Effectiveness of cell culture-based influenza vaccines compared with egg-based vaccines: What does the literature say?

OBJECTIVE: Influenza vaccination is an effective way of reducing the burden of seasonal influenza. Chicken egg embryos are the most common source of influenza vaccines, but cell culture production has emerged as an alternative that could be advantageous. This article reviews the available literature on the efficacy/effectiveness of cell culture-based influenza vaccines compared with egg-based vaccines. METHODS: We conducted a review of the actual literature and analyzed those studies comparing the effectiveness of cell culture-based and egg-based vaccines in the last ten years. RESULTS: Eight studies were analyzed; 1 was a clinical trial and 7 were retrospective cohort studies. The clinical trial found no significant differences in the efficacy of both vaccines with respect to placebo. The results of the observational studies were inconsistent and relative effectiveness varied among studies, even though most were performed during the same season, and in some cases, in the same region and using the same data records. Furthermore, in most studies, the comparisons between vaccines were not statistically significant. CONCLUSIONS: There is insufficient evidence that cell culture-based vaccines are superior to egg-based vaccines in terms of efficacy/effectiveness.

[Influenza and cardiorespiratory events: a clinical-epidemiological review with a multidisciplinary point of view]. / Gripe y eventos cardiorrespiratorios: una revisión clínico-epidemiológica multidisciplinar.

There is accumulating evidence showing that influenza infection and cardiorespiratory diseases are closely associated. Influenza has been described as a triggering factor capable of both exacerbate underlying chronic diseases as well as inducing the appearance of new respiratory and cardiovascular events. Consequently, influenza infection and its associated comorbidity have a significant impact on the health system. In this document, we extensively reviewed the current literature to describe the most relevant data on the relationship between influenza infection and cardiorespiratory diseases. Likewise, we analyzed the possible pathophysiological mechanisms explaining the connection between influenza infection and cardiac and respiratory events. Finally, reviewed data has been put into perspective to highlight the importance of influenza vaccination as an effective measure in the prevention of cardiorespiratory diseases, especially in the population with underlying chronic diseases.

Vacunación frente a rotavirus en niños prematuros: una cuestión de tiempo / Rotavirus vaccine in preterm infants: a matter of time

La infección por rotavirus continúa siendo un problema relevante de salud pública en los países desarrollados, y los niños prematuros constituyen la población más vulnerable tanto en términos de riesgo de infección como por la gravedad de la misma. En la actualidad existen dos vacunas frente a rotavirus disponibles en España: la vacuna pentavalente bovina-humana reordenada (RotaTeq®, MSD) y la monovalente humana atenuada (Rotarix®, Glaxo-SmithKline Biologicals). Los datos de los ensayos clínicos y estudios observacionales indican que la vacunación anti-rotavirus en niños prematuros es bien tolerada y segura, con un perfil similar en este sentido al observado en niños nacidos a término. Por otra parte, los resultados de los estudios clínicos y observacionales también apoyan una eficacia similar a la comunicada en niños a término. Más aún, al tratarse de un grupo de mayor riesgo de infecciones, es posible teóricamente que el beneficio obtenido sea incluso mayor que en niños a término. La transmisión horizontal del virus vacunal, aun siendo posible, no ha sido documentada en ensayos clínicos y los estudios observacionales existentes hasta ahora sugieren un riesgo bajo. En consonancia con diversas recomendaciones nacionales e internacionales, consideramos que esta población, siempre que su condición clínica lo permita, debe recibir la vacunación frente a rotavirus sin retrasos, incluyendo su vacunación mientras estén hospitalizados, si así fuese necesario

Rotavirus infection continues to be a relevant public health problem in developed countries and premature children constitute a more vulnerable population both in terms of risk and severity of infection. Currently, there are two available vaccines against rotavirus in Spain: the pentavalent bovine-human reasortant vaccine (RotaTeq®, MSD) and the attenuated human monovalent vaccine (Rotarix®, GlaxoSmithKline Biologicals). Results from clinical trials and from observational studies indicate that anti-rotavirus vaccination in preterm infants is well tolerated and safe, with a similar profile in this regard to that reported in full-term infants. On the other hand, the results of clinical trials and observational studies also support efficacy similar to that reported in children at term. Moreover, as it is a group with a higher risk of infections, it is theoretically possible that the benefit obtained is even greater than in full-term children. The virus transmission to unvaccinated contacts, although possible, has not been documented in clinical studies and the studies published to date so far suggest a low risk in this regard. Consistently with various national and international recommendations, these authors therefore consider that this population, whenever its clinical condition permits, should receive vaccination against rotavirus without delays, including vaccination while hospitalized, if necessary

Bacteriemia por "Bordetella holmesii" en un paciente con drepanocitosis / Febrile syndrome caused by Bordetella holmesii and sickle cell disease

Introducción: Bordetella holmesii es un microorganismo que fue aislado por primera vez en un varón esplenectomizado en 1983. Existen pocos casos descritos en la literatura hasta ahora, pero todos comparten un factor de riesgo común: la inmunodepresión del paciente. Se presenta el caso de un niño diagnosticado de dicha infección en nuestro hospital. Caso clínico: Niño de 11 años de edad diagnosticado de drepanocitosis homocigota y asplenia funcional a los 8 años, que ingresa por un cuadro de mialgias de 24 horas de evolución, disuria y dolor lumbar, en tratamiento con amoxicilina-ácido clavulánico desde las 12 horas previas debido a la presencia de un síndrome febril sin foco. A su ingreso se inicia rehidratación y tratamiento antibiótico intravenoso. Se obtienen los resultados de las pruebas complementarias realizadas durante su ingreso, en los que destaca el aislamiento en el hemocultivo de un bacilo gramnegativo a las 72 horas, que no pudo ser identificado inicialmente pero fue catalogado como B. holmesii tras ser analizado por espectrómetro de masas en nuestro laboratorio de referencia. Tras su recuperación, destaca como dato analítico la presencia de una trombocitosis llamativa. Conclusión: Los gérmenes causantes de bacteriemias en los últimos años han cambiado y B. holmesii se presenta como un patógeno emergente que cabe tener en cuenta en los pacientes que presenten un síndrome febril e inmunosupresión como factor de riesgo

