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1.
JAMA ; 322(2): 123-133, 2019 07 09.
Artigo em Inglês | MEDLINE | ID: mdl-31287523

RESUMO

Importance: Herpes zoster, a frequent complication following autologous hematopoietic stem cell transplantation (HSCT), is associated with significant morbidity. A nonlive adjuvanted recombinant zoster vaccine has been developed to prevent posttransplantation zoster. Objective: To assess the efficacy and adverse event profile of the recombinant zoster vaccine in immunocompromised autologous HSCT recipients. Design, Setting, and Participants: Phase 3, randomized, observer-blinded study conducted in 167 centers in 28 countries between July 13, 2012, and February 1, 2017, among 1846 patients aged 18 years or older who had undergone recent autologous HSCT. Interventions: Participants were randomized to receive 2 doses of either recombinant zoster vaccine (n = 922) or placebo (n = 924) administered into the deltoid muscle; the first dose was given 50 to 70 days after transplantation and the second dose 1 to 2 months thereafter. Main Outcomes and Measures: The primary end point was occurrence of confirmed herpes zoster cases. Results: Among 1846 autologous HSCT recipients (mean age, 55 years; 688 [37%] women) who received 1 vaccine or placebo dose, 1735 (94%) received a second dose and 1366 (74%) completed the study. During the 21-month median follow-up, at least 1 herpes zoster episode was confirmed in 49 vaccine and 135 placebo recipients (incidence, 30 and 94 per 1000 person-years, respectively), an incidence rate ratio (IRR) of 0.32 (95% CI, 0.22-0.44; P < .001), equivalent to 68.2% vaccine efficacy. Of 8 secondary end points, 3 showed significant reductions in incidence of postherpetic neuralgia (vaccine, n=1; placebo, n=9; IRR, 0.1; 95% CI, 0.00-0.78; P = .02) and of other prespecified herpes zoster-related complications (vaccine, n=3; placebo, n=13; IRR, 0.22; 95% CI, 0.04-0.81; P = .02) and in duration of severe worst herpes zoster-associated pain (vaccine, 892.0 days; placebo, 6275.0 days; hazard ratio, 0.62; 95% CI, 0.42-0.89; P = .01). Five secondary objectives were descriptive. Injection site reactions were recorded in 86% of vaccine and 10% of placebo recipients, of which pain was the most common, occurring in 84% of vaccine recipients (grade 3: 11%). Unsolicited and serious adverse events, potentially immune-mediated diseases, and underlying disease relapses were similar between groups at all time points. Conclusions and Relevance: Among adults who had undergone autologous HSCT, a 2-dose course of recombinant zoster vaccine compared with placebo significantly reduced the incidence of herpes zoster over a median follow-up of 21 months. Trial Registration: ClinicalTrials.gov Identifier: NCT01610414.


Assuntos
Transplante de Células-Tronco Hematopoéticas , Vacina contra Herpes Zoster , Herpes Zoster/prevenção & controle , Hospedeiro Imunocomprometido , Adjuvantes Imunológicos , Adulto , Feminino , Seguimentos , Herpes Zoster/epidemiologia , Vacina contra Herpes Zoster/administração & dosagem , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Injeções Intramusculares , Masculino , Pessoa de Meia-Idade , Neuralgia Pós-Herpética/prevenção & controle , Modelos de Riscos Proporcionais , Método Simples-Cego , Transplante Autólogo , Vacinas Sintéticas/administração & dosagem
2.
Pediatr Pulmonol ; 54(5): 517-524, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30784235

RESUMO

AIM: The aim was to analyze the epidemiological, microbiological and clinical characteristics of patients with complicated pneumococcal pneumonia with pleural effusion (PE) or empyema. METHOD: Prospective study in three Catalan hospitals in persons aged <18 years diagnosed with complicated pneumonia with PE or empyema with isolation of Streptococcus pneumoniae in blood or pleural fluid by culture or real-time PCR between January 2012 and June 2016. Patients were divided into <2 years and 2-17 years age groups. Epidemiological, microbiological, and clinical data of patients were compared annually in both groups. PCV13 vaccination coverage increased from 48.2% in 2012 to 74.5% in 2015. RESULTS: We included 143 patients. The incidence of pneumococcal pneumonia was 6.83 cases × 10-5 persons/year in cases with PE or empyema and 2.09 cases × 10-5 person-years in cases without (rate ratio [RR]: 3.27; 2.25-4.86; P < 0.001). Empyema was more frequent than PE (79.7% vs 20.3%, P < 0.005). Of 143 cases studied, 93 (65.0%, P < 0.001) were diagnosed by real-time-PCR, 43 (30.1%) by culture and RT-PCR and 7 (4.9%) by culture only. PCV13 serotypes were more frequent in complicated than in uncomplicated pneumonia (116/142, 81.7% vs 27/45, 60.0%; P = 0.003), especially serotype 1 (41/142, 28.9% vs 6/45, 13.3%, P : 0.036). From 2012 to 2015 there was a significant reduction in serotype 1 (16/43, 37.2% vs 3/27, 11.1%, P = 0.026), and a trend to an increase in non-PCV13 serotypes (6/43, 14% vs 9/27, 33.3%, P = 0.054). CONCLUSIONS: A directly proportional relationship was observed between the reduction in pneumonia complicated with PE or empyema and a significant reduction in PCV13 serotypes, especially serotype 1, coinciding with increased PCV13 coverage.

