Viajeros atendidos en un centro de vacunación internacional. ¿Está aumentando el riesgo en el viajero pediátrico? / Travelers attending an international vaccine center. Is the risk for the pediatric traveler increasing?

Introducción: Existe la percepción de que están aumentando los viajeros pediátricos, fundamentalmente a expensas del grupo de viajeros conocidos como visiting friends and relatives (VFR). Las características demográficas y de los viajes en este grupo de viajeros confieren un mayor riesgo y condicionan una mayor complejidad en las recomendaciones vacunales y profilácticas. Objetivo: Analizar la evolución en el tiempo de los diferentes grupos de viajeros pediátricos. Describir las características demográficas y del viaje en la población pediátrica y analizar si los VFR difieren de los no VFR en cuanto a los factores que puedan conferir un mayor riesgo. Metodología: Estudio descriptivo transversal de las características de los niños viajeros atendidos en la Unidad de Vacunación Internacional del Hospital Universitario Vall d’Hebron entre julio de 2002 y febrero de 2009. Resultados: Se atendieron 692 niños, con una edad media de 8 años (DE 5,4). Se observó un aumento en el número de viajeros pediátricos y una tendencia al incremento de niños VFR en los primeros años que posteriormente se mantuvo estable. En los viajeros VFR la edad media fue menor, confirmándose una menor previsión antes del viaje y una mayor duración del mismo en este grupo de viajeros. Se actualizó el calendario vacunal al 29,2% y se recomendó profilaxis antipalúdica al 52% de los viajeros. Conclusión: A pesar del aumento progresivo de viajes internacionales y del aumento inicial de los viajeros VFR, el porcentaje de este grupo de viajeros se mantuvo estable en los últimos años. La escasa percepción del riesgo entre la población inmigrante señala la necesidad de promover una adecuada consulta previa al viaje en este colectivo (AU)

Introduction: There is a perception that the number of pediatric travelers is increasing, mainly due to the so-called visiting friends and relatives (VFRs) group. Both the demographic and trips characteristics in this group may lead to an increased risk and a greater complexity in vaccinations and other preventive recommendations. Objective: To analyze the outcomes of different groups of pediatric travelers. To describe the demographic and travel characteristics within the pediatric population, and to analyze whether the VFRs differ from non-VFRs with regards to the factors that may contribute to a greater risk. Methodology: A cross sectional descriptive study of the characteristics of pediatric travelers treated in the International Pre-travel Consultation Unit of the University Hospital Vall d’Hebron, from July 2002 to January 2009. Results: Of the 692 children analyzed, with a mean age of 8 years (SD 5.4), an increase in the overall number of travelers was identified, along with an initial increase in the number of VFR children in the early years of the study, although later on, the numbers of this group stabilized. The mean age of the VFR travelers was also found to be lower. A lack of planning prior to the start of the travel was also noted in the VFRs group, as well as longer trip durations. A routine vaccine was administered to 29.2% of children, and malaria prophylaxis was recommended for 52% of travelers. Conclusion: Despite the progressive increase in international travel and the initial increase in VFR travelers, the percentage of this group has remained stable in recent years. However, the perception of a low risk among the immigrant population suggests the need to encourage an adequate pre-travel consultation within this group (AU)

[Travelers attending an international vaccine center. Is the risk for the pediatric traveler increasing?]. / Viajeros atendidos en un centro de vacunación internacional. ¿Está aumentando el riesgo en el viajero pediátrico?

