RESUMO
The influenza virus has accompanied humans since time immemorial, in the form of annual epidemics and occasional pandemics. It is a respiratory infection with multiple repercussions on people's lives at an individual and social level, as well as representing a significant burden on the health system. This Consensus Document arises from the collaboration of various Spanish scientific societies involved in influenza virus infection. The conclusions drawn are based on the highest quality evidence available in the scientific literature and, failing that, on the opinion of the experts convened. The Consensus Document addresses the clinical, microbiological, therapeutic, and preventive aspects (with respect to the prevention of transmission and in relation to vaccination) of influenza, for both adult and pediatric populations. This Consensus Document aims to help facilitate the clinical, microbiological, and preventive approach to influenza virus infection and, consequently, to reduce its important consequences on the morbidity and mortality of the population.
Assuntos
Doenças Transmissíveis , Influenza Humana , Orthomyxoviridae , Adulto , Criança , Humanos , Influenza Humana/diagnóstico , Influenza Humana/prevenção & controle , Saúde Pública , Medicina Comunitária , VacinologiaRESUMO
A decomposition procedure was used to estimate the percentage contributions of exposure, risk of collision and fatality to explain the decreases in pedestrian collision death rates observed in Spain from 1993 to 2011. Information was obtained from the Spanish National Institute of Statistics and the Spanish Register of Road Crashes with Victims. A quasi-induced method was used to obtain estimates of annual pedestrian exposure. Poisson regression was used to obtain age-adjusted and sex-adjusted estimates of the mean annual percentage decrease in pedestrian death rates attributable to exposure, collision and fatality; these values were +2.28%, -45.86% and -51.86%, respectively. The results suggest that the decrease in fatality rates and, to a lesser extent, collision rates were the most important determinants of the reduction in pedestrian collision death rates, whereas the contribution of exposure was irrelevant.
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Prevenção de Acidentes , Acidentes de Trânsito/mortalidade , Caminhada , Ferimentos e Lesões/mortalidade , Acidentes de Trânsito/estatística & dados numéricos , Humanos , Modelos Teóricos , Distribuição de Poisson , Fatores de Risco , Distribuição por Sexo , Espanha/epidemiologia , Caminhada/lesõesRESUMO
Respiratory syncytial virus (RSV) is a major cause of respiratory tract infections in adults, particularly older adults and those with underlying medical conditions. Vaccination has emerged as a potential key strategy to prevent RSV-related morbidity and mortality. This Neumoexperts Prevention (NEP) Group scientific paper aims to provide an evidence-based positioning and RSV vaccination recommendations for adult patients. We review the current literature on RSV burden and vaccine development and availability, emphasising the importance of vaccination in the adult population. According to our interpretation of the data, RSV vaccines should be part of the adult immunisation programme, and an age-based strategy should be preferred over targeting high-risk groups. The effectiveness and efficiency of this practice will depend on the duration of protection and the need for annual or more spaced doses. Our recommendations should help healthcare professionals formulate guidelines and implement effective vaccination programmes for adult patients at risk of RSV infection now that specific vaccines are available.
Assuntos
Infecções por Vírus Respiratório Sincicial , Vírus Sincicial Respiratório Humano , Infecções Respiratórias , Humanos , Pessoa de Meia-Idade , Idoso , Infecções por Vírus Respiratório Sincicial/epidemiologia , Infecções por Vírus Respiratório Sincicial/prevenção & controle , VacinaçãoRESUMO
The Spanish Society of Tropical Medicine and International Health (SEMTSI), the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), the Spanish Society of Emergency Medicine (SEMES), the Spanish Society of Primary Care Physicians (SEMERGEN) and the Spanish Society of Family and Community Medicine (SEMFYC) have prepared a consensus statement on the diagnosis and management of patients with imported febrile illnesses. Twenty authors with different backgrounds and representing different healthcare perspectives (ambulatory primary care, travel and tropical medicine specialists, emergency medicine, hospital care, microbiology and parasitology and public health), identified 39 relevant questions, which were organised in 7 thematic blocks. After a systematic review of the literature and a thoughtful discussion, the authors prepared 125 recommendations, as well as several tables and figures to be used as a consulting tool. The present executive summary shows a selection of some of the most relevant questions and recommendations included in the guidelines.
