Medicina Intensiva y Medicina Extrahospitalaria: ¿la integración supone la clave del éxito? Proyecto Integra / Intensive Care Medicine and pre-hospital care: Is the integration the key to success? Integra Project

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A new mass spectrometry-based method for the quantification of histones in plasma from septic shock patients.

The aim of this study was to develop a novel method to detect circulating histones H3 and H2B in plasma based on multiple reaction monitoring targeted mass spectrometry and a multiple reaction monitoring approach (MRM-MS) for its clinical application in critical bacteriaemic septic shock patients. Plasma samples from 17 septic shock patients with confirmed bacteraemia and 10 healthy controls were analysed by an MRM-MS method, which specifically detects presence of histones H3 and H2B. By an internal standard, it was possible to quantify the concentration of circulating histones in plasma, which were significantly higher in patients, and thus confirmed their potential as biomarkers for diagnosing septic shock. After comparing surviving patients and non-survivors, a correlation was found between higher levels of circulating histones and unfavourable outcome. Indeed, histone H3 proved a more efficient and sensitive biomarker for septic shock prognosis. In conclusion, these findings suggest the accuracy of the MRM-MS technique and stable isotope labelled peptides to detect and quantify circulating plasma histones H2B and H3. This method may be used for early septic shock diagnoses and for the prognosis of fatal outcomes.

Localisation of stem cell factor, stanniocalcin-1, connective tissue growth factor and heparin-binding epidermal growth factor in the bovine uterus at the time of blastocyst formation.

Early embryonic losses before implantation account for the highest rates of reproductive failure in mammals, in particular when in vitro-produced embryos are transferred. In the present study, we used molecular biology techniques (real-time quantitative polymerase chain reaction), classical immunohistochemical staining coupled with confocal microscopy and proteomic analysis (multiple reaction monitoring and western blot analysis) to investigate the role of four growth factors in embryo-uterine interactions during blastocyst development. Supported by a validated embryo transfer model, the study investigated: (1) the expression of stem cell factor (SCF), stanniocalcin-1 (STC1), connective tissue growth factor (CTGF) and heparin-binding epidermal growth factor-like growth factor (HB-EGF) in bovine uterine fluid; (2) the presence of SCF, STC1, CTGF and HB-EGF mRNA and protein in the bovine endometrium and embryos; and (3) the existence of reciprocal regulation between endometrial and embryonic expression of SCF, STC1, CTGF and HB-EGF. The results suggest that these growth factors most likely play an important role during preimplantation embryo development in cattle. The information obtained from the present study can contribute to improving the performance of in vitro culture technology in cattle and other species.

SPARC (secreted protein acidic and rich in cysteine) knockdown protects mice from acute liver injury by reducing vascular endothelial cell damage.

Secreted protein, acidic and rich in cysteine (SPARC) is involved in many biological process including liver fibrogenesis, but its role in acute liver damage is unknown. To examine the role of SPARC in acute liver injury, we used SPARC knock-out (SPARC(-/-)) mice. Two models of acute liver damage were used: concanavalin A (Con A) and the agonistic anti-CD95 antibody Jo2. SPARC expression levels were analyzed in liver samples from patients with acute-on-chronic alcoholic hepatitis (AH). SPARC expression is increased on acute-on-chronic AH patients. Knockdown of SPARC decreased hepatic damage in the two models of liver injury. SPARC(-/-) mice showed a marked reduction in Con A-induced necroinflammation. Infiltration by CD4+ T cells, expression of tumor necrosis factor-α and interleukin-6 and apoptosis were attenuated in SPARC(-/-) mice. Sinusoidal endothelial cell monolayer was preserved and was less activated in Con A-treated SPARC(-/-) mice. SPARC knockdown reduced Con A-induced autophagy of cultured human microvascular endothelial cells (HMEC-1). Hepatic transcriptome analysis revealed several gene networks that may have a role in the attenuated liver damaged found in Con A-treated SPARC(-/-) mice. SPARC has a significant role in the development of Con A-induced severe liver injury. These results suggest that SPARC could represent a therapeutic target in acute liver injury.

Elements of functional genital asymmetry in the cow.

