ABSTRACT
Resumen Introducción: Los pacientes con leucemia linfoblástica aguda (LLA) tienen alto riesgo de influenza grave y la vacunación es altamente recomendada. La inmunogenicidad y efectividad de la vacuna es menor comparada a los sujetos sanos. Objetivo: Evaluar la respuesta inmune inducida por vacuna anti-influenza en niños con LLA y observar su efectividad. Métodos: Se reclutaron niños con LLA en terapia de mantención y niños sanos. Se tomaron muestras de sangre el día de la vacuna (D0) y al día 28 (D28), y se realizó test de inhibición de hemaglutinación (IHA) contra H1N1. Los pacientes fueron seguidos por un año, registrando datos clínicos y episodios de influenza. Resultados: Se incluyeron 34 niños con LLA y 9 niños sanos. Respecto al IHA en D28, 12/34 pacientes y 5/8 niños sanos presentaron títulos ≥ 1/40, resultando una tasa de seroprotección de 35 y 63%, respectivamente. Los niños seroprotegidos eran significativamente mayores. Durante el seguimiento, sólo tres pacientes, no seroprotegidos, presentaron infección por influenza, ninguno requirió oxigeno o cuidados intensivos. Discusión: Los niños con LLA alcanzaron una tasa seroprotección más baja que la observada en niños sanos. Sin embargo, ninguno de los niños seroprotegidos presentó infección por influenza, reforzando la recomendación de vacunación anual.
Abstract Background: Patients with acute lymphoblastic leukemia (ALL) have high risk of severe influenza infection and vaccination is highly recommended. The immunogenicity and effectiveness of vaccination are lower than in healthy people. Aim: To evaluate the immune response induced by influenza vaccine in children with ALL and observe effectiveness. Method: Children with ALL in maintenance phase and healthy children were recruited. Blood samples were taken at vaccination day (D0) and at day 28 (D28). Humoral response was evaluated by hemaglutination inhibition test (HAI) against H1N1. Patients were followed up for one year, clinical data and influenza episodes were recorded. Results: 34 children with ALL and 9 healthy children were included. Concerning HAI on D28, 12/34 patients and 5/8 healthy children had titers ≥ 1/40, with seroprotection rates of 35 and 63% respectively. Seroprotected children were older than non-seroprotected ones. During follow-up, only 3 patients non seroprotected, presented influenza infection, without oxygen supplementation or critical care support. Discussion: Children with ALL had a lower seroprotection rate than healthy children. Nevertheless, none of the seroprotected children presented influenza infection, reinforcing the annual vaccination recommendation.
Subject(s)
Humans , Child , Influenza Vaccines , Influenza, Human , Precursor Cell Lymphoblastic Leukemia-Lymphoma , Vaccination , Influenza A Virus, H1N1 Subtype , Immunity, Humoral , Antibodies, ViralABSTRACT
Resumen Introduccion: Las infecciones asociadas a atencion de salud (IAAS) aumentan la morbilidad y mortalidad. Durante 2014, en Hospital Clinico Red de Salud UC Christus (RS-UCCH) se estimo que 15% de las infecciones virales respiratorias fueron adquiridas durante la atencion de salud, siendo mas frecuente el virus influenza. Objetivos: Caracterizacion clinico-epidemiologica de IAAS por influenza en pacientes hospitalizados en unidades de pacientes criticos (UPC) y cuidados especiales. Material y Metodos: Estudio descriptivo. Se incluyeron pacientes en UPC y cuidados especiales con IAAS influenza entre 2014 y 2017 en RS-UCCH. IAAS por influenza se definio como: inicio de sintomas y/o RPC-TR positiva para virus influenza ≥ 48 h de ingreso hospitalario, sin sintomatologia respiratoria o estudio negativo previo. Resultados: Se identificaron 22 pacientes, edad mediana 74 anos. La influenza fue adquirida en promedio al dia 13; el 77% fue por influenza A y el 27% presento coinfeccion respiratoria. Trece (59%) estaban hospitalizados en UPC, dos (15%) por problemas pulmonares. El 86% tenia co-morbilidad y el 50% descompensacion de ella. No estaba vacunado 59%; la letalidad observada fue 18%. Conclusiones: IAAS por influenza ocurrio en pacientes cronicos, de mayor edad y no vacunados. Es primordial educar en prevencion de IAAS y mantener altas coberturas de vacunacion.