Assuntos
Doenças Transmissíveis Importadas , Febre , Humanos , Febre/etiologia , Febre/diagnóstico , Doenças Transmissíveis Importadas/diagnóstico , Doenças Transmissíveis Importadas/terapia , Doença Relacionada a Viagens , EspanhaRESUMO
BACKGROUND AND OBJECTIVES: A cost-utility analysis was conducted to assess the efficiency of implementing a PCV20 vaccination strategy in the Spanish adult population older than 60 years, for the prevention of non-bacteremic pneumococcalpneumonia (NBP) and invasive pneumococcal disease (IPD). METHODS: A Markov model, with annual cycles and a time horizon of 10 years was used. The analysis population was stratified by age and risk groups. The comparator was the sequential vaccination with the 15-valent pneumococcal conjugate vaccine (PCV15) followed by one dose of the pneumococcal polysaccharide vaccine (PPV23). The base case analysis was performed from the National Healthcare System (NHS) perspective including direct costs (2018) and applying a discount of 3% to future costs and outcomes. Alternative scenarios explored a shorter time horizon (5 years), the societal perspective and other available vaccination strategies. All the parameters and assumptions were validated by a panel of experts. To evaluate the robustness of the model, deterministic and probabilistic sensitivity analyses (PSA) were carried out. RESULTS: The results of the study showed that the vaccination strategy with PCV20 is a dominant option compared to the sequential regimen (PCV15 + PPSV23), resulting in direct cost savings of 85.7 M over 10 years, with a small increase in quality-adjusted life years (QALYs). PCV20 vaccination avoided 2,161 cases of IPD, 19,470 of NBP and 3,396 deaths and according to the PSA, the probability of PCV20 being cost-effective compared to a sequential regimen (PCV15 + PPSV23) was 100%. CONCLUSIONS/RECOMMENDATIONS: In the Spanish adult population older than 60 years, the vaccination strategy with one dose of PCV20 is more effective and less expensive (dominant) than vaccination with a sequential schedule with PCV15 and PPSV23.
Assuntos
Bacteriemia , Infecções Pneumocócicas , Adulto , Humanos , Análise Custo-Benefício , Espanha , Vacinas Pneumocócicas , Infecções Pneumocócicas/tratamento farmacológico , Vacinação/métodos , Vacinas ConjugadasRESUMO
In the adult population, community-acquired pneumonia (CAP) is a serious disease that is responsible for high morbidity and mortality rates, being frequently associated with multidrug resistant pathogens. The aim of this review is to update a practical immunization prevention guideline for CAP in Spain caused by prevalent respiratory pathogens, based on the available scientific evidence through extensive bibliographic review and expert opinion. The emergence of COVID-19 as an additional etiological cause of CAP, together with the rapid changes in the availability of vaccines and recommendations against SARS-CoV-2, justifies the need for an update. In addition, new conjugate vaccines of broader spectrum against pneumococcus, existing vaccines targeting influenza and pertussis or upcoming vaccines against respiratory syncytial virus (RSV) will be very useful prophylactic tools to diminish the burden of CAP and all of its derived complications. In this manuscript, we provide practical recommendations for adult vaccination against the pathogens mentioned above, including their contribution against antibiotic resistance. This guide is intended for the individual perspective of protection and not for vaccination policies, as we do not pretend to interfere with the official recommendations of any country. The use of vaccines is a realistic approach to fight these infections and ameliorate the impact of antimicrobial resistance. All of the recently available scientific evidence included in this review gives support to the indications established in this practical guide to reinforce the dissemination and implementation of these recommendations in routine clinical practice.
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The inï¬uenza virus has accompanied humans since time immemorial, in the form of annual epidemics and occasional pandemics. It is a respiratory infection with multiple repercussions on people's lives at an individual and social level, as well as representing a signiï¬cant burden on the health system. This Consensus Document arises from the collaboration of various Spanish scientiï¬c societies involved in inï¬uenza virus infection. The conclusions drawn are based on the highest quality evidence available in the scientiï¬c literature and, failing that, on the opinion of the experts convened. The Consensus Document addresses the clinical, microbiological, therapeutic, and preventive aspects (with respect to the prevention of transmission and in relation to vaccination) of inï¬uenza, for both adult and pediatric populations. This Consensus Document aims to help facilitate the clinical, microbiological, and preventive approach to inï¬uenza virus infection and, consequently, to reduce its important consequences on the morbidity and mortality of the population.