3.
Euro Surveill ; 24(7)2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30782268

RESUMO

INTRODUCTION: Although human papillomavirus (HPV) routine vaccination programmes have been implemented around the world and recommendations have been expanded to include other high-risk individuals, current recommendations often differ between countries in Europe, as well as worldwide. AIM: To find and summarise the best available evidence of HPV vaccination in high-risk patients aiding clinicians and public health workers in the day-to-day vaccine decisions relating to HPV in Spain. METHODS: We conducted a systematic review of the immunogenicity, safety and efficacy/effectiveness of HPV vaccination in high-risk populations between January 2006 and June 2016. HPV vaccination recommendations were established with levels of evidence according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. RESULTS: A strong recommendation about HPV vaccination was made in the following groups: HIV infected patients aged 9-26 years; men who have sex with men aged 9-26 years; women with precancerous cervical lesions; patients with congenital bone marrow failure syndrome; women who have received a solid organ transplant or hematopoietic stem cell transplantation aged 9-26 years; and patients diagnosed with recurrent respiratory papillomatosis. CONCLUSIONS: Data concerning non-routine HPV vaccination in populations with a high risk of HPV infection and associated lesions were scarce. We have developed a document to evaluate and establish evidence-based guidelines on HPV vaccination in high-risk populations in Spain, based on best available scientific evidence.

4.
J Infect ; 2018 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-29981774

RESUMO

OBJECTIVE: To estimate outpatient visits and hospitalization rates due to cardiopulmonary illness attributable to influenza from 2008-09 to 2012-13 in a large cohort of pregnant women from Catalonia, Spain. METHODS: We estimated the event rates occurring during influenza epidemic, influenza non-epidemic and non-influenza seasons, and by pregnancy status (one year before pregnancy, first, second and third trimester). We fitted quasi-Poisson models in order to identify the variables associated to higher event rates. RESULTS: During influenza epidemic seasons, pregnant women in their second trimester had the highest rates of outpatient visits (153 per 10,000 women-months). An increased risk of outpatient visits was associated to first or second trimester (adjusted rate ratio (aRR) = 1.17; 95% CI, 1.10-1.23 and aRR, 1.36; 95% CI, 1.28-1.43, respectively) and having any comorbidity (aRR = 1.28; 95% CI, 1.21-1.36). Women during third trimester had the highest rates of hospitalizations (1.60 per 10,000 women-months), and an increased risk of hospitalization was significantly associated to third trimester (aRR, 1.85; 95% CI, 1.01-3.39), having any comorbidity (aRR, 1.93; 95% CI, 1.10-3.41) and the pandemic influenza season (aRR, 2.90 (1.81; 95% CI, 1.81-4.64). CONCLUSION: Our findings provide significant information regarding influenza burden of disease among pregnant women.

5.
Euro Surveill ; 23(13)2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29616610

RESUMO

In May 2015, following a 30-year diphtheria-free interval in Catalonia, an unvaccinated 6-year-old child was diagnosed with diphtheria caused by toxigenic Corynebacterium diphtheriae. After a difficult search for equine-derived diphtheria antitoxin (DAT), the child received the DAT 4 days later but died at the end of June. Two hundred and seventeen contacts were identified in relation to the index case, and their vaccination statuses were analysed, updated and completed. Of these, 140 contacts underwent physical examination and throat swabs were taken from them for analysis. Results were positive for toxigenic C. diphtheriae in 10 contacts; nine were asymptomatic vaccinated children who had been in contact with the index case and one was a parent of one of the nine children. Active surveillance of the 217 contacts was initiated by healthcare workers from hospitals and primary healthcare centres, together with public health epidemiological support. Lack of availability of DAT was an issue in our case. Such lack could be circumvented by the implementation of an international fast-track procedure to obtain it in a timely manner. Maintaining primary vaccination coverage for children and increasing booster-dose immunisation against diphtheria in the adult population is of key importance.

