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2.
Vaccine ; 37(16): 2200-2207, 2019 Apr 10.
Artigo em Inglês | MEDLINE | ID: mdl-30902478

RESUMO

Streptococcus pneumoniae is a major cause of morbidity and mortality worldwide. Using the data from the HERACLES clinical surveillance study (2007-2016), we describe the population impact of the 13-valent pneumococcal conjugate vaccine (PVC13) on invasive pneumococcal disease (IPD) in children <15 years of age in the Community of Madrid, Spain. After six years of the inclusion of PCV13 in the vaccination calendar (2010-2016), and despite changes in the Regional Immunization Programme that limited its availability, the net benefit incidence rate (IR) of IPD fell by 70.1% (IRR 0.3 [95% CI: 0.22-0.4]; p ≤ 0.001), mainly due to a significant reduction (91%) in the PCV13 serotypes (IRR 0.09 [95% CI: 0.05-0.16], p ≤ 0.001). Furthermore, no significant changes were detected in the IR of IPD caused by non-PCV13 serotypes. The IRs of the aggressive, resistant and most prevalent serotype in the analysed population, the 19A serotype, dramatically decreased from the beginning to the end of the study (98%) [IRR 0.03 (95% CI: 0.00-0.19), p ≤ 0.001], to its almost total disappearance. Remarkably, this reduction led to a pronounced decline in the percentage of cefotaxime-resistant isolates and the incidence of meningitis cases. Assessment of the clinical impact revealed a reduction in the number of all clinical presentations of IPD, confirming the effectiveness of the PCV13. Finally, PCV13 detected by PCR is predicted to have a stronger impact than the one based on culture methods, which can overlook more than 20% of cases of IPD, mainly pleural empyemas.

3.
An. pediatr. (2003. Ed. impr.) ; 90(2): 86-93, feb. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-177219

RESUMO

Introducción: La información existente sobre el impacto de la gripe en la población infantil española es escasa. El presente trabajo pretende aumentar este conocimiento estudiando aspectos clave como la incidencia de hospitalización, clínica, comorbilidades y el estado vacunal en los niños hospitalizados. Métodos: Estudio retrospectivo, observacional, por revisión de historias clínicas, en menores de 15 años hospitalizados por gripe adquirida en la comunidad, confirmada microbiológicamente, durante 2 temporadas gripales (2014-2015 y 2015-2016). El estudio se realizó en 10 hospitales de 6 ciudades, que atienden aproximadamente al 12% de la población infantil española. Resultados: Fueron hospitalizados 907 niños con diagnóstico principal de gripe (447 < 2 años), con una tasa media anual de incidencia de hospitalización de 0,51 casos/1.000 niños (IC del 95% 0,48-0,55). El 45% presentó enfermedades subyacentes consideradas factores de riesgo para gripe grave, y la mayor parte de ellos (74%) no habían sido vacunados. El porcentaje con enfermedades subyacentes aumentó con la edad, desde el 26% en menores de 6 meses al 74% en mayores de 10 años. El 10% de los casos (n = 92) precisaron cuidados intensivos pediátricos por fallo respiratorio agudo. Conclusión: La gripe es causa importante de hospitalización en la población infantil española. Los menores de 6 meses de edad y los niños con enfermedades subyacentes constituyen una parte mayoritaria (> 50%) de los casos. Una gran parte de las formas graves de gripe en población infantil podrían ser evitada si se cumplieran las indicaciones actuales de vacunación


Introduction: There are only a limited number of studies on the impact of influenza in the Spanish child population. The present work intends to increase this knowledge by studying some key aspects, such as the incidence of hospital admissions, clinic variables, comorbidities, and the vaccination status in the hospitalised children. Methods: A retrospective, observational study was conducted by reviewing the medical records of children under 15 years and hospitalised due to community acquired influenza confirmed microbiologically, during 2́ flu seasons (2014-2015 and 2015-2016). The study was carried out in 10 hospitals of 6cities, which represent approximately 12% of the Spanish child population. Results: A total of 907 children were admitted to hospital with main diagnosis of influenza infection (447 < 2 years), estimating an average annual rate of hospitalisation incidence of 0.51 cases / 1,000 children (95% CI; 0.48-0.55). Just under half (45%) of the cases had an underlying disease considered a risk factor for severe influenza, and most (74%) had not been vaccinated. The percentage of children with underlying diseases increased with age, from 26% in children < 6 months to 74% in children >10 years. Admission to the PICU was required in 10% (92) of the cases, mainly due to acute respiratory failure. Conclusion: Influenza continues to be an important cause of hospitalisation in the Spanish child population. Children < 6 months of age and children with underlying diseases make up the majority (> 50%) of the cases. Many of the severe forms of childhood influenza that occur today could be avoided if current vaccination guidelines were met


