Monografía dedicada a las áreas de capacitación específicas pediátricas (ACES) del Hospital Materno Infantil Gregorio Marañón / Monograph dedicated to the specific area of pediatric training (SAPT) of the Hospital Materno Infantil Gregorio Marañón

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Sección de Enfermedades Infecciosas Pediátricas del Hospital General Universitario Gregorio Marañón. Servicio de Pediatría y sus áreas específicas / Pediatric Infectious Diseases Section of the Hospital General Universitario Gregorio Marañón. Pediatric Department and its specific areas

La Sección de Enfermedades Infecciosas Pediátricas del Hospital Infantil Gregorio Marañón es actualmente una Unidad de referencia tanto en la Comunidad de Madrid como a nivel nacional. Desde su creación ha ido adaptándose a las nuevas necesidades de la atención en patología infecciosa pediátrica en el siglo XXI, lo que supone un conocimiento de esta patología en los pacientes críticos, inmunodeprimidos y aquellos supervivientes gracias al desarrollo de la medicina actual. El trabajo asistencial dela Sección se desarrolla en la atención de pacientes hospitalizados como médicos responsables directos, de los pacientes atendidos de forma ambulatoria y también participando de forma transversal como médicos consultores en el asesoramiento en cuanto a la prevención, el diagnóstico y el tratamiento de la patología infecciosa de los pacientes pediátricos ingresados en las distintas unidades de un hospital de elevada complejidad médica y quirúrgica. La Sección de Enfermedades Infecciosas Pediátricas tiene un compromiso docente participando de la docencia pregrado en pediatría y en la postgrado, no solo del médico interno residente (MIR) sino también de Masters en Enfermedades Infecciosas Pediátricas de la Universidad Complutense así como en formación de otros profesionales de países de baja renta mediante la red PENTA y el proyecto ESTHER del Ministerio de Sanidad. Respecto a su labor investigadora, la Sección de Enfermedades Infecciosas Pediátricas participa con grupo propio consolidado en el Instituto de Investigación del hospital, siendo destacable el trabajo en redes reconocidas a nivel nacional e internacional en distintos campos en enfermedades infecciosas: red de tuberculosis, red de VIH, red de CMV congénito y otras. La Sección también participa en cooperación, formando parte del programa de ayuda mediante telemedicina con los hospitales de Lamu y Meki en África. Asimismo, realiza una actividad de asesoramiento en el tratamiento de cohortes de pacientes VIH de Latinoamérica, como son las cohortes de Ecuador y Guatemala. Fruto de todo lo anterior, los profesionales que trabajan en la Sección de Enfermedades Infecciosas Pediátricas del Hospital Gregorio Marañón participan en la divulgación de los conocimientos y directrices en cuanto a la patología infecciosa pediátrica en nuestro país y en Europa, encontrándose formando parte de comités de sociedades, redes y grupos de trabajo científicos y administrativos tanto nacionales como internacionales, dentro de sociedades científicas como son la AEP, la SEIP, la ESPID, y del Ministerio de Sanidad, como la comisión nacional creada para el uso racional de antimicrobianos, comisiones locales con el mismo fin, así como representatividad en la actual comisión creada desde el Ministerio para la elaboración del programa de formación del Área de Capacitación específica en Enfermedades Infecciosas (AU)

Pediatric Infectious Diseases Hospital Infantil Gregorio Maranon Section is currently a reference unit in Madrid and also in Spain. Since its creation it has adapted to the new needs of care in pediatric infectious disease in the XXI century. The Section treats inpatients directly, outpatients and also participate transversely as consulting physicians in advising on the prevention, diagnosis and treatment of infectious disease hospitalized in the units of a high complex clinical and surgery hospital. Pediatric Infectious Diseases Section has a teaching in undergraduate in pediatrics but also the specialist and also Masters in Pediatric Infectious Diseases at the Complutense University as well as training of lower rent professionals. With regard to research, Pediatric Infectious Diseases Section, participates with own group consolidated in the HGUGM Research Institute, The section works in recognized networks at national and international level in diferents networks (tuberculosis, HIV, congenital CMV, etc.). The Section also participates in cooperation as part of the aid program through telemedicine Lamu and Meki hospitals in Africa. It also performs an advisory activity in the treatment of HIV patient cohorts of Latin America, such as Ecuador and Guatemala cohorts. The result of the above professionals working in the Pediatric Infectious Diseases Hospital Gregorio Maranon Section involved in the dissemination of knowledge and guidelines for infectious disease pediatric in our country and in Europe, being part of committees of societies, networks and groups of national and international scientific work within scientific societies such as AEP, SEIP, ESPID, and the Ministry of Health, as the national commission created for the rational use of antimicrobials, local commissions the same purpose and representativeness in the current Ministry commission to prepare the Specific training pograme (AU)

