N. García Sánchez

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.

Cobertura de vacuna antigripal en niños de riesgo durante 2007-2008 en un centro de Atención Primaria en España

espanolIntroduccion: los ninos con enfermedades cronicas (EC) tienen mas riesgo de presentar complicaciones importantes debidas a la gripe. Aunque la vacunacion rutinaria anual con vacuna trivalente inactivada esta indicada en estos ninos, son muy pocos los que cumplen esta recomendacion. El objetivo de nuestro estudio es comprobar la cobertura de vacuna antigripal en ninos con alto riesgo de complicaciones (ARC) en un centro de salud urbano en Espana. Pacientes y metodos: durante el otono e invierno 2007-2008 se reviso la base de datos de las historias clinicas de los ninos de 0-14 anos de edad, en un centro de salud. De un total de 3.479 ninos, 232 presentaban ARC. Se comprobo si habian recibido la vacuna antigripal en ese ano, examinando cada historia clinica informatizada. Resultados: la cobertura global de vacuna antigripal en ninos con ARC fue 43,1%. El 98% de los ninos vacunados recibio una vacunacion completa. Segun las patologias subyacentes encontradas, la cobertura vacunal fue del 44% en caso de asma, 35% en cardiopatia congenita y 42,85% en diabetes mellitus. La cobertura de vacuna antigripal fue menor en ninos de familias inmigrantes con ARC que en espanoles, 35,6% frente al 45,7%. Conclusiones: la cobertura de vacuna antigripal en nuestros ninos con ARC es mayor que la comunicada en la bibliografia medica (10-23%). A pesar de estos buenos resultados, se necesita aumentar la vacunacion antigripal en todos los ninos con EC. Los profesionales de la salud deberian disenar estrategias para conseguir una cobertura de un 75% como un objetivo mucho mejor. EnglishIntroduction: children with chronic medical conditions (CMC) are at high-risk of suffering from serious complications due to influenza. Although routine annual influenza immunization with trivalent inactivated vaccine is recommended in these children, few of them fulfil the recommendation. The aim of our study is to assess the rate of influenza vaccine coverage among children with CMC in a Primary Care Setting in a metropolitan area in Spain. Patients and methods: in the 2007-2008 influenza season, the computerized database of all children aged 0-14 years in a Primary Care Setting was checked. Over 3,479 children, 232 were indentified as high-risk. The administration of influenza vaccine in these children that year was assessed checking every computerized medical record. Results: the global influenza vaccine coverage among children with CMC was 43.1%. Full immunization was received in 98% of them. Depending on the underlying medical condition, the coverage was 44% in children with Asthma, 35% in Congenital Heart Diseases and 42.8% in Diabetes Mellitus. Children with CMC living in immigrant families had lower rate of influenza vaccination than those in Spanish families, 35.6% versus 45.7%. Conclusions: the rate of vaccine coverage among children with CMC in our setting is higher than the one reported in medical reviews (range: 10-23%). Despite these good results, to increase the rates of vaccination among children with CMC is needed. Health care professionals should design strategies to achieve a 75% rate of influenza vaccine coverage in high-risk children as a much better goal.

Alivio del dolor y el estrés al vacunar. Síntesis de la evidencia. Recomendaciones del Comité Asesor de Vacunas de la AEP

