Early estimates of nirsevimab immunoprophylaxis effectiveness against hospital admission for respiratory syncytial virus lower respiratory tract infections in infants, Spain, October 2023 to January 2024.

The monoclonal antibody nirsevimab was at least 70% effective in preventing hospitalisations in infants with lower respiratory tract infections (LRTI) positive for respiratory syncytial virus (RSV) in Spain (Oct 2023-Jan 2024), where a universal immunisation programme began late September (coverage range: 79-99%). High protection was confirmed by two methodological designs (screening and test-negative) in a multicentre active surveillance in nine hospitals in three regions. No protection against RSV-negative LRTI-hospitalisations was shown. These interim results could guide public-health decision-making.

Clinical characteristics, health care resource utilization and direct medical costs of Rotavirus hospitalizations in Spain (2013-2018).

Rotavirus (RV) is the most common cause of severe gastroenteritis (GE) in infants and young children worldwide and is associated with a significant clinical and economic burden. The objective of this study was to analyze the characteristics, healthcare resource utilization and the direct medical costs related to RVGE hospitalizations in Spain. An observational, multicenter, cross-sectional study was conducted from June 2013 to May 2018 at the pediatric departments of 12 hospitals from different Spanish regions. Children under 5 years of age admitted to the hospital with a confirmed diagnosis of RVGE were selected. Data on clinical characteristics, healthcare resource use and costs were collected from patient records and hospital databases. Most children hospitalized for RVGE did not have any previous medical condition or chronic disease. Forty-seven percent had previously visited the Emergency Room (ER), 27% had visited a primary care pediatrician, and 15% had received pharmacological treatment prior to hospital admission due to an RVGE episode. The average length of a hospital stay for RVGE was 5.6 days, and the mean medical costs of RVGE hospitalizations per episode ranged from 3,940€ to 4,100€. The highest direct medical cost was due to the hospital stay. This study showed a high burden of health resource utilization and costs related to the management of cases of RVGE requiring hospitalization. RV vaccination with high coverage rates should be considered to minimize the clinical and economic impacts of this disease on the health-care system.

Impact of Pneumococcal Vaccination in the Nasopharyngeal Carriage of Streptococcus pneumoniae in Healthy Children of the Murcia Region in Spain.

BACKGROUND: An epidemiological study of Streptococcus pneumoniae nasopharyngeal carriage in healthy children was carried out five years after the introduction of the 13-valent pneumococcal conjugate vaccine (PCV13). OBJECTIVES: Study the impact of pediatric vaccination with PCV13, and other associated epidemiological factors on the status of nasopharyngeal carriage, the circulating pneumococcal serotypes, and the antibiotic susceptibility to more frequently used antibiotics. METHODS: A multi-center study was carried out in Primary Health Care, which included 1821 healthy children aged 1 to 4 years old. All isolates were sent to the Spanish Pneumococcal Reference Laboratory for serotyping and antimicrobial susceptibility testing. RESULTS: At least one dose of PCV13 had been received by 71.9% of children and carriage pneumococcal prevalence was 19.7%. The proportion of PCV13 serotypes was low (14.4%), with an observed predominance of non-vaccine serotypes, 23B, 11A, 10A, 35B/F, and 23A were the five most frequent. A high rate of resistance to penicillin, erythromycin, and trimethoprim sulfamethoxazole was found. CONCLUSIONS: A low proportion of PCV13 serotypes were detected, confirming the impact of pediatric vaccination for reducing the serotypes vaccine carriage. High resistance rates to clinically important antibiotics were observed.

Rational use of antimicrobials in the treatment of upper airway infections / Uso racional de antimicrobianos no tratamento de infecções das vias aéreas superiores

Abstract Objective To analyze the main cause of the irresponsible use of antibiotics at the pediatric level in a very frequent, usually self-limited, and typically viral condition: upper airway respiratory infections. Sources Different databases were searched using specific terms related to resistance to antibiotics, upper airway respiratory infections, and pediatrics patients. Summary of the findings Effectiveness varies depending on the place, the form of intervention, and the resources used. Multiple interventions appear to be more effective. The foundations of treatment are training in technical aspects and in communication skills for the prescribers, and having enough time for each patient; and training through the health clinic and the media for patients/parents. Deferred prescription and the use of rapid diagnostic tests in the primary care setting have been shown to be effective. A fluid relationship based on trust between clinicians and parents/guardians is one of the keystones. Conclusions Any project that seeks to be totally effective must include a health authority, which in addition to helping implement these measures, has the firm intention of drastically reducing the use of antibiotics in animals and in the environment, as well as favoring research into new antimicrobials.

