) and varicella (15 months and 2-4 years). Coverage of human papillomavirus vaccination in girls aged 11-12 with a two dose scheme (0, 6 months) should be improved. Information for male adolescents about potential beneficial effects of this immunisation should be provided as well. Regarding recommended unfunded immunisations, CAV-AEP recommends the administration of meningococcal B vaccine, due to the current availability in Spanish communitary pharmacies, with a 3+1 scheme (3, 5, 7 and 13-15 months). CAV-AEP requests the incorporation of this vaccine in the funded unified schedule. Vaccination against rotavirus is recommended in all infants. Annual influenza immunisation and vaccination against hepatitis A are indicated in population groups considered at risk.

Novedades en las recomendaciones del Comité Asesor de Vacunas de la Asociación Española de Pediatría para el año 2016 / Recent developments in the recommendations of the Vaccine Advisory Committee of the Spanish Association of Pediatrics for the year 2016

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[Consensus position document on the child with an allergic reaction after vaccination or an allergy to vaccine components]. / Documento de consenso sobre la actitud ante un niño con una reacción alérgica tras la vacunación o alergia a componentes vacunales.

Vaccinations are one of the main public health tools for the control of vaccine-preventable diseases. If a child is labeled to have had an allergic reaction to a vaccine, the next immunizations will probably be suspended in that child, with the risks involved in this decision. The rate of severe allergic reactions is very low, ranging between 0.5-1/100,000 doses. The causes of allergic reactions to vaccines, more than the vaccine itself, are often due to residual protein components in the manufacturing process, such as gelatin or egg, and rarely to yeast or latex. Most of vaccine reactions are mild, localized at the site of injection, but in some circumstances, severe anaphylactic reactions can occur. If an immediate-type allergic reaction is suspected when vaccinating, or a child allergic to some of the vaccine components has to be vaccinated, a correct diagnosis of the possible allergy has to be made. The usual components of each vaccine should be known, in order to determine if vaccination can be performed safely on the child.

[Immunisation schedule of the Spanish Association of Paediatrics: 2015 recommendations]. / Calendario de vacunaciones de la Asociación Española de Pediatría: recomendaciones 2015.

The Advisory Committee on Vaccines of the Spanish Association of Paediatrics updates the immunisation schedule every year, taking into account epidemiological data as well as evidence on the safety, effectiveness and efficiency of current vaccines, including levels of recommendation. In our opinion, this is the optimal vaccination calendar for all children resident in Spain. Regarding the vaccines included in the official unified immunization schedule, the Committee emphasizes the administration of the first dose of hepatitis B either at birth or at 2 months of life; the recommendation of the first dose of MMR and varicella vaccine at the age of 12 months, with the second dose at the age of 2-3 years; DTaP or Tdap vaccine at the age of 6 years, followed by another Tdap booster dose at 11-12 years old; Tdap strategies for pregnant women and household contacts of the newborn, and immunization against human papillomavirus in girls aged 11-12 years old with a 2 dose scheme (0, 6 months). The Committee reasserts its recommendation to include vaccination against pneumococcal disease in the routine immunisation schedule, the same as it is being conducted in Western European countries. The recently authorised meningococcal B vaccine, currently blocked in Spain, exhibits the profile of a universal vaccine. The Committe insists on the need of having the vaccine available in communitary pharmacies. It has also proposed the free availability of varicella vaccines. Their efectiveness and safety have been confirmed when they are administred from the second year of life. Vaccination against rotavirus is recommended in all infants. The Committee stresses the need to vaccinate population groups considered at risk against influenza and hepatitis A.

[Vaccination against meningococcal B disease. Public statement of the Advisory Committee on Vaccines of the Spanish Association of Paediatrics (CAV-AEP)]. / Vacunación frente al meningococo B. Posicionamiento del Comité Asesor de Vacunas de la Asociación Española de Pediatría.

