Vacunación antineumocócica: situación actual / Pneumococcal vaccination: current status

Las infecciones por Streptococcus pneumoniae originan una importante morbilidad y mortalidad. Entre las personas más susceptibles a su desarrollo se encuentran las de mayor edad, los pacientes inmunodeprimidos y aquellos con comorbilidad, pudiendo presentar además una mayor gravedad y una evolución más desfavorable. Las pautas de vacunación frente al neumococo tienen como objetivo disminuir la incidencia de estas infecciones. Las recomendaciones para ello han ido cambiando a lo largo de los años. La reciente aprobación de la vacuna neumocócica conjugada 20-valente simplifica la pauta previa, al unificar las indicaciones de vacunación en población adulta a partir de los 60 años con y sin factores predisponentes, así como en menores de 60 años con condiciones de riesgo. Está autorizada para mayores de 18 años, por lo que en menores se mantiene la pauta previa: a) si no hay factores ni condiciones de riesgo, se indican tres dosis de vacuna neumocócica conjugada 13 o 15-valente a los 2, 4 y 11 meses; b) si existen factores o condiciones de riesgo, a partir de los 2 años de edad puede ser necesario asociar la vacuna neumocócica de polisacáridos de 23 serotipos. (AU)

Streptococcus pneumoniae infections cause significant morbidity and mortality. Among the people most susceptible to infections are the elderly, immunosuppressed patients, and those with comorbidities, presenting a greater severity and a more unfavorable condition. Vaccination guidelines against pneumococcus aim to reduce the incidence of these infections, whose recommendations have changed over the years. The recent approval of the 20-valent conjugate pneumococcal vaccine simplifies the previous regimen, by unifying the indications for vaccination in the adult population aged 60 years and older with and without predisposing factors, as well as in those aged under 60 years with conditions of risk. It is authorized for the individuals aged over 18 years, so the previous regimen has been maintained in minors: a) if there are no risk factors or conditions, three doses are indicated: 13- or 15-valent pneumococcal conjugate vaccine at 2, 4, and 11 months and b) if there are risk factors or conditions, it may be necessary to associate the 23 serotypes pnemococcal polysaccharide vaccine from 2 years of age. (AU)

High-flow nasal cannula for Acute Respiratory Distress Syndrome (ARDS) due to COVID-19.

INTRODUCTION: High-flow nasal cannula oxygen therapy (HFNC) has been shown to be a useful therapy in the treatment of patients with Acute Respiratory Distress Syndrome (ARDS), but its efficacy is still unknown in patients with COVID-19. Our objective is to describe its utility as therapy for the treatment of ARDS caused by SARS-CoV-2. METHODS: A retrospective, observational study was performed at a single centre, evaluating patients with ARDS secondary to COVID-19 treated with HFNC. The main outcome was the intubation rate at day 30, which defined failure of therapy. We also analysed the role of the ROX index to predict the need for intubation. RESULTS: In the study period, 196 patients with bilateral pneumonia were admitted to our pulmonology unit, 40 of whom were treated with HFNC due to the presence of ARDS. The intubation rate at day 30 was 52.5%, and overall mortality was 22.5%. After initiating HFNC, the SpO2/FiO2 ratio was significantly better in the group that did not require intubation (113.4±6.6 vs 93.7±6.7, p=0.020), as was the ROX index (5.0±1.6 vs 4.0±1.0, p=0.018). A ROX index less than 4.94 measured 2 to 6 h after the start of therapy was associated with increased risk of intubation (HR 4.03 [95% CI 1.18 - 13.7]; p=0.026). CONCLUSION: High-flow therapy is a useful treatment in ARDS in order to avoid intubation or as a bridge therapy, and no increased mortality was observed secondary to the delay in intubation. After initiating HFNC, a ROX index below 4.94 predicts the need for intubation.