Background: Healthcare-associated infections (HAIs) increase morbidity and mortality. During 2014, at the Hospital Clinico Red de Salud UC Christus (RS-UCCH) it was estimated that 15% of respiratory viral infections were acquired during hospitalization and influenza A was more frequent. Aims: Clinical and epidemiological characterization of HAIs due to influenza virus in patients hospitalized in critical care units (CCU) and special care. Methods: Descriptive study. We included patients hospitalized in CCU and special care with hospital acquired influenza during 2014-2017. HAI due to influenza was defined as: symptom onset and/or positive influenza PCR after ≥ 48 hours of hospital admission, without previous respiratory symptoms or previous negative influenza test study. Results: 22 patients were identified, median age was 74 years. Influenza was acquired average on day 13. Influenza A was detected in 77% and 27% had respiratory co-infection. Thirteen (59%) were hospitalized in CCU, only 2 (15%) due to lung problems. Comorbidity was present in 86% and decompensation in 50%. Only 41% received influenza vaccine. The associated lethality was 18%. Conclusions: HAI due to influenza occurred in chronic, older and unvaccinated patients. Education about HAIs and continuous high vaccination coverage must be reinforced.
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Cross Infection/epidemiology , Influenza, Human/epidemiology , Intensive Care Units/statistics & numerical data , Influenza Vaccines , Comorbidity , Chile/epidemiology , Cross Infection/diagnosis , Cross Infection/prevention & control , Age Factors , Critical Care , Influenza, Human/diagnosis , Influenza, Human/prevention & control , Hospitalization/statistics & numerical dataABSTRACT
Resumen El virus de la parotiditis produce una infección benigna caracterizada por un aumento de volumen parotídeo que, antes de la introducción de la vacuna tres vírica, afectaba principalmente a niños y adolescentes. Luego de que esta vacuna se implementara en el Programa Nacional de Inmunizaciones, se produjo una notable disminución en su incidencia. Además, ocasionó un cambio en la edad y presentación clínica, siendo más frecuente en adultos jóvenes con mayor riesgo de complicaciones. Presentamos dos casos clínicos de parotiditis en adultos jóvenes confirmados por serología y en uno de ellos, por biología molecular. Se caracterizó el virus como del genotipo G, como el descrito en los brotes en E.U.A y Europa, diferente al virus contenido en la vacuna. El virus parotídeo sigue circulando en nuestro país y debemos mantenernos alerta ante eventuales brotes. Se hace relevante optimizar el diagnóstico etiológico por serología o técnicas de biología molecular con fines clínicos y epidemiológicos.
Mumps virus usually produces a benign infection characterized by increased parotid volume which, prior to vaccination, mainly affected children and adolescents. After the introduction of measles, mumps and rubella (MMR) vaccine, mumps incidence decreased dramatically. This intervention also produced a change in its clinical presentation, moving to young adult patients, with an increased risk of complications. We report two clinical mumps cases in young adults with different clinical presentations. In both cases, serologic assays were assessed and, in one case, a polymerase chain reaction (PCR) was performed in order to confirm the diagnosis. The isolated virus was characterized and identifed as G genotype, the same genotype observed during outbreaks in United States and Europe, and different to the vaccinal strain. Mumps virus is currently circulating in Chile and it is important to be aware of possible outbreaks. Viral diagnosis can be difficult, particularly in populations with high vaccination coverage. Therefore, the access to etiologic study through PCR and serology becomes more relevant in order to optimize clinical management and secondary prevention measures.