Meningococcal invasive disease, including the main clinical presentation forms (sepsis and meningitis), is a severe and potentially lethal infection caused by different serogroups of Neisseria meningitidis. Meningococcal serogroup B is the most prevalent in Europe. Most cases occur in children, with a mortality rate of 10% and a risk of permanent sequelae of 20-30% among survivors. The highest incidence and case fatality rates are observed in healthy children under 2-3 years old, followed by adolescents, although it can occur at any age. With the arrival in Spain of the only available vaccine against meningococcus B, the Advisory Committee on Vaccines of the Spanish Association of Paediatrics has analysed its preventive potential in detail, as well as its peculiar administrative situation in Spain. The purpose of this document is to publish the statement of the Committee as regards this vaccination and the access to it by the Spanish population, taking into account that it has been only authorized for people at risk. The vaccine is available free in the rest of Europe for those who want to acquire it, and in some countries and regions it has been introduced into the systematic immunisation schedules. The Committee considers that Bexsero® has a profile of a vaccine to be included in the official schedules of all the Spanish autonomous communities and insists on the need for it to be available in pharmacies for its administration in all children older than 2 months.

[Immunisation schedule of the Spanish Association of Paediatrics: 2014 recommendations]. / Calendario de vacunaciones de la Asociación Española de Pediatría: recomendaciones 2014.

The Advisory Committee on Vaccines of the Spanish Association of Paediatrics (CAV-AEP) updates the immunisation schedule every year, taking into account epidemiological data as well as evidence on safety, effectiveness and efficiency of vaccines. The present schedule includes levels of recommendation. We have graded, as routine vaccinations, those that the CAV-AEP consider all children should receive; as recommended those that fit the profile for universal childhood immunisation and would ideally be given to all children, but that can be prioritised according to the resources available for their public funding; and as risk group vaccinations those that specifically target individuals in special situations. Immunisation schedules tend to be dynamic and adaptable to ongoing epidemiological changes. Based on the latest epidemiological trends, CAV-AEP recommends the administration of the first dose of MMR and varicella vaccines at age 12 months, with the second dose at age 2-3 years; the administration of DTaP or Tdap vaccine at age 4-6 years, always followed by another Tdap dose at 11-12 years; and the three meningococcal C scheme at 2 months, 12 months and 12 years of age. It reasserts its recommendation to include vaccination against pneumococcal disease in the routine immunisation schedule. The CAV-AEP believes that the coverage of vaccination against human papillomavirus in girls aged 11-12 years must be increased. Universal vaccination against varicella in the second year of life is an effective strategy, and the immediate public availability of the vaccine is requested in order to guarantee the right of healthy children to be vaccinated. Vaccination against rotavirus is recommended in all infants due to the morbidity and elevated healthcare burden of the virus. The Committee stresses the need to vaccinate population groups considered at risk against influenza and hepatitis A. The recently authorised meningococcal B vaccine has opened a chapter of hope in the prevention of this disease. In anticipation of upcoming national and international studies, the Committee recommends the vaccine for the control of disease outbreaks, and insists on the need to be available in pharmacies. Finally, it emphasises the need to bring incomplete vaccinations up to date following the catch-up immunisation schedule.

Trombosis y obstrucción asociadas a vías venosas centrales. Incidencia y factores de riesgo / Thrombosis and obstruction associated with central venous lines. Incidence and risk factors

Objetivo: Analizar la incidencia de trombosis y obstrucción asociada a las vías centrales implantadas a niños críticamente enfermos y la determinación de sus factores de riesgo. Diseño: Estudio prospectivo observacional, desarrollado en una unidad de cuidados intensivos pediátrica de un hospital universitario. Material y método: Se analizaron 825 catéteres venosos centrales (CVC) insertados en 546 pacientes. Se recogieron la edad, el sexo, el peso, el tipo de catéter (luces, tamaño, marca), la localización final del catéter, la existencia de ventilación mecánica, el tipo de sedación y analgesia utilizado, el médico que realizó la técnica, el fallo inicial del residente con posterior canalización por el adjunto, el número de intentos, la indicación, la enfermedad de base, el diagnóstico de ingreso, el tipo de cateterización (urgente, programada o recanalización) y las complicaciones mecánicas tardías (CMT). Se determinaron los factores de riesgo para estas complicaciones mediante un análisis de regresión múltiple. Resultados: Se registraron 52 CMT (6,14%), 42 obstrucciones y 10 trombosis. Las tasas de obstrucción y trombosis fueron de 4,96 y 1,18 por cada 100 CVC, respectivamente. El único factor de riesgo asociado de forma independiente a la obstrucción fue el tiempo de duración del CVC (OR = 1,05, IC del 95%, 1,00-1,10). Respecto a la trombosis, tanto el número de luces (OR = 4,88, IC del 95%, 1,26-18,90) como la nutrición parenteral (OR = 4,17, IC del 95%, 1,06-16,31) alcanzaron significación estadística en el análisis bivariante. Sin embargo, no se objetivaron factores de riesgo para trombosis en el análisis multivariante. Conclusiones: La obstrucción y la trombosis de los CVC insertados en una unidad de cuidados intensivos pediátrica de un hospital universitario son relativamente frecuentes. El tiempo de duración de la vía central es un factor de riesgo independiente para la obstrucción de alguna de sus luces (AU)

