[Emergence of invasive pneumococcal disease caused by non-vaccine serotypes in the era of the 7-valent conjugate vaccine]. / Serotipos no vacunales emergentes causantes de enfermedad neumocócica invasora en la era de la vacuna 7-valente.

INTRODUCTION: There has been an increased incidence in invasive pneumococcal disease (IPD) produced by non-vaccine serotype (NVS) of Streptococcus pneumoniae after the introduction of PCV7. Our objective was to describe the epidemiological, clinical and microbiological characteristics of IPD caused by NVS in a tertiary hospital in Madrid. PATIENTS AND METHODS: Retrospective (1998-2004) and prospective (2005-2009) study evaluating IPD caused by NVS in children. The study was divided into three periods: P1 (1998-2001) when PCV7 was not commercialized; P2 (2002-2005) with 40% vaccine coverage among children; and P3 (2006-2009) when the vaccine was added to the Childhood Immunization Schedule in Madrid. RESULTS: We analyzed 155 cases of IPD. One hundred and fifty of these isolates were serotyped (100 were NVS). There was an increase in the prevalence of IPD from P1 (31%) to P2 (54%) and P3 (91%). The most relevant emerging serotypes were 19A, 7F, 1, 5, 3 and 15C. The most significant clinical syndromes produced by some specific serotypes were as follows: lower respiratory tract infection (LRTI) by serotypes 1, 3, 5 and 15C; LRTI, primary bacteremia and meningitis by serotype 19A; and primary bacteremia by serotype 7F (66%). The large majority (83.8%) of NVS were sensitive to penicillin. CONCLUSIONS: There has been an increased prevalence of IPD caused by NVS since the introduction of PCV7. These changes should prompt the introduction of new pneumococcal vaccines, which include most of the NVS, in the childhood immunization calendar to prevent IPD in children.

[Increase in the incidence of invasive pneumococcal disease caused by serotype 19A prior to the implementation of the expanded pneumococcal vaccines]. / Aumento de la incidencia de enfermedad neumocócica invasora producida por el serotipo 19A previo a la introducción de las vacunas neumocócicas ampliadas.

OBJECTIVE: To describe the epidemiology, clinical syndromes and microbiological characteristics of serotype 19A as the main cause of invasive pneumococcal disease (IPD) in children admitted to a tertiary hospital in Spain. METHODS: A retrospective (1998-2004) and prospective (2005-2009) study was conducted on children with IPD produced by serotype 19A. The study was divided into three periods (P): P1 (1998-2001) when PCV7 had not been commercialized; P2 (2002-2005) with 40% vaccine coverage among children; and P3 (2006-2009) when the vaccine was added to the Childhood Immunization Schedule in Madrid. RESULTS: A total of 155 isolates of Streptococcus pneumoniae (SP) producing IPD were analysed, with 21 of them being serotype 19A (14%). An increased prevalence of serotype 19A was found: 2/45 cases (4.4%) in P1, 3/41 cases (7.3%) in P2 and 16/69 cases (23.2%) in P3. It occurred mostly in children younger than 2 years (16/21; 76%). This serotype was the main cause of meningitis (5/20; 25%), pleural empyema (3/22; 14%) and bacteraemic mastoiditis (2/4; 50%). Thirteen isolates (61.5%) had an MIC ≥ 0.12µ/ml for penicillin in extra-meningeal infections, and 3 of the 5 isolates causing meningitis (60%) had an MIC ≥ 1µ/ml for cefotaxime. CONCLUSIONS: Serotype 19A was the main causal agent of IPD in the PCV7 era (P3), with high antibiotic resistance rates. This serotype was responsible for all types of IPD, being the main cause of meningitis.

Vacunación en niños inmigrantes / Vaccination in immigrant children

Immigration and international adoptions in Spain have increased over recent years. In general, the children come from developing countries with low vaccination coverage. An assessment of the vaccination status of every immigrant child or adopted child should be carried out as soon as possible. Depending on the results of the assessment the necessary vaccines should be given, until the child is up to date with the calendar of each of the Autonomous Communities (ideally the calendar recommended by the AEP, the Spanish Association of Paediatrics).Only those vaccines for which reliable, written information is available should be taken into consideration (taking into account the number of doses, the interval and the age at which they were given) and an «administered vaccine» should be considered to be a «valid vaccine». In general, when in doubt, it is preferable to revaccinate; alternatively, certain serologic tests can be carried out (diphtheria, tetanus, poliovirus 1-2 and 3,measles, rubella and parotitis). Quick vaccination schedules should be chosen, injecting the highest possible number of doses at once and taking advantage of any visit for its administration. In developing countries the following vaccines are not systematically administered: the heptavalent vaccine against pneumococcal disease, the Hib conjugate vaccine, the vaccine against meningococcal C disease and against chicken pox(AU)