Introduction: Bordetella holmesii is a microorganism which was isolated in a splenectomized male in 1983 for the first time. Few cases have been described in the literature since then, but all of them share a common risk factor: the immunodepression of the patient. We introduce the case of a child diagnosed with the above mentioned infection in our hospital. Clinical case: 11-year-old child diagnosed of homozygous sickle cell disease and functional asplenia at 8 years of age, who was admitted to the hospital for muscle pain of 24 hours of evolution, dysuria and backache. He was being treated with amoxicilina-acid clavulanic for 12 hours because of a febrile syndrome without focus. When he was admitted to the hospital a rehydration and antibiotic intravenous treatment is initiated. Once the results of the complementary tests made during his admission become available, in which it stands out the isolation in the blood culture of a gram-negative bacilli after 72 hours, which could not be initially identified, but eventually was recognized as a B. holmesii after being analysed by mass spectrometry in our reference laboratory. After his recovery, the presence of a mild thrombocytosis is stressed as an analytical data. Conclusion: The microorganism which causes bacterieamia has changed in the last years and B. holmesii seems to be an emerging pathogenic which must be considered in patients who have a febrile syndrome and immunosuppression as a risk factor

Micropápulas generalizadas en una niña de ocho años / Micropapular rash in an 8 year-old girl

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[Post-traumatic stress disorder in premature newborns]. / Trastorno por estrés postraumático en nacidos prematuros.

INTRODUCTION: Preterm newborns are physiologically immature and vulnerable. Following birth, they must face a battery of adverse stimuli, radically different from the warmth of the mother's womb. The aims of this study were to evaluate the prevalence of emotional alterations in the neonate and to examine the influence of physical contact with the mother during the infant's stay in the Neonatal-Intensive-Care-Unit (NICU). PATIENTS AND METHODS: Prospective follow-up study of a group of 15 neonates admitted to a NICU, together with a control-group of 15 full-term neonates, not admitted to a NICU. RESULTS: The number of responses considered to be pathological observed among neonates, in the mothers' arms was 0.6-per-hour and in the incubator/cot, 20.6, (p < 0.001). There were statistically significant differences as regards the presence of pathological reactions to external stimuli, which tended to produce a repeated sensation of living out the traumatic event (RR = 3.3). CONCLUSIONS: Beyond a doubt, many factors should be taken into consideration in order to prevent the development of PTSD, and research such as the present leads us to believe that studies should be made of possible modifications to the environmental surroundings of the NICU.

Trastorno por estrés postraumático en nacidos prematuros / Post-traumatic stress disorder in premature newborns

Introducción: El recién nacido prematuro es fisiológicamente inmaduro y vulnerable. Tras el alumbramiento, se enfrenta a un contingente de estímulos adversos, radicalmente opuestos a la calidez del útero materno. En este estudio se pretende evaluar la prevalencia de las alteraciones emocionales del recién nacido y la influencia del contacto físico con la madre durante el ingreso en una unidad de cuidados intensivos neonatales (UCIN). Pacientes y métodos: Estudio de seguimiento prospectivo de una cohorte de recién nacidos ingresados en una UCIN, con grupo de comparación de recién nacidos a término, no ingresados. Resultados: Comparando el número de respuestas consideradas patológicas dentro de la incubadora/cuna y fuera de la misma en brazos de la madre, se hallaron los siguientes promedios: en brazos de la madre, 0,6/h, y en la incubadora/ cuna, 20,6/h (p < 0,001). Se encontraron diferencias estadísticamente significativas respecto a la presencia de reacciones patológicas a estímulos externos que favorecían la reexperimentación del acontecimiento traumático (riesgo relativo: 3,3). Conclusiones: Sin duda, son muchos los factores que deben considerarse en la prevención del desarrollo de trastorno por estrés postraumático, y son investigaciones de esta índole las que nos impulsan a pensar en la necesidad de realizar estudios sobre modificaciones ambientales en la UCIN

Introduction: Preterm neborns are physiologically immature and vulnerable. Following birth, they must face a battery of adverse stimuli, radically different from the warmth of the mother's womb. The aims of this study were to evaluate the prevalence of emotional alterations in the neonate and to examine the influence of physical contact with the mother during the infant's stay in the Neonatal-Intensive-Care-Unit (NICU). Patients and methods: Prospective follow-up study of a group of 15 neonates admitted to a NICU, together with a control-group of 15 full-term neonates, not admitted to a NICU. Results: The number of responses considered to be pathological observed among neonates, in the mothers' arms was 0.6-per-hour and in the incubator/cot, 20.6, (p < 0.001). There were statistically significant differences as regards the presence of pathological reactions to external stimuli, which tended to produce a repeated sensation of living out the traumatic event (RR 3.3). Conclusions: Beyond a doubt, many factors should be taken into consideration in order to prevent the development of PTSD, and research such as the present leads us to believe that studies should be made of possible modifications to the environmental surroundings of the NICU