Waning protection of influenza vaccination during four influenza seasons, 2011/2012 to 2014/2015.

BACKGROUND: Concerns have been raised about intraseasonal waning of the protection conferred by influenza vaccination. METHODS: During four influenza seasons, we consecutively recruited individuals aged 18years or older who had received seasonal influenza vaccine and were subsequently admitted to the hospital for influenza infection, asassessed by reverse transcription polymerase chain reaction. We estimated the adjusted odds ratio (aOR) of influenza infection by date of vaccination, defined by tertiles, as early, intermediate or late vaccination. We used a test-negative approach with early vaccination as reference to estimate the aOR of hospital admission with influenza among late vaccinees. We conducted sensitivity analyses by means of conditional logistic regression, Cox proportional hazards regression, and using days between vaccination and hospital admission rather than vaccination date. RESULTS: Among 3615 admitted vaccinees, 822 (23%) were positive for influenza. We observed a lower risk of influenza among late vaccinees during the 2011/2012 and 2014/2015A(H3N2)-dominant seasons: aOR=0.68 (95% CI: 0.47-1.00) and 0.69 (95% CI: 0.50-0.95). We found no differences in the risk of admission with influenza among late versus early vaccinees in the 2012/2013A(H1N1)pdm09-dominant or 2013/2014B/Yamagata lineage-dominant seasons: aOR=1.18 (95% CI: 0.58-2.41) and 0.98 (95% CI: 0.56-1.72). When we restricted our analysis to individuals aged 65years or older, we found a statistically significant lower risk of admission with influenza among late vaccinees during the 2011/2012 and 2014/2015A(H3N2)-dominant seasons: aOR=0.61 (95% CI: 0.41-0.91) and 0.69 (95% CI: 0.49-0.96). We observed 39% (95% CI: 9-59%) and 31% (95% CI: 5-50%) waning of vaccine effectiveness among participants aged 65years or older during the two A(H3N2)-dominant seasons. Similar results were obtained in the sensitivity analyses. CONCLUSION: Waning of vaccine protection was observed among individuals aged 65years old or over in two A(H3N2)-dominant influenza seasons.

[Pott's puffy tumor: a rare complication of frontal sinusitis]. / Tumor inflamatorio de Pott: una complicación infrecuente de la sinusitis frontal.

Pott's puffy tumor is a rare complication of frontal sinusitis characterized by swelling and edema in the brow due to a subperiosteal abscess associated with frontal osteomyelitis. Added complications are cellulitis by extension to the orbit and intracranial infection by posterior extension, with high risk of meningitis, intracranial abscess, and venous sinus thrombosis. Early diagnosis and aggressive medical or surgical treatment are essential for optimal recovery of affected patients. In the antibiotic age it is extremely rare, with very few cases described in the recent literature. A case is presented of a Pott inflammatory tumor in a 7 year-old boy, as a complication of acute pansinusitis who presented with front preseptal swelling and intracranial involvement with thrombosis of ophthalmic and superior orbital veins and frontal epidural abscess extending to the subarachnoid space.

[Hospitalizations for varicella in the Hospital Infantil La Fe, Valencia,Spain, 2001-2004]. / Hospitalizaciones por varicela en el Hospital Infantil La Fe (Valencia 2001-2004).

INTRODUCTION: Varicella is a common, highly contagious disease. It is usually benign but has potentially serious complications. PATIENTS AND METHODS: To assess the clinical characteristics and the associated cost of varicella hospitalization, we reviewed the medical records of children hospitalized for varicella between 2001 and 2004. Children with coincidental varicella hospitalized for a different reason were excluded. RESULTS: Of 1177 children with varicella attended at the emergency room, 101 (8.6 %) were hospitalized. The median age was 3.2 years (21 days to 18.9 years). Twenty-eight children had underlying disease. Thirty-seven children had no complications and the reason for admission was: a) risk of severe varicella (21 immunocompromised children, three neonates), and b) high fever or observation (13 cases). The 64 remaining children were admitted for 66 complications of varicella. The most common complications were skin/soft tissue infections (33 patients) and the leading cause was Streptococcus pyogenes (n = 13) and Staphylococcus aureus (n = 10) isolated in blood or the site of infection. Other complications were pneumonia (13 children), neurological (febrile seizures in nine, meningoencephalitis in two, acute disseminated encephalomyelitis in one, cerebellitis in one), hematological (neutropenia in one, Henoch-Schönlein purpura in one and thrombopenic purpura in three) and osteoarticular (synovitis in one and septic arthritis in one). One patient died of multiorgan failure. During the study period, the rate of emergency room visits due to varicella doubled and the number of admissions for complications tripled. The mean length of hospital stay was 6.8 days (range: 1-28 days) and the total associated cost was 397,314.14 Euro, excluding symptomatic treatment. CONCLUSIONS: The high morbidity associated with varicella and its complications, as well as the high social costs of this disease, support the implementation of routine varicella vaccination. This could reduce the total number of cases, their severity, direct costs, generated by medical care, and indirect costs, generated by the disease and hospitalization.