6.
Matern Child Health J ; 22(7): 1016-1024, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29417364

RESUMO

Objective Maternal care providers (MCPs), obstetrician-gynaecologists and midwives are uniquely placed to increase maternal vaccination acceptance. We aimed to assess their knowledge, attitudes and practices regarding influenza and pertussis vaccination during pregnancy. Methods We conducted an online survey among MCPs working at "Attention to Sexual and Reproductive Health" (ASSIR) Units in Catalonia region. The survey included questions about current recommendations of influenza and pertussis immunization during pregnancy, reasons for not routinely recommending vaccination and several strategies to increase vaccination uptake. Results A total of 194 MCPs completed the survey, 178 (91.8%) were female and 145 (70%) were midwives. Only 61 (31.4%) stated they vaccinated themselves annually against influenza with a significant lower uptake among midwives (26.9%) than obstetrician-gynaecologists (44.9%) (p = 0.03). Overall, 53.6% of MCPs knew influenza vaccine was indicated during first trimester but only 43.3% stated they prescribed it. Almost all MCPs (98.5%) knew pertussis vaccine was recommended and 97.4% stated they prescribed it. The most important vaccination barrier found was the concern related to vaccine adverse events (25.9%) and more midwives than obstetrician-gynaecologists expressed this concern (30.8 vs. 10%) (p = 0.02). The most popular strategies were: including vaccine recommendations in the pregnancy booklet (93.8%) and receiving vaccination training (92.3%). In the adjusted analysis, the only factor significantly associated with MCPs' prescription of influenza vaccine during second/third trimester was having been vaccinated themselves (odds ratio 3.70, 95% confidence interval 1.3-13.2). Conclusions for Practice Implementation of practical tools, continuous training and clear definition of responsibilities regarding vaccination among MCPs may have a significant impact on maternal vaccination coverage.

7.
Emerg Infect Dis ; 23(11): 1856-1859, 2017 11.
Artigo em Inglês | MEDLINE | ID: mdl-29052540

RESUMO

We describe the detection of Bordetella holmesii as a cause of whooping cough in Spain. Prevalence was 3.9% in 2015, doubling to 8.8% in 2016. This emergence raises concern regarding the contribution of B. holmesii to the reemergence of whooping cough and the effectiveness of the pertussis vaccine.


Assuntos
Bordetella/isolamento & purificação , Doenças Transmissíveis Emergentes/epidemiologia , Vacina contra Coqueluche/imunologia , Coqueluche/virologia , Adolescente , Adulto , Bordetella/genética , Bordetella/imunologia , Criança , Pré-Escolar , Doenças Transmissíveis Emergentes/virologia , Feminino , Humanos , Lactente , Masculino , Estudos Retrospectivos , Espanha/epidemiologia , Coqueluche/epidemiologia , Coqueluche/prevenção & controle
8.
PLoS One ; 12(8): e0183191, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28806737

RESUMO

BACKGROUND: The 13-valent pneumococcal conjugate vaccine (PCV13) was licensed based on the results of immunogenicity studies and correlates of protection derived from randomized clinical trials of the 7-valent conjugate pneumococcal vaccine. We assessed the vaccination effectiveness (VE) of the PCV13 in preventing invasive pneumococcal disease (IPD) in children aged 7-59 months in a population with suboptimal vaccination coverage of 55%. METHODS: The study was carried out in children with IPD admitted to three hospitals in Barcelona (Spain) and controls matched by hospital, age, sex, date of hospitalization and underlying disease. Information on the vaccination status was obtained from written medical records. Conditional logistic regression was made to estimate the adjusted VE and 95% confidence intervals (CI). RESULTS: 169 cases and 645 controls were included. The overall VE of ≥1 doses of PCV13 in preventing IPD due to vaccine serotypes was 75.8% (95% CI, 54.1-87.2) and 90% (95% CI, 63.9-97.2) when ≥2 doses before 12 months, two doses on or after 12 months or one dose on or after 24 months, were administered. The VE of ≥1 doses was 89% (95% CI, 42.7-97.9) against serotype 1 and 86.0% (95% CI, 51.2-99.7) against serotype 19A. Serotype 3 showed a non-statistically significant effectiveness (25.9%; 95% CI, -65.3 to 66.8). CONCLUSIONS: The effectiveness of ≥1 doses of PCV13 in preventing IPD caused by all PCV13 serotypes in children aged 7-59 months was good and, except for serotype 3, the effectiveness of ≥1 doses against the most frequent PCV13 serotypes causing IPD was high when considered individually.


