Effectiveness of different vaccine schedules for heptavalent and 13-valent conjugate vaccines against pneumococcal disease in the Community of Madrid.

INTRODUCTION: The heptavalent pneumococcal conjugate vaccine (PCV-7) was added to the childhood routine vaccination program in the Community of Madrid in November of 2006 with 3+1 recommended doses and a catch-up for those under 2years old. In June 2010, PCV-7 was replaced by 13-valent vaccine (PCV-13) with 2+1 recommended doses. In July of 2012, the PCV-13 was removed from the funded program and reintroduced again (2+1 recommended doses) in December 2014. In between, children were vaccinated privately with 3+1 recommended doses of PCV-13. The aim of this study was to evaluate the effectiveness of each vaccination schedule used in the Community of Madrid. METHODS: We included all cases of invasive pneumococcal disease (IPD) reported between 2007 and 2015 to the Notifiable Diseases Surveillance System. Vaccination information was obtained from the Immunization Registry. Vaccine effectiveness (VE) was estimated using the indirect cohort design for cases with serotype information. RESULTS: A total 779 cases were included in the study. Among them 47.6% of the cases were primo-vaccinated with booster, 20% primo-vaccinated, 15.9% incompletely primo-vaccinated and 16.5% not vaccinated. The VE for ≥1 doses of any PCV was 82% (CI 95%: 67.8-89.9%): 91.9% (CI 95%: 76.5-97.2%) for PCV-7 and 77.2% (48.6-89.9%) for PCV-13. VE in those receiving the full 2+1 or 3+1 schedules was 100% for both vaccines. CONCLUSIONS: A high number of vaccine failures were reported in children before they had the opportunity to receive the booster dose, especially due to PCV-13-non-PCV-7 serotypes. VE was higher for PCV-7 compared to PCV-13, except for those that received the complete schedule with booster that achieved 100% of VE, which shows the relevance of the vaccines and complying with all doses scheduled.

Diagnóstico mediante ELISA de un brote de infección gastrointestinal por Norovirus en una guardería infantil / ELISA Diagnosis of a gastrointestinal norovirus outbreak in a nursery

La incidencia de brotes de gastroenteritis por Norovirus en niños ha sido infravalorada. Esto se ha debido principalmente a la dificultad para disponer de procedimientos diagnósticos adecuados (microscopía electrónica y reacción en cadena de polimerasa de trascripción inversa[RT-PCR]). Los nuevos métodos de enzimoinmuno ensayo (ELISA), capaces de detectar antígenos virales en heces, constituyen una alternativa diagnóstica prometedora. El objetivo de este estudio es describir la aplicación de una técnica de ELISA en la investigación de un brote de gastroenteritis por Norovirus en una guardería. En septiembre de 2003 se notificaron varios casos de gastroenteritis entre niños que acudían a una guardería. El brote afectó a 15 de los 64 niños expuestos. La sintomatología fue vómitos (100%), dolor abdominal (66%), náuseas (40%) y diarrea (40%). La duración del cuadro fue de 3 días (mediana 2 días). Tres pacientes requirieron ingreso hospitalario y todos se recuperaron con tratamiento sintomático. Se estudiaron 3 muestras de heces de 3 pacientes. La presencia de Salmonella sp, Shigella sp y Campylobacter sp se descartó por coprocultivo. La investigación de Norovirus, Rotavirus, Adenovirus y Astrovirus se realizó mediante ELISA específicos (IDEIA NLV, IDEIA Rotavirus, IDEIA Adenovirus e IDEIA Astrovirus; Dako Ltd, Ely UK). En las 3 muestras procesadas se obtuvieron resultados positivos por ELISA para Norovirus y negativos para el resto de los patógenos. La confirmación de resultados para Norovirus se llevó a cabo mediante RT-PCR. La aplicación generalizada de técnicas de ELISA permitirá ayudar a definir en nuestro entorno el papel de los Norovirus como agentes responsables de brotes de gastroenteritis aguda en niños

The incidence of gastrointestinal outbreaks caused by Norovirus in children has been underestimated. This fact is mainly due to the difficulty in the availability of adequate diagnostic procedures (electronic microscopy and Reverse Transcriptase Polymerase Chain Reaction [RTPCR]).The new Enzyme-Linked Immunosorbent Assay (ELISA) methods for the detection of viral antigens in stools represent a promising diagnostic alternative. The objective of this study was to describe the application of an ELISA technique in the investigation of an outbreak by Norovirus in a day care center. In September 2003 several cases of gastroenteritis in children attending a day care center were communicated. The outbreak affected to 15 out of 64 exposed children. The symptomatology was vomits (100%), abdominal pain (66%), nauseas(40%) and diarrhoea (40%). The duration of the symptoms was 3 days (median 2 days). Three patients required hospitalisation and all of them improved with symptomatic treatment. Three faecal samples of three patients were studied. The presence of Salmonella sp, Shigella sp and Campylobacter sp was discarded by coproculture. The investigation of Norovirus, Rotavirus, Adenovirus and Astrovirus was carried out by specific ELISAs (IDEIA NLV, IDEIA Rotavirus, IDEIA Adenovirus e IDEIA Astrovirus; Dako Ltd, Ely UK). In the three processed samples were obtained positive results for Norovirus. These results were confirmed by using RT-PCR. The results for all other pathogens were negative. The wide application of similar ELISA techniques will allow defining the role of Norovirus as agents of gastrointestinal outbreaks among children in our environment

[A non-invasive diagnostic method in edema of the legs: early detection of lymphedema]. / Metodología diagnóstica no invasiva en el edema de las extremidades inferiores: detección precoz del linfedema.

Lower limbs edema may have manifold local or systemic causes. Is in the "May's edematous limb" when the diagnosis problems appears, needing complementary technics in its treatment. The non invasive methods in phlebedema and lymphedema diagnosis are exposed, emphasizing the precocious diagnosis of the last one.