Vaccination in pregnancy. Consensus document of the CAV-AEP and the SEGO.

During pregnancy, physiological changes in the immune response make pregnant women more susceptible to serious infection, increasing the risk for the mother as well as the foetus, newborn and infant. All women should be correctly and fully vaccinated as they enter their reproductive years, especially against diseases such as tetanus, hepatitis B, measles, rubella and varicella. In addition to the recommended vaccines, in risk situations, inactivated vaccines could be administered to women who were not correctly vaccinated before, while attenuated vaccines are contraindicated. Despite the fact that vaccination during pregnancy is a very important preventive measure and the existing recommendations from public health authorities, scientific societies and health professionals, the vaccination coverage could clearly be improved, especially against influenza and SARS-CoV-2, so any health professional involved in the care of pregnant women should proactively recommend these vaccines. The Spanish Association of Pediatrics (AEP), through its Advisory Committee on Vaccines, and the Spanish Society of Gynaecology and Obstetrics (SEGO) recommend vaccination against the following diseases during pregnancy: against influenza and COVID-19, in any trimester of pregnancy and during the postpartum period (up to 6 months post birth) in women not vaccinated during pregnancy; against pertussis, with the Tdap vaccine, between weeks 27 and 36 of gestation (in the CAV-AEP recommendations, preferably between weeks 27 and 28); and against RSV, with RSVPreF, between weeks 24 and 36 of gestation, preferably between weeks 32 and 36.

Efficacy and safety of mRNA1273 SARS-CoV-2 vaccination in hematopoietic stem cell transplant recipients: Single center experience

Background: COVID-19 represents a worldwide pandemic and vaccination remains the most effective preventive strategy. Among hematological patients, COVID-19 has been associated with a high mortality rate. Vaccination against SARS-CoV-2 has shown high efficacy in reducing community transmission, hospitalization and deaths related to severe COVID-19 disease. However, patients with impaired immunity may have lower sero-responsiveness to vaccination.MethodsThis study focuses on hematopoietic stem cell transplantation (HSCT) recipients. We performed a unicenter, prospective, observational study of a cohort of 31 allogeneic and 56 autologous-HSCT recipients monitored between March 2021 and May 2021 for serological response after COVID-19 vaccination with two doses of mRNA1273 vaccine (Moderna). In order to determine seroconversion, serological status before vaccination was studied.ResultsAt a median range of 75 days after the second vaccine dose, seroconversion rates were 84% and 85% for the autologous and allogeneic-HSCT groups, respectively. We confirmed some potential risk factors for a negative serological response, such as receiving anti-CD20 therapy in the previous year before vaccination, a low B-lymphocyte count and hypogammaglobulinemia. Neutralizing antibodies were quantified in 44 patients, with a good correlation with serological tests. Adverse events were minimal.ConclusionmRNA1273 vaccination is safe and effective in HSCT recipients, especially in those presenting recovered immunity. (AU)

Introducción: Entre los pacientes hematológicos, la COVID-19 se ha asociado a una mayor mortalidad. La vacunación frente a SARS-CoV-2 es la principal estrategia de prevención y ha demostrado eficacia en la reducción de la transmisión, de la hospitalización y de la tasa de mortalidad. Aun así, los pacientes oncohematológicos con un sistema inmunológico disfuncional podrían presentar una respuesta menor a la vacunación.MétodosEstudio unicéntrico, prospectivo y observacional, con una cohorte de 31 receptores de un trasplante alogénico de progenitores hematopoyéticos y de 56 receptores de un trasplante autólogo que recibieron la vacunación frente a SARS-CoV-2 entre marzo de 2021 y mayo de 2021, con 2 dosis de la vacuna mRNA1273 (Moderna). Para poder determinar la tasa de seroconversión, se determinó el estado serológico previamente a la vacunación y posteriormente se monitorizó la respuesta serológica.ResultadosCon un tiempo medio de seguimiento de 75 días después de la segunda vacuna, la tasa de seroconversión fue del 84%, y del 85% en el grupo receptor de trasplante autólogo y alogénico, respectivamente. Se confirmaron algunos potenciales factores de riesgo para la ausencia de respuesta serológica, como haber recibido terapias anti-CD20, un recuento bajo de linfocitos B y la hipogammaglobulinemia. En 44 pacientes se cuantificaron títulos de anticuerpos neutralizantes, con buena correlación con los test serológicos. Los efectos adversos de la vacuna fueron mínimos.ConclusiónLa vacunación con mRNA1273 es segura y efectiva en los pacientes receptores de un trasplante de progenitores hematopoyéticos, especialmente en los que presentan reconstitución inmune previa. (AU)

Vacunación en el embarazo. Documento de consenso del CAV-AEP y la SEGO / Vaccination in pregnancy. Consensus document of the CAV-AEP and the SEGO