Assuntos
Infecções Pneumocócicas/imunologia , Infecções Pneumocócicas/prevenção & controle , Vacinas Pneumocócicas/imunologia , Vacinas Conjugadas/imunologia , Estudos de Casos e Controles , Criança , Pré-Escolar , Relação Dose-Resposta Imunológica , Feminino , Vacina Pneumocócica Conjugada Heptavalente/imunologia , Humanos , Lactente , Masculino , Sorogrupo , Resultado do Tratamento , Vacinação
9.
Prev Med ; 99: 111-117, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28216380

RESUMO

Pregnant women are vaccinated against influenza less frequently than other high-risk groups. To design effective vaccination strategies, we must understand how decisions regarding vaccination may vary by trimester and over vaccination campaigns. We used a Cox model indexed by calendar time to estimate the effect of gestational trimester and other factors on vaccination uptake in a large cohort of pregnant women in Catalonia (Spain) during 2008-09 to 2012-13 influenza vaccination campaigns. We analyzed 247,316 pregnancies. Vaccination coverage was 3.7%, 5.2%, 4.8%, 5.6% and 4.6% from 2008-09 to 2012-13 seasonal vaccination campaigns and 8.3% for the 2009 pandemic vaccination campaign. Pregnant women previously vaccinated had higher uptake than women not previously vaccinated and the hazard ratios (HRs) comparing these 2 groups decreased from 10, the first day of seasonal campaigns, to 1.3 the last day. During the pandemic campaign, HRs decreased over the course of the campaign from 8.6 to 1.9. Women in second and third trimester had higher uptake than women in first trimester, with HR=2.8 and 2.3, respectively, at the start of seasonal campaigns. Influenza vaccination coverage among this cohort of pregnant women was alarmingly low. Our analysis reveals that gestational and calendar time have distinct and interacting effects on vaccination uptake; women in their second trimester and third trimester and previously vaccinated were more prone to be vaccinated, but this effect wanes as the influenza season progresses.


Assuntos
Vacinas contra Influenza/uso terapêutico , Vacinação em Massa , Segundo Trimestre da Gravidez , Terceiro Trimestre da Gravidez , Gestantes/psicologia , Adulto , Estudos de Coortes , Feminino , Humanos , Influenza Humana/prevenção & controle , Gravidez , Espanha , Fatores de Tempo
10.
Int J Infect Dis ; 52: 43-48, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27686727

RESUMO

OBJECTIVE: To reduce ventilator-associated infections (VARI) and improve outcomes for children. METHODS: This prospective interventional cohort study was conducted in a paediatric intensive care unit (PICU) over three periods: pre-intervention, early post-intervention, and late post-intervention. These children were on mechanical ventilation (MV) for ≥48h. RESULTS: Overall, 312 children (11.9% of whom underwent tracheostomy) and 6187 ventilator-days were assessed. There was a significant reduction in ventilator-associated pneumonia (VAP) among tracheostomized patients (8.16, 3.27, and 0.65 per 1000 tracheostomy ventilation-days before the intervention, after the general bundle implementation, and after the tracheostomy intervention, respectively). The median time from onset of MV to diagnosis of ventilator-associated tracheobronchitis (VAT) increased from 5.5 to 48 days in the late post-intervention period (p=0.004), and was associated with a significant increase in median 28-day ventilator-free days and PICU-free days. Tracheostomy (odds ratio 7.44) and prolonged MV (odds ratio 2.75) were independent variables significantly associated with VARI. A trend towards a reduction in PICU mortality was observed, from 28.4% to 16.6% (relative risk 0.58). CONCLUSIONS: The implementation of a care bundle to prevent VARI in children had a different impact on VAP and VAT, diminishing VAP rates and delaying VAT onset, resulting in reduced healthcare resource use. Tracheostomized children were at increased risk of VARI, but preventive measures had a greater impact on them.


Assuntos
Pacotes de Assistência ao Paciente , Pneumonia Associada à Ventilação Mecânica/prevenção & controle , Respiração Artificial/efeitos adversos , Traqueostomia , Broncopatias , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Lactente , Unidades de Terapia Intensiva , Unidades de Terapia Intensiva Pediátrica , Masculino , Pneumonia Associada à Ventilação Mecânica/etiologia , Estudos Prospectivos , Fatores de Risco
12.
Diagn Microbiol Infect Dis ; 86(2): 153-9, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27524509

RESUMO

Human parainfluenza virus type 3 (HPIV-3) is one of the most common respiratory viruses particularly among young children and immunocompromised patients. The seasonality, prevalence and genetic diversity of HPIV-3 at a Spanish tertiary-hospital from 2013 to 2015 are reported. HPIV-3 infection was laboratory-confirmed in 102 patients (76%, under 5 years of age). Among <5 years-old patients, 9 (11.5%) were under any degree of immunosuppression, whereas this percentage was significantly higher (19; 79.2%) among patients older than 5 years. HPIV-3 was detected at varying levels, but mainly during spring and summer. All characterized HN/F sequences fell within C1b, C5 and in other two closely C3a-related groups. Furthermore, a new genetic lineage (C1c) was described. Genetic similarity and epidemiological data confirmed some nosocomial infections, highlighting the importance of the HPIV-3 surveillance, particularly in high-risk patients. This study provides valuable information on HPIV-3 diversity due to the scarce information in Europe.


