Comparing Exposure to Psychosocial Risks: Face-to-Face Work vs. Telework.

BACKGROUND: In recent years, substantial changes have occurred in the work organization and arrangements. One of the main ones has been the popularization of teleworking among non-manual workers. This paper aims to assess the exposure of psychosocial risks among non-manual Spanish wage-earners, depending on the working modality (mainly telework, combining teleworking with onsite work, or onsite work). METHODS: Based on an online survey conducted between April and May 2021, a cross-sectional study was carried out among n=11,519 members of a trade union where Psychosocial Risks (PSR) were measured through COPSOQ Questionnaire Scales. All analyses were performed stratifying by sex. RESULTS: Women who combine telework and face-to-face work (aPR: 1.21; 95%CI 1.07-1.37) and men who mainly telework (aPR: 1.26; 95%CI 1.11-1.43) and that combine (aPR: 1.27; 95%CI 1.11-1.45) are more exposed to quantitative demands than men and women who do not telework. On the other hand, women who telework, either entirely (aPR: 0.89; 95%CI 0.82-0.97) or combining (aPR: 0.89; 95%CI 0.81-0.98), are less exposed to emotional demands than women who do not telework, and the same occurs among men who mainly telework (aPR: 0.84; 95%CI 0.76-0.92). Telework and horizontal or vertical social support are not associated, except for supervisor support among males, nor with work-life conflict. CONCLUSIONS: Except for quantitative demands, employees who combine telework and face-to-face work are less exposed to psychosocial risks than those who mainly telework or work face-to-face only. More studies with a gender and class perspective are needed in this area.

Is it possible to anchor a tooth with photobiomodulation?

During orthodontic treatment, we can achieve differential movements by using photobiomodulation (PBM) as an adjuvant before applying force. We can expect a greater bone density that initially resists movement while applying PBM to the other teeth to achieve an accelerating effect. The proposed protocol is to use an 810 nm laser at 0.1W power, applying between 4 and 6J per tooth for 22 s on the vestibular and lingual root surfaces, following the axial axis of the tooth. The energy density depends on the tip selected in the instrument. Normal bone remodeling cannot be avoided by applying high doses of PBM. PBM should be applied before orthodontic force to reduce tooth movement. In addition, PBM can be used during force application to teeth that require acceleration to achieve differential movement in orthodontic treatments. The protocol is the same in both scenarios.

Root Regeneration with Photobiomodulation of an Upper Lateral Incisor Associated with Root Resorption Due to an Impacted Maxillary Canine: A Case Report.

Objective: To present a case report of maxillary lateral incisor root regeneration after severe root resorption, treated with photobiomodulation (PBM). Background: Impacted maxillary canines often come with the risk of maxillary lateral incisor root resorption, which is widely recognized as the predominant adverse effect in these situations. This progressive process of root resorption is currently irreversible, with no known way to reverse it. Materials and methods: A male patient was 14 years old. Radiographically it was observed that canine 23 is impacting against the root of 22 producing signs of root resorption and having a less than 1:1 crown-to-root ratio with mobility grade 1. From the beginning of the treatment, PBM-assisted orthodontics was proposed. To address the patient's dental concerns, the treatment plan outlined the extraction of the deciduous upper left canine tooth leaving the lateral as long as possible in the mouth. During each appointment, PBM was applied with a diode laser. The wavelength was 810 nm, Ap = 0.2 W, 4.4 J, 22 sec every 21 days, 13 applications in total (57.2J), with a 400 µm inactive surgical tip, in a scanning movement, 1 mm from the mucosa while moving following the vestibular surface of the upper left lateral and canine roots. Results: After 12 months, the 22 had root neoformation and complete closure of the apex with vitality. Conclusions: PBM with an 810 nm diode laser in this clinical case promoted root regeneration of an upper lateral incisor, with severe root resorption, owing to an impacted maxillary canine while still vital.

Effective Parameters for Orthodontic Tooth Movement Acceleration with Photobiomodulation: An Umbrella Review.

