L. Ortigosa del Castillo

Calendario de vacunaciones de la Asociacion Espanola de Pediatria: recomendaciones 2010

The Advisory Committee on Vaccines of the Spanish Association of Paediatrics (CAV-AEP) updates the immunisation schedule every year, taking into account epidemiological data as well as evidence on safety, effectiveness and efficiency of vaccines. The present schedule includes levels of recommendation. We have graded, as routine vaccinations, those that the CAV-AEP consider all children should receive; as recommended those that fit the profile for universal childhood immunisation and would ideally be given to all children, but that can be prioritised according to the resources available for their public funding; and as risk group vaccinations those that specifically target individuals in special situations. Immunisation schedules tend to be dynamic and adaptable to ongoing epidemiological changes. Based on the latest epidemiological trends, CAV-AEP recommends the administration of the first dose of MMR and varicella vaccines at age 12 months, with the second dose at age 2-3 years; the administration of DTaP or Tdap vaccine at age 4-6 years, always followed by another Tdap dose at 11-12 years; and the three meningococcal C scheme at 2 months, 12 months and 12 years of age. It reasserts its recommendation to include vaccination against pneumococcal disease in the routine immunisation schedule. The CAV-AEP believes that the coverage of vaccination against human papillomavirus in girls aged 11-12 years must be increased. Universal vaccination against varicella in the second year of life is an effective strategy, and the immediate public availability of the vaccine is requested in order to guarantee the right of healthy children to be vaccinated. Vaccination against rotavirus is recommended in all infants due to the morbidity and elevated healthcare burden of the virus. The Committee stresses the need to vaccinate population groups considered at risk against influenza and hepatitis A. The recently authorised meningococcal B vaccine has opened a chapter of hope in the prevention of this disease. In anticipation of upcoming national and international studies, the Committee recommends the vaccine for the control of disease outbreaks, and insists on the need to be available in pharmacies. Finally, it emphasises the need to bring incomplete vaccinations up to date following the catch-up immunisation schedule.

Immunization schedule of the Spanish Association of Pediatrics: 2012 recommendations

The Advisory Committee on Vaccines of the Spanish Association of Pediatrics (CAV-AEP) updates the immunization schedule every year, taking into account epidemiological data as well as evidence on the effectiveness and efficiency of vaccines. The present schedule includes grades of recommendation. We have graded as routine vaccinations those that the CAV-AEP believes all children should receive; as recommended those that fit the profile for universal childhood immunization and would ideally be given to all children, but that can be prioritized according to the resources available for their public funding; and as risk group vaccinations those that specifically target individuals in situations of risk. Immunization schedules tend to be dynamic and adaptable to ongoing epidemiological changes. Nevertheless, the achievement of a unified immunization schedule in all regions of Spain is a top priority for the CAV-AEP. Based on the latest epidemiological trends, the main changes introduced to the schedule are the administration of the first dose of the MMR and the varicella vaccines at age 12 months (12-15 months) and the second dose at age 2-3 years, as well as the administration of the Tdap vaccine at age 4-6 years, always followed by another dose at 11-14 years of age. The CAV-AEP believes that the coverage of vaccination against human papillomavirus in girls aged 11-14 years must increase. It reasserts its recommendation to include vaccination against pneumococcal disease in the routine immunization schedule. Universal vaccination against varicella in the second year of life is an effective strategy and therefore a desirable objective. Vaccination against rotavirus is recommended in all infants due to the morbidity and elevated healthcare burden of the virus. The Committee stresses the need to vaccinate population groups considered at risk against influenza and hepatitis A. Finally, it emphasizes the need to bring incomplete vaccinations up to date following the catch-up immunization schedule.