En los últimos años se ha producido en España un aumento dela inmigración y de la adopción internacional. Los niños provienen generalmente de países en vías de desarrollo con coberturas vacunales bajas. En todo niño inmigrante o adoptado se debe realizar lo antes posible una evaluación de su estado vacunal y, en función de éste, completar las inmunizaciones, hasta adaptarlo al calendario de cada una de las comunidades autónomas (idealmente el recomendado por la Asociación Española de Pediatría). Sólo hay que tener en cuenta las vacunas de las que se disponga de información fiable por escrito (teniendo en cuenta el número de dosis, el intervalo y la edad a la que se administraron),y considerar que toda «vacuna administrada es vacuna válida». En general, ante la duda, es preferible revacunar; alternativamente se pueden realizar determinaciones serológicas (difteria, tétanos, poliovirus 1-2 y 3, sarampión, rubéola y parotiditis). Se debe optar por pautas de vacunación rápida, inyectando el mayor número de dosis posibles a la vez y aprovechando cualquier visita para su administración. No se administran de modo sistemático en países en vías de desarrollo la vacuna heptavalente frente al neumococo, la vacuna Hib-conjugada ni la vacuna frente al meningococo C y frente a la varicela(AU)

Hepatitis virales / Viral hepatitides

En conjunto, las hepatitis virales suponen un importante problema mundial, con unas elevadas tasas de incidencia y prevalencia, que varían ampliamente según las distintas regiones. Hasta ahora se han caracterizado cinco tipos distintos de virus causantes de hepatitis, con unas características clínicas y epidemiológicas diferentes. El A y el E se transmiten por vía fecal-oral y no producen enfermedad crónica. Por otro lado, el B, el D y el C se transmiten por vía parenteral y sexual principalmente, y pueden ocasionar, sobre todo en población pediátrica, una afectación crónica. En el estudio inicial del niño inmigrante se debe incluir el cribado serológico de la infección por el virus de la hepatitis B. Aunque la vacunación frente a este virus es universal, no se suele realizar de modo adecuado la inmunoprofilaxis en el recién nacido. La hepatitis A es endémica en países en vías de desarrollo. Suele afectar a niños que regresan a su país para visitar a amigos y familiares, por lo que es especialmente importante indicar la vacunación o la administración de gammaglobulina hiperinmune, según el caso, antes del viaje. La incidencia de hepatitis C en general es baja en la infancia (<0,2%); sólo se debe realizar un cribado serológico en niños inmigrantes con factores de riesgo (antecedente de transfusión, hijos de madre con virus de la hepatitis C positivo, etc.)(AU)

As a whole, viral hepatitides are an important problem on a world level, with high rates of incidence and prevalence, which vary greatly according to the different regions. Until now five different hepatitis-causing viruses have been characterised, with certain different clinical and epidemiological characteristics. Hepatitides A and E are faecal-orally transmitted and do not produce chronic diseases. Hepatitides B, D and C, on the other hand, are mainly transmitted parenterally and sexually, and can cause chronic diseases, especially among the paediatric population. The initial study of the immigrant child should include the serologic tests for the HBV infection. Although the vaccination against that virus is universal, the immunoprophylaxis does not tend to be carried out properly in new borns. Hepatitis A is endemic to developing countries. It tends to affect children who return to their countries to visit family members and friends, which is why it is especially important that the hyperimmune gamma-globulin vaccination/administration is given, as the case may be, before the trip. In general, the incidence of hepatitis C is low in infancy (<0.2%), and serologic tests should only be carried out in immigrant children with risk factors (with a history of transfusions, children of HCV positive mothers, etc.)(AU)

Trombosis de la vena subclavia en una adolescente sin factores de riesgo / Thrombosis of the subclavian vein in an adolescent with no risk factors

La trombosis venosa profunda es una entidad poco frecuente en pediatría. En los últimos años se ha observado un aumento de su incidencia, relacionado con una mayor utilización de catéteres centrales. Exponemos el caso de una niña previamente sana, sin factores de riesgo cardiovascular, que acude al servicio de urgencias por presentar enrojecimiento, edema, aumento de la trama vascular y sensación de opresión en el brazo derecho de 3 semanas de evolución. Se realizaron hemograma, bioquímica sanguínea y coagulación básica, con resultados normales. La eco-Doppler puso de manifiesto una trombosis de la vena subclavia derecha. Se indicó tratamiento ambulatorio, inicialmente con heparina de bajo peso molecular, y se mantuvo una pauta de anticoagulantes orales durante 6 meses. Una vez suspendido el tratamiento, se realizó un estudio de trombofilia, con resultados normales. Un año después, la niña se encuentra asintomática y sin tratamiento. El manejo de este grupo de pacientes se realiza según lo indicado en estudios sobre series de adultos, ya que los trabajos pediátricos publicado sal respecto son escasos(AU)

Deep venous thrombosis is rarely seen in paediatrics. In recent years an increase has been noted in its incidence, linked to the greater use of central catheters. We report on the case of a previously healthy girl, free of cardiovascular risk factors, who came to the emergency services with reddening, o edema, increased vascular markings and a feeling of tightness in her right arm of 3 weeks of evolution. A haemogram, blood biochemistry analysis and basic coagulation tests were performed, with normal results. The echo-Doppler revealed a thrombosis of the right subclavian vein. An out-patient treatment was prescribed, initially with low-molecular-weight heparin, and a course of oral anticoagulants was maintained for 6 months. Once the treatment was stopped, a thrombophilia study was performed, with normal results. One year later, the girl is asymptomatic and without treatment. This group of patients is treated according to the findings of the studies on series of adults, since very few paediatric studies have been published on the subject(AU)

Mastoiditis por Fusobacterium necrophorum / Mastoiditis due to Fusobacterium necrophorum

No disponible