Objective: To answer this research question: What are the effective wavelength, power, and energy density parameters for achieving dental movement acceleration? Background Data: Photobiomodulation (PBM) has been clinically studied for its ability to accelerate dental movements in orthodontics. However, its effectiveness is dose dependent. Methods: The search was carried out in PubMed, SCOPUS, and ISI Web of Science. The quality of the included systematic reviews was performed using the AMSTAR 2 tool. The risk of bias was assessed using the ROBIS tool. Results: In total, 29 articles in PubMed, 75 in Scopus, and 61 in ISI Web of Science. Finally, only five systematic reviews were included. Conclusions: The results showed the range from 730 to 830 nm as the most effective range of wavelength to accelerate the orthodontic dental movement. A power range of 0.25-200 mW, with emphasis on the direct correlation between power, wavelength, and energy density. Energy density has not been adequately reported in the most randomized controlled clinical trials.

Factors Associated with Non-Adherence to Tuberculosis Preventive Treatment among Adult Contacts of Pulmonary Tuberculosis Cases with Latent Tuberculosis Infection in Catalonia, Spain, in 2019-2021.

The aim of this study was to identify factors associated with non-adherence to tuberculosis (TB) preventive treatment among contacts with latent TB infection for new cases of pulmonary TB cases reported in Catalonia in 2019-2021. All contacts aged 18 years or older with a latent TB infection who received a TB preventive treatment were included in the study. The Chi square test and the odds ratios (OR) were used to assess the association between non-adherence to TB preventive treatment and the study variables; a p < 0.05 was considered statistically significant. Multiple logistic regression analysis was used to detect the independent factors associated with TB preventive treatment non-adherence; a p < 0.05 was considered statistically significant. The percentage of non-adherence to TB preventive treatment found in this study was 23.7%. A multivariable logistic regression analysis determined that the following factors were significantly associated with TB preventive treatment non-adherence among adult contacts: "exposure at school or workplace" (aOR = 3.34), "exposure to an index case without laboratory confirmation of TB" (aOR = 2.07), "immigrant contact" (aOR = 1.81), "male gender" (aOR = 1.75) and "exposure duration < 6 h per week or sporadic" (aOR = 1.60. By contrast, the factor "short-term TB preventive treatment regimen" (aOR = 0.38) was significantly associated with a lower treatment non-adherence. Adherence to TB preventive treatment should be improved among adult contacts of TB pulmonary cases with latent TB infection by recommending short-term treatment regimens and by developing health education activities, with a greater focus on contacts with factors associated with treatment non-adherence.

The Vaccine Training Barometer: Assessing healthcare providers' confidence to answer vaccine-related questions and their training needs.

Healthcare providers (HCP) are seen by the public as the most trustworthy source of information about vaccination. While HCPs could be a valuable partner to increase vaccine confidence in general, it is not clear whether they feel confident themselves to address questions concerning vaccination. In the context of the EU Joint Action on Vaccination (EU-JAV), the Vaccine Training Barometer, an online survey tool, was developed to assess how frequently HCPs receive questions about vaccination, how confident they feel to answer these questions, and to what extent they are willing to follow extra training. After a pilot test in Flanders, Belgium, the Barometer was launched and completed by 833 HCPs in Flanders and 291 HCPs in the Spanish regions of Catalonia, Navarre and Valencian Community from November 2020 until January 2021, during the COVID-19 pandemic, just before and during the start of the first COVID-19 vaccination campaigns. In both countries, HCPs frequently received questions about vaccination (mostly on a daily or weekly basis), and about two thirds of them indicated that the frequency of questions had increased during the three months prior to completing the survey. Most questions were about the side effects and safety of vaccines. In both countries, a considerable proportion of HCPs did not feel confident to answer vaccine-related questions (31.5% felt confident in Flanders, 21.6% in Spain). A large proportion of HCPs received questions in the last three months before the survey that they could not answer (52.4% of respondents in Flemish sample, 41.5% in Spanish sample). Only 11.4% (Flanders) and 11.3% (Spain) of the respondents felt they gained sufficient knowledge through their standard education to be able to answer questions about vaccination. Almost all respondents were willing to follow extra training on vaccination (Flanders: 95.4%, Spain: 96.6%). The Vaccine Training Barometer is thus a useful tool to monitor HCPs' confidence to answer questions about vaccination and to capture their training needs.

