[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.

Manejo y actualización de las vacunas frente al virus del papiloma humano (VPH) en Pediatría / Management and up-date of the human papiloma virus (HPV) vaccines in Pediatrics

Los autores hacen una revisión de conjunto y puesta al día sobre los aspectos pediátricos más relevantes aparecidos en el curso de los últimos años sobre las vacunas frente al virus del papiloma humano (VPH), señalando la relación existente entre el VPH y el desarrollo del cáncer de cuello uterino (CCU). Actualmente es admitido por la comunidad científica internacional que el VPH es causa necesaria, aunque no suficiente, para la producción del CCU y otras localizaciones de cáncer en el área genital, si bien deben coexistir otros factores adicionales y determinantes de la carcinogénesis. Se realiza un resumen de la clasificación de los distintos grupos del VPH, señalando aquellos tipos patógenos y las enfermedades producida por ellos. Mención especial merecen la epidemiología, conductas sexuales y su relación con laa transmisión de la infección, analizando los datos de los estudios existentes en nuestro país. Se describen también las principales formas clínicas, su expresión, así como los métodos diagnósticos más importantes recogidos en la literatura. Describimos brevemente el procedimiento de obtención de las vacunas frente al VPH por la técnica de virus like particles (partículas similares al virus), confirmando se trata de vacunas profilácticas y no terapéuticas, sin genoma ni capacidad infectiva. En España se encuentra comercializadas y autorizadas dos vacunas desde el2007-2008; se denominan Gardasil®, tetravalente de Sanofi Pasteur MSD y Cervarix®, bivalente de GlaxoSmithKline, con una eficacia, inmunogenicidad y seguridad próximas al 100%. Revisamos igualmente los datos sobre eficacia en hombres de la vacuna tetravalente aparecidos recientemente. Las recomendaciones de la vacunación por VPH en nuestro país, se establecieron por el Consejo (AU)

A review is made of the group and an up-date made on the most relevant pediatric aspects that have appeared over recent years on human papiloma virus (HPV) vaccines, pointing out the relation existing between human papiloma virus and the develop of uterine cervical cancer. At present, the scientific community accepts that the human papilloma virus is a necessary but not sufficient cause for the production of uterine cervical cancer and other localizations in the genital area, although other additional factors and determinats of cervical carcinogenesis must exist. A summary is made of the classification of the different papilloma virus groups, indicating those pathogen types and diseases relatied with them. Special mention is made to the epidemiology of the disease, virus transmission, sexual behavior and relation to the transmission of the disease. The study data on sexual behaviors in our country are analyzed. Some comments are made on the clinical manifestations of the different diseases caused by human papillomas and an update is made of the Bethesda classification, mentioning the principal methods of detection of the human papilloma virus and utility in the diagnosis. The principal identification test are indicated as the PCR and hybrid capture. A brief description was made on how the vaccines are obtained for HPV using the virus like technique (particles similar to the virus), indicating that these are prophylactic and never therapeutic vaccines, with no genome and therefore without any infective capacity. In Spain, 2 vaccines have been on the market since the year 2007-2008 and approved by the AEMPS through the procedure centralized through the European Drug Agency. These vaccines are the tetravalent called Gardasil® Sanofi Pasteur MSD, effective against types 6, 11, 16 and 18 and the bivalent Cervarix® of GlaxoSmithKline, effective against types 16 and 18. Both vaccines have a demonstrated efficacy of about 100% (AU)

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.

Complicaciones agudas inusuales de la infección por el virus de Epstein-Barr / Unusual acute complications of Epstein-Barr virus infection

La infección por el virus de Epstein-Barr es muy prevalente en la infancia y, aunque en la mayoría de los casos el diagnóstico es sencillo y su evolución favorable, hay casos como el que presentamos que pueden tener un amplio espectro clínico y complicaciones agudas que dificultan el diagnóstico y pueden ensombrecer el pronóstico. Se han descrito muchas complicaciones agudas que afectan a todos los sistemas y aparatos. Presentamos un caso que presenta complicaciones respiratorias, neurológicas y hepáticas (AU)

The infection caused by the Epstein-Barr virus is very common in childhood. In most cases the diagnosis is easy and its evolution of the illness is favourable, but there are some patients in whom the infectious mononucleosis can have a large clinical spectrum with acute complications that make the diagnosis difficult. We report a patient who had respiratory, neurological and hepatic complications (AU)

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.