Assuntos
Variação Genética , Vírus da Parainfluenza 3 Humana/classificação , Vírus da Parainfluenza 3 Humana/genética , Infecções por Respirovirus/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Estudos Epidemiológicos , Feminino , Genótipo , Hospitais Universitários , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Epidemiologia Molecular , Vírus da Parainfluenza 3 Humana/isolamento & purificação , Reação em Cadeia da Polimerase , Prevalência , Estações do Ano , Análise de Sequência de DNA , Espanha/epidemiologia , Adulto Jovem
14.
Enferm. infecc. microbiol. clín. (Ed. impr.) ; 34(5): 293-297, mayo 2016. tab
Artigo em Espanhol | IBECS | ID: ibc-152542

RESUMO

Introducción: Streptococcus pneumoniae es una causa importante de morbimortalidad. Los niños con ciertas patologías de base tienen más riesgo de presentar una enfermedad neumocócica, incluida la enfermedad neumocócica invasiva (ENI). El objetivo de este estudio es estimar las tasas de hospitalización por ENI en niños con condiciones de riesgo en Cataluña y describir sus características. Material y método: Estudio longitudinal retrospectivo de la incidencia de ingresos hospitalarios por ENI entre 2005 y 2012, en los niños menores de 16 años asignados a los centros de atención primaria del Institut Català de la Salut, con condiciones de riesgo para enfermedad neumocócica invasiva. La información se recogió a partir de la historia clínica electrónica de los equipos de atención primaria y del Conjunto Mínimo Básico de Datos de hospitalización de agudos. Resultados: La tasa global de hospitalizaciones por ENI en niños con enfermedad de base fue de 43,1 casos por 100.000 personas-año (IC del 95%: 32,2-57,7). La tasa más alta se observó en los niños < 2 años (107,8 por 100.000 personas-año; IC del 95%: 69-168,3) y en aquellos con trastornos neuromusculares y/o fístula de líquido cefalorraquídeo (141,6 por 100.000 personas-año) y síndrome de Down (133,5 por 100.000 personas-año). Conclusiones: La tasa de ingresos por ENI en población pediátrica con condiciones de riesgo en Cataluña es similar a la observada en otras series y superior a la descrita en población general. Es necesario implementar estrategias de vacunación dirigidas específicamente a estos grupos de alto riesgo (AU)


Introduction: Streptococcus pneumoniae is a significant cause of morbidity and mortality. Children with certain conditions are at risk of developing pneumococcal disease, including invasive pneumococcal disease (IPD). The aim of this study is to estimate admission rates for IPD in children with risk conditions in Catalonia, and to describe their characteristics. Material and method: Retrospective longitudinal study of admission rates due to IPD between 2005 and 2012 in children younger than 16 years referred by Primary Care Centres of the Catalan Institute of Health, with risk conditions for invasive pneumococcal disease. Information was obtained from electronic medical records in the Primary Care Centres and from the Minimum Basic Data Set (MBDS) of acute hospital admissions. Results: The overall IPD hospital admission rate in children with underlying conditions was 43.1 cases per 100,000 persons-year (95% CI: 32.2-57.7). The rate was higher in children <2 years old (107.8 per 100,000 persons-year; 95% CI: 69-168.3), and in those with neuromuscular disease and/or cerebrospinal fluid leak (141.6 per 100,000 persons-year), and Down's syndrome (133.5 per 100,000 persons-year). Conclusions: The hospital admission rate due to IPD in children with risk conditions in Catalonia is similar to that observed in other series, and higher than that described in the general population. It is necessary to implement immunisation strategies aimed directly at these risk groups (AU)


Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Hospitalização/estatística & dados numéricos , Infecções Pneumocócicas/epidemiologia , Estudos de Coortes , Streptococcus pneumoniae/patogenicidade , Fatores de Risco , Criança Hospitalizada/estatística & dados numéricos , Estudos Retrospectivos
15.
Pediatr Infect Dis J ; 35(4): 460-3, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26658626

RESUMO

Vaccine failures occurring with 13-valent pneumococcal conjugate vaccine (PCV13) in 3 pediatric hospitals in Barcelona (2012-2013) are described. PCV13 vaccine failure was defined as the occurrence of an invasive pneumococcal infection in children properly vaccinated by PCV13. Among 84 patients with invasive pneumococcal infection, 32 had received at least one dose of PCV13. Seventeen of them had invasive pneumococcal infection produced by a PCV13 serotype. Among those, 9 patients were considered to have a PCV13 vaccine failure. Serotype 3 was isolated in 6 patients, serotype 19A in 2 and serotype 6B in 1.


