Vacunas acelulares (DTPa/dTpa) contra la tos ferina: duración de la protección / Acellular vaccines (DTPa/dTpa) against whooping cough, protection duration

INTRODUCCIÓN: En el último decenio se ha documentado un incremento en la incidencia de casos de tos ferina en países desarrollados. OBJETIVO: Conocer si la administración de la dTpa en lugar de la DTPa como 5.ª dosis podría estar contribuyendo a la aparición de los casos. MÉTODOS: Se realizó un estudio descriptivo de los casos de tos ferina declarados durante una epidemia en la ciudad de Alicante, durante los 5 primeros meses de 2014. Se consideraron casos de tos ferina aquellos confirmados por la PCR. Para el análisis del tiempo de protección se incluyó a vacunados con 5 dosis. RESULTADOS: Se notificaron 104 casos de tos ferina confirmados por la PCR, 85 casos (82%) tenían 5 dosis de la vacuna. El tiempo de protección en años mostró una media (DE) 2,1 ± 1,1 años con la dTpa y de 5,1 ± 1,5 con la DTPa (p < 0,001). En cuanto a la protección, ajustada por edad, se observa que pasados 3 años solo el 47,6% de los vacunados con dTpa la mantenían y en los vacunados con la DTPa estaban protegidos el 100% (p < 0,001). CONCLUSIÓN: Nuestro estudio encontró que los vacunados correctamente contra la tos ferina y a quienes en la última dosis de revacunación se les administró dTpa tuvieron un periodo de protección más corto que los que fueron vacunados con DTPa

INTRODUCTION: An increase in whooping cough in most of the developed countries has been detected in the last decade. OBJECTIVE: To determine whether the administration of dTpa vaccine instead of DTPa fifth dose is contributing to the appearance of these cases. METHODS: A descriptive study based on cases of whooping cough reported during an epidemic period in the city of Alicante in the first 5 months of 2014. Only pertussis cases confirmed by PCR were included in the study, and only those vaccinated with 5 doses were included in the analysis of the period of protection. RESULTS: A total of 104 cases of pertussis confirmed by PCR were reported, with 85 cases (82%) having had 5 doses of vaccine. The mean time and standard deviation (SD) of protection was 2.1 ± 1.1 years with dTpa, and 5.1 ± 1.5 years with DTPa (p < .001). In the protection, adjusted for age, it was observed that, after 3 years, only 47.6% of people vaccinated with dTpa were still protected, while people vaccinated with DTPa were 100% protected (P<.001). CONCLUSIONS: This study found that people who were properly vaccinated against pertussis and received their last re-vaccination dose with dTpa had a shorter period of protection than those who were vaccinated with DTPa

[Acellular vaccines (DTPa/dTpa) against whooping cough, protection duration]. / Vacunas acelulares (DTPa/dTpa) contra la tos ferina: duración de la protección.

INTRODUCTION: An increase in whooping cough in most of the developed countries has been detected in the last decade. OBJECTIVE: To determine whether the administration of dTpa vaccine instead of DTPa fifth dose is contributing to the appearance of these cases. METHODS: A descriptive study based on cases of whooping cough reported during an epidemic period in the city of Alicante in the first 5 months of 2014. Only pertussis cases confirmed by PCR were included in the study, and only those vaccinated with 5 doses were included in the analysis of the period of protection. RESULTS: A total of 104 cases of pertussis confirmed by PCR were reported, with 85 cases (82%) having had 5 doses of vaccine. The mean time and standard deviation (SD) of protection was 2.1±1.1 years with dTpa, and 5.1±1.5 years with DTPa (p<.001). In the protection, adjusted for age, it was observed that, after 3 years, only 47.6% of people vaccinated with dTpa were still protected, while people vaccinated with DTPa were 100% protected (P<.001). CONCLUSIONS: This study found that people who were properly vaccinated against pertussis and received their last re-vaccination dose with dTpa had a shorter period of protection than those who were vaccinated with DTPa.

Reemergencia del sarampión. Situación epidémica en la Comunidad Valenciana durante los años 2011 y 2012 / Reemergence of measles. Epidemic situation in the Valencian Community during the years 2011 and 2012

La incidencia del sarampión descendió hasta llegar a ser una notificación esporádica e infrecuente en la última década. La reemergencia de la enfermedad alcanzó 744 casos en 2012, tasa de 14,50 × 105 habitantes. Se aplicó un diseño clásico en Vigilancia de Salud Pública: análisis retrospectivo de incidencia acumulada y características de los sujetos afectados. Se cruzaron los datos de encuesta con los de la Red Microbiológica Valenciana (RedMIVA). En total, 976 casos de sarampión fueron confirmados en el período epidémico 2011-2012. La distribución temporal muestra 3 ondas de amplitud constante: 12 a 15 semanas. La proporción de sujetos no vacunados y con estado vacunal desconocido alcanzó el 85% de los casos. Se documentaron 25 brotes, 499 casos asociados; en 7 de 10 brotes comunitarios, el inicio ocurrió en población de etnia gitana sin vacunar. En la ciudad de Valencia se aplicó profilaxis postexposición en 32 colegios, observándose bajas coberturas, entre el 63 y el 77%, en 8 centros e inferiores al 50% en 4. La tasa de serologías negativas fue del 12,4%, destacando los menores de 16 meses con el 44,8%. Las cohortes de 20 a 59 años presentaron tasas de negatividad del 13,5 al 5,9%. La epidemia tuvo su origen en la importación de casos a un territorio con insuficiente protección inmunitaria contra el sarampión. Su impacto y desarrollo estuvo condicionado por la cobertura vacunal previa, el patrón social y étnico de diferentes territorios y barrios, y la aplicación extensiva de profilaxis postexposición a contactos escolares y familiares de casos