Assuntos
Doenças Transmissíveis , Influenza Humana , Orthomyxoviridae , Criança , Adulto , Humanos , Influenza Humana/diagnóstico , Influenza Humana/prevenção & controle , Saúde Pública , Medicina Comunitária , VacinologiaRESUMO
The influenza virus has accompanied humans since time immemorial, in the form of annual epidemics and occasional pandemics. It is a respiratory infection with multiple repercussions on people's lives at an individual and social level, as well as representing a significant burden on the health system. This Consensus Document arises from the collaboration of various Spanish scientific societies involved in influenza virus infection. The conclusions drawn are based on the highest quality evidence available in the scientific literature and, failing that, on the opinion of the experts convened. The Consensus Document addresses the clinical, microbiological, therapeutic, and preventive aspects (with respect to the prevention of transmission and in relation to vaccination) of influenza, for both adult and pediatric populations. This Consensus Document aims to help facilitate the clinical, microbiological, and preventive approach to influenza virus infection and, consequently, to reduce its important consequences on the morbidity and mortality of the population.
Assuntos
Doenças Transmissíveis , Influenza Humana , Orthomyxoviridae , Adulto , Criança , Humanos , Influenza Humana/diagnóstico , Influenza Humana/prevenção & controle , Influenza Humana/tratamento farmacológico , Saúde Pública , Medicina Comunitária , VacinologiaRESUMO
New SARS-CoV-2 variants, breakthrough infections, waning immunity, and sub-optimal vaccination rates account for surges of hospitalizations and deaths. There is an urgent need for clinically valuable and generalizable triage tools assisting the allocation of hospital resources, particularly in resource-limited countries. We developed and validate CODOP, a machine learning-based tool for predicting the clinical outcome of hospitalized COVID-19 patients. CODOP was trained, tested and validated with six cohorts encompassing 29223 COVID-19 patients from more than 150 hospitals in Spain, the USA and Latin America during 2020-22. CODOP uses 12 clinical parameters commonly measured at hospital admission for reaching high discriminative ability up to 9 days before clinical resolution (AUROC: 0·90-0·96), it is well calibrated, and it enables an effective dynamic risk stratification during hospitalization. Furthermore, CODOP maintains its predictive ability independently of the virus variant and the vaccination status. To reckon with the fluctuating pressure levels in hospitals during the pandemic, we offer two online CODOP calculators, suited for undertriage or overtriage scenarios, validated with a cohort of patients from 42 hospitals in three Latin American countries (78-100% sensitivity and 89-97% specificity). The performance of CODOP in heterogeneous and geographically disperse patient cohorts and the easiness of use strongly suggest its clinical utility, particularly in resource-limited countries.
While COVID-19 vaccines have saved millions of lives, new variants, waxing immunity, unequal rollout and relaxation of mitigation strategies mean that the pandemic will keep on sending shockwaves across healthcare systems. In this context, it is crucial to equip clinicians with tools to triage COVID-19 patients and forecast who will experience the worst forms of the disease. Prediction models based on artificial intelligence could help in this effort, but the task is not straightforward. Indeed, the pandemic is defined by ever-changing factors which artificial intelligence needs to cope with. To be useful in the clinic, a prediction model should make accurate prediction regardless of hospital location, viral variants or vaccination and immunity statuses. It should also be able to adapt its output to the level of resources available in a hospital at any given time. Finally, these tools need to seamlessly integrate into clinical workflows to not burden clinicians. In response, Klén et al. built CODOP, a freely available prediction algorithm that calculates the death risk of patients hospitalized with COVID-19 (https://gomezvarelalab.em.mpg.de/codop/). This model was designed based on biochemical data from routine blood analyses of COVID-19 patients. Crucially, the dataset included 30,000 individuals from 150 hospitals in Spain, the United States, Honduras, Bolivia and Argentina, sampled between March 2020 and February 2022 and carrying most of the main COVID-19 variants (from the original Wuhan version to Omicron). CODOP can predict the death or survival of hospitalized patients with high accuracy up to nine days before the clinical outcome occurs. These forecasting abilities are preserved independently of vaccination status or viral variant. The next step is to tailor the model to the current pandemic situation, which features increasing numbers of infected people as well as accumulating immune protection in the overall population. Further development will refine CODOP so that the algorithm can detect who will need hospitalisation in the next 24 hours, and who will need admission in intensive care in the next two days. Equipping primary care settings and hospitals with these tools will help to restore previous standards of health care during the upcoming waves of infections, particularly in countries with limited resources.