Asymmetry in the cow affects ovarian function and pregnancy. In this work we studied ovarian and uterine asymmetry. Synchronised animals, in which in vitro-produced embryos (n=30-60) had been transferred on Day 5 to the uterine horn ipsilateral to the corpus luteum (CL), were flushed on Day 8. Ovulatory follicle diameter, oestrus response and total protein flushed did not differ between sides. However, a corpus luteum in the right ovary led to plasma progesterone concentrations that were higher than when it was present in the left ovary. Fewer embryos were recovered from the left than the right horn. Among 60 uterine proteins identified by difference gel electrophoresis, relative abundance of nine (acyl-CoA dehydrogenase, very long chain; twinfilin, actin-binding protein, homologue 1; enolase 1; pyruvate kinase isozymes M1/M2 (rabbit); complement factor B Bb fragment ; albumin; fibrinogen gamma-B chain; and ezrin differed (P<0.05) between horns. Glucose concentration was higher, and fructose concentration lower, in the left horn. In a subsequent field trial, pregnancy rates after embryo transfer did not differ between horns (51.0±3.6, right vs 53.2±4.7, left). However, Day 7 blood progesterone concentrations differed (P=0.018) between pregnant and open animals in the left (15.9±1.7 vs 8.3±1.2) but not in the right horn (12.4±1.3 vs 12.4±1.2). Progesterone effects were independent of CL quality (P=0.55). Bilateral genital tract asymmetry in the cow affects progesterone, proteins and hexoses without altering pregnancy rates.

Validez y fiabilidad del cuestionario de Cultura De Calidad en Servicios de Salud en México / Validity and realibility of the Culture of Quality Health Services questionnaire in Mexico

Introducción. La seguridad del paciente es un aspecto clave de la salud pública a nivel mundial del que todos los actores implicados en la atención a la salud somos corresponsables. Establecer una cultura de seguridad ha demostrado ser un factor que favorece la integración de equipos de trabajo, la comunicación y la construcción de procedimientos claros en diversas organizaciones. Promover una cultura de seguridad depende de varios factores, tales como la organización, la unidad de trabajo y el personal. La evaluación objetiva de estos factores permitirá identificar las áreas de mejora y establecer líneas estratégicas de acción. Objetivo. Adaptar, calibrar y establecer la validez y fiabilidad del cuestionario de Cultura de Calidad en Servicios de Salud (CCSS) en la población mexicana. Material y métodos. Estudio descriptivo transversal con una muestra representativa y estratificada de 522 trabajadores de la salud. El cuestionario fue traducido y adaptado del original de Singer. Se validó el contenido por juicio de expertos, consistencia interna, validez factorial confirmatoria y calibración de ítems con el modelo de respuesta graduada de Samejima. Resultados. Se confirmó la validez de constructo convergente y divergente del CCSS. La calibración de ítems demostró que el cuestionario contaba con las propiedades psicométricas para discriminar entre sujetos y representar distintos niveles de las dimensiones establecidas en la hipótesis con mayor precisión y menor error estándar. Conclusiones. El CCSS es un instrumento válido y fiable para evaluar la cultura de seguridad del paciente en los centros hospitalarios de México (AU)

Introduction: Patient Safety is a major public health problem worldwide and is responsibility of all those involved in health care. Establishing a Safety Culture has proved to be a factor that favors the integration of work teams, communication and construction of clear procedures in various organizations. Promote a culture of safety depends on several factors, such as organization, work unit and staff. Objective assessment of these factors will help to identify areas for improvement and establish strategic lines of action. Objetive: To adapt, validate and calibrate the questionnaire Culture of Quality in Health Services (CQHS) in Mexican population. Material and methods: A cross with a stratified representative sample of 522 health workers. The questionnaire was translated and adapted from Singer’s. Content was validated by experts, internal consistency, confirmatory factorial validity and item calibration with Samejima’s Graded Response Model. Results: Convergent and divergent construct validity was confirmed from the CQHS, item calibration showed that the questionnaire is able to discriminate between patients and represent different levels of the hypothesized dimensions with greater accuracy and lower standard error. Conclusions: The CQHS is a valid and reliable instrument to assess patient safety culture in hospitals in Mexico (AU)

[Validity and reliability of the Culture of Quality Health Services questionnaire in Mexico]. / Validez y fiabilidad del cuestionario de Cultura De Calidad en Servicios de Salud en México.