Durante el embarazo, los cambios fisiológicos en la respuesta inmunitaria favorecen que las gestantes sean más susceptibles a infecciones graves, tanto para ellas como para el feto, el recién nacido y el lactante. Todas las mujeres deberían entrar en el período reproductivo con su calendario vacunal correctamente cumplimentado, sobre todo en lo que respecta a enfermedades como tétanos, hepatitisB, sarampión, rubeola y varicela. Además de las vacunas recomendadas, en situaciones de riesgo las vacunas inactivadas podrían ser administradas en aquellas mujeres que no estuvieran correctamente inmunizadas con anterioridad, mientras que las atenuadas están contraindicadas.A pesar de que la vacunación durante el embarazo es una medida preventiva muy importante, y de las recomendaciones de autoridades sanitarias, sociedades científicas y profesionales sanitarios, las coberturas vacunales son claramente mejorables, especialmente en lo que respecta a gripe y COVID-19, por lo que todo profesional sanitario que atienda a la embarazada debe ser proactivo en aconsejarlas.La Asociación Española de Pediatría (AEP), a través de su Comité Asesor de Vacunas (CAV), y la Sociedad Española de Ginecología y Obstetricia (SEGO) recomiendan las siguientes vacunaciones durante la gestación: frente a gripe y COVID-19, en cualquier trimestre del embarazo, y durante el puerperio (hasta los 6meses) en aquellas que no hubieran sido vacunadas durante la gestación; frente a tosferina con Tdpa, entre las 27 y 36 semanas de gestación (el CAV-AEP da preferencia entre las 27 y 28 semanas); y frente al VRS con RSVPreF, entre las 24 y 36 semanas de gestación, de preferencia entre las 32 y 36 semanas. (AU)

During pregnancy, physiological changes in the immune response make pregnant women more susceptible to serious infection, increasing the risk for the mother as well as the foetus, newborn and infant. All women should be correctly and fully vaccinated as they enter their reproductive years, especially against diseases such as tetanus, hepatitisB, measles, rubella and varicella. In addition to the recommended vaccines, in risk situations, inactivated vaccines could be administered to women who were not correctly vaccinated before, while attenuated vaccines are contraindicated.Despite the fact that vaccination during pregnancy is a very important preventive measure and the existing recommendations from public health authorities, scientific societies and health professionals, the vaccination coverage could clearly be improved, especially against influenza and SARS-CoV-2, so any health professional involved in the care of pregnant women should proactively recommend these vaccines.The Spanish Association of Pediatrics (AEP), through its Advisory Committee on Vaccines (CAV), and the Spanish Society of Gynaecology and Obstetrics (SEGO) recommend vaccination against the following diseases during pregnancy: against influenza and COVID-19, in any trimester of pregnancy and during the postpartum period (up to 6months post birth) in women not vaccinated during pregnancy; against pertussis, with the Tdap vaccine, between weeks 27 and 36 of gestation (in the CAV-AEP recommendations, preferably between weeks 27 and 28); and against RSV, with RSVPreF, between weeks 24 and 36 of gestation, preferably between weeks 32 and 36. (AU)

Programa de vacunación en prisiones: impacto del virus SARS-CoV-2 y retos de futuro / Prison vaccination programmes: the impact of the SARS-CoV-2 virus and future challenges

La vacunación ha sido tradicionalmente una de las actividades de prevención primaria a la que mayor esfuerzo se ha dedicado en las instituciones penitenciarias españolas. Una vez más, la pandemia de coronavirus de tipo 2 causante del síndrome respiratorio agudo severo (SARS-CoV-2) ha puesto de manifiesto la importancia de la vacunación en el control de las enfermedades inmunoprevenibles. Tras superar la emergencia sanitaria provocada por la enfermedad del coronavirus de 2019 (COVID-19), tenemos por delante el reto de recuperar las coberturas vacunales que teníamos antes de la pandemia, además de aumentar las de otras vacunas con menor implantación en nuestro medio. Entre las estrategias de mejora que se deben implementar, estaría la optimización de la transmisión de la información sanitaria entre centros penitenciarios dependientes de diferentes administraciones. También sería deseable poder acceder a los sistemas de información sobre vacunas de las diferentes comunidades autónomas, tanto para conocer el estado vacunal de los pacientes como para notificar las dosis administradas durante el periodo de internamiento, así como mejorar las estadísticas vacunales disponibles en prisión.(AU)

Vaccination has traditionally been one of the primary prevention activities to which most effort has been devoted in Spanish penitentiary institutions. Once again, the type 2 coronavirus pandemic causing severe acute respiratory syndrome (SARS-CoV-2) pandemic has highlighted the importance of vaccination in the control of immunopreventable diseases.After overcoming the health emergency caused by the coronavirus disease 2019 (COVID-19), we face the challenge of recovering the vaccination coverage we had before the pandemic, in addition to increasing the coverage of other vaccines with lesser implantation in our environment. Among the improvement strategies to be implemented would be the optimization of the transmission of health information between penitentiary centers dependent on different administrations. It would also be desirable to be able to access the vaccine information systems of the different autonomous communities, both to know the vaccination status of patients and to report the doses administered during the period of internment, as well as to improve the vaccine statistics available in prison.(AU)

Cobertura de vacunación contra COVID-19 e influenza en personal de salud y administrativo en Paraguay