[Skin and soft tissue infections caused by Haemophilus influenzae type b over a 30 year period]. / Infecciones graves de piel y tejidos blandos por Haemophilus influenzae tipo b a lo largo de 30 años.

INTRODUCTION: The skin and soft tissue infections caused by Haemophilus influenzae type b (Hib) are usually mild but can be potentially serious due to the high probability of bacteremia. Prompt instauration of empiric intravenous antibiotic therapy according to the localization and characteristics of the lesion is mandatory to prevent severe complications. PATIENTS AND METHODS: Of 257 children admitted to the Children's Hospital of La Fe due to invasive Haemophilus influenzae type b disease (1973 to 2003), we reviewed 15 cases (5.8%) of skin and soft tissue infections, their outcome, complications and sequelae. RESULTS: Ten children (66.7%) were aged < 2 years old. In eight patients (53.3%) there was a history of upper respiratory tract infection. Localization was in the head in 9 children (60%) and blood culture was positive in 10 patients (66.7%). Meningitis was a complication in 2 children (13.3%) and limited mobility of the hand was a sequel in one child (6.6%). After the universal establishment of the Hib vaccine in 1997, 3 new patients were admitted; 2 children with an infected thyroglossal cyst and another with cellulitis in the left leg. Of these children, one had received only the three primary doses of the vaccine but not the booster dose, and the remaining two were unvaccinated immigrant children. CONCLUSION: Skin and soft tissue infections caused by Hib are potentially severe diseases with a risk of complications and sequelae. Due to the increase in unvaccinated immigrants and possible vaccine failures, universal immunization and epidemiological surveillance of carriers should be carried out to achieve total eradication.

[Pyriform sinus fistulae]. / Fístulas de seno piriforme.

Pyriform sinus fistulae (PSF) are rare branchial pouch anomalies. In most previously described cases the anomaly is located on the left side. PSF should be suspected in cervical inflammatory processes (cervical abscesses and types of suppurative thyroiditis). We report two cases of acute thyroiditis and deep cervical abscesses secondary to PSF, which were diagnosed and treated in our hospital in the last 2 years. Both presented inflammatory cervical masses associated with painful swallowing, high fever and laboratory findings compatible with acute infection. In both cases the diagnosis of PSF was confirmed by barium esophagogram. Cervical ultrasonography and computed tomography were also performed. The treatment of choice consists of broad-spectrum antibiotic therapy during acute exacerbation and subsequent fistulectomy. Definitive surgical treatment prevents recurrences.

[Social and family characteristics in children born to women infected by the human immunodeficiency virus]. / Características sociofamiliares de los niños nacidos de mujeres infectadas por el virus de la inmunodeficiencia humana.

OBJECTIVES: To evaluate the social and family characteristics of children born to women infected by the human immunodeficiency virus (HIV). As secondary objectives, to analyse their schooling and the number of hospital admissions and lengths of stay that these children required. DESIGN: A prospective observation study. SETTING: HIV unit in a children's hospital. INCLUSION CRITERIA: all the children recruited from the HIV unit who had their infection status defined during the study period, understood as between the first known case in 1985 and April 1994. The sample included 177 children (62 HIV-infected and 115 not infected). MEASUREMENTS AND MAIN RESULTS: Through an interview the social, family and school variables were collected. On comparison between infected and non-infected children, there were no important differences as to the lack of protection of the new-born (8.1% vs 13%), scant mother-child relationship (31.2% vs 36.5%) or people responsible for the custody of these children. Less schooling and greater problems of school integration were detected in infected cases, with odds ratios of 2.68 (p = 0.004) and 11.36 (p = 0.004), respectively. Children infected also needed more admissions (4.3 +/- 5.7) than the non-infected (1.7 +/- 0.9) (p = 0.001), and more days of hospital stay (75.1 +/- 110.3 vs 23.3 +/- 19.6) (p = 0.0003). CONCLUSIONS: Infected children and non-infected children had similar social and family characteristics. However, less schooling, problems of school integration, and more and longer hospital admissions were related to HIV infection in children, and not so much to their status as children of seropositive mothers.

