Hospitalizaciones infantiles asociadas a infección por virus de la gripe en 6 ciudades de España (2014-2016) / Child hospital admissions associated with influenza virus infection in 6 Spanish cities (2014-2016)

Introducción: La información existente sobre el impacto de la gripe en la población infantil española es escasa. El presente trabajo pretende aumentar este conocimiento estudiando aspectos clave como la incidencia de hospitalización, clínica, comorbilidades y el estado vacunal en los niños hospitalizados. Métodos: Estudio retrospectivo, observacional, por revisión de historias clínicas, en menores de 15 años hospitalizados por gripe adquirida en la comunidad, confirmada microbiológicamente, durante 2 temporadas gripales (2014-2015 y 2015-2016). El estudio se realizó en 10 hospitales de 6 ciudades, que atienden aproximadamente al 12% de la población infantil española. Resultados: Fueron hospitalizados 907 niños con diagnóstico principal de gripe (447 < 2 años), con una tasa media anual de incidencia de hospitalización de 0,51 casos/1.000 niños (IC del 95% 0,48-0,55). El 45% presentó enfermedades subyacentes consideradas factores de riesgo para gripe grave, y la mayor parte de ellos (74%) no habían sido vacunados. El porcentaje con enfermedades subyacentes aumentó con la edad, desde el 26% en menores de 6 meses al 74% en mayores de 10 años. El 10% de los casos (n = 92) precisaron cuidados intensivos pediátricos por fallo respiratorio agudo. Conclusión: La gripe es causa importante de hospitalización en la población infantil española. Los menores de 6 meses de edad y los niños con enfermedades subyacentes constituyen una parte mayoritaria (> 50%) de los casos. Una gran parte de las formas graves de gripe en población infantil podrían ser evitada si se cumplieran las indicaciones actuales de vacunación

Introduction: There are only a limited number of studies on the impact of influenza in the Spanish child population. The present work intends to increase this knowledge by studying some key aspects, such as the incidence of hospital admissions, clinic variables, comorbidities, and the vaccination status in the hospitalised children. Methods: A retrospective, observational study was conducted by reviewing the medical records of children under 15 years and hospitalised due to community acquired influenza confirmed microbiologically, during 2́ flu seasons (2014-2015 and 2015-2016). The study was carried out in 10 hospitals of 6cities, which represent approximately 12% of the Spanish child population. Results: A total of 907 children were admitted to hospital with main diagnosis of influenza infection (447 < 2 years), estimating an average annual rate of hospitalisation incidence of 0.51 cases / 1,000 children (95% CI; 0.48-0.55). Just under half (45%) of the cases had an underlying disease considered a risk factor for severe influenza, and most (74%) had not been vaccinated. The percentage of children with underlying diseases increased with age, from 26% in children < 6 months to 74% in children >10 years. Admission to the PICU was required in 10% (92) of the cases, mainly due to acute respiratory failure. Conclusion: Influenza continues to be an important cause of hospitalisation in the Spanish child population. Children < 6 months of age and children with underlying diseases make up the majority (> 50%) of the cases. Many of the severe forms of childhood influenza that occur today could be avoided if current vaccination guidelines were met

[Child hospital admissions associated with influenza virus infection in 6 Spanish cities (2014-2016)]. / Hospitalizaciones infantiles asociadas a infección por virus de la gripe en 6 ciudades de España (2014-2016).