Objective: To analyse the incidence of thrombosis and obstruction associated with central venous lines (CVL) inserted in critically ill children, and to determine their risk factors. Design: Prospective observational study in a Pediatric Intensive Care Unit in a University Hospital. Material and method: An analysis was made of 825 CVL placed in 546 patients. Age, gender, weight, type of catheter (lines, size, and brand), final location of the catheter, mechanical ventilation, type of sedation and analgesia used, initial failure by the doctor to perform CVL catheterization, number of attempts, CVL indication, admission diagnosis, emergency or scheduled procedure, and delayed mechanical complications (DMC). Risk factors for these complications were determined by a multiple regression analysis. Results: A total of 52 cases of DMC, 42 cases of obstruction, and 10 of thrombosis were registered. Obstruction and thrombosis rates were 4.96 and 1.18 per 100 CVL, respectively. The only risk factor independently linked to obstruction was the duration of the CVL (OR 1.05; 95% CI; 1.00-1.10). The number of lines with thrombosis (OR 4.88; 95% CI; 1.26-18.0), as well as parenteral nutrition (OR 4.17; 95% CI; 1.06-16.31) was statistically significant according to bivariate analysis. However, no risk factors for thrombosis were found in the multivariate analysis. Conclusions: Obstruction and thrombosis of CVL inserted in a Pediatric Intensive Care Unit are relatively common complications. CVL duration is an independent risk factor for any line obstruction (AU)

[Thrombosis and obstruction associated with central venous lines. Incidence and risk factors]. / Trombosis y obstrucción asociadas a vías venosas centrales. Incidencia y factores de riesgo.

OBJECTIVE: To analyse the incidence of thrombosis and obstruction associated with central venous lines (CVL) inserted in critically ill children, and to determine their risk factors. DESIGN: Prospective observational study in a Pediatric Intensive Care Unit in a University Hospital. MATERIAL AND METHOD: An analysis was made of 825 CVL placed in 546 patients. Age, gender, weight, type of catheter (lines, size, and brand), final location of the catheter, mechanical ventilation, type of sedation and analgesia used, initial failure by the doctor to perform CVL catheterization, number of attempts, CVL indication, admission diagnosis, emergency or scheduled procedure, and delayed mechanical complications (DMC). Risk factors for these complications were determined by a multiple regression analysis. RESULTS: A total of 52 cases of DMC, 42 cases of obstruction, and 10 of thrombosis were registered. Obstruction and thrombosis rates were 4.96 and 1.18 per 100 CVL, respectively. The only risk factor independently linked to obstruction was the duration of the CVL (OR 1.05; 95% CI; 1.00-1.10). The number of lines with thrombosis (OR 4.88; 95% CI; 1.26-18.0), as well as parenteral nutrition (OR 4.17; 95% CI; 1.06-16.31) was statistically significant according to bivariate analysis. However, no risk factors for thrombosis were found in the multivariate analysis. CONCLUSIONS: Obstruction and thrombosis of CVL inserted in a Pediatric Intensive Care Unit are relatively common complications. CVL duration is an independent risk factor for any line obstruction.

[Immunisation schedule of the Spanish Association of Paediatrics: 2013 recommendations]. / Calendario de vacunaciones de la Asociación Española de Pediatría: recomendaciones 2013.

