M. García López Hortelano

Exposición a tuberculosis multirresistente: estudio y seguimiento de nueve niños

A world increase in multidrug-resistant tuberculosis (MDR-TB) has been reported over the last few years. A larger number of diagnoses are being seen in Spain, due to the increase of immigration from high endemic TB countries. Articles published on this are anecdotal in children, and there is no clear directives for treatment of MDR-TB, or latent tuberculosis infection (ITBL) or on prophylaxis after exposure to active pulmonary MDR-TB. We present the initial management and progression of nine children after close contact exposure to an Ecuadorian woman diagnosed with active pulmonary TB, resistant to Isoniazid, Rifampicin and Pyrazinamide.

Vacunación frente a la encefalitis centroeuropea o encefalitis transmitida por garrapatas en niños viajeros

En mayo del año 2002 el Ministerio de Sanidad acreditó al Hospital Carlos III como centro de vacunación internacional, con dos consultas: consulta del niño y del adulto viajero. En la consulta pediátrica se evaluaron, sólo en el año 2007, 528 niños con edades comprendidas entre los 15 días y los 16 años. La mitad de los niños viajeros que acudieron a la consulta precisaron quimioprofilaxis antipalúdica y las vacunas más prescritas fueron contra la hepatitis A y la fiebre amarilla. Recientemente, ha surgido la alarma en los medios de comunicación sobre la indicación de vacunar frente a encefalitis centroeuropea a viajeros que van a zonas boscosas de Europa central esta primavera. El Servicio de Pediatría del Hospital Carlos III, como en años anteriores, recomienda: La vacuna frente a la encefalitis centroeuropea transmitida por garrapatas es una vacuna de virus inactivados cultivados en células de embrión de pollo. Se indica en los niños viajeros campistas a zonas boscosas del centro, norte y este de Europa en primavera y verano cuando el viaje tiene una duración superior a 3 semanas. La pauta son 3 dosis administradas con un intervalo de 1-3 meses entre la primera y la segunda (mínimo 15 días) y de 9-12 meses entre la segunda y la tercera. Existe, no obstante, una pauta acelerada: 0,7 y 21 días. En este caso la protección comienza a los 15 días de la segunda dosis. En niños de entre 1 y 11 años se administrará la dosis pediátrica (la mitad de la dosis de adultos) y en los mayores de 11 años, la dosis completa. Se recomienda un recuerdo cada 3-5 años si el niño se mantiene en zona de riesgo. La vacuna está comercializada como FSME-inmun inject. Júnior o Encepur Children dosis pediátrica (jeringa precargada de 0,25 ml) para niños menores de 11 años. Esta vacuna se administra únicamente en los centros de vacunación internacional autorizados por el Ministerio de Sanidad en cada comunidad autónoma. Los países con riesgo elevado de encefalitis centroeuropea son: Alemania, Austria, Bielorrusia, Croacia, Eslovaquia, Eslovenia, Finlandia, Hungría, Lituania, Polonia, Republica Checa, Rusia, Suecia, Suiza y Ucrania. Los países con riesgo bajo de encefalitis centroeuropea son Albania, Bosnia, China, Dinamarca (solo la isla de Bornholm), Francia, Grecia, Italia, Japón, Kazajstán, Moldavia, Mongolia, Noruega, Rumanía y Serbia1. Puede consultarse el mapa de distribución de los casos comunicados a la Organización Mundial de la Salud (OMS)2 (CDC Health Information for Internacional Travel 2008) disponible en http://www.isw-tbe.info/tbe.aspx.

Identificación de las diferentes variantes geneticas del VIH-1 en niños de procedencia no española

INTRODUCTION The prevalence of HIV-1 non-B subtypes (HIV-NBS) is increasing in Europe, because of emigration from countries where genetic variants are endemic. Although HIV-NBS could have a different clinical evolution and could respond differently to antiretrovirals (AR) than B-subtypes, these variants response remain undocumented. AIMS To identify HIV-1 genetic variants and to determine clinical evolution in a non-Spaniard children infected with HIV-1. PATIENTS AND METHOD Children with HIV-1 infection from endemic countries were tested for HIV-1 subtypes between 1-1-1988 and 31-12-2006. Twelve children less than 18 years old and born abroad were selected. RESULTS HIV-NBS were isolated in 5 children (42%): CRF2_AG recombinant in 3 cases (Equatorial Guinea), Subtype C in one (Equatorial Guinea) and CRF13_cpx in last one (India). DISCUSSION Because of the increasing frequency of patients with HIV-NBS and their unknown long-term evolution, all children from endemic countries should be tested for HIV subtypes. We believe new studies with more patients during longer times could reveal differences in these patients clinical, immunological and virological evolution.

Por la protección de la salud de los niños refugiados

In recent months Europe has had to contend with the arrival of a large number of displaced persons, most of them from Syria. The United Nations Refugee Agency (UNHCR; in Spain, ACNUR) has warned of the vulnerability of this population and of the higher risk of health problems it presents.1 Some of us, as paediatricians, have had occasion to treat Syrian children in our consulting rooms recently, and have been able to observe their health needs. This situation is likely to become more common in the coming months. In a recent document, the Spanish Association of Paediatrics committed itself to taking an active part both in direct health care and in designing and implementing a reception programme for these refugees.2 The Spanish Society for Paediatric Infectious Diseases (SEIP: Sociedad Española de Infectología Pediátrica) has also felt moved to show its concern through this editorial. In the following paragraphs the members of the Tropical Infections, Tuberculosis and International Cooperation Working

Alerta de rabia terrestre en España en 2013. Actuación pediátrica

Rabies is a zoonotic viral disease found all over the world. Dogs are the source of infection in over 99% of human cases. Rabies is caused by an RNA virus in the family Rhabdoviridae family, genus Lyssavirus, found in the saliva of infected mammals. The virus is transmitted to humans through bites from such animals, and the risk of contracting the disease ranges between 5% and 80% depending on the intensity of the contact and the amount of inoculated pathogen. In Europe, the epidemiology of rabies has changed in recent years due to extensive establishment of the virus in bats, the re-emergence of rabies in foxes, and the import of rabid dogs from North Africa. Spain had been free of terrestrial rabies since 1978. In June of 2013 a case of rabies was confirmed in a dog that had come from Morocco. A level 1 rabies alert was declared, and a restricted area for interventions set up across several autonomous communities (Catalonia, Castilla-La Mancha and Madrid). The Hospital Carlos III was designated as the reference centre for patients that had had animal contacts within the restricted area. We performed a retrospective, observational descriptive study based on the review of medical records from suspected paediatric cases during the rabies alert period. We collected data on epidemiology variables, the source of transmission, the contact category as defined by the WHO classification (Table 1) and the subsequent interventions. During the rabies alert, 29 suspected cases were seen at the hospital; 9 of them (31%) occurred in children. The mean age of these patients was 9.8 years, and 66.7% of them were male. Eight cases involved dog bites, and one patient had been bitten by a rat. All patients had their wounds cleaned and were given amoxicillin-clavulanate for postexposure prophylaxis. Five bites were classified as category