Lupus neonatal: manifestaciones cutáneas asociadas con trombopenia neonatal / No disponible

El lupus neonatal es un síndrome raro que afecta a recién nacidos y lactantes, que se define por la presencia e autoanticuerpos maternos y características clínicas, como lesiones cutáneas típicas, bloqueo cardíaco completo, miocardiopatía, alteraciones hematológicas y hepatobiliares. Presentamos un lactante de 5 semanas derivado desde Atención Primaria por lesiones cutáneas anulares en tronco, cuero cabelludo y cara. Como antecedentes destaca en la mare afecta de síndrome Overlap (esclerosis sistémica, lupus y miositis). Se inicia estudio confirmándose el diagnóstico de lupus neonatal mediante punch biopsia y ANA moteado positivo con anti SSA-Ro y anti RNP positivos (AU)

Neonatal Lupus Erythematosus is a rare disroder that affects newborns and infants and it is caused by mother´s autoantibodies and several clinical features as typical skin rash, congenital complete heart block, miocardiapathies, haematoligical and hepatobiliary diseases. We attended a 5 weeks male infant, who was derived from the primary care center because of an annular skin rash on trunk, scalp and face. There was maternal history of Overlap syndrome (systemic sclerosis, lupus and myosistis). Diagnosis of neonatal Lupus was made by the skin biopsy and an ANAs with autoantibodies against Ro and U1-ribonucleoprotein (RNP) (AU)

Eritema discrómico Perstans: a propósito de un caso / No disponible

El eritema discrómico Perstans o dematosis cenicienta es una dermatosis idiopática adquirida, caracterizada por la aparición de manchas gris pizarra en el tronco, extremidades y cuello. De etiología desconocida, su prevalencia es mayor entre la población latinoamericana (AU)

The Erythema Dischromicum Perstans (ashy dermatosis) is an idiopathic acquired blue-gray macular hypermelanosis, usually affects the trunk, arms, neck and face. The etiology of the ashy dermatosis remains unknown and it´s more common in Latin America (AU)

Actualización de las nuevas vacunas de 2ª generación frente al rotavirus autorizadas en España: perspectivas, retos y oportunidades / Up-date of the new 2nd generation vaccines against rotavirus authorized in Spain: perspectives, challenges and opportunities

Se realiza una revisión de conjunto y puesta al día sobre la importancia del rotavirus y su implicación como fuente de gastroenteritis en el niño, haciendo unas consideraciones sobre la estructura del virus, clasificación, patogenia, clínica y tratamiento. Se revisa la respuesta inmunológica del huésped y la protección de la enfermedad por el virus salvaje, señalando cómo tras la primoinfección la reinfección es cada vez menos severa al prevenir la enfermedad diarreica grave. De una forma concisa se detalla la epidemiología y carga de la enfermedad, señalando cómo el rotavirus es el causante de más de 600.000 muertes anuales en países subdesarrollados, un número elevado de hospitalizaciones, visitas ambulatorias e infecciones nosocomiales y por ello de la elevada morbilidad y mortalidad que representa para la salud pública. Se destaca como la única intervención posible es la preventiva, dado que la mejoría lograda con las condiciones higiénico sanitarias, potabilidad del agua, acceso a la rehidratación oral, etc., no han conducido a una disminución significativa de la incidencia de la enfermedad, tanto en los países industrializados como el los de en vías de desarrollo. Se describen los serotipos y genotipos más prevalentes de rotavirus conocidos en el mundo y en nuestro país, haciendo énfasis en los serotipos emergentes en la actualidad. Se hace una revisión amplia de los principales estudios aparecidos recientemente en la literatura científica sobre las nuevas vacunas de 2ª generación frente al rotavirus autorizadas por EMEA (Agencia Europea del Medicamento) y también en Estados Unidos. Aunque las dos vacunas autorizadas en España parten de principios diferentes, tienen un objetivo común, ,la prevención de la diarrea grave por rotavirus en el niño. Dados los antecendentes acontecidos con Rotashield (primera vacuna resortatne bovina-humana utilizada en Estados Unidos frente al rotavirus y actualmente retirada del mercado) y su asociación con la invaginación intestinal, han sido necesarios amplios diseños de estudios de seguridad que incluyeran a más de 70.000 niños. Con ambas vacunas Rotarix y RotaTeq TM ha quedado suficientemente probado que no existe aumento del riesgo de invaginación intestinal asociado a la vacunación. Igualmente se han revisado los ensayos sobre eficacia, inmunogenicidad, efectos adversos, etc., que han resultado ser estadísticamente significativos y suficientemente probados dentro de los rangos permisibles en relación con losa placebos. Se relacionan las recomendaciones del ACIP (Advisory Committee Inmunization Practices) para la vacuna RotaTeq TM aparecidas recientemente. Se hacen unas breves consideraciones sobre varios de los estudios de fármaco-economía encontrados en la literatura, mostrando ser coste efectivos algunos de ellos, aunque sean necesarios otros más avanzados una vez que las vacunas estén funcionando y se fijen los precios de la inmunización para la sanidad pública. Finalmente se discuten las oportunidades, retos y perspectivas de las actuales vacunas de 2ª generación y el algunas de las futuras señalando las dificultades con las que tendrán que enfrentarse. Se llega a la conclusión de la importancia en la mentalización de los pediatras en el uso de estas nuevas vacunas, sensibilización de los padres, educación sanitaria de los mismos y la de nuestras autoridades sanitarias para su inclusión en la práctica rutinaria común de las inmunizaciones precisando estudios de fármaco-economía, cargas actualizadas y reales de la enfermedad

