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1.
Clin Infect Dis ; 70(2): 181-190, 2020 Jan 02.
Artigo em Inglês | MEDLINE | ID: mdl-30843046

RESUMO

BACKGROUND: The incidence of herpes zoster is up to 9 times higher in immunosuppressed solid organ transplant recipients than in the general population. We investigated the immunogenicity and safety of an adjuvanted recombinant zoster vaccine (RZV) in renal transplant (RT) recipients ≥18 years of age receiving daily immunosuppressive therapy. METHODS: In this phase 3, randomized (1:1), observer-blind, multicenter trial, RT recipients were enrolled and received 2 doses of RZV or placebo 1-2 months (M) apart 4-18M posttransplant. Anti-glycoprotein E (gE) antibody concentrations, gE-specific CD4 T-cell frequencies, and vaccine response rates were assessed at 1M post-dose 1, and 1M and 12M post-dose 2. Solicited and unsolicited adverse events (AEs) were recorded for 7 and 30 days after each dose, respectively. Solicited general symptoms and unsolicited AEs were also collected 7 days before first vaccination. Serious AEs (including biopsy-proven allograft rejections) and potential immune-mediated diseases (pIMDs) were recorded up to 12M post-dose 2. RESULTS: Two hundred sixty-four participants (RZV: 132; placebo: 132) were enrolled between March 2014 and April 2017. gE-specific humoral and cell-mediated immune responses were higher in RZV than placebo recipients across postvaccination time points and persisted above prevaccination baseline 12M post-dose 2. Local AEs were reported more frequently by RZV than placebo recipients. Overall occurrences of renal function changes, rejections, unsolicited AEs, serious AEs, and pIMDs were similar between groups. CONCLUSIONS: RZV was immunogenic in chronically immunosuppressed RT recipients. Immunogenicity persisted through 12M postvaccination. No safety concerns arose. CLINICAL TRIALS REGISTRATION: NCT02058589.

2.
Med. clín (Ed. impr.) ; 152(8): 317-323, abr. 2019. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-183611

RESUMO

Mycobacterium chimaera (M. chimaera) es una micobacteria no tuberculosa del complejo Mycobacterium avium complex. Desde 2013 hasta abril de 2018 se han identificado más de 140 casos de infección grave por M. chimaera, todos ellos en pacientes sometidos a cirugía cardiotorácica con circulación extracorpórea. Las investigaciones epidemiológicas han mostrado que la mayoría de las infecciones tienen una fuente común: módulos de normo-hipotermia contaminados. Estos aparatos poseen en su interior un circuito de agua y ventiladores de enfriamiento que producen un aerosol, que puede contener M. chimaera, contaminar el aire del quirófano y transmitirse al paciente. La sintomatología clínica puede tardar meses, incluso años, en aparecer tras la cirugía extracorpórea, con una media de 1,5 años, y en general se presenta en forma de síntomas constitucionales. La sarcoidosis es la entidad descrita con mayor frecuencia como error diagnóstico en estos pacientes, por lo que es necesario mantener una elevada sospecha diagnóstica en todos aquellos pacientes con antecedente de cirugía cardíaca con circulación extracorpórea


Mycobacterium chimaera (M. chimaera) is a non-tuberculous mycobacterium of the Mycobacterium avium complex. Between 2013 and April 2018, more than 140 cases of severe infection have been identified, all of them in patients who had undergone cardiothoracic surgery with extracorporeal circulation. The epidemiological investigations have shown that the majority of infections have a common source: contaminated normo-hypothermia modules. These devices have a water circuit inside and cooling fans that produce an aerosol, which can be contaminated with M. chimaera, and disperse it into the air in the operating room. The clinical symptoms can take months, even years to appear after the extracorporeal surgery, with an average of 1.5 years. Sarcoidosis is the most frequently described entity as a misdiagnosis in these patients, so it is necessary to maintain a high diagnostic suspicion in all patients with a history of cardiac surgery with extracorporeal circulation


Assuntos
Humanos , Circulação Extracorpórea/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Infecção Hospitalar/microbiologia , Contaminação de Equipamentos , Mycobacterium/classificação , Mycobacterium/isolamento & purificação , Infecções por Mycobacterium/microbiologia , Infecções por Mycobacterium/diagnóstico
3.
Future Microbiol ; 14: 373-381, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30860397

RESUMO

AIM: Human respiratory syncytial virus (HRSV) is the main cause of respiratory tract infections among infants. MATERIALS & METHODS: In the present study, the molecular epidemiology of HRSV detected from 2013 to 2017 has been described. RESULTS: A 10% of collected samples were laboratory confirmed for HRSV. Patients under 2 years of age were the main susceptible population to respiratory syncytial virus disease, but an increasingly number of confirmed patients over 65 years of age was reported. Epidemics usually started in autumn and ended in spring. Both HRSV groups co-circulated every season, but the HRSV-B was the most predominant. HRSV-A and HRSV-B strains mainly belonged to ON1 and BA9 genotypes, respectively. CONCLUSION: The present study reports recent data about the genetic diversity of circulating HRSV in Spain.