The Advisory Committee on Vaccines of the Spanish Association of Paediatrics (CAV-AEP) updates the immunisation schedule every year, taking into account epidemiological data as well as evidence on the safety, effectiveness and efficiency of vaccines. The present schedule includes levels of recommendation. We have graded as routine vaccinations those that the CAV-AEP consider all children should receive; as recommended those that fit the profile for universal childhood immunisation and would ideally be given to all children, but that can be prioritised according to the resources available for their public funding; and as risk group vaccinations those that specifically target individuals in situations of risk. Immunisation schedules tend to be dynamic and adaptable to ongoing epidemiological changes. Nevertheless, the achievement of a unified immunisation schedule in all regions of Spain is a top priority for the CAV-AEP. Based on the latest epidemiological trends, CAV-AEP follows the innovations proposed in the last year's schedule, such as the administration of the first dose of the MMR and the varicella vaccines at age 12 months and the second dose at age 2-3 years, as well as the administration of the Tdap vaccine at age 4-6 years, always followed by another dose at 11-14 years of age, preferably at 11-12 years. The CAV-AEP believes that the coverage of vaccination against human papillomavirus in girls aged 11-14 years, preferably at 11-12 years, must increase. It reasserts its recommendation to include vaccination against pneumococcal disease in the routine immunisation schedule. Universal vaccination against varicella in the second year of life is an effective strategy and therefore a desirable objective. Vaccination against rotavirus is recommended in all infants due to the morbidity and elevated healthcare burden of the virus. The Committee stresses the need to vaccinate population groups considered at risk against influenza and hepatitis A. Finally, it emphasizes the need to bring incomplete vaccinations up to date following the catch-up immunisation schedule.

Calendario de vacunaciones de la Asociación Española de Pediatría: recomendaciones 2012 / Immunization schedule of the Spanish Association of Pediatrics: 2012 recommendations

El Comité Asesor de Vacunas de la Asociación Española de Pediatría (CAV-AEP) actualiza anualmente el calendario de vacunaciones teniendo en cuenta tanto aspectos epidemiológicos, como de efectividad y eficiencia de las vacunas. El presente calendario incluye grados de recomendación. Se han considerado como vacunas sistemáticas aquellas que el CAV-AEP estima que todos los niños deberían recibir; como recomendadas las que presentan un perfil de vacuna sistemática en la edad pediátrica y que es deseable que los niños reciban, pero que pueden ser priorizadas en función de los recursos para su financiación pública; y dirigidas a grupos de riesgo aquellas con indicación preferente para personas en situaciones de riesgo. Los calendarios de vacunaciones tienen que ser dinámicos y adaptarse a los cambios epidemiológicos que vayan surgiendo, pero el CAV-AEP considera como objetivo prioritario la consecución de un calendario de vacunación único para toda España.Teniendo en cuenta los últimos cambios en la epidemiología de las enfermedades, las principales novedades propuestas en este calendario son la administración de la primera dosis de las vacunas triple vírica y varicela a los 12 meses (12-15 meses) y la segunda dosis a los 2-3 años, así como la administración de la vacuna Tdpa a los 4-6 años siempre acompañada de otra dosisa los 11-14 años. El CAV-AEP estima que deben incrementarse las coberturas de vacunación frente al papiloma virus humano en las niñas de 11 a 14 años. Se reafirma en la recomendación de incluir la vacunación frente al neumococo en el calendario de vacunación sistemática. La vacunación universal frente a la varicela en el segundo año de vida es una estrategia efectiva y por tanto un objetivo deseable. La vacunación frente al rotavirus, dada la morbilidad y la elevada carga sanitaria, es recomendable en todos los lactantes. Se insiste en la necesidad de vacunar frente a la gripe y la hepatitis A a todos los que presenten factores de riesgo para dichas enfermedades. Finalmente, se insiste en la necesidad de actualizar las vacunaciones incompletas con las pautas de vacunación acelerada (AU)

The Advisory Committee on Vaccines of the Spanish Association of Pediatrics (CAVAEP) updates the immunization schedule every year, taking into account epidemiological data as well as evidence on the effectiveness and efficency of vaccines.The present schedule includes grades of recommendation. We have graded as routine vaccinations those that the CAV-AEP believes all children should receive; as recommended those that fit the profile for universal childhood immunization and would ideally be given to all children, but that can be prioritized according to the resources available for their public funding; and as risk group vaccinations those that specifically target individuals in situations of risk. Immunization schedules tend to be dynamic and adaptable to on going epidemiological changes. Nevertheless, the achievement of a unified immunization schedule in all regions of Spainis a top priority for the CAV-AEP. Based on the latest epidemiological trends, the main changes introduced to the schedule are the administration of the first dose of the MMR and the varicella vaccines at age 12 months(12---15 months) and the second dose at age 2---3 years, as well as the administration of the Tdap vaccine at age 4---6 years, always followed by another dose at 11---14 years of age.The CAV-AEP believes that the coverage of vaccination against human papilloma virus in girls aged 11---14 years must increase. It reasserts its recommendation to include vaccination against pneumococcal disease in the routine immunization schedule. Universal vaccination against varicellain the second year of life is an effective strategy and therefore a desirable objective. Vaccination against rotavirus is recommended in all infants due to the morbidity and elevated healthcare burden of the virus. The Committee stresses the need to vaccinate population groups considered at risk against influenza and hepatitis A. Finally, it emphasizes the need to bring incomplete vaccinations up to date following the catch-up immunization schedule (AU)