INTRODUCTION: There are only a limited number of studies on the impact of influenza in the Spanish child population. The present work intends to increase this knowledge by studying some key aspects, such as the incidence of hospital admissions, clinic variables, comorbidities, and the vaccination status in the hospitalised children. METHODS: A retrospective, observational study was conducted by reviewing the medical records of children under 15 years and hospitalised due to community acquired influenza confirmed microbiologically, during 2́flu seasons (2014-2015 and 2015-2016). The study was carried out in 10 hospitals of 6cities, which represent approximately 12% of the Spanish child population. RESULTS: A total of 907 children were admitted to hospital with main diagnosis of influenza infection (447 <2 years), estimating an average annual rate of hospitalisation incidence of 0.51 cases / 1,000 children (95% CI; 0.48-0.55). Just under half (45%) of the cases had an underlying disease considered a risk factor for severe influenza, and most (74%) had not been vaccinated. The percentage of children with underlying diseases increased with age, from 26% in children <6 months to 74% in children >10 years. Admission to the PICU was required in 10% (92) of the cases, mainly due to acute respiratory failure. CONCLUSION: Influenza continues to be an important cause of hospitalisation in the Spanish child population. Children <6 months of age and children with underlying diseases make up the majority (> 50%) of the cases. Many of the severe forms of childhood influenza that occur today could be avoided if current vaccination guidelines were met.

Recomendaciones de la Asociación Española de Pediatría sobre la vacuna neumocócica de 2017. Respuesta de los autores / 2017 pneumococcal vaccine recommendations of the Spanish Association of Paediatrics. Authors reply

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[Immunisation schedule of the Spanish Association of Paediatrics: 2017 recommendations]. / Calendario de vacunaciones de la Asociación Española de Pediatría (CAV-AEP): recomendaciones 2017.

The Advisory Committee on Vaccines of the Spanish Association of Paediatrics (CAV- AEP) annually publishes the immunisation schedule which, in our opinion, is considered optimal for children resident in Spain, taking into account the evidence available on current vaccines. Pneumococcal and varicella immunisation in early childhood is already included in all funded vaccines present in the regional immunisation programmes. Furthermore, this committee establishes recommendations on vaccines not included in official calendars (non-funded immunisations), such as rotavirus, meningococcal B, and meningococcal ACWY. As regards funded immunisations, 2+1 strategy (2, 4, 11-12 months) with hexavalent (DTaP-IPV-Hib-HB) and 13-valent pneumococcal vaccines is recommended. Administration of the 6-year booster dose with DTaP is recommended, as well as a poliomyelitis dose for children who had received the 2+1 scheme, with the Tdap vaccine for adolescents and pregnant women between 27 and 32 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 12 with a two-dose scheme (0, 6 months) should be improved. Information and recommendations for male adolescents about potential beneficial effects of the tetravalent HPV vaccine should also be provided. ACWY meningococcal vaccine is the optimal choice in adolescents. For recommended unfunded immunisations, the CAV-AEP recommends the administration of meningococcal B vaccine, due to the current availability in Spanish community pharmacies, with a 3+1 scheme. CAV-AEP requests the incorporation of this vaccine in the funded unified schedule. Vaccination against rotavirus is recommended in all infants.

Vacunación frente a la hepatitis B. Impacto de los programas de vacunación tras 20 años de su utilización en España. ¿Es tiempo de cambios? / Vaccination against hepatitis B. Impact of vaccination programmes after 20 years of use in Spain. Is it time for a change?

La tasa de incidencia más alta de hepatitis B (HB) en España se detecta en los adultos entre 20 y 54 años, mientras que la incidencia de casos en menores de un año es casi nula. La baja prevalencia de HB en los menores de un año se debe principalmente al éxito de las estrategias de cribado gestacional para la detección de gestantes HBsAg(+) y a las campañas de vacunación durante la infancia. Actualmente en España la última dosis de la vacuna frente a la HB en el calendario de vacunación infantil es a los 6 meses de edad, si bien hay estudios que demuestran que retrasar la edad de la administración de la última dosis y aumentar el tiempo entre las dosis pueden mejorar la memoria inmunológica ofreciendo una mayor protección frente al virus en la edad adulta. Se revisa el impacto de la vacunación frente a la HB en España y se comentan otras estrategias posibles de vacunación en nuestro medio, ampliando el intervalo entre dosis y la administración de la última dosis en el segundo año de la vida, adaptando la estrategia vigente en España al actual contexto epidemiológico con el fin de disminuir la prevalencia en la edad adulta