A general review and update are done on the importance of the rotavirus and its implication as a source of gastroenteritis in the child. Comments are made on the structure of the virus, classification, pathogeny, symptoms and treatment. The immunological response of the host on protection of wild virus disease is reviewed, indicating how, after first infection, reinfection is increasingly less severe as serious diarrheic disease is prevented. Briefly, the epidemiology and disease load are explained, indicating how the rotavirus is the cause of more than 600,000 deaths yearly in underdeveloped countries elevated, number of hospitalisations, outpatients visits and nosocomial infections and, consequently, the elevated morbidity and mortality that it represents for public health. It sands out that the only possible interventions is the preventive one, since the improvement achieved with health care hygienic conditions, water potability, access to oral rehydration, etc. have not led to a significant decrease in the disease incidence in both industrialized countries and developing ones. The most prevalent rotavirus serotypes and genotypes known in the world and in our country are described. Emphasis is placed on the current emergent serotypes. An extensive review is made of the principal studies that have recently appeared in the scientific literature on the new 2nd generation vaccines against the rotavirus authorized by the European Drug Agency (EMEA) and also in the United States. Although the two vaccines authorized in Spain come from different active ingredients, they have a common objective, the prevention of serious diarrhea dur to rotavirus in the child. Wide designs of safety studies including more than 70,000 children have been necessary given the events that have occurred with rotashield (first human-bovine reassortant rotavirus vaccine used in the United States and currently withdrawn from the market) and its association with bowel intussusception. It has been sufficiently provent that there is no increased risk of bowel invagination associated with the vaccination with both vaccines, Rotarix and RotaTeq TM. Trials on efficacy, immunogenicity, adverse events, etc. have also been reviewed. They have been statistically significant and sufficiently tested within the permissible ranges in relarionship with the placebos. A list is given of the recently appeared ACID (Advisory Committee Immunization Practices) recommendations for the RotaTeq TM. Brief comments are made on several of the pharmacoeconomics studies found in the literature, some of them being cost-effective, although more advanced ones will be necessary onec the vaccines are functioning and the immunization prices established for the public health system. Finally, the opportunities, challenges and perspectives of the current 2nd generation vaccines are discussed. In some of the future ones, the difficulties that they will have to face are indicated. The conclusion is reached on the importance of convincing the pediatricians on the use of these new vaccines, making the parents aware of it, providing both the regulatory authorities and them with health care education in order to include it within the common routine practice of immunizations. This requires pharmacoeconomics studies, with up-dated and real costs of the disease