Resumo Objetivo Analisar a principal causa do uso irresponsável de antibióticos em nível pediátrico de doenças muito frequentes, normalmente autolimitadas e virais: infecções respiratórias das vias aéreas superiores. Fontes Diferentes bases de dados foram pesquisadas com termos específicos relacionados à resistência a antibióticos, infecções respiratórias das vias aéreas superiores e pacientes de pediatria. Resumo dos achados A eficácia varia, depende do local, da forma e dos recursos usados. As formas de múltiplas intervenções parecem mais eficazes. O treinamento em aspectos técnicos e habilidades de comunicação para médicos e tempo suficiente para cada paciente, além do treinamento por meio da clínica e da mídia para pacientes/pais, são a base da eficácia. Prescrições de uso posterior e testes de diagnóstico rápido no ambiente de cuidado primário mostraram ser eficazes. Uma relação de confiança entre médicos e pais ou responsáveis é uma das pedras angulares. Conclusões Qualquer projeto que busque ser completamente eficaz deve incluir uma autoridade em saúde, que, além de ajudar a implantar as medidas nos pacientes, tem a sólida intenção de reduzir drasticamente o uso de antibióticos em animais e no meio ambiente, além de favorecer a pesquisa sobre novos antimicrobianos.

Rational use of antimicrobials in the treatment of upper airway infections.

OBJECTIVE: To analyze the main cause of the irresponsible use of antibiotics at the pediatric level in a very frequent, usually self-limited, and typically viral condition: upper airway respiratory infections. SOURCES: Different databases were searched using specific terms related to resistance to antibiotics, upper airway respiratory infections, and pediatrics patients. SUMMARY OF THE FINDINGS: Effectiveness varies depending on the place, the form of intervention, and the resources used. Multiple interventions appear to be more effective. The foundations of treatment are training in technical aspects and in communication skills for the prescribers, and having enough time for each patient; and training through the health clinic and the media for patients/parents. Deferred prescription and the use of rapid diagnostic tests in the primary care setting have been shown to be effective. A fluid relationship based on trust between clinicians and parents/guardians is one of the keystones. CONCLUSIONS: Any project that seeks to be totally effective must include a health authority, which in addition to helping implement these measures, has the firm intention of drastically reducing the use of antibiotics in animals and in the environment, as well as favoring research into new antimicrobials.

Amoxicilina, ácido clavulánico y quinolonas: ¿hay algo nuevo? / Amoxicillin, clavulanic acid and quinolones: is there something new?

Ninguno de estos antimicrobianos son novedades terapéuticas, y ambos son ampliamente utilizados en Atención Primaria. Sin embargo el interés por cada uno de ellos es radicalmente distinto desde el punto de vista pediátrico. Por un lado, las quinolonas, usadas en exceso en la patología infecciosa en adultos y restringida en población infantil. Por otro, la combinación de amoxicilina con ácido clavulánico, con diferentes formulaciones, alguna de ellas prácticamente olvidada y denostada por los pediatras, es uno de los antibióticos de mayor uso en Pediatría. Viejos conocidos, de los que es posible se desconozcan ciertas características que merece la pena actualizar. La selección del agente adecuado, junto con la dosis, la pauta y la duración serán esenciales tanto para un adecuado tratamiento como para evitar resistencias bacterianas, así como el conocimiento de sus restricciones y posibles efectos adversos. Por lo tanto, profundizar en el conocimiento de estos fármacos potenciará uno de los elementos de la lucha frente al aumento de resistencias de los microorganismos. El objetivo final será fomentar el uso racional de estos fármacos antimicrobianos, siguiendo las indicaciones de guías y consensos actuales

Neither of these antimicrobials are innovations; both are widely spread therapeutic tools at primary health care. However, the interest for each of them is dramatically different from the pediatric point of view. On the one hand, the quinolones, overused in adults ́ infectious patologies and restricted for children. On the other hand, the combination of amoxicillin with clanulanic acid, using different formulations, some of which has been almost forgotten and disdained by peditricians, is one of the most useful antibiotics in pediatrics. Old acquaintances, whose characteristics are worth updating. The selection of the right agent, along with the dose, the pattern and the duration will be essential both for an adequate treatment and to avoid bacterial resistences, and also to know their restrictions and possible adverse effects. Therefore, to deepen in the knowledge of these drugs will boost one of the elements of the fight against the increase of microbial resistances. The final goal will be to encourage the use of this antimicrobials, following the indications of guidelines and actual consensus

Epidemiology of Nasopharyngeal Carriage by Haemophilus influenzae in Healthy Children: A Study in the Mediterranean Coast Region.

