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 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.

[Cardiac complications in Kawasaki disease]. / Complicaciones cardiacas en la enfermedad de Kawasaki.

We present 3 patients, aged 7 and 12 months. and 5 years, who meet the diagnostic criteria for Kawasaki's disease. In these, there was coronary artery involvement. which was identified by two dimensional echocardiography. In two of these, a coronary artery involvement which was identified by two dimensional echocardiography. In two of these, a coronary artery aneurysm was demonstrated within the 3rd week. The aneurysm resolved after 4 months in one patient, and still persist after 15 months in the other. The third patient had a left coronary artery aneurysm, confirmed by angiocardiography, which also showed small aneurysms in the right coronary artery. The electrocardiographic study of this patient, performed 3 months after onset, showed a patterns of necrosis (anterolateral infarction), confirmed by mean of a thallium scintigraphy. We have performed a study about the management of this kind of patients, and can conclude: 1. Coronary angiocardiography may permit the detection of right coronary artery aneurysms, not visualized by echocardiography. 2. Patients with coronary artery aneurysms, with no stenotic lesions 1 the coronary angiocardiography, may evolve into myocardia infarction. 3. We expose our doubts about the indication and right time to perform the angiocardiographic study.

[Cytomegalovirus disease in immunosuppressed patients]. / Enfermedad por virus citomegálico en pacientes inmunodeprimidos.

Cytomegalovirus (CMV) infection is relatively frequent and severe in immunosuppressed patients giving rise to diagnostic and therapeutic problems. We describe a series of 7 patients, six with acute lymphoblastic leukemia and one with aplastic anemia. All patients had CMV infection at the moment of maximum immunodepression. Two patients had undergone recent bone-marrow transplant. Six had been transfused in the two months prior to the onset of infection. Diagnosis was established through isolation of CMV from blood or serological methods. Symptoms ranged from prolonged fever to multi-organic involvement. Two cases had pulmonary involvement as well as fever, hepatitis and petechial rash. Two other cases presented with fever and hepatosplenomegaly and in the remaining, 3, fever was the only sign. Clinical course was favourable in all cases including the two with pneumonitis; of these two the first received acyclovir and anti-CMV Ig and the other received no specific therapy. One of the remaining cases was also given acyclovir and specific anti CMV Ig was administered to the 3 patients with isolated fever. In conclusion, CMV infection should be suspected in immunosuppressed patients with prolonged fever.

[Metastatic neuroblastomas: factors influencing survival]. / Neuroblastomas metastáticos: factores que influyen en la supervivencia.

Sixty-two patients with metastatic neuroblastoma admitted to the Hospital Infantil "Valle de Hebrón" de Barcelona during the period of October 1966-March 1985 are reviewed. The survival rate was 16% with an overall cure rate of 9.6%. The age, sex, site of primary tumor, site of metastases, and urinary catecholamine excretion were not independent prognostic factors. Patients with initial stage I, II or III and late evolution to stage IV had a worse prognostic (survival rate 13%, p less than or equal to 0.05). We compare five treatment protocols. We obtain a better response by a multichemotherapy made of cyclophosphamide, vincristine, adriamycin, DTIC combined in a sequential order with cis-platin and VM-26. The median survival for this group was 19.9 months and the survival rate 57.1% (p less than 0.001).