Assuntos
Infecções por Vírus Respiratório Sincicial/virologia , Vírus Sincicial Respiratório Humano/isolamento & purificação , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Monitoramento Epidemiológico , Feminino , Genótipo , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Filogenia , Infecções por Vírus Respiratório Sincicial/epidemiologia , Vírus Sincicial Respiratório Humano/classificação , Vírus Sincicial Respiratório Humano/genética , Estações do Ano , Espanha/epidemiologia , Centros de Atenção Terciária/estatística & dados numéricos , Adulto Jovem
4.
Vaccine ; 37(18): 2470-2476, 2019 Apr 24.
Artigo em Inglês | MEDLINE | ID: mdl-30926297

RESUMO

BACKGROUND: Influenza viruses (FLUV) are continuously evolving, which explain the occurrence of seasonal influenza epidemics and the need to review the vaccine strain composition annually. The aim is to describe the genetic diversity and clinical outcomes of FLUV detected at a tertiary university hospital in Barcelona (Spain) during the 2012-2016 seasons. METHODS: The detection of FLUV from patients attended at the Emergency Department or admitted to the hospital was performed by either immunofluorescence or PCR-based assays. A specific real-time one-step multiplex RT-PCR was performed for influenza A (FLUAV) subtyping. The complete coding haemagglutinin domain 1 (HA1) and neuraminidase (NA) (2015-2016) protein sequences from a representative sampling were molecular characterised. RESULTS: A total 1774 (66.1%) FLUAV and 910 (33.9%) influenza B (FLUBV) cases were laboratory-confirmed. The hospitalisation rate was different between seasons, being the highest (81.4%) during the 2014-2015 season. FLUV were genetically close to vaccine strains except to the 2014-2015, in which most characterised A(H3N2) viruses belonged to a genetic group different from the vaccine strain. During the 2015-2016 season, B/Victoria-like viruses were the most predominant, but this component was not included in the trivalent vaccine used. Mutations D222G or D222N in HA1-domain were found in 3 A(H1N1)pdm09 strains from ICU-admitted cases. Three A(H1N1)pdm09 strains carried the NA H275Y (2) and S247N (1) mutations, respectively related to resistance or decreased susceptibility to oseltamivir. CONCLUSIONS: The circulation of drifted A(H3N2) strains during the 2014-2015 season was related to the high hospitalisation rate due to the mismatch with the vaccine strains. The predominance of a FLUBV lineage not included in the trivalent influenza vaccine during the 2015-2016 season highlights the need to use a tetravalent influenza vaccine. Virological surveillance of viral variants carrying protein changes that alter tropism and susceptibility to antivirals features should be strengthened in hospital settings.

5.
Hum Vaccin Immunother ; 15(5): 1080-1091, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30735474

RESUMO

Pertussis vaccination of parents and household contacts ('cocooning') to protect newborn infants is an established strategy in many countries, although uptake may be low. Many aspects may influence such decision-making. We conducted a cross-sectional survey (NCT01890447) of households and other close contacts of newborns aged ≤6 months (or of expectant mothers in their last trimester) in Spain and Italy, using an adaptive discrete-choice experiment questionnaire. Aims were to assess the relative importance of attributes influencing vaccine adoption, and to estimate variation in vaccine adoption rates and the impact of cost on vaccination rates. Six hundred and fifteen participants (Spain, n = 313; Italy, n = 302) completed the survey. Of 144 available questionnaire scenarios, the most frequently selected (14% of respondents in both countries) were infant protection by household vaccination at vaccination center, recommendation by family physician and health authorities, with information available on leaflets and websites. The attribute with highest median relative importance was 'reduction in source of infection' in Spain (23.1%) and 'vaccination location' in Italy (18.8%). Differences between other attributes were low in both countries, with media attributes showing low importance. Over 80% of respondents indicated a definite or probable response to vaccine adoption (at no-cost) with estimated probability of adoption of 89-98%; applying vaccine costs (25€ per person) would reduce the probability of uptake by 7-20% in definite/probable respondents. Awareness of these determinants is helpful in informing Health Authorities and healthcare practitioners implementing a cocooning strategy for those populations where maternal immunization is not a preferred option.