Vacunación frente a la gripe estacional en la infancia y la adolescencia. Recomendaciones del Comité Asesor de Vacunas de la Asociación Española de Pediatría (CAV-AEP) para la campaña antigripal 2016-2017 / Seasonal influenza vaccination in children and adolescents. Recommendations of the Vaccine Advisory Committee of the Spanish Society of Paediatrics for the 2016-2017 campaign

El Comité Asesor de Vacunas de la Asociación Española de Pediatría (CAV-AEP) emite todos los años sus recomendaciones sobre la vacunación frente a este virus en la infancia y la adolescencia. La vacunación de la gripe es una actuación especialmente beneficiosa cuando va dirigida a personas (niños y adultos) que se incluyen en los grupos de población considerados de riesgo. Sin embargo, muchos niños y adolescentes pertenecientes a estos grupos de riesgo, y sus convivientes, continúan sin recibir, por distintas razones, dicha vacunación anual. Asimismo, se insiste en la recomendación de la vacunación de los profesionales sanitarios. En el presente documento se presentan las recomendaciones para la vacunación antigripal en la temporada 2016-2017, y se explican los fundamentos y limitaciones de las mismas. Es necesaria una mayor implicación de los profesionales, las autoridades sanitarias y todos los agentes sociales para transmitir cada año a la población, y de forma especial a los padres de niños y adolescentes pertenecientes a los grupos de riesgo, las recomendaciones de vacunación frente a la gripe estacional (AU)

The Advisory Committee on Immunization of the Spanish Association of Paediatrics issues its recommendations about vaccination against influenza virus in children and adolescents every year before the onset of the flu season. Influenza vaccination is particularly beneficial when aimed at individuals, both children and adults, who are included in the population groups considered at risk. However, for various reasons, many children and adolescents with underlying conditions and their contacts are still not given this vaccination annually. There is a need for a greater involvement of health professionals, health authorities and all social agents to inform the population, especially to the parents of children and adolescents in those risk groups, on the recommendations for seasonal influenza vaccination. In this document, current recommendations for influenza vaccination for the 2016-2017 season are presented, and reasons and limitations are explained. The recommendation for influenza vaccination is emphasized for health professionals (AU)

Calendario de vacunaciones de la Asociación Española de Pediatría (CAV-AEP): recomendaciones 2016 / Immunisation schedule of the Spanish Association of Paediatrics: 2016 recommendations

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[Immunisation schedule of the Spanish Association of Paediatrics: 2016 recommendations]. / Calendario de vacunaciones de la Asociación Española de Pediatría (CAV-AEP): recomendaciones 2016.

The Advisory Committee on Vaccines of the Spanish Association of Paediatrics (CAV-AEP) annually publishes the immunisation schedule which, in our opinion, estimates optimal for children resident in Spain, considering available evidence on current vaccines. We acknowledge the effort of the Ministry of Health during the last year in order to optimize the funded unified Spanish vaccination schedule, with the recent inclusion of pneumococcal and varicella vaccination in early infancy. Regarding the funded vaccines included in the official unified immunization schedule, taking into account available data, CAV-AEP recommends 2+1 strategy (2, 4 and 12 months) with hexavalent (DTPa-IPV-Hib-HB) vaccines and 13-valent pneumococcal conjugate vaccine. Administration of Tdap and poliomyelitis booster dose at the age of 6 is recommended, as well as Tdap vaccine for adolescents and pregnant women, between 27-36 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 11-12 with a two dose scheme (0, 6 months) should be improved. Information for male adolescents about potential beneficial effects of this immunisation should be provided as well. Regarding recommended unfunded immunisations, CAV-AEP recommends the administration of meningococcal B vaccine, due to the current availability in Spanish communitary pharmacies, with a 3+1 scheme (3, 5, 7 and 13-15 months). CAV-AEP requests the incorporation of this vaccine in the funded unified schedule. Vaccination against rotavirus is recommended in all infants. Annual influenza immunisation and vaccination against hepatitis A are indicated in population groups considered at risk.

Vacunación frente al meningococo B. Posicionamiento del Comité Asesor de Vacunas de la Asociación Española de Pediatría / Vaccination against meningococcal B disease. Public statement of the Advisory Committee on Vaccines of the Spanish Association of Paediatrics (CAV-AEP)