Introducción: A nivel mundial, la cobertura de vacunación contra el COVID-19, así como contra la influenza es baja tanto en la población general como en los profesionales de la salud a pesar de que la vacuna es gratuita y obligatoria en el personal sanitario. Objetivo: Describir la cobertura de vacunación contra el COVID -19, y la influenza en personal de salud y administrativo de un hospital de referencia del Ministerio de Salud Pública y Bienestar Social en el periodo 2021-2022. Metodología: Estudio observacional descriptivo de corte trasverso. Se hizo la revisión de los registros del personal sanitario y administrativo del centro vacunatorio del Hospital Nacional de Itauguá de la campaña vacunal contra el COVID-19 y de anti-influenza en el periodo 2021- 2022. Resultados: De los 3.586 funcionarios, 999 (27,9 %) eran médicos, 1494 (41,7 %) personal de enfermería, 366 (10,2 %) otra categoría de personal sanitario, y 727 (20,3 %) personal administrativo. En forma global, el 86,5 % de los funcionarios recibió por lo menos las dos dosis que constituyen el esquema primario y el 73 % la dosis de refuerzo. El 2,1 % del personal no recibió ninguna dosis de vacuna anti covid-19, la cifra fue mayor en el personal administrativo (4,8 %). La cobertura de vacunación contra la influenza fue de 20 % en el 2021 y 25 % en el 2022. Discusión: Si bien cobertura de vacunación anti-COVID-19 fue comparable a otros países, la vacunación contra la influenza fue muy baja. Es urgente implementar estrategias dirigidas a aumentar la percepción de riesgo y aceptabilidad de las vacunas obligatorias para el personal sanitario.

Introduction: Worldwide, vaccination coverage against COVID-19, as well as against influenza, is low both in the general population and in health professionals, despite the fact that the vaccine is free and mandatory for health personnel. Objective: To describe the COVID -19 and influenza vaccination coverage in health and administrative personnel of a reference hospital of the Ministry of Public Health and Social Welfare in the period 2021-2022. Methods: Cross-sectional descriptive observational study. Charts of the health and administrative personnel of the vaccination center of the Itauguá National Hospital of the COVID-19 and influenza vaccination campaign in the period 2021-2022 were reviewed. Results: Of the 3,586 personnel, 999 (27.9%) were medical personnel, 1,494 (41.7%) nursing personnel, 366 (10.2%) other category of health personnel, and 727 (20.3%) administrative personnel. Overall, 86.5% of the employees received at least the two doses that constitute the primary schedule and 73% the booster dose; 2.1% of the staff did not receive any dose of the anti COVID-19 vaccine, which was higher in the administrative staff (4.8%). Influenza vaccination coverage was 20% in 2021 and 25% in 2022. Discussion: Even though the vaccination coverage of anti-COVID-19 was comparable to other countries, vaccination anti-influenza was very low. It is urgent to implement strategies aimed at increasing the perception of risk and acceptability of mandatory vaccines for health personnel.

Kikuchi–Fujimoto disease type lymph node reaction with increased plasmacytoid dendritic cells may appear as a side effect following COVID-19 vaccination: Report of a case and literature review / Linfadenitis de tipo Kikuchi-Fujimoto con expansión de células dendríticas plasmocitoides como evento adverso asociado a la vacunación por COVID-19. Reporte de un caso y revisión de la literatura

Subsequent to mass vaccination programs against COVID-19, diverse side effects have been described, both at the injection site, such as pain, redness and swelling, and systemic effects such as fatigue, headache, muscle or joint pain. On rare occasions, a lymphadenopathic syndrome may develop, raising the clinical suspicion of a lymphoproliferative disorder. We present the case of a 30-year-old woman who developed self-limiting left axillary lymphadenopathy following COVID-19 vaccination. To date, only seven similar cases with a complete clinicopathological description have been published, and fourteen cases have been notified to the European adverse events databases (Eudravigilance) in relationship with vaccination against COVID-19. It is important to be aware of this potential complication when a lymphadenopathic syndrome develops following vaccination, to avoid unnecessary treatment. (AU)

Tras la vacunación masiva frente a la COVID-19 se han comenzado a describir diversos efectos adversos incluyendo efectos locales en el lugar de la inyección, como dolor, enrojecimiento, hinchazón, etc., y efectos sistémicos como fatiga, dolor de cabeza, dolor muscular o articular. Más infrecuentemente se pueden desarrollar cuadros linfadenopáticos sospechosos clínicamente de proceso linfoproliferativo. Presentamos el caso de una mujer de 30 años que desarrolló linfadenopatía axilar izquierda tras la vacunación contra la COVID-19 con hallazgos histopatológicos de linfadenopatía necrotizante de tipo Kikuchi y resolución espontánea. Hasta el momento se han publicado 7 casos con descripción clinicopatológica completa en la literatura y notificado 14 casos en la Red Europea de Farmacovigilancia en relación con la vacunación. Es importante tener en cuenta esta entidad en linfadenopatías sospechosas de procesos linfoproliferativos en este contexto, para evitar un tratamiento innecesario. (AU)

Effects of vaccination with Brucella melitensis, strains Rev 1 ΔeryCD and Rev 1, on the reproductive system of young male goats.

The present study evaluates the effects of vaccination with Brucella melitensis strains Rev 1 ΔeryCD and Rev 1 on the reproductive system of male goats. Three groups, each of them consisting of 15 six-month-old brucellosis-free male goats, were studied. The first group was vaccinated with the Rev 1 ΔeryCD strain, the second group received Rev 1 and the third group was inoculated with sterile physiological saline solution. The dose of both strains was of 1×109CFU/ml. Over the course of the five months of this study, three males from each group were euthanized every month. Their reproductive tracts, spleens, and lymph nodes were collected to analyze serology, bacteriology PCR, histology, and immunohistochemistry. Results show that vaccination with B. melitensis strains Rev 1 ΔeryCD and Rev 1 does not harm the reproductive system of male goats. Strain B. melitensis Rev 1 ΔeryCD displayed a lower capacity to colonize the reproductive tract than strain Rev 1, which was attributed to its limited catabolic action toward erythritol.