Vacunación frente a la gripe estacional en la infancia y la adolescencia. Recomendaciones del CAV-AEP para la campaña 2011-2012 / Seasonal influenza vaccination in children and adolescents. Recommendations of the CAV-AEP for the campaign

El Comité Asesor de Vacunas de la Asociación Española de Pediatría emite todos los años, antes del inicio de la temporada estacional de la gripe, unas recomendaciones sobre la vacunación frente a este virus en la edad pediátrica. Este comité sigue considerando que la vacunación antigripal es una actuación especialmente beneficiosa cuando va dirigida a los niños mayores de 6 meses pertenecientes a los grupos de riesgo, así como a sus convivientes. Se insiste en la recomendación de la vacunación antigripal en el personal sanitario que trabaja con niños (AU)

The Advisory Committee on Vaccines of the Spanish Association of Paediatrics establishes annual recommendations on influenza vaccination in childhood before the onset of influenza season. Routine influenza vaccination is particularly beneficial when the strategy isaimed at children older than 6 months of age with high-risk conditions and their home contacts.The recommendation of influenza vaccination in health workers with children is also emphasised (AU)

[Seasonal influenza vaccination in children and adolescents. Recommendations of the CAV-AEP for the campaign]. / Vacunación frente a la gripe estacional en la infancia y la adolescencia. Recomendaciones del CAV-AEP para la campaña 2011-2012.

The Advisory Committee on Vaccines of the Spanish Association of Paediatrics establishes annual recommendations on influenza vaccination in childhood before the onset of influenza season. Routine influenza vaccination is particularly beneficial when the strategy is aimed at children older than 6 months of age with high-risk conditions and their home contacts. The recommendation of influenza vaccination in health workers with children is also emphasized.

Immunization schedule of the Spanish Association of Pediatrics: 2012 recommendations.

The Advisory Committee on Vaccines of the Spanish Association of Pediatrics (CAV-AEP) updates the immunization schedule every year, taking into account epidemiological data as well as evidence on the effectiveness and efficiency of vaccines. The present schedule includes grades of recommendation. We have graded as routine vaccinations those that the CAV-AEP believes all children should receive; as recommended those that fit the profile for universal childhood immunization and would ideally be given to all children, but that can be prioritized according to the resources available for their public funding; and as risk group vaccinations those that specifically target individuals in situations of risk. Immunization schedules tend to be dynamic and adaptable to ongoing epidemiological changes. Nevertheless, the achievement of a unified immunization schedule in all regions of Spain is a top priority for the CAV-AEP. Based on the latest epidemiological trends, the main changes introduced to the schedule are the administration of the first dose of the MMR and the varicella vaccines at age 12 months (12-15 months) and the second dose at age 2-3 years, as well as the administration of the Tdap vaccine at age 4-6 years, always followed by another dose at 11-14 years of age. The CAV-AEP believes that the coverage of vaccination against human papillomavirus in girls aged 11-14 years must increase. It reasserts its recommendation to include vaccination against pneumococcal disease in the routine immunization schedule. Universal vaccination against varicella in the second year of life is an effective strategy and therefore a desirable objective. Vaccination against rotavirus is recommended in all infants due to the morbidity and elevated healthcare burden of the virus. The Committee stresses the need to vaccinate population groups considered at risk against influenza and hepatitis A. Finally, it emphasizes the need to bring incomplete vaccinations up to date following the catch-up immunization schedule.