INTRODUCTION: Patient Safety is a major public health problem worldwide and is responsibility of all those involved in health care. Establishing a Safety Culture has proved to be a factor that favors the integration of work teams, communication and construction of clear procedures in various organizations. Promote a culture of safety depends on several factors, such as organization, work unit and staff. Objective assessment of these factors will help to identify areas for improvement and establish strategic lines of action. OBJECTIVE: [corrected] To adapt, validate and calibrate the questionnaire Culture of Quality in Health Services (CQHS) in Mexican population. MATERIAL AND METHODS: A cross with a stratified representative sample of 522 health workers. The questionnaire was translated and adapted from Singer's. Content was validated by experts, internal consistency, confirmatory factorial validity and item calibration with Samejima's Graded Response Model. RESULTS: Convergent and divergent construct validity was confirmed from the CQHS, item calibration showed that the questionnaire is able to discriminate between patients and represent different levels of the hypothesized dimensions with greater accuracy and lower standard error. CONCLUSIONS: The CQHS is a valid and reliable instrument to assess patient safety culture in hospitals in Mexico.

Spanish human proteome project: dissection of chromosome 16.

The Chromosome 16 Consortium forms part of the Human Proteome Project that aims to develop an entire map of the proteins encoded by the human genome following a chromosome-centric strategy (C-HPP) to make progress in the understanding of human biology in health and disease (B/D-HPP). A Spanish consortium of 16 laboratories was organized into five working groups: Protein/Antibody microarrays, protein expression and Peptide Standard, S/MRM, Protein Sequencing, Bioinformatics and Clinical healthcare, and Biobanking. The project is conceived on a multicenter configuration, assuming the standards and integration procedures already available in ProteoRed-ISCIII, which is encompassed within HUPO initiatives. The products of the 870 protein coding genes in chromosome 16 were analyzed in Jurkat T lymphocyte cells, MCF-7 epithelial cells, and the CCD18 fibroblast cell line as it is theoretically expected that most chromosome 16 protein coding genes are expressed in at least one of these. The transcriptome and proteome of these cell lines was studied using gene expression microarray and shotgun proteomics approaches, indicating an ample coverage of chromosome 16. With regard to the B/D section, the main research areas have been adopted and a biobanking initiative has been designed to optimize methods for sample collection, management, and storage under normalized conditions and to define QC standards. The general strategy of the Chr-16 HPP and the current state of the different initiatives are discussed.

[Immunisation schedule of the Spanish Association of Paediatrics: 2013 recommendations]. / Calendario de vacunaciones de la Asociación Española de Pediatría: recomendaciones 2013.

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 the 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 situations of risk. Immunisation schedules tend to be dynamic and adaptable to ongoing epidemiological changes. Nevertheless, the achievement of a unified immunisation schedule in all regions of Spain is a top priority for the CAV-AEP. Based on the latest epidemiological trends, CAV-AEP follows the innovations proposed in the last year's schedule, such as the administration of the first dose of the MMR and the varicella vaccines at age 12 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, preferably at 11-12 years. The CAV-AEP believes that the coverage of vaccination against human papillomavirus in girls aged 11-14 years, preferably at 11-12 years, must increase. It reasserts its recommendation to include vaccination against pneumococcal disease in the routine immunisation 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 immunisation schedule.

Manejo y actualización de las vacunas frente al virus del papiloma humano (VPH) en Pediatría / Management and up-date of the human papiloma virus (HPV) vaccines in Pediatrics

