Temporada de gripe y VRS 2018-19 y efectividad vacunal frente a la necesidad de atención hospitalaria por gripe en la provincia de Guadalajara / Flu and VRS 2018-19 Season and vaccine effectiveness against the need for hospital flu treatment in Guadalajara province, Spain

INTRODUCCIÓN: El objetivo fue estimar la efectividad de la vacuna (EV) trivalente inactivada para prevenir atenciones hospitalarias por gripe (AHG) en Guadalajara, Castilla-La Mancha (CLM), España, temporada 2018-2019. MATERIAL Y MÉTODOS: Estudio de cohortes retrospectivo; semanas 40/2018 a 13/2019. Fuentes: Programa Microbiología; historia clínica electrónica; censo poblacional (INE, 1/7/2018). Casos: AHG (urgencias y/u observación de urgencias o ingreso), confirmadas mediante prueba antigénica o PCR. Se calcularon: fracciones preventivas ([FPv(vacunados) y FPp(poblacional)]) y número necesario de pacientes a vacunar (NNV). RESULTADOS: Hubo 228 AHG (tasa incidencia [TI] acumulada=8,9/104; ≥ 65 años=65%; cobertura vacunal=13% [≥ 65 años=58%]; mortalidad=9%); con máxima incidencia en la semana 6.ª (TI=1,7/104) (en CLM, en la 4.ª). El mayor pico de VRS ocurrió en la 3.ª semana (en CLM, en la 52). La FPv entre 14-65 años fue del 96% (FPp=58%) y en ≥ 65, del 32% (FPp=21%). NNV=414. Como en España, predominó el virus A, siendo A(H3N2) un 13% más prevalente (cepa no concordante con la vacunal). CONCLUSIONES: La temporada se retrasó por una sostenida circulación del VRS. La EV resultó inferior a la nacional. Sería imprescindible impulsar próximas campañas para mejorar la cobertura

INTRODUCTION: The objective was to estimate the effectiveness of inactivated trivalent vaccine (VE) in preventing hospital flu care (HFC) in Guadalajara, Castile-La Mancha (CLM), Spain, 2018-19 season. MATERIAL AND METHODS: Retrospective cohort study (40/2018 to 13/2019 weeks). Sources: Microbiology programme; electronic medical history; population census (INE, 1/7/2018). Cases: Population requiring HFC (hospital emergencies and/or emergency observation unit and/or hospital admissions), confirmed by antigenic test and/or PCR. Preventive fractions [PFv(vaccinated) and PFp(population)] and Necessary number of patients to be vaccinated (NNV) were calculated. RESULTS: 228 HFT occurred [cumulative incidence rate (IR)=8.9/104; ≥65 years=65%; vaccination coverage=13% (≥65 years=58%); mortality=9%); maximum incidence in the 6th week (IR=1.7/104) (in CLM, in 4th)]. Highest peak of RSV occurred in the 3rd (in CLM, in the 52th). PFv (14-65 years) was 96% (PFp=58%) and in ≥65, 32% (PFp=21%). NNV=414. As in Spain, influenza virus A predominated, with A(H3N2) being 13% more prevalent (strain not included in the vaccine). CONCLUSIONS: The season was delayed by sustained VRS circulation. The VE was lower than the national one. It is be essential to promote future campaigns to improve vaccination coverage

Fiebre en el paciente pediátrico. La importancia de la exploración física repetida / Fever in the paediatric patient. The importance of repeated physical examination

Los cuadros clínicos consistentes en fiebre e inflamación sistémica con afectación mucocutánea pueden ser debidos a múltiples etiologías. El pronóstico de estos, en algunas ocasiones, depende del diagnóstico e instauración de tratamiento precoz. Se presenta el caso clínico de un niño atendido en el servicio de urgencias por fiebre, dolor abdominal y cervical. En su caso, los hallazgos de leucocitosis, neutrofilia, elevación de reactantes de fase aguda y transaminasas orientan inicialmente hacia una patología gastrointestinal. Sin embargo, la exploración física continuada junto a un alto índice de sospecha permitió establecer el diagnóstico correcto de enfermedad de Kawasaki mediante ecocardiografía en los primeros cinco días de evolución de la enfermedad. Se trató con gammaglobulina intravenosa, con evolución favorable y resolución completa del cuadro a los cuatro meses del diagnóstico

Clinical pictures consisting of fever and systemic inflammation with mucocutaneous involvement can be caused by multiple aetiologies. Prognosis, in some cases, depends on diagnosis and on early treatment. We present the clinical case of a boy seen in the emergency department with fever, and abdominal and cervical pain. In this case, findings of leucocytosis, neutrophilia, increased acute phase reactants and transaminases initially lead to gastrointestinal disease. However, continued physical examination and high degree of suspicion enabled to make the correct diagnosis of Kawasaki disease using echocardiogram within the first five days of the disease. The treatment was intravenous gamma globulin, with a favourable evolution and complete recovery four months after diagnosis

Flu and VRS 2018-19 Season and vaccine effectiveness against the need for hospital flu treatment in Guadalajara province, Spain. / Temporada de gripe y VRS 2018-19 y efectividad vacunal frente a la necesidad de atención hospitalaria por gripe en la provincia de Guadalajara.

INTRODUCTION: The objective was to estimate the effectiveness of inactivated trivalent vaccine (VE) in preventing hospital flu care (HFC) in Guadalajara, Castile-La Mancha (CLM), Spain, 2018-19 season. MATERIAL AND METHODS: Retrospective cohort study (40/2018 to 13/2019 weeks). SOURCES: Microbiology programme; electronic medical history; population census (INE, 1/7/2018). CASES: Population requiring HFC (hospital emergencies and/or emergency observation unit and/or hospital admissions), confirmed by antigenic test and/or PCR. Preventive fractions [PFv(vaccinated) and PFp(population)] and Necessary number of patients to be vaccinated (NNV) were calculated. RESULTS: 228 HFT occurred [cumulative incidence rate (IR)=8.9/104; ≥65 years=65%; vaccination coverage=13% (≥65 years=58%); mortality=9%); maximum incidence in the 6th week (IR=1.7/104) (in CLM, in 4th)]. Highest peak of RSV occurred in the 3rd (in CLM, in the 52th). PFv (14-65 years) was 96% (PFp=58%) and in ≥65, 32% (PFp=21%). NNV=414. As in Spain, influenza virus A predominated, with A(H3N2) being 13% more prevalent (strain not included in the vaccine). CONCLUSIONS: The season was delayed by sustained VRS circulation. The VE was lower than the national one. It is be essential to promote future campaigns to improve vaccination coverage.