Assuntos
Humanos , Criança , Hospitalização , Influenza Humana/epidemiologia , Influenza Humana/microbiologia , Vacinas contra Influenza/imunologia , Espanha/epidemiologia , Estudos Retrospectivos , Estudo Observacional , Doença Crônica , Oxigenoterapia , Corticosteroides/administração & dosagem , Broncodilatadores/administração & dosagem
4.
An Pediatr (Barc) ; 90(1): 56.e1-56.e9, 2019 Jan.
Artigo em Espanhol | MEDLINE | ID: mdl-30609975

RESUMO

The Advisory Committee on Vaccines of the Spanish Association of Paediatrics annually publishes the immunisation schedule considered optimal for children resident in Spain, according to available evidence on current vaccines. As regards funded immunisations, the 2+1 strategy (2, 4, 11 months) with hexavalent (DTPa-IPV-Hib-HB) and 13-valent pneumococcal vaccines are recommended. Administration of the 6-year booster dose with DTPa is recommended, with a poliomyelitis dose for children who had received the 2+1 scheme, as well as Tdap vaccine for adolescents and pregnant women in every pregnancy between 27 and 32 weeks gestation. The 2-dose scheme should be used for MMR (12 months and 3-4 years) and varicella (15 months and 3-4 years). MMRV vaccine could be applied as the second dose. Vaccination against HPV is recommended in both genders, preferably at 12 years of age. A stronger effort should be made to improve vaccination coverage. The new 9-valent vaccine is now available, expanding the coverage for both genders. Tetravalent meningococcal vaccine (MenACWY) is recommended at 12 months and 12-14 years, with a catch-up up at 19 years of age. It is also recommended in infants older than 6 weeks of age with risk factors, or travellers to countries with high incidence of ACWY meningococcal serogroups. As regards non-funded immunisations, it is recommended meningococcal B vaccination, with a 2+1 schedule, and requests that it be included in the National Immunisation Program. Vaccination against rotavirus is recommended in all infants.


Assuntos
Esquemas de Imunização , Criança , Humanos
5.
An. pediatr. (2003. Ed. impr.) ; 90(1): 56.e1-56.e9, ene. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-177179

RESUMO

El Comité Asesor de Vacunas de la Asociación Española de Pediatría publica anualmente el calendario de vacunaciones que estima idóneo para los niños residentes en España, teniendo en cuenta la evidencia disponible. En cuanto a las vacunas financiadas, se recomienda emplear el esquema 2 + 1 (2, 4 y 11 meses) con vacunas hexavalentes (DTPa-VPI-Hib-HB) y con antineumocócica conjugada 13-valente. Se aconseja un refuerzo a los 6 años, preferentemente con DTPa, junto con una dosis de polio para aquellos que recibieron esquemas 2 + 1, así como vacunación con Tdpa en adolescentes y en cada embarazo, entre la semana 27 y la 32. Se emplearán esquemas de 2 dosis para triple vírica (12 meses y 3-4 años) y varicela (15 meses y 3-4 años). La segunda dosis se podría aplicar como vacuna tetravírica. Se recomienda vacunación sistemática universal frente al VPH, tanto a chicas como a chicos, preferentemente a los 12 años, debiéndose realizar un mayor esfuerzo para mejorar las coberturas. La nueva vacuna de 9 genotipos amplía la cobertura para ambos sexos. Se recomienda que la vacuna antimeningocócica conjugada tetravalente (MenACWY) se introduzca en el calendario financiado a los 12 meses y a los 12-14 años, aconsejándose un rescate hasta los 19 años. Igualmente, se recomienda en los mayores de 6 semanas de edad con factores de riesgo o que viajen a países de elevada incidencia de estos serogrupos. Respecto a las vacunas no financiadas, se recomienda la antimeningocócica B, con esquema 2 + 1, solicitando su entrada en el calendario. Es recomendable vacunar a todos los lactantes frente al rotavirus


