Documento de opinión de expertos para la mejora de la cobertura vacunal frente a la gripe estacional / Expert opinion on strategies to improve vaccination coverage against seasonal influenza

La gripe estacional sigue siendo un importante problema de salud pública, y la vacuna antigripal es la medida más efectiva para su prevención. En nuestro país, los datos de coberturas vacunales de las últimas temporadas muestran unas tasas de vacunación muy por debajo de los objetivos marcados por los organismos oficiales. Tras la pandemia de la COVID19, las coberturas vacunales para la gripe han experimentado una notable mejoría. Dado que resulta imperativo alcanzar y mantener unas elevadas tasas de vacunación con el fin de evitar el impacto clínico y económico de la gripe, un grupo multidisciplinar de expertos en el área de las vacunas hemos analizado cómo afectan las bajas coberturas en nuestro país y hemos diseñado una serie de medidas para incrementar la cobertura vacunal de la gripe, especialmente en los colectivos definidos como prioritarios. (AU)

Seasonal flu continues to be a major public health concern, and the influenza vaccine remains the most effective preventive measure. In Spain, vaccination coverage data from previous seasons show vaccination rates well below official targets; however, these figures improved significantly after the COVID-19 pandemic. Given the importance of achieving and maintaining high vaccination rates in order to avoid the clinical and economic impact of influenza, our multidisciplinary group of experts on vaccines analyzed the impact of low vaccination rates in Spain and drafted a series of measures to boost influenza vaccination coverage, particularly among priority groups. (AU)

[Prevalence of BreastFeeding in a Galician Health Area, Spain]. / Prevalencia de lactancia materna en el Área Sanitaria de Vigo, Galicia.

OBJECTIVE: The quantitative evaluation of actions to promote breastfeeding, with standardized material and method, is essential to understand their impact and allow international comparison. The aim was to know the prevalence of breastfeeding in Galician Health Area. METHODS: A cross-sectional descriptive study through interviews, following methodology and questionnaire designed by the Baby-Friendly Initiative. The infant´s mother/caregiver were asked about feeding to calculate the five indicators proposed (exclusive breastfeeding under 15 days, exclusive breastfeeding under six months, continued breastfeeding at one year and two years, introduction of solid, semi-solid or soft foods). A random sample of 431 infants aged between 0 and 2 years of the participating centers, between 2013 and 2014, has been selected. Descriptive and bivariate analyses have been performed. RESULTS: In the sample, 50.00% (95% CI 39.3 to 60.7) of infants fewer than 15 days were exclusively receiving breastfeeding. At 6 months, the prevalence was 50.28% (95% CI 43.0 to 57.6). Breastfeeding at 12 to 15 months was 34.62% (95% CI 22.0 to 49.1). At two years, it was 26.67% (95% CI 17.1 to 38.1), with significant differences between rural and urban areas. Between 6 and 8 months, all infants have breastfeeding combined with other foods. CONCLUSIONS: In our environment the starting rate and average duration are lower than desirable.

OBJETIVO: La evaluación cuantitativa de las actuaciones para promover la lactancia materna, con material y método estandarizados, es imprescindible para conocer su impacto y permitir la comparación internacional. El objetivo fue conocer la prevalencia de la lactancia materna en un Área Sanitaria de Galicia. METODOS: Estudio observacional mediante entrevista, siguiendo metodología y cuestionario diseñados por la Iniciativa para la Humanización de la Asistencia al Nacimiento y la Lactancia. Se preguntó a la madre/cuidador principal del lactante sobre la alimentación recibida por él/ella para calcular los 5 indicadores propuestos (lactancia materna exclusiva en menores de 15 días, lactancia materna exclusiva en menores de 6 meses, lactancia materna entre 12 y 15 meses y a los dos años, combinación con otros alimentos a los 6-7 meses). Se seleccionó una muestra aleatoria de 431 lactantes entre 0 y 2 años de los centros participantes, entre 2013 y 2014. Se realizó un análisis descriptivo y bivariante. RESULTADOS: Se observó que el 50,00% (IC 95%: 39,3-60,7) de lactantes menores de 15 días recibieron lactancia materna en exclusiva. A los 6 meses, la prevalencia fue del 50,28% (IC 95%: 43,0-57,6). La lactancia materna en lactantes de 12 a 15 meses era del 34,62% (IC 95%: 22,0-49,1). A los dos años era 26,67% (IC 95% 17,1-38,1), con diferencias significativas entre ámbito rural y urbano. Entre 6 y 8 meses la totalidad combinaban lactancia con otros alimentos. CONCLUSIONES: En nuestro entorno se observa una tasa de inicio y una duración media menor de lo deseable.