La enfermedad meningocócica invasora, con sus 2 formas de presentación principales (sepsis y meningitis), es una patología grave y potencialmente mortal, causada por distintos serogrupos de Neisseria meningitidis, entre los cuales, actualmente, predomina el serogrupo B en Europa. La mayoría de los casos se producen en la edad pediátrica, con una mortalidad aproximada del 10% y un riesgo de secuelas permanentes del 20-30% entre los supervivientes. Presenta mayor incidencia y letalidad en niños sanos menores de 2-3 años, seguidos de los adolescentes, aunque puede ocurrir a cualquier edad. Hasta ahora no se contaba con ningún arma inmunopreventiva contra el meningococo B. Así, con la llegada a España de la única vacuna actualmente disponible, el Comité Asesor de Vacunas de la Asociación Española de Pediatría (CAV-AEP) ha analizado detalladamente tanto el potencial preventivo de dicha vacuna, como la situación peculiar administrativa de la misma en España. El objetivo de este documento es informar del posicionamiento del CAV-AEP en relación con la vacuna frente al meningococo B y el acceso a la misma por parte de la población infantil española, teniendo en cuenta que ha sido autorizada exclusivamente para el uso hospitalario en personas de riesgo. En Europa, la vacuna sí está disponible en farmacias, incluso incluida en calendarios oficiales de algunos países o regiones. Este comité considera que Bexsero(R) presenta un perfil de vacuna a incluir en todos los calendarios españoles y que debería estar disponible libremente en farmacias para su administración en todos los niños mayores de 2 meses

Meningococcal invasive disease, including the main clinical presentation forms (sepsis and meningitis), is a severe and potentially lethal infection caused by different serogroups of Neisseria meningitidis. Meningococcal serogroup B is the most prevalent in Europe. Most cases occur in children, with a mortality rate of 10% and a risk of permanent sequelae of 20-30% among survivors. The highest incidence and case fatality rates are observed in healthy children under 2-3 years old, followed by adolescents, although it can occur at any age. With the arrival in Spain of the only available vaccine against meningococcus B, the Advisory Committee on Vaccines of the Spanish Association of Paediatrics has analysed its preventive potential in detail, as well as its peculiar administrative situation in Spain. The purpose of this document is to publish the statement of the Committee as regards this vaccination and the access to it by the Spanish population, taking into account that it has been only authorized for people at risk. The vaccine is available free in the rest of Europe for those who want to acquire it, and in some countries and regions it has been introduced into the systematic immunisation schedules. The Committee considers that Bexsero(R) has a profile of a vaccine to be included in the official schedules of all the Spanish autonomous communities and insists on the need for it to be available in pharmacies for its administration in all children older than 2 months

[Immunisation schedule of the Spanish Association of Paediatrics: 2015 recommendations]. / Calendario de vacunaciones de la Asociación Española de Pediatría: recomendaciones 2015.

The Advisory Committee on Vaccines of the Spanish Association of Paediatrics updates the immunisation schedule every year, taking into account epidemiological data as well as evidence on the safety, effectiveness and efficiency of current vaccines, including levels of recommendation. In our opinion, this is the optimal vaccination calendar for all children resident in Spain. Regarding the vaccines included in the official unified immunization schedule, the Committee emphasizes the administration of the first dose of hepatitis B either at birth or at 2 months of life; the recommendation of the first dose of MMR and varicella vaccine at the age of 12 months, with the second dose at the age of 2-3 years; DTaP or Tdap vaccine at the age of 6 years, followed by another Tdap booster dose at 11-12 years old; Tdap strategies for pregnant women and household contacts of the newborn, and immunization against human papillomavirus in girls aged 11-12 years old with a 2 dose scheme (0, 6 months). The Committee reasserts its recommendation to include vaccination against pneumococcal disease in the routine immunisation schedule, the same as it is being conducted in Western European countries. The recently authorised meningococcal B vaccine, currently blocked in Spain, exhibits the profile of a universal vaccine. The Committe insists on the need of having the vaccine available in communitary pharmacies. It has also proposed the free availability of varicella vaccines. Their efectiveness and safety have been confirmed when they are administred from the second year of life. Vaccination against rotavirus is recommended in all infants. The Committee stresses the need to vaccinate population groups considered at risk against influenza and hepatitis A.

Calendario de vacunaciones de la Asociación Española de Pediatría: recomendaciones 2015 / Immunisation schedule of the Spanish Association of Paediatrics: 2015 Recommendations

El Comité Asesor de Vacunas de la Asociación Española de Pediatría actualiza anualmente su calendario de vacunaciones, tras un análisis tanto epidemiológico como de la seguridad, efectividad y eficiencia de las vacunas actuales, incluyendo grados de recomendación. Es el calendario que se estima idóneo actualmente para los niños residentes en España. En cuanto a las vacunas oficiales incluidas en el calendario común, se recalca la posibilidad de vacunar indistintamente frente a hepatitis B desde el nacimiento o desde los 2 meses; la recomendación de la primera dosis de triple vírica y de varicela a los 12 meses y la segunda a los 2-3 años; la administración de la vacuna DTPa o Tdpa a los 6 años, con refuerzo en la adolescencia; estrategias con Tdpa en embarazadas y convivientes del recién nacido, y la inmunización frente al papilomavirus en niñas a los 11-12 años con pauta de 2 dosis (0, 6 meses). Este comité insiste en la vacunación antineumocócica universal, tal y como se está llevando a cabo en todos los países de Europa Occidental. La vacuna frente al meningococo B, autorizada pero bloqueada actualmente en España, presenta un perfil de vacuna sistemática y se reivindica que, al menos, esté disponible en las farmacias comunitarias. Se propone, igualmente, la disponibilidad pública de las vacunas frente a la varicela, ya que han demostrado ser efectivas y seguras a partir del segundo año de vida. La vacunación frente al rotavirus es recomendable en todos los lactantes. La vacunación antigripal anual y la inmunización frente a la hepatitis A están indicadas en grupos de riesgo

