Research progress of influenza vaccination, pneumococcal vaccination and COVID-19 vaccination among cancer patients / 中华预防医学杂志

This article reviews the relevant studies on the efficacy and safety of influenza, pneumococcal and COVID-19 vaccination among tumor patients worldwide in recent years. By combing and analyzing the retrieved literature, the results show that influenza and pneumococcal vaccination can significantly reduce the morbidity and hospitalization rate of infectious diseases in tumor patients, reduce the risk of cardiovascular events and death, and significantly improve survival prognosis. COVID-19 vaccination can also protect tumor patients, especially those who have completed full dose vaccination. Authoritative guidelines and consensuses worldwide all recommend that tumor patients receive influenza, pneumococcal and COVID-19 vaccines. We should carry out relevant researches, as well as take effective measures to strengthen patient education, so that tumor patients can fully experience the health protection brought by the vaccine to this specific group.

The inverse correlation between serum levels of anti-pneumococcal and ferritin after pneumococcal vaccination in splenectomised beta thalassemia major

Splenectomy is necessary in beta thalassemia major patients when the spleen becomes hyperactive, leading to extreme destruction of erythrocytes. This study assessed the ferritin effect on serum pneumococcal antibody response following pneumococcal vaccination, in patients with beta thalassemia major after splenectomy. In this case series study, convenience sampling was used to recruit 347 splenectomised beta thalassemia patients under the auspices of Jahrom University of Medical Sciences. Demographic data such as age, sex, and time after splenectomy were recorded by a questionnaire. All participants had been splenectomised and received a dose of Pneumovax1 23 vaccine 14 days before surgery. The IgG antibody responses to pneumococcal vaccine and levels of serum specific ferritin were determine by commercial enzyme immunoassay kits. For the analysis, SPSS software version 16 was used. A p-value less than 0.05 was considered statistically significant. Most of the participants (63.4 percent) were hypo-responders to pneumococcal vaccine. Also, serum anti-pneumococcal IgG antibody was related to post splenectomy duration and serum ferritin (p 0.05). An important result was a relation of serum anti-pneumococcal IgG antibody to serum ferritin according to post splenectomy duration groups. Therefore, in three groups of post splenectomy duration, the serum ferritin was higher in hypo-responder than in good responder subjects. Our results indicate that serum anti-pneumococcal IgG antibody decreased with increment of serum ferritin and post splenectomy duration. Thus, there is a need to re-address the approach towards revaccination in this immune-compromised group of patients by administering a booster pneumococcal vaccination in an attempt to recover immunity and reduce morbidity(AU)

La esplenectomía es necesaria en pacientes con beta talasemia mayor cuando el bazo se vuelve hiperactivo, lo que lleva a una destrucción extrema de los eritrocitos. Este estudio evaluó el efecto de la ferritina sobre la respuesta de anticuerpos antineumocócicos en suero después de la vacunación antineumocócica, en pacientes con talasemia beta mayor a los que se les realizó esplenectomía. En este estudio de serie de casos, se utilizó un muestreo de conveniencia para reclutar a 347 pacientes con beta talasemia esplenectomizados bajo los auspicios de la Universidad de Ciencias Médicas de Jahrom. Los datos demográficos como la edad, el sexo y el tiempo después de la esplenectomía se registraron mediante un cuestionario. Todos los participantes fueron esplenectomizados y recibieron una dosis de la vacuna Pneumovax® 23, 14 días antes de la cirugía. Las respuestas de anticuerpos IgG a la vacuna neumocócica y los niveles de ferritina sérica específica se determinaron mediante estuches comerciales de inmunoensayo enzimático. Para el análisis se utilizó el programa SPSS versión 16. Un valor de p inferior a 0,05 se consideró estadísticamente significativo. La mayoría de los participantes (63,4 por ciento) resultaron hiporrespondedores a la vacuna antineumocócica. Además, el anticuerpo sérico antineumocócico IgG se relacionó con la duración de la esplenectomía y la ferritina sérica (p0,05). Un resultado importante fue la relación del anticuerpo sérico IgG antineumocócico con la ferritina sérica según los grupos de duración postesplenectomía. Por lo tanto, en tres grupos de duración posterior a la esplenectomía, la ferritina sérica fue mayor en los sujetos con hiporrespuesta que en los sujetos con buena respuesta. Nuestros resultados indican que el anticuerpo sérico IgG antineumocócico disminuyó con el incremento de la ferritina sérica y la duración posterior a la esplenectomía. Por lo tanto, existe la necesidad de volver a abordar el enfoque hacia la revacunación en este grupo de pacientes inmunocomprometidos mediante la administración de una vacunación antineumocócica de refuerzo en un intento por recuperar la inmunidad y reducir la morbilidad(AU)

Incremento de los costos del Programa Nacional de Inmunización por la introducción del candidato vacunal contra neumococo / Increase in the costs of the National Immunization Program due to the introduction of the pneumococcal vaccine candidate

Introducción: La industria nacional ha desarrollado un candidato vacunal contra neumococo. Ante su posible introducción en el sistema de salud debe valorarse el costo incremental que acarrearía. Objetivo: Estimar el incremento de los costos del Programa Nacional de Inmunización por la introducción del candidato vacunal contra neumococo. Métodos: Estudio de descripción de costos desde la perspectiva social para el año 2021. Se estudiaron ocho policlínicos de La Habana y se entrevistaron 38 familiares de lactantes. Se estimó el costo institucional, el gasto de bolsillo y el costo indirecto mediante microcosteo. Se estimó el costo incremental para un esquema de tres dosis (2p+1), concomitantes con otras vacunas. Resultados: El costo total para el Programa Nacional de Inmunización en estos policlínicos estuvo entre los 337 000,00 CUP y los 513 000,00 CUP, con un costo por dosis entre 33,11 CUP y 47,30 CUP. El 31,6 por ciento de las familias reportó gastos en transportación de entre 5,00 CUP y 40,00 CUP. La introducción de la vacuna representaría un incremento entre 8,43 por ciento y 18,99 por ciento del costo base del Programa Nacional de Inmunización en los policlínicos. El costo por dosis sería de entre 34,17 CUP y 47,82 CUP, para un incremento de entre 0,28 CUP y 1,33 CUP. Conclusiones: La mayor parte del costo del Programa Nacional de Inmunización lo asume el Estado. La aplicación de la vacuna cubana contra neumococo solo aumentaría muy levemente el costo por dosis(AU)