Calendario de vacunaciones de la Asociación Española de Pediatría: recomendaciones 2011 / Vaccination schedule of the Spanish Association of Paediatrics: recommendations 2011

El Comité Asesor de Vacunas (CAV) de la Asociación Española de Pediatría actualiza anualmente el calendario de vacunaciones teniendo en cuenta tanto aspectos epidemiológicos, como de efectividad y eficiencia de las vacunas. El presente calendario incluye grados de recomendación. Se han considerado como vacunas sistemáticas aquellas que el CAV estima que todos los niños deberían recibir, como recomendadas las que presentan un perfil de vacuna sistemática en la edad pediátrica y que es deseable que los niños reciban, pero que pueden ser priorizadas en función de los recursos para su financiación pública, y dirigidas a grupos de riesgo aquellas con indicación preferente para personas en situaciones epidemiológicas de riesgo. El CAV considera como objetivo prioritario la consecución de un calendario de vacunaciones único para toda España. El CAV se reafirma en la recomendación de incluir la vacunación frente a neumococo en el calendario de vacunación sistemática. La vacunación universal frente a varicela en el segundo año de vida es una estrategia efectiva y por tanto un objetivo deseable. La vacunación frente a rotavirus, dada la morbilidad y la elevada carga sanitaria, es recomendable en todos los lactantes. Debido a los problemas actuales de disponibilidad de las vacunas, relacionados con la presencia de circovirus, el CAV insta a que, tan pronto como sea posible, se reinicie la vacunación frente a rotavirus por considerarla una oferta de salud deseable para todos los niños en nuestro país. El CAV se adhiere a las recomendaciones del Consejo Interterritorial del Sistema Nacional de Salud en referencia al la vacunación sistemática frente al virus del papiloma humano de todas las niñas de 11 a 14 años e insiste en la necesidad de vacunar frente a la gripe y hepatitis A, a todos los que presenten factores de riesgo para dichas enfermedades. Finalmente, se insiste en la necesidad de actualizar las vacunaciones incompletas con las pautas de vacunación acelerada (AU)

The Advisory Committee on Vaccines of the Spanish Paediatric Association updates annually the immunization schedule, taking into account epidemiological data as well as evidence of the effectiveness and efficiency of vaccines. This vaccination schedule includes grades of recommendation. The committee has graded as universal vaccines those that all children should receive, as recommended, those with a profile of universal vaccines of childhood and as are desirable those that all children may receive, but that can be prioritized based on public funding resources and for risk groups, targeting those groups of people in epidemiological situations of risk. The Committee considers as a priority to achieve a common immunization schedule for Spain. The Committee reaffirms the recommendation to include pneumococcal vaccination in the routine vaccination schedule. Vaccination against varicella in the second year of life is an effective strategy and therefore a desirable goal. Given the morbidity and high burden on the health care system, vaccination against rotavirus is recommended for all infants. Due to the current problems of availability of both vaccines, associated with the recent finding of circovirus, the committee urges that rotavirus vaccination is restarted as soon as possible as it is considered a desirable health benefit for all children in our country. The Committee adheres to the recommendations of the National Health Coordination Council in reference to routine vaccination against HPV for all girls aged 11 to 14 years and stresses the need to vaccinate all patients with risk factors for these diseases against influenza and hepatitis A. Finally, it stresses the need to update incomplete immunizations using accelerated immunization schedules (AU)

[Vaccination schedule of the Spanish Association of Paediatrics: recommendations 2011]. / Calendario de vacunaciones de la Asociación Española de Pediatría: recomendaciones 2011.

The Advisory Committee on Vaccines of the Spanish Paediatric Association updates annually the immunization schedule, taking into account epidemiological data as well as evidence of the effectiveness and efficiency of vaccines. This vaccination schedule includes grades of recommendation. The committee has graded as universal vaccines those that all children should receive, as recommended, those with a profile of universal vaccines of childhood and as are desirable those that all children may receive, but that can be prioritized based on public funding resources and for risk groups, targeting those groups of people in epidemiological situations of risk. The Committee considers as a priority to achieve a common immunization schedule for Spain. The Committee reaffirms the recommendation to include pneumococcal vaccination in the routine vaccination schedule. Vaccination against varicella in the second year of life is an effective strategy and therefore a desirable goal. Given the morbidity and high burden on the health care system, vaccination against rotavirus is recommended for all infants. Due to the current problems of availability of both vaccines, associated with the recent finding of circovirus, the committee urges that rotavirus vaccination is restarted as soon as possible as it is considered a desirable health benefit for all children in our country. The Committee adheres to the recommendations of the National Health Coordination Council in reference to routine vaccination against HPV for all girls aged 11 to 14 years and stresses the need to vaccinate all patients with risk factors for these diseases against influenza and hepatitis A. Finally, it stresses the need to update incomplete immunizations using accelerated immunization schedules.