The Advisory Committee on Vaccines of the Spanish Association of Paediatrics annually publishes the immunisation schedule considered optimal for children resident in Spain, according to available evidence on current vaccines. As regards funded immunisations, the 2 + 1 strategy (2, 4, 11 months) with hexavalent (DTPa-IPV-Hib-HB) and 13-valent pneumococcal vaccines are recommended. Administration of the 6-year booster dose with DTPa is recommended, with a poliomyelitis dose for children who had received the 2 + 1 scheme, as well as Tdap vaccine for adolescents and pregnant women in every pregnancy between 27 and 32 weeks gestation. The 2-dose scheme should be used for MMR (12 months and 3-4 years) and varicella (15 months and 3-4 years). MMRV vaccine could be applied as the second dose. Vaccination against HPV is recommended in both genders, preferably at 12 years of age. A stronger effort should be made to improve vaccination coverage. The new 9-valent vaccine is now available, expanding the coverage for both genders. Tetravalent meningococcal vaccine (MenACWY) is recommended at 12 months and 12-14 years, with a catch-up up at 19 years of age. It is also recommended in infants older than 6 weeks of age with risk factors, or travellers to countries with high incidence of ACWY meningococcal serogroups. As regards non-funded immunisations, it is recommended meningococcal B vaccination, with a 2 + 1 schedule, and requests that it be included in the National Immunisation Program. Vaccination against rotavirus is recommended in all infants


Assuntos
Humanos , Lactente , Pré-Escolar , Criança , Adolescente , Programas de Imunização/organização & administração , Sociedades Médicas/organização & administração , Pediatria , Medicina Preventiva , Rotavirus/imunologia , Vacina Quadrivalente Recombinante contra HPV tipos 6, 11, 16, 18
6.
An Pediatr (Barc) ; 2018 Jul 25.
Artigo em Espanhol | MEDLINE | ID: mdl-30055938

RESUMO

INTRODUCTION: There are only a limited number of studies on the impact of influenza in the Spanish child population. The present work intends to increase this knowledge by studying some key aspects, such as the incidence of hospital admissions, clinic variables, comorbidities, and the vaccination status in the hospitalised children. METHODS: A retrospective, observational study was conducted by reviewing the medical records of children under 15 years and hospitalised due to community acquired influenza confirmed microbiologically, during 2́flu seasons (2014-2015 and 2015-2016). The study was carried out in 10 hospitals of 6cities, which represent approximately 12% of the Spanish child population. RESULTS: A total of 907 children were admitted to hospital with main diagnosis of influenza infection (447 <2 years), estimating an average annual rate of hospitalisation incidence of 0.51 cases / 1,000 children (95% CI; 0.48-0.55). Just under half (45%) of the cases had an underlying disease considered a risk factor for severe influenza, and most (74%) had not been vaccinated. The percentage of children with underlying diseases increased with age, from 26% in children <6 months to 74% in children >10 years. Admission to the PICU was required in 10% (92) of the cases, mainly due to acute respiratory failure. CONCLUSION: Influenza continues to be an important cause of hospitalisation in the Spanish child population. Children <6 months of age and children with underlying diseases make up the majority (> 50%) of the cases. Many of the severe forms of childhood influenza that occur today could be avoided if current vaccination guidelines were met.

