Epidemiología del derrame pleural paraneumónico en la infancia durante la implementación de la vacuna antineumocócica conjugada de 13 serotipos / Epidemiology of pediatric parapneumonic pleural effusion during 13-valent pneumococcal conjugate vaccine implementation

Introducción: La incidencia del derrame pleural paraneumónico, incluyendo el empiema, ha sufrido variaciones en las últimas décadas, que se han relacionado con la implantación de distintos tipos de vacuna antineumocócica conjugada. Métodos: Se han revisado retrospectivamente los datos de los 10 hospitales públicos de la provincia de Alicante (España), que abarcan una población de 279.000 niños menores de 15 años, entre 2010 y 2018. Se desglosaron los derrames menores de 10mm (DP−) y los de 10mm o más (DP+). Resultados: Se han analizado 366 episodios de derrame pleural paraneumónico, 178 DP− (48,6%) y 188 DP+ (51,4%), con una mediana de edad de 4 años (rango intercuartílico: 2-7 años) y una evidente estacionalidad con máximo en invierno y mínimo en verano. Se identificó al agente etiológico por cultivo en 34 pacientes (9,3%), destacando Streptococcus pneumoniae (24 pacientes) seguido por Streptococcus pyogenes (7 pacientes). El serotipo de S. pneumoniae más frecuente fue el 19A (6 pacientes) y se han identificado 3 fallos vacunales. La tasa anual media de incidencia fue de 14,3 casos por 100.000 menores de 15 años (7,0 para DP− y 7,3 para DP+), sin cambios significativos a lo largo del tiempo, aunque sí se apreciaron diferencias marcadas de la incidencia entre los distintos departamentos sanitarios. Conclusiones: No hemos encontrado variaciones temporales en la incidencia del derrame paraneumónico pese a la implementación de la vacuna antineumocócica conjugada de 13 serotipos. Es destacable la variabilidad de la incidencia entre departamentos vecinos sin motivo aparente.(AU)

Introduction: The reported incidence of parapneumonic pleural effusion, including empyema, has shown fluctuations in the last decades. It has been related to the implementation of different types of conjugate pneumococcal vaccines. Methods: We have retrospectively reviewed data from all 10 public hospitals in Alicante Province (Spain) covering a population of 279,000 children under 15 years of age, between 2010 and 2018. Effusions less than 10mm (PE−) and those of 10mm or more (PE+) were separated. Results: A total of 366 episodes of parapneumonic pleural effusion have been analyzed, 178 PE− (48.6%) and 188 PE+ (51.4%), with a median age of 4 years (interquartile range: 2-7 years) and marked seasonality with the maximum in winter and the minimum in summer. A culture proven bacterial agent was identified in 34 patients (9.3%), mainly Streptococcus pneumoniae (24 patients) followed by Streptococcus pyogenes (7 patients). The most frequent S. pneumoniae serotype was 19A (6 patients) and 3 vaccine failures were observed. The mean annual incidence rate was 14.3 cases per 100,000 children under 15 years of age (7.0 for PE− and 7.3 for PE+). No significant changes were observed in incidence over time, but noticeable differences in incidence were observed in different health departments. Conclusions: We have not found temporal variations in incidence of parapneumonic effusion despite the implementation of the 13-valent pneumococcal conjugate vaccine. The unexplained disparity in incidence between close departments is noteworthy.(AU)

Epidemiology of pediatric parapneumonic pleural effusion during 13-valent pneumococcal conjugate vaccine implementation.

INTRODUCTION: The reported incidence of parapneumonic pleural effusion, including empyema, has shown fluctuations in the last decades. It has been related to the implementation of different types of conjugate pneumococcal vaccines. METHODS: We have retrospectively reviewed data from all 10 public hospitals in Alicante Province (Spain) covering a population of 279,000 children under 15 years of age, between 2010 and 2018. Effusions less than 10 mm (PE-) and those of 10 mm or more (PE+) were separated. RESULTS: A total of 366 episodes of parapneumonic pleural effusion have been analyzed, 178 PE- (48.6%) and 188 PE+ (51.4%), with a median age of 4 years (interquartile range: 2-7 years) and marked seasonality with the maximum in winter and the minimum in summer. A culture proven bacterial agent was identified in 34 patients (9.3%), mainly Streptococcus pneumoniae (24 patients) followed by Streptococcus pyogenes (7 patients). The most frequent S. pneumoniae serotype was 19A (6 patients) and 3 vaccine failures were observed. The mean annual incidence rate was 14.3 cases per 100,000 children under 15 years of age (7.0 for PE- and 7.3 for PE+). No significant changes were observed in incidence over time, but noticeable differences in incidence were observed in different health departments. CONCLUSIONS: We have not found temporal variations in incidence of parapneumonic effusion despite the implementation of the 13-valent pneumococcal conjugate vaccine. The unexplained disparity in incidence between close departments is noteworthy.

Impacto de la vacuna antineumocócica en la incidencia y hospitalización de niños con neumonía adquirida en la comunidad

Introducción: A nivel mundial, el 99 % de las muertes por neumonía la sufren los niños menores de 5 años. La Organización Mundial de la Salud recomienda la inclusión de vacunas antineumocócicas en los programas de inmunización infantil con ampliación internacional para reducir muertes anuales en este grupo de edad. Objetivo: Evaluar el impacto de la vacuna antineumocócica en la incidencia y hospitalización de niños menores de 5 años con neumonía adquirida en la comunidad. Métodos: Revisión sistemática de diversas publicaciones científicas relacionadas con el tema. Las fuentes de búsqueda fueron PubMed, SciELO y Google Scholar. Las palabras clave fueron: "niños", "vacuna neumocócica" en combinación con "neumonía adquirida en la comunidad" o "child", "pneumococcalvaccines" y "pneumonia, bacterial". Se seleccionaron los artículos de corte analítico publicados desde 1 de enero de 2017 hasta 6 de octubre de 2021. Se excluyeron los artículos que no consignen autor o Digital Object Identifier System o se refieran a neumonías intrahospitalarias o nosocomiales. Análisis y síntesis de la información: De los 136 artículos encontrados se descartaron 125 por no cumplir con los criterios de inclusión y exclusión, quedaron 4 artículos para la base teórica y 7 artículos para esta revisión. Se observó que la vacuna antineumocócica PCV 13 disminuye la incidencia hasta 22 % y las tasas de hospitalización en 35 %. Conclusión: La vacunación es una estrategia de salud muy eficaz para reducir esta clase de enfermedades, prevenibles por medio de la inmunización.

Introduction: Globally, 99% of pneumonia deaths are children under 5 years old. The World Health Organization recommends the inclusion of pneumococcal vaccines in internationally expanded childhood immunization programs to reduce annual deaths in this age group. Objective: To evaluate the impact of pneumococcal vaccine on the incidence and hospitalization of children under 5 years of age with community-acquired pneumonia. Methods: Systematic review of various scientific publications related to the subject. The search sources were PubMed, SciELO and Google Scholar. The key words were: "children", "pneumococcal vaccine" in combination with "community-acquired pneumonia" or "child", "pneumococcal vaccines" and "pneumonia, bacterial". Analytical articles published from January 1, 2017 to October 6, 2021 were selected. Articles that do not include an author or Digital Object Identifier System or refer to hospital or nosocomial pneumonias were excluded. Analysis and synthesis of information: Of the 136 articles found, 125 were discarded for not meeting the inclusion and exclusion criteria, 4 articles remained for the theoretical basis and 7 articles for this review. Pneumococcal vaccine PCV 13 was found to decrease incidence by up to 22% and hospitalization rates by 35%. Conclusion: Vaccination is a very effective health strategy to reduce this kind of diseases, which are preventable through immunization.