The Advisory Committee on Vaccines of the Spanish Association of Paediatrics updates the immunisation schedule every year, taking into account epidemiological data as well as evidence on the safety, effectiveness and efficiency of current vaccines, including levels of recommendation. In our opinion, this is the optimal vaccination calendar for all children resident in Spain. Regarding the vaccines included in the official unified immunization schedule, the Committee emphasizes the administration of the first dose of hepatitis B either at birth or at 2 months of life; the recommendation of the first dose of MMR and varicella vaccine at the age of 12 months, with the second dose at the age of 2-3 years; DTaP or Tdap vaccine at the age of 6 years, followed by another Tdap booster dose at 11-12 years old; Tdap strategies for pregnant women and household contacts of the newborn, and immunization against human papillomavirus in girls aged 11-12 years old with a 2 dose scheme (0, 6 months). The Committee reasserts its recommendation to include vaccination against pneumococcal disease in the routine immunisation schedule, the same as it is being conducted in Western European countries. The recently authorised meningococcal B vaccine, currently blocked in Spain, exhibits the profile of a universal vaccine. The Committe insists on the need of having the vaccine available in communitary pharmacies. It has also proposed the free availability of varicella vaccines. Their efectiveness and safety have been confirmed when they are administred from the second year of life. Vaccination against rotavirus is recommended in all infants. The Committee stresses the need to vaccinate population groups considered at risk against influenza and hepatitis A

[Vaccination against meningococcal B disease. Public statement of the Advisory Committee on Vaccines of the Spanish Association of Paediatrics (CAV-AEP)]. / Vacunación frente al meningococo B. Posicionamiento del Comité Asesor de Vacunas de la Asociación Española de Pediatría.

Meningococcal invasive disease, including the main clinical presentation forms (sepsis and meningitis), is a severe and potentially lethal infection caused by different serogroups of Neisseria meningitidis. Meningococcal serogroup B is the most prevalent in Europe. Most cases occur in children, with a mortality rate of 10% and a risk of permanent sequelae of 20-30% among survivors. The highest incidence and case fatality rates are observed in healthy children under 2-3 years old, followed by adolescents, although it can occur at any age. With the arrival in Spain of the only available vaccine against meningococcus B, the Advisory Committee on Vaccines of the Spanish Association of Paediatrics has analysed its preventive potential in detail, as well as its peculiar administrative situation in Spain. The purpose of this document is to publish the statement of the Committee as regards this vaccination and the access to it by the Spanish population, taking into account that it has been only authorized for people at risk. The vaccine is available free in the rest of Europe for those who want to acquire it, and in some countries and regions it has been introduced into the systematic immunisation schedules. The Committee considers that Bexsero® has a profile of a vaccine to be included in the official schedules of all the Spanish autonomous communities and insists on the need for it to be available in pharmacies for its administration in all children older than 2 months.

Serotipos no vacunales emergentes causantes de enfermedad neumocócica invasora en la era de la vacuna 7-valente / Emergence of invasive pneumococcal disease caused by non-vaccine serotypes in the era of the 7-valent conjugate vaccine

INTRODUCCIÓN: Tras la introducción de la VNC7 se ha objetivado una importante expansión de algunos serotipos emergentes (SNV) de Streptococcus pneumoniae, siendo los principales productores de enfermedad neumocócica invasora (ENI) actualmente. Nuestro objetivo ha sido describir los aspectos epidemiológicos, clínicos y microbiológicos de la ENI producida por SNV en un hospital terciario de Madrid. PACIENTES Y MÉTODOS: Estudio retrospectivo (1998-2004) y prospectivo (2005-2009) de los SNV productores de ENI. Se analizaron 3 periodos de estudio: P1 (1998-2001), sin comercialización de la VNC7, P2 (2002-2005), con una cobertura vacunal del 40% y P3 (2006-2009), con la vacuna incorporada al calendario vacunal de la Comunidad de Madrid. RESULTADOS: Se analizaron 155 casos de ENI, de los que se pudieron serotipar 150 aislamientos (100 de ellos SNV). Se produjo un incremento de la prevalencia de SNV desde P1 (31%) a P2 (53,6%) y P3 (91,3%). Los serotipos emergentes más prevalentes fueron 19A, 1, 5, 3, 7 F y 15C. Los serotipos 1, 3, 5 y 15C produjeron, fundamentalmente, enfermedad respiratoria; el serotipo 19A tanto enfermedad respiratoria como bacteriemia primaria, siendo la principal causa de meningitis; el serotipo 7 F produjo, fundamentalmente, bacteriemia primaria (66%). El 83,8% de los SNV fueron sensibles a penicilina. CONCLUSIONES: Desde la introducción de la VNC7 se ha objetivado un aumento de la prevalencia de ENI producida por SNV. Estos cambios encontrados deberían hacer considerar la utilización de las vacunas antineumocócicas ampliadas para la prevención de ENI, al incluir la mayoría de los SNV emergentesies