Assuntos
Infecções Pneumocócicas/epidemiologia , Infecções Pneumocócicas/prevenção & controle , Vacinas Pneumocócicas/imunologia , Streptococcus pneumoniae/imunologia , Vacinação , Humanos , Espanha/epidemiologia , Falha de Tratamento
16.
Clin Drug Investig ; 36(1): 41-53, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26547199

RESUMO

BACKGROUND: Patients with chronic obstructive pulmonary disease (COPD) are at elevated risk of pneumococcal infection. A 13-valent pneumococcal conjugate vaccine (PCV13) was approved for protection against invasive disease and pneumonia caused by Streptococcus pneumoniae in adults. This study estimated the incremental cost-effectiveness ratio (ICER) of vaccinating COPD patients ≥50 years old with PCV13 compared with current vaccination policy (CVP) with 23-valent pneumococcal polysaccharide vaccine. METHODS: A Markov model accounting for the risks and costs for all-cause non-bacteremic pneumonia (NBP) and invasive pneumococcal disease (IPD) was developed. All parameters, such as disease incidence and costs (€; 2015 values), were based on published data. The perspective of the analysis was that of the Spanish National Healthcare System, and the horizon of evaluation was lifetime in the base case. Vaccine effectiveness considered waning effect over time. Outcomes and costs were both discounted by 3% annually. RESULTS: Over a lifetime horizon and for a 629,747 COPD total population, PCV13 would prevent 2224 cases of inpatient NBP, 3134 cases of outpatient NBP, and 210 IPD extra cases in comparison with CVP. Additionally, 398 related deaths would be averted. The ICER was €1518 per quality-adjusted life-year (QALY) gained for PCV13 versus CVP. PCV13 was found to be cost effective versus CVP from a 5-year modelling horizon (1302 inpatient NBP and 1835 outpatient NBP cases together with 182 deaths would be prevented [ICER €25,573/QALY]). Univariate and probabilistic sensitivity analyses confirmed the robustness of the model. CONCLUSIONS: At the commonly accepted willingness-to-pay threshold of €30,000/QALY gained, PCV13 vaccination in COPD patients aged ≥50 years was a cost-effective strategy compared with CVP from 5 years to lifetime horizon in Spain.


Assuntos
Infecções Pneumocócicas/prevenção & controle , Vacinas Pneumocócicas/administração & dosagem , Doença Pulmonar Obstrutiva Crônica/complicações , Idoso , Idoso de 80 Anos ou mais , Análise Custo-Benefício , Humanos , Programas de Imunização/economia , Pessoa de Meia-Idade , Anos de Vida Ajustados por Qualidade de Vida , Espanha , Vacinação
17.
Enferm Infecc Microbiol Clin ; 34(5): 293-7, 2016 May.
Artigo em Espanhol | MEDLINE | ID: mdl-26321130

RESUMO

INTRODUCTION: Streptococcus pneumoniae is a significant cause of morbidity and mortality. Children with certain conditions are at risk of developing pneumococcal disease, including invasive pneumococcal disease (IPD). The aim of this study is to estimate admission rates for IPD in children with risk conditions in Catalonia, and to describe their characteristics. MATERIAL AND METHOD: Retrospective longitudinal study of admission rates due to IPD between 2005 and 2012 in children younger than 16 years referred by Primary Care Centres of the Catalan Institute of Health, with risk conditions for invasive pneumococcal disease. Information was obtained from electronic medical records in the Primary Care Centres and from the Minimum Basic Data Set (MBDS) of acute hospital admissions. RESULTS: The overall IPD hospital admission rate in children with underlying conditions was 43.1 cases per 100,000 persons-year (95% CI: 32.2-57.7). The rate was higher in children <2 years old (107.8 per 100,000 persons-year; 95% CI: 69-168.3), and in those with neuromuscular disease and/or cerebrospinal fluid leak (141.6 per 100,000 persons-year), and Down's syndrome (133.5 per 100,000 persons-year). CONCLUSIONS: The hospital admission rate due to IPD in children with risk conditions in Catalonia is similar to that observed in other series, and higher than that described in the general population. It is necessary to implement immunisation strategies aimed directly at these risk groups.