Enfermedad neumocócica invasiva en pacientes de un hospital pediátrico de Perú, 2017-2020 / Invasive pneumococcal disease in patients from a pediatric hospital in Peru, 2017-2020

El propósito del presente estudio fue describir las características clínicas, serotipos y susceptibilidad antibiótica en pacientes con enfermedad neumocócica invasiva (ENI). Se revisaron las historias clínicas de los pacientes con ENI hospitalizados en el Instituto Nacional de Salud del Niño-Breña (Lima, Perú). Se evaluaron a 29 pacientes. La mediana de edad fue 1,9 años (rango intercuartílico 1 a 4 años). El 51,7% eran mujeres y la forma clínica de la ENI más frecuente fue la bacteriemia en 18 (62,1%) pacientes. El 65,5% tenía el esquema de vacunación completo, según el Ministerio de Salud de Perú. El 82,8% del aislamiento del germen fue de sangre. La resistencia antibiótica fue más frecuente a la eritromicina (55,2%), trimetoprim-sulfametoxazol (48,3%) y penicilina (24,1%). Los serotipos registrados fueron 6C, 19A, 23A y 24F. Un paciente falleció por meningitis. En conclusión, la ENI fue más frecuente en niños de uno a cinco años y en la forma clínica de bacteriemia. Se encontraron cinco serotipos reportados en estudios previos con resistencia a penicilina y eritromicina.

This study aimed to describe the clinical characteristics, serotypes, and antibiotic susceptibility in patients with invasive pneumococcal disease (IPD). The medical records of patients with IPD who were hospitalized at the Instituto Nacional de Salud del Niño-Breña (Lima, Peru) were reviewed. We evaluated 29 patients. The median age was 1.9 years (interquartile range: 1 to 4 years). Of the sample, 51.7% were women and the most frequent clinical form of IPD was bacteremia in 18 (62.1%) patients; 65.5% had a complete vaccination schedule, according to the Peruvian Ministry of Health. Germ isolation was performed from blood samples in 82.8% of patients. Antibiotic resistance to erythromycin (55.2%) was the most frequent, followed by resistance to trimethoprim-sulfamethoxazole (48.3%) and penicillin (24.1%). The isolated serotypes were 6C, 19A, 23A and 24F. One patient died of meningitis. In conclusion, IPD was more frequent in children aged one to five years and the most frequent clinical form was bacteremia. Five serotypes reported in previous studies were found to be resistant to penicillin and erythromycin.

The inverse correlation between serum levels of anti-pneumococcal and ferritin after pneumococcal vaccination in splenectomised beta thalassemia major

Splenectomy is necessary in beta thalassemia major patients when the spleen becomes hyperactive, leading to extreme destruction of erythrocytes. This study assessed the ferritin effect on serum pneumococcal antibody response following pneumococcal vaccination, in patients with beta thalassemia major after splenectomy. In this case series study, convenience sampling was used to recruit 347 splenectomised beta thalassemia patients under the auspices of Jahrom University of Medical Sciences. Demographic data such as age, sex, and time after splenectomy were recorded by a questionnaire. All participants had been splenectomised and received a dose of Pneumovax1 23 vaccine 14 days before surgery. The IgG antibody responses to pneumococcal vaccine and levels of serum specific ferritin were determine by commercial enzyme immunoassay kits. For the analysis, SPSS software version 16 was used. A p-value less than 0.05 was considered statistically significant. Most of the participants (63.4 percent) were hypo-responders to pneumococcal vaccine. Also, serum anti-pneumococcal IgG antibody was related to post splenectomy duration and serum ferritin (p 0.05). An important result was a relation of serum anti-pneumococcal IgG antibody to serum ferritin according to post splenectomy duration groups. Therefore, in three groups of post splenectomy duration, the serum ferritin was higher in hypo-responder than in good responder subjects. Our results indicate that serum anti-pneumococcal IgG antibody decreased with increment of serum ferritin and post splenectomy duration. Thus, there is a need to re-address the approach towards revaccination in this immune-compromised group of patients by administering a booster pneumococcal vaccination in an attempt to recover immunity and reduce morbidity(AU)

La esplenectomía es necesaria en pacientes con beta talasemia mayor cuando el bazo se vuelve hiperactivo, lo que lleva a una destrucción extrema de los eritrocitos. Este estudio evaluó el efecto de la ferritina sobre la respuesta de anticuerpos antineumocócicos en suero después de la vacunación antineumocócica, en pacientes con talasemia beta mayor a los que se les realizó esplenectomía. En este estudio de serie de casos, se utilizó un muestreo de conveniencia para reclutar a 347 pacientes con beta talasemia esplenectomizados bajo los auspicios de la Universidad de Ciencias Médicas de Jahrom. Los datos demográficos como la edad, el sexo y el tiempo después de la esplenectomía se registraron mediante un cuestionario. Todos los participantes fueron esplenectomizados y recibieron una dosis de la vacuna Pneumovax® 23, 14 días antes de la cirugía. Las respuestas de anticuerpos IgG a la vacuna neumocócica y los niveles de ferritina sérica específica se determinaron mediante estuches comerciales de inmunoensayo enzimático. Para el análisis se utilizó el programa SPSS versión 16. Un valor de p inferior a 0,05 se consideró estadísticamente significativo. La mayoría de los participantes (63,4 por ciento) resultaron hiporrespondedores a la vacuna antineumocócica. Además, el anticuerpo sérico antineumocócico IgG se relacionó con la duración de la esplenectomía y la ferritina sérica (p0,05). Un resultado importante fue la relación del anticuerpo sérico IgG antineumocócico con la ferritina sérica según los grupos de duración postesplenectomía. Por lo tanto, en tres grupos de duración posterior a la esplenectomía, la ferritina sérica fue mayor en los sujetos con hiporrespuesta que en los sujetos con buena respuesta. Nuestros resultados indican que el anticuerpo sérico IgG antineumocócico disminuyó con el incremento de la ferritina sérica y la duración posterior a la esplenectomía. Por lo tanto, existe la necesidad de volver a abordar el enfoque hacia la revacunación en este grupo de pacientes inmunocomprometidos mediante la administración de una vacunación antineumocócica de refuerzo en un intento por recuperar la inmunidad y reducir la morbilidad(AU)

Facilitating access to pneumococcal vaccine for people living with HIV: an experience report / Como facilitar el acceso a la vacuna neumocócica a las personas que viven con el VIH: informe de una experiencia / Facilitando o acesso à vacina pneumocócica para pessoas vivendo com HIV: relato de experiência

ABSTRACT The article describes a strategy to facilitate access to pneumococcal conjugate vaccine 13 (PCV-13) for people living with HIV/AIDS (PLHIV) during the COVID-19 pandemic. Method: report on the experience regarding the organization of a care service for PLHIV in the city of São Paulo to facilitate access to PCV-13 in the framework of the 2020 influenza vaccination campaign during the COVID-19 pandemic. Results: through the integration between a PLHIV care service and an Immunization Center (CRIE in Portuguese), it was possible to offer PCV-13 to PLHIV at the point of care, reducing physical barriers to access to immunization. Thus, of the 1,906 PLHIV who passed through the service during the period March 23-July 31, 2020, 84.4% (1,609) received the influenza vaccine, PCV-13 or both. Of the 1609 vaccinated, 50.6% (814) were eligible and received PCV-13. Conclusion: offering the vaccine at the point of care and orienting PLHIV on the importance of vaccination as a disease prevention strategy, identifying those eligible to receive it, was an important action carried out by the institution together with the nursing team, as a strategy to facilitate access to vaccination.