Introduction: The national industry has developed a vaccine candidate against pneumococcus. Given its possible introduction into the health system, the incremental cost that it would entail must be assessed. Objective: To estimate the increase in the costs of the National Immunization Program due to the introduction of the pneumococcal vaccine candidate. Methods: Study of cost description from the social perspective for the year 2021. Eight polyclinics in Havana were studied and 38 relatives of infants were interviewed. Institutional cost, out-of-pocket costs and indirect costs were estimated through microcost. The incremental cost was estimated for a three-dose schedule (2p+1), concomitant with other vaccines. Results: The total cost for the National Immunization Program in these polyclinics was between 337,000.00 CUP and 513,000.00 CUP, with a cost per dose between 33.11 CUP and 47.30 CUP. 31.6percent of families reported transportation expenses from 5.00 CUP to 40.00 CUP. The introduction of the vaccine would represent an increase between 8.43 percent and 18.99 percent of the base cost of the National Immunization Program in polyclinics. The cost per dose would be between 34.17 CUP and 47.82 CUP, for an increase of between 0.28 CUP and 1.33 CUP. Conclusions: Most of the cost of the National Immunization Program is borne by the State. The application of the Cuban pneumococcal vaccine would only slightly increase the cost per dose(AU)

Evaluation of the direct and indirect impact on pneumonia hospitalization after almost a decade of the 10-valent pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine in Brazil

Introduction: Pneumococcal pneumonia is a leading cause of severe disease, leading to approximately 2.2 million hospital admissions in 2019 in Brazil. Since 2010, the 10-valent pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine was introduced in Brazil, as part of the National Immunization Program (NIP) with universal access, approximated coverage of 91.4% in 2019. Although studies from many countries are available, there is still a need to understand the effect of the vaccine introduction on the incidence of pneumonia hospitalizations in Brazil.Methods: Data on hospitalization associated with the diagnosis of pneumonia in the population assisted by the Brazilian Public Health System were accessed to fit a time series analysis, which tested the main hypothesis of the influence of vaccination on the trends for the incidence of pneumonia hospitalizations.Results: The post-vaccination period showed a negative trend, reducing 1.75, 0.16, and 0.11 cases per 100,000 inhabitants per month for the groups < 1, 1­4, and 5­9 years old, respectively. In individuals older than 20 years, the post-vaccination period has a positive trend, but not as great as compared trends before the vaccination period. These results indicate a protective herd effect in the older population, nine years after introducing the pneumococcal vaccine in the NIP.Conclusion: Vaccination with pneumococcal conjugated vaccine reduces hospitalizations associated with pneumonia diagnosis in vaccinated and non-vaccinated populations in a sustained and progressive manner.

Expert consensus on immunoprophylaxis of pneumococcal disease (2020 version) / 中华流行病学杂志

Pneumococcal disease is a serious global public health problem and a leading cause of morbidity and mortality of children and adults in China. Antibiotics are commonly used to treat pneumococcal disease. However, antibiotic resistance to Streptococcus pneumoniae has become a severe problem around the world due to widespread antibiotic use. Immunoprophylaxis of pneumococcal disease with pneumococcal vaccines is therefore of great importance. In this article, we review the etiology, clinical presentation, epidemiology, and disease burden of pneumococcal disease and the vaccinology of pneumococcal vaccines. Our review is based on the Expert Consensus on Immunoprophylaxis of Pneumococcal Disease (2017 version), the Pneumococcal Vaccines WHO Position Paper (2019), and recent national and international scientific advances. This consensus article aims to provide public health and vaccination staff with appropriate evidence for pneumococcal vaccine use and to improve professional capacity for pneumococcal disease prevention and control.

Carga de neumonía en adultos hospitalizados / Pneumonia loading in hospitalized adults / Pneumonia carregando em adultos hospitalizados

La neumonía adquirida en la comunidad en adultos, es un importante problema de salud pública. En América Latina son muy escasas las publicaciones que documenten su incidencia. Esta comunicación breve proporciona datos preliminares sobre la incidencia (105 persona/año) de neumonías en adultos hospitalizados. La base de datos de una institución médica privada de Uruguay, posibilitó la estimación de la incidencia de esa patología, antes de la implementación de la vacuna conjugada neumocóccica (VCN) en la infancia y luego de su aplicación. En 1.688 pacientes con neumonía los mayores de 64 años predominaron y su incidencia fue de 1.938 en el período prevacunación, descendiendo significativamente a 1.365 luego de la VCN. A pesar de la posible protección indirecta de la vacunación, la información presentada alerta sobre la persistencia de morbimortalidad por neumonía en adultos mayores.

Pneumonia in adults poses severe health risks, but data on its burden still lacks in Latin American countries including Uruguay. To fill this gap preliminary information on hospitalized pneumonia incidence in adults was analyzed. A data base from a private medical institution enabled to estimate, pre and post pneumococcal conjugate vaccine incidences (105 person/year), by age groups. Out of 1 688 adults hospitalized due to pneumonia, the group aged >64 yers predominated. For the same age group, a significant difference (1.938 vs. 1.365) was observed on incidences before and after conjugate vaccine application in children. Although more robust information on adult pneumonia hospitalizations are required to confirm indirect vaccine effect, these data alert on pneumonia persistence which requires preventive measures.