Assuntos
Hospitalização/estatística & dados numéricos , Infecções Pneumocócicas/epidemiologia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Estudos Longitudinais , Masculino , Vacinas Pneumocócicas , Estudos Retrospectivos , Sorotipagem , Espanha/epidemiologia , Streptococcus pneumoniae
18.
Enferm. infecc. microbiol. clín. (Ed. impr.) ; 33(9): 585-589, nov. 2015. ilus, tab
Artigo em Inglês | IBECS | ID: ibc-144633

RESUMO

Several outbreaks of Enterovirus 68 (EV-D68) have recently been reported in the USA and Canada, causing substantial hospitalisation of children with severe respiratory disease. The acute flaccid paralysis detected in the USA and Canada among children with EV-D68 infection has raised concerns about the aetiological role of this EV serotype in severe neurological disease. The circulation of EV-D68 in the general European population seems to be low, but European Centre for Disease Prevention and Control (ECDC) recommends being vigilant to new cases, particularly in severely ill hospitalised patients. In October 2014, enteroviruses were detected in respiratory samples collected from five hospitalised patients, children and adults. Phylogenetic analysis of partial VP1 sequences confirmed that the detected enteroviruses belonged to the D68 serotype, which were also similar to strains reported in USA (2014). However, all five patients developed respiratory symptoms, but only one required ICU admission. None of the patients described had symptoms of neurological disease. Other considerations related to the detection methods used for the diagnosis of respiratory enteroviruses are also discussed. In conclusion, additional evidence has been provided that supports the role of EV-D68 in respiratory infections in hospitalised patients (AU)


En EEUU y Canadá, desde el pasado verano, se han descrito varios brotes causados por EV-D68 afectando a pacientes, principalmente niños, con enfermedad respiratoria grave. En algunos de estos casos la infección por EV-D68 se ha asociado a enfermedad neurológica grave. Aunque en población europea la circulación de este serotipo parece ser baja, el ECDC recuerda la necesidad de reforzar la vigilancia, especialmente en pacientes hospitalizados. En octubre de 2014, en las muestras respiratorias de 5 pacientes ingresados en el Hospital Universitario Vall d’Hebron de Barcelona, se pudieron detectar enterovirus. Estos fueron caracterizados como EV-D68 mediante análisis filogenético de las secuencias parciales codificantes para la proteína viral VP1. Estas secuencias eran además similares a las de las cepas aisladas en los últimos meses en EEUU. Estos 5 pacientes presentaron síntomas respiratorios, pero sólo uno requirió ingreso en la Unidad de Cuidados Intensivos. Sin embargo, ninguno de los pacientes presentó síntomas de enfermedad neurológica. En este trabajo se comentan también consideraciones relacionadas con los métodos de diagnóstico para enterovirus, especialmente para este serotipo. En conclusión, en este trabajo se confirma el posible papel etiológico del EV-D68 en la infección respiratoria del paciente ingresado (AU)


Assuntos
Humanos , Enterovirus Humano D/isolamento & purificação , Infecções por Enterovirus/microbiologia , Infecções Respiratórias/epidemiologia , /estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Índice de Gravidade de Doença
19.
Enferm. infecc. microbiol. clín. (Ed. impr.) ; 33(9): 597-602, nov. 2015. tab
Artigo em Espanhol | IBECS | ID: ibc-144635

RESUMO

Introducción: En Cataluña, el sistema público de sanidad solo financia la vacunación antineumocócica en pediatría a niños con condiciones de riesgo. El objetivo del estudio fue determinar la cobertura de dicha vacunación y su asociación con la edad, factores sociodemográficos y otras variables. Material y método: Estudio descriptivo transversal de los niños de 2 meses a 15 años de edad, asignados a los centros de atención primaria de Cataluña, y con enfermedades para las que el programa oficial de vacunas indica la vacunación antineumocócica. La información sobre el estado vacunal y las variables en estudio se recogió a partir de los datos registrados en la historia clínica electrónica de los equipos de atención primaria. Se analizó la asociación de la vacunación antineumocócica con variables demográficas y médicas mediante un análisis bivariado y un modelo de regresión logística múltiple, utilizando como medida de asociación la odds ratio ajustada (ORa), con su intervalo de confianza al 95%. Resultados: La cobertura vacunal fue del 47,7%. Las variables asociadas a la vacunación fueron: edad (ORa: 9,2 [7,9-10,7] en niños de 2 meses a 2 años; ORa: 8,1 [7,0-9,3] en ni˜nos de 3-5 a˜nos; ORa: 4,6 [4,0-5,2] en niños de 6-11 años), nacionalidad española (ORa: 3,9 [3,5-4,3]), inmunización correcta según el calendario de vacunación sistemática (ORa: 2,5 [2,1-3,0]), y número de condiciones de riesgo (ORa: 3,2 [2,5-4,1] en niños con 2 o más condiciones). Conclusiones: La cobertura vacunal frente a neumococo en niños con condiciones de riesgo es baja en Cataluña. Es necesario implementar estrategias para aumentar la cobertura (AU)