RESUMEN El artículo describe una estrategia para facilitar el acceso a la vacuna neumocócica conjugada 13 (PCV-13) a las personas que viven con VIH/SIDA (PVVS) durante la pandemia de COVID-19. Método: relato de experiencia sobre la organización de un servicio de atención a las PVVS en la ciudad de São Paulo, para facilitar el acceso a la PCV-13 en el marco de la campaña de vacunación contra la gripe de 2020, durante la pandemia de COVID-19. Resultados: a través de la integración entre un servicio de atención a las PVVS y un Centro de Inmunización (CRIE), fue posible ofrecer la PCV-13 a las PVVS en su punto de atención, reduciendo las barreras físicas para el acceso a la inmunización. Así, de las 1.906 PVVS que pasaron por el servicio durante el periodo comprendido entre el 23 de marzo y el 31 de julio de 2020, el 84,4% (1.609) recibieron la vacuna de la gripe, la PCV-13 o ambas. De los 1609 vacunados, el 50,6% (814) eran elegibles y recibieron la PCV-13. Conclusión: ofrecer la vacuna en el lugar de atención y orientar a las PVVS sobre la importancia de la vacunación como estrategia de prevención de enfermedades, identificando a las personas elegibles para recibirlas, fue una acción importante realizada por la institución junto con el equipo de enfermería, como estrategia para facilitar el acceso a la vacunación.

RESUMO Descrever uma estratégia para facilitar o acesso à vacina conjugada pneumocócica 13-valente (PCV-13) para pessoas vivendo com HIV (PVHIV), durante a pandemia de COVID-19. Método: relato de experiência sobre a organização de um serviço de atendimento para PVHIV na cidade de São Paulo, para facilitar o acesso à PCV-13 no decorrer da campanha de vacinação de influenza de 2020, durante a pandemia de COVID-19. Resultados: por meio da integração entre um serviço de atendimento para PVHIV e um Centro de Imunizações (CRIE) foi possível oferecer a PCV-13 para as PVHIV em seu local de atendimento, diminuindo barreiras físicas de acesso à imunização. Dessa forma, das 1906 PVHIV que passaram pelo serviço durante o período de 23 de março a 31 de julho de 2020, 84,4% (1609) receberam a vacina influenza, PCV-13 ou ambas. Dos 1609 vacinados, 50,6% (814) foram elegíveis e receberam a PCV-13. Conclusão: oferecer a vacina em seu local de tratamento e orientar as PVHIV sobre a importância da vacinação como estratégia de prevenção de doenças, identificando os elegíveis a recebê-las, foi uma importante ação realizada pela instituição em conjunto com a equipe de enfermagem, como estratégia de facilitar o acesso à vacinação.

Necrotizing pneumonia due to Streptococcus pneumoniae in children during the period of non-systematic use of PCV13 in Catalonia, Spain.

BACKGROUND: Some studies have observed an increased incidence of necrotizing pneumonia (NP) in recent years. This might be related to the emergence of non-vaccine S. pneumoniae serotypes after PCV7 introduction although it is suggested that evolutionary factors may have modified the virulence and the interactions of pneumococci. The aim of this study was to clinically and microbiologically define NP in the population served by the three major paediatric hospitals in Barcelona (Catalonia, Spain). METHODS: A prospective observational study was conducted in patients <18 years hospitalized due to invasive pneumococcal disease (January 2012-June 2016). Data of confirmed cases of pneumococcal NP (diagnosed by culture or DNA detection and serotyped) were collected. PCV13 was not systematically administered in Catalonia during the study period, but was available in the private market so the vaccination coverage in children increased from 48.2% to 74.5%. RESULTS: 35 cases of NP were identified. 77.1% of cases were associated with empyema. In the first 4 years, a trend to a decrease in NP incidence was observed (p=0.021), especially in children <5 years (p=0.006). Serotype 3 was responsible for 48.6% of NP cases. Five patients with NP due to serotype 3 were fully vaccinated for their age with PCV13. CONCLUSIONS: Serotype 3 has a preeminent role in pneumococcal NP and was associated with all PCV13 vaccination failures. Although in our series the incidence does not seem to be increasing, evolution of pneumococcal NP rates should be monitored after inclusion of PCV13 in the systematic calendar.

Necrotizing pneumonia due to Streptococcus pneumoniae in children during the period of non-systematic use of PCV13 in Catalonia, Spain / Neumonía necrosante por Streptococcus pneumoniae en niños durante el periodo de uso no sistemático de la PCV13 en Cataluña, España

Background: Some studies have observed an increased incidence of necrotizing pneumonia (NP) in recent years. This might be related to the emergence of non-vaccine S. pneumoniae serotypes after PCV7 introduction although it is suggested that evolutionary factors may have modified the virulence and the interactions of pneumococci. The aim of this study was to clinically and microbiologically define NP in the population served by the three major paediatric hospitals in Barcelona (Catalonia, Spain). Methods: A prospective observational study was conducted in patients <18 years hospitalized due to invasive pneumococcal disease (January 2012–June 2016). Data of confirmed cases of pneumococcal NP (diagnosed by culture or DNA detection and serotyped) were collected. PCV13 was not systematically administered in Catalonia during the study period, but was available in the private market so the vaccination coverage in children increased from 48.2% to 74.5%. Results: 35 cases of NP were identified. 77.1% of cases were associated with empyema. In the first 4 years, a trend to a decrease in NP incidence was observed (p=0.021), especially in children <5 years (p=0.006). Serotype 3 was responsible for 48.6% of NP cases. Five patients with NP due to serotype 3 were fully vaccinated for their age with PCV13. Conclusions: Serotype 3 has a preeminent role in pneumococcal NP and was associated with all PCV13 vaccination failures. Although in our series the incidence does not seem to be increasing, evolution of pneumococcal NP rates should be monitored after inclusion of PCV13 in the systematic calendar.(AU)

Antecedentes: En algunos estudios se ha observado un aumento de la incidencia de neumonía necrosante (NN) en los últimos años. Dicho aumento podría estar asociado a la aparición de serotipos de S. pneumoniae no vacunales después de la introducción de la PCV7, aunque se sugiere que factores evolutivos podrían haber modificado la virulencia y las interacciones de los neumococos. El objetivo de este estudio fue definir clínica y microbiológicamente la NN en la población tratada en los 3 hospitales pediátricos principales de Barcelona (Cataluña, España). Métodos: Se llevó a cabo un estudio observacional prospectivo en pacientes <18 años hospitalizados a causa de una enfermedad neumocócica invasiva (enero de 2012-junio de 2016). Se recopilaron datos de casos confirmados de NN neumocócica (diagnosticada mediante cultivo o detección de ADN y serotipado). La PCV13 no se administró de forma sistemática en Cataluña durante el periodo del estudio, pero se encontraba disponible en el mercado privado, por lo que la cobertura de vacunación en niños pasó del 48,2 al 74,5%. Resultados: Se identificaron 35 casos de NN. El 77,1% de los casos estuvieron asociados a un empiema. En los primeros 4 años se observó una tendencia decreciente de la incidencia de NN (p=0,021), especialmente en niños <5 años (p=0,006). El serotipo 3 causó el 48,6% de los casos. Cinco pacientes con NN debida al serotipo 3 estaban completamente vacunados para su edad con la PCV13. Conclusiones: El serotipo 3 desempeña un papel prominente en la NN neumocócica y se asoció a todos los fracasos de vacunación de la PCV13. Aunque en nuestra serie la incidencia no parece estar aumentando, debe controlarse la evolución de las tasas de NN neumocócica tras la inclusión de la PCV13 en el calendario sistemático.(AU)