6.
Med Clin (Barc) ; 152(8): 317-323, 2019 04 18.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30509614

RESUMO

Mycobacterium chimaera (M. chimaera) is a non-tuberculous mycobacterium of the Mycobacterium avium complex. Between 2013 and April 2018, more than 140 cases of severe infection have been identified, all of them in patients who had undergone cardiothoracic surgery with extracorporeal circulation. The epidemiological investigations have shown that the majority of infections have a common source: contaminated normo-hypothermia modules. These devices have a water circuit inside and cooling fans that produce an aerosol, which can be contaminated with M. chimaera, and disperse it into the air in the operating room. The clinical symptoms can take months, even years to appear after the extracorporeal surgery, with an average of 1.5 years. Sarcoidosis is the most frequently described entity as a misdiagnosis in these patients, so it is necessary to maintain a high diagnostic suspicion in all patients with a history of cardiac surgery with extracorporeal circulation.

7.
Future Microbiol ; 13: 1565-1573, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30417657

RESUMO

AIM: To describe the genetic diversity of rhinovirus (RV) from patients attended at a tertiary hospital in Barcelona (Spain) from October 2014 to May 2017. METHODS: RV detection was performed by real-time multiplex RT-PCR. A specific real-time quantitive retrotranscription PCR (qRT-PCR) was carried out to select those samples (Ct < 35) for molecular characterization based on partial VP4/2 protein. RESULTS: Phylogenetic characterization revealed proportions of 63% RV-A, 6% RV-B and 31% RV-C (119 different types). RV-A circulated throughout all the study period, with a minor circulation during winter, just when RV-C prevailed. Differences between age medians by RV-specie were reported. CONCLUSION: The large genetic diversity of RV detected in our area is described here. The variable cocirculation of multiple RV types is also reported, showing differences by age.


Assuntos
Variação Genética/genética , Infecções por Picornaviridae/virologia , Infecções Respiratórias/virologia , Rhinovirus/genética , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Razão de Chances , Filogenia , Infecções por Picornaviridae/epidemiologia , Infecções Respiratórias/epidemiologia , Estudos Retrospectivos , Rhinovirus/isolamento & purificação , Estações do Ano , Espanha/epidemiologia , Estatísticas não Paramétricas , Centros de Atenção Terciária , Proteínas da Matriz Viral/genética
8.
Enferm. infecc. microbiol. clín. (Ed. impr.) ; 35(9): 550-555, nov. 2017. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-168880

RESUMO

Introducción: La reemergencia de la tos ferina y la gravedad de sus complicaciones en lactantes menores de 3 meses de edad determinó el inicio del programa de vacunación de las mujeres embarazadas en el tercer trimestre de gestación, en Cataluña en febrero del 2014, la primera comunidad autónoma que la introdujo de España. El objetivo del estudio fue estimar la cobertura del programa en su primer año de implementación. Métodos: Se analizaron de forma retrospectiva los registros médicos informatizados de los Centros de Atención Primaria de embarazadas atendidas en centros de Asistencia de Salud Sexual y Reproductiva del área Metropolita Nord de la provincia de Barcelona, dependientes del Institut Català de la Salut. Se estimó la cobertura global y según variables sociodemográficas de vacunación con dTpa de las mujeres que tenían registrado un parto de un recién nacido vivo entre agosto del 2014 y agosto del 2015. Resultados: Se registraron 6.697 partos de nacidos vivos y 1.713 mujeres embarazadas fueron vacunadas, lo que representó una cobertura global del 25,6% (IC del 95%: 24,1-26,1). La cobertura de vacunación fue mayor en las mujeres embarazadas menores de 18 años y las nativas (p=0,018 y p=0,036, respectivamente). Conclusión: La estimación de cobertura vacunal frente a tos ferina de embarazadas en el tercer trimestre de gestación, tras el primer año de implementación del programa en un área sanitaria de Cataluña, ha resultado inferior al objetivo marcado. Será necesario diseñar estrategias dirigidas a mejorar la cobertura del programa (AU)


