[Epidemiological features of invasive pneumococcal disease before and after the introduction of pneumococcal conjugate vaccine in Gran Canaria (Canary Islands)]. / Aspectos epidemiológicos de la enfermedad neumocócica invasiva antes y después del uso de la vacuna neumocócica conjugada en Gran Canaria.

INTRODUCTION: The introduction of pneumococcal conjugate vaccine (PCV-7) has modified the epidemiology of invasive pneumococcal disease (IPD). Our aim was to investigate the epidemiological features of IPD before and after implementing the use of PCV-7. METHODS: All invasive Streptococcus pneumoniae strains isolated in our hospital from 2000 to 2006 were included. Serotypes were identified and antibiograms were performed in all cases. Data obtained before (2000-2001) and after (2004-2006) authorization of PCV-7 use in Spain were compared. RESULTS: There were 241 cases of IPD. None of the patients with IPD aged 2 years or younger had received PCV-7. PCV-7 coverage in children aged 5 or younger was about 48%. There was a non-significant increase in the incidence of IPD in children (from 53.8 to 57.8 cases/100 000 population), with no change in adults. When IPD incidence was adjusted by the number of blood samples collected, there was a non-significant decrease in both children and adults. Since PCV-7 came on the market, there has been a decrease in vaccine serotypes and an increase in non-vaccine serotypes. The emergent serotypes since that time include 3, 6A, 15, and 19A. Penicillin resistance decreased significantly (p<0.001) from the pre-vaccine period (87.3%) to 2003 (13.8%), and later rose from 2003 through 2006 (41.7%). Erythromycin resistance showed no changes during the study. CONCLUSIONS: The incidence of IPD in children aged 2 years and younger in Gran Canaria has not decreased despite the introduction of PCV-7. However, there has been a reduction in the number of cases related to vaccine serotypes and a significant decrease in penicillin resistance. In contrast, non-vaccine serotype IPD cases have increased. Universal vaccination and the use of new polyvalent vaccines may enhance these effects.

Aspectos epidemiológicos de la enfermedad neumocócica invasiva antes y después del uso de la vacuna neumocócica conjugada en Gran Canaria / Epidemiological features of invasive pneumococcal disease before and after the introduction of pneumococcal conjugate vaccine in Gran Canaria (Canary Islands)

Introducción: la comercialización de la vacuna neumocócica conjugada (PCV-7) ha modificado la epidemiología de la enfermedad neumocócica invasiva (ENI). Nuestro objetivo fue conocer la epidemiología de la ENI antes y después de su uso. Métodos: se incluyeron todas las cepas de Streptococcus pneumoniae causantes de ENI de 2000 a 2006. Se realizó serotipado y antibiograma. Se compararon los datos obtenidos antes (2000¿2001) y después (2004¿2006) de la comercialización de PCV-7. Resultados: hubo 241 casos de ENI. Ningún paciente menor de 2 años con ENI estaba vacunado. La cobertura vacunal en menores de 5 años fue del 48%. Hubo un incremento no significativo de ENI en niños (de 53,8 a 57,8 casos por 100.000 habitantes), manteniéndose invariable en adultos. Al corregir la incidencia según el número de hemocultivos, se observó un descenso no significativo, tanto en niños como en adultos. Tras la comercialización de PCV-7 hubo un descenso de los serotipos vacunales y un aumento de los no vacunales. Los serotipos emergentes tras la vacuna fueron: 3, 6A, 15 y 19A. La resistencia a penicilina descendió significativamente (p<0,001) desde el período prevacunal (87,3%) hasta 2003 (13,8%), y posteriormente aumentó (41,7% en 2006). La resistencia a eritromicina no varió durante el estudio. Conclusiones: la incidencia de ENI en menores de 2 años en Gran Canaria no ha disminuido a pesar de la vacuna PCV-7. Los casos debidos a serotipos vacunales han disminuido, así como la resistencia a penicilina. En cambio, han aumentado los casos debidos a serotipos no vacunales emergentes. La estrategia de vacunación universal y la adopción de nuevas vacunas polivalentes podrían potenciar estos efectos (AU)