Los autores hacen una revisión de conjunto y puesta al día sobre los aspectos pediátricos más relevantes aparecidos en el curso de los últimos años sobre las vacunas frente al virus del papiloma humano (VPH), señalando la relación existente entre el VPH y el desarrollo del cáncer de cuello uterino (CCU). Actualmente es admitido por la comunidad científica internacional que el VPH es causa necesaria, aunque no suficiente, para la producción del CCU y otras localizaciones de cáncer en el área genital, si bien deben coexistir otros factores adicionales y determinantes de la carcinogénesis. Se realiza un resumen de la clasificación de los distintos grupos del VPH, señalando aquellos tipos patógenos y las enfermedades producida por ellos. Mención especial merecen la epidemiología, conductas sexuales y su relación con laa transmisión de la infección, analizando los datos de los estudios existentes en nuestro país. Se describen también las principales formas clínicas, su expresión, así como los métodos diagnósticos más importantes recogidos en la literatura. Describimos brevemente el procedimiento de obtención de las vacunas frente al VPH por la técnica de virus like particles (partículas similares al virus), confirmando se trata de vacunas profilácticas y no terapéuticas, sin genoma ni capacidad infectiva. En España se encuentra comercializadas y autorizadas dos vacunas desde el2007-2008; se denominan Gardasil®, tetravalente de Sanofi Pasteur MSD y Cervarix®, bivalente de GlaxoSmithKline, con una eficacia, inmunogenicidad y seguridad próximas al 100%. Revisamos igualmente los datos sobre eficacia en hombres de la vacuna tetravalente aparecidos recientemente. Las recomendaciones de la vacunación por VPH en nuestro país, se establecieron por el Consejo (AU)

A review is made of the group and an up-date made on the most relevant pediatric aspects that have appeared over recent years on human papiloma virus (HPV) vaccines, pointing out the relation existing between human papiloma virus and the develop of uterine cervical cancer. At present, the scientific community accepts that the human papilloma virus is a necessary but not sufficient cause for the production of uterine cervical cancer and other localizations in the genital area, although other additional factors and determinats of cervical carcinogenesis must exist. A summary is made of the classification of the different papilloma virus groups, indicating those pathogen types and diseases relatied with them. Special mention is made to the epidemiology of the disease, virus transmission, sexual behavior and relation to the transmission of the disease. The study data on sexual behaviors in our country are analyzed. Some comments are made on the clinical manifestations of the different diseases caused by human papillomas and an update is made of the Bethesda classification, mentioning the principal methods of detection of the human papilloma virus and utility in the diagnosis. The principal identification test are indicated as the PCR and hybrid capture. A brief description was made on how the vaccines are obtained for HPV using the virus like technique (particles similar to the virus), indicating that these are prophylactic and never therapeutic vaccines, with no genome and therefore without any infective capacity. In Spain, 2 vaccines have been on the market since the year 2007-2008 and approved by the AEMPS through the procedure centralized through the European Drug Agency. These vaccines are the tetravalent called Gardasil® Sanofi Pasteur MSD, effective against types 6, 11, 16 and 18 and the bivalent Cervarix® of GlaxoSmithKline, effective against types 16 and 18. Both vaccines have a demonstrated efficacy of about 100% (AU)

Calendario de vacunaciones de la Asociación Española de Pediatría: recomendaciones 2012 / Immunization schedule of the Spanish Association of Pediatrics: 2012 recommendations

El Comité Asesor de Vacunas de la Asociación Española de Pediatría (CAV-AEP) actualiza anualmente el calendario de vacunaciones teniendo en cuenta tanto aspectos epidemiológicos, como de efectividad y eficiencia de las vacunas. El presente calendario incluye grados de recomendación. Se han considerado como vacunas sistemáticas aquellas que el CAV-AEP estima que todos los niños deberían recibir; como recomendadas las que presentan un perfil de vacuna sistemática en la edad pediátrica y que es deseable que los niños reciban, pero que pueden ser priorizadas en función de los recursos para su financiación pública; y dirigidas a grupos de riesgo aquellas con indicación preferente para personas en situaciones de riesgo. Los calendarios de vacunaciones tienen que ser dinámicos y adaptarse a los cambios epidemiológicos que vayan surgiendo, pero el CAV-AEP considera como objetivo prioritario la consecución de un calendario de vacunación único para toda España.Teniendo en cuenta los últimos cambios en la epidemiología de las enfermedades, las principales novedades propuestas en este calendario son la administración de la primera dosis de las vacunas triple vírica y varicela a los 12 meses (12-15 meses) y la segunda dosis a los 2-3 años, así como la administración de la vacuna Tdpa a los 4-6 años siempre acompañada de otra dosisa los 11-14 años. El CAV-AEP estima que deben incrementarse las coberturas de vacunación frente al papiloma virus humano en las niñas de 11 a 14 años. Se reafirma en la recomendación de incluir la vacunación frente al neumococo en el calendario de vacunación sistemática. La vacunación universal frente a la varicela en el segundo año de vida es una estrategia efectiva y por tanto un objetivo deseable. La vacunación frente al rotavirus, dada la morbilidad y la elevada carga sanitaria, es recomendable en todos los lactantes. Se insiste en la necesidad de vacunar frente a la gripe y la hepatitis A a todos los que presenten factores de riesgo para dichas enfermedades. Finalmente, se insiste en la necesidad de actualizar las vacunaciones incompletas con las pautas de vacunación acelerada (AU)