7.
Pediatr. aten. prim ; 20(supl.27): 13-21, jun. 2018. tab
Artigo em Espanhol | IBECS | ID: ibc-174725

RESUMO

Las resistencias bacterianas a antibióticos constituyen un problema global que afecta tanto a los países desarrollados como a los que están en vías de desarrollo. Se ha estimado que para el año 2050 el número de personas que morirá cada año por infeccionas causadas por bacterias multirresistentes excederá al número de personas que muere actualmente por cáncer cada año. La expansión de las poblaciones de bacterias resistentes está estrechamente relacionada con el consumo de antibiótico, tanto en agricultura y ganadería como en el tratamiento de los humanos. Muchos niños con infecciones respiratorias son tratados con antibióticos, pese a que la mayoría de ellas son de etiología viral, con la excepción de la otitis media aguda, la faringitis estreptocócica y la sinusitis. Estas tres últimas entidades, aunque de etiología bacteriana, son autolimitadas e incluso sin tratamiento antibiótico rara vez se complican. Además, el beneficio clínico de los antibióticos es modesto. Para disminuir el consumo de antibióticos y, por tanto, la expansión de las bacterias resistentes, se recomiendan utilizar las guías profesionales para el diagnóstico y tratamiento de las infecciones de vías respiratorias altas. Es fundamental hacer un diagnóstico preciso, identificar a los pacientes que más se beneficiarán del tratamiento antibiótico, y utilizar cursos de antibióticos con las dosis adecuadas y lo más cortos posibles. La utilización de algunas vacunas como la antigripal y las vacunas neumocócicas conjugadas también ayudan a disminuir el consumo de antibióticos


Antimicrobial resistance is a global problem that affects both developed and developing countries. It has been estimated that by 2050, ten million people a year will die by infections caused by multidrug-resistant bacteria, a figure that exceeds the 8.2 million people a year who die from cancer currently. The spread of drug-resistant bacteria is closely related to antibiotic consumption in animals, agriculture and clinical use in humans. Many children with upper respiratory infections are treated with antibiotics, even though most of them are caused by viruses, with the exception of acute otitis media, streptococcal pharyngitis and sinusitis. These last three entities are autolimited and complications are uncommon, even though they are not treated with antibiotics. Besides, clinical benefit of antibiotic treatment is modest. To reduce antibiotic consumption and consequently the spread of drug-resistant bacteria, it has been recommended adhering to Clinical guidelines to manage upper respiratory infections. It is essential to make an accurate diagnosis, to identify those patients who will benefit most from the treatment and to use short antibiotic courses with proper doses. Pneumococcal conjugate vaccines and influenza vaccines can also help to reduce antibiotic consumption and bacterial resistances


Assuntos
Humanos , Criança , Resistência Microbiana a Medicamentos , Antibacterianos/uso terapêutico , Doenças Transmissíveis/tratamento farmacológico , Infecções Respiratórias/tratamento farmacológico , Otite Média Supurativa/tratamento farmacológico , Sinusite/tratamento farmacológico , Vacinas contra Influenza/administração & dosagem , Vacinas Pneumocócicas/administração & dosagem
8.
Pediatr. aten. prim ; 20(supl.27): 23-31, jun. 2018. tab
Artigo em Espanhol | IBECS | ID: ibc-174726

RESUMO

El uso de antibióticos siempre supone un impacto sobre la flora bacteriana, patógena y colonizadora, del organismo al que se administran seleccionando el crecimiento de cepas resistentes a su acción. Y esto, la inducción de resistencias bacterianas, debe considerarse un efecto adverso de este grupo de fármacos. En España, la población pediátrica recibe más antibióticos que en otros países de Europa y hay estudios que muestran un porcentaje importante de inadecuación en los tratamientos antibióticos prescritos. Por este motivo y porque está demostrado que en poblaciones con un mayor consumo de antibióticos las tasas de resistencias microbianas son más altas, es preciso mejorar la prescripción antibiótica con el objetivo de controlar la infección, minimizando el riesgo de producir efectos adversos y de inducir resistencias. Para ello se deben confirmar las infecciones bacterianas utilizando los métodos diagnósticos disponibles y, cuando la prescripción se realice empíricamente, se debe seleccionar el antibiótico más adecuado y selectivo en función de los patógenos responsables de cada proceso, el patrón de resistencias y sensibilidad de los mismos, las características del antibiótico y del propio paciente. Es importante que estos datos sean locales, actualizados y correspondan a muestras de pacientes semejantes al paciente atendido. A continuación se describen los datos concretos a tener en cuenta para los procesos bacterianos más frecuentes de manejo ambulatorio