Introduction: The re-emergence of pertussis and the severity of its complications in infants younger than 3 months, were determining factors for starting a vaccination program for pregnant women in the third trimester of gestation in Catalonia in February 2014. This was the first autonomous community to introduce it in Spain. The aim of the study was to estimate the coverage of the program in its first year of implementation. Methods: A retrospective analysis was performed on the data from the Primary Care Centre computerised medical records of pregnant women attending Sexual and Reproductive Health Care centres of the Metropolitan Nord area of the province of Barcelona, part of the Catalan Institute of Health. The overall coverage was estimated, as well as the sociodemographic variables of Tdap vaccination of women who had registered a delivery of a live birth between August 2014 and August 2015. Results: A total of 6,697 deliveries of live births were recorded, and 1,713 pregnant women were vaccinated, which represented an overall coverage of 25.6% (95% CI; 24.1-26.1). Vaccination coverage was higher in pregnant women under 18 years and Spanish women (P=.018 and P=.036, respectively). Conclusion: The estimation of vaccine coverage against pertussis in pregnant women in the third trimester of pregnancy, after the first year of implementation of the program in a health area of Catalonia was lower than the objective set. Strategies need to be designed in order to improve program coverage (AU)


Assuntos
Humanos , Feminino , Gravidez , Vacina contra Coqueluche/administração & dosagem , Coqueluche/prevenção & controle , Cobertura Vacinal , Vacinação em Massa/tendências , Estudos Retrospectivos , Avaliação de Resultado de Ações Preventivas , Centros de Assistência à Gravidez e ao Parto/estatística & dados numéricos
9.
Enferm Infecc Microbiol Clin ; 35(9): 550-555, 2017 Nov.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-27769682

RESUMO

INTRODUCTION: The re-emergence of pertussis and the severity of its complications in infants younger than 3 months, were determining factors for starting a vaccination program for pregnant women in the third trimester of gestation in Catalonia in February 2014. This was the first autonomous community to introduce it in Spain. The aim of the study was to estimate the coverage of the program in its first year of implementation. METHODS: A retrospective analysis was performed on the data from the Primary Care Centre computerised medical records of pregnant women attending Sexual and Reproductive Health Care centres of the Metropolitan Nord area of the province of Barcelona, part of the Catalan Institute of Health. The overall coverage was estimated, as well as the sociodemographic variables of Tdap vaccination of women who had registered a delivery of a live birth between August 2014 and August 2015. RESULTS: A total of 6,697 deliveries of live births were recorded, and 1,713 pregnant women were vaccinated, which represented an overall coverage of 25.6% (95% CI; 24.1-26.1). Vaccination coverage was higher in pregnant women under 18 years and Spanish women (P=.018 and P=.036, respectively). CONCLUSION: The estimation of vaccine coverage against pertussis in pregnant women in the third trimester of pregnancy, after the first year of implementation of the program in a health area of Catalonia was lower than the objective set. Strategies need to be designed in order to improve program coverage.


Assuntos
Programas de Imunização , Cobertura Vacinal/estatística & dados numéricos , Coqueluche/prevenção & controle , Adolescente , Adulto , Feminino , Humanos , Recém-Nascido , Gravidez , Estudos Retrospectivos , Espanha , Fatores de Tempo , Adulto Jovem
10.
Enferm. infecc. microbiol. clín. (Ed. impr.) ; 34(8): 484-489, oct. 2016. tab
Artigo em Inglês | IBECS | ID: ibc-156251

RESUMO

Introduction. A retrospective study was conducted to investigate the usefulness of systematic quantitative blood culture (QBC) in the diagnosis of catheter-related bloodstream infection (CRBSI) during two 1-year periods (2002 and 2012). Methods. The study included all QBC requests sent to the microbiology laboratory for suspected CRBSI in adults (≥18 years) with any type of intravascular catheter (IVC). Based on a ratio of ≥4:1CFU/mL of the same microorganism between IVC blood culture from any lumen and peripheral blood culture, 5 diagnostic groups were defined: confirmed or probable CRBSI, primary BSI, other focus of infection, and colonization. Results. In total, 4521 QBCs were evaluated; 24% positive in 2002 and 16% in 2012 (P<0.0001). There were 243 episodes of suspected CRBSI (101 in 2002 and 142 in 2012). Confirmed CRBSI episodes were higher in 2002 than 2012 (56% vs 34%) (P<0.0001), whereas colonization episodes were lower (18% vs 38%) (P=0.0006). Gram-positive cocci decrease in 2012 relative to 2002 (56% vs 79.7%) (P=0.022). Almost one-third (32%) of confirmed CRBSI would have been missed if blood from all catheter lumens had not been cultured. Conclusions. QBC is a useful method for diagnosing CRBSI. Blood samples from all catheter lumens must be cultured to avoid missing around one-third of CRBSI diagnoses (AU)