[Haemophilus influenzae type b osteoarthritis. A report of 7 cases and a review of the literature]. / Osteoartritis por Haemophilus influenzae tipo b. Presentación de 7 casos y revisión de la literatura.

OBJECTIVE: The epidemiological and clinical characteristics, treatment and evolution of osteoarthritis by Haemophilus influenzae type b (HIB) are reviewed since there has been little published on this subject in our country. PATIENTS AND METHODS: The clinical histories of the 7 children with osteoarthritis due to Hib infection are reviewed. The diagnostic criteria included classical signs and symptoms of septic arthritis, radiological alterations compatible with joint infection and isolation of microorganisms in joint effusion and/or in the blood. RESULTS: During a 24-year period (1973-1996), 248 cases of invasive infection by Hib were documented. Seven cases (2.82%) had osteoarticular infections. The ages were between 5 and 7 years and there were more males than females (71.4% vs. 28.6%). Four children/58%) had previous upper respiratory infections (URI). The microorganism was isolated in the joint effusion in 5 children and in the blood sample of the other 2. C-reactive protein was high and radiology showed alterations in 100% of the cases. Surgical treatment with articular drainage was necessary in 5 children/71.4%). In 6 cases (85.7%) initial medical treatment was i.v. beta-lactam antibiotics for 2-3 weeks followed by oral antibiotic treatment for a minimum of 6 weeks. Three children (42.8%) had sequelae. CONCLUSIONS: Early diagnosis of bacterial osteoarthritis by Hib is difficult. Final therapeutical success depends on an early clinical diagnosis and aggressive multidisciplinary treatment. Drainage of the hip joint is mandatory for successful outcome. Currently, arthritis by Hib can be avoided and its sequelae prevented by vaccination.

[Pneumonia due to Haemophilus influenzae type b in children: presentation of 24 cases]. / Neumonía por Haemophilus influenzae tipo b en niños: presentación de 24 casos.

OBJECTIVE: Due to the higher incidence in invasive infections, the changes observed in the sensitivity of this microorganism during the last decade and the seriousness of pulmonary infections in children, the objective of this paper is to review the clinical and epidemiological characteristics of Haemophilus influenzae type b (Hib) pneumonia, as well as to give an update of treatment. PATIENTS AND METHODS: Twenty-four children diagnosed between 1973 and 1992 are reviewed using the following criteria: clinical manifestations of pneumonia, radiology and isolation of the microorganism. RESULTS: The annual average was 7.8 cases/100,000 children under 5 years of age. More females were affected (58.3% vs 41.6%). Of the cases studied, 58.3% of the children were under one year and 83.3% under 2 years of age. Fever was the most common clinical manifestation (95.8%). Blood cultures were positive in 21 cases (87.5%); pleural effusion culture contributed to the diagnosis in two other cases (8.3%) and deep bronchial aspirate in one other case. Of the Haemophilus influenzae type b strains 62.5% were resistant to ampicillin and 100% were sensitive to second and third generation cephalosporins. Three infants with chronic illness died (12.5%). CONCLUSIONS: Hib pneumonia is an infection usually affecting children younger than 2 years of age. Its clinical manifestations are indistinguishable from those of other microorganisms. Blood culture is the most useful technique to confirm the diagnosis. The increase in resistance to classical treatment (ampicillin) obliges us to consider amoxicillin-clavulanic as the selected empirical treatment. Second and third generation cephalosporins may be considered a good alternative. There is a high mortality in children with chronic illness.

[Nutritional status in HIV infection in infancy]. / Estado nutricional en la infección por el virus de la inmunodeficiencia humana en la edad pediatría.