Kikuchi–Fujimoto disease type lymph node reaction with increased plasmacytoid dendritic cells may appear as a side effect following COVID-19 vaccination: Report of a case and literature review / Linfadenitis de tipo Kikuchi-Fujimoto con expansión de células dendríticas plasmocitoides como evento adverso asociado a la vacunación por COVID-19. Reporte de un caso y revisión de la literatura

Subsequent to mass vaccination programs against COVID-19, diverse side effects have been described, both at the injection site, such as pain, redness and swelling, and systemic effects such as fatigue, headache, muscle or joint pain. On rare occasions, a lymphadenopathic syndrome may develop, raising the clinical suspicion of a lymphoproliferative disorder. We present the case of a 30-year-old woman who developed self-limiting left axillary lymphadenopathy following COVID-19 vaccination. To date, only seven similar cases with a complete clinicopathological description have been published, and fourteen cases have been notified to the European adverse events databases (Eudravigilance) in relationship with vaccination against COVID-19. It is important to be aware of this potential complication when a lymphadenopathic syndrome develops following vaccination, to avoid unnecessary treatment. (AU)

Tras la vacunación masiva frente a la COVID-19 se han comenzado a describir diversos efectos adversos incluyendo efectos locales en el lugar de la inyección, como dolor, enrojecimiento, hinchazón, etc., y efectos sistémicos como fatiga, dolor de cabeza, dolor muscular o articular. Más infrecuentemente se pueden desarrollar cuadros linfadenopáticos sospechosos clínicamente de proceso linfoproliferativo. Presentamos el caso de una mujer de 30 años que desarrolló linfadenopatía axilar izquierda tras la vacunación contra la COVID-19 con hallazgos histopatológicos de linfadenopatía necrotizante de tipo Kikuchi y resolución espontánea. Hasta el momento se han publicado 7 casos con descripción clinicopatológica completa en la literatura y notificado 14 casos en la Red Europea de Farmacovigilancia en relación con la vacunación. Es importante tener en cuenta esta entidad en linfadenopatías sospechosas de procesos linfoproliferativos en este contexto, para evitar un tratamiento innecesario. (AU)

Trombocitopenia inmunitaria, como efecto adverso a vacuna frente a COVID-19, descripción de dos casos y revisión de bibliografía / Immune thrombocytopenia, as an adverse effect of the COVID-19 vaccine. Two 2 case studies and literature review

La trombopenia inducida por fármacos (DITP) es una trombocitopenia adquirida debida a anticuerpos reactivos a plaquetas dependientes de fármacos que causan destrucción plaquetaria. Desde el inicio de la vacunación para SARC-CoV-2 han ido apareciendo casos de diferentes efectos adversos. Entre los más sonados se encuentra la trombosis trombopénica inmune. Presentamos dos pacientes con trombopenia aislada con antecedente de vacunación para COVID-19 en las semanas previas como evento desencadenante, tras haber hecho un estudio completo que descartó las otras posibles etiologías, así como una revisión bibliográfica sobre esta entidad.(AU)

Drug-induced thrombocytopenia (DITP) is an acquired thrombocytopenia due to drug-dependent platelet-reactive antibodies causing platelet destruction. Since the onset of vaccination for SARS-CoV-2, cases of different adverse effects have been appearing. Among the most notorious is immune thrombopenic thrombosis. We report two patients with isolated thrombocytopenia with a history of vaccination for COVID19 in the previous weeks as the triggering event; after having performed a full study that ruled out other possible aetiologies, as well as a bibliographic review on this entity.(AU)

Immunogenicity of BNT162b2 vaccine after two and three doses in health personnel and institutionalized elderly people not infected with SARS-CoV-2 / Inmunogenicidad de la vacuna BNT162b2 tras la administración de 2 y 3 dosis en personal sanitario y personas mayores institucionalizadas sin infección previa por SARS-CoV-2

Objective The aim of our research was to compare the evolution of the immune response induced by the BNT162b2 vaccine after the administration of two and three doses in healthcare personnel and in institutionalized elderly people (>65 years of age) without previous SARS-CoV-2 infection. Material and methods A prospective observational study was carried out on a convenience sample made up of health workers and institutionalized elderly people, measuring antibodies against S and N proteins of SARS-CoV-2 two and six months after receiving the second vaccine dose, as well as two months after receiving the third dose. Results A significant reduction of the anti-S humoral immune response was reported six months after the second dose of vaccine in both health workers and residents. The administration of a third dose of vaccine induced a significant increase in this antibody response in both investigated groups reaching a similar proportion of responders two months after this third dose. Conclusions Humoral immunity induced by two doses of the BNT162b2 vaccine in persons without prior SARS-CoV-2 infection wanes over time. The administration of a third dose significantly increases anti-S antibodies being highly recommended, especially in people over 65 years of age (AU)