Vacuna frente a la varicela. Actualización y nuevas indicaciones autorizadas en España / Vaccination against chicken pox. Up-date and new authorized indications in Spain

Presentamos una actualización y revisión de conjunto sobre la varicela y su vacuna haciendo especial énfasis en la epidemiología y estudios de seroprevalencia en España, sus manifestaciones clínicas y complicaciones. Se enumeran las principales vacunas disponibles en nuestro país y en los del entorno. Se discuten los obstáculos mas importantes y controversias encontrados/as en la literatura médica que están dificultando la introducción de la vacuna frente a la varicela en los calendarios de vacunaciones sistemáticos. De forma general pero sucinta, se analizan los resultados de algunas publicaciones más destacadas de la bibliografía médica Sobre inmunogenicidad, eficacia, efectividad y seguridad de las vacunas. Igualmente se hacen unas breves consideraciones acerca de la rentabilidad obtenida en los distintos estudios económicos revisados, resultando que la vacuna frente a la varicela resulta ser coste-efectiva, especialmente si se consideran los costes indirectos o sociales; se concluye que es una intervención eficiente. Se hacen algunos comentarios sobre el síndrome de la varicela modificada, su importancia, frecuencia, incidencia, clínica, etc. Realizamos una puesta al día sobre la situación actual de la única vacuna disponible en nuestro país (Varilrix®), enumerándose las indicaciones ampliadas y autorizadas durante el año 2003 por la Agencia Española de Medicamentos y Productos Sanitarios, al haber pasado a ser un medicamento de denominación de "uso hospitalario" a "diagnóstico hospitalario" y su financiación por parte del SNS. Además, se mencionan las indicaciones de la vacunación en adultos y adolescentes siguiendo las recomendaciones del Comité de Inmunizaciones del CDC de EE.UU. Igualmente se mencionan las contraindicaciones, interacciones con otras vacunas, posología, vía de administración, etc. Finalmente, se discuten las recomendaciones internacionales y las del Comité Asesor de Vacunaciones de la Asociación Española de Pediatría, quedando establecida por este último como estrategia la vacunación universal de todos los niños sanos por encima de los 12 meses de vida, instando a las autoridades sanitarias su inclusión en los calendarios vacunales en las distintas Comunidades Autónomas de forma simultánea (AU)

[Cerebral arteriovenous fistula as a cause of neonatal cardiac insufficiency. Presentation of 3 cases]. / Fístula arteriovenosa cerebral como causa de insuficiencia cardiaca neonatal. Presentación de tres casos.

The CAVF with aneurysm of the vein of Galen is an uncommon malformation, leading to the wrong diagnosis of congenital heart disease. We present the clinical and hemodynamic findings in three cases. Cranial echography has been useful as a noninvasive diagnostic tool. Surgical treatment can be difficult and the general outlook is poor.

[Purine nucleoside phosphorylase deficiency. Report of two cases]. / Déficit de purina nucleósido fosforilasa. Presentación de dos casos.

Two brothers with a PNP deficit are reported. The first case presented recurrent upper respiratory infections and died of a sepsis by pseudomonas. The second one was diagnosed when he was six months old and remains asymptomatic. Immunologic tests revealed a deficit of T cell mediated immunity. Treatment consisted on radiated erythrocytes transfusions because HLA compatible donors were not available.

[Renal venous and inferior cava vein thrombosis post-catheterization (author's transl)]. / Trombósis venosa renal y de cava tras cateterismo.

A case of renal vein and inferior cava thrombosis in a previously catheterized infant with cyanotic congenital heart disease is reported. The different origins of R.V.T. in newborns and infants are briefly discussed. The different factors that favour the beginning of thrombotic process (cyanotic heart disease diabetic mother, etc.) are also emphasized. Some considerations are made on the danger inherent to the use of intravascular catheters.

[Intrauterine renal vein thrombosis (author's transl)]. / Trombósis venosa renal intrauterina.

One case of renal venous thrombosis in a male foetus, born of a diabetic mother is reported. The intrauterine origin and the long age of the thrombosis were confirmed by pathologic studies. Some speculation about the etiopathogenic mechanisms of intrauterine renal venous thrombosis are made.