Estudio sobre la introducción del Sistema de Transferencia de Créditos Europeo en Pediatría y modificaciones de la metodología docente

Introduccion Las Facultades Medicas espanolas han comenzado el nuevo proceso de reforma curricular en el marco del proceso de implantacion del Espacio Europeo de Educacion Superior y deben incorporar el Sistema de Transferencia de Creditos Europeo (ECTS) a los nuevos planes del estudio antes de 2010. Objetivos El objetivo del trabajo fue experimentar la introduccion de los creditos ECTS en la asignatura de Pediatria y modificar la metodologia docente. Diseno del estudio Adaptacion del programa teorico y practico, estableciendo unos objetivos docentes y un sistema de evaluacion. Se realizaron encuestas a los alumnos al inicio del Segundo cuatrimestre del curso 2004-2005, antes de realizar el examen teorico de la asignatura y al finalizar el curso academico, utilizando para las respuestas una escala de tipo Likert con 5 grados. Se comparo la priorizacion de las competencias genericas y especificas de los alumnos con la de los profesionales medicos en la encuesta de la Conferencia Nacional de Decanos (CND). Para el analisis de los resultados se aplicaron pruebas no parametricas. Resultados Los 15 creditos actuales se transformaron en 11 ECTS, con 297 h de trabajo para los alumnos. Se redujo el programa teorico de 80 a 52 lecciones. Los alumnos prepararon y presentaron 14 casos clinicos, bajo la supervision de sus tutores. Los profesores consideraron que el aprendizaje teorico habia sido similar al de cursos anteriores (66,6 %) y habia sido mejor el practico (73,3 %). Los alumnos opinaron que el proyecto debia continuar (73,2 %), pero el 98,8% consideraron que la carga de trabajo habia sido excesiva. Los alumnos apreciaron de forma estadisticamente significativa que mejoro la docencia practica y su capacidad para preparar y presentar casos clinicos. El rendimiento academico de los alumnos fue significativamente mejor que el de los alumnos del curso anterior. Los estudiantes estuvieron de acuerdo con la prioridad de competencias de la CND para 9/9 de las generales y 4/17 de las especificas. La estimacion de horas de trabajo de los alumnos fue mayor por los alumnos que por los profesores. El 73,3% de los alumnos contestaron que el proyecto debia mejorarse, reduciendo la carga de trabajo de los alumnos y mejorando el sistema de evaluacion. Conclusiones La introduccion de los ECTS mejoro el rendimiento academico, la formacion practica y el autoaprendizaje de los alumnos. La experiencia fue satisfactoria para profesores y alumnos. La estimacion de la carga de trabajo de los alumnos fue subestimada.

Documento de consenso sobre la actitud ante un niño con una reacción alérgica tras la vacunación o alergia a componentes vacunales

Vaccinations are one of the main public health tools for the control of vaccine-preventable diseases. If a child is labeled to have had an allergic reaction to a vaccine, the next immunizations will probably be suspended in that child, with the risks involved in this decision. The rate of severe allergic reactions is very low, ranging between 0.5-1/100,000 doses. The causes of allergic reactions to vaccines, more than the vaccine itself, are often due to residual protein components in the manufacturing process, such as gelatin or egg, and rarely to yeast or latex. Most of vaccine reactions are mild, localized at the site of injection, but in some circumstances, severe anaphylactic reactions can occur. If an immediate-type allergic reaction is suspected when vaccinating, or a child allergic to some of the vaccine components has to be vaccinated, a correct diagnosis of the possible allergy has to be made. The usual components of each vaccine should be known, in order to determine if vaccination can be performed safely on the child.

Vacunación frente al meningococo B. Posicionamiento del Comité Asesor de Vacunas de la Asociación Española de Pediatría

Meningococcal invasive disease, including the main clinical presentation forms (sepsis and meningitis), is a severe and potentially lethal infection caused by different serogroups of Neisseria meningitidis. Meningococcal serogroup B is the most prevalent in Europe. Most cases occur in children, with a mortality rate of 10% and a risk of permanent sequelae of 20-30% among survivors. The highest incidence and case fatality rates are observed in healthy children under 2-3 years old, followed by adolescents, although it can occur at any age. With the arrival in Spain of the only available vaccine against meningococcus B, the Advisory Committee on Vaccines of the Spanish Association of Paediatrics has analysed its preventive potential in detail, as well as its peculiar administrative situation in Spain. The purpose of this document is to publish the statement of the Committee as regards this vaccination and the access to it by the Spanish population, taking into account that it has been only authorized for people at risk. The vaccine is available free in the rest of Europe for those who want to acquire it, and in some countries and regions it has been introduced into the systematic immunisation schedules. The Committee considers that Bexsero® has a profile of a vaccine to be included in the official schedules of all the Spanish autonomous communities and insists on the need for it to be available in pharmacies for its administration in all children older than 2 months.