Mortalidad por neumonía y por todas las causas en niños menores de 5 años en Colombia entre el 2005 y 2016 / Pneumonia and all causes mortality in children under 5 year old in Colombia between 2005 and 2016

RESUMEN Introducción: Las infecciones neumocócicas son una de las causas más importantes de enfermedades en niños menores de 5 años en Colombia. Objetivo: Calcular la mortalidad por neumonía y por todas las causas en niños menores de 5 años en Colombia. Métodos: Estudio ecológico, los principales desenlaces del estudio fue mortalidad por todas las causas y neumonía (CIE-10 J12-18). Resultados: Durante el año 2005 al 2016 se encontraron un total de 122.074 muertes por todas las causas, de las cuales 13359 (10.94%) correspondieron a muerte por neumonía, 750 a meningitis (0.61%) y 17.511 a muerte por otras causas respiratorias (14.34%). Conclusiones: Se ha observado una disminución de la mortalidad en las tasas de mortalidad por todas las causas, y las demás estudiadas en este artículo.

ABSTRACT Introduction: Pneumococcal infections are one of the most important causes of diseases in children under 5 years old in Colombia. Objective: Evaluate mortality from pneumonia and all causes in children under 5 years old in Colombia. Methods: Ecological study, the main outcomes of the study was all-cause mortality and pneumonia (ICD-10 J12-18). Results: During 2005 to 2016, a total of 122,074 deaths were found for all causes, of which 13,359 (10.94%) corresponded to death due to pneumonia, 750 to meningitis (0.61%) and 17,511 to death due to other respiratory causes (14.34% ). Conclusions: A decrease in mortality has been observed in all-cause mortality rates, and the others studied death causes in this article.

Bases inmunológicas de la enfermedad neumocócica y el candidato vacunal PVC7-TT / Immunological bases of pneumococcal disease and vaccine candidate PVC7-TT

Introducción: Las enfermedades infecciosas del tracto respiratorio se encuentran entre las primeras causas de entidades respiratorias en edades extremas de la vida. Objetivo: Describir las bases inmunológicas de la enfermedad y el nuevo candidato vacunal conjugado antineumocócico PCV7-TT desarrollado en Cuba. Métodos: Se realizó una búsqueda en las bases de datos Medline, Pubmed, SciELO, LILACS, Cochrane Library y Web of Science, de documentos publicados entre mayo del 2018 y marzo del 2020. Se seleccionaron los 64 artículos de mayor relevancia y novedad. Resultados: Streptococcus pneumoniae es el agente etiológico de la enfermedad neumocócica; se le atribuye alrededor de un millón de defunciones anuales, principalmente en países en vías de desarrollo. Es un coco Gram-positivo, anaerobio facultativo y encapsulado que se encuentra dividido en 48 serogrupos y 97 serotipos tipificados. Presenta varios factores de virulencia que garantizan su mecanismo de patogenicidad; uno de los más importantes es el polisacárido capsular que constituye la diana de las vacunas antineumocócicas conjugadas y no conjugadas existentes. En el presente artículo se consideró la proteína de superficie C del neumococo como un posible candidato en la investigación y desarrollo de vacunas preventivas. Asimismo, las vesículas extracelulares podría ser un posible candidato para adyuvante vacunal con fines preventivos y terapéuticos. Conclusiones: El neumococo es un problema de salud a nivel global y el uso de vacunas conjugadas antineumocócicas constituye la herramienta más eficaz para su prevención. El candidato vacunal PCV7-TT desarrollado en Cuba es seguro, bien tolerado, inmunogénico y no inferior a las vacunas actualmente registradas(AU)

Introduction: Infectious diseases of the respiratory tract are among the leading causes of respiratory conditions in patients at extreme ages. Objective: Describe the immunological bases of the disease and the new conjugate pneumococcal vaccine candidate PCV7-TT developed in Cuba. Methods: A search was conducted in the databases Medline, Pubmed, SciELO, LILACS, Cochrane Library and Web of Science for documents published from May 2018 to March 2020. The 64 most relevant and novel papers were selected. Results: Streptococcus pneumoniae is the causative agent of pneumococcal disease, a condition causing about one million deaths a year worldwide, mainly in developing countries. It is a Gram-positive facultative anaerobic encapsulated coccus divided into 48 serogroups and 97 typified serotypes. Several virulence factors ensure its pathogenicity mechanism. One of the most important of these is the capsular polysaccharide constituting the target of the existing conjugate and non-conjugate pneumococcal vaccines. The study considered pneumococcal surface protein C as a possible candidate for the research and development of preventive vaccines. On the other hand, extracellular vesicles could be a possible vaccine adjuvant candidate for preventive and therapeutic use. Conclusions: Pneumococcus is a global health problem, and the use of conjugate pneumococcal vaccines is the most effective tool for its prevention. The vaccine candidate PCV7-TT developed in Cuba is safe, well-tolerated, immunogenic and not inferior to the vaccines so far registered(AU)

Necrotizing pneumonia due to Streptococcus pneumoniae in children during the period of non-systematic use of PCV13 in Catalonia, Spain.

BACKGROUND: Some studies have observed an increased incidence of necrotizing pneumonia (NP) in recent years. This might be related to the emergence of non-vaccine S. pneumoniae serotypes after PCV7 introduction although it is suggested that evolutionary factors may have modified the virulence and the interactions of pneumococci. The aim of this study was to clinically and microbiologically define NP in the population served by the three major paediatric hospitals in Barcelona (Catalonia, Spain). METHODS: A prospective observational study was conducted in patients <18 years hospitalized due to invasive pneumococcal disease (January 2012-June 2016). Data of confirmed cases of pneumococcal NP (diagnosed by culture or DNA detection and serotyped) were collected. PCV13 was not systematically administered in Catalonia during the study period, but was available in the private market so the vaccination coverage in children increased from 48.2% to 74.5%. RESULTS: 35 cases of NP were identified. 77.1% of cases were associated with empyema. In the first 4 years, a trend to a decrease in NP incidence was observed (p=0.021), especially in children <5 years (p=0.006). Serotype 3 was responsible for 48.6% of NP cases. Five patients with NP due to serotype 3 were fully vaccinated for their age with PCV13. CONCLUSIONS: Serotype 3 has a preeminent role in pneumococcal NP and was associated with all PCV13 vaccination failures. Although in our series the incidence does not seem to be increasing, evolution of pneumococcal NP rates should be monitored after inclusion of PCV13 in the systematic calendar.

Trends of invasive pneumococcal disease and its serotypes in the Autonomous Community of Madrid. / Evolución de la enfermedad neumocócica invasora y sus serotipos en la Comunidad de Madrid.