Introduction: The public health system in Catalonia only funds pneumococcal vaccination in paediatrics for children at-risk. The aim of this study was to determine pneumococcal vaccination coverage and its association with age, sociodemographic factors and other variables. Material and method: Descriptive cross-sectional study of children aged between 2 months and 15 years old assigned to primary care centres in Catalonia and with diseases that are included for pneumococcal vaccine in the official vaccination program. The information on vaccination status and study variables were obtained from data registered in the electronic medical records in the primary care centres. An analysis was made of the association between pneumococcal vaccination and demographic and medical variables using bivariate analysis and a multiple logistic regression model. The adjusted odds ratio (aOR), with a confidence interval of 95%, was used to measure the relationships. Results: Pneumococcal vaccination coverage was 47.7%. Variables which predicted pneumococcal vaccination were: age (aOR: 9.2 [7.9-10.7] in children 2 months-2 years old; aOR 8.1 [7.0-9.3] in children 3-5 years; aOR: 4.6 [4.0-5.2] in children 6-10 years), Spanish nationality (aOR: 3.9 [3.5-4.3]), correct immunisation according to systematic immunisation schedule (aOR: 2.5 [2.1-3.0]), and number of risk conditions (aOR: 3.2 [2.5-4.1] in children with 2 or more conditions). Conclusions: Pneumococcal vaccination coverage in children with risk conditions is low in Catalonia. Strategies need to be implemented to increase coverage (AU)


Assuntos
Criança , Pré-Escolar , Humanos , Infecções Pneumocócicas/prevenção & controle , Vacinas Pneumocócicas/análise , Cobertura Vacinal , Fatores de Risco , Streptococcus pneumoniae/patogenicidade , Programas de Imunização , Estudos Transversais , Indicadores de Morbimortalidade
20.
J Clin Virol ; 66: 27-32, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25866332

RESUMO

BACKGROUND: Human respiratory syncytial virus (HRSV) is the main cause of lower respiratory tract infections among infants and young children. OBJECTIVES: The molecular epidemiology and characterization of HRSV strains detected at a Spanish tertiary hospital during the 2013-2014 season is reported. STUDY DESIGN: Phylogenetic analysis and molecular characterization of HRSV laboratory-confirmed respiratory samples were performed, based on coding sequences of G and F proteins. RESULTS: HRSV infection was laboratory-confirmed in respiratory samples from 320 patients of which 223 (70%) were less than 2 years of age and none undergoing Palivizumab treatment. HRSV was detected at varying levels throughout the season with a maximum rate in the week 52/2013, right before the beginning of the influenza epidemic. Whilst both HRSV groups were found co-circulating, HRSV-B group clearly predominated. The phylogenetic analyses from 139 HVR-2 sequences revealed that most characterized strains belonged to ON1 and BA9 genotypes. Three different phylogenetic subgroups could be distinguished within these genotypes. In addition, three strains (out of the 52 randomly selected) were carrying amino acid substitutions in the epitope A of the F protein, one of them previously related to Palivizumab resistance. CONCLUSIONS: The results of the present study highlight the importance of a continuous HRSV surveillance to monitor not only the introduction of new genotypes on circulation but also the emergence of viral variants with new genetic characteristics that can affect the antigenicity features and the susceptibility to the only current prophylaxis treatment and also for the future development of HRSV vaccines.


Assuntos
Infecções por Vírus Respiratório Sincicial/epidemiologia , Infecções por Vírus Respiratório Sincicial/virologia , Vírus Sincicial Respiratório Humano/classificação , Vírus Sincicial Respiratório Humano/genética , Idoso , Idoso de 80 Anos ou mais , Pré-Escolar , Feminino , Genótipo , Hospitais Universitários , Humanos , Lactente , Masculino , Epidemiologia Molecular , Dados de Sequência Molecular , Filogenia , RNA Viral/genética , Vírus Sincicial Respiratório Humano/isolamento & purificação , Análise de Sequência de DNA , Homologia de Sequência , Espanha/epidemiologia , Atenção Terciária à Saúde , Proteínas do Envelope Viral/genética , Proteínas Virais de Fusão/genética
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