A pneumonia adquirida na comunidade em adultos é um grande problema de saúde pública. Na América Latina existem muito poucas publicações que documentam sua incidência. Esta breve comunicação fornece dados preliminares sobre a incidência (105 pessoas / ano) de pneumonias em adultos hospitalizados. O banco de dados de uma instituição médica privada no Uruguai possibilitou estimar a incidência dessa patologia, antes da implementação da vacina conjugada pneumocócica (VCN) na infância e após sua aplicação. Em 1.688 pacientes com pneumonia, aqueles com mais de 64 anos de idade predominaram e sua incidência foi de 1.938 no período de pré-vacinação, descendo significativamente para 1.365 após a VCN. Apesar da possível proteção indireta da vacinação, as informações apresentadas alertam sobre a persistência da morbimortalidade por pneumonia em idosos.

Ciencia en equipo e introducción acelerada de vacunas en Cuba: una mirada desde el Proyecto Neumococo / Team science and accelerated introduction of vaccines in Cuba: a look from the Pneumococcal Project

El proceso de investigación y evaluación de nuevos productos y tecnologías necesita de la combinación de enfoques teóricos y metodológicos transdiciplinarios para la gestión y consecución de los objetivos. La estrategia de investigación, desarrollo y evaluación de la nueva vacuna cubana contra neumococo combina las perspectivas de Ciencia en Equipo e Introducción acelerada de nuevas vacunas. Se presenta como debate la adopción de estos marcos en el contexto de evaluación de productos de la biotecnológicos y se ejemplifica su aplicación al Proyecto Neumococo. Se enfatiza en cómo la eliminación de obstáculos en la obtención de un producto de alta complejidad científica y tecnológica y la conformación de un cuerpo de evidencias científicas robustas que soportan su uso y comercialización, constituyen los principales resultados aportados por los que asumen el enfoque de ciencia en equipo, en favor de una toma de decisiones oportunas y eficientes para la introducción acelerada de nuevas vacunas en Cuba(AU)

The process of research and evaluation of new products and technologies requires the combination of theoretical and methodological transdisciplinary approaches for the management and achievement of the objectives. The research, development and evaluation strategy of the new Cuban pneumococcal vaccine combines the perspectives of Team Science and Accelerated introduction of new vaccines. The adoption of these frameworks in the context of evaluation of biotechnological products is presented as a debate and the application to the Pneumococcal Project is exemplified. Emphasis is on how the elimination of obstacles in obtaining a product of high scientific and technological complexity, and the conformation of a body of robust scientific evidence that supports its use and commercialization constitute the main results contributed by those who assume the team science approach, in favor of timely and efficient decision making for the accelerated introduction of new vaccines in Cuba(AU)

Características epidemiológicas, clínicas y bacteriológicas de meningitis neumocócica en pacientes pediátricos de Lima, Perú / Epidemiologic, clinical and bacteriologic characteristics of pneumococcal meningitis in pediatric patients from Lima, Peru

RESUMEN Objetivos. Describir las características clínicas, letalidad, susceptibilidad antibiótica y distribución de serotipos de meningitis neumocócica en pacientes pediátricos de Lima, Perú. Materiales y Métodos. Serie de casos de meningitis neumocócica en niños menores de 16 años. Los datos fueron obtenidos de dos estudios multicéntricos prospectivos, de vigilancia pasiva de enfermedad neumocócica invasiva realizados en Lima-Perú desde los años 2006 al 2008, y del 2009 al 2011. Resultados. Reportamos 44 episodios de meningitis neumocócica; 68,2% fueron en niños menores de 2 años. La tasa de letalidad fue 32,6; y 92,9% de los casos letales ocurrieron en niños menores de dos años (p<0,05). La desnutrición estuvo asociada a los casos letales (p<0,05). El 64,3% de los casos fatales murieron dentro de los 2 primeros días. El 41,9% de los cultivos con neumococo fueron resistentes a la penicilina, 23,3% mostró resistencia intermedia a ceftriaxona (ninguno mostró resistencia completa) y 9,3% mostró resistencia a cloranfenicol. Los serotipos más frecuentes fueron 6B, 14, 19F y 23F, los cuales constituyeron el 68,3% de todas las cepas; 84,1% de las cepas encontradas están incluidas en los serotipos de la vacuna 13 valente. Conclusiones. La meningitis neumocócica continúa siendo una enfermedad letal, especialmente en niños menores de 2 años. Dado que aproximadamente dos tercios de los casos letales fallecen en las primeras 48 h, es crítico un diagnóstico y tratamiento oportuno, así como asegurar el cumplimiento de la inmunización con la vacuna neumocócica.

ABSTRACT Objectives. To describe the clinical characteristics, lethality, antibiotic susceptibility, and serotype distribution of pneumococcal meningitis in pediatric patients in Lima, Peru. Materials and Methods. A case series of pneumococcal meningitis in children less than 16 years of age from two prospective, multicenter, passive surveillance studies of invasive pneumococcal diseases held in Lima-Peru from 2006 to 2008 and 2009 to 2011. Results. We report 44 pneumococcal meningitis episodes; 68.2% of them were in children less than 2 years old. The overall case fatality rate was 32.6%; 92.9% of fatal cases were in children less than 2 years of age (p<0.05). Malnutrition was associated with fatal cases (p<0.05). 64.3% of fatal cases died within the first two days. 41.9% of pneumococcal isolates were resistant to penicillin, 23.3% were intermediate resistant to ceftriaxone (none were highly resistant) and 9.3% were resistant to chloramphenicol. The most common serotypes were 6B, 14, 19F and 23F, which accounted for 68.3% of all strains; 84.1% of strains were PCV13 serotypes. Conclusions. Pneumococcal meningitis continues to be a lethal disease, especially in children less than 2 years of age. Since almost two third of lethal cases lead to death within the first 48 hours, prompt diagnosis and management is critical, as well as assurance of immunization with pneumococcal vaccine.

