[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.

[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.

Vacunaciones en el niño con síndrome de Down / Vaccinations in children with Down syndrome

Se hace una revisión de las circunstancias y características de los niños y jóvenes con síndrome de Down en lo que se refiere a la especial susceptibilidad de los mismos a padecer infecciones y las oportunidades de optimización que suponen las inmunizaciones sistemáticas disponibles. Se propone un calendario de vacunaciones sistemáticas aplicables a los pacientes con síndrome de Down que pretende responder al objetivo citado, y que incluye a las vacunas frente a: hepatitis B, difteria, tétanos y tosferina, sarampión, rubeola y parotiditis, poliomielitis, enfermedad invasiva por neumococo y Haemophilus influenzae tipo b, gripe, varicela, rotavirus y hepatitis A (AU)

This article reviews the circumstances and characteristics of children and young people with Down syndrome in regard to their special susceptibility to infection and the opportunities to optimization posed by the routine immunization available. It also proposes a systematic vaccination schedule applicable to patients with Down syndrome who attempt to meet the above objective, and that includes vaccines against hepatitis B, diphtheria, tetanus, pertussis, measles, mumps and rubella, polio, pneumococcal invasive disease and Haemophilus influenzae type b, influenza, chickenpox, rotavirus and hepatitis A

[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.

[Universal immunisation against influenza in paediatrics, yes or no?]. / Vacunación antigripal universal en pediatría, ¿sí o no?

INTRODUCTION: The recommendations on influenza vaccination are not homogeneous between countries, with striking differences between the current recommendations in United States and Europe. OBJECTIVE: The objective of the study is to determine the efficacy, effectiveness and safety of the current flu vaccine (trivalent inactivated vaccine and adapted to the cold [LAIV] live virus vaccine) in healthy children, and to try and answer the following question: universal immunization against influenza in Paediatrics, yes or no? MATERIAL AND METHODS: A scheme of work based on the five standard steps of evidence or science-based medicine was used: 1) question, 2) search, 3) valuation, 4) applicability and 5) adequacy. RESULTS: Nine systematic reviews, published between 2005 and 2012, were selected that answered our clinical question, and which included the best available information (randomised clinical trials, cohort studies and case studies). CONCLUSIONS: The flu vaccine in childhood has the right cost - benefit - risk relationship. In all systematic reviews the efficacy of the flu vaccine varied between 58%-65%, and effectiveness between 28%-61%. Both efficacy and effectiveness increase with age, and there are limited studies showing sufficient evidence in children < 2 years. There are further areas to develop: more and better clinical trials on influenza vaccines in infants from 6 to 23 months; further research to achieve better influenza vaccines (addition of adjuvants, higher doses in children between 6 and 23 months, and study the LAIV vaccine in children between 6 and 23 months); and improvement in the prediction of vaccine strains responsible for the outbreak.

[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)

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.

[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.

Documento de consenso sobre el tratamiento de la exposición a tuberculosis y de la infección tuberculosa latente en niños / Treatment of tuberculosis exposure and latent tuberculosis infection in children

Introducción La pobreza, la infección por el virus de la inmunodeficiencia humana (VIH), la resistencia a fármacos y la diseminación a partir de pacientes con infección latente son las causas más importantes de la pandemia actual de tuberculosis. En los países industrializados, la población inmigrante procedente de países en desarrollo y la falta de programas eficaces de control son las causas principales del incremento de la enfermedad. La situación de los niños es todavía más grave por ser más vulnerables a la enfermedad que los adultos. El mayor riesgo de contraer tuberculosis lo tienen los niños autóctonos que conviven con adultos que tienen factores de riesgo de tuberculosis y los niños inmigrantes y adoptados del tercer mundo. A pesar de que los niños desarrollan la enfermedad no son prácticamente nunca bacilíferos, el tratamiento adecuado de la exposición a tuberculosis bacilífera y de la infección tuberculosa latente en niños contribuye a crear una vigilancia estrecha de los núcleos familiares que asegura un riguroso estudio de contactos y contribuye a evitar formas graves de tuberculosis, más frecuentes en el niño. Objetivo El objetivo de este segundo documento de consenso del Grupo de Trabajo de Tuberculosis de la Sociedad de Infectología Pediátrica (SEIP) es unificar criterios para el tratamiento de las situaciones de exposición a tuberculosis e infección tuberculosa latente en niños y sensibilizar a las autoridades sanitarias acerca de la necesidad de acometer programas muy estrictos de detección de tuberculosis en población de riesgo