[Level of knowledge, attitudes and the use of preventive measures among household contacts of COVID-19 cases after the acute phase of the pandemic].

BACKGROUND: Assessment of the level of knowledge and attitudes regarding COVID-19 and preventive measures in household contacts of COVID-19 cases after the acute phase of the pandemic. METHODS: Survey among household contacts of COVID-19 cases conducted in healthcare centers in Navarre (1) and Catalonia (8) between May 2022 and July 2023. The frequency of use of preventive measures and the knowledge and attitudes towards COVID-19 were assessed through 12 items. RESULTS: 215 contacts participated who correctly used the preventive measures (>85%), except for facemasks (35.8%) and interpersonal distance (47%); >85% showed adequate knowledge (5/6 items) and >80% had a positive attitude (3/6 items). Moreover, 54.7% considered that COVID-19 negatively affected their life and 54.1% that it is better to develop immunity by getting infected than by vaccination. CONCLUSIONS: Household contacts show a correct level of knowledge and positive attitude towards the disease and its preventive measures.

Absence of short-term changes in knowledge and attitudes among household contacts of COVID-19 cases during the post-acute phase of the pandemic in Catalonia and Navarre, Spain.

Objectives: To evaluate short-term changes in knowledge and attitude towards COVID-19 and preventive measures during the post-acute phase of the pandemic in Spain. Methods: A survey was performed in Catalonia and Navarre between May-2022 and July-2023 in household contacts of COVID-19 cases. Knowledge and attitude were assessed at baseline and at three months, using a Likert scale. Responses were grouped according to correct or incorrect. Results: At baseline, 172 subjects were contacted, 118 (69%) of which completed a follow-up interview three months later. Knowledge of correct hand-washing and mask protocols had maintained over time (-1.7%, p = 0.553 and - 2.5%, p = 0.473, respectively). Attitudes toward preventive measures was adequate in the first interview (86%), but attitudes regarding use of face masks decreased significantly (-9.1%, p = 0.048) over time in participants with higher risk of severe COVID-19. However, most short-term changes in knowledge and attitudes were not statistically significant. Conclusion: Household contacts showed correct knowledge and attitude towards COVID-19 and its preventive measures, without significant changes in the short term despite a relaxation of government-mandated preventive measures. These results provide relevant information in case of a new health emergency due to respiratory viruses.

Effectiveness of Influenza Vaccination and Early Antiviral Treatment in Reducing Pneumonia Risk in Severe Influenza Cases.

INTRODUCTION: Influenza vaccination may be effective in preventing influenza infection and may reduce the risk of influenza-associated pneumonia. The study aim was to evaluate the effect of influenza vaccination in preventing pneumonia when it failed to prevent influenza hospitalization. METHODS: This was a case-control study comparing hospitalized cases of influenza with and without pneumonia in patients aged ≥18 years in 16 hospitals in Catalonia over 10 influenza seasons (2010-11 to 2019-20). Data on sociodemographic, virological characteristics, comorbidities, vaccination history, and antiviral treatment were collected and analysed. The crude odds ratio (OR) and adjusted OR (aOR) with the corresponding 95% confidence interval (CI) values were calculated. RESULTS: In total, 5080 patients hospitalized for severe influenza were included, 63.5% (3224/5080) of whom had pneumonia-mostly men (56.8%; 1830/3224) and mostly in the ≥75 age group (39.3%; 1267/3224)-and of whom 14.0% died (451/3224). Virus A and virus B accounted for 78.1% (2518/3224) and 21.9% (705/3224) of influenza types, respectively. Starting antiviral treatment ≤48 h after symptom onset (aOR = 0.69; 95%CI: 0.53-0.90) and a history of seasonal influenza vaccination (aOR = 0.85; 95%CI: 0.72-0.98) were protective factors in developing pneumonia. CONCLUSIONS: Adherence to seasonal influenza vaccination and starting antiviral treatment within 48 h of symptom onset can reduce pneumonia risk in severe influenza cases.

Impact of the Universal Implementation of Adolescent Hepatitis B Vaccination in Spain.