BACKGROUND: Haemophilus influenzae, a colonizer of the nasopharynx, in children causes mainly otitis and sinusitis. The primary objective of this study was to determine the prevalence of pharyngeal colonization by H. influenzae, and the secondary objectives were to identify risk factors associated with H. influenzae colonization and its antibiotic susceptibility. METHODS: A prospective, multicenter study of nasopharyngeal carriers of H. influenzae was conducted in the pediatric consulting rooms of 10 primary healthcare centers in Murcia (Spain). The study consisted of 404 healthy children less than 5 years of age and was carried out during winter (January-March) and summer (July-September) of 2015. A nasopharyngeal sample was collected from each child, and an epidemiologic survey was completed by a pediatrician. RESULTS: In total, 112 (27.7%) children had colonization by H. influenzae, with 73.2% of cases in winter and 26.8% of cases in summer (P < 0.001). The median (interquartile range) age in months of the colonized children (13 months, 12-47.5) was lower than that of the noncolonized children (46 months, 12-49) (P < 0.001). All H. influenzae found were nontypeable H. influenzae (NTHi). Among 112 isolates, 20% were ampicillin resistant, of which 10% produced ß-lactamase, and 9% were ampicillin resistant and did not produce ß-lactamase. A logistic regression analysis showed that young age (odds ratio: 0.98) and the winter period (odds ratio: 3.41; P < 0.001) were risk factors for colonization by NTHi. CONCLUSIONS: Colonization by NTHi is high in this Mediterranean coast region with remarkable ampicillin resistant. Younger age and the winter period were facilitating factors.

Estudio epidemiológico de portadores nasofaríngeos de Streptococcus pneumoniae en niños en la comunidad autónoma de Murcia / Epidemiological study of nasopharyngeal carriers of Streptococcus pneumoniae in children in Murcia region

INTRODUCCIÓN Y OBJETIVOS: Streptococcus pneumoniae es un patógeno para el ser humano que precisa de colonización nasofaríngea previa para causar enfermedad. Realizamos un estudio epidemiológico de portadores nasofaríngeos de neumococo en niños sanos en Murcia, tras la introducción de la vacuna neumocócica conjugada heptavalente (VCN7) y ante la inmediata comercialización de las nuevas vacunas con el objetivo de conocer, en nuestro ámbito geográfico, la influencia de la vacunación y de otros factores sobre el estado de portador y los diferentes serotipos circulantes. MÉTODOS: En verano de 2009 e invierno de 2010 realizamos un estudio multicéntrico en 60 consultas de atención primaria, recogiéndose una muestra nasofaríngea y cumplimentándose una encuesta epidemiológica en 1.562 niños de 1 y 4años. De las 1.562 muestras nasofaríngeas se obtuvieron 489 neumococos, habiéndose podido serotipar 343 (72% de los aislados). RESULTADOS: El 31,3% (489/1.562) de los niños eran portadores. El 61,7% (964/1.562) de los pacientes incluidos habían recibido al menos una dosis de la VCN7. El 12,8% (44/343) de los serotipos identificados eran serotipos vacunales. Fueron factores protectores independientes de colonización: el periodo de verano en todas las edades, la vacunación en el total de los niños (OR: 0,73; IC 95%: 0,56-0,93; p = 0,010) y en niños de 1año (OR: 0,6; IC 95%: 0,42-0,84; p = 0,002) y haber tomado antibióticos en el último mes en el total de la población (OR: 0,69; IC95%: 0,50-0,96). Por el contrario, para todo el grupo, la escolarización (OR: 1,85; IC95%: 1,27-2,18; p = 0,001), el número de hermanos (OR: 1,31; IC 95%: 1,01-0,91) y la exposición al tabaco (OR: 1,33; IC 95%: 1,02-1,73) fueron factores de riesgo. Los serotipos 6A, 19A, 23B, 15A/B, 11A, 14, 23A/F, 3 y 19F fueron los más prevalentes. CONCLUSIONES: La proporción de serotipos vacunales encontrados fue baja, persistiendo el 14, el 23F y el 19F. Hallamos una alta prevalencia de serotipos 6A y 19A. El periodo estival, la vacunación y la administración previa de antibióticos demostraron ser protectores de la colonización; y la escolarización, el hábito tabáquico y el número de hermanos, facilitadores de la misma