Prevalencia de lactancia materna en el Área sanitaria de Vigo, Galicia / Prevalence of breastfeeding in a Galician Health Area, Spain

Fundamentos: La evaluación cuantitativa de las actuaciones para promover la lactancia materna, con material y método estandarizados, es imprescindible para conocer su impacto y permitir la comparación internacional. El objetivo fue conocer la prevalencia de la lactancia materna en un Área Sanitaria de Galicia. Métodos: Estudio observacional mediante entrevista, siguiendo metodología y cuestionario diseñados por la Iniciativa para la Humanización de la Asistencia al Nacimiento y la Lactancia. Se preguntó a la madre/cuidador principal del lactante sobre la alimentación recibida por él/ella para calcular los 5 indicadores propuestos (lactancia materna exclusiva en menores de 15 días, lactancia materna exclusiva en menores de 6 meses, lactancia materna entre 12 y 15 meses y a los dos años, combinación con otros alimentos a los 6-7 meses). Se seleccionó una muestra aleatoria de 431 lactantes entre 0 y 2 años de los centros participantes, entre 2013 y 2014. Se realizó un análisis descriptivo y bivariante. Resultados: Se observó que el 50,00% (IC 95%: 39,3-60,7) de lactantes menores de 15 días recibieron lactancia materna en exclusiva. A los 6 meses, la prevalencia fue del 50,28% (IC 95%: 43,0-57,6). La lactancia materna en lactantes de 12 a 15 meses era del 34,62% (IC 95%: 22,0-49,1). A los dos años era 26,67% (IC 95% 17,1-38,1), con diferencias significativas entre ámbito rural y urbano. Entre 6 y 8 meses la totalidad combinaban lactancia con otros alimentos. Conclusiones: En nuestro entorno se observa una tasa de inicio y una duración media menor de lo deseable (AU)

Background: The quantitative evaluation of actions to promote breastfeeding, with standardized material and method, is essential to understand their impact and allow international comparison. The aim was to know the prevalence of breastfeeding in Galician Health Area. Methods: A cross-sectional descriptive study through interviews, following methodology and questionnaire designed by the Baby-Friendly Initiative. The infant´s mother/caregiver were asked about feeding to calculate the five indicators proposed (exclusive breastfeeding under 15 days, exclusive breastfeeding under six months, continued breastfeeding at one year and two years, introduction of solid, semi-solid or soft foods). A random sample of 431 infants aged between 0 and 2 years of the participating centers, between 2013 and 2014, has been selected. Descriptive and bivariate analyses have been performed. Results: In the sample, 50.00% (95% CI 39.3 to 60.7) of infants fewer than 15 days were exclusively receiving breastfeeding. At 6 months, the prevalence was 50.28% (95% CI 43.0 to 57.6). Breastfeeding at 12 to 15 months was 34.62% (95% CI 22.0 to 49.1). At two years, it was 26.67% (95% CI 17.1 to 38.1), with significant differences between rural and urban areas. Between 6 and 8 months, all infants have breastfeeding combined with other foods. Conclusions: In our environment the starting rate and average duration are lower than desirable (AU)

The safety and efficacy of the tetanus vaccine intramuscularly versus subcutaneously in anticoagulated patients: a randomized clinical trial.

BACKGROUND: In patients treated with oral anticoagulants, subcutaneous injections of anti-tetanus vaccine are usually recommended to reduce the risk of bleeding, although the effectiveness of the vaccine has only been proven for intramuscular injection. The objective of this study was to compare the safety and efficacy of intramuscular and subcutaneous injections of tetanus-diphtheria vaccine in patients treated with oral anticoagulants. METHODS/DESIGN: We present a prospective, double blinded, clinical trial comparing two groups of patients with oral anticoagulants: one group was administered tetanus-diphtheria vaccine by intramuscular injection, while the other was administered the same vaccine by subcutaneous injection. Allocation to each group was randomized and the duration of the study was six years. STUDY POPULATION: all patients treated with oral anticoagulants, who had been administered with at least one dose of vaccine, at 15 Health Centres in Vigo (Spain), and who agreed to participate in the study. The sample size was 115 patients in each group. The main variables for the safety analysis were the measurement of the brachial diameter, the appearance of basic injuries at the vaccine administration site, the appearance of pain and systemic reactions. The variable used for the efficacy analysis was a significant increase in the titres of anti-tetanus toxoid antibodies.An Intention-to-treat analysis will be performed. Details will be classified according to the administration route, while within each group a 3-tiered stratification will be defined by the administered number of doses. As a measure of association, relative risk will be estimated; the reduction of relative risk will also measured. For safety and to control the confounder effect, a logistic regression analysis will be carried out. As a measure of impact the reduction of absolute risk in relation to the total number of patients to be treated and the Number Needed to Treat will be estimated.CONSORT 2010 guidelines were applied for reporting parallel group randomised trials. DISCUSSION: The most significant difficulties on the project are related to the large number of participating centres, required to obtain a viable study population sample size, and the coordination given the scattering of the centres and researchers. TRIAL REGISTRATION: ISRCTN69942081.