Introducción. Se ha realizado un estudio retrospectivo, para investigar la utilidad del hemocultivo cuantitativo (HC) para el diagnóstico de las bacteriemias relacionadas con catéteres (BRC), durante dos periodos de un año (2002 y 2012). Métodos. Todos los HC recibidos en el laboratorio de microbiología realizados ante la sospecha de BRC, a pacientes ≥18 años portadores de cualquier tipo de catéter intravascular (CIV), han sido incluidos en este estudio. Basándonos en la proporción ≥4:1CFU/mL del mismo microorganismo entre el HC de cualquier luz del CIV y el HC periférico se han definido 5 grupos diagnósticos: BRC confirmada o probable, bacteriemia primaria, otro foco de infección y colonización. Resultados. Han sido evaluados 4521 HC; 24% positivos en 2002 y 16% en 2012 (P<0.0001). Fueron sospechosos de BRC 243 episodios (101 en 2002 y 142 en 2012). El Porcentaje de episodios de BRC confirmados fue mayor en 2002 que en 2012 (56% vs 34%) (P<0.0001), en cambio fue menor el de los episodios de colonización (18% vs 38%) (P=0.0006). Los cocos Gram-positivos disminuyeron en 2012 en relación con 2002 (56% vs 79.7%) (P=0.022). En el 32.2% de las BRC confirmadas se hubiese perdido el diagnóstico si no se hubiera realizado HC de todas las luces. Conclusiones. El HC es un método muy útil para el diagnóstico de las BRC. Hay que obtener muestra de sangre de todas luces para cultivo con el fin de evitar la pérdida de alrededor del 30% de los episodios de BRC (AU)


Assuntos
Humanos , Bacteriemia/microbiologia , Infecções Relacionadas a Cateter/microbiologia , Técnicas de Cultura de Células/métodos , Estudos Retrospectivos , Técnicas Microbiológicas , Cateteres de Demora/microbiologia
12.
Enferm Infecc Microbiol Clin ; 34(8): 484-9, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26778796

RESUMO

INTRODUCTION: A retrospective study was conducted to investigate the usefulness of systematic quantitative blood culture (QBC) in the diagnosis of catheter-related bloodstream infection (CRBSI) during two 1-year periods (2002 and 2012). METHODS: The study included all QBC requests sent to the microbiology laboratory for suspected CRBSI in adults (≥18 years) with any type of intravascular catheter (IVC). Based on a ratio of ≥4:1CFU/mL of the same microorganism between IVC blood culture from any lumen and peripheral blood culture, 5 diagnostic groups were defined: confirmed or probable CRBSI, primary BSI, other focus of infection, and colonization. RESULTS: In total, 4521 QBCs were evaluated; 24% positive in 2002 and 16% in 2012 (P<0.0001). There were 243 episodes of suspected CRBSI (101 in 2002 and 142 in 2012). Confirmed CRBSI episodes were higher in 2002 than 2012 (56% vs 34%) (P<0.0001), whereas colonization episodes were lower (18% vs 38%) (P=0.0006). Gram-positive cocci decrease in 2012 relative to 2002 (56% vs 79.7%) (P=0.022). Almost one-third (32%) of confirmed CRBSI would have been missed if blood from all catheter lumens had not been cultured. CONCLUSIONS: QBC is a useful method for diagnosing CRBSI. Blood samples from all catheter lumens must be cultured to avoid missing around one-third of CRBSI diagnoses.


Assuntos
Bacteriemia/diagnóstico , Hemocultura , Infecções Relacionadas a Cateter/diagnóstico , Bacteriemia/microbiologia , Infecções Relacionadas a Cateter/microbiologia , Humanos , Estudos Retrospectivos , Fatores de Tempo
13.
Enferm. infecc. microbiol. clín. (Ed. impr.) ; 33(9): 617-624, nov. 2015. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-144639

RESUMO

Las infecciones neumocócicas son una importante causa de morbimortalidad y constituyen una de las 10 principales causas de muerte en el mundo. Los niños menores de 2 años son los que tienen una tasa de incidencia más elevada, seguidos de los adultos mayores de 64 años. El principal grupo de riesgo son los individuos con inmunodeficiencias de cualquier tipo y aquellos con asplenia anatómica o funcional, aunque también afecta a personas inmunocompetentes con ciertas enfermedades crónicas. En la última década se ha realizado un importante progreso en la prevención de estas infecciones. Hasta hace pocos años solo se disponía de la vacuna antineumocócica no conjugada 23-valente, con resultados controvertidos en cuanto a su eficacia y efectividad, y con limitaciones importantes por el tipo de respuesta inmune inducida. La posibilidad actual de utilizar la vacuna conjugada 13-valente en el adulto abre expectativas importantes en la mejora de la prevención de la enfermedad neumocócica en estos grupos de edad (AU)