INTRODUCTION: There has been an increased incidence in invasive pneumococcal disease (IPD) produced by non-vaccine serotype (NVS) of Streptococcus pneumoniae after the introduction of PCV7. Our objective was to describe the epidemiological, clinical and microbiological characteristics of IPD caused by NVS in a tertiary hospital in Madrid. PATIENTS AND METHODS: Retrospective (1998-2004) and prospective (2005-2009) study evaluating IPD caused by NVS in children. The study was divided into three periods: P1 (1998-2001) when PCV7 was not commercialized; P2 (2002-2005) with 40% vaccine coverage among children; andP3 (2006-2009) when the vaccine was added to the Childhood Immunization Schedule in Madrid. RESULTS: We analyzed 155 cases of IPD. One hundred and fifty of these isolates were serotyped (100 were NVS). There was an increase in the prevalence of IPD from P1 (31%) to P2 (54%) and P3 (91%). The most relevant emerging serotypes were 19A, 7 F, 1, 5, 3 and 15C. The most significant clinical syndromes produced by some specific serotypes were as follows: lower respiratory tract infection (LRTI) by serotypes 1, 3, 5 and 15C; LRTI, primary bacteremia and meningitis by serotype 19A; and primary bacteremia by serotype 7 F (66%). The large majority (83.8%) of NVS were sensitive to penicillin. CONCLUSIONS: There has been an increased prevalence of IPD caused by NVS since the introduction of PCV7. These changes should prompt the introduction of new pneumococcal vaccines, which include most of the NVS, in the childhood immunization calendar to prevent IPD in children

[Immunisation schedule of the Spanish Association of Paediatrics: 2014 recommendations]. / Calendario de vacunaciones de la Asociación Española de Pediatría: recomendaciones 2014.

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 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 special situations. Immunisation schedules tend to be dynamic and adaptable to ongoing epidemiological changes. Based on the latest epidemiological trends, CAV-AEP recommends the administration of the first dose of MMR and varicella vaccines at age 12 months, with the second dose at age 2-3 years; the administration of DTaP or Tdap vaccine at age 4-6 years, always followed by another Tdap dose at 11-12 years; and the three meningococcal C scheme at 2 months, 12 months and 12 years of age. It reasserts its recommendation to include vaccination against pneumococcal disease in the routine immunisation schedule. The CAV-AEP believes that the coverage of vaccination against human papillomavirus in girls aged 11-12 years must be increased. Universal vaccination against varicella in the second year of life is an effective strategy, and the immediate public availability of the vaccine is requested in order to guarantee the right of healthy children to be vaccinated. 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. The recently authorised meningococcal B vaccine has opened a chapter of hope in the prevention of this disease. In anticipation of upcoming national and international studies, the Committee recommends the vaccine for the control of disease outbreaks, and insists on the need to be available in pharmacies. Finally, it emphasises the need to bring incomplete vaccinations up to date following the catch-up immunisation schedule.

Calendario de vacunaciones de la Asociación Española de Pediatría: recomendaciones 2014 / Immunisation schedule of the Spanish Association of Paediatrics: 2014 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 consideran vacunas sistemáticas aquellas que el CAV-AEP estima que todos los niños deberían recibir; 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 ciertas situaciones especiales. Los calendarios de vacunaciones tienen que ser dinámicos y adaptarse a los cambios epidemiológicos que vayan surgiendo. Teniendo en cuenta los últimos cambios en la epidemiología de las enfermedades, el CAV-AEP recomienda la administración de la 1.a dosis de las vacunas triple vírica y varicela a los 12 meses y la 2.a dosis a los 2-3 años; la administración de la vacuna DTPa o Tdpa a los 4-6 años, siempre acompañada de otra dosis de Tdpa a los 11-12 años; y el paso a un esquema 2 meses, 12 meses y 12 años de la vacunación frente al meningococo C. Se reafirma en la recomendación de incluir la vacunación frente al neumococo en el calendario de vacunación sistemático. El CAV-AEP estima que deben incrementarse las coberturas de vacunación frente al papiloma virus humano en las niñas a los 11-12 años. La vacunación universal frente a la varicela iniciada en el segundo año de vida es una estrategia efectiva, y se solicita la inmediata disponibilidad pública de la vacuna, reclamando el derecho a la prescripción y el derecho de los niños sanos a poder ser vacunados. 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. La vacuna frente al meningococo B, recientemente autorizada, abre un capítulo de esperanza en la prevención de esta enfermedad. En espera de próximos estudios nacionales e internacionales se recomienda, por el momento, para el control de brotes epidémicos y se insiste en el deseo de que sea comercializada libremente en las oficinas de farmacia. Por último, se insiste en la necesidad de actualizar las vacunaciones incompletas con las pautas de vacunación acelerada