Use of antibiotics has always an impact on the microbiome of the person who receives the treatment, in both pathogen and saprophytic bacteria. Antibiotics cause a selection of resistant bacteria, and this fact must be considered an adverse effect. Pediatric populations in Spain receive more antibiotics than children from other European countries. Different studies show an inadequacy in an important percentage of treatments prescribed. Because of this reason, and also because of the known fact that populations with a higher consume of antibiotics develop higher resistance rates, we need to make improvements in antibiotic prescription. The goal must be to control infections while minimizing the risk of adverse effects and induction of resistances. In order to achieve this goal, bacterial infections must be confirmed with available diagnostic methods, and in empirical prescriptions, the choice of the antibiotic prescribed must be done according to the usual pathogens responsible for the process, resistance patterns, and sensitivity, characteristics of the antibiotic, and the patient. Those data must be current, collected locally, and taken from a population resembling closely the patient that will be prescribed the antibiotic treated. We are going to describe the precise data to take in account in the most usual bacterial infections, to be managed in community settings


Assuntos
Humanos , Criança , Resistência Microbiana a Medicamentos , Antibacterianos/uso terapêutico , Doenças Transmissíveis/tratamento farmacológico , Dermatopatias Infecciosas/tratamento farmacológico , Infecções Respiratórias/tratamento farmacológico , Infecções Urinárias/tratamento farmacológico , Testes de Sensibilidade Microbiana , Fatores de Risco
10.
An Pediatr (Barc) ; 88(1): 53.e1-53.e9, 2018 Jan.
Artigo em Espanhol | MEDLINE | ID: mdl-29301718

RESUMO

The Advisory Committee on Vaccines of the Spanish Association of Paediatrics annually publishes the immunisation schedule considered optimal for children resident in Spain, according to available evidence on current vaccines. Regarding funded immunisations, 2+1 strategy (2, 4, 11-12 months) with hexavalent (DTPa-IPV-Hib-HB) and 13-valent pneumococcal vaccines are recommended. Administration of the 6-year booster dose with DTPa is recommended, and a poliomyelitis dose for children who had received the 2+1 scheme, as well as Tdap vaccine for adolescents and pregnant women in every pregnancy between 27 and 32 weeks' gestation. The two-dose scheme should be used for MMR (12 months and 2-4 years) and varicella (15 months and 2-4 years). MMRV vaccine could be applied as the second dose if available. Coverage of human papillomavirus vaccination in girls aged 12 with a two dose scheme (0, 6 months) should be improved. Information and recommendation for male adolescents about potential beneficial effects of this immunisation should be provided as well. The new 9 genotypes vaccine is now available, expanding the coverage for both gender. Regarding non-funded immunisations, Committee on Vaccines of the Spanish Association of Paediatrics recommends meningococcal B vaccination, with a 3+1 schedule, and requests to be included in the National Immunisation Program. Tetravalent meningococcal vaccine (MenACWY) is recommended to adolescents (14-18 years) who are going to live in countries with systematic vaccination against ACWY serogroups, and people >6 weeks of age with risk factors or travellers to countries with very high incidence. Vaccination against rotavirus is recommended in all infants.

11.
An. pediatr. (2003. Ed. impr.) ; 88(1): 53.e1-53.e9, ene. 2018. tab
Artigo em Espanhol | IBECS | ID: ibc-170647

RESUMO

El Comité Asesor de Vacunas de la Asociación Española de Pediatría publica anualmente el calendario de vacunaciones que estima idóneo para los niños residentes en España, teniendo en cuenta la evidencia disponible. En cuanto a las vacunas financiadas, se recomienda emplear el esquema 2+1 (2, 4 y 11-12 meses) con vacunas hexavalentes (DTPa-VPI-Hib-VHB) y con antineumocócica conjugada 13-valente. Se aconseja un refuerzo a los 6 años, preferentemente con DTPa, junto a una dosis de polio para aquellos que recibieron esquemas 2+1, así como vacunación con Tdpa en adolescentes y en cada embarazo, entre la 27 y 32 semanas. Se emplearán esquemas de dos dosis para triple vírica (12 meses y 2-4 años) y varicela (15 meses y 2-4 años). De haber disponibilidad, la segunda dosis se podría aplicar como vacuna tetravírica. Se deben incrementar las coberturas frente al papilomavirus en niñas de 12 años con dos dosis (0, 6 meses), así como informar y recomendar la vacunación de los varones, dados los beneficios potenciales de la misma. La nueva vacuna de 9 genotipos ya está disponible, ampliando la cobertura para ambos sexos. Respecto a vacunas no financiadas, se recomienda la antimeningocócica B, con esquema 3+1, solicitando su entrada en calendario. Se recomienda individualmente la vacuna antimeningocócica conjugada tetravalente (MenACWY) en adolescentes (14-18 años) que vayan a residir en países con vacunación sistemática frente a los serogrupos ACWY. También en mayores de 6 semanas de vida con factores de riesgo o viajeros a países de elevada incidencia. Es recomendable vacunar a todos los lactantes frente al rotavirus (AU)


