Calendario de vacunaciones de la Asociación Española de Pediatría: recomendaciones 2015 / Immunisation schedule of the Spanish Association of Paediatrics: 2015 Recommendations

El Comité Asesor de Vacunas de la Asociación Española de Pediatría actualiza anualmente su calendario de vacunaciones, tras un análisis tanto epidemiológico como de la seguridad, efectividad y eficiencia de las vacunas actuales, incluyendo grados de recomendación. Es el calendario que se estima idóneo actualmente para los niños residentes en España. En cuanto a las vacunas oficiales incluidas en el calendario común, se recalca la posibilidad de vacunar indistintamente frente a hepatitis B desde el nacimiento o desde los 2 meses; la recomendación de la primera dosis de triple vírica y de varicela a los 12 meses y la segunda a los 2-3 años; la administración de la vacuna DTPa o Tdpa a los 6 años, con refuerzo en la adolescencia; estrategias con Tdpa en embarazadas y convivientes del recién nacido, y la inmunización frente al papilomavirus en niñas a los 11-12 años con pauta de 2 dosis (0, 6 meses). Este comité insiste en la vacunación antineumocócica universal, tal y como se está llevando a cabo en todos los países de Europa Occidental. La vacuna frente al meningococo B, autorizada pero bloqueada actualmente en España, presenta un perfil de vacuna sistemática y se reivindica que, al menos, esté disponible en las farmacias comunitarias. Se propone, igualmente, la disponibilidad pública de las vacunas frente a la varicela, ya que han demostrado ser efectivas y seguras a partir del segundo año de vida. La vacunación frente al rotavirus es recomendable en todos los lactantes. La vacunación antigripal anual y la inmunización frente a la hepatitis A están indicadas en grupos de riesgo

The Advisory Committee on Vaccines of the Spanish Association of Paediatrics updates the immunisation schedule every year, taking into account epidemiological data as well as evidence on the safety, effectiveness and efficiency of current vaccines, including levels of recommendation. In our opinion, this is the optimal vaccination calendar for all children resident in Spain. Regarding the vaccines included in the official unified immunization schedule, the Committee emphasizes the administration of the first dose of hepatitis B either at birth or at 2 months of life; the recommendation of the first dose of MMR and varicella vaccine at the age of 12 months, with the second dose at the age of 2-3 years; DTaP or Tdap vaccine at the age of 6 years, followed by another Tdap booster dose at 11-12 years old; Tdap strategies for pregnant women and household contacts of the newborn, and immunization against human papillomavirus in girls aged 11-12 years old with a 2 dose scheme (0, 6 months). The Committee reasserts its recommendation to include vaccination against pneumococcal disease in the routine immunisation schedule, the same as it is being conducted in Western European countries. The recently authorised meningococcal B vaccine, currently blocked in Spain, exhibits the profile of a universal vaccine. The Committe insists on the need of having the vaccine available in communitary pharmacies. It has also proposed the free availability of varicella vaccines. Their efectiveness and safety have been confirmed when they are administred from the second year of life. Vaccination against rotavirus is recommended in all infants. The Committee stresses the need to vaccinate population groups considered at risk against influenza and hepatitis A

Acute hepatitis due to hepatitis A virus subgenotype IA as an imported infectious disease from Indonesia.

A 25-year-old Japanese man was admitted with general malaise and fever, which had developed 12 days after coming back to Japan from Indonesia. Blood examination revealed elevated transaminase levels and positivity for the IgM anti-HAV antibody; therefore, he was diagnosed with acute hepatitis A. HAV-RNA was detected in his serum and phylogenetically classified as subgenotype IA. The partial genome in the VP1/P2A region was consistent with the strain recently isolated from Surabaya, which indicated that he had been infected during his stay in Indonesia. Thus, HAV vaccination is recommended before visiting HAV-endemic countries for a long period of time.

Hepatitis a virus vaccine escape variants and potential new serotype emergence.

Six hepatitis A virus antigenic variants that likely escaped the protective effect of available vaccines were isolated, mostly from men who have sex with men. The need to complete the proper vaccination schedules is critical, particularly in the immunocompromised population, to prevent the emergence of vaccine-escaping variants.

Hepatitis A bifásica en niños colombianos: reporte de nueve casos y revisión de la literatura / Biphasic hepatitis A in colombian children: report of nine cases and literature review

La hepatitis A tiene una prevalencia o incidencia en los países en desarrollo de 50 a 100 por cada 100000 personas. La presentación atípica de la hepatitis A bifásica, es rara. El objetivo es presentar 9 casos de niños con hepatitis A bifásica. Se estudiaron nueve niños de edades comprendidas entre los 7 y 13 años (edad media 8,6 años); 5 varones con antecedentes de fiebre, vómito, ictericia, dolor abdominal y coluria de 3 a 5 días de evolución, e IgM para la hepatitis A (IgM VHA) positivo. Después de un mes de evolución asintomáticos, se volvieron a presentar iguales manifestaciones clínicas del primer episodio, con la presencia de IgM VHA positiva otra vez. La media de las pruebas de función hepática en el segundo cuadro fueron: ALT 1258 U/L,AST 986 U/l, bilirrubina directa 5,87 mg/dl, y fosfatasa alcalina 580 U/L. En ninguno se informó anomalías a la ecografía abdominal y la serología de hepatitis autoinmune fue negativa. No hubo morbilidad en los niños. La hepatitis agudaApuede tener entre un 3% a 20% de casos con más de un pico de aminotransferasas, que se eleva entre las 2 y 8 semanas después del primer cuadro. Las hipótesis para explicar ello, son fenómenos de reinfección y autoinmunes. En general, la evolución es satisfactoria.