Objetivo El objetivo de nuestra investigación fue comparar la evolución de la respuesta inmunitaria humoral inducida por la vacuna BNT162b2 tras la administración de 2 y 3 dosis en personal sanitario y en personas mayores institucionalizadas (>65años) sin infección previa por SARS-CoV-2. Material y métodos Se realizó un estudio observacional prospectivo en una muestra de conveniencia conformada por sanitarios y mayores institucionalizados, determinando anticuerpos contra las proteínas S y N del SARS-CoV-2 a los 2 y 6 meses de recibir la segunda dosis de la vacuna, así como a los 2 meses después de recibir la tercera dosis. Resultados Se observó una reducción significativa de la respuesta inmune humoral anti-S 6 meses después de la segunda dosis de vacuna, tanto en sanitarios como en residentes. La administración de una tercera dosis de vacuna indujo un aumento significativo de esta respuesta de anticuerpos en ambos grupos, alcanzándose una proporción similar de individuos respondedores a los 2 meses de esta tercera dosis. Conclusiones La inmunidad humoral inducida por 2 dosis de la vacuna BNT162b2 en personas sin infección previa por SARS-CoV-2 disminuye con el tiempo. La administración de una tercera dosis aumenta significativamente los anticuerpos anti-S siendo muy recomendable, especialmente en personas mayores de 65 años (AU)

Lineamientos técnicos para la vacunación contra el SARS-CoV-2 / Technical guidelines for vaccination against SARS-CoV-2

El objetivo general de los presentes lineamientos es establecer las disposiciones técnicas para la realización de las acciones para continuar la vacunación de la población contra el SARS-CoV-2. La priorización vacunal es una estrategia para proteger poblaciones de riesgo, evitando caer en el error de no vacunar a otros grupos cuyo riesgo puede ser bajo, pero que pueden generar enfermedad severa, complicaciones, hospitalizaciones y muerte asociada a COVID-19. En razón de lo anterior se actualizan los esquemas de vacunación frente a COVID-19, a partir de priorización de grupos poblacionales

The general objective of these guidelines is to establish technical provisions for the implementation of actions to continue the vaccination of the population against SARS-CoV-2. Vaccine prioritization is a strategy to protect at-risk populations, avoiding the error of not vaccinating other groups whose risk may be low, but which can lead to severe disease, complications, hospitalizations and death associated with VOCID-19. In view of the foregoing, vaccination schemes against VOCID-19 are updated, based on the prioritization of population groups

Impact of influenza vaccination history in the clinical course of older adults hospitalized with COVID-19.

BACKGROUND AND PURPOSE: Some studies have shown that influenza vaccination is associated with a lower risk of SARS-CoV-2 infection; in patients with COVID-19 infection, admission to intensive care is reduced, with less need for mechanical ventilation, shorter hospital stays, and reduced mortality. This study aimed to determine if a history of annual influenza vaccination impacts the clinical course of SARS-CoV-2 infection during hospitalization. METHODS: This was an observational, prospective, cohort study of patients older than 65 admitted to the COVID-19 unit from January to June 2021. The history of influenza vaccination over the last 5 years was assessed in each patient during hospitalization. We measured the length of hospital stay, the need for admission to the intensive care unit (ICU), the patient's oxygen requirements, complications during hospitalization, and outcome (medical discharge or death). Patients with a history of vaccination against SARS-CoV-2 were not included. RESULTS: We analyzed 125 patients, 50.4% (n=63) with history of influenza vaccination and 49.6% (n=62) without a history of influenza vaccination. In-hospital mortality was 44.8%, higher in the unvaccinated (54.8%) population (p=0.008). ICU admission was 27% higher in vaccinated (35%) patients (p=0.05). Patients without a history of influenza vaccination had a higher prevalence of cardiac (8% vs. 5%, p=0.04) and renal complications (29% vs. 13%, p=0.02). Patients with a history of vaccination had a greater need for invasive mechanical ventilation (25.4%, p=0.02). CONCLUSION: In this study, a history of influenza vaccination in older adults with SARS-CoV-2 infection was related to lower in-hospital mortality.

[Tixagevimab-cilgavimab as pre-exposure prophylactic treatment against SARS-CoV-2 in kidney transplantation patients]. / Tixagevimab-cilgavimab como tratamiento profiláctico preexposición frente a SARS-CoV-2 en pacientes trasplantados renales.

INTRODUCTION: It has been reported that after vaccination with RNAm or viral vectors from SARS-CoV-2 a significant number of solid organ transplant recipients do not develop an effective immune response. In this scenario, the use of tixagevimab-cilgavimab was approved by the European Medicines Agency for COVID-19 prophylaxis in immunocompromised patients in March 2022. We present our experience with a group of kidney transplant recipients who received prophylactic treatment with tixagevimab-cilgavimab. MATERIAL AND METHODS: Prospective study from a cohort of kidney transplant recipients who had been previously vaccinated with 4 doses and did not achieve a satisfactory immune response to vaccination, presenting antibody titers lower than 260 BAU/mL when measured by ELISA. A total of 55 patients who received a single dose of 150mg of tixagevimab and 150mg of cilgavimab between May and September of 2022 were included in this study. RESULTS: No immediate or severe adverse reactions, including worsening of kidney function, were observed after administering the drug or during follow up. All patients who had received the drug 3 months prior presented positive antibody titers (>260 BAU/mL). Seven patients were diagnosed with COVID, and one of those patients had to be admitted to the hospital and died 5 days later from infectious complications and a suspected diagnosis of bacterial coinfection. CONCLUSIONS: In our experience, all kidney transplant recipients reached antibody titers higher than 260 BAU/mL 3 months after receiving prophylactic treatment with tixagevimab-cilgavimab with no severe or irreversible adverse reactions.