Enfermedad por arañazo de gato con afectaciÓn hepatoesplénica

Paciente de 14 años de edad, previamente sano, que presenta un cuadro de 3 semanas de evolución, que comenzó con una tumefacción dolorosa a nivel axilar izquierdo, fiebre alta y malestar general. En la exploración inicial presentaba una adenopatía de 2 cm de diámetro en la axila izquierda y microadenopatías laterocervicales no dolorosas. No refería antecedentes de viajes; un amigo cursaba un cuadro similar. Mantenía contacto con perros y gatos fuera de su domicilio. Dos semanas después comienza con dolor abdominal, de predominio en hipocondrio derecho, palpándose un borde hepático y 1 cm de bazo. Ambulatoriamente se había instaurado tratamiento empírico con claritromicina. En los exámenes complementarios se constataba una leucocitosis leve y trombocitosis. La actividad del tiempo de protrombina estaba discretamente disminuida y presentaba una ligera elevación de alanino transferasa (ALT) y gammaglutamil transferasa (GGT), con aspartato transferasa (AST), bilirrubina, fosfatasa alcalina y amilasa normales. Los reactantes de fase aguda estaban elevados (velocidad de sedimentación globular [VSG] 63 mm, reacción en cadena de la polimerasa [PCR] 7,2 mg/dl). El estudio inmunológico, factor reumatoide, alfa-fetoproteína y anticuerpos antinucleares (ANA) fueron negativos. Se le realizó una ecografía abdominal donde se observó una discreta esplenomegalia, visualizándose cuatro imágenes hipoecoicas de menos de 1 cm de diámetro, sin pared, compatibles con microabscesos (fig. 1). En la tomografía computarizada (TC) abdominal se comprobó la existencia de pequeñas imágenes hipodensas en el bazo, y lesiones similares repartidas por ambos lóbulos hepáticos, con anillo de captación de contraste (fig. 2). El estudio microbiológico mostró la negatividad de todos los cultivos y la serología de fiebre de origen desconocido resultó negativa. Se le extrajo serología (ELISA) frente a Bartonella henselae dando títulos IgM 1:1.600, IgG 1:160. Se instauró tratamiento con claritromicina oral, y un mes después se observó la seroconversión (IgM 1:20, IgG 1:1.600) con mejoría evidente de las lesiones en la TC. Actualmente se encuentra asintomático; ecográficamente se apreciaron pequeñas lesiones residuales calcificadas en el bazo.

Calendario de vacunaciones de la Asociación Española de Pediatría: recomendaciones 2014

The Advisory Committee on Vaccines of the Spanish Association of Paediatrics (CAVAEP) updates the immunisation schedule every year, taking into account epidemiological data as well as evidence on safety, effectiveness and efficiency of vaccines. The present schedule includes levels of recommendation. We have graded, as routine vaccinations, those that the CAV-AEP consider all children should receive; as recommended those that fit the profile for universal childhood immunisation and would ideally be given to all children, but that can be prioritised according to the resources available for their public funding; and as risk group vaccinations those that specifically target individuals in special situations. Immunisation schedules tend to be dynamic and adaptable to ongoing epidemiological changes. Based on the latest epidemiological trends, CAV-AEP recommends the administration of the first dose of MMR and varicella vaccines at age 12 months, with the second dose at age 2-3 years; the administration of DTaP or Tdap vaccine at age 4-6 years, always followed by another Tdap dose at 11-12 years; and the three meningococcal C scheme at 2 months, 12 months and

Vacunación frente a la gripe estacional en la infancia y la adolescencia. Recomendaciones del CAV-AEP para la campaña 2011-2012

Seasonal influenza vaccination in children and adolescents. Recommendations of the CAV-AEP for the campaign Abstract The Advisory Committee on Vaccines of the Spanish Association of Paediatrics esta- blishes annual recommendations on influenza vaccination in childhood before the onset of influenza season. Routine influenza vaccination is particularly beneficial when the strategy is aimed at children older than 6 months of age with high-risk conditions and their home con- tacts. The recommendation of influenza vaccination in health workers with children is also emphasised.