The aim of this study was to analyse the impact of the introduction of universal adolescent HBV vaccination on the incidence of acute hepatitis B virus (HBV) infections. Acute HBV cases reported to the Spanish National Epidemiological Surveillance Network between 2005 and 2021 were included. For regions starting adolescent vaccination in 1991-1993 and in 1994-1996, HBV incidence rates were compared by calculating the incidence rate ratio (IRR) and 95% confidence interval (CI). We also analysed the 2017 Spanish national seroprevalence survey data. The overall acute HBV incidence per 100,000 persons was 1.54 in 2005 and 0.64 in 2021 (p < 0.001). The incidence in 2014-2021 was lower for regions that started adolescent vaccination in 1991-1993 rather than in 1994-1996 (IRR 0.76; 95% CI 0.72-0.83; p < 0.001). In the 20-29 age group, incidence in regions that started adolescent vaccination in 1991-1993 was also lower (IRR 0.87; 95% CI 0.77-0.98; p = 0.02 in 2005-2013 and IRR 0.71; 95% CI 0.56-0·90; p < 0.001 in 2014-2021). Anti-HBc prevalence in the 35-39 age group was lower in the regions that started vaccination earlier, although the difference was not statistically significant (p = 0.09). Acute HBV incidence decreased more in the young adult population in regions that began adolescent vaccination earlier. Maintaining high universal vaccination coverage in the first year of life and in at-risk groups is necessary to achieve HBV elimination by 2030.

Risk of tuberculosis among pulmonary tuberculosis contacts: the importance of time of exposure to index cases.

INTRODUCTION: The intensity of exposure to index cases of tuberculosis [TB] may increase the risk of TB in their contacts. The aim was to determine TB risk factors among contacts of TB index cases. METHODS: A cohort study was carried out in the contacts of pulmonary TB cases registered by the epidemiological surveillance network from 01/01/2019 to 06/30/2021. The factors associated with the risk of TB in contacts were determined using the adjusted odds ratio [aOR] and its 95% confidence interval [CI]. RESULTS: From 847 TB cases, 7087 contacts were identified. The prevalence of TB was 2.0% [145/7087] and was higher in < 5 years compared to those ≥ 65 years [4.4% versus 1.2%; p < 0.001], in those exposed ≥ 6 h daily [4%], and < 6 h daily [1.6%] with respect to weekly exposure of < 6 h [0.7%; p < 0.001]. Those contacts exposed ≥ 6 h daily [aOR= 6.9; 95%CI:2.1-22.1], < 5 years [aOR= 8.3; 95%CI:1.8-37.8] and immigrants [aOR= 1.7; 95%CI:1.1-2.7] had a higher risk of TB. CONCLUSIONS: The risk of TB increases with the time of exposure to the index case and this risk is also higher in < 5 years and immigrants. Contact tracing has a high yield for detecting new cases of TB.

Vaccinated COVID-19 Index Cases Are Less Likely to Transmit SARS-CoV-2 to Their Household Contacts: A Cohort Study.

The aim of this study was to evaluate the impact of index case vaccination on SARS-CoV-2 transmission to household contacts. In our epidemiological cohort study (May 2022-November 2023), we surveyed registered index case vaccination status and test results for contacts (testing on day 0, and on day 7 for negative contacts) and calculated the secondary attack rate (SAR), i.e., newly infected contacts/susceptible included contacts. The association of the independent variable, index case COVID-19 vaccination (yes/no), with household contact infection was determined using the adjusted odds ratio (aOR) and its 95% confidence interval (CI). We recorded 181 index cases and 314 contacts, of whom 250 agreed to participate; 16 contacts were excluded upon testing positive on day 0. Of the 234 included contacts, 49.1% were women, and the mean (SD) age was 51.9 (19.8) years. The overall SAR of 37.2% (87/234) was lower in the contacts of both vaccinated index cases (34.9% vs. 63.2%; p = 0.014) and index cases with a previous SARS-CoV-2 infection history (27.0% vs. 46.3%; p = 0.002). Index case vaccination showed a protective effect against infection for their household contacts (aOR = 0.21; 95% CI: 0.07, 0.67). The household SAR was high when the Omicron variant circulated. Vaccinated index cases were less likely to transmit SARS-CoV-2 to their contacts.