Opinión del Comité Consultivo de Inmunizaciones Sociedad Chilena de Infectología: Vacuna neumocóccica conjugada en niños y la emergencia de serotipo 19A / Statement of the Advisory Immunization Committee of the Chilean Society of Infectious Diseases on the emergence of serotype 19A pneumococcal infection and the use of pneumococcal conjugated vaccine in Chilean children

La incorporación de la vacuna conjugada antineumocóc-cica 10 valente (PCV10) en lactantes en Chile el año 2011 ha permitido reducir las hospitalizaciones y muertes por neumonía en este grupo etario. Sin embargo, se ha observado desde entonces un aumento progresivo de los aislados de Streptococcus pneumoniae del serotipo 19A no incluido en la vacuna en uso (de < 5% del total de cepas recibidas en el Laboratorio de Referencia Nacional del Instituto de Salud Pública para vigilancia de infecciones invasores causadas por S. pneumoniae hasta el año 2010, a 12-23% en los años 2014-2015). En lactantes, el serotipo 19A representaba 4 a 8% de los aislados en la era pre vacuna, porcentaje que se incrementa a 25% el 2014. Este aumento ha ocurrido en dos terceras partes de las regiones administrativas del país. Cepas del serotipo 19A de pacientes menores de 5 años, muestran 25% de resistencia a penicilina para aislados extra-meníngeos y casi 100% para aislados de meningitis. El análisis genético de las cepas del serotipo 19A ha demostrado que 48% pertenecen al complejo clonal 320 de carácter pandémico y asociado a resistencia antimicrobiana. Además, casi todas las infecciones invasoras por serotipo 19A en niños se han dado en pacientes con esquema completo de vacunación PCV10. Los cambios epidemiológicos presentados indican la emergencia de infecciones invasoras por el serotipo 19A y la necesidad de controlar este problema con el cambio de la vacuna PCV10 a la vacuna PCV13 que contiene el serotipo 19A.

Inclusion of the 10-valent pneumococcal conjugated vaccine (PCV10) in the Chilean infant vaccination Program in 2011 was followed by a reduction of hospital admissions and pneumonia-related deaths in this age group. However, a progressive increase of serotype 19A pneumococcal isolates (not included in PCV10) has been observed. According to the analysis of pneumococcal strains performed by the national reference laboratory of the Institute of Public Health as part of a national surveillance on invasive pneumococcal infections, the relative proportion of serotype 19A isolates increased from <5% before 2010 to 12-23% in years 2014-2015. Serotype 19A represented 4-8% of the isolates in the pre-vaccine era among children less than 2 years, increasing to 25% during 2014. This increase has been documented in two-thirds of the national territory. Aimong children <5 years of age, 25% of 19A serotype isolates from non-meningeal infections were penicillin resistant wheras from meningeal infections near 100% were penicillin resistant. Genetic analysis indicates that 48% of these 19A strains belong to clonal complex 320, recognized for its pandemic potential and high antimicrobial resistance. Among children, most invasive infections secondary to serotype 19A have occurred in patients fully vaccinated with PCV10. These epidemiological changes indicate an increase in invasive pneumococcal infections by serotype 19A in Chile and the need to control this problem by changing the current PCV10 for the PCV13 vaccine containing serotype 19A.

Impacto de la vacuna neumocócica conjugada 13-valente en la incidencia de neumonía consolidante en menores de 5 anos en el partido de Pilar, Buenos Aires: estudio de base poblacional / Impact of the 13-valent pneumococcal conjugate vaccine on the incidence of consolidated pneumonia in children younger than 5 years old in Pilar, Buenos Aires: A population-based study

Introducción. En enero de 2012, en Argentina, fue introducida la vacuna neumocócica conjugada 13-valente (13-Valent Pneumococcal Conjugate Vaccine; PCV13, por sus siglas en inglés) en el Calendario Nacional, en menores de 2 anos. La cobertura en el partido de Pilar en 2012 fue > 90% para las primeras 2 dosis y 60% para la tercera. Objetivo. Medir la efectividad de la PCV13 en la reducción de la incidencia de neumonías consolidantes (NC), durante los dos anos siguientes a su introducción en el Calendario. Métodos. Estudio prospectivo debase poblacional en Pilar. Se incluyeron todos los menores de 5 anos con signos clínicos de neumonía atendidos en hospitales de referencia (ambulatorios y hospitalizados) en los primeros 2 anos de la incorporación (2012-2013). Se comparó la incidencia anual de NC con el período basal 2003-2005. Evaluación clínica-radiológica, según criterio de la Organización Mundial de la Salud. Resultados. Se incluyeron 666 pacientes con sospecha clínica de neumonía. Se diagnosticó NC en 309 pacientes; 52,1% de mujeres, 70,2% menores de 2 anos y 56,4% vacunado con PCV13; 4,5% (14/309) con bacteriología confirmada (S. pneumoniae: 4; N. meningitidis: 4; S. aureus: 2; otros: 4). Se observó una reducción significativa en la incidencia de NC (por 100000 niños menores de 5 anos) entre los períodos pre y posvacunal de 750 (204/27209) a 561 (171/30 475) en 2012 y 453 (138/30 475) en 2013; efectividad de 25,2% y 39,6%, respectivamente. Reducción en menores de 1 año: 33,9% en 2012 y 44,6% en 2013; y en niños de 12-23 meses: 57,9% en 2013. No se observaron diferencias significativas en las incidencias en edades mayores. Conclusiones. Luego de la introducción de la PCV13 en el Calendario de Vacunación en Argentina, se observó una reducción rápida y significativa en la incidencia de NC, principalmente en menores de 1 año en 2012 y menores de 2 anos en 2013.