Calendario de vacunaciones de la Asociación Española de Pediatría: recomendaciones 2010 / Vaccination schedule of the spanish association of paediatrics: recommendations 2010

El Comité Asesor de Vacunas (CAV) de la Asociación Española de Pediatría actualiza anualmente el calendario de vacunaciones teniendo en cuenta, tanto aspectos epidemiológicos como de efectividad y eficiencia de las vacunas. El presente calendario incluye grados de recomendación. Se han considerado como vacunas sistemáticas aquellas que el CAV estima que todos los niños deberían recibir, como recomendadas las que presentan un perfil de vacuna sistemática en la edad pediátrica y que es deseable que los niños reciban, pero que pueden ser priorizadas en función de los recursos para su financiación pública y dirigidas a grupos de riesgo aquellas con indicación preferente para personas en situaciones epidemiológicas de riesgo. El CAV considera como objetivo prioritario la consecución de un calendario de vacunaciones único. El CAV se reafirma en la recomendación de incluir la vacunación frente a neumococo en el calendario de vacunación sistemática. La vacunación universal frente a varicela en el segundo año de vida es una estrategia efectiva y por tanto un objetivo deseable. La vacunación frente a rotavirus, dada la morbilidad y la elevada carga sanitaria, es recomendable en todos los lactantes. El CAV se adhiere a las recomendaciones del Consejo Interterritorial del Sistema Nacional de Salud en referencia a la vacunación sistemática frente a VPH de todas las niñas de 11 a 14 años e insiste en la necesidad de vacunar frente a la gripe y hepatitis A a todos los pacientes que presentan factores de riesgo para dichas enfermedades. Finalmente se insiste en la necesidad de actualizar las vacunaciones incompletas con las pautas de vacunación acelerada (AU)

The Vaccine Advisory Committee of the Spanish Association of Paediatrics updates annually, the immunization schedule, taking into account epidemiological data, as well as evidence of the effectiveness and efficiency of vaccines. This vaccination schedule includes grades of recommendation. The committee has graded as universal vaccines those that all children should receive, as recommended those with a profile of universal vaccination in childhood and which are desirable that all children receive, but that can be prioritized based on resources for its public funding and for risk groups those targeting groups of people in situations of epidemiological risk. The Committee considers as a priority to achieve a common immunization schedule. The Committee reaffirms the recommendation to include pneumococcal vaccination in the routine vaccination schedule. Vaccination against varicella in the second year of life is an effective strategy and therefore a desirable goal. Vaccination against rotavirus is recommended for all infants given the morbidity and high burden on the health care system. The Committee adheres to the recommendations of the Interterritorial Council of the National Health Care System in reference to routine vaccination against HPV for all girls aged 11 to 14 years and stresses the need to vaccinate against influenza and hepatitis A all patients with risk factors for these diseases. Finally, it stresses the need to update incomplete immunization schedules using accelerated immunization schedules (AU)

[Vaccination schedule of the Spanish association of paediatrics: recommendations 2010]. / Calendario de vacunaciones de la Asociación Española de Pediatría: recomendaciones 2010.

The Vaccine Advisory Committee of the Spanish Association of Paediatrics updates annually, the immunization schedule, taking into account epidemiological data, as well as evidence of the effectiveness and efficiency of vaccines. This vaccination schedule includes grades of recommendation. The committee has graded as universal vaccines those that all children should receive, as recommended those with a profile of universal vaccination in childhood and which are desirable that all children receive, but that can be prioritized based on resources for its public funding and for risk groups those targeting groups of people in situations of epidemiological risk. The Committee considers as a priority to achieve a common immunization schedule. The Committee reaffirms the recommendation to include pneumococcal vaccination in the routine vaccination schedule. Vaccination against varicella in the second year of life is an effective strategy and therefore a desirable goal. Vaccination against rotavirus is recommended for all infants given the morbidity and high burden on the health care system. The Committee adheres to the recommendations of the Interterritorial Council of the National Health Care System in reference to routine vaccination against HPV for all girls aged 11 to 14 years and stresses the need to vaccinate against influenza and hepatitis A all patients with risk factors for these diseases. Finally, it stresses the need to update incomplete immunization schedules using accelerated immunization schedules.