Kikuchi-Fujimoto disease type lymph node reaction with increased plasmacytoid dendritic cells may appear as a side effect following COVID-19 vaccination: Report of a case and literature review.

Subsequent to mass vaccination programs against COVID-19, diverse side effects have been described, both at the injection site, such as pain, redness and swelling, and systemic effects such as fatigue, headache, muscle or joint pain. On rare occasions, a lymphadenopathic syndrome may develop, raising the clinical suspicion of a lymphoproliferative disorder. We present the case of a 30-year-old woman who developed self-limiting left axillary lymphadenopathy following COVID-19 vaccination. To date, only seven similar cases with a complete clinicopathological description have been published, and fourteen cases have been notified to the European adverse events databases (Eudravigilance) in relationship with vaccination against COVID-19. It is important to be aware of this potential complication when a lymphadenopathic syndrome develops following vaccination, to avoid unnecessary treatment.

Distribution, seroprevalence and risk factors for bovine brucellosis in Brazil: Official data, systematic review and meta-analysis.

Bovine brucellosis is an endemic disease in Brazil, and evidence-based assessments of the available literature on its seroprevalence and risk factors are limited. The aim of this study was to systematically review and summarize studies related to seroprevalence and risk factors of bovine brucellosis in the entire Brazil, in addition to comparing published data with the most recent official reports. Articles available in scientific databases and published between October 2006 and October 2021 were evaluated. Forty-five publications were included in the meta-analysis on the seroprevalence of brucellosis and 29 publications in the review on risk factors. The largest number of publications was found for the State of Mato Grosso do Sul (n=4), and the highest and lowest seroprevalences were observed in Acre (11%; 95% CI: 8.0-14.0%) and in the Federal District (0.4%; 95% CI: 0.2-0.7%). The main risk factors were the purchase of animals for breeding, vaccination, the number of heifers (female ≥2 years), the presence of calving paddocks and the occurrence of abortions. The need for new official studies has been suggested to determine the true prevalence of bovine brucellosis in Brazil, supported by the National Program for the Control and Eradication of Animal Brucellosis and Tuberculosis.

La equidad en la campaña de vacunación COVID de la Provincia de Buenos Aires (Argentina): un análisis del Municipio de Quilmes.

INTRODUCCIÓN: la pandemia de la COVID-19 ha acentuado las desigualdades sociales, económicas y relacionadas con la salud, afectando desproporcionadamente a las personas en situación de vulnerabilidad y perpetuando la inequidad en salud. En Argentina se implementó una campaña nacional gratuita de vacunación contra la COVID-19 con una perspectiva de equidad. OBJETIVO: identificar desigualdades territoriales en el acceso a la vacunación contra la COVID-19 en Quilmes. MÉTODOS: se analizó la información referida a la vacunación contra la COVID-19 de personas residentes en el Municipio. Se efectuó la georreferenciación de cada vacunatorio y de cada persona a partir del domicilio declarado en el momento de la vacunación. Para caracterizar el grado de vulnerabilidad de las personas vacunadas, a cada una se le asignó el índice de carencias múltiples (ICM) correspondiente al radio censal de residencia. RESULTADOS: al menos el 82 % de la población completó el esquema primario de vacunación (dosis 1 y dosis 2), porcentaje que alcanzó el 97 % en los mayores de 65 años. Analizando la media de dosis aplicadas se observa algo similar con un gradiente hacia los quintiles más altos pero con una mínima diferencia entre sí, situación que también se corrobora en todos los grupos etarios. DISCUSIÓN: no se observaron brechas significativas entre los diferentes niveles socioeconómicos. Si bien se observó un mínimo gradiente en el promedio de dosis recibidas, el tiempo de acceso a las diferentes vacunas y el porcentaje de esquemas primarios completos recibidos, las mismas tienen escasa relevancia clínica y sanitaria.

Immunogenicity of BNT162b2 vaccine after two and three doses in health personnel and institutionalized elderly people not infected with SARS-CoV-2.

OBJECTIVE: The aim of our research was to compare the evolution of the immune response induced by the BNT162b2 vaccine after the administration of two and three doses in healthcare personnel and in institutionalized elderly people (>65 years of age) without previous SARS-CoV-2 infection. MATERIAL AND METHODS: A prospective observational study was carried out on a convenience sample made up of health workers and institutionalized elderly people, measuring antibodies against S and N proteins of SARS-CoV-2 two and six months after receiving the second vaccine dose, as well as two months after receiving the third dose. RESULTS: A significant reduction of the anti-S humoral immune response was reported six months after the second dose of vaccine in both health workers and residents. The administration of a third dose of vaccine induced a significant increase in this antibody response in both investigated groups reaching a similar proportion of responders two months after this third dose. CONCLUSIONS: Humoral immunity induced by two doses of the BNT162b2 vaccine in persons without prior SARS-CoV-2 infection wanes over time. The administration of a third dose significantly increases anti-S antibodies being highly recommended, especially in people over 65 years of age.