Hepatitis A has a prevalence or incidence in developing countries from 50 to 100 per 100,000 people. The atypical presentation of biphasic hepatitis A, is rare. The objective was to report 9 cases of children with biphasic hepatitis A. We studied 9 children aged between 7 and 13 years (mean age 8.6 years), including 5 males with a history of fever, vomiting, jaundice, abdominal pain, and coluria for about 3 to 5 days of evolution, and IgM to hepatitisA(IgMVHA) positive. After a mean month evolution asymptomatic, again showed the same clinic manifestations for the second time in the presence of IgM VHA positive again. The median liver function tests in the second frame were ALT 1258 U/L, AST 986 U/L, direct bilirubin 5.87 mg/dL, FA 580 U/L. In all reported no abdominal ultrasound abnormalities and autoimmune hepatitis serology was negative. There was no morbidity in children. Acute hepatitisAcan take on 3%-20% of cases with more than 1 peak of aminotransferases, which can be raised between 2 and 8 weeks after the first frame. Hypotheses to explain this, are reinfection and autoimmune phenomena. In general, evolution is satisfactory.

Hepatitis A en niños / Hepatitis A in children

La Hepatitis A (HVA), también llamada hepatitis infecciosa, transmitida por alimentos, epidémica,ictericia catarral o epidémica, entre otros, es una enfermedad producida por un agente viral que se trasmite por vía fecal oral y generalmente su curso es autolimitado, aunque, puede progresar ahepatitis fulminante ocasionando la muerte a una proporción pequeña de los infectados. Pertenece al géner o Hepatovir us de la Familia Picornaviridae. La HVA, tiene una distribución universal, aunque con grandes diferencias geográficas en cuanto a su prevalencia, ocurre en forma esporádica y epidémica en todo el mundo, con una tendencia a presentarse en ciclos. La HVA, tiene un periodo de incubación prolongado, entre 15 a 50 días, con un promedio de 29 días, lo que hace difícil relacionar los síntomas con algún alimento o bebida ingerida. El diagnostico de la HVA, se basa en la detección de anticuerpos contra el VHA tipo IgM e IgG. El tratamiento básicamente es de soporte, sintomático y en casos de falla hepática, el trasplante es la única opción. La inmunoglobulina confiere inmunidad pasiva a corto plazo mientras la vacuna provee una protección activa a largo plazo.

Hepatitis A (HVA), also called infectious hepatitis, foodborne, epidemic, or epidemic or catarrhaljaundice, among others, is a disease caused by a viral agent that spreads through fecal-oral routeand usually self-limited course, although fulminant hepatitis can progress to causing death to a small proportion of those infected. Is a Hepatovirus genus of the Picornaviridae Family. The HVA, has a worldwide distribution, but with large geographical differences in its prevalence, occurs in sporadic and epidemic worldwide, with a tendency to occur in cycles. The HVA, has a long incubation period between 15 to 50 days, with an average of 29 days, making it difficult to correlate symptoms with food or drink intake. The diagnosis of HVA was based on the detection of antibodies against HAV IgM and IgG.

Analysis of hepatitis A virus protein 2B in sera of hepatitis A of various severities.

BACKGROUND: In our recent study of the full-length hepatitis A virus (HAV) genome from some patients with fulminant hepatitis and acute hepatitis, possible associations were suggested between the severity of hepatitis A and the amino acid substitutions in the nonstructural protein 2B. We therefore analyzed HAV 2B from many patients with various clinical disease severities. METHODS: Serum samples from 30 Japanese patients with sporadic hepatitis A from five widely separated regions of Japan, comprising nine patients with fulminant hepatitis (FH), six with severe acute hepatitis (AHs), and 15 with acute hepatitis (AH), were examined for HAV RNA. The entire sequences of HAV 2B were analyzed. RESULTS: Compared with the sequence of the wild-type HAV strain GBM, nucleotide sequences of 2B had homology of 94.5 +/- 1.0% in FH, 95.2 +/- 1.2% in AHs, and 95.1 +/- 1.8% in AH. Deduced amino acid sequences had homology of 97.5 +/- 2.1% in FH, 97.9 +/- 2.4% in AHs, and 98.5 +/- 1.3% in AH. Differences were not statistically significant among the three groups. The average number of amino acid mutations between amino acids 100 and 200 was 5.0 +/- 5.2 per case in FH, 4.0 +/- 6.0 in AHs, and 1.9 +/- 2.9 in AH. The differences between FH and AH, AHs and AH, and between severe cases (FH and AHs) and nonsevere cases (AH) were not statistically significant (P = 0.13, P = 0.45, and P = 0.10, respectively). CONCLUSIONS: There were no obvious differences in the sequences among FH, AHs, and AH throughout the 2B region, but there seemed to be more mutations in the strains obtained from FH and AHs patients than in those obtained from AH patients in the central part of HAV 2B.