BACKGROUND AND OBJECTIVES: Streptococcus pneumoniae is a human pathogen that requires prior nasopharyngeal colonization to cause disease. An epidemiological study was conducted on nasopharyngeal carriers of pneumococci in healthy children in Murcia after the introduction of the VCN7, and immediately before the marketing of new vaccines, with the aim of determining the influence of vaccination in our geographic area, and other factors in relation to the state of being a carrier, and the different circulating serotypes. METHODS: A multicentre study was conducted in in 60 primary care health centres in summer 2009 and winter of 2010. A nasopharyngeal swab was collected, and an epidemiological study was carried out on 1562 children aged 1 and 4 years. Of the 1562 nasopharyngeal samples, pneumococci were found in 489 of them, with 343 of them able to be serotyped (70.2%). RESULTS: The prevalence of carriers was 31.3%. Of the patients included, 61.7% (964/1562) had received at least one dose of VCN7. Only 12.8% of the identified serotypes were vaccine serotypes. The independent protective factors against colonization were; Summer time in all age groups, previous vaccination in all the children (OR: 0.75; 95%CI: 0.56-0.93]; P = .01, and in 1-year-olds (OR: 0.6; 95% CI: 0.42-0.84; P =.002), and had taken antibiotics in the last month in the total cohort [OR: 0.69; 95% CI: 0.50-0.96). On the other hand, attendance at school or day-care centre (OR: 1.85; 95% CI: 1.27-2.18; P=.001), number of siblings (OR: 1.3; 95% CI: 1.01-1.91), and passive tobacco smoke exposure (OR: 1.33; 95%CI: 1.02-1.73), were colonization risk factors. The serotypes 6A, 19A, 23B, 15A/B, 11A, 14, 23A/F, 3 y 19F were the most prevalent. CONCLUSIONS: A low proportion of SV was found, with 14, 23F and 19F are persisting. A high prevalence of serotypes 6A and 19A was found. Summer time, vaccination, and the prior administration of antibiotics proved to be protective against colonization, whereas schooling, smoking, and siblings contributed to it

[Epidemiological study of nasopharyngeal carriers of Streptococcus pneumoniae in children in Murcia region]. / Estudio epidemiológico de portadores nasofaríngeos de Streptococcus pneumoniae en niños en la comunidad autónoma de Murcia.

BACKGROUND AND OBJECTIVES: Streptococcus pneumoniae is a human pathogen that requires prior nasopharyngeal colonization to cause disease. An epidemiological study was conducted on nasopharyngeal carriers of pneumococci in healthy children in Murcia after the introduction of the VCN7, and immediately before the marketing of new vaccines, with the aim of determining the influence of vaccination in our geographic area, and other factors in relation to the state of being a carrier, and the different circulating serotypes. METHODS: A multicentre study was conducted in in 60 primary care health centres in summer 2009 and winter of 2010. A nasopharyngeal swab was collected, and an epidemiological study was carried out on 1562 children aged 1 and 4 years. Of the 1562 nasopharyngeal samples, pneumococci were found in 489 of them, with 343 of them able to be serotyped (70.2%). RESULTS: The prevalence of carriers was 31.3%. Of the patients included, 61.7% (964/1562) had received at least one dose of VCN7. Only 12.8% of the identified serotypes were vaccine serotypes. The independent protective factors against colonization were; Summer time in all age groups, previous vaccination in all the children (OR: 0.75; 95%CI: 0.56-0.93]; P=.01, and in 1-year-olds (OR: 0.6; 95%CI: 0.42-0.84; P=.002), and had taken antibiotics in the last month in the total cohort [OR: 0.69; 95%CI: 0.50-0.96). On the other hand, attendance at school or day-care centre (OR: 1.85; 95%CI: 1.27-2.18; P=.001), number of siblings (OR: 1.3; 95%CI: 1.01-1.91), and passive tobacco smoke exposure (OR: 1.33; 95%CI: 1.02-1.73), were colonization risk factors. The serotypes 6A, 19A, 23B, 15A/B, 11A, 14, 23A/F, 3 y 19F were the most prevalent. CONCLUSIONS: A low proportion of SV was found, with 14, 23F and 19F are persisting. A high prevalence of serotypes 6A and 19A was found. Summer time, vaccination, and the prior administration of antibiotics proved to be protective against colonization, whereas schooling, smoking, and siblings contributed to it.

