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)

[Primary adrenal insufficiency as the form of onset of adrenoleukodystrophy in a 4-year-old boy]. / Insuficiencia suprarrenal primaria como inicio de adrenoleucodistrofia en un varón de 4 años.

X-linked adrenoleukodystrophy is an inherited metabolic disease caused by the accumulation of saturated very long chain fatty acids (VLCFA). Given that the form of presentation can be primary adrenal insufficiency, diagnosis in affected males is important. Patient was a 4-year-old boy with attention deficit hyperactivity disorder, cutaneous-mucosal hyperpigmentation, and dehydration with hyponatremia and hyperpotassemia was diagnosed with adrenoleukodystrophy presenting as primary adrenal insufficiency. Antiadrenal antibodies: negative. Plasma VLCFA: C(26:0)=1.25mg/ml (0.18-0.48), C(24:0)/C(22:0) =1.53 (< 1), and C(26:0)/ C(22:0)=0.04 (< 0.02). Abdominal computed tomography: small adrenal glands. Cranial magnetic resonance imaging and evoked potentials: normal at diagnosis and with signs of white matter demyelination after 2 years of follow-up. Testing for an autoimmune etiology and adrenoleukodystrophy is important in boys with primary adrenal insufficiency before Addison's disease is diagnosed.

Insuficiencia suprarrenal primaria como inicio de adrenoleucodistrofia en un varón de 4 años / Primary adrenal insufficiency as the form of onset of adrenoleukodystrophy in a 4-year-old boy

La adrenoleucodistrofia ligada al cromosoma X es una enfermedad metabólica hereditaria producida por acumulación de ácidos grasos saturados de cadena muy larga (VLCFA). dado que puede aparecer con insuficiencia suprarrenal primaria, es importante su estudio en los varones afectados. Varón de 4 años de edad con síndrome de hiperactividad, hiperpigmentación cutaneomucosa y deshidratación hiponatrémica e hiperpotasémica que es diagnosticado de adrenoleucodistrofia con insuficiencia suprarrenal primaria como forma de manifestación clínica. Presentaba: anticuerpos antiadrenales negativos; VLCFA en plasma, C26:0 = 1,25 μg/ml (0,18-0,48), C2/C22:04:0= 1,53 (< 1) y C26:0/C22:0= 0,04 (< 0,02); tomografía abdominal: glándulas suprarrenales de pequeño tamaño; resonancia magnética craneal y potenciales evocados: normales al diagnóstico y con signos de demielinización de sustancia blanca tras 2 años de seguimiento. Ante un niño varón con insuficiencia suprarrenal primaria, es necesario descartar causas autoinmunitarias y adrenoleucodistrofia antes del diagnóstico de enfermedad de Addison (AU)

X-linked adrenoleukodystrophy is an inherited metabolic disease caused by the accumulation of saturated very long chain fatty acids (VLCFA). Given that the form of presentation can be primary adrenal insufficiency, diagnosis in affected males is important. Patient was a 4-year-old boy with attention deficit hyperactivity disorder, cutaneous-mucosal hyperpigmentation, and dehydration with hyponatremia and hyperpotassemia was diagnosed with adrenoleukodystrophy presenting as primary adrenal insufficiency. Antiadrenal antibodies: negative. Plasma VLCFA: C26:0 = 1.25 mg/ml (0.18-0.48), C24:0/C22:0=1.53 (< 1), and C26:0/C22:0 = 0.04 (< 0.02). Abdominal computed tomography: small adrenal glands. Cranial magnetic resonance imaging and evoked potentials: normal at diagnosis and with signs of white matter demyelination after 2 years of follow-up. Testing for an autoimmune etiology and adrenoleukodystrophy is important in boys with primary adrenal insufficiency before Addison’s disease is diagnosed (AU)

Anthropometric, bone age, and bone mineral density changes after a family-based treatment for obese children.

Our objective was to identify anthropometric, bone age, and bone mineral density (BMD) changes after a family-based treatment program for obese children. We conducted a longitudinal prospective study of 50 obese children (body mass index percentage [BMI%] > or =120%) aged 9.12 +/- 1.72 years (range 6-13) at baseline. A family-based treatment program, based on inadequate feeding style with progressive modification, aerobic physical exercise increase, active parental involvement, and the use of behavioural strategies (contracting, self-monitoring, social reinforcement), was developed during a 12-month period. Anthropometric data, lumbar spine (L2-L4) BMD by dual-energy X-ray absorptiometry, bone age (BA), bone age to chronological age ratio (BA/CA), and predicted adult height (PAH) were determined at baseline and 12 months. The statistical method used was analysis of variance and the paired Student t-test. Mean BMI standard deviation score (SDS) loss was -0.61 +/- 0.76 and BMI% loss was -5.17 +/- 9.73%. Height SDS significantly decreased, BA/CA ratio also decreased significantly, and PAH change was not significant. Lumbar spine BMD SDS and BMD% did not significantly change. A family-based treatment program was effective in obese children by reducing by 5% the BMI in 1 year and increasing the activity level. Treatment reduced growth velocity and delayed bone maturation rate without affecting PAH, reflecting a situation of previous early maturation. The treatment did not modify gaining bone mass.