ABSTRACT
This study aimed to assess the impact of the introduction of pneumococcal conjugate vaccine 13 (PCV13) on the molecular epidemiology of invasive pneumococcal disease (IPD) in children from Andalusia. A population-based prospective surveillance study was conducted on IPD in children aged <14 years from Andalusia (2018-2020). Pneumococcal invasive isolates collected between 2006 and 2009 in the two largest tertiary hospitals in Andalusia were used as pre-PCV13 controls for comparison of serotype/genotype distribution. Overall IPD incidence rate was 3.55 cases per 100 000 in 2018; increased non-significantly to 4.20 cases per 100 000 in 2019 and declined in 2020 to 1.69 cases per 100 000 (incidence rate ratio 2020 vs. 2019: 0.40, 95% confidence interval (CI) 0.20-0.89, P = 0.01). Proportion of IPD cases due to PCV13 serotypes in 2018-2020 was 28% (P = 0.0001 for comparison with 2006-2009). Serotypes 24F (15%) and 11A (8.3%) were the most frequently identified non-PCV13 serotypes (NVT) in 2018-2020. Penicillin- and/or ampicillin-resistant clones mostly belonged to clonal complex 156 (serotype 14-ST156 and ST2944 and serotype 11A-ST6521). The proportion of IPD cases caused by PCV13 serotypes declined significantly after the initiation of the PCV13 vaccination programme in 2016. Certain NVT, such as serotypes 24F and 11A, warrant future monitoring in IPD owing to invasive potential and/or antibiotic resistance rates.
Subject(s)
Pneumococcal Infections , Child , Humans , Molecular Epidemiology , Pneumococcal Infections/epidemiology , Pneumococcal Vaccines , Prospective Studies , Spain/epidemiology , Streptococcus pneumoniae , Vaccines, ConjugateABSTRACT
FUNDAMENTO: Conocer la situación de implementación del cribado de Chagas en embarazo y neonato, en las ocho provincias andaluzas. MÉTODO: Se realizó un estudio descriptivo observacional, transversal, a través de una encuesta revisada y validada por expertos del Grupo Andaluz de Infectología e Inmunopatología Pediátrica. Participaron dieciocho infectólogos pediátricos de centros hospitalarios andaluces de referencia (catorce públicos y cuatro privados). RESULTADOS: El cribado de Chagas durante el embarazo era conocido por diecisiete encuestados (94%), y aplicado de manera sistemática por ginecólogos o matrones en siete hospitales (38,9%). El protocolo de seguimiento de neonatos hijos de madre con Chagas era conocido por dieciséis encuestados (88,9%) y aplicado en diez hospitales (55,5%), dos de los cuales no lo aplicaban a hermanos mayores y familiares de neonatos en riesgo. Solo se detectaron dos casos de transmisión vertical de Chagas (11,1%) en dos centros con cribado sistematizado de Chagas a embarazadas de riesgo, en los cuales también se diagnosticaron dos casos en hermanos de lactantes de riesgo. CONCLUSIÓN: En Andalucía el cribado de Chagas en embarazadas y neonatos de riesgo no se realiza de manera protocolaria ni uniforme en todos los hospitales de referencia, por lo que es altamente probable un infradiagnóstico de Chagas congénito. La formación de los profesionales implicados en la asistencia a la mujer embarazada y a su descendencia, y la unificación de criterios de seguimiento serían fundamentales para realizar un correcto diagnóstico y tratamiento precoz de estos casos
BACKGROUND: To determine the current state of the implementation of Chagas screening in pregnancy and newborns at risk in the eight Andalusian provinces. METHODS: An observational, cross-sectional and descriptive study was carried out through a survey reviewed and validated by experts from the Andalusian Group of Pediatric Infectious Diseases and Immunology. Eighteen pediatric infectious disease specialists from Andalusian referral hospitals (fourteen public and four private) participated. RESULTS: The Chagas screening during pregnancy was known by seventeen specialists (94%), and systema-tically applied in seven hospitals (38.9%) by gynecologists or midwives. The protocol for following-up newborns at risk was known by sixteen specialists (88.9%) and applied in ten hospitals (55.5%), two of which did not study siblings and relatives of these newborns. Only two cases of vertical transmission of Chagas (11.1%) were detected; it happened in two hospitals applying systematically the Chagas screening to pregnant woman at risk, the same ones that also diagnosed two cases in siblings of newborns at risk. CONCLUSION: In Andalusia screening of Chagas disease in pregnant women and newborns at risk is not carried out in a systematic and uniform way in all the reference hospitals, so an underdiagnosis of congenital Chagas disease is highly probable. The training of professionals involved in assisting pregnant women and their offspring, and the unification of the follow-up criteria for newborns at risk would be essential for carrying out both a correct diagnosis and an early treatment of these cases
Subject(s)
Humans , Female , Pregnancy , Infant, Newborn , Neonatal Screening/methods , Prenatal Diagnosis/methods , Chagas Disease/epidemiology , Pregnancy Complications, Infectious/epidemiology , Cross-Sectional Studies , Health Care Surveys/statistics & numerical data , Serologic Tests/statistics & numerical data , Cost-Benefit Analysis , Infectious Disease Transmission, Vertical/statistics & numerical data , Risk FactorsABSTRACT