Introduction The most important causes of the current tuberculosis pandemic are poverty, HIV infection, drug resistance, and the spread of infection by patients with latent tuberculosis infection. In industrialized countries, the main reasons for the increase of this disease are immigration from developing countries and the lack of effective surveillance programs. The situation of children is even more serious as they are more vulnerable to the disease than adults. The children most at risk are those who live with adults at risk for tuberculosis, immigrant children, and adoptees from developing countries. Although children are bacilliferous only exceptionally, the appropriate management of bacilliferous tuberculosis exposure and latent tuberculosis infection in children contributes to the creation of close surveillance of nuclear families and rigorous study of contacts. Moreover, it could prevent serious forms of the disease, which are more frequent in children. Objective The principal objective of this second consensus document of the Spanish Society of Pediatric Infectious Diseases (Sociedad Española de Infectología Pediátrica [SEIP]) is to unify the criteria for the treatment of tuberculosis exposure and latent tuberculosis infection in children. A further aim is to increase awareness of the need for strict detection measures in high-risk populations among health authorities

[Pneumococcal disease and its prevention. The heptavalent pneumococcal conjugate vaccine]. / La enfermedad neumocócica y su prevención. Vacuna neumocócica conjugada heptavalente.

Pneumococcal disease is a major cause of morbidity, hospitalization and mortality. Two age groups show a greater incidence and severity of the disease: children under the age of 5 years (mainly during the first 2 years of life) and adults aged more than 65 years. The heptavalent pneumococcal conjugate vaccine, which was commercialized in Spain in June 2001, is efficacious in children aged less than 2 years and, unlike the non-conjugate 23-valent vaccine, it induces immunological memory. In Spain the heptavalent vaccine covers 80 % of serotypes causing pneumococcal invasive disease and acute otitis media in children aged 2-59 months. The heptavalent vaccine has been shown to be immunogenic, efficacious and safe. It has proven efficacy in the prevention of invasive disease caused by the seven vaccine serotypes. In addition, it significantly decreases pneumonia and also prevent acute otitis media. The vaccine is preferably indicated in children aged less than 2 years; children aged 2-5 years may also benefit from the vaccine but those in risk groups should be prioritized. Greater knowledge of the epidemiology of pneumococcal disease and the efficiency of this vaccine in Spain will determine whether it should be included in the immunization schedule.

[Clinical and microbiological study of otitis media in infants]. / Estudio clínico y microbiológico de la otitis media del lactante.

The objective of this study was to determine the prevalence of bacteria isolated from middle ear effusions in infants with otitis media in our environment. Data collected from 50 patients of the Infant Section of the Unidad Integrada Hospital Clínico-San Juan de Dios were evaluated prospectively from October 1, 1992 to March 7, 1994. Patients between 1 month and 1 year of age, with unilateral or bilateral otitis media diagnosed by otoscopy criteria and positive myringotomy, were recruited for study. Those who had received any antibiotic during the previous 3 days or had been admitted to the hospital more than 5 days before were excluded. We found that failure to thrive (18%) is a common form of onset of otitis media in children under one year of age. Rhinorrhea and nasal obstruction (60%), cough (50%) and fever (46%) were the most frequent symptoms at the moment of diagnosis. Blood analysis does not add any information for diagnosing otitis media. The difference between acute otitis media and otitis media with effusion is likely to be more clinical rather than microbiological. The recovery of pathogens from 62% of the ear cultures correlates with the figures reported in the literature. The predominance of S. pneumoniae (38%), followed by H. influenzae (25%), is in agreement with previous findings internationally. In our study, there is no evidence of viruses alone causing otitis media in infants. Consequently, antibiotic therapy should be indicated in every child with otitis media.

[Craneopharyngioma in children (author's transl)]. / Clínica del craneofaringioma en la infancia

Clinical findings in the initial and developed stages were studied in 33 cases of craneopharyngiomas in children under sixteen. A predominance of intracraneal hypertension symptoms and sight defects over endocrine symptoms was discovered; the latter appearing later on or only being detected after exhaustive studies.