Molecular epidemiology of hepatitis A virus in Brazilian Amazon.

BACKGROUND: Hepatitis A virus (HAV) is highly endemic in the Amazon. However, few data are available regarding HAV genotypes circulating in this region of the world. The aim of the present study was to characterize genetically HAV isolates circulating in the Brazilian part of the Amazon. METHODS: Blood samples were collected from 134 IgM anti-HAV positive patients (sporadic cases). Viral RNA was extracted and the virion protein (VP)1/2A junction region of the HAV genome was successfully amplified by reverse transcription-polymerase chain reaction for 81 samples (60.4%). Nucleotide sequences (210 bp) of the 81 isolates were determined. RESULTS: All HAV samples were from genotype I, with 78 (96.3%) belonging to subgenotype IA and three (3.7%) to subgenotype IB. By phylogenetic analysis, it was shown that 72/78 of the subgenotype IA isolates formed a cluster separated from the other South American HAV isolates previously characterized. CONCLUSION: The present study provides valuable new data on the genetic relatedness of HAV from the Amazon. Subgenotype IB circulates in the Brazilian Amazon but the predominant genotype is 1A, similar to what occurs in most South American countries.

[Molecular epidemiology of hepatitis A virus].

The genome of hepatitis A virus (HAV) is a linear plus-strand RNA molecule of 7,500 nucleotides and it shares common strategies of construction and function of the picornavirus family. Since it has a unique nucleotide sequence homology, HAV has been classified in the genus of hepatovirus, newly added to the family. Nucleotide sequence of the putative VP1/2A junction area was found variable and a 168 nucleotide portion of the region has been compared with many HAV sequences obtained from all over the world. It was found that HAV strains could be identified and classified into 7 genotypes or 9 subgenotypes. Analyses of the nucleotide sequence homology of this particular region is useful, not only in the study of epidemiology of hepatitis A, but also in the study of the molecular epidemiology of HAV.

Prevención de la hepatitis A / Prevention of hepatitis A

Entre las hepatitis virales agudas, la causada por el virus A (HVA) es tal vez la de mayor importancia debido a su alta frecuencia derivada de su mecanismo de transmisión fecal-oral. Clínicamente la hepatitis A es similar al resto de las hepatitis virales, sin embargo su aparición es más súbita, caracterizada por síntomas gripales y mialgias, dolor de cabeza y malestar general. Se autolimita en un lapso breve, aunque puede haber recaídas o colestásis prolongada al término de la fase aguda, ambas con carácter benigno. Su tasa de mortalidad es baja y nunca conduce a hepatitis crónica o a un estado de acarreador. La infección de individuos suceptibles puede ocurrir a cualquier edad. La prevención de la hepatitis por virus A debe planearse a nivel del saneamiento ambiental, de la correcta eliminación de las aguas negras y del cuidado en el riego de las legumbres. El mejoramiento de las condiciones socioeconómicas y de higiene, modifican los patrones epidemiológicos ya que a medida que disminuyen las infecciones en los niños, se incrementa la población adulta suceptible. La infección con el HVA da por resultado una inmunidad permanente, por lo que las reinfecciones son extraordinariamente infrecuentes. Existe la inmunización pasiva, inmunización activa, las vacunas inactivadas para HVA, vacunas atenuadas para HVA y se señalan otras opciones para la producción de vacunas contra HVA

The etiology of acute viral hepatitis in an endemic area of hepatitis A and B.

To understand the etiology of acute viral hepatitis in an endemic area of hepatitis A and B, serological markers of hepatitis were studied by radioimmunoassay in a consecutive series of 145 adult patients with biopsy-verified acute viral hepatitis. Seven (4.8%) were classified as hepatitis A, 92 (63.5%) as hepatitis B, and 46 (31.7%) as hepatitis non-A, non-B. Most persons with severe acute viral hepatitis were hepatitis B antigen (HBsAg)-positive, and hepatitis A appears to play a minor role if any. The evidence also implies that non-B hepatitis may have occurred intercurrently in chronic HBsAg carriers in this area.

Acute and chronic hepatitis in children.

Discrimination between hepatitis A and B is becoming easier as the serologic and clinical characteristics of each type become better known. Hepatitis A is generally a benign pediatric illness with few sequelae. In contrast, hepatitis B is more often associated with complications and may progress to chronic liver disease in as many as 10% of cases. Chronic persistent hepatitis appears to be a benign disorder not requiring therapy. Occasionally related etiologically to virus B, chronic active hepatitis is often associated with severe clinical illness. However, it generally responds to steroid therapy, at least initially, and may be arrested or cured.