Enterovirus reverse transcriptase polymerase chain reaction assay in cerebrospinal fluid: An essential tool in meningitis management in childhood

Background Enteroviruses (EV) are the main aetiological agents of aseptic meningitis in children and a common cause of febrile illnesses in young infants in summer. A rapid diagnosis is essential to rule out other conditions. Real-time reverse transcriptase polymerase chain reaction (RT-PCR) assay performed in cerebrospinal fluid (CSF) has proved to be a very fast and useful tool. Methods We collected demographic, clinical and laboratory data of children (aged 11-years or younger) with EV RT-PCR (Cepheid® Xpert EV) positive in CSF from December 2007 to July 2010, to describe EV meningitis in children and to determine the role of this assay. Results We included 92 children (mean age 2.5 years), 32% of whom were neonates. There was no pleocytosis in the CSF of 18.5% (36% in newborn) of the patients, and 23 (25%) were discharged to home from the Emergency Room after the positive results. Length of hospital stay was 2 days (>2 years) versus 4.5 days in newborns (P<0.0001). Antibiotic treatment was prescribed in 38% (75% <3 months), but in 40% of these, it was stopped after the positive results. Mean EV RT-PCR information time was 7h (4–18h). All children had a good clinical outcome. Conclusions EV RT-PCR assay in CSF has played an essential role in the management of children with EV meningitis, allowing earlier discharges and decreasing avoidable inappropriate antibiotic treatments. This test should be considered as part of the initial study of children with aseptic meningitis, especially during epidemic seasons (AU)

Introducción Los enterovirus (EV) son los principales agentes etiológicos de meningitis aséptica en niños, y una causa frecuente de síndrome febril en lactantes durante el verano. El diagnóstico rápido es esencial para descartar otras entidades. La reacción en cadena de la polimerasa en tiempo real (RT-PCR) realizada en líquido cefalorraquídeo (LCR) ha demostrado ser una herramienta rápida y útil. Métodos Se recogieron datos demográficos, clínicos y de laboratorio de los niños (<11 años) con RT-PCR a EV (Cepheid® Xpert EV) positiva en LCR desde diciembre de 2007 a julio de 2010 para describir las meningitis por EV en niños y conocer el papel de esta técnica. Resultados Incluimos a 92 niños (edad media 2,5 años), un 32% neonatos. El 18,5% (36% de los neonatos) no tenía pleocitosis en el LCR, 23 (25%) se fueron de alta desde la Sala de Urgencias tras el resultado positivo. La estancia hospitalaria fue de 2 días (>2 años) versus 4,5 días en neonatos (p<0,0001). Se pautó tratamiento antibiótico en el 38% (75% <3 meses), pero en el 40% se suspendió tras el resultado positivo. El tiempo medio de información del resultado de RT-PCR a EV fue de 7h (4-18h). La evolución fue favorable en todos los casos. Conclusiones La RT-PCR a EV en LCR ha desempeñado un papel esencial en el manejo de los niños con meningitis por EV, permitiendo altas más precoces y disminuyendo los tratamientos antibióticos inadecuados. Este test debería considerarse dentro del estudio inicial de los niños con meningitis aséptica, especialmente en los meses epidémicos (AU)

Enterovirus reverse transcriptase polymerase chain reaction assay in cerebrospinal fluid: an essential tool in meningitis management in childhood.

BACKGROUND: Enteroviruses (EV) are the main aetiological agents of aseptic meningitis in children and a common cause of febrile illnesses in young infants in summer. A rapid diagnosis is essential to rule out other conditions. Real-time reverse transcriptase polymerase chain reaction (RT-PCR) assay performed in cerebrospinal fluid (CSF) has proved to be a very fast and useful tool. METHODS: We collected demographic, clinical and laboratory data of children (aged 11-years or younger) with EV RT-PCR (Cepheid(®) Xpert EV) positive in CSF from December 2007 to July 2010, to describe EV meningitis in children and to determine the role of this assay. RESULTS: We included 92 children (mean age 2.5 years), 32% of whom were neonates. There was no pleocytosis in the CSF of 18.5% (36% in newborn) of the patients, and 23 (25%) were discharged to home from the Emergency Room after the positive results. Length of hospital stay was 2 days (>2 years) versus 4.5 days in newborns (P<0.0001). Antibiotic treatment was prescribed in 38% (75% <3 months), but in 40% of these, it was stopped after the positive results. Mean EV RT-PCR information time was 7h (4-18h). All children had a good clinical outcome. CONCLUSIONS: EV RT-PCR assay in CSF has played an essential role in the management of children with EV meningitis, allowing earlier discharges and decreasing avoidable inappropriate antibiotic treatments. This test should be considered as part of the initial study of children with aseptic meningitis, especially during epidemic seasons.