Introduccion: en ninos y adolescentes sanos, las vacunaciones son con frecuencia fuente de dolor y sufrimiento. Padres, ninos, adolescentes y profesionales sanitarios muestran preocupacion sobre ello. El Comite Asesor de Vacunas de la Asociacion Espanola de Pediatria (CAV-AEP) cree que abordar el dolor y el sufrimiento al vacunar es necesario, siguiendo la metodologia de la medicina basada en la evidencia. El objetivo del presente trabajo es elaborar recomendaciones basadas en el conocimiento cientifico. Material y metodos: se dividio la materia de estudio en cuatro areas: amamantamiento y soluciones azucaradas, anestesicos topicos, metodos para la administracion de vacunas y otras intervenciones (distraccion). Se realizo una sintesis de la evidencia, asumiendo las recomendaciones de la Guia de practica clinica de Anna Taddio (2010) e incorporando la evidencia de revisiones sistematicas y ensayos clinicos posteriores a los incorporados en dicha guia. Resultados: las medidas que se han mostrado efectivas en la disminucion del dolor han sido las siguientes: en lactantes, amamantar antes, durante y despues de la inyeccion; las soluciones azucaradas son una alternativa si la lactancia materna no fuera posible; los anestesicos topicos son eficaces para todas las edades, pero requieren un tiempo para mostrar su efecto y tienen un coste; no aspirar en la inyeccion intramuscular y hacerlo lo mas rapido posible; administrar las vacunas de forma que la mas dolorosa sea la ultima; cuando sea posible, es preferible inyectar simultaneamente mas de una vacuna que hacerlo de forma secuencial; sostener al nino en brazos; y utilizar maniobras de distraccion para ninos de 2-14 anos. Conclusiones: realizada una exhaustiva revision del tema, hay pruebas suficientes para afirmar que los profesionales que administran vacunas infantiles deberian poner en practica medidas para atenuar el dolor que indudablemente acompana al procedimiento de la vacunacion. Se trata ademas, en general, de medidas tecnicamente sencillas y faciles de incorporar a la practica.

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.

Adolescente con obesidad: ¿presenta síndrome metabólico?

La obesidad es una condicion cada vez mas presente en ninos y jovenes, en especial en paises industrializados. El problema de la obesidad infantil es su alta probabilidad de persistir en la vida adulta y la posibilidad de acompanarse de comorbilidad, siendo lo mas destacable el aumento del riesgo cardiovascular y otras complicaciones metabolicas, como es el sindrome metabolico.

Estudio de la epidemia de gripe A nH1N1 de 2009-2010: Síntomas guía en Atención Primaria. Comparación clínica con los casos hospitalarios

Objetivos: analizar la capacidad de prediccion clinica respecto al diagnostico de gripe A nH1N1 de los sintomas que presentan los pacientes ambulatorios registrados en la base de datos de la Red Centinela de Aragon (RCA). Comparar la casuistica ambulatoria con los pacientes ingresados durante la epidemia de gripe A nH1N1 (2009-2010). Pacientes y metodos: estudio descriptivo retrospectivo de los pacientes que cumplian los criterios epidemiologicos de definicion de caso, en los que de manera aleatoria se les realizo reaccion en cadena de la polimerasa en tiempo real (PCR-RT) de gripe A nH1N1, asi como de los pacientes ingresados en el hospital de tercer nivel de referencia. Comparacion de las caracteristicas epidemiologicas y clinicas entre los pacientes ambulatorios y hospitalarios. Resultados: de los pacientes registrados por la RCA no se encontraron diferencias clinicas entre los ninos con frotis (PCR-RT) positivo o negativo para el virus gripal nH1N1, por lo que no se ha podido encontrar un conjunto de sintomas que sean predictores de tener un frotis positivo con la PCR-RT. Los pacientes hospitalizados tenian menor edad que los de la RCA, asi como mayor porcentaje de patologia de base y comorbilidad asociada. Conclusion: segun los datos analizados, la epidemia de gripe A se comporto como una enfermedad benigna, de sintomatologia similar a la gripe estacional. Tan solo el hecho de encontrar clinica gripal en una semana epidemiologica de alta incidencia (semanas 43-48) resultaron moderadamente predictores de infeccion por gripe A.

Prevención del tabaquismo activo y pasivo en la infancia

Smoking is one of the main Public Health problems. In many western countries, Spain among them. In the last few years in particular, Health authorities are working hard in order to get this important problem under control. In spite of this, it can be seen that tobacco use is still significant, thus in secondary school children, over 20 % of adolescents aged 14-16 years are smokers. Moreover, around 50 % of children younger than 14, have domestic exposure to environmental tobacco smoke. Smoking during pregnancy causes significant morbidity and mortality, not only in neonatal age but also throughout life. There are not enough studies of sufficient quality that evaluate the effectiveness of individual advice in adolescents. School and community programs have a limited efficacy. Anti-smoking counselling to parents in a Paediatric Primary Ca

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