Current protocol to achieve dental movement acceleration and pain control with Photo-biomodulation.

When designing a study on dental movement acceleration or pain control during orthodontic treatment, it is crucial to consider effective parameters. The objective of this editorial is to compile the most effective parameters supported by evidence that should be considered in future studies to achieve complete parameter homogenization. The protocol currently recommended to homogenize the parameters and facilitate the development of further meta-analysis in terms of acceleration of movement and pain control in orthodontics is Wavelength: 810 nm, 2.2 J per surface, 0.1 W in continuous mode/0.1 W average power in a super-pulsed, sweeping movement, 1mm from the mucosa, 22 seconds along the vestibular surface and 22 seconds along the lingual surface, the recommended speed of movement is 2 mm/sec, 1 application during each orthodontic control, to achieve dental movement acceleration and repeat the dose at 24 h to ensure pain elimination. The energy density and power density will depend on the spot size used in the equipment and the distance from the mucosa. It will strengthen the evidence of photobiomodulation as the best therapy to accelerate tooth movement and at the same time control the pain produced by orthodontic treatments.

Factors Associated with Treatment Prescription to Pulmonary Tuberculosis Contacts in Catalonia (2019-2021): A Population-Based Epidemiological Study.

In countries with low tuberculosis (TB) incidence, the systematic testing and treatment of latent TB infection (LTBI) in contacts of pulmonary TB index cases is the standard of care. The objective of this study, conducted in Catalonia over 2019-2021, was to assess the factors associated with LTBI treatment prescription to close contacts of pulmonary TB index cases. In this population-based epidemiological study of LTBI prevalence among pulmonary TB contacts between 2019 and 2021, multiple logistic backward stepwise regression was used to identify the factors associated with treatment prescription, for which the adjusted odds ratio (aOR) and 95% confidence intervals (CI) were calculated. A total of 1487 LTBI contacts of 542 pulmonary TB index cases were studied, 80.6% of whom received a prescription. The factors associated with LTBI treatment prescription were exposure ≥6 h/day (aOR 14.20; 95% CI 5.22-38.66) and exposure <6 h/day (aOR 7.32, 95% CI 2.48-21.64), whereas the factors associated with no LTBI treatment prescription were age ≥55 years (aOR 0.22, 95% CI 0.08-0.64) and bacillus Calmette-Guerin vaccination (aOR 0.38, 95% CI 0.16-0.90). Crucial to LTBI treatment prescription is information on the contact's duration of exposure to pulmonary TB, not only for contacts exposed for ≥6 h/day, but also for contacts with lower daily exposure levels.

Impact of a Mediterranean diet, physical activity, body composition, and insulin delivery methods on metabolic control in children with type 1 diabetes.

Aims: To evaluate the synergistic impact of diet, lifestyle and technology on glycemic control in children with type 1 diabetes (T1D). Methods: This cross-sectional study included 112 randomly selected patients with T1D from Gran Canaria (median age 12 years; 51.8% female). The study collected data on height, weight, body composition (bioimpedance), age, disease duration, and method of insulin delivery. Physical activity was evaluated using the Krece questionnaire and an accelerometer (GENEActiv). Adherence to the Mediterranean diet was assessed using the KIDMED Quick Nutrition Test. Glycemic control was evaluated using HbA1c and the percentage of time in range. SPSS version 21 and RStudio were used for statistical analysis of the data. Stepwise linear regression analysis (backwards) was used to identify factors independently associated with metabolic control. Results: Insulin pump use, age and adherence to the Mediterranean diet were found to be significantly and independently associated with better glycemic control, whereas years with T1D was associated with worse HbA1c values. No relationship was found between body composition and physical activity measured by accelerometry or questionnaire. Conclusion: Adherence to the Mediterranean diet, insulin delivery methods, age, and number of years with T1D are important factors to consider in the management of T1D in children.