Pneumococcal infections are a significant cause of morbidity and mortality, and are one of the 10 leading causes of death worldwide. Children under 2 years have a higher incidence rate, followed by adults over 64 years. The main risk group are individuals with immunodeficiency, and those with anatomical or functional asplenia, but can also affect immunocompetent persons with certain chronic diseases. Significant progress has been made in the last 10 years in the prevention of these infections. Until a few years ago, only the 23-valent non-conjugate pneumococcal vaccine was available. Its results were controversial in terms of efficacy and effectiveness, and with serious limitations on the type of immune response induced. The current possibility of using the 13-valent conjugate vaccine in adults has led to greater expectations in improving the prevention of pneumococcal disease in these age groups (AU)


Assuntos
Adulto , Humanos , Infecções Pneumocócicas/prevenção & controle , Vacinas Pneumocócicas/análise , Vacinas Conjugadas/análise , Fatores de Risco , Streptococcus pneumoniae/patogenicidade , Programas de Imunização , Indicadores de Morbimortalidade
14.
Enferm Infecc Microbiol Clin ; 33(9): 617-24, 2015 Nov.
Artigo em Espanhol | MEDLINE | ID: mdl-26474708

RESUMO

Pneumococcal infections are a significant cause of morbidity and mortality, and are one of the 10 leading causes of death worldwide. Children under 2 years have a higher incidence rate, followed by adults over 64 years. The main risk group are individuals with immunodeficiency, and those with anatomical or functional asplenia, but can also affect immunocompetent persons with certain chronic diseases. Significant progress has been made in the last 10 years in the prevention of these infections. Until a few years ago, only the 23-valent non-conjugate pneumococcal vaccine was available. Its results were controversial in terms of efficacy and effectiveness, and with serious limitations on the type of immune response induced. The current possibility of using the 13-valent conjugate vaccine in adults has led to greater expectations in improving the prevention of pneumococcal disease in these age groups.


Assuntos
Infecções Pneumocócicas/prevenção & controle , Vacinas Pneumocócicas , Adulto , Idoso , Suscetibilidade a Doenças , Humanos , Esquemas de Imunização , Hospedeiro Imunocomprometido , Imunogenicidade da Vacina , Incidência , Pessoa de Meia-Idade , Infecções Pneumocócicas/epidemiologia , Vacinas Pneumocócicas/imunologia , Polissacarídeos Bacterianos/imunologia , Espanha/epidemiologia , Streptococcus pneumoniae/imunologia , Vacinas Conjugadas/imunologia
15.
Enferm. infecc. microbiol. clín. (Ed. impr.) ; 33(8): 536-538, oct. 2015. ilus, tab
Artigo em Inglês | IBECS | ID: ibc-143286

RESUMO

Introduction: In neonatal units, Salmonella infections have been attributed to food-borne sources and person to person transmission. Methods: The outbreak described is the first reported by Salmonella enterica serotype Newport in a neonatal facility in Spain. Results: The index case was an 8-day premature newborn that developed clinical sepsis with positive blood cultures. The outbreak source was the mother of the index case. Conclusions: It is essential to improve infection control measures taking into account the parents, as they can be an important source of infection (AU)


Introducción: En unidades de neonatología, las infecciones por Salmonella han sido atribuidas a fuentes alimentarias y a transmisión de persona a persona. Métodos: El brote descrito es el primero ocasionado por Salmonella enterica serotipo Newport en una unidad neonatal en España. Resultados: El caso índice era un recién nacido prematuro que desarrolló sepsis clínica con hemocultivos positivos. La fuente del brote fue la madre del caso índice. Conclusiones: Al implementar medidas de control de la infección nosocomial se debe tener en cuenta a los padres ya que pueden constituir una fuente importante de infección (AU)


Assuntos
Humanos , Recém-Nascido , Salmonella/patogenicidade , Intoxicação Alimentar por Salmonella/complicações , Infecções por Salmonella/transmissão , Enteropatias/microbiologia , Transmissão Vertical de Doença Infecciosa , Surtos de Doenças/prevenção & controle , Controle de Doenças Transmissíveis/organização & administração , Portador Sadio/epidemiologia , Unidades de Terapia Intensiva Neonatal/organização & administração
16.
Vaccine ; 33(19): 2213-2220, 2015 May 05.
Artigo em Inglês | MEDLINE | ID: mdl-25825331