Introduction. In January 2012, Argentina introduced the 13-valent pneumococcal conjugate vaccine (PCV13) in its immunization schedule for children younger than 2 years old. Coverage in Pilar in 2012 reached>90% for the first two doses and 60% for the third dose. Objective. To measure the effectiveness of PCV13 to reduce the incidence of consolidated pneumonia (CP)in the two-year period following its introduction in the immunization schedule. Methods. Prospective, population-based study conducted in Pilar. All children younger than 5 year sold with clinical signs of pneumonia assisted at the reference hospitals (both inpatients and utpatients) in the first two years since the vaccine introduction (2012-2013) were included. The annual incidence of CP was compared to the 2003-2005 baseline period. Clinical and radiological assessments were done as per the World Health Organization's criteria. Results. Six hundred and sixty-six patients with clinical suspicion of pneumonia were included. CP was diagnosed in 309 patients; 52.1% were girls, 70.2% were younger than 2 years old, and 56.4% had been immunized with the PCV13; 4.5% (14/309) had bacteriological confirmation (S. pneumoniae: 4; N. meningitidis: 4; S. aureus: 2; others: 4). A significant reduction in the incidence of CP (per 100 000 children younger than 5 years old) was observed between the pre- and postimmunization periods, from 750 (204/27209) to 561 (171/30 475) in 2012 and to 453 (138/30 475) in 2013; effectiveness accounted for 25.2% and 39.6%, respectively. Reduction in infants younger than 1 year old: 33.9% in 2012 and 44.6% in 2013; and in children aged 12-23 months old: 57.9% in 2013. No significant differences were observed in the incidence of CP at an older age. Conclusions. Following the introduction of PCV13 in Argentina's immunization schedule, a fast and significant reduction in the incidence of CP was observed, mainly in infants younger than 1 year old in 2012 and in children younger than 2 years old in 2013.

Puesta al día en vacunación antineumocócica en adultos / Update on pneumococcal vaccination in adults

La enfermedad invasiva por Streptococcus pneumoniae constituye una importante causa de morbilidad y mortalidad, y es la primera causa de muerte prevenible mediante vacunación en el mundo, no solo en niños sino en todas las edades. Tanto la vacuna polisacárida como la vacuna conjugada antineumocócicas han demostrado reducción de las tasas de enfermedad invasiva en adultos. En los últimos años, a la luz de nueva evidencia disponible, los esquemas de vacunación antineumocócica para esta población han sufrido modificaciones. Este documento ofrece una actualización sobre las recomendaciones de vacunación a través de los fundamentos que han llevado a dicho cambio. (AU)

The Streptococcus pneumoniae invasive disease is a major cause of morbidity and mortality, being the leading cause of vaccine-preventable death in the world, not only in children but in all ages. Both the polysaccharide vaccine and pneumococcal conjugate vaccine have shown reduced rates of invasive disease in adults. In recent years, in light of new evidence available, schedules of pneumococcal vaccination for this population have changed. This document provides an update on vaccine recommendations through the rational that have led to this change. (AU)

Impact of 10-valent pneumococcal conjugate vaccine on pneumococcal meningitis in children up to two years of age in Brazil / Impacto de la vacuna neumocócica conjugada 10-valente en la meningitis neumocócica en niños de hasta dos años de edad en Brasil / Impacto da vacina pneumocócica conjugada 10-valente na meningite pneumocócica em crianças com até dois anos de idade no Brasil

The objective of this study was to analyze the impact of vaccination against Streptococcus pneumoniae on the morbidity and mortality from pneumococcal meningitis in children ≤ 2 years in Brazil, from 2007 to 2012. This is a descriptive study and ecological analysis using data from the Information System on Notifiable Diseases. Pre-vaccination (2007-2009) and post-vaccination (2011-2012) periods were defined to compare incidence rates and mortality. A total of 1,311 cases and 430 deaths were reported during the study period. Incidence decreased from 3.70/100,000 in 2007 to 1.84/100,000 in 2012, and mortality decreased from 1.30/100,000 to 0.40/100,000, or 50% and 69% respectively, with the greatest impact in the 6-11 month age group. This decrease in Pneumococcal meningitis morbidity and mortality rates two years after introduction of the 10-valent pneumococcal conjugate vaccine suggests its effectiveness.

El objetivo de este estudio fue analizar el impacto de la vacunación contra el Streptococcus pneumoniae en la morbilidad y mortalidad de la meningitis neumocócica en niños ≤ 2 años en Brasil, 2007-2012. Se trata de un estudio descriptivo ecológico que analiza los datos del Sistema de Información Enfermedades de Notificación Obligatoria en Brasil. El período previo (2007-2009) y posterior a la vacunación (2011-2012) fueron examinados para comparar las tasas de incidencia y mortalidad. 1.311 casos de meningitis neumocócica con 430 muertes se registraron durante el período de estudio. Hubo una disminución de la incidencia de 3,70 casos por 100.000 habitantes en 2007, a 1,84/100.000 en 2012, mientras que la tasa de mortalidad cayó 1,30 a 0,40 óbitos/100.000, se produjeron reducciones del 50% y 69%, respectivamente, con mayores impactos identificados entre los niños de 6-11 meses de edad. Los resultados indican una reducción en la morbilidad y mortalidad por meningitis neumocócica dos años después de la introducción de la vacuna conjugada antineumocócica 10-valente, lo que sugiere su eficacia.