Assuntos
COVID-19 , SARS-CoV-2 , Hospitalização , Hospitais , Humanos , Aprendizado de Máquina , Estudos RetrospectivosRESUMO
OBJECTIVE: Streptococcus pneumoniae can cause invasive and noninvasive diseases. Invasive pneumococcal disease causes infections in tissues, organs and fluids that are normally sterile and is associated with severe clinical processes generally. The aim of this study was to characterize ENI episodes as well as to describe the antimicrobial susceptibility and distribution of serotypes (vaccinal and non-vacunal) of S. pneumoniae strains isolated in blood cultures of patients treated at the Hospital Costa del Sol between September 2012 and January 2017. METHODS: Descriptive study from S. pneumoniae strains isolated in blood cultures. The variables studied were: age, sex, death, smoking, HIV infection, clinical diagnosis, serotype and antibiotic susceptibility profile. The source of information used was the clinic management program called Doctor. RESULTS: 76 S. pneumoniae strains were isolated. The most prevalent serotypes were 8, 3, 9N, 6C, 22F, 11A and 14. 77.3% of the strains were responsible for IPD (Invasive Pneumococcal Disease) episodes with clinical diagnosis of bacterial pneumonia. According to the CLSI 2016 (Clinical & Laboratory Standards Institute) criteria, 2 strains were non-susceptible to penicillin, 23 strains were non-susceptible to erythromycin and 3 were strains non-susceptible to levofloxacin. CONCLUSIONS: The results of this study show that the most frequent serotypes among ENI patients attended in our hospital are not covered by conjugate vaccines, although they do so by VNP23. Serotype 6C, not covered by any vaccine, was among the three most frequently isolated, causing death in one third of patients.
OBJETIVO: Streptococcus pneumoniae puede causar enfermedades invasivas y no invasivas. Bajo la denominación de enfermedad neumocócica invasiva, se incluyen aquellas infecciones que se localizan en tejidos, órganos y fluidos que normalmente son estériles y que se asocian con procesos clínicos generalmente severos. El objetivo de este estudio fue caracterizar los episodios de ENI (Enfermedad Neumocócica Invasiva) así como describir la sensibilidad antimicrobiana y distribución de los serotipos (vacunales y no vacunales) de cepas de S. pneumoniae aisladas en hemocultivos de pacientes atendidos en el Hospital Costa del Sol entre septiembre de 2012 y enero de 2017. METODOS: Estudio descriptivo a partir de cepas de S. pneumoniae aisladas en hemocultivos. Las variables de estudio fueron: edad, sexo, fallecimiento, tabaquismo, infección por VIH, diagnóstico clínico, serotipo y perfil de sensibilidad antimicrobiana. La fuente de información utilizada fue el programa de gestión clínica "Doctor". El análisis estadístico se llevó a cabo mediante el software SPSS (SPSS, version 15,0; SPSS, Chicago Illinois, USA). RESULTADOS: Se aislaron un total de 76 cepas de S. pneumoniae. Los serotipos más prevalentes fueron, en orden descendente 8, 3, 9N, 6C, 22F, 11A y 14. El 77,3% de las cepas fueron causantes de episodios de ENI con diagnóstico clínico de neumonía bacteriémica. Según el criterio del CLSI 2016 (Clinical & Laboratory Standards Institute), encontramos 2 cepas no sensibles a penicilina, 23 cepas no sensibles a eritromicina y 3 cepas no sensibles a levofloxacino. CONCLUSIONES: Los resultados de este estudio muestran que los serotipos más frecuentes entre los pacientes con ENI atendidos en nuestro hospital no están cubiertos por las vacunas conjugadas, aunque sí por la VNP23. El serotipo 6C, no cubierto por ninguna vacuna, se situó entre los tres más frecuentemente aislados, causando exitus en un tercio de los pacientes.