RESUMO

BACKGROUND: Pertussis remains a public health problem in countries with high vaccination coverage. Classic vaccination approaches have failed to effectively control the infection. The incidence of pertussis hospitalizations in infants is high, especially in those younger than 3 months who are in high risk of a severe disease and death. Additional strategies are recommended for short-term protection of this vulnerable population. In this study, we estimated the impact of 2 strategies for pertussis prevention in infants younger than 1 year of age-a cocoon vaccination strategy and the vaccination of pregnant women (VPW)-and the cost-benefit of these approaches relative to the current vaccination policy in Spain. METHODS: A cost-benefit analysis was conducted from the perspective of the publically-funded Spanish healthcare system, based on the yearly number of hospitalizations during the period of 2009 to 2011. We calculated the absolute risk reduction, the number of parents that would need to be vaccinated to prevent 1 hospitalization or death in infants <1 year, and the net benefit-to-cost ratio of each strategy. RESULTS: From 2009 to 2011, the incidence of pertussis in Spain was 153.44 hospitalizations per 100,000 infants <1 year. The absolute risk reduction for hospitalization would be 42.1/100,000 with cocooning and 75.2/100,000 with VPW. The number of parents needed to vaccinate with the cocoon strategy to prevent 1 pertussis hospitalization would be 4752 and to prevent 1 death, more than 900,000. With VPW, 1331 pregnant women would have to be vaccinated to prevent 1 hospitalization and 200,000 to prevent 1 death. The benefit-to-cost ratio was 0.04 for cocooning and 0.15 for VPW.


Assuntos
Vacina contra Coqueluche/administração & dosagem , Vacina contra Coqueluche/economia , Vacinação/economia , Vacinação/métodos , Coqueluche/epidemiologia , Coqueluche/prevenção & controle , Adolescente , Adulto , Idoso , Análise Custo-Benefício , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Gravidez , Espanha/epidemiologia , Adulto Jovem
17.
Enferm. infecc. microbiol. clín. (Ed. impr.) ; 33(3): 190-196, mar. 2015. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-134572

RESUMO

La tos ferina continúa siendo un problema de salud pública a pesar de la importante disminución de su incidencia debido a la vacunación sistemática porque se está observando una reemergencia en países que han mantenido altas coberturas vacunales. La vacunación es la medida preventiva más eficaz para su control, pero tanto la inmunidad natural como la artificial disminuyen con el tiempo, por lo que la protección que las actuales vacunas ofrecen no es duradera; además, las vacunas acelulares son menos efectivas. Se necesita, por una parte, implementar nuevas estrategias vacunales, y por otra, nuevas vacunas seguras y más efectivas. La vacunación de la embarazada es la estrategia más efectiva para prevenir la tos ferina en el lactante pequeño (edad en la que tiene mayor gravedad), y debe recomendarse junto con la estrategia del nido, es decir, la vacunación de los futuros contactos domiciliarios y extradomiciliarios del lactante, que son los que la contagian (AU)


Pertussis continues to be a public health problem despite the significant decrease in its incidence due to routine vaccination. Resurgence of the disease in countries that have maintained high vaccination coverage has been observed in recent years. Although vaccination is the most effective preventive control measure, both natural and artificial immunity wane over time, and thus the protection offered by current vaccines is not long-lasting. Furthermore, acellular vaccines are less effective. The implementation of new vaccine strategies is required. Vaccination of pregnant women is the most effective strategy for preventing pertussis in young infants, who are the most vulnerable, and should be recommended together with cocooning, ie vaccination of future household and extra-domiciliary contacts who are the main transmitters of the disease (AU)


Assuntos
Humanos , Gravidez , Lactente , Feminino , Adolescente , Adulto , Criança , Pré-Escolar , Pessoa de Meia-Idade , Adulto Jovem , Coqueluche/epidemiologia , Coqueluche/prevenção & controle , Vacina contra Coqueluche/administração & dosagem , Doenças Transmissíveis Emergentes/epidemiologia , Doenças Transmissíveis Emergentes/prevenção & controle , Vacinação
18.
Enferm Infecc Microbiol Clin ; 33(3): 190-6, 2015 Mar.
Artigo em Espanhol | MEDLINE | ID: mdl-25707329

RESUMO

Pertussis continues to be a public health problem despite the significant decrease in its incidence due to routine vaccination. Resurgence of the disease in countries that have maintained high vaccination coverage has been observed in recent years. Although vaccination is the most effective preventive control measure, both natural and artificial immunity wane over time, and thus the protection offered by current vaccines is not long-lasting. Furthermore, acellular vaccines are less effective. The implementation of new vaccine strategies is required. Vaccination of pregnant women is the most effective strategy for preventing pertussis in young infants, who are the most vulnerable, and should be recommended together with cocooning, ie vaccination of future household and extra-domiciliary contacts who are the main transmitters of the disease.