Nivel de conocimientos, de actitudes y utilización de medidas preventivas entre los contactos domiciliarios de casos de COVID-19 tras la fase aguda de la pandemia / Level of knowledge, attitudes and the use of preventive measures among household contacts of COVID-19 cases after the acute phase of the pandemic

Fundamento. Describir el nivel de conocimiento y actitudes sobre la COVID-19 y sus medidas preventivas en contactos domiciliarios de casos de COVID-19 tras la fase aguda de la pandemia. Métodos. Encuesta a contactos domiciliarios de casos de COVID-19 realizada en centros de salud de Navarra (1) y Cataluña (8) entre mayo/2022 y julio/2023. Se evaluó el uso de medidas preventivas y, mediante 12 ítems, los conocimientos y actitudes frente a COVID-19. Resultados. Participaron 215 contactos que usaron correctamente las medidas preventivas (>85%), exceptuando mascarilla (35,8%) y distancia interpersonal (47%); >85% mostraron conocimientos adecuados en 5/6 ítems y >80% mostraron actitud positiva en 3/6 ítems. El 54,7% consideró que la COVID-19 influyó negativamente en su vida y el 54,1% que es mejor desarrollar inmunidad enfermando que mediante la vacunación. Conclusiones. Los contactos domiciliarios mostraron un correcto nivel de conocimiento y una actitud positiva frente a la COVID-19 y sus medidas preventivas. (AU)

Background. Assessment of the level of knowledge and attitudes regarding COVID-19 and preventive measures in household contacts of COVID-19 cases after the acute phase of the pandemic. Methods. Survey among household contacts of COVID-19 cases conducted in healthcare centers in Navarre (1) and Catalonia (8) between May 2022 and July 2023. The frequency of use of preventive measures and the knowledge and attitudes towards COVID-19 were assessed through 12 items. Results. 215 contacts participated who correctly used the preventive measures (>85%), except for facemasks (35.8%) and interpersonal distance (47%); >85% showed adequate knowledge (5/6 items) and >80% had a positive attitude (3/6 items). Moreover, 54.7% considered that COVID-19 negatively affected their life and 54.1% that it is better to develop immunity by getting infected than by vaccination. Conclusions. Household contacts show a correct level of knowledge and positive attitude towards the disease and its preventive measures. (AU)

Validación del cuestionario sobre vacunas y reticencia a vacunarse en la Sociedad Española de Epidemiología / Validation of the questionnaire on vaccines and hesitancy to be vaccinated in the Spanish Society of Epidemiology

Objetivo: Confeccionar y validar una encuesta dirigida a profesionales de epidemiología para medir factores asociados a la reticencia vacunal. Método: La reticencia a la vacunación se refiere al retraso en la aceptación o el rechazo de la vacunación a pesar de la disponibilidad de ella. La OMS la incluyó entre las diez amenazas a la salud global en 2019.En este marco conceptual propuesto por la OMS, un comité de seis expertos de la Sociedad Española de Epidemiología (SEE) diseñó un cuestionario autoadministrado para estudiar los factores asociados a la reticencia a la vacunación en epidemiólogos/as. Este cuestionario fue aprobado por la Junta de la SEE y se envió on line a todos/as los/las socios/as en 2019. A partir de las respuestas obtenidas se validaron las siguientes características: validez aparente, interna, de constructo y de criterio, fiabilidad, curvas características de cada ítem y función de información por ítem y conjunta. Resultados: El cuestionario mostró dos componentes bien definidos: la percepción sobre las vacunas y la confianza en la transparencia de los datos sobre vacunas con altos grados de ajuste en todos los aspectos de la validación. Ambos componentes han demostrado que cuanto mayor es la reticencia a la vacunación, mejor informa el cuestionario sobre estos aspectos. Conclusiones: El estudio ha permitido elaborar un instrumento validado en español para medir los factores asociados a la reticencia vacunal entre los/las epidemiólogos/as.(AU)