O objetivo deste trabalho foi analisar o impacto da vacinação contra o Streptococcus pneumoniae na morbidade e mortalidade por meningite pneumocócica em crianças ≤ 2 anos, no Brasil, entre 2007-2012. Este é um estudo descritivo com análise ecológica, utilizando dados do Sistema de Informação de Agravos de Notificação. Foram definidos os períodos pré-vacinal (2007-2009) e pós-vacinal (2011-2012) para comparar as taxas de incidência e mortalidade. Foram identificados 1.311 casos e 430 óbitos no período do estudo. A taxa de incidência diminuiu de 3,70/100.000 no ano de 2007 para 1,84/100.000 em 2012, e a mortalidade reduziu de 1,30/100.000 para 0,40/100.000, o que significa uma redução de 50% e 69%, respectivamente, com maior impacto identificado na faixa etária de 6 a 11 meses. Os resultados indicam uma diminuição nos indicadores de morbidade e mortalidade de meningite pneumocócica, observados dois anos após a introdução da vacina pneumocócica conjugada 10-valente, sugerindo sua efetividade.

Prevención de las neumonías mediante vacunas / Vaccine-preventable pneumonias

La neumonía es una infección respiratoria aguda que afecta a los pulmones. La neumonía adquirida en la comunidad, es la principal causa individual de mortalidad infantil en todo el mundo. Se calcula que cada año mueren por su causa más de 1,5 millones de niños menores de 5 años, lo que supone el 18 % de todas las defunciones de este grupo etario en todo el mundo. Diversos agentes infecciosos, particularmente los virus y bacterias, causan neumonía, y son los más comunes el Streptococcus pneumoniae -la causa más común de neumonía bacteriana en niños-; el Haemophilus influenzae de tipo b -la segunda causa más común de neumonía bacteriana-; así como el virus sincitial respiratorio. La prevención de la neumonía infantil es un componente fundamental de toda estrategia para reducir la mortalidad infantil. La inmunización, particularmente contra el Haemophilus influenzae de tipo b, los neumococos, el sarampión y la tos ferina, es la forma más eficaz de prevenirla. Por tal motivo se considera importante una revisión y actualización de las principales vacunas existentes hoy en día.

Pneumonia is an acute respiratory infection affecting the lungs. Community-acquired pneumonia is the main single cause of infant mortality worldwide. It is estimated that 1.5 million children younger than 5 years die from this cause every year, which accounted for 18 % of all deaths in this age group globally. Several infective agents, particularly virus and bacteria, cause pneumonia, being the most common Streptococcus pneumonia -leading cause of bacterial pneumonia in children-; Haemophilus influenza type b -the second cause-, and finally the respiratory syncytial virus. The infant pneumonia prevention is a fundamental element in every strategy aimed at reducing infant mortality rates. Immunization, mainly against Haemophilus influenzae type B, pneumoccoci, measles and whooping cough, is the most effective method to prevent them. Therefore, the review of and the updating on the main vaccines existing nowadays are important.

Neumonía necrotizante en niños hospitalizados en el hospital pediátrico Centro Hospitalario Pereira Rossell en el año 2010 / Necrotizing pneumonia in children hospitalized at children's hospital Centro Hospitalario Pereira Rossell Hospital in 2010

Tras la incorporación en Uruguay de vacunas conjugadas neumocócicas (PCV), se registró un descenso en las hospitalizaciones por neumonía bacteriana adquirida en la comunidad (NAC) en el Hospital Pediátrico del Centro Hospitalario Pereira Rossell (HP-CHPR). Así mismo, en los últimos años se asistió a niños que desarrollaron neumonía necrotizante (NN). Se denomina NN a casos de NAC en los que la inflamación determina isquemia y necrosis del parénquima, con formación de neumatoceles y fístula broncopleural, cuando ésta se produce en la periferia del pulmón. Son pacientes graves, con mal estado general, fiebre persistente y requieren hospitalizaciones prolongadas. Los neumatoceles se diagnostican en la radiografía y/o la tomografía computada de tórax. Se realizó la descripción de los niños con NAC hospitalizados en el HP-CHPR, que evolucionaron a NN en el año 2010. Se diagnosticaron 28 niños, con un promedio de edad de 36 meses, la mayoría sanos y eutróficos. Los neumatoceles fueron identificados en la radiografía de tórax en casi todos los pacientes. Presentaron en promedio 7 días de fiebre. La mayoría evolucionó con complicaciones pulmonares y/o extrapulmonares. Diez niños requirieron ingreso a unidad de terapia intensiva. Las hospitalizaciones tuvieron una duración de hasta 43 días. Ningún paciente falleció. En la mitad de los casos se identificó Streptococcus pneumoniae. Todas las cepas aisladas eran sensibles a penicilina. Ninguno de los pacientes en los que se aisló cepas contenidas en las PCV estaba adecuadamente vacunado. La NN es una complicación grave de NAC, que ocurre en niños sanos. Determina hospitalizaciones prolongadas y gran morbilidad. Es importante mantener la vigilancia de los ingresos hospitalarios por NAC y sus complicaciones luego de la vacunación universal con PCV...

Impacto de la bacteriemia en una cohorte de pacientes con neumonía neumocócica / Impact of bacteremia in a cohort of patients with pneumococcal pneumonia

