Documento de reflexión sobre la vacunación antigripal tetravalente / No disponible

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Cost-effectiveness analysis of quadrivalent influenza vaccine in Spain.

Influenza has a major impact on healthcare systems and society, but can be prevented using vaccination. The World Health Organization (WHO) currently recommends that influenza vaccines should include at least two virus A and one virus B lineage (trivalent vaccine; TIV). A new quadrivalent vaccine (QIV), which includes an additional B virus strain, received regulatory approval and is now recommended by several countries. The present study estimates the cost-effectiveness of replacing TIVs with QIV for risk groups and elderly population in Spain. A static, lifetime, multi-cohort Markov model with a one-year cycle time was adapted to assess the costs and health outcomes associated with a switch from TIV to QIV. The model followed a cohort vaccinated each year according to health authority recommendations, for the duration of their lives. National epidemiological data allowed the determination of whether the B strain included in TIVs matched the circulating one. Societal perspective was considered, costs and outcomes were discounted at 3% and one-way and probabilistic sensitivity analyses were performed. Compared to TIVs, QIV reduced more influenza cases and influenza-related complications and deaths during periods of B-mismatch strains in the TIV. The incremental cost-effectiveness ratio (ICER) was 8,748€/quality-adjusted life year (QALY). One-way sensitivity analysis showed mismatch with the B lineage included in the TIV was the main driver for ICER. Probabilistic sensitivity analysis shows ICER below 30,000€/QALY in 96% of simulations. Replacing TIVs with QIV in Spain could improve influenza prevention by avoiding B virus mismatch and provide a cost-effective healthcare intervention.

[Epidemic outbreak of meningitis due to Echovirus type 13 on the island of Gran Canaria (Spain)]. / Brote epidémico de meningitis por virus Echo serotipo 13 en la isla de Gran Canaria.

INTRODUCTION: Since the implementation of routine vaccination against mumps, enteroviruses have become the commonest cause of viral meningitis. In Spain the most frequently isolated echoviruses are serotypes 30, 9, 6 and 4.Objectives. Determine the clinical-epidemiological characteristics of a meningitis outbreak due to echovirus type 13. METHODS: We studied 152 cases of enteroviral meningitis diagnosed in the year 2000. Viral isolation was performed on fibroblast MRC-5 and human rhabdomyosarcoma cells. The viruses were identified with monoclonal antibodies and serotyped by neutralization. RESULTS: Echovirus was isolated in 131 out of 152 CSF samples (86.2%). In 21 patients with negative CSF culture, the diagnosis was made by echovirus isolation from upper respiratory tract and/or feces samples. The cytopathic effect was seen in all cases in monolayers of rhabdomyosarcoma cells. The average age of the patients was 67 months (range: 1-350) and the male:female ratio was 2:1. Most of the patients had fever, headache and other signs of meningitis. Hospitalization was required in 52.6%. All patients were discharged without sequelae. The highest incidence was recorded from April to June. CONCLUSIONS: There had been no record of the presence of echovirus 13 in Spain in recent years until the emergence of this outbreak. Isolation of the virus from sites other than CSF is often helpful in establishing the diagnosis and patient management. Enterovirus isolates must be specifically serotyped to determine enteroviral activity in the population, which can be sporadic or epidemic.

Brote epidémico de meningitis por virus Echo serotipo 13 en la isla de Gran Canaria / Epidemic outbreak of meningitis due to Echovirus type 13 on the island of Gran Canaria (Spain)

INTRODUCCIÓN. Desde la introducción de la vacuna de la parotiditis, los enterovirus son la causa más frecuente de meningitis viral en niños. En España, los más frecuentemente aislados son los virus Echo serotipo 30, 9, 6 y 4. OBJETIVOS. Describir las características clinicoepidemiológicas de un brote de meningitis por virus Echo serotipo 13. MÉTODOS. Se detectaron 152 casos de meningitis por virus Echo serotipo 13 durante el año 2000. Las muestras fueron sembradas en fibroblastos de pulmón de feto humano (MRC-5) y células de rabdomiosarcoma. Los virus se identificaron con anticuerpos monoclonales y se tipificaron por neutralización. RESULTADOS. El aislamiento en líquido cefalorraquídeo (LCR) del virus fue positivo en 131 de 152 (86,2 por ciento). En los 21 pacientes con cultivo de LCR negativo, el diagnóstico se realizó por cultivo del frotis faríngeo y/o heces. El efecto citopático se detectó en todos los casos en rabdomiosarcoma. La edad media de los pacientes fue de 67 meses (intervalo, 1-350) y la relación varón: mujer 2:1.La mayoría presentaron fiebre, cefalea y otros signos meníngeos. El 52,6 por ciento de los niños requirieron ingreso. La evolución fue buena en todos los casos. La mayor incidencia se produjo de abril a junio. CONCLUSIONES. No había constancia de la circulación del virus Echo serotipo 13 en España en los últimos años hasta la aparición de nuestro brote. El aislamiento del virus de otras localizaciones diferentes del LCR ayudan en el diagnóstico y manejo del paciente. La tipificación del virus es esencial para conocer la actividad enteroviral en la población, que puede ocurrir de forma esporádica o epidémica (AU)