The Advisory Committee on Vaccines of the Spanish Association of Paediatrics annually publishes the immunisation schedule considered optimal for children resident in Spain, according to available evidence on current vaccines. Regarding funded immunisations, 2+1 strategy (2, 4, 11-12 months) with hexavalent (DTPa-IPV-Hib-HB) and 13-valent pneumococcal vaccines are recommended. Administration of the 6-year booster dose with DTPa is recommended, and a poliomyelitis dose for children who had received the 2+1 scheme, as well as Tdap vaccine for adolescents and pregnant women in every pregnancy between 27 and 32 weeks' gestation. The two-dose scheme should be used for MMR (12 months and 2-4 years) and varicella (15 months and 2-4 years). MMRV vaccine could be applied as the second dose if available. Coverage of human papillomavirus vaccination in girls aged 12 with a two dose scheme (0, 6 months) should be improved. Information and recommendation for male adolescents about potential beneficial effects of this immunisation should be provided as well. The new 9 genotypes vaccine is now available, expanding the coverage for both gender. Regarding non-funded immunisations, Committee on Vaccines of the Spanish Association of Paediatrics recommends meningococcal B vaccination, with a 3+1 schedule, and requests to be included in the National Immunisation Program. Tetravalent meningococcal vaccine (MenACWY) is recommended to adolescents (14-18 years) who are going to live in countries with systematic vaccination against ACWY serogroups, and people >6 weeks of age with risk factors or travellers to countries with very high incidence. Vaccination against rotavirus is recommended in all infants (AU)


Assuntos
Humanos , Vacinação em Massa/organização & administração , Esquemas de Imunização , Programas de Imunização/organização & administração , Prevenção de Doenças , Controle de Doenças Transmissíveis/métodos , Guias como Assunto
16.
Front Immunol ; 8: 802, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28747912

RESUMO

GATA binding protein 2 (GATA2) deficiency is a rare disorder of hematopoiesis, lymphatics, and immunity caused by spontaneous or autosomal dominant mutations in the GATA2 gene. Clinical manifestations range from neutropenia, lymphedema, deafness, to severe viral and mycobacterial infections, bone marrow failure, and acute myeloid leukemia. Patients also present with monocytopenia, dendritic cell, B- and natural killer (NK)-cell deficiency. We studied the T-cell and NK-cell compartments of four GATA2-deficient patients to assess if changes in these lymphocyte populations could be correlated with clinical phenotype. Patients with more severe clinical complications demonstrated a senescent T-cell phenotype whereas patients with lower clinical score had undetectable changes relative to controls. In contrast, patients' NK-cells demonstrated an immature/activated phenotype that did not correlate with clinical score, suggesting an intrinsic NK-cell defect. These studies will help us to determine the contribution of T- and NK-cell dysregulation to the clinical phenotype of GATA2 patients, and may help to establish the most accurate therapeutic options for these patients. Asymptomatic patients may be taken into consideration for hematopoietic stem cell transplantation when dysregulation of T-cell and NK-cell compartment is present.