Hesitação vacinal infantil e COVID-19: uma análise a partir da percepção dos profissionais de saúde / Childhood vaccine hesitancy and COVID-19: an analysis based on the perception of health professionals / La reticencia vacunal infantil y la COVID-19: un análisis a partir de la percepción de los profesionales de la salud

Resumo: Este artigo apresenta os resultados de uma pesquisa sobre a percepção dos profissionais de saúde sobre a hesitação vacinal infantil relacionada à COVID-19. Baseado no constructo teórico da hesitação vacinal, foi realizada uma pesquisa qualitativa com 86 trabalhadores da atenção primária à saúde (APS) em quatro municípios de quatro estados brasileiros e no Distrito Federal. A análise temática foi realizada e obtiveram-se três categorias: medo, desinformação em vacina e papel dos profissionais de saúde. O medo como motivo de hesitação vacinal gerou reflexões sobre a condução da pandemia pelo Governo Federal, principalmente no que tange à governabilidade por meio desse afeto, e sobre as consequências do uso das plataformas digitais na população. O medo relacionou-se ao fato de a vacina ainda ser percebida como experimental; às possíveis reações adversas; à ausência de estudos de longo prazo; à falsa percepção de risco reduzido da COVID-19 em crianças; e às condutas do Governo Federal geradoras de insegurança nos efeitos da vacina. A desinformação em vacina relacionou-se às fake news sobre a vacina e suas reações; ao fenômeno da infodemia e desinformação; e à ausência de orientação e conhecimento sobre vacinas. Por fim, o trabalho discute o papel fundamental dos profissionais de saúde da APS no aumento da cobertura vacinal devido à confiabilidade perante a população e à proximidade com os territórios, fatores que possibilitam reverter o medo e a desinformação diante das vacinas. Ao longo do trabalho, buscou-se apresentar as convergências entre o conteúdo dos temas delineados e os determinantes da hesitação vacinal e refletir sobre possibilidades para a reconstrução da alta adesão às vacinas infantis.

Abstract: This article presents the results of a study on health professionals' perceptions of childhood vaccine hesitancy related to COVID-19. Based on the theoretical construct of vaccine hesitancy, a qualitative study was conducted with 86 primary health care (PHC) workers in four municipalities in four Brazilian states and in the Federal District. A thematic analysis was performed and three categories were obtained: fear, misinformation about vaccines, and the role of health professionals. Fear as a reason for vaccine hesitancy has led to reflections on the Brazilian Federal Government's management of the pandemic, especially regarding governability and the consequences of the use of digital platforms on the population. Fear was related to the vaccine still being perceived as experimental; to the adverse reactions it may cause; to the lack of long-term studies; to the false perception of reduced risk of COVID-19 in children; and to the Federal Government's behavior, which creates uncertainty about the effects of the vaccine. Vaccine misinformation was related to fake news about the vaccine and its reactions; the phenomenon of infodemic and misinformation; and the lack of guidance and knowledge about vaccines. Finally, the article discusses the fundamental role of PHC workers in increasing vaccination coverage due to the trust among the population and proximity to the territories, factors that enable the reversal of fear and misinformation about vaccines. Throughout the study, authors' sought to show the convergences between the content of the themes outlined and the determinants of vaccine hesitancy and to consider possibilities for rebuilding high adherence to childhood vaccines.

Resumen: Este artículo presenta los resultados de una encuesta sobre la percepción de los profesionales de la salud acerca de la reticencia vacunal infantil relacionada con la COVID-19. Con base en el constructo teórico de la reticencia vacunal, se realizó una encuesta cualitativa con 86 trabajadores de la atención primaria de salud (APS) en 4 municipios de 4 estados brasileños y en el Distrito Federal. Se realizó un análisis temático y se obtuvieron tres categorías: miedo, desinformación sobre vacunas y papel de los profesionales de la salud. El miedo como motivo de reticencia vacunal dio lugar a reflexiones sobre el manejo de la pandemia por parte del Gobierno Federal, sobre todo en lo que respecta a la gobernabilidad por medio de esta afección y las consecuencias del uso de plataformas digitales en la población. El temor se relacionó con el hecho de que la vacuna todavía se percibe como experimental; con las reacciones adversas que puedan provocar; con la ausencia de estudios a largo plazo; con la falsa percepción de riesgo reducido de COVID-19 en niños y con las conductas del Gobierno Federal que generan inseguridad sobre los efectos de la vacuna. La desinformación sobre las vacunas se relacionó con noticias falsas sobre la vacuna y sus reacciones; el fenómeno de la infodemia y la desinformación; y la ausencia de orientación y conocimiento sobre las vacunas. Finalmente, el trabajo discute el papel fundamental de los profesionales de la salud de la APS en el aumento de la cobertura vacunal debido a su confiabilidad entre la población y cercanía a los territorios, factores que permiten revertir el miedo y la desinformación respecto a las vacunas. A lo largo del trabajo, se buscó presentar las convergencias entre el contenido de los temas delineados y los determinantes de la reticencia vacunal y reflexionar sobre las posibilidades para la reconstrucción de una alta adhesión a las vacunas infantiles.

Prevalence of errors causing events allegedly attributable to vaccination/immunization: systematic review and meta-analysis / Prevalencia de errores causantes de acontecimientos supuestamente atribuibles a la vacunación/inmunización: revisión sistemática y metanálisis / Prevalência de erros que causaram eventos supostamente atribuíveis à vacinação/imunização: revisão sistemática e metanálise

ABSTRACT Objective: To identify the prevalence of errors that caused events supposedly attributable to vaccination or immunization. Method: Systematic literature review with meta-analysis carried out on the Medline, Cochrane Library, Cinahl, Web of Science, Lilacs, Scopus; Embase; Open Grey; Google Scholar; and Grey Lit databases; with studies that presented the prevalence of immunization errors that caused events or that provided data that allowed this indicator to be calculated. Results: We evaluated 11 articles published between 2010 and 2021, indicating a prevalence of 0.044 errors per 10,000 doses administered (n=762; CI95%: 0.026 - 0.075; I2 = 99%, p < 0.01). The prevalence was higher in children under 5 (0.334 / 10,000 doses; n=14). The predominant events were fever, local pain, edema and redness. Conclusion: A low prevalence of errors causing events was identified. However, events supposedly attributable to vaccination or immunization can contribute to vaccine hesitancy and, consequently, have an impact on vaccination coverage.