INTRODUCTION: There is a perception that the number of pediatric travelers is increasing, mainly due to the so-called visiting friends and relatives (VFRs) group. Both the demographic and trips characteristics in this group may lead to an increased risk and a greater complexity in vaccinations and other preventive recommendations. OBJECTIVE: To analyze the outcomes of different groups of pediatric travelers. To describe the demographic and travel characteristics within the pediatric population, and to analyze whether the VFRs differ from non-VFRs with regards to the factors that may contribute to a greater risk. METHODOLOGY: A cross sectional descriptive study of the characteristics of pediatric travelers treated in the International Pre-travel Consultation Unit of the University Hospital Vall d'Hebron, from July 2002 to January 2009. RESULTS: Of the 692 children analyzed, with a mean age of 8 years (SD 5.4), an increase in the overall number of travelers was identified, along with an initial increase in the number of VFR children in the early years of the study, although later on, the numbers of this group stabilized. The mean age of the VFR travelers was also found to be lower. A lack of planning prior to the start of the travel was also noted in the VFRs group, as well as longer trip durations. A routine vaccine was administered to 29.2% of children, and malaria prophylaxis was recommended for 52% of travelers. CONCLUSION: Despite the progressive increase in international travel and the initial increase in VFR travelers, the percentage of this group has remained stable in recent years. However, the perception of a low risk among the immigrant population suggests the need to encourage an adequate pre-travel consultation within this group.

[MMR vaccine and egg allergy. Experience in a hospital immunization unit]. / Vacuna triple vírica y alergia al huevo. Experiencia en una unidad de vacunación hospitalaria.

INTRODUCTION: We review the scientific evidence on the safety of the measles, mumps, and rubella (MMR) vaccine (produced in chicken embryo cell culture) in children with egg allergy. Data on the reactogenicity observed with this vaccine in a large series of children with this type of allergy immunized in an hospital immunization unit are presented. MATERIAL AND METHODS: An observational prospective study was performed in the International Immunization Unit of the Epidemiology and Preventive Medicine Service of the Vall d'Hebron University Hospital from March 2004 to December 2005. Demographic variables, clinical history of allergy, and the adverse reactions observed 30 minutes after vaccine administration were analyzed. RESULT: A total of 140 patients (106 referred for the first MMR vaccine dose, and 34 for the second) were evaluated. Of these, 75.7 % showed clinical signs after egg ingestion (severe reactions were described in only seven patients: respiratory distress in six and systemic anaphylaxis in one). The MMR vaccine was administered to 121 children. No significant adverse reactions were observed (17.8 % of the vaccinated children developed mild local symptoms). CONCLUSIONS: According to current scientific evidence and the data obtained in this study, the MMR vaccine is safe in patients with egg allergy.

Vacuna triple vírica y alergia al huevo. Experiencia en una unidad de vacunación hospitalaria / MMR vaccine and egg allergy. Experience in a hospital immunization unit

Introducción En este estudio se revisan las evidencias científicas disponibles sobre la seguridad de la vacuna triple vírica convencional (cultivada en fibroblastos de embriones de pollo) en niños con alergia al huevo, y se evalúa la reactogenicidad vacunal en una serie amplia de niños con este tipo de alergia inmunizados con triple vírica en una unidad de vacunación hospitalaria. Material y métodos Estudio observacional prospectivo, realizado en la Unidad de Vacunación Internacional del Servicio de Medicina Preventiva y Epidemiología del Hospital Universitario Vall d'Hebron, entre marzo de 2004 y diciembre de 2005. Se analizan variables demográficas, las relativas a los antecedentes de alergia y la reactogenicidad apreciada tras la observación directa del niño durante los 30 min posteriores a la vacunación. Resultados Se han incluido en el estudio 140 pacientes (106 en primera dosis de vacuna triple vírica y 34 en segunda). El 75,7 % había presentado manifestaciones clínicas tras la ingesta de huevo o de alimentos que lo contenían (sólo siete niños habían presentado manifestaciones graves, en forma de dificultad respiratoria en 6 casos y de anafilaxia en uno). Se administró la vacuna convencional a 121 niños, y no se observó ninguna reacción adversa importante (el 17,8 % de ellos presentó reacción local leve en el punto de inyección). Conclusiones Las evidencias científicas actuales, así como los datos del presente estudio, sustentan la seguridad de la vacuna triple vírica en personas con hipersensibilidad al huevo