Assuntos
Infecções Pneumocócicas/microbiologia , Vacinas Pneumocócicas , Sorogrupo , Streptococcus pneumoniae/classificação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Infecções Pneumocócicas/diagnóstico , Infecções Pneumocócicas/prevenção & controle , Estudos Retrospectivos , Sorotipagem , Espanha , Streptococcus pneumoniae/isolamento & purificação , Vacinas Conjugadas , Adulto JovemRESUMO
[This corrects the article DOI: 10.1186/s40621-016-0079-2.].
RESUMO
BACKGROUND: This ecological study aimed i) to quantify the association of age and gender with the three components of pedestrians' death rates after a pedestrian-vehicle crash: exposure, risk of crash and fatality, and ii) to determine the contribution of each component to differences in death rates according to age and gender in Spain. METHODS: We analyzed data for 220 665 pedestrians involved in road crashes recorded in the Spanish registry of road crashes with victims from 1993 to 2011, and a subset of 39 743 pedestrians involved in clean collisions (in which the pedestrian did not commit an infraction). Using decomposition and quasi-induced exposure methods, we obtained the proportion of increase in death rates for each age and gender group associated with exposure, risk of collision and fatality. RESULTS: Death rates increased with age. The main contributor to this increase was fatality, although exposure also increased with age. In contrast, the risk of collision decreased with age. Males had higher death rates than females, especially in the 24-54 year old group. Higher fatality rates in males were the main determinant of this difference, which was also related with a higher risk of collision in males. However, exposure rates were higher in females. CONCLUSIONS: The magnitude and direction of the associations between age and gender and each of the three components of pedestrians' death rates differed depending on the specific component explored. These differences need to be taken into account in order to prioritize preventive strategies intended to decrease mortality among pedestrians.
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BACKGROUND: In 2009 a system was introduced for the automatic import (AI) of cases with suspected notifiable diseases (ND) from electronic medical record (EMR) to RedAlerta, an application for surveillance in Andalusia. At present, the contribution of this system to classical active statement has not been determined enough. The main objective of this study is to evaluate the usefulness of IA in the province of Granada, between 2009 and 2014. METHODS: During the study period (2009-2014), an epidemiologist assessed whether AI met declaration criteria or not. We calculate the contribution of AI to RedAlerta and the percentage of validation of AI, estimating 95% CI. RESULTS: The contribution of AI was 17.3% (95% CI 16.1 to 18.5); and type of statement, 5.2% (95% CI 4.1 to 6.5) for urgent and 24.4% (95% CI 22.7 to 26.2) for ordinary. The contribution was higher (more than 45%) in Lyme disease, congenital hypothyroidism, genital herpes, hepatitis C and other viral hepatitis. 30% (95% CI 28.1 to 32) of AI were validated; 39.9% (95% CI 33 to 47.2) urgent and 29.1% (95% CI 27.2 to 31.2%) ordinary. The percentage of validation was higher than 45% (between 47.5 and 100%) in vaccine-preventable diseases, sexually transmitted infections and low incidence. CONCLUSIONS: Although not replace manual reporting and requires verification, the AI system is useful and increases the completeness of the epidemiological surveillance system.
