Evaluación de las coberturas de vacunación antineumocócica y antigripal en pacientes reumatológicos con terapia biológica de un hospital autonómico de referencia / Evaluation of pneumococcal and influenza vaccination coverage in rheumatology patients receiving biological therapy in a regional referral hospital

OBJETIVO: Conocer las coberturas de vacunación frente a gripe estacional y neumococo en pacientes reumatológicos con terapia biológica. Identificar las variables que predicen adherencia a la vacunación. MATERIAL Y MÉTODO: Estudio transversal. Se incluyeron los pacientes reumatológicos que iniciaron terapia biológica entre el 01/01/2016 y el 31/12/2016 en un hospital autonómico de referencia. Se recogieron variables sociodemográficas, relacionadas con el diagnóstico, médico prescriptor, derivación a la Unidad de Vacunas y vacunación frente a neumococo con vacuna conjugada de 13 serotipos (VNC13) y polisacárida de 23 serotipos (VNP23), así como gripe estacional (2016/17). Se realizó análisis univariante, bivariante (Chi-cuadrado) y multivariante (regresión logística). Se consideró significativa una p < 0,05 y se utilizó el programa PASW V.18. RESULTADOS: Se incluyeron 222 pacientes. Las coberturas de vacunación fueron: VNC13, 80,2%; VNP23v, 77,9%; gripe 2016/17, 78,8%; VNC13 + VNP23, 75,2%; VNC13 + VNP23 + gripe 2016/17, 68,9%. La espondilitis axial registró las coberturas más altas (>80%) para la vacunación antineumocócica y en combinación con la antigripal. El 27% de los pacientes no fueron derivados a la Unidad. El médico prescriptor se asoció de manera estadísticamente significativa con cada una de las vacunas y sus combinaciones, pero fue la derivación a la Unidad de Vacunas la que se asoció de manera independiente con las mayores coberturas de vacunación (p < 0,001) en todos los casos. CONCLUSIONES: Comparando con la literatura científica, consideramos que las coberturas frente a neumococo y gripe en estos pacientes son elevadas. La derivación de estos pacientes a la Unidad de Vacunas resulta clave para garantizar una correcta inmunización y minimizar así algunos de los posibles efectos adversos infecciosos de las terapias biológicas

OBJECTIVE: Vaccination coverage for seasonal influenza and pneumococcus in rheumatology patients receiving biological treatment. To identify variables that predict vaccination adherence. MATERIAL AND METHOD: Descriptive cross-sectional study. The study involved rheumatology patients who initiated biological therapy between 01/01/2016 and 12/31/2016 in a regional referral hospital. Variables included sociodemographic information, diagnostic data, treating physician, referral to the vaccine unit and vaccination against pneumococcus with 13-valent pneumococcal conjugate vaccine (PCV13) and 23-valent pneumococcal polysaccharide vaccine (PPSV23), as well as seasonal influenza (2016/17). Univariate, bivariate (Chi-square) and multivariate analysis (logistic regression) were performed. The differences were considered significant (P<.05) and the PASW V.18 software package was used. RESULTS: In all, 222 patients were included. Vaccination coverage was: PCV13, 80.2%; PPSV23, 77.9%; influenza 2016/17, 78.8%; PCV13 + PPSV23, 75.2%; PCV13 + PPSV23 + influenza 2016/17, 68.9%. Axial spondylitis had the highest coverage (>80%) for pneumococcal vaccination and combination of pneumococcal with influenza. Overall, 27% of the patients were not referred to the unit. The treating physician was associated with statistical significance in each vaccine alone or combined, but referral to the vaccine unit was independently associated with the highest vaccination coverage (P<.001) in all cases. CONCLUSIONS: Compared to the scientific literature, we consider that the coverage of our patients against pneumococcus and influenza is high. Referral of these patients to the vaccine unit is the key to guarantee a correct immunization and to minimize some of the possible infectious adverse effects of biological therapies

Evaluation of pneumococcal and influenza vaccination coverage in rheumatology patients receiving biological therapy in a regional referral hospital. / Evaluación de las coberturas de vacunación antineumocócica y antigripal en pacientes reumatológicos con terapia biológica de un hospital autonómico de referencia.