Introduction We review the scientific evidence on the safety of the measles, mumps, and rubella (MMR) vaccine (produced in chicken embryo cell culture) in children with egg allergy. Data on the reactogenicity observed with this vaccine in a large series of children with this type of allergy immunized in an hospital immunization unit are presented. Material and methods An observational prospective study was performed in the International Immunization Unit of the Epidemiology and Preventive Medicine Service of the Vall d'Hebron University Hospital from March 2004 to December 2005. Demographic variables, clinical history of allergy, and the adverse reactions observed 30 minutes after vaccine administration were analyzed. Result A total of 140 patients (106 referred for the first MMR vaccine dose, and 34 for the second) were evaluated. Of these, 75.7 % showed clinical signs after egg ingestion (severe reactions were described in only seven patients: respiratory distress in six and systemic anaphylaxis in one). The MMR vaccine was administered to 121 children. No significant adverse reactions were observed (17.8 % of the vaccinated children developed mild local symptoms). Conclusions According to current scientific evidence and the data obtained in this study, the MMR vaccine is safe in patients with egg allergy

[Evaluation of Spanish websites useful for the primary care physicians]. / Evaluación de las páginas web en lengua española útiles para el médico de atención primaria.

OBJECTIVE: To assess the usefulness of medical websites in spanish for the primary care physicians using quality criteria chosen by themselves. DESIGN: Observational, descriptive, cross-sectional study. SETTING: Internet. PARTICIPANTS: The search was performed in Google and Yahoo using as key words the name of Spanish National Health Service medical specialities, primary care and synonyms. The first one hundred links in spanish for every keyword were included in the study. EXCLUSION CRITERIA: paysites, commercial sites, non-clinical content, link sites, patient oriented sites and on-line editions of printed issues. METHODS: A survey was carried out asking the primary care physicians of area IV in Asturias which were the most important criteria that a medical website should fulfil. The results of this survey were used to make an assessment questionnaire. Every site was analysed randomizedly by two researchers and was classified as excelent, good, medium or bad. RESULTS: 2.095 medical websites in spanish were found, being repeated 1.218 (58.14%). From the 877 analysed websites, 597 (68.07%) were excluded. The Intraclass Correlation Coefficient (ICC) was 0.73 (95% CI, 0.66%-0.785%). 5 websites (1.8%) were rated as excelent and the 77.2% as medium or bad. The sites with better ratings were those oriented to the primary care professionals. CONCLUSIONS: The most websites were rated as medium or bad. The evaluation questionnaire is useful for futures studies.

Evaluación de las páginas web en lengua española útiles para el médico de atención primaria / Evaluation of Spanish websites useful for the primary care physicians

Objetivo. Evaluar las páginas web en lengua española útiles para el médico de atención primaria a partir de criterios de calidad determinados por los propios médicos. Diseño. Estudio descriptivo transversal. Emplazamiento. Internet. Participantes. Cien primeros enlaces en lengua española encontrados en Google y Yahoo empleando como palabras claves las especialidades reconocidas por el Ministerio de Educación y Ciencia de España, así como atención primaria, sus sinónimos y los distintos programas de salud. Se excluyeron páginas de pago, comerciales, de contenido no clínico, destinadas a pacientes, revistas, y las constituidas únicamente por enlaces. Métodos. Cuestionario de evaluación elaborado a partir de los resultados de una encuesta realizada entre los médicos de atención primaria del Área IV de Asturias, sobre los criterios más importantes que debía presentar una web médica. Cada página fue evaluada de forma aleatoria por dos observadores independientes. El análisis se realizó por ponderación de cada una de las preguntas según a los resultados de la encuesta clasificándose cada página en mala, regular, buena o excelente. Resultados. Se encontraron 2.095 páginas, 1.218 (58,14 por ciento) estaban repetidas. De las 877 analizadas 597 (68,07 por ciento) cumplían algún criterio de exclusión; evaluándose 280.El coeficiente de correlación intraclase fue de 0,73 (IC del 95 por ciento, 0,66-0,78 por ciento). Cinco páginas (1,8 por ciento) obtuvieron la calificación de excelentes, mientras que el 72,2 por ciento fue clasificado como regular-malo. Conclusiones. La mayoría de las páginas presentan una calidad regular o mala. El cuestionario ofrece una buena correlación entre observadores que permite su utilización en posteriores estudios (AU)