Objective: To develop and validate a survey aimed at epidemiologists to measure factors associated withvaccine reluctance.Method: Vaccination hesitancy refers to delayed acceptance or refusal of vaccination despite the availa-bility of vaccination services. WHO included vaccination hesitancy among the 10 global health threats in2019. Within this conceptual framework proposed by WHO, a committee of six experts from the Spanish Society of Epidemiology (SEE) designed a self-administered questionnaire to study factors associatedwith vaccination hesitancy in epidemiologists. This questionnaire was approved by the SEE Board, andwas sent online to all members in 2019. Based on the responses obtained, the following characteristicswere validated: face validity, internal validity, construct validity, criterion validity, reliability, as well asthe characteristic curves of each item and the information function per item and overall. Results: The final questionnaire showed two well-defined components, perception of vaccines and con-fidence in the transparency of vaccine data with high degrees of fit in all aspects of validation. Bothcomponents have shown that the higher the reluctance to vaccinate the better the questionnaire reportson these aspects. Conclusions: The study has allowed the development of a validated instrument in Spanish to measurethe factors associated with vaccine reluctance among epidemiologists.(AU)

Características de los pacientes con enfermedad neumocócica invasora que requieren ingreso en la unidad de cuidados intensivos / Characteristics of patients with invasive pneumococcal disease requiring admission to intensive care units

INTRODUCCIÓN: La enfermedad neumocócica invasora (ENI) puede requerir ingreso en la unidad de cuidados intensivos pediátricos (UCIP). El objetivo de este trabajo es analizar las características epidemiológicas, clínicas y microbiológicas asociadas a la ENI que predisponen el ingreso en la UCIP. MATERIAL Y MÉTODOS: Estudio prospectivo de casos diagnosticados con ENI en tres hospitales pediátricos de Barcelona entre enero de 2012 y junio de 2016. Se analizaron las asociaciones entre el ingreso en la UCIP y las variables epidemiológicas, clínicas y microbiológicas. RESULTADOS: Se incluyeron 263 casos con ENI. El 19% (n = 50) requirió ingreso en la UCIP. El 100% (7) de los pacientes con shock séptico, 84,2% (16) con meningitis y 15,2% (23) con neumonía complicada ingresaron en la UCIP. Las complicaciones más frecuentes fueron pulmonares (35,2%) y neurológicas (39,5%). La razón entre ingreso y no ingreso en la UCIP fue 4,17 veces mayor en los sujetos con enfermedad de base. Los serotipos asociados al ingreso en la UCIP fueron el 19A (23% del total de este serotipo), el 14 (20%), el 3 (17%) y el serotipo 1 (12,5%). CONCLUSIONES: La ENI requiere ingreso en la UCIP en caso de shock séptico y meningitis, no así, de entrada, la neumonía complicada. El porcentaje de ingresos es mayor en los niños con enfermedad de base. El ingreso en la UCIP conlleva una estancia más prolongada, así como complicaciones durante la fase aguda y secuelas, sobre todo, neurológicas. Los serotipos de los pacientes que ingresaron en la UCIP fueron, predominantemente, serotipos vacunales

INTRODUCTION: Patients with invasive pneumococcal disease (IPD) may require admission into paediatric intensive care units (PICU). The aim of this study is to analyse the epidemiological, clinical, and microbiological characteristics associated with IPD that may require admission to the PICU. MATERIAL AND METHODS: A prospective study was conducted on cases of IPD diagnosed in three Paediatric Hospitals in Barcelona between January 2012 and June 2016. An analysis was made of the associations between the admission to PICU and the epidemiological, clinical, and microbiological variables. RESULTS: A total of 263 cases with IPD were included, of which 19% (n = 50) required admission to PICU. Patients with septic shock (7; 100%), meningitis (16; 84.2%), and those with complicated pneumonia (23; 15.2%) were admitted to the PICU. The most frequent complications were pulmonary (35.2%) and neurological (39.5%). The ratio between admission and non-admission to PICU was 4.7 times higher in subjects with an underlying disease. The serotypes associated with PICU admission were 19A (23% of the total of this serotype), serotype 14 (20%), serotype 3 (17%), and serotype 1 (12.5%). CONCLUSIONS: IPD required PICU admission in cases of septic shock and meningitis, and less so with complicated pneumonia. The percentage of admissions is greater in children with an underlying disease. Admission into the PICU involves a longer stay, complications during the acute phase, as well as sequelae, particularly neurological ones. The serotypes of the patients that were admitted to PICU were predominantly vaccine serotypes

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)

Sobre falsas creencias y tiomersal en las vacunas. Réplica de los autores / About false beliefs and thiomersal in vaccines. Reply of the authors

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