Measles incidence declined until becomes a sporadic reporting and infrequent notification in the last decade. The reemergence of the disease reached 744 cases in 2012, a rate of 14.50 × 105 inhabitants. A classic design in Public Health Surveillance was performed: retrospective analysis of cumulative incidence and characteristics of the affected subjects. Those dates were in record linkage with Valencia Microbiology Network (RedMIVA). Finally, 976 cases of measles were confirmed in 2011-2012 epidemic period. Time-line distribution shows three waves with amplitude length on 12-15 weeks. Proportion of unvaccinated or unknown subjects came up to 85% of cases. 25 outbreaks were reported, 499 cases associated. In 7 of the 10 community outbreaks early cases were from Roma population unvaccinated. In the city of Valencia was applied post-exposure prophylaxis in 32 schools and was observed low coverage: between 63% and 77% in 8 schools and less than 50% in 4. Serum negative rate was 12.4% and we highlight the rate under 16 months: 44.8%. Cohorts of 20- 59 years had negative rates between 13.5 to 5.9%. The origin of the epidemic was the importation of cases to a territory with inadequate immune protection against measles. Its impact and development was conditioned by previous immunization coverage, the social and ethnic pattern of different areas or quarters and the extensive application of post-exposure prophylaxis at school and family contacts of cases

Reemergencia del sarampión. Situación epidémica en la Comunidad Valenciana durante los años 2011 y 2012 / Reemergence of measles. Epidemic situation in the Valencian Community during the years 2011 and 2012

La incidencia del sarampión descendió hasta llegar a ser una notificación esporádica e infrecuente en la última década. La reemergencia de la enfermedad alcanzó 744 casos en 2012, tasa de 14,50 × 105habitantes.Se aplicó un diseño clásico en Vigilancia de Salud Pública: análisis retrospectivo de incidencia acumulada y características de los sujetos afectados. Se cruzaron los datos de encuesta con los de la Red Microbiológica Valenciana (RedMIVA).En total, 976 casos de sarampión fueron confirmados en el período epidémico 2011-2012. La distribución temporal muestra 3 ondas de amplitud constante: 12 a 15 semanas. La proporción de sujetos no vacunados y con estado vacunal desconocido alcanzó el 85% de los casos. Se documentaron 25 brotes, 499 casos asociados; en 7 de 10 brotes comunitarios, el inicio ocurrió en población de etnia gitana sin vacunar. En la ciudad de Valencia se aplicó profilaxis postexposición en 32 colegios, observándose bajas coberturas, entre el 63 y el 77%, en 8 centros e inferiores al 50% en 4. La tasa de serologías negativas fue del 12,4%, destacando los menores de 16 meses con el 44,8%. Las cohortes de 20 a 59 años presentaron tasas de negatividad del 13,5 al 5,9%.La epidemia tuvo su origen en la importación de casos a un territorio con insuficiente protección inmunitaria contra el sarampión. Su impacto y desarrollo estuvo condicionado por la cobertura vacunal previa, el patrón social y étnico de diferentes territorios y barrios, y la aplicación extensiva de profilaxis postexposición a contactos escolares y familiares de casos (AU)

Measles incidence declined until becomes a sporadic reporting and infrequent notification in the last decade. The reemergence of the disease reached 744 cases in 2012, a rate of 14.50 × 105 inhabitants. A classic design in Public Health Surveillance was performed: retrospective analysis of cumulative incidence and characteristics of the affected subjects. Those dates were in record linkage with Valencia Microbiology Network (RedMIVA).Finally, 976 cases of measles were confirmed in 2011-2012 epidemic period. Time-line distribution shows three waves with amplitude length on 12-15 weeks. Proportion of unvaccinated or unknown subjects came up to 85% of cases. 25 outbreaks were reported, 499 cases associated. In 7 of the 10 community outbreaks early cases were from Roma population unvaccinated. In the city of Valencia was applied post-exposure prophylaxis in 32 schools and was observed low coverage: between 63% and 77% in 8 schools and less than 50% in 4. Serum negative rate was 12.4% and we highlight the rate under 16 months: 44.8%. Cohorts of 20-59 years had negative rates between 13.5 to 5.9%.The origin of the epidemic was the importation of cases to a territory with inadequate immune protection against measles. Its impact and development was conditioned by previous immunization coverage, the social and ethnic pattern of different areas or quarters and the extensive application of post-exposure prophylaxis at school and family contacts of cases (AU)