Assuntos
Doenças Transmissíveis Emergentes/epidemiologia , Doenças Transmissíveis Emergentes/prevenção & controle , Vacina contra Coqueluche , Vacinação , Coqueluche/epidemiologia , Coqueluche/prevenção & controle , Adolescente , Adulto , Criança , Pré-Escolar , Humanos , Lactente , Pessoa de Meia-Idade , Adulto Jovem
19.
Eur J Pediatr ; 174(7): 957-63, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25652766

RESUMO

UNLABELLED: Surgical site infection (SSI) remains a major source of morbidity, mortality, and increased health care costs in children undergoing heart surgery. The aim of this study was to assess the effectiveness of an intervention program designed to reduce the high incidence of SSI observed at our center in pediatric patients. An interdisciplinary infection control program including pre-, intra-, and postoperative measures was introduced for children undergoing heart surgery with cardiopulmonary bypass. We conducted a quasi-experimental interventional study comparing a pre-intervention cohort (June 2009 to March 2010) and a post-intervention cohort (July 2011 to July 2012). A significant drop in SSI incidence from 10.9 % (95 % CI 4.7-18.8) to 1.92 % (95 % CI 0.4-5.52) was observed. Variables significantly associated with infection risk were median age (14 days in infected vs 2.3 years in non-infected patients; p<0.01), hospitalization unit (10.3 % SSI cumulative incidence in the neonatal intensive care unit vs 0 cases in the pediatric intensive care unit; p<0.01), and median preoperative hospital stay (14 days in infected vs 1 day in non-infected patients; p=0.03). CONCLUSIONS: The implementation of a new intervention program was associated with an 82 % (95 % CI 34-94) reduction in SSI incidence in children undergoing heart surgery at our center. WHAT IS KNOWN: • Surgical site infection (SSI) is associated with significant morbidity and mortality following pediatric cardiac surgery. • Younger patients and longer cardiopulmonary bypass times are associated with higher SSI rates. What is New: • Comprehensive infection control program including preoperative, intraoperative and postoperative nonpharmacologic measures is a key factor for the prevention of SSI. • A significant reduction in SSI rates can be achieve despite a narrower-spectrum antibiotic usage.


Assuntos
Ponte Cardiopulmonar , Controle de Infecções , Esternotomia , Infecção da Ferida Cirúrgica/prevenção & controle , Fatores Etários , Estudos de Coortes , Feminino , Hospitalização , Humanos , Incidência , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Unidades de Terapia Intensiva Pediátrica , Masculino , Equipe de Assistência ao Paciente , Fatores de Risco , Espanha/epidemiologia , Infecção da Ferida Cirúrgica/epidemiologia
20.
Enferm Infecc Microbiol Clin ; 33(8): 536-8, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25600024

RESUMO

INTRODUCTION: In neonatal units, Salmonella infections have been attributed to food-borne sources and person to person transmission. METHODS: The outbreak described is the first reported by Salmonella enterica serotype Newport in a neonatal facility in Spain. RESULTS: The index case was an 8-day premature newborn that developed clinical sepsis with positive blood cultures. The outbreak source was the mother of the index case. CONCLUSIONS: It is essential to improve infection control measures taking into account the parents, as they can be an important source of infection.


Assuntos
Portador Sadio/microbiologia , Infecção Hospitalar/transmissão , Doenças do Prematuro/microbiologia , Mães , Infecções por Salmonella/transmissão , Salmonella enterica/isolamento & purificação , Adulto , Doença de Crohn/microbiologia , Infecção Hospitalar/microbiologia , Surtos de Doenças , Feminino , Higiene das Mãos , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Controle de Infecções , Transmissão de Doença Infecciosa do Paciente para o Profissional , Masculino , Leite Humano/microbiologia , Berçários Hospitalares , Recursos Humanos de Enfermagem no Hospital , Quartos de Pacientes , Infecções por Salmonella/microbiologia , Sepse/etiologia
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