OBJETIVO: Bacteriemia es la forma invasiva más común de neumonía adquirida en la comunidad (NAC) por Streptococcus pneumoniae. Investigamos si la bacteriemia en NAC neumocócica empeora los resultados y si ella guarda relación con la vacunación antineumocócica (VAN). MÉTODOS: Análisis secundario de una cohorte de pacientes con NAC neumocócica confirmada por cultivo de sangre o esputo o antígeno urinario. Se registraron datos demográficos, clínicos, radiográficos y de laboratorio, escores Acute Physiology and Chronic Health Evaluation II (APACHE II) y pneumonia severity index (PSI), comorbilidades y antecedente de VAN. Se compararon pacientes con NAC neumocócica bacteriémica (NNB) vs. no bacteriémica (NNNB). RESULTADOS: Cuarenta y siete pacientes tenían NNB y 71 NNNB (45 por cultivo de esputo y 26 por antígeno urinario); 107 tenían alguna indicación de VAN. Ningún paciente con NNB, pero 9 con NNNB, habían recibido VAN (p = 0,043). Los pacientes con NNB eran mayores (76,4 ± 11,5 vs. 67,5 ± 20,9 años), tenían mayor APACHE II (16,4 ± 4,6 vs. 14,1 ± 6,5) y PSI (129,5 ± 36 vs. 105,2 ± 45), más frecuentemente cardiopatía e insuficiencia renal crónica e internación en UTI (42,5% vs. 22,5%) y menor hematocrito (35,7 ± 5,8 vs. 38,6 ± 6,7%) y sodio plasmático (133,9 ± 6,0 vs. 137,1 ± 5,5 mEq/L). La mortalidad fue similar (29,8% vs. 28,2%). CONCLUSIONES: Los niveles de VAN (8,4%) en esta población con alto riesgo de NAC por S. pneumoniae fueron extremadamente bajos. Los pacientes con NNB estaban más graves, pero la mortalidad fue similar entre los dos grupos. La VAN reduce la incidencia de NNB y es razonable incrementar el nivel de vacunación de la población en riesgo.

OBJECTIVE: Bacteremia is the most common presentation of invasive disease in community-acquired pneumonia (CAP) due to Streptococcus pneumoniae. We investigated whether bacteremia in pneumococcal CAP worsens outcomes and whether it is related to pneumococcal vaccination (PV). METHODS: Secondary analysis of a cohort of patients with pneumococcal CAP confirmed by blood culture, sputum culture, or urinary antigen testing. Demographic, clinical, radiographic, and biochemical data were collected, as were Acute Physiology and Chronic Health Evaluation II (APACHE II) and pneumonia severity index (PSI) scores, comorbidities, and PV history. We drew comparisons between patients with bacteremic pneumococcal CAP (BPP) and those with non-bacteremic pneumococcal CAP (NBPP). RESULTS: Forty-seven patients had BPP, and 71 had NBPP (confirmed by sputum culture in 45 and by urinary antigen testing in 26); 107 had some indication for PV. None of the BPP patients had received PV, compared with 9 of the NBPP patients (p = 0.043). Among the BPP patients, the mean age was higher (76.4 ± 11.5 vs. 67.5 ± 20.9 years), as were APACHE II and PSI scores (16.4 ± 4.6 vs. 14.1 ± 6.5 and 129.5 ± 36 vs. 105.2 ± 45, respectively), as well as the rate of ICU admission for cardiopathy or chronic renal failure (42.5% vs. 22.5%), whereas hematocrit and plasma sodium levels were lower (35.7 ± 5.8 vs. 38.6 ± 6.7% and 133.9 ± 6.0 vs. 137.1 ± 5.5 mEq/L, respectively), although mortality was similar (29.8% vs. 28.2%). CONCLUSIONS: In this population at high risk for CAP due to S. pneumoniae, the PV rate was extremely low (8.4%). Although BPP patients were more severely ill, mortality was similar between the two groups. Because PV reduces the incidence of BPP, the vaccination rate in at-risk populations should be increased.

Recurrent meningitis secondary to isolated C3 deficiency.

A 5-year-old child presented with the second episode of meningitis when we started investigating her to find a cause for recurrent episode of meningitis. During this she suffered from a third attack after which she was diagnosed as having isolated C(3) deficiency. She was put on penicillin prophylaxis and vaccinated against encapsulated bacteria, after which she is now doing well.

O papel de novas vacinas na prevenção da otite média: [revisão] / The role of new vaccines in the prevention of otitis media: [review]

A Otite Média é uma das doenças infecciosas mais comuns da infância e a diminuição de sua incidência levaria a um grande impacto econômico e social para o mundo. Como uma das formas de prevenção temos as vacinas. As duas vacinas escolhidas para esta revisão são as vacinas antipneumocócica e antiinfluenza. Esta revisão da literatura procurou mostrar os resultados dos principais estudos sobre essas vacinas e seu papel na prevenção da otite média. A vacina antipneumocócica polissacarídea 23-valente não alterou a incidência de otite média pela ineficácia para menores de 2 anos, grupo de maior incidência dessa enfermidade. A vacina antipneumocócica heptavalente, apesar de não provocar grande queda na incidência geral de otite média, mudou o perfil de seus microorganismos causadores, diminuindo os episódios de otite média com efusão e recorrente e aumentando as otites causadas por H. influenza, M. catarrhalis e sorotipos de pneumococo ausentes da vacina heptavalente. A vacina antiinfluenza com vírus inativado mostrou-se efetiva na redução da otite média aguda nos períodos de maior incidência desse vírus. Os otorrinolaringologistas devem estar cientes do papel dessas novas vacinas já disponíveis no Brasil e seu impacto na redução da otite média, para saber orientar adequadamente os seus pacientes.

Otitis media is one of the most common infectious diseases of infancy; a reduction in its incidence would have a significant economic and social impact. Vaccines may play a role in the prevention of otitis media. This report discusses vaccines against pneumococci and influenza viruses. We reviewed the literature for results of studies examining the role of these vaccines in the prevention of otitis media. The 23-valent polysaccharide anti-pneumococcal vaccine did not modify the incidence of otitis media in children aged 2 years less, the age group with the highest incidence of otitis. The heptavalent anti-pneumococcal vaccine did not significantly reduce the incidence of otitis media overall. This vaccine did, however, reduce the number of episodes of otitis media with effusion and the number of recurrences; it also altered the profile of causative microorganisms by increasing otitis caused by different microorganisms. We found the inactivated anti-influenza virus vaccine to be effective in reducing otitis media during peak incidence periods of influenza. As these new vaccines are currently available in Brazil, otolaryngologists must be aware of their potential role and impact in the reduction of otitis media, to counsel patients appropriately.