Assuntos
Notificação de Doenças/métodos , Registros Eletrônicos de Saúde , Vigilância em Saúde Pública/métodos , Estudos Transversais , Humanos , Espanha/epidemiologiaRESUMO
Respiratory syncytial virus (RSV) is a major cause of respiratory tract infections in adults, particularly older adults and those with underlying medical conditions. Vaccination has emerged as a potential key strategy to prevent RSV-related morbidity and mortality. This Neumoexperts Prevention (NEP) Group scientific paper aims to provide an evidence-based positioning and RSV vaccination recommendations for adult patients. We review the current literature on RSV burden and vaccine development and availability, emphasising the importance of vaccination in the adult population. According to our interpretation of the data, RSV vaccines should be part of the adult immunisation programme, and an age-based strategy should be preferred over targeting high-risk groups. The effectiveness and efficiency of this practice will depend on the duration of protection and the need for annual or more spaced doses. Our recommendations should help healthcare professionals formulate guidelines and implement effective vaccination programmes for adult patients at risk of RSV infection now that specific vaccines are available.(AU)
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Vírus Sinciciais Respiratórios/imunologia , Vacinação , Prevenção de Doenças , Pneumopatias/prevenção & controle , Pneumopatias/imunologia , Programas de ImunizaçãoRESUMO
Fundamentos: Streptococcus pneumoniae puede causar enfermedades invasivas y no invasivas. Bajo la denominación de enfermedad neumocócica invasiva, se incluyen aquellas infecciones que se localizan en tejidos, órganos y fluidos que normalmente son estériles y que se asocian con procesos clínicos generalmente severos. El objetivo de este estudio fue caracterizar los episodios de ENI (Enfermedad Neumocócica Invasiva) así como describir la sensibilidad antimicrobiana y distribución de los serotipos (vacunales y no vacunales) de cepas de S. pneumoniae aisladas en hemocultivos de pacientes atendidos en el Hospital Costa del Sol entre septiembre de 2012 y enero de 2017. Métodos: Estudio descriptivo a partir de cepas de S. pneumoniae aisladas en hemocultivos. Las variables de estudio fueron: edad, sexo, fallecimiento, tabaquismo, infección por VIH, diagnóstico clínico, serotipo y perfil de sensibilidad antimicrobiana. La fuente de información utilizada fue el programa de gestión clínica "Doctor ". El análisis estadístico se llevó a cabo mediante el software SPSS (SPSS, version 15,0; SPSS, Chicago Illinois, USA). Resultados: Se aislaron un total de 76 cepas de S. pneumoniae. Los serotipos más prevalentes fueron, en orden descendente 8, 3, 9N, 6C, 22F, 11A y 14. El 77,3% de las cepas fueron causantes de episodios de ENI con diagnóstico clínico de neumonía bacteriémica. Según el criterio del CLSI 2016 (Clinical & Laboratory Standards Institute), encontramos 2 cepas no sensibles a penicilina, 23 cepas no sensibles a eritromicina y 3 cepas no sensibles a levofloxacino. Conclusiones: Los resultados de este estudio muestran que los serotipos más frecuentes entre los pacientes con ENI atendidos en nuestro hospital no están cubiertos por las vacunas conjugadas, aunque sí por la VNP23. El serotipo 6C, no cubierto por ninguna vacuna, se situó entre los tres más frecuentemente aislados, causando exitus en un tercio de los pacientes
Background: Streptococcus pneumoniae can cause invasive and noninvasive diseases. Invasive pneumococcal disease causes infections in tissues, organs and fluids that are normally sterile and is associated with severe clinical processes generally. The aim of this study was to characterize ENI episodes as well as to describe the antimicrobial susceptibility and distribution of serotypes (vaccinal and non-vacunal) of S. pneumoniae strains isolated in blood cultures of patients treated at the Hospital Costa del Sol between September 2012 and January 2017. Methods: Descriptive study from S. pneumoniae strains isolated in blood cultures. The variables studied were: age, sex, death, smoking, HIV infection, clinical diagnosis, serotype and antibiotic susceptibility profile. The source of information used was the clinic management program called Doctor. Results: 76 S. pneumoniae strains were isolated. The most prevalent serotypes were 8, 3, 9N, 6C, 22F, 11A and 14. 77.3% of the strains were responsible for IPD (Invasive Pneumococcal Disease) episodes with clinical diagnosis of bacterial pneumonia. According to the CLSI 2016 (Clinical & Laboratory Standards Institute) criteria, 2 strains were non-susceptible to penicillin, 23 strains were non-susceptible to erythromycin and 3 were strains non-susceptible to levofloxacin. Conclusions: The results of this study show that the most frequent serotypes among ENI patients attended in our hospital are not covered by conjugate vaccines, although they do so by VNP23. Serotype 6C, not covered by any vaccine, was among the three most frequently isolated, causing death in one third of patients