INTRODUCTION: Streptococcus pneumoniae is an important cause of morbidity. Vaccination is the most effective measure to prevent it. The aim of this study is to analyse the evolution of invasive pneumococcal disease (IPD). MATERIAL AND METHODS: Observational study of IPD cases notified to the Epidemiological Surveillance Network of the Autonomous Community of Madrid between 2008 and 2015. The IPD case was defined as the disease caused by Streptococcus pneumoniae, with isolation and DNA or antigen detection, in samples from normally sterile sites. The isolated strains were sent to the Regional Public Health Laboratory for identification of the serotype. Serotypes were classified according to their inclusion in the 7-valent conjugate vaccine (PCV7), in the 13-valent vaccine, but not in the 7-valent vaccine (PCV13-additional) and not included in the 13-valent vaccine (non-PCV). The Incidence Rate Ratios (IRRs) were calculated comparing the 2011-2012 and 2013-2015 periods with the 2008-2010 period. RESULTS: 4,307 cases were reported. 86.6% were serotyped. The IRR of IPD was 0.67 and 0.67 for all serotypes; 0.43 and 0.45 for PCV7 serotypes; 0.46 and 0.25 for PCV13-additional serotypes, and 1.01 and 1.32 for non-PCV13 serotypes in the 2011-2012 and 2013-2015 periods. The incidence of serotypes 8, 9N, 10A, 23B, 24F and serogroup 33 increased significantly in the 2013-2015 period. Serotypes 15B and 24F accounted for 24% of non-PCV13 cases in children under 5years, serotypes 8 and 9N for 51% in the population aged 5 to 59years and serotypes 8 and 22F for 25% in the population aged over 59years. CONCLUSIONS: The incidence of serotypes not included in conjugate vaccines has increased, especially in children under 5years, but the total incidence of IPD has decreased. It is important to continue with the epidemiological and microbiological surveillance programmes to assess the effect of vaccination on the incidence of IPD.

Efecto de la vacuna antineumocócica conjugada 10-valente en el área sur de Santiago de Chile, 2009-2015 / Impact of the 10-valent pneumococcal conjugate vaccine on the southern area of Santiago (Chile), 2009-2015 / Efeito da vacina pneumocócica 10-valente conjugada na região sul de Santiago, Chile, 2009-2015

RESUMEN Objetivo El objetivo de este estudio fue evaluar el efecto de la incorporación de la vacuna antineumococica 10-valente (PCV 10) en la incidencia de la enfermedad neumocócica invasora (ENI) y en la neumonía adquirida en la comunidad (NAC) en niños hospitalizados menores de 5 años en el área sur de Santiago de Chile. Métodos Se realizó un estudio ecológico de la incidencia de ENI y NAC en menores de 5 años del área sur de Santiago de Chile de 2009 a 2015. Las fuentes de información utilizadas fueron las de los laboratorios de bacteriología de cuatro hospitales, del Instituto de Salud Pública de Chile (ISP) y los registros de egresos hospitalarios. Resultados Un total de 6 461 casos de NAC y 173 casos de ENI fueron confirmados por el ISP, de los cuales 169 casos fueron diagnosticados en los laboratorios de bacteriología de los hospitales incluidos en el estudio. Al comparar la incidencia de casos de 2010 frente a 2011-2015, la razón de incidencias (RI) de ENI se redujo 10% anualmente (p = 0,026) y la de NAC, 8% en el mismo período (p <0,001). El total de días cama ocupados en el período 2009-2015 fue de 39 565 con una mediana de días cama ocupados entre 4 y 5. Hasta 2012 fallecieron 7 niños y desde entonces no ha habido fallecimientos por estas enfermedades. Conclusiones La incorporación de la vacuna PCV-10 en el Programa Nacional de Inmunizaciones tuvo un efecto positivo, con una reducción significativa de las ENI y NAC y de la ocupación de camas por ENI y evitó casos y muertes.

ABSTRACT Objective The objective of this study was to evaluate the impact of the introduction of the 10-valent pneumococcal conjugate vaccine (PCV10) on the incidence of invasive pneumococcal disease (IPD) and on community-acquired pneumonia (CAP) in hospitalized children under 5 years of age in the southern area of Santiago, Chile. Methods An ecological study was conducted on the incidence of IPD and CAP in children under age 5 in the southern area of Santiago (Chile) from 2009 to 2015. The information used was from bacteriology laboratories in four hospitals, the Chilean Institute of Health Public (ISP), and hospital discharge records. Results A total of 6,461 cases of CAP and 173 cases of IPD were confirmed by the ISP; 169 of these cases were diagnosed in the bacteriology laboratories of the hospitals included in the study. When the incidence of cases in 2010 was compared to 2011-2015, the incidence ratio (IR) of IPD declined 10% annually (p=0.026) and CAP declined by 8% in the same period (p<0.001). Days of hospitalization due to IPD were reduced by 39% (p<0.001). Between 2009 and 2012, seven children died, but since then there have been no deaths due to these diseases. Conclusions The introduction of the PCV-10 vaccine into the National Immunization Program has had a positive effect, with a significant reduction in IPD and CAP and in days of hospitalization due to IPD, while preventing cases and deaths.

RESUMO Objetivo Avaliar o efeito da incorporação da vacina pneumocócica 10-valente (PCV 10) na incidência de doença pneumocócica invasiva (DPI) e pneumonia adquirida na comunidade (PAC) em crianças menores de cinco anos internadas em hospital. Métodos Foi realizado um estudo ecológico da incidência de DPI e PAC em crianças menores de cinco anos na região sul de Santiago, no Chile, de 2009 a 2015. As fontes de informação usadas foram os registros dos laboratórios de bacteriologia de quatro hospitais, dados do Instituto de Saúde Pública do Chile (ISP) e registros de altas hospitalares. Resultados Ao todo, 6.461 casos de PAC e 173 casos de DPI foram confirmados pelo ISP, dos quais 169 casos foram diagnosticados nos laboratórios de bacteriologia dos hospitais participantes do estudo. Ao comparar a incidência de casos entre 2010 e o período de 2011-2015, observou-se um declínio de 10% na taxa de incidência anual de DPI (p = 0,026) e de 8% na de PAC no mesmo período (p<0,001). Os dias de leito ocupado por DPI tiveram uma redução de 39% ao ano (p <0,001). Sete crianças morreram até 2012 e a partir daí não ocorreram mais mortes por estas doenças. Conclusões A incorporação da vacina PCV-10 no programa nacional de vacinação surtiu um efeito positivo: houve uma redução significativa do número de casos de DPI e PAC e da ocupação de leitos por DPI e casos e mortes foram evitados.

Community acquired pneumonia incidence among children less than 5 years of age in Concordia, Argentina: vaccination impact / Incidencia de la neumonía extrahospitalaria en menores de 5 años en Concordia (Argentina): repercusión de la vacunación / Incidência de pneumonia adquirida na comunidade em crianças menores de 5 anos em Concordia, Argentina: impacto da vacinação

ABSTRACT Objective To measure the effectiveness of pneumococcal conjugated vaccine (PCV13) against Community Acquired Pneumonia (CAP) and invasive pneumococcal disease, 2 years after the vaccine (2+1) was included into the National Immunization Program of Argentina, and to describe variables associated with bacterial pneumonia and hospitalization. Methods This was a prospective, population-based surveillance study of CAP incidence (ambulatory and hospitalized) among children less than 5 years of age in the Department of Concordia (Entre Rios, Argentina) from April 2014 - March 2016. The diagnosis of probable bacterial pneumonia (PBP) was determined following the standardized WHO protocol. Incidence during the post-vaccine introduction period was compared with the results from a previous study that used similar methodology for the pre-PCV13 introduction period from 2002 - 2005. Results During the study period, 330 patients had a clinical diagnosis of CAP, of which 92 were PBP (6 with pleural effusion). S. pneumoniae was not isolated from any sample. No factors associated with PBP were found in multivariable analysis. The decrease in PBP and pleural effusion was significant in relation to the previous study: 63% (P < 0.0001) and 80.9% (P < 0.003), respectively. PCV13 uptake was 97.3% for the 1st dose and 84.8% for the booster dose. Conclusions PCV13 was effective to reduce incidence of consolidated pneumonia and pleural effusion, among children less than 5 years of age in Concordia, Argentina. Vaccination is a very effective public health strategy for reducing vaccine preventable diseases, with impact on burden of disease and hospitalization.