Introduction: The introduction of pneumococcal conjugate vaccine (PCV-7) has modified the epidemiology of invasive pneumococcal disease (IPD). Our aim was to investigate the epidemiological features of IPD before and after implementing the use of PCV-7. Methods: All invasive Streptococcus pneumoniae strains isolated in our hospital from 2000 to 2006 were included. Serotypes were identified and antibiograms were performed in all cases. Data obtained before (2000¿2001) and after (2004¿2006) authorization of PCV-7 use in Spain were compared. Results: There were 241 cases of IPD. None of the patients with IPD aged 2 years or younger had received PCV-7. PCV-7 coverage in children aged 5 or younger was about 48%. There was a non-significant increase in the incidence of IPD in children (from 53.8 to 57.8 cases/100 000 population), with no change in adults. When IPD incidence was adjusted by the number of blood samples collected, there was a non-significant decrease in both children and adults. Since PCV-7 came on the market, there has been a decrease in vaccine serotypes and an increase in non-vaccine serotypes. The emergent serotypes since that time include 3, 6A, 15, and 19A. Penicillin resistance decreased significantly (p<0.001) from the pre-vaccine period (87.3%) to 2003 (13.8%), and later rose from 2003 through 2006 (41.7%). Erythromycin resistance showed no changes during the study. Conclusions: The incidence of IPD in children aged 2 years and younger in Gran Canaria has not decreased despite the introduction of PCV-7. However, there has been a reduction in the number of cases related to vaccine serotypes and a significant decrease in penicillin resistance. In contrast, non-vaccine serotype IPD cases have increased. Universal vaccination and the use of new polyvalent vaccines may enhance these effects (AU)

Immunomodulatory effects of the intake of fermented milk with Lactobacillus casei DN114001 in lactating mothers and their children.

The healthy action of probiotics is not only due to their nutritional properties and their influence on the gastrointestinal environment, but also to their action on the immune system. The aim of the present study was to determine if 6 weeks of probiotic intake would be able to modulate the immune system in women who had recently delivered and were breast-feeding. The design consisted of a randomised, controlled and double-blind nutritional intervention study with parallel groups with a sample size of 104 women. The main variable is the T helper type 1/T helper type 2 (Th1/Th2) profile determined by measuring interferon-gamma (Th1) and IL-4 (Th2) values in peripheral blood by flow cytometry. The modifications of cytokines were evaluated in maternal milk by cytometric bead array in a flow cytometer and ELISA at three stages of breast-feeding: colostrum, early milk (10 d) and mature milk (45 d). Additionally, the anthropometry and infectious and allergic episodes in the newborn were followed up throughout the first 6 months of life. After the consumption of milk fermented with Lactobacillus casei during the puerperium, we observed a nonsignificant increase in T and B lymphocytes and a significant increase in natural killer cells. A decrease in the pro-inflammatory cytokine TNF-alpha in maternal milk and fewer gastrointestinal disturbances were also observed in the breast-fed child of the mothers who consumed L. casei. The intake of milk fermented with L. casei during the lactation period modestly contributes to the modulation of the mother's immunological response after delivery and decreases the incidence of gastrointestinal episodes in the breast-fed child.

Estudio seroepidemiológico de hepatitis A en Gran Canaria / Seroepidemiological study of hepatitis A in Gran Canaria (Spain)

Fundamento: El propósito de este estudio fue conocer la prevalencia y los factores de riesgo de infección por el virus de la hepatitis A (VHA) en la población de Gran Canaria y determinar la edad en la que el cribado prevacunal de anti-VHA (IgG) podría ser útil. Métodos: Durante el período comprendido entre enero de 1995 y diciembre de 1996 se realizó un estudio observacional de tipo transversal para evaluar la presencia de anti-VHA (IgG) en muestras de suero de una población con edades comprendidas entre 8 meses y 63 años. Los anticuerpos IgG anti-VHA se detectaron mediante un enzimoinmunoanálisis comercial. El estudio incluyó a 547 personas residentes en Gran Canaria. Los datos epidemiológicos (edad, sexo, número de miembros de familia, nivel educativo, residencia urbana/rural y antecedentes de hepatitis) fueron recogidos mediante encuesta dirigida. Las variables confusoras se excluyeron mediante un análisis de regresión logística múltiple. Resultados: La prevalencia global de anti-VHA (IgG) fue del 36,0 por ciento (IC del 95 por ciento 32,0-40,0). La seroprevalencia aumentó de forma significativa con la edad desde el 2,3 por ciento en los menores de 4 años hasta el 98,9 por ciento (OR 3.956,0; IC del 95 por ciento 241,7-64.753,5) en los mayores de 40 años. Únicamente la edad, el sexo y el nivel de educación se relacionaban significativamente y de forma independiente con el riesgo de exposición previa al VHA. Sólo el 4,8 por ciento de los individuos anti-VHA positivos referían antecedentes clínicos de hepatitis. Conclusiones: La baja prevalencia de anti-VHA (IgG) en personas menores de 25 años sugiere la conveniencia de establecer un programa de vacunación universal en la población adolescente, incluso sin cribado serológico previo. Por otro lado, los resultados sugieren que el cribado prevacunal en nuestro medio debería limitarse a las personas mayores de 25 años de edad (AU)