The Advisory Committee on Vaccines of the Spanish Association of Paediatrics (CAVAEP) updates the immunisation schedule every year, taking into account epidemiological data as well as evidence on 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 special situations. Immunisation schedules tend to be dynamic and adaptable to ongoing epidemiological changes. Based on the latest epidemiological trends, CAV-AEP recommends the administration of the first dose of MMR and varicella vaccines at age 12 months, with the second dose at age 2-3years; the administration of DTaP or Tdap vaccine at age 4-6 years, always followed by another Tdap dose at 11-12 years; and the three meningococcal C scheme at 2 months, 12 months and 12 years of age. It reasserts its recommendation to include vaccination against pneumococcal disease in the routine immunisation schedule. The CAV-AEP believes that the coverage of vaccination against human papilloma virus in girls aged 11-12 years must be increased. Universal vaccination against varicella in the second year of life is an effective strategy, and the immediate public availability of the vaccine is requested in order to guarantee the right of healthy children to be vaccinated. 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. The recently authorised meningococcal B vaccine has opened a chapter of hope in the prevention of this disease. In anticipation of upcoming national and international studies, the Committee recommends the vaccine for the control of disease outbreaks, and insists on the need to be available in pharmacies. Finally, it emphasises the need to bring incomplete vaccinations up to date following the catch-up immunisation schedule

[Emergence of invasive pneumococcal disease caused by non-vaccine serotypes in the era of the 7-valent conjugate vaccine]. / Serotipos no vacunales emergentes causantes de enfermedad neumocócica invasora en la era de la vacuna 7-valente.

INTRODUCTION: There has been an increased incidence in invasive pneumococcal disease (IPD) produced by non-vaccine serotype (NVS) of Streptococcus pneumoniae after the introduction of PCV7. Our objective was to describe the epidemiological, clinical and microbiological characteristics of IPD caused by NVS in a tertiary hospital in Madrid. PATIENTS AND METHODS: Retrospective (1998-2004) and prospective (2005-2009) study evaluating IPD caused by NVS in children. The study was divided into three periods: P1 (1998-2001) when PCV7 was not commercialized; P2 (2002-2005) with 40% vaccine coverage among children; and P3 (2006-2009) when the vaccine was added to the Childhood Immunization Schedule in Madrid. RESULTS: We analyzed 155 cases of IPD. One hundred and fifty of these isolates were serotyped (100 were NVS). There was an increase in the prevalence of IPD from P1 (31%) to P2 (54%) and P3 (91%). The most relevant emerging serotypes were 19A, 7F, 1, 5, 3 and 15C. The most significant clinical syndromes produced by some specific serotypes were as follows: lower respiratory tract infection (LRTI) by serotypes 1, 3, 5 and 15C; LRTI, primary bacteremia and meningitis by serotype 19A; and primary bacteremia by serotype 7F (66%). The large majority (83.8%) of NVS were sensitive to penicillin. CONCLUSIONS: There has been an increased prevalence of IPD caused by NVS since the introduction of PCV7. These changes should prompt the introduction of new pneumococcal vaccines, which include most of the NVS, in the childhood immunization calendar to prevent IPD in children.

Aumento de la incidencia de enfermedad neumocócica invasora producida por el serotipo 19A previo a la introducción de las vacunas neumocócicas ampliadas / Increase in the incidence of invasive pneumococcal disease caused by serotype 19A prior to the implementation of the expanded pneumococcal vaccines