OBJECTIVE: Vaccination coverage for seasonal influenza and pneumococcus in rheumatology patients receiving biological treatment. To identify variables that predict vaccination adherence. MATERIAL AND METHOD: Descriptive cross-sectional study. The study involved rheumatology patients who initiated biological therapy between 01/01/2016 and 12/31/2016 in a regional referral hospital. Variables included sociodemographic information, diagnostic data, treating physician, referral to the vaccine unit and vaccination against pneumococcus with 13-valent pneumococcal conjugate vaccine (PCV13) and 23-valent pneumococcal polysaccharide vaccine (PPSV23), as well as seasonal influenza (2016/17). Univariate, bivariate (Chi-square) and multivariate analysis (logistic regression) were performed. The differences were considered significant (P<.05) and the PASW v.18 software package was used. RESULTS: In all, 222 patients were included. Vaccination coverage was: PCV13, 80.2%; PPSV23, 77.9%; influenza 2016/17, 78.8%; PCV13+PPSV23, 75.2%; PCV13+PPSV23+influenza 2016/17, 68.9%. Axial spondylitis had the highest coverage (>80%) for pneumococcal vaccination and combination of pneumococcal with influenza. Overall, 27% of the patients were not referred to the unit. The treating physician was associated with statistical significance in each vaccine alone or combined, but referral to the vaccine unit was independently associated with the highest vaccination coverage (P<.001) in all cases. CONCLUSIONS: Compared to the scientific literature, we consider that the coverage of our patients against pneumococcus and influenza is high. Referral of these patients to the vaccine unit is the key to guarantee a correct immunization and to minimize some of the possible infectious adverse effects of biological therapies.

Miocarditis como forma de presentación de una miopatía inflamatoria autoinmunitaria asociada con anticuerpos antipartícula de reconocimiento de señal / Myocarditis as a form of presentation of an inflammatory autoimmune myopathy associated with anti-signal recognition particle antibodies

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Uso de vacuna frente a hepatitis B adyuvada con AS04C en pacientes VIH / Use of hepatitis B AS04C adjuvanted vaccine in HIV patients

Introducción. La coinfección por virus de hepatitis B (VHB) en pacientes con virus de inmunodeficiencia humana (VIH) aumenta la morbimortalidad asociada. La vacunación frente al VHB ha mostrado ser el método más efectivo para prevenir esta situación. Los esquemas de vacunación estándar utilizados en esta población no parecen ser suficientemente efectivos. El objetivo es conocer la tasa de respondedores tras el uso de la vacuna de hepatitis B adyuvada con AS04C en pacientes VIH, así como las posibles reacciones adversas asociadas. Métodos. Estudio analítico observacional con una cohorte retrospectiva de pacientes VIH positivos vacunados y dados de alta en 2016 de la Unidad de Vacunas de un Servicio de Medicina Preventiva y Salud Pública. Se incluyeron los pacientes que presentaban antiHBs (-), antiHBcActot (-) y HBsAg (-) a nivel basal, sin haber recibido previamente vacunación frente al VHB. Se utilizó la vacuna frente al VHB adyuvada con AS04C en pauta de 4 dosis (0-1-2-6 meses). Cuando antiHBs <10 UI/mL tras la primovacunación, se aplicaron 2 dosis más de la misma vacuna separadas de 30 días. Resultados. Se incluyeron un total de 39 pacientes. De ellos, 74,4% fueron hombres. La media de edad fue 47,26 años. Se observó una tasa de respondedores tras la primovacunación superior al 92% y hasta el 100% con las dos dosis posteriores. No se detectó ninguna reacción adversa tras la vacunación. Conclusión: la administración en pacientes VIH de vacuna frente a hepatitis B adyuvada con AS04C registró una tasa de respuesta del 100% mostrando, además, un excelente perfil de seguridad

Introduction. Co-infection with hepatitis B virus (HBV) in patients with human immunodeficiency virus (HIV) increases associated morbidity and mortality. Vaccination against HBV has been shown to be the most effective method to prevent this situation. Standard vaccination schemes used in this population do not appear to be effective enough. The objective is to identify the response rate following the use of AS04C-adjuvanted hepatitis B vaccine in HIV patients as well as the possible associated adverse reactions. Methods. An observational, analytical study with a retrospective cohort of HIV positive patients discharged in 2016 from the Vaccines Unit of a Preventive Medicine and Public Health Service. Patients with antiHBs (-), antiHBcActot (-) and HBsAg (-) at baseline were included, none of them had received prior HBV vaccination. HBV adjuvanted vaccine was used in a 4-dose regimen (0-1-2-6 months). When antiHBs was <10 IU/mL after primovaccination, two additional doses of the same vaccine were applied with an interval of 30 days. Results. A total of 39 patients were included. Of them, 74.4% were men. The mean age was 47.26 years. The response rate after primary vaccination was higher than 92% and up to 100% with the two subsequent doses. No adverse reactions were reported. Conclusion. The administration of AS04C-adjuvanted hepatitis B vaccine in HIV patients showed a 100% response rate, showing an excellent safety profile