The physiopathology of malnutrition among AIDS, ARC and HIV infected children was reviewed. One-hundred eight-three newborns were studied, 152 of which were born at "La Fe" Maternity Hospital. Of these patients, 29% were LBW and 28% preterm. Transfused and hemophiliac patients were excluded from the study. Anorexia, vomiting, fever, infections of the respiratory and GI tracts and drug therapy were the most frequent factors affecting the nutritional status. Fifty-three newborns were infected with the HIV (29%). The children were classified into three groups (G). Group-I was formed by HIV+children > 18 months of age, G-II, P-2 class by children < 18 months of age and G-III was formed by those children that died of AIDS. The most common symptoms were chronic diarrhea and infections of the respiratory tract. Of the HIV+children > 18 months of age, 65% had a weight < the 10th percentile and 61% were < the 10th percentile for height. Of the children that died of AIDS, 80% were in the lower 10th percentile for both weight and height. Hemoglobin, T4/T8, total proteins, seroalbumin and calcium were also negatively affected. Those most severely affected were the dead patients, followed by P-2 < 18 months and finally the HIV+ > 18 months of age. The differences between G-I and G-II-G-III were statistically significant, p < 0.01. The biochemical quantification of the nutritional status was difficult due to the limited amount of blood available. HIV infected children require nutrition supplementation to maintain an adequate nutritional status. Among these patients, malnutrition is a multifactorial phenomenon.(ABSTRACT TRUNCATED AT 250 WORDS)

[Lumbosacral dermal sinus as entry point of purulent meningitis. Report of 3 cases]. / Seno dérmico lumbo-sacro como puerta de entrada de meningitis purulenta. Presentación de tres casos.

Defects of neural tube closure, although minimal, can provide access for infections of the central nervous system. All skin alterations in rear middle line of the body, however, minimal, must be carefully investigated as they could give access to bacterial meningitis. We present three new cases of dermal lumbosacral sinus which went unnoticed in the neonatal period later becoming the access point for bacterial meningitis.

[Bacterial meningitis in valencia: epidemiology and therapeutic results in 208 cases (author's transl)]. / Meningitis purulenta en Valencia Epidemiología y resultados sobre 208 casos.

Review of 208 patients with bacterial meningitis, admitted from march 1, 1971 to march 1, 1976. Incidence peak was found in Winter (december to march). Etiologically N. meningitiditis, 39, 9%, was the mainly predominate germ. In 49% of the patients C.S.F. cultures were negative, significantly influenced by the previous treatment with antibiotics (P less than 0.001). Cure was obtained in 86.5% Convulsions, 12%, were the most frequent complication, followed by subdural effussion, 3.8%, and arthritis, 2.4%. Twenty patients died, 9.6%; fifteen of them with endotoxic shock. Definitive sequelae was present in the 3.8%, mainly hidrocephaly. A comparative study with other series in Spain is performed.

[Toxic hepatitis caused by rifampin and isoniazid in treatment of tuberculosis (author's transl)]. / Hepatitis tóxica por tratamiento antituberculoso con rifampicina e isoniazida

Five children with tuberculosis were treated with isoniazid (20 mg./Kg./day) and rifampin (15 mg./Kg./day). After five to twenty seven days of treatment they presented anorexia, vomiting and jaundice. Hepatomegaly was found in two of them. High indirect bilirubin, S.G.O.T. and S.G.P.T. and low prothrombin levels were present in all of them. Eight to thirty one days after withdrawal of rifampin, all patients were well and their laboratory data was normal.

[CSF. changes in partially treated bacterial meningitis (author's transl)]. / Modificaciones del L.C.R. por tratamiento antibiótico parcial en meningitis purulentas

Review of 102 admissions of children (one month to seven years of age) with bacterial meningitis is presented. 46 of the patients (45%) had been treated previously with one or more antibiotics. Previous treatment made culture of CSF negative in a statistically significant (p less than 0.001) number of cases, mainly in meningococcal meningitis. There were no significant differences in the levels of CSF glucose, proteins and WBC's between both groups. A decrease of the percentage PMN/lymphocytes was found in the CSF of the partially treated group. In 7 out of 102 no more than two CSF pathological findings were present. In 5 or 7 CSF cultures were positive. In the other two there were pathological changes in CSF even with correct dosage of previous antibiotics. In 4 patients with positive cultures and little changes in CSF on admission, LP after 48 hours of correct treatment showed an increase in the alterations of CSF. This could mean that previous low dosage antibiotic treatment should not modify CSF findings enough not to make correct diagnosis.