Objetivo: Describir los aspectos epidemiológicos, clínicos y microbiológicos del serotipo 19A como principal productor de enfermedad neumocócica invasiva (ENI) en un hospital terciario de la Comunidad de Madrid (CAM). Métodos: Estudio retrospectivo (1998-2004) y prospectivo (2005-2009) del serotipo 19A como agente productor de ENI en pediatría entre 1998-2009. Se analizaron 3 periodos de estudio: P1 (1998-2001), previo a la comercialización de la VNC7; P2 (2002-2005), con una cobertura vacunal de 40%, y P3 (2006-2009), cuando la vacuna fue incorporada al calendario vacunal de la CAM. Resultados: Se analizaron un total de 155 muestras de Streptococcus pneumoniae (S. pneumoniae) productoras de ENI; 21 casos producidos por el serotipo 19A (14%). Se detectó un aumento de la prevalencia del serotipo 19A: 2 casos de un total de 45 en P1 (4,4%), 3 de 41 casos en P2 (7,3%) y 16 de 69 casos en P3 (23,2%). Afectó, principalmente, a niños menores de 2 años (16/21; 76%), siendo, globalmente, el principal productor de meningitis (5/20; 25%), así como de empiema pleural (3/22; 14%) y mastoiditis bacteriémica (2/4; 50%). Trece aislamientos (61,5%) presentaron una CMI ≥ 0,12 μ/ml para penicilina en infecciones extrameníngeas y 3 de los 5 casos de meningitis (60%) presentaron una CMI ≥ 1 μ/ml para cefotaxima. Conclusiones: El serotipo 19A se convirtió en el principal agente etiológico productor de ENI en la era de la VNC7 (P3), asociando altas tasas de resistencia antibiótica. Este serotipo produjo todas las formas clínicas de ENI, siendo el principal causante de meningitis (AU)

Objective: To describe the epidemiology, clinical syndromes and microbiological characteristics of serotype 19A as the main cause of invasive pneumococcal disease (IPD) in children admitted to a tertiary hospital in Spain. Methods: A retrospective (1998-2004) and prospective (2005-2009) study was conducted on children with IPD produced by serotype 19A. The study was divided into three periods (P):P1 (1998-2001) when PCV7 had not been commercialized; P2 (2002-2005) with 40% vaccine coverage among children; and P3 (2006-2009) when the vaccine was added to the Childhood Immunization Schedule in Madrid. Results: A total of 155 isolates of Streptococcus pneumoniae (SP) producing IPD were analysed ,with 21 of them being serotype 19A (14%). An increased prevalence of serotype 19A was found:2/45 cases (4.4%) in P1, 3/41 cases (7.3%) in P2 and 16/69 cases (23.2%) in P3. It occurred mostly in children younger than 2 years (16/21; 76%). This serotype was the main cause of meningitis (5/20; 25%), pleural empyema (3/22; 14%) and bacteraemic mastoiditis (2/4; 50%). Thirteen isolates (61.5%) had an MIC ≥0.12 μ/ml for penicillin in extra-meningeal infections, and 3 of the 5 isolates causing meningitis (60%) had an MIC ≥1 μ/ml for cefotaxime. Conclusions: Serotype 19A was the main causal agent of IPD in the PCV7 era (P3), with high antibiotic resistance rates. This serotype was responsible for all types of IPD, being the main cause of meningitis (AU)

[Increase in the incidence of invasive pneumococcal disease caused by serotype 19A prior to the implementation of the expanded pneumococcal vaccines]. / Aumento de la incidencia de enfermedad neumocócica invasora producida por el serotipo 19A previo a la introducción de las vacunas neumocócicas ampliadas.

OBJECTIVE: To describe the epidemiology, clinical syndromes and microbiological characteristics of serotype 19A as the main cause of invasive pneumococcal disease (IPD) in children admitted to a tertiary hospital in Spain. METHODS: A retrospective (1998-2004) and prospective (2005-2009) study was conducted on children with IPD produced by serotype 19A. The study was divided into three periods (P): P1 (1998-2001) when PCV7 had not been commercialized; P2 (2002-2005) with 40% vaccine coverage among children; and P3 (2006-2009) when the vaccine was added to the Childhood Immunization Schedule in Madrid. RESULTS: A total of 155 isolates of Streptococcus pneumoniae (SP) producing IPD were analysed, with 21 of them being serotype 19A (14%). An increased prevalence of serotype 19A was found: 2/45 cases (4.4%) in P1, 3/41 cases (7.3%) in P2 and 16/69 cases (23.2%) in P3. It occurred mostly in children younger than 2 years (16/21; 76%). This serotype was the main cause of meningitis (5/20; 25%), pleural empyema (3/22; 14%) and bacteraemic mastoiditis (2/4; 50%). Thirteen isolates (61.5%) had an MIC ≥ 0.12µ/ml for penicillin in extra-meningeal infections, and 3 of the 5 isolates causing meningitis (60%) had an MIC ≥ 1µ/ml for cefotaxime. CONCLUSIONS: Serotype 19A was the main causal agent of IPD in the PCV7 era (P3), with high antibiotic resistance rates. This serotype was responsible for all types of IPD, being the main cause of meningitis.

[Immunisation schedule of the Spanish Association of Paediatrics: 2013 recommendations]. / Calendario de vacunaciones de la Asociación Española de Pediatría: recomendaciones 2013.