La malaria es una de las enfermedades tropicales importadas que con más frecuencia se diagnostican en nuestro país. La mortalidad en viajeros que adquieren la enfermedad oscila alrededor del 2-3%, siendo el principal factor asociado al mal pronóstico el retraso diagnóstico y del inicio del tratamiento antiparasitario. Los casos de malaria importada suelen presentarse con fiebre, cefalea y artromialgias, aunque pueden aparecer otros síntomas. El diagnóstico se debe realizar de forma urgente, a través de gota gruesa o pruebas de diagnóstico rápido, y extensión sanguínea. El tratamiento debe ser instaurado lo antes posible. En los casos de malaria grave, el uso de artemisininas intravenosas ha demostrado ser superior al uso de quinina intravenosa. En este documento se detallan las recomendaciones del grupo de expertos de la Sociedad Española de Medicina Tropical y Salud Internacional (SEMTSI) para el diagnóstico y tratamiento de la malaria importada
Malaria is a common parasitic disease diagnosed in the returned traveler. Mortality in travelers with imported malaria is around 2-3%, and one of the main factors associated with poor prognosis is the delay in the diagnosis and treatment. Imported malaria cases usually present with fever, headache and myalgia, but other symptoms may appear. The diagnosis should be performed as soon as possible, using thick smear or rapid diagnostic tests, and a blood smear. Treatment should be initiated urgently. In cases of severe malaria, the use of intravenous artemisinins has proved to be superior to intravenous quinine. This document reviews the recommendations of the expert group of the Spanish Society of Tropical Medicine and International Health (SEMTSI) for the diagnosis and treatment of imported malaria in Spain
Subject(s)
Adult , Child , Female , Humans , Infant, Newborn , Male , Pregnancy , Malaria/diagnosis , Malaria/drug therapy , Malaria/epidemiology , Malaria/mortality , Antimalarials/therapeutic use , Malaria, Falciparum/drug therapy , Artemisinins/therapeutic use , Quinine/therapeutic use , Parasitemia/microbiology , Epidemiological Monitoring/trends , Diagnostic Techniques and Procedures , Artemisinins/administration & dosage , Quinine/administration & dosage , Pregnancy Complications , Infant, Newborn, Diseases , Malaria, Vivax , Malaria, Cerebral , Plasmodium ovale , Plasmodium knowlesi , Spain/epidemiologyABSTRACT
Malaria is a common parasitic disease diagnosed in the returned traveler. Mortality in travelers with imported malaria is around 2-3%, and one of the main factors associated with poor prognosis is the delay in the diagnosis and treatment. Imported malaria cases usually present with fever, headache and myalgia, but other symptoms may appear. The diagnosis should be performed as soon as possible, using thick smear or rapid diagnostic tests, and a blood smear. Treatment should be initiated urgently. In cases of severe malaria, the use of intravenous artemisinins has proved to be superior to intravenous quinine. This document reviews the recommendations of the expert group of the Spanish Society of Tropical Medicine and International Health (SEMTSI) for the diagnosis and treatment of imported malaria in Spain.
Subject(s)
Antimalarials/therapeutic use , Malaria/diagnosis , Malaria/therapy , Adult , Algorithms , Anticonvulsants/therapeutic use , Antimalarials/administration & dosage , Blood Transfusion , Child , Combined Modality Therapy , Comorbidity , Early Diagnosis , Female , Fluid Therapy , Humans , Malaria/epidemiology , Malaria/transmission , Parasitemia/diagnosis , Parasitology/methods , Pregnancy , Pregnancy Complications, Infectious/diagnosis , Pregnancy Complications, Infectious/therapy , Societies, Medical , Spain/epidemiology , Travel , Tropical MedicineABSTRACT
Introducción La transmisión vertical de la enfermedad de Chagas supone un problema de Salud Pública en países no endémicos. Métodos Cribado de Chagas mediante dos test serológicos a las gestantes procedentes de áreas endémicas durante 4 años. Resultados Se estudiaron 261 gestantes procedentes de 13 países latinoamericanos, realizando un diagnóstico confirmatorio (dos test positivos) en 4 casos. No existió ningún caso de transmisión vertical. Conclusión Aunque la enfermedad de Chagas tiene una baja prevalencia en la provincia de Almería, su cribado es necesario para la detección y tratamiento de los recién nacidos con la enfermedad (AU)
Introduction: The transmission of Chagas disease is a public health problem in non-endemic countries. Methods: Chagas screening was performed by two serological tests in pregnant women from endemic areas for 4 years. Results: We studied 261 pregnant women from 13 Latin American countries, making a confirmatory diagnosis (two positive tests) in 4 cases. There was no case of vertical transmission. Conclusion: Although Chagas disease has a low prevalence in the province of Almeria, the screening is necessary for the detection and treatment of infants with the disease (AU)
Subject(s)
Humans , Female , Pregnancy , Chagas Disease/epidemiology , Pregnancy Complications/epidemiology , Mass Screening , Infectious Disease Transmission, Vertical/prevention & control , Latin America/epidemiologyABSTRACT
INTRODUCTION: The transmission of Chagas disease is a public health problem in non-endemic countries. METHODS: Chagas screening was performed by two serological tests in pregnant women from endemic areas for 4 years. RESULTS: We studied 261 pregnant women from 13 Latin American countries, making a confirmatory diagnosis (two positive tests) in 4 cases. There was no case of vertical transmission. CONCLUSION: Although Chagas disease has a low prevalence in the province of Almeria, the screening is necessary for the detection and treatment of infants with the disease.