17.
Vaccine ; 35(35 Pt B): 4646-4651, 2017 08 16.
Artigo em Inglês | MEDLINE | ID: mdl-28711388

RESUMO

OBJECTIVES: To evaluate the impact of 13-valent pneumococcal conjugate vaccine on pneumococcal meningitis in children. METHODS: Children younger than 15years of age attending 27 hospitals in the Region of Madrid with confirmed pneumococcal meningitis were identified in a prospective surveillance study, from 2007 to 2015. Clinical data, neurological sequelae, pneumococcal vaccination status, serotyping and antibiotic susceptibility were recorded. RESULTS: One hundred and four cases of pneumococcal meningitis were identified, 63 during the period of routine 7-valent pneumococcal conjugate vaccine immunisation (May 2007-April 2010) and 41 during the period of 13-valent pneumococcal conjugate vaccine immunisation (May 2010-April 2015). When both periods were compared, a 62% (95% CI: 45-75%) decrease in the incidence of pneumococcal meningitis was observed, from 2.19 cases per 100,000 inhabitants in the PCV7 period to 0.81 per 100,000 inhabitants in the PCV13 period (p=0.0001), mainly due to an 83% (95% CI: 30-96%) reduction in cases caused by serotype 19A. Isolates not susceptible to cefotaxime (MIC>0.5µg/L) decreased from 27% to 8%, (p=0.02). Mean patient ages rose from 28.7months to 38.5months (p<0.05). Case fatality rate across both periods was 5%. An unfavourable outcome (death or neurological sequelae) occurred in 27% of patients, while the rate was similar in both periods. There was no increase in meningitis caused by pneumococcal serotypes not included in 13-valent pneumococcal conjugate vaccine throughout the years of the study. CONCLUSIONS: Immunisation with 13-valent pneumococcal conjugate vaccine has reduced the rate of pneumococcal meningitis in children less than 15years, with a near-elimination of cefotaxime-resistant isolates, but morbidity has remained unchanged. A shift of pneumococcal meningitis towards slightly higher age groups was also observed.


Assuntos
Meningite Pneumocócica/imunologia , Meningite Pneumocócica/prevenção & controle , Vacinas Pneumocócicas/imunologia , Streptococcus pneumoniae/imunologia , Adolescente , Fatores Etários , Antibacterianos/farmacologia , Cefotaxima/farmacologia , Cefotaxima/uso terapêutico , Criança , Pré-Escolar , Feminino , Vacina Pneumocócica Conjugada Heptavalente/imunologia , Humanos , Vigilância Imunológica , Incidência , Lactente , Masculino , Meningite Pneumocócica/tratamento farmacológico , Meningite Pneumocócica/epidemiologia , Infecções Pneumocócicas/microbiologia , Infecções Pneumocócicas/prevenção & controle , Vacinas Pneumocócicas/administração & dosagem , Estudos Prospectivos , Sorogrupo , Sorotipagem , Espanha/epidemiologia , Streptococcus pneumoniae/classificação , Streptococcus pneumoniae/efeitos dos fármacos , Vacinação , Vacinas Conjugadas/efeitos adversos , Vacinas Conjugadas/imunologia
18.
Pediatr Dev Pathol ; 20(1): 28-37, 2017 Jan-Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28276298

RESUMO

Objectives Hirschsprung disease (HSCR) has a wide range of severity. There are nonsevere forms treated conservatively until surgery and severe forms that require an early stoma and prolonged hospitalization. Our objective was to establish a clinical scoring system to predict the severity of HSCR and to evaluate the possible existence of a clinical-genetic correlation. Methods We carried out a retrospective observational study including all HSCR cases treated in our hospital. The sample was divided into severe and nonsevere disease according to the number of surgical procedures, hospitalization time, and episodes of enterocolitis. The proposed score was applied at diagnosis, and the sensitivity, specificity, and optimal cut-point were determined. We conducted a prospective molecular study of RET, EDNRB, and EDN3 on all patients, as well as SOX10 in Waardenburg Syndrome type 4 forms. Results Among the 42 patients treated between 1983 and 2013, 15 met the severe disease criteria. This group had a higher mean score (13.15 ± 2.36) than the nonsevere group (8.15 ± 2.13; p < 0.001). A score ≥11 had a sensitivity of 87% and a specificity of 81% in detecting the severe cases. Causative mutations were identified in 12 patients, 8 of them in the severe group ( p = 0.015). Most of these mutations (75%) were located in the RET proto-oncogene. Conclusion The proposed scoring system enables the early selection of patients with severe behavior of HSCR. A value ≥11 showed good sensitivity and specificity for this purpose. Causative mutations were identified in more than 50% of patients who met the criteria for severe disease.