The Advisory Committee on Vaccines of the Spanish Association of Pediatrics (CAVAEP) updates the immunization schedule every year, taking into account epidemiological data as well as evidence on the effectiveness and efficency 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 on going epidemiological changes. Nevertheless, the achievement of a unified immunization schedule in all regions of Spainis 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 papilloma virus 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 varicellain 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 (AU)

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

El Comité Asesor de Vacunas de la Asociación Española de Pediatría emite todos los años, antes del inicio de la temporada estacional de la gripe, unas recomendaciones sobre la vacunación frente a este virus en la edad pediátrica. Este comité sigue considerando que la vacunación antigripal es una actuación especialmente beneficiosa cuando va dirigida a los niños mayores de 6 meses pertenecientes a los grupos de riesgo, así como a sus convivientes. Se insiste en la recomendación de la vacunación antigripal en el personal sanitario que trabaja con niños (AU)

The Advisory Committee on Vaccines of the Spanish Association of Paediatrics establishes annual recommendations on influenza vaccination in childhood before the onset of influenza season. Routine influenza vaccination is particularly beneficial when the strategy isaimed at children older than 6 months of age with high-risk conditions and their home contacts.The recommendation of influenza vaccination in health workers with children is also emphasised (AU)

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.

[Seasonal influenza vaccination in children and adolescents. Recommendations of the CAV-AEP for the campaign]. / Vacunación frente a la gripe estacional en la infancia y la adolescencia. Recomendaciones del CAV-AEP para la campaña 2011-2012.

The Advisory Committee on Vaccines of the Spanish Association of Paediatrics establishes 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 contacts. The recommendation of influenza vaccination in health workers with children is also emphasized.

Complicaciones agudas inusuales de la infección por el virus de Epstein-Barr / Unusual acute complications of Epstein-Barr virus infection

La infección por el virus de Epstein-Barr es muy prevalente en la infancia y, aunque en la mayoría de los casos el diagnóstico es sencillo y su evolución favorable, hay casos como el que presentamos que pueden tener un amplio espectro clínico y complicaciones agudas que dificultan el diagnóstico y pueden ensombrecer el pronóstico. Se han descrito muchas complicaciones agudas que afectan a todos los sistemas y aparatos. Presentamos un caso que presenta complicaciones respiratorias, neurológicas y hepáticas (AU)

The infection caused by the Epstein-Barr virus is very common in childhood. In most cases the diagnosis is easy and its evolution of the illness is favourable, but there are some patients in whom the infectious mononucleosis can have a large clinical spectrum with acute complications that make the diagnosis difficult. We report a patient who had respiratory, neurological and hepatic complications (AU)

Calendario de vacunaciones de la Asociación Española de Pediatría: recomendaciones 2011 / Vaccination schedule of the Spanish Association of Paediatrics: recommendations 2011