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.

Calendario de vacunaciones de la Asociación Española de Pediatría: recomendaciones 2012 / Immunization schedule of the Spanish Association of Pediatrics: 2012 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 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, pero 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, las principales novedades propuestas en este calendario son la administración de la primera dosis de las vacunas triple vírica y varicela a los 12 meses (12-15 meses) y la segunda dosis a los 2-3 años, así como la administración de la vacuna Tdpa a los 4-6 años siempre acompañada de otra dosisa los 11-14 años. El CAV-AEP estima que deben incrementarse las coberturas de vacunación frente al papiloma virus humano en las niñas de 11 a 14 años. Se reafirma en la recomendación de incluir la vacunación frente al neumococo en el calendario de vacunación sistemática. 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, dada 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 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 Pediatrics (CAVAEP) updates the immunization schedule every year, taking into account epidemiological data as well as evidence on the effectiveness and efficency of vaccines.The present schedule includes grades of recommendation. We have graded as routine vaccinations those that the CAV-AEP believes all children should receive; as recommended those that fit the profile for universal childhood immunization and would ideally be given to all children, but that can be prioritized according to the resources available for their public funding; and as risk group vaccinations those that specifically target individuals in situations of risk. Immunization schedules tend to be dynamic and adaptable to on going epidemiological changes. Nevertheless, the achievement of a unified immunization schedule in all regions of Spainis a top priority for the CAV-AEP. Based on the latest epidemiological trends, the main changes introduced to the schedule are the administration of the first dose of the MMR and the varicella vaccines at age 12 months(12---15 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.The CAV-AEP believes that the coverage of vaccination against human papilloma virus in girls aged 11---14 years must increase. It reasserts its recommendation to include vaccination against pneumococcal disease in the routine immunization schedule. Universal vaccination against varicellain 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 immunization schedule (AU)

Vacunación frente a la gripe estacional en la infancia y la adolescencia. Recomendaciones del CAV-AEP para la campaña 2011-2012 / Seasonal influenza vaccination in children and adolescents. Recommendations of the CAV-AEP for the campaign

El Comité Asesor de Vacunas de la Asociación Española de Pediatría emite todos los años, antes del inicio de la temporada estacional de la gripe, unas recomendaciones sobre la vacunación frente a este virus en la edad pediátrica. Este comité sigue considerando que la vacunación antigripal es una actuación especialmente beneficiosa cuando va dirigida a los niños mayores de 6 meses pertenecientes a los grupos de riesgo, así como a sus convivientes. Se insiste en la recomendación de la vacunación antigripal en el personal sanitario que trabaja con niños (AU)

The Advisory Committee on Vaccines of the Spanish Association of Paediatrics establishes annual recommendations on influenza vaccination in childhood before the onset of influenza season. Routine influenza vaccination is particularly beneficial when the strategy isaimed at children older than 6 months of age with high-risk conditions and their home contacts.The recommendation of influenza vaccination in health workers with children is also emphasised (AU)

Immunization schedule of the Spanish Association of Pediatrics: 2012 recommendations.

The Advisory Committee on Vaccines of the Spanish Association of Pediatrics (CAV-AEP) updates the immunization schedule every year, taking into account epidemiological data as well as evidence on the effectiveness and efficiency of vaccines. The present schedule includes grades of recommendation. We have graded as routine vaccinations those that the CAV-AEP believes all children should receive; as recommended those that fit the profile for universal childhood immunization and would ideally be given to all children, but that can be prioritized according to the resources available for their public funding; and as risk group vaccinations those that specifically target individuals in situations of risk. Immunization schedules tend to be dynamic and adaptable to ongoing epidemiological changes. Nevertheless, the achievement of a unified immunization schedule in all regions of Spain is a top priority for the CAV-AEP. Based on the latest epidemiological trends, the main changes introduced to the schedule are the administration of the first dose of the MMR and the varicella vaccines at age 12 months (12-15 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. The CAV-AEP believes that the coverage of vaccination against human papillomavirus in girls aged 11-14 years must increase. It reasserts its recommendation to include vaccination against pneumococcal disease in the routine immunization 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 immunization schedule.

[Seasonal influenza vaccination in children and adolescents. Recommendations of the CAV-AEP for the campaign]. / Vacunación frente a la gripe estacional en la infancia y la adolescencia. Recomendaciones del CAV-AEP para la campaña 2011-2012.

The Advisory Committee on Vaccines of the Spanish Association of Paediatrics establishes annual recommendations on influenza vaccination in childhood before the onset of influenza season. Routine influenza vaccination is particularly beneficial when the strategy is aimed at children older than 6 months of age with high-risk conditions and their home contacts. The recommendation of influenza vaccination in health workers with children is also emphasized.