RESUMEN Objetivo Medir la efectividad de la vacuna antineumocócica conjugada (VNC13)contra la neumonía extrahospitalaria y las enfermedades neumocócicas invasoras, dos años después de que se incorporara la vacuna (2+1) en el Programa Nacional de Vacunación de Argentina, y describir las variables asociadas con la neumonía bacteriana y la hospitalización. Métodos Se llevó a cabo un estudio prospectivo de vigilancia poblacional de la incidencia de la neumonía extrahospitalaria (pacientes ambulatorios y hospitalizados) en menores de 5 años en el departamento Concordia (Entre Ríos, Argentina) desde abril del 2014 hasta marzo del 2016. Se determinó el diagnóstico de probable neumonía bacteriana según el protocolo estandarizado de la OMS. Se comparó la incidencia durante el período posterior a la incorporación de la vacuna con los resultados de un estudio anterior en el que se usó una metodología similar para el período previo a la incorporación de la VNC13 entre el 2002 y el 2005. Resultados Durante el estudio, 330 pacientes presentaron un diagnóstico clínico de neumonía extrahospitalaria, de los cuales 92 presentaron probable neumonía bacteriana (6 con derrame pleural). No se aisló ninguna muestra del S. pneumoniae. No se encontraron factores asociados con la neumonía bacteriana probable en el análisis multivariante. La disminución de la neumonía bacteriana probable y el derrame pleural fue significativa en relación con el estudio anterior: 63 % (P < 0,0001) y 80,9 % (P < 0,003), respectivamente. La absorción de la VNC13 fue de 97,3 % para la primera dosis y de 84,8 % para la dosis de refuerzo. Conclusiones La VNC13 fue efectiva para reducir la incidencia consolidada de derrame pleural y neumonía en menores de 5 años en Concordia (Argentina). La vacunación es una estrategia de salud pública muy efectiva para reducir las enfermedades prevenibles por vacunación, con repercusión en la carga de enfermedad y la hospitalización.

RESUMO Objetivo Avaliar a efetividade da vacina pneumocócica conjugada (PCV13) em prevenir pneumonia adquirida na comunidade (PAC) e doença pneumocócica invasiva (DPI) após 2 anos da incorporação da vacina (2 + 1) ao Programa Nacional de Vacinação da Argentina e descrever as variáveis associadas à ocorrência de pneumonia bacteriana e internação hospitalar. Métodos Estudo prospectivo de base populacional de vigilância da incidência de PAC (atendimento ambulatorial e em internação hospitalar) em crianças menores de 5 anos de idade realizado no Departamento de Concordia, Entre Rios, na Argentina, de abril de 2014 a março de 2016. O diagnóstico de provável pneumonia bacteriana foi determinado segundo o protocolo padronizado da OMS. A incidência no período pós-introdução da vacina foi comparada aos resultados de um estudo anterior realizado com metodologia semelhante no período pré-introdução da PCV13 de 2002 a 2005. Resultados No período de estudo, foi feito o diagnóstico clínico de PAC em 330 pacientes, dos quais 92 foram casos de provável pneumonia bacteriana (6 com derrame pleural). A bactéria Streptococcus pneumoniae não foi isolada em nenhuma amostra. Não foi observado nenhum fator associado à provável pneumonia bacteriana na análise multivariada. Houve uma redução significativa da ocorrência de provável pneumonia bacteriana e derrame pleural em relação ao estudo anterior: 63% (P < 0,0001) e 80,9% (P < 0,003), respectivamente. A cobertura vacinal de PCV13 foi de 97,3% para a primeira dose e 84,8% para a dose de reforço. Conclusões A PCV13 foi efetiva em reduzir a incidência de pneumonia com consolidação e derrame pleural em crianças menores de 5 anos em Concordia, na Argentina. A vacinação é uma estratégia de saúde pública muito efetiva para reduzir doenças que podem ser evitadas com vacina, com impacto na morbidade e nas internações hospitalares.

Impacto da vacina pneumocócica na redução das internações hospitalares por pneumonia em crianças menores de 5 anos, em Santa Catarina, 2006 a 2014 / El impacto de la vacuna neumocócica en la reducción de las hospitalizaciones por neumonía en niños menores de 5 años, en Santa Catarina, Brasil, 2006 a 2014 / The impact of pneumococcal vaccine in reducing pneumonia hospitalizations in children under 5 years old, in Santa Catarina, Brazil, 2006 a 2014

Objetivo: analisar o impacto da vacina pneumocócica conjugada (PCV10) nas internações hospitalares por pneumonia em menores de 5 anos de idade, em Santa Catarina, Brasil, no período 2006-2014. Métodos: estudo ecológico com dados do Departamento de Informática do Sistema Único de Saúde (Datasus) em 2006-2009 (período pré-vacinal) e 2010-2014 (período pós-vacinal); tendências temporais foram avaliadas pelo coeficiente de regressão de Poisson. Resultados: comparados os períodos pré e pós-vacinal, a diferença percentual da taxa de internação por pneumonia em menores de 1 ano variou de -44,1% na região Oeste a -1,4% no Planalto Serrano, e nas crianças de 1-4 anos, de -37,1% no Planalto Norte a 16,9% no Planalto Serrano (p<0,05), implicando reduções nas taxas de internação no estado de 23,3% em <1 ano e de 8,4% em crianças de 1-4 anos. Conclusão: observou-se redução significativa da taxa de internação por pneumonia em menores de 1 ano, sugerindo a efetividade da vacina.

Objetivo: analizar el impacto de la vacuna neumocócica conjugada (PCV10) en las internaciones por neumonía, en niños, en Santa Catarina, Brasil, en 2006-2014. Métodos: estudio ecológico con datos del Departamento de Informática del Sistema Único de Salud (Datasus), entre 2006-2009 y 2010-2014; se evaluaron las tendencias temporales por medio del coeficiente de regresión de Poisson. Resultados: comparados ambos períodos, la diferencia porcentual de la tasa de internación por neumonía en menores de 1 año varió de -44,1% en la región Oeste a -1,4% en el Planalto Serrano, y en los niños de 1-4 años, de -37,1% en el Planalto Norte al 16,9% en el Planalto Serrano (p<0,05, siendo la reducción en las tasas de internación en el estado del 23,3% en <1 año y del 8,4% en 1-4 años. Conclusión: se observó una reducción significativa de la tasa de internación por neumonía en menores de un año, sugiriendo la efectividad de la vacuna.