Acute bacterial meningitis in HIV, pacients in southern Brazil: Curitiba, Paraná, Brazil

Acute communitarian bacterial meningitis and AIDS are prevalent infectious disease in Brazil. The objective of this study was to evaluate the frequency of acute communitarian bacterial meningitis in AIDS patients, the clinical and cerebrospinal fluid (CSF) characteristics. It was reviewed the Health Department data from city of Curitiba, Southern Brazil, from 1996 to 2002. During this period, 32 patients with AIDS fulfilled criteria for acute bacterial meningitis, representing 0.84 percent of the AIDS cases and 1.85 percent of the cases of bacterial meningitis. S. pneumoniae was the most frequent bacteria isolated. The number of white blood cells and the percentage of neutrophils were higher and CSF glucose was lower in the group with no HIV co-infection (p 0.12; 0.008; 0.04 respectively). Bacteria not so common causing meningitis can occur among HIV infected patients. The high mortality rate among pneumococcus meningitis patients makes pneumococcus vaccination important.

A meningite bacteriana aguda comunitária e a AIDS são doenças prevalentes no Brasil. O objetivo desse estudo foi avaliar a freqüência de meningite bacteriana aguda comunitária entre os pacientes com AIDS e as características clínicas e do líquido cefalorraquidiano (LCR). Foram revistos os dados da Secretaria Municipal da Saúde, Curitiba, Paraná, Brasil, nos anos de 1996 a 2002. Nesse período, 32 pacientes com AIDS preencheram os critérios para meningite bacteriana aguda, representando 0,84 por cento dos casos com AIDS e 1,85 por cento dos casos com meningite bacteriana aguda. A bactéria mais freqüentemente isolada foi S. pneumoniae. A celularidade total e a porcentagem de neutrófilos no LCR foi mais elevada e a glicose foi mais baixa no grupo sem co-infecção (p 0,12; 0,008; 0,04 respectivamente). Bactérias menos freqüentes como agentes etiológicos de meningite podem ocorrer. A taxa de mortalidade elevada entre pacientes com meningite por pneumococo torna a vacinação importante.

Streptococcus pneumoniae: estudo das cepas isoladas de liquor / Streptococcus pneumoniae: a study of strains isolated from cerebrospinal fluid

OBJETIVO: Determinar a freqüência dos sorotipos capsulares e a susceptibilidade antimicrobiana de cepas de Streptococcus pneumoniae, assim como dar suporte à indicação de vacinas disponíveis e ao uso de antimicrobianos. MÉTODOS: Neste estudo retrospectivo, foram adotadas metodologias padronizadas para identificar, sorotipar e determinar a susceptibilidade à penicilina, cefotaxima e vancomicina. O estudo foi realizado com cepas de pneumococo isoladas de liquor em pacientes atendidos nos hospitais públicos e em três hospitais particulares do Distrito Federal no período de janeiro de 1995 a dezembro de 2004. A identificação e a determinação de susceptibilidade a antimicrobianos foi realizada no Laboratório Central de Saúde Pública no Distrito Federal. A sorotipagem foi realizada no Instituto Adolfo Lutz. RESULTADOS: Foram isoladas 232 cepas de pneumococo, compreendendo 126 cepas (54,31 por cento) de pacientes do sexo masculino. A idade dos pacientes variou de 0 a 62 anos, sendo agrupados em faixas etárias de 0 a 5, 6 a 17, 18 a 50 e acima de 50 anos. Identificaram-se 36 sorotipos distintos. Desses destacaram-se oito: 14, 6B, 18C, 5, 19F, 23F, 9V e 6A. O teste de oxacilina caracterizou 67 cepas resistentes à penicilina; dessas, 47 foram confirmadas pelo E teste com resistência de nível intermediário. Nenhuma cepa apresentou resistência de alto nível. CONCLUSÃO: A resistência do pneumococo à penicilina apresentou um aumento gradativo nos últimos 10 anos no Distrito Federal. Os sorotipos mais isolados na faixa etária de 0 a 5 anos foram também os mais envolvidos na resistência à penicilina, e estão incluídos na vacina 7-valente.

OBJECTIVE: To determine the frequency of capsular serotypes and the antimicrobial susceptibility of strains of Streptococcus pneumoniae, as well as to provide recommendations on the use of available vaccines and antimicrobial drugs. METHODS: In this retrospective study, standard procedures were followed to identify, serotype, and determine bacterial susceptibility to penicillin, cefotaxime, and vancomycin. Pneumococcal strains were isolated from the cerebrospinal fluid (CSF) of patients admitted to nine public and three private hospitals in Distrito Federal, Brazil, between January 1995 and December 2004. Identification and antimicrobial susceptibility tests were carried out at the Central Laboratory of Public Health (Laboratório Central de Saúde Pública). Serotyping was performed at Instituto Adolfo Lutz. RESULTS: A total of 232 pneumococcal strains were isolated, including 126 (54.31 percent) strains from male patients. Patients had an age range of 0 to 62 years and were distributed into four age groups: 0 to 5, 6 to 17, 18 to 50, and above 50. From the 36 distinct serotypes identified, eight were more prevalent: 14, 6B, 18C, 5, 19F, 23F, 9V, and 6A. The oxacillin test identified 67 penicillin-resistant strains, out of which 47 were confirmed by the E test as having intermediate level of resistance. None of the strains exhibited high-level resistance. CONCLUSIONS: Pneumococcal resistance to penicillin has gradually increased over the last 10 years in Distrito Federal. Serotypes more frequently isolated in the 0 to 5 years age group were the same involved in penicillin-resistance, all of which are covered by the 7-valent vaccine.