The highest incidence rate of hepatitis B (HB) in Spain is detected in adults between 20 and 54 years old, whereas the incidence in children under 1 year old is almost nil. The low prevalence of HB in children under 1 year is mainly due to the success of gestational screening strategies for the detection of HBsAg(+) in pregnant women, and vaccination campaigns during childhood. Currently, in Spain, the last dose of the HB included in the national childhood immunization program is administered at 6 months of age, although some studies show that delaying the age of the administration of the last dose of HB vaccine and increasing the time between doses, may improve immune memory by offering greater protection against this virus in the adulthood. In this article, the impact of HB vaccination in Spain is reviewed, and other potential vaccination strategies in our environment are discussed, such as extending the interval between doses, and administering the last dose in the second year of life, adapting the valid strategy in Spain to the current epidemiological context in order to reduce the prevalence of HB in adulthood

[Vaccination against hepatitis B. Impact of vaccination programmes after 20 years of use in Spain. Is it time for a change?]. / Vacunación frente a la hepatitisB. Impacto de los programas de vacunación tras 20años de su utilización en España. ¿Es tiempo de cambios?

The highest incidence rate of hepatitis B (HB) in Spain is detected in adults between 20 and 54 years old, whereas the incidence in children under 1 year old is almost nil. The low prevalence of HB in children under 1 year is mainly due to the success of gestational screening strategies for the detection of HBsAg(+) in pregnant women, and vaccination campaigns during childhood. Currently, in Spain, the last dose of the HB included in the national childhood immunization program is administered at 6 months of age, although some studies show that delaying the age of the administration of the last dose of HB vaccine and increasing the time between doses, may improve immune memory by offering greater protection against this virus in the adulthood. In this article, the impact of HB vaccination in Spain is reviewed, and other potential vaccination strategies in our environment are discussed, such as extending the interval between doses, and administering the last dose in the second year of life, adapting the valid strategy in Spain to the current epidemiological context in order to reduce the prevalence of HB in adulthood.

Tos ferina en España. Situación epidemiológica y estrategias de prevención y control. Recomendaciones del Grupo de Trabajo de Tos ferina / Whooping cough in Spain. Current epidemiology, prevention and control strategies. Recommendations by the Pertussis Working Group

En los últimos años se está observando una reemergencia de la tos ferina en los países con amplias coberturas vacunales, con la aparición de brotes importantes. Este aumento de la incidencia tiene una distribución por edades bipolar: en los lactantes menores de 6meses, que por su edad no han iniciado la vacunación o no han completado la primovacunación, y en los adolescentes y adultos por la disminución de su inmunidad, vacunal o natural, con el tiempo transcurrido desde la inmunización o el padecimiento de la enfermedad. Estos cambios epidemiológicos justifican la adopción de nuevas estrategias vacunales con la finalidad de proteger al lactante pequeño y disminuir la incidencia de la enfermedad en toda la población. La vacunación del adolescente y del adulto debería ser prioritaria; en el primer caso solo supone cambiar la vacuna dT por la dTpa, con un coste adicional pequeño. La vacunación del adulto puede ser más difícil de implementar, pero de la misma forma que en muchos países se revacuna cada 10años frente a la difteria y el tétanos (con la vacuna dT), debería hacerse también frente a la tos ferina (con la vacuna dTpa). La estrategia que puede tener un impacto más importante sobre la incidencia de la tos ferina en el lactante es la vacunación de las personas con quienes convive o va a convivir, lo que se conoce como estrategia del nido. Recientemente, en algunos países se ha introducido también la vacunación de la embarazada, a partir de las 20semanas de gestación, como la forma más efectiva para proteger al recién nacido (AU)