El Comité Asesor de Vacunas (CAV) de la Asociación Española de Pediatría actualiza anualmente el calendario de vacunaciones teniendo en cuenta tanto aspectos epidemiológicos, como de efectividad y eficiencia de las vacunas. El presente calendario incluye grados de recomendación. Se han considerado como vacunas sistemáticas aquellas que el CAV estima que todos los niños deberían recibir, como recomendadas las que presentan un perfil de vacuna sistemática en la edad pediátrica y que es deseable que los niños reciban, pero que pueden ser priorizadas en función de los recursos para su financiación pública, y dirigidas a grupos de riesgo aquellas con indicación preferente para personas en situaciones epidemiológicas de riesgo. El CAV considera como objetivo prioritario la consecución de un calendario de vacunaciones único para toda España. El CAV se reafirma en la recomendación de incluir la vacunación frente a neumococo en el calendario de vacunación sistemática. La vacunación universal frente a varicela en el segundo año de vida es una estrategia efectiva y por tanto un objetivo deseable. La vacunación frente a rotavirus, dada la morbilidad y la elevada carga sanitaria, es recomendable en todos los lactantes. Debido a los problemas actuales de disponibilidad de las vacunas, relacionados con la presencia de circovirus, el CAV insta a que, tan pronto como sea posible, se reinicie la vacunación frente a rotavirus por considerarla una oferta de salud deseable para todos los niños en nuestro país. El CAV se adhiere a las recomendaciones del Consejo Interterritorial del Sistema Nacional de Salud en referencia al la vacunación sistemática frente al virus del papiloma humano de todas las niñas de 11 a 14 años e insiste en la necesidad de vacunar frente a la gripe y hepatitis A, a todos los que presenten factores de riesgo para dichas enfermedades. Finalmente, se insiste en la necesidad de actualizar las vacunaciones incompletas con las pautas de vacunación acelerada (AU)

The Advisory Committee on Vaccines of the Spanish Paediatric Association updates annually the immunization schedule, taking into account epidemiological data as well as evidence of the effectiveness and efficiency of vaccines. This vaccination schedule includes grades of recommendation. The committee has graded as universal vaccines those that all children should receive, as recommended, those with a profile of universal vaccines of childhood and as are desirable those that all children may receive, but that can be prioritized based on public funding resources and for risk groups, targeting those groups of people in epidemiological situations of risk. The Committee considers as a priority to achieve a common immunization schedule for Spain. The Committee reaffirms the recommendation to include pneumococcal vaccination in the routine vaccination schedule. Vaccination against varicella in the second year of life is an effective strategy and therefore a desirable goal. Given the morbidity and high burden on the health care system, vaccination against rotavirus is recommended for all infants. Due to the current problems of availability of both vaccines, associated with the recent finding of circovirus, the committee urges that rotavirus vaccination is restarted as soon as possible as it is considered a desirable health benefit for all children in our country. The Committee adheres to the recommendations of the National Health Coordination Council in reference to routine vaccination against HPV for all girls aged 11 to 14 years and stresses the need to vaccinate all patients with risk factors for these diseases against influenza and hepatitis A. Finally, it stresses the need to update incomplete immunizations using accelerated immunization schedules (AU)

[Vaccination schedule of the Spanish Association of Paediatrics: recommendations 2011]. / Calendario de vacunaciones de la Asociación Española de Pediatría: recomendaciones 2011.

The Advisory Committee on Vaccines of the Spanish Paediatric Association updates annually the immunization schedule, taking into account epidemiological data as well as evidence of the effectiveness and efficiency of vaccines. This vaccination schedule includes grades of recommendation. The committee has graded as universal vaccines those that all children should receive, as recommended, those with a profile of universal vaccines of childhood and as are desirable those that all children may receive, but that can be prioritized based on public funding resources and for risk groups, targeting those groups of people in epidemiological situations of risk. The Committee considers as a priority to achieve a common immunization schedule for Spain. The Committee reaffirms the recommendation to include pneumococcal vaccination in the routine vaccination schedule. Vaccination against varicella in the second year of life is an effective strategy and therefore a desirable goal. Given the morbidity and high burden on the health care system, vaccination against rotavirus is recommended for all infants. Due to the current problems of availability of both vaccines, associated with the recent finding of circovirus, the committee urges that rotavirus vaccination is restarted as soon as possible as it is considered a desirable health benefit for all children in our country. The Committee adheres to the recommendations of the National Health Coordination Council in reference to routine vaccination against HPV for all girls aged 11 to 14 years and stresses the need to vaccinate all patients with risk factors for these diseases against influenza and hepatitis A. Finally, it stresses the need to update incomplete immunizations using accelerated immunization schedules.