Objective: to analyze the impact of pneumococcal conjugate vaccine (PCV10) on pneumonia hospital admissions among children in Santa Catarina, Brazil, 2006-2014. Methods: this was an ecological study using data obtained from Brazilian National Health System Information Technology Department (Datasus) for 2006-2009 (pre-vaccination period) and 2010-2014 (post-vaccination period); time trends were evaluated using the Poisson regression coefficient. Results: in the comparison between pre- and post-vaccination periods, the percentage difference in the hospitalization rate for children under 1 year old ranged from -44.1% in the Western region to -1.4% in the Serrano Plateau region, and in children between 1-4 years old it ranged from -37.1% in the Northern Plateau region to 16.9% in the Serrano Plateau region (p<0.05); hospitalization rates in the state reduced by 23.3% in children under 1 year old and by 8.4% in those aged 1-4 years. Conclusion: a significant reduction in the rate of pneumonia hospitalization in children under 1 year old age was found, suggesting the effectiveness of the vaccine in reducing hospitalizations.

Resistencia antibiótica y distribución de serotipos en cepas neumocócicas invasivas en adultos hospitalizados en Lima, Perú / Antibiotic resistance and distribution of serotypes of invasive pneumococcal strains isolated from hospitalized adults in Lima, Peru

RESUMEN Objetivos. Describir las características clínicas, resistencia antibiótica y distribución de serotipos de cepas causantes de enfermedad neumocócica invasiva (ENI) en adultos. Materiales y métodos. Estudio tipo serie de casos. Se recolectaron cepas de neumococo de pacientes adultos hospitalizados con ENI en cinco hospitales nacionales y dos laboratorios de Lima durante los años 2009-2011. Resultados. Se estudiaron datos de 43 pacientes con ENI, el 58,2% fueron mayores de 60 años. Los diagnósticos fueron neumonía 39,5%, meningitis 30,2%, bacteriemia 13,9%, peritonitis 11,6%, artritis séptica 4,8%. El porcentaje de fallecidos fue 28,9%, de los cuales el 72,7% fueron mayores de 60 años. Las cepas de neumococo presentaron la siguiente resistencia: penicilina 0% en cepas no meningitis y 30,8% en cepas meningitis; ceftriaxona 4,5% y 16,7% de resistencia intermedia en cepas no meningitis y cepas meningitis respectivamente; 69% a trimetoprim/sulfametoxazol y 35,7% a eritromicina. Los serotipos más comunes fueron 19F, 23F, 6B, 14 y 6C. El porcentaje de cepas vacunales fue 44,2% para la vacuna conjugada siete-valente (PCV7) y para la PCV10, 51,2% para PCV13 y 60,4% para la vacuna polisacárida veintitrés-valente (PPV23). Conclusiones. El neumococo es un patógeno relevante en adultos, en especial en los adultos mayores, debido a su elevada mortalidad.

ABSTRACT Objectives. To describe the clinical characteristics, antibiotic resistance, and distribution of serotypes of bacterial strains that cause invasive pneumococcal disease (IPD) in adults. Materials and methods. Case series. Pneumococcal strains were isolated from 2009 to 2011 from hospitalized adult patients with IPD in five hospitals and two laboratories located in Lima. Results. The analysis of data from 43 patients with IPD indicated that 58.2% were older than 60 years. The most common complications were pneumonia (39.5%), meningitis (30.2%), bacteremia (13.9%), peritonitis (11.6%), and septic arthritis (4.8%). The mortality rate was 28.9%, and 72.7% of cases involved patients older than 60 years. The pneumococcal strains were resistant to the following antibiotics: penicillin, 0% and 30.8% in non-meningitis and meningitis strains, respectively; ceftriaxone, 4.5% and 16.7% in non-meningitis and meningitis strains, respectively; trimethoprim/sulfamethoxazole, 69.0%; and erythromycin, 35.7%. The most common serotypes were 19F, 23F, 6B, 14, and 6C. The percentage of vaccine strains was 44.2% for the 7-valent conjugate pneumococcal vaccine (PCV7) and PCV10, 51.2% for PCV13, and 60.4% for the 23-valent polysaccharide vaccine (PPV23). Conclusions. Pneumococcus is an important pathogen in adults, particularly in older adults, owing to its high mortality rate.

Meningitis por Streptococcus pneumoniae en paciente pediátrico previamente inmunizado: reporte de un caso / Streptococcus pneumoniae meningitis in a previously immunized pediatric patient: report of a case

La meningitis bacteriana constituye una importante causa de morbimortalidad en el mundo y, a pesar de que la incidencia se ha reducido en los años posteriores a la inclusión de la vacuna antineumocócica en los calendarios de inmunizaciones, no se ha podido evitar el surgimiento de cepas emergentes. Presentamos el caso de una paciente de 5 años con inmunizaciones completas para la edad, con un cuadro clínico sugerente de meningoencefalitis, cuya evolución (con gran compromiso sistémico y pobre respuesta al tratamiento) nos hizo sospechar de la presencia de cepas emergentes y/o resistencia antimicrobiana, en el planteamiento de interrogantes respecto a estados de inmunodeficiencia o respuesta inadecuada a la vacunación, el impacto que realmente tiene la vacuna en nuestro país y la necesidad de realizar una más stricta vigilancia epidemiológica para la identificación de serotipos emergentes

Bacterial meningitis is an important cause of morbidity and mortality all over the world; and, in spite of a reduction in its incidence because of the introduction of an anti-pneumococcal vaccine in the immunization programs in many places, the occurrence of emerging strains has not been stopped. We present the case of a 5-year old girl with complete immunizations for her age, with a clinical condition suggesting meningoencephalitis, whose progress and outcome (significant systemic involvement and poor response to therapy) lead us to think in the possibility of emerging strains and/or resistance to antibacterial agents, and also to ask ourselves about an underlying immune deficiency or inadequate response to vaccination, the real impact of the vaccine in our country, and the need for performing more stringent epidemiological vigilance in order to identify emerging serotypes

Self-reported vaccination in the elderly: SABE Bogotá study, Colombia / El auto reporte de vacunación en los adultos mayores: Estudio SABE Bogotá, Colombia

Objectives: To determine the frequency of vaccination in older adults within the city of Bogotá and to estimate the association with sociodemographic and health factors. Methods: This is a secondary data analysis from the SABE-Bogotá Study, a cross-sectional population-based study that included a total of 2,000 persons aged 60 years. Weighted percentages for self-reported vaccination [influenza, pneumococcal, tetanus] were determined. The association between vaccination and covariates was evaluate by logistic regression models. Results: A total of 73.0% of respondents received influenza, 57.8% pneumococcal and 47.6% tetanus vaccine. Factors independently associated with vaccination included: 1- age (65-74 years had higher odds of receiving vaccinations, compared to 60-64 years; 2socioeconomic status (SES) (higher SES had lower odds of having influenza and pneumococcal vaccines, compared to those with lower SES); 3- health insurance (those with contributive or subsidized health insurance had higher odds (between 3 and 5 times higher) of having vaccinations, compared to those with no insurance); 4- older adults with better functional status (greater Lawton scores) had increased odds for all vaccinations; 5- older adults with higher comorbidity had increased odds for influenza and pneumococcal vaccinations. Conclusion: Vaccination campaigns should be strengthened to increase vaccination coverage, especially in the group more reticent to vaccination or vulnerable to reach it such as the disable elder.