19.
PLoS One ; 12(2): e0172222, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28207888

RESUMO

In the Community of Madrid, the 13-valent pneumococcal conjugate vaccine (PCV13) replaced the 7-valent (PCV7) in the fully government-funded Regional Immunization Program (RIP) in May, 2010, but was later excluded in May, 2012, and included again in January, 2015. These unique changes allowed us to assess the impact of the different pneumococcal vaccination policies on PCV13 uptake in infants and on the incidence rate (IR) of invasive pneumococcal disease (IPD) in children <15 years old. In this prospective, active, surveillance study, we estimated PCV13 uptakes, IR and incidence rate ratios (IRR) for total IPD and for IPD caused by PCV13- and non-PCV13 serotypes in children <15 years, stratified by age, in four periods with different vaccination policies: fully government-funded PCV7 vaccination, fully government-funded PCV13, mixed public/private funding and only private funding. Vaccine uptakes reached 95% in periods with public-funded pneumococcal vaccination, but fell to 67% in the private funding period. Overall, IR of IPD decreased by 68% (p<0.001) in 2014-15, due to 93% reduction in the IR of PCV13-type IPD (p<0.001) without significant changes in non-PCV13-type IPD. A fully government-funded PCV13 vaccination program lead to high vaccine uptake and dramatic reductions in both overall and PCV13-type IPD IR. When this program was switched to private PCV13 vaccination, there was a fall in vaccine coverage and stagnation in the decline of PCV13-type IPD with data suggesting a weakening of herd immunity.


Assuntos
Infecções Pneumocócicas/epidemiologia , Infecções Pneumocócicas/prevenção & controle , Vacinas Pneumocócicas/administração & dosagem , Vacinas Pneumocócicas/imunologia , Streptococcus pneumoniae/classificação , Pré-Escolar , Feminino , Vacina Pneumocócica Conjugada Heptavalente/administração & dosagem , Vacina Pneumocócica Conjugada Heptavalente/imunologia , Hospitais , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Infecções Pneumocócicas/microbiologia , Estudos Prospectivos , Sorotipagem , Espanha/epidemiologia , Streptococcus pneumoniae/isolamento & purificação , Fatores de Tempo
20.
An Pediatr (Barc) ; 86(2): 98.e1-98.e9, 2017 Feb.
Artigo em Espanhol | MEDLINE | ID: mdl-28038948

RESUMO

The Advisory Committee on Vaccines of the Spanish Association of Paediatrics (CAV- AEP) annually publishes the immunisation schedule which, in our opinion, is considered optimal for children resident in Spain, taking into account the evidence available on current vaccines. Pneumococcal and varicella immunisation in early childhood is already included in all funded vaccines present in the regional immunisation programmes. Furthermore, this committee establishes recommendations on vaccines not included in official calendars (non-funded immunisations), such as rotavirus, meningococcal B, and meningococcal ACWY. As regards funded immunisations, 2+1 strategy (2, 4, 11-12 months) with hexavalent (DTaP-IPV-Hib-HB) and 13-valent pneumococcal vaccines is recommended. Administration of the 6-year booster dose with DTaP is recommended, as well as a poliomyelitis dose for children who had received the 2+1 scheme, with the Tdap vaccine for adolescents and pregnant women between 27 and 32 weeks gestation. The two-dose scheme should be used for MMR (12 months and 2-4 years) and varicella (15 months and 2-4 years). Coverage of human papillomavirus vaccination in girls aged 12 with a two-dose scheme (0, 6 months) should be improved. Information and recommendations for male adolescents about potential beneficial effects of the tetravalent HPV vaccine should also be provided. ACWY meningococcal vaccine is the optimal choice in adolescents. For recommended unfunded immunisations, the CAV-AEP recommends the administration of meningococcal B vaccine, due to the current availability in Spanish community pharmacies, with a 3+1 scheme. CAV-AEP requests the incorporation of this vaccine in the funded unified schedule. Vaccination against rotavirus is recommended in all infants.


Assuntos
Esquemas de Imunização , Adolescente , Criança , Pré-Escolar , Humanos , Lactente
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