Calendario de vacunaciones de la Asociación Española de Pediatría: recomendaciones 2010 / Vaccination schedule of the spanish association of paediatrics: recommendations 2010

El Comité Asesor de Vacunas (CAV) de la Asociación Española de Pediatría actualiza anualmente el calendario de vacunaciones teniendo en cuenta, tanto aspectos epidemiológicos como de efectividad y eficiencia de las vacunas. El presente calendario incluye grados de recomendación. Se han considerado como vacunas sistemáticas aquellas que el CAV estima que todos los niños deberían recibir, como recomendadas las que presentan un perfil de vacuna sistemática en la edad pediátrica y que es deseable que los niños reciban, pero que pueden ser priorizadas en función de los recursos para su financiación pública y dirigidas a grupos de riesgo aquellas con indicación preferente para personas en situaciones epidemiológicas de riesgo. El CAV considera como objetivo prioritario la consecución de un calendario de vacunaciones único. El CAV se reafirma en la recomendación de incluir la vacunación frente a neumococo en el calendario de vacunación sistemática. La vacunación universal frente a varicela en el segundo año de vida es una estrategia efectiva y por tanto un objetivo deseable. La vacunación frente a rotavirus, dada la morbilidad y la elevada carga sanitaria, es recomendable en todos los lactantes. El CAV se adhiere a las recomendaciones del Consejo Interterritorial del Sistema Nacional de Salud en referencia a la vacunación sistemática frente a VPH de todas las niñas de 11 a 14 años e insiste en la necesidad de vacunar frente a la gripe y hepatitis A a todos los pacientes que presentan factores de riesgo para dichas enfermedades. Finalmente se insiste en la necesidad de actualizar las vacunaciones incompletas con las pautas de vacunación acelerada (AU)

The Vaccine Advisory Committee of the Spanish Association of Paediatrics updates annually, the immunization schedule, taking into account epidemiological data, as well as evidence of the effectiveness and efficiency of vaccines. This vaccination schedule includes grades of recommendation. The committee has graded as universal vaccines those that all children should receive, as recommended those with a profile of universal vaccination in childhood and which are desirable that all children receive, but that can be prioritized based on resources for its public funding and for risk groups those targeting groups of people in situations of epidemiological risk. The Committee considers as a priority to achieve a common immunization schedule. The Committee reaffirms the recommendation to include pneumococcal vaccination in the routine vaccination schedule. Vaccination against varicella in the second year of life is an effective strategy and therefore a desirable goal. Vaccination against rotavirus is recommended for all infants given the morbidity and high burden on the health care system. The Committee adheres to the recommendations of the Interterritorial Council of the National Health Care System in reference to routine vaccination against HPV for all girls aged 11 to 14 years and stresses the need to vaccinate against influenza and hepatitis A all patients with risk factors for these diseases. Finally, it stresses the need to update incomplete immunization schedules using accelerated immunization schedules (AU)

[Vaccination schedule of the Spanish association of paediatrics: recommendations 2010]. / Calendario de vacunaciones de la Asociación Española de Pediatría: recomendaciones 2010.

The Vaccine Advisory Committee of the Spanish Association of Paediatrics updates annually, the immunization schedule, taking into account epidemiological data, as well as evidence of the effectiveness and efficiency of vaccines. This vaccination schedule includes grades of recommendation. The committee has graded as universal vaccines those that all children should receive, as recommended those with a profile of universal vaccination in childhood and which are desirable that all children receive, but that can be prioritized based on resources for its public funding and for risk groups those targeting groups of people in situations of epidemiological risk. The Committee considers as a priority to achieve a common immunization schedule. The Committee reaffirms the recommendation to include pneumococcal vaccination in the routine vaccination schedule. Vaccination against varicella in the second year of life is an effective strategy and therefore a desirable goal. Vaccination against rotavirus is recommended for all infants given the morbidity and high burden on the health care system. The Committee adheres to the recommendations of the Interterritorial Council of the National Health Care System in reference to routine vaccination against HPV for all girls aged 11 to 14 years and stresses the need to vaccinate against influenza and hepatitis A all patients with risk factors for these diseases. Finally, it stresses the need to update incomplete immunization schedules using accelerated immunization schedules.