Objetivos: determinar la frecuencia de vacunación en la población adulta mayor de la ciudad de Bogotá, y estimar la asociación con factores sociodemográficos y de salud. Métodos: Este es un análisis secundario de datos del estudio SABE-Bogotá, un estudio poblacional transversal que incluyó un total de 2,000 personas mayores de 60 años. Se obtuvieron porcentajes ponderados del auto-reporte de vacunación (influenza, neumococo, tétano). La asociación entre la vacunación y otras variables se evaluó mediante modelos de regresión logística. Resultados: el 73.0% se vacunó contra la Influenza, 57.8% contra el Neumococo y el 47.6% recibió la antitetánica. Los factores que estaba independientemente asociados con la vacunación incluyen: 1-edad (6574 tenían probabilidad aumentada comparada con 60-64 años); 2- nivel socioeconómico (NSE) (mayor NSE tenían menos probabilidades de tener vacunas contra la influenza y neumococo, en comparación con aquellos con menor SES); 3- seguro de salud (con seguro contributivo o subsidiado tenían probabilidades más altas, (entre 3 y 5 veces mayor) de tener vacunación contra la influenza, neumococo y tétanos, en comparación con aquellos que no tienen seguro); 4- aquellos con estado funcional mejor (puntaje mayor Lawton) tenían probabilidades mayores para todas las vacunas; 5- aquellos con morbilidad aumentada tenían probabilidades mayores para tener vacunas de influenza y neumococo. Conclusión: Las campañas de vacunación se deben fortalecer para incrementan la cobertura, especialmente en el grupo más reacio a la vacunación o vulnerable para alcanzarla tales como los adultos mayores con discapacidad.

O impacto da vacina pneumocócica PCV10 na redução da mortalidade por pneumonia em crianças menores de um ano em Santa Catarina, Brasil / Impact of PCV10 pneumococcal vaccine on mortality from pneumonia in children less than one year of age in Santa Catarina State, Brazil / Impacto de la vacuna PCV10 neumocócica en la reducción de la mortalidad por neumonía en niños menores de un año en Santa Catarina, Brasil

O objetivo deste trabalho foi avaliar o impacto da vacina pneumocócica PCV10 na redução da mortalidade por pneumonia em crianças menores de um ano, em Santa Catarina, Brasil, considerando os quatro anos antes versusquatro anos após a introdução da vacina em 2010. Estudo com delineamento ecológico, realizado com dados do Sistema de Informações sobre Mortalidade e das coberturas vacinais em menores de um ano de idade. Os dados foram agrupados por município de residência e macrorregião. A taxa média de mortalidade por pneumonia em menores de um ano no período 2006-2009 versus2010-2013 diminuiu de 29,69 para 23,40 por 100 mil, uma redução de 11%. Porém, observa-se uma divisão entre regiões com redução (Grande Florianópolis, Sul, Planalto Norte e Nordeste) e outras com aumento do gradiente das taxas anuais (Oeste, Itajaí e Serra). No estado, verificou-se uma redução média da taxa de mortalidade, por pneumonia em menores de um ano, de 11% após quatro anos da implantação da vacina como rotina no Programa Nacional de Imunizações, porém com efeitos heterógenos entre as regiões.

The aim of this study was to evaluate the impact of PCV10 pneumococcal vaccine on mortality from pneumonia in children less than one year of age in Santa Catarina State, Brazil, comparing the four years prior and the four years subsequent to the vaccine's introduction in 2010. This ecological study used data from the Mortality Information System and vaccination coverage of children less than one year. Data were grouped by municipalities of residence and regions. Average mortality from pneumonia in children under one year decreased from 29.69 to 23.40 per 100,000, comparing 2006-2009 and 2010-2013, or a reduction of 11%. However there were differences between regions with a drop in mortality (Grande Florianópolis, Sul, Planalto Norte, and Nordeste) and others with an increase in the annual rates (Oeste, Itajaí, and Serra). In short, the state as a whole showed 11% reduction in mortality from pneumonia in children less than one year of age, four years after implementing routine PCV10 vaccination in the National Immunization Program, but with heterogeneous effects when comparing regions of the state.

El objetivo de este estudio fue evaluar el impacto de la PCV10 en la reducción de mortalidad por neumonía en niños menores de un año en Santa Catarina, Brasil, teniendo en cuenta los cuatro años anteriores, frente a los cuatro años posteriores a la introducción de la vacuna en 2010. Este estudio ecológico se hizo con datos del Sistema de Informaciones sobre Mortalidad y cobertura de vacunación en niños menores de un año de edad. Los datos se agruparon según el lugar de residencia y región. La tasa media de mortalidad por neumonía en niños menores de un año en el período 2006-2009, en comparación con 2010-2013, disminuyó de 29,69 a 23,40 por 100.000 habitantes, una reducción del 11%. Sin embargo, hay una división entre las regiones con la reducción (Florianópolis, Sur, Norte y Nordeste Meseta) y otra con el aumento del gradiente de tasas anuales (West, Itajaí y Serra). En el estado hubo una reducción media de mortalidad por neumonía en niños menores de un año de un 11%, tras cuatro años de aplicación de la vacuna en el Programa Nacional de Inmunización, pero con efectos heterogéneos entre regiones.

Economic impact of vaccination with PCV13 vs. vaccination with PCV 10 in Colombia / Impacto económico de la vacunación con PCV13 frente al PCV 10 en Colombia

We aim was to estimate the difference of costs and expected cases from serotype coverage of the 13-valent pneumococcal conjugated vaccine (PCV13) and 10-valent pneumococcal conjugated vaccine (PCV10) in the population under 5 years of age in Colombia, using a deterministic model. We considered the probabilities of incidence, mortality and sequelae from infections of pneumonia, meningitis, sepsis and acute otitis media, as well as the clinical effectiveness of PCV13 and PCV10, which were determined by a systematic review of the literature. A2 + 1 immunization schedule was considered, and a 42% herd effect and 84.09% population coverage were assumed. The perspective was the Colombian health system with a time horizon of 5-years. The model showed greater protection of PCV13 in comparison to PCV10. A difference of 98 prevented deaths was observed for meningitis, pneu monia and sepsis. The opportunity cost difference found in the 5-year follow-up between PCV13 and PCV10 vaccines was COP (Colombian pesos) 36,128,082,380 at 2012 prices, which represents COP 7,225,616,476 of difference per year. PCV13 is considered the better alternative, this is mainly due to the impact that this vaccine has on the disease burden of the infections produced by Streptococcus pneumoniae in Colombian children under five years of age.

Nuestro objetivo fue estimar la diferencia de los costos y los casos que se esperan de la cobertura de serotipos de la vacunas conjugadas 13-valente neumocócica (PCV13) y 10-valente neumocócica (PCV10), en la población menor de cinco años de edad en Colombia, mediante un modelo determinista. Se consideraron las probabilidades de incidencia, mortalidad y secuelas de las infecciones de neumonía, meningitis, sepsis y la otitis media aguda, así como la efectividad clínica de la PCV13 y la PCV10, que se determinaron mediante una revisión sistemática de la literatura. Se consideró un esquema de vacunación A2 + 1 y se supuso un efecto grupal del 42% y una cobertura de la población de 84,09%. La perspectiva fue el sistema de salud colombiano, con un horizonte temporal de cinco años. El modelo mostró una mayor protección de PCV13 en comparación con PCV10. Se observó una diferencia de 98 muertes que se evitaron por causa de la meningitis, la neumonía y la sepsis. La diferencia costooportunidad encontrada en el seguimiento de cinco años entre las vacunas PCV13 y la PCV10 fue de 36,128,082,380 pesos colombianos (COP) a precios de 2012, lo que representa una diferencia de COP 7,225,616,476 por año.