RESUMEN Objetivo: Identificar la prevalencia de errores que causaron eventos supuestamente atribuibles a la vacunación o inmunización. Método: Revisión sistemática de la literatura con metaanálisis realizada en las bases de datos Medline, Cochrane Library, Cinahl, Web of Science, Lilacs, Scopus; Embase; Open Grey; Google Scholar; y Grey Lit; con estudios que presentaran la prevalencia de errores de inmunización que causaron eventos o que aportaran datos que permitieran calcular este indicador. Resultados: Se evaluaron 11 artículos publicados entre 2010 y 2021, indicando una prevalencia de 0,044 errores por cada 10.000 dosis administradas (n=762; IC95%: 0,026 - 0,075; I2 = 99%, p < 0,01). La prevalencia fue mayor en niños menores de 5 años (0,334 / 10.000 dosis; n=14). Los eventos predominantes fueron fiebre, dolor local, edema y enrojecimiento. Conclusión: Se identificó una baja prevalencia de eventos causantes de errores. Sin embargo, los eventos supuestamente atribuibles a la vacunación o inmunización pueden contribuir a la indecisión sobre la vacunación y, en consecuencia, repercutir en la cobertura vacunal.

RESUMO Objetivo: Identificar a prevalência de erros que causaram eventos supostamente atribuíveis à vacinação ou imunização. Método: Revisão sistemática da literatura com metanálise realizada nas bases Medline, Cochrane Library, Cinahl, Web of Science, Lilacs, Scopus; Embase; Open Grey; Google Scholar; e Grey Lit; com estudos que apresentassem prevalência de erros de imunização que causaram eventos ou que disponibilizassem dados que permitissem o cálculo deste indicador. Resultados: Avaliou-se 11 artigos publicados entre 2010 e 2021, apontando prevalência de 0,044 erros por 10.000 doses administradas (n=762; IC95%: 0,026 - 0,075; I2= 99%, p < 0,01). A prevalência foi maior em crianças menores de 5 anos (0,334 / 10.000 doses; n=14). Quanto aos eventos, predominou-se: febre, dor local, edema, rubor. Conclusão: Identificou-se uma prevalência baixa de erros que causaram eventos. Entretanto, os eventos supostamente atribuíveis à vacinação ou imunização podem contribuir para a hesitação vacinal e, consequentemente, impactar nas coberturas vacinais.

Determinantes del estado de vacunación infantil: abordando la brecha de equidad en República Dominicana-2019 / Determinants of childhood immunization status: addressing the equity gap in the Dominican Republic­2019

Introducción: Las desigualdades amenazan el progreso del país hacia la equidad y la cobertura de vacunación infantil. Siendo la cobertura inferior a la meta del 90% de la Organización Mundial de la Salud. Objetivo: Identificar los determinantes sociales y las desigualdades en el estado de vacunación infantil en República Dominicana, 2019. Métodos: Se realiza un análisis basado en la Encuesta de Indicadores Múltiples por Conglomerados. Incluyendo una muestra ponderada de 1674 niños de 12-23 meses. Se calcula la regresión logística multinomial para identificar factores asociados a la vacunación. Adoptando p<0,05 para significación estadística. Utilizando una razón de probabilidades ajustada con intervalo de confianza del 95%. Empleando HEAT 4.0 para medir desigualdades y SPSS.23 para gestión y análisis de datos. Resultados: La edad media de los niños fue 17,4±3,5 meses. El 33% de ellos estaban completamente vacunados. La cobertura fue significativamente menor entre hijos de madre sin educación [AOR= 7,27; IC95%= 2,98­17,74]. La mayor cobertura se concentra en niños con altos niveles de educación y riqueza. Conclusión: Para lograr una cobertura de vacunación completa y equitativa, las intervenciones de salud pública deben diseñarse para satisfacer las necesidades de grupos de alto riesgo.

Introduction: In the Dominican Republic, inequalities threaten progress towards childhood vaccination equity and coverage, the latter being inferior to the World Health Organization's 90% goal. Objective: Identify the social determinants and inequalities in the state of childhood vaccination in the Dominican Republic, 2019. Methods: An analysis based on the Multiple Indicator Cluster Surveys is conducted. Including a weighted sample of 1674 children aged 12-23 months. The multinomial logistic regression is calculated to identify factors associated with vaccination. Using p<0,05 for statistical significance and an adjusted probability ratio with a 95% confidence interval. Employing HEAT 4.0 to measure inequalities and SPSS.23 for data management and analysis. Results: The children's mean age was 17,4±3,5 months. 33% of them were completely vaccinated. Coverage was significantly lower in children of mothers without education [AOR= 7,27; CI95%= 2,98­17,74]. Coverage was the highest in kids with high levels of education and wealth. Conclusion: To achieve complete and equitable vaccine coverage, public health interventions should be designed to satisfy the needs of high-risk groups.