A large increase of pertussis incidence has been observed in recent years in countries with high vaccination coverage. Outbreaks of pertussis are increasingly being reported. The age presentation has a bipolar distribution: infants younger 6months that have not initiated or completed a vaccination schedule, and adolescents and adults, due to the lost of natural or vaccine immunity over time. These epidemiological changes justify the need to adopt new vaccination strategies in order to protect young infants and to reduce pertussis incidence in all age groups. Adolescents and adults immunization must be a priority. In the first group, strategy is easy to implement, and with a very low additional cost (to replace dT vaccine by dTap one). Adult vaccination may be more difficult to implement; dT vaccine decennial booster should be replaced by dTap. The immunization of household contacts of newborn infants (cocooning) is the strategy that has a most important impact on infant pertussis. Recently, pregnant women vaccination (after 20weeks of gestation) has been recommended in some countries as the most effective way to protect the newborn (AU)

[Whooping cough in Spain. Current epidemiology, prevention and control strategies. Recommendations by the Pertussis Working Group]. / Tos ferina en España. Situación epidemiológica y estrategias de prevención y control. Recomendaciones del Grupo de Trabajo de Tos ferina.

A large increase of pertussis incidence has been observed in recent years in countries with high vaccination coverage. Outbreaks of pertussis are increasingly being reported. The age presentation has a bipolar distribution: infants younger 6months that have not initiated or completed a vaccination schedule, and adolescents and adults, due to the lost of natural or vaccine immunity over time. These epidemiological changes justify the need to adopt new vaccination strategies in order to protect young infants and to reduce pertussis incidence in all age groups. Adolescents and adults immunization must be a priority. In the first group, strategy is easy to implement, and with a very low additional cost (to replace dT vaccine by dTap one). Adult vaccination may be more difficult to implement; dT vaccine decennial booster should be replaced by dTap. The immunization of household contacts of newborn infants (cocooning) is the strategy that has a most important impact on infant pertussis. Recently, pregnant women vaccination (after 20weeks of gestation) has been recommended in some countries as the most effective way to protect the newborn.

Calendario de vacunaciones de la Asociación Española de Pediatría: recomendaciones 2013 / Immunisation schedule of the Spanish Association of Paediatrics: 2013 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 seguridad, 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. 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, el CAV-AEP mantiene las novedades propuestas la temporada anterior, como la administración de las primeras dosis de las vacunas triple vírica y varicela a los 12 meses y las segundas dosis a los 2-3 años, así como la administración de la vacuna Tdpa a los 4-6 años, siempre acompañada de otra dosis a los 11-14 años, con preferencia a los 11-12 años. El CAV-AEP estima que deben incrementarse las coberturas de vacunación frente al papilomavirus humano en las niñas de 11 a 14 años, con preferencia a los 11-12 años. Se reafirma en la recomendación de incluir la vacunación frente al neumococo en el calendario de vacunación sistemático. 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, dadas 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 a 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 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 (AU)

Documento de consenso sobre el tratamiento de la tuberculosis pulmonar en niños / Consensus document for the treatment of pulmonar tuberculosis in children

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Evaluation of the safety and immunogenicity of pneumococcal seven-valent conjugate vaccine (Prevenar) administered in previously unvaccinated Spanish children aged 24 to 36 months.

This study evaluates the safety and immunogenicity of pneumococcal seven-valent conjugate vaccine (Prevenar) in 115 children, aged 2-3 years (24-36 months), who have not been previously vaccinated with Prevenar. SAFETY: As for local reactions, 40% of children reported erythema, 32.2% induration and 39.1% tenderness at the injection site. Regarding systemic reactions, fever > or 38 C was recorded in 7% of patients. Other commonly reported events were decreased appetite (24.3%), restlessness (20%), and fussiness (18.3%). IMMUNOGENICITY: After vaccination, more than 98% of the subjects achieved antibody levels of > or = 0.15 microg/mL for all seven serotypes and more than 95% achieved antibody levels > or = 0.50 microg/mL for all serotypes. CONCLUSIONS: Pneumococcal seven-valent conjugate vaccine (Prevenar) was safe, well tolerated and highly immunogenic when administered in previously unvaccinated children aged 14-36 months.

Perspectivas en la erradicación de las infecciones prevenibles por vacunación / Perspectives in the eradication on the immuno-preventable diseases

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