Evolución de la vacunación frente al meningococo del serogrupo B: ¿qué ha cambiado a lo largo de 5 años? / Evolution of vaccination against serogroup B meningococcus: what has changed over 5 years?

Introducción: la infección por meningococo del serogrupo B puede provocar enfermedad meningocócica invasiva, con un 20-30% de secuelas y hasta un 10% de mortalidad. Material y métodos: estudio observacional, descriptivo y retrospectivo de vacunación frente al meningococo del serogrupo B en la población pediátrica del Sector I de Zaragoza desde octubre de 2015 hasta diciembre de 2019. Se estudió: edad de inicio de la vacunación, edad a la fecha de la primera dosis (≤3 meses, 4-11 meses, 12-23 meses, 2-9 años, 10-16 años), sexo, centro de salud (CS) y número de dosis recibidas. Resultados: se vacunó a 11 776 pacientes, de los cuales un 51,6% fueron varones. Presentaron una edad media de inicio de vacunación a los 5,0 ± 4,4 años y 2,2 ± 0,6 dosis recibidas. La distribución del total de vacunados fue muy variada, con una diferencia del 17,8% entre el CS con más vacunados y el CS con menos vacunados. El 0,7% recibieron primera dosis en 2015, el 23,8% en 2016, el 38% en 2017, el 26,7% en 2018 y el 10,8% en 2019. El 12% tenía ≤3 meses al inicio de la vacunación, el 11,5% tenía 4-11 meses, el 6,7% tenía 12-23 meses, el 50,4% 2-9 años y el 19,5% 10-16 años, existiendo diferencias en relación con la fecha de primera dosis (p = 0,000). El 2017 cuenta con mayor incidencia de vacunación global (12,2%), aunque en lactantes fue superior en 2018 (42,1%) y en los grupos de 2-9 años y adolescentes en 2017: el 15,8 y el 5,4% respectivamente. La incidencia global acumulada fue 32,5%, siendo en lactantes de 133,5%. Conclusiones: a pesar de las prometedoras cifras de incidencia acumulada, encontramos numerosas diferencias de vacunación entre grupos de edad y CS, por lo que resulta interesante la vacunación sistemática y financiada de meningococo B (AU)

Introduction: infection by serogroup B meningococcus can cause invasive meningococcal disease, with development of sequelae in 20-30% of cases and a mortality of up to 10%.Material and methods: observational, descriptive and retrospective study of vaccination against serogroup B meningococcus in the paediatric population of health sector I of Zaragoza between October 2015 and December 2019. We analysed the age at primary vaccination, age group at time of first dose (≤3 months, 4-11 months, 12-23 months, 2-9 years, 10-16 years), sex, primary care centre (PCC) and number of received doses.Results: 11 776 patients were vaccinated, of who 51.6% were male. The mean age at initiation of vaccination was 5.0 ± 4.4 years, and they received a mean of 2.2 ± 0.6 doses. The distribution of vaccinated patients by PCC was heterogeneous, with a difference of 17.8% between the centre with the most vaccinated patients and the centre with the least. Of all patients, 0.7% received the first dose in 2015, 23.8% in 2016, 38% in 2017, 26.7% in 2018 and 10.8% in 2019. Twelve percent were aged 3 months or less when they received the first dose, 11.5% 4-11 months, 6.7% 12-23 months, 50.4% 2-9 years and 19.5% 10-16 years, with differences based on the date of the first dose (p = 0.000). The highest frequency of overall vaccination corresponded to 2017 (12.2%), although in children under 2 years it was higher in 2018 (42.1%) and in children aged 2-9 years and adolescents it was highest in 2017: 15.8% and 5.4%, respectively. The cumulative frequency of vaccination was 32.5% in the overall sample and 133.5% in the group aged less than 2 years.Conclusions: although we found promising cumulative vaccination rates, there were numerous differences in vaccination between age groups and PCCs, which is why publicly funded routine vaccination against meningococcus B is worth contemplating. (AU)

[Serogroup C invasive meningococcal disease in the post-vaccine era and vaccine failures]. / Enfermedad meningocócica invasiva por serogrupo C en la era posvacunal y fallos vacunales.

INTRODUCTION: The incidence of serogroup C invasive meningococcal disease (IMD) has decreased since the introduction of systematic vaccination in 2000. The aim of this study is to determine the number of serogroup C IMD cases diagnosed since then and the vaccine failures. PATIENTS AND METHODS: A retrospective analysis was performed on patients diagnosed with IMD by culture or polymerase chain reaction (PCR) in a maternity and childhood hospital in Barcelona between 2001 and 2018. An analysis was made of the number of vaccine doses and the age received, as well as on the medical records and vaccine cards. RESULTS: There were 128 confirmed cases of IMD (7.1 cases/year; 70.3 in <5 years). The serogroup was studied in 125 (97.6%) cases, in which 103 (82.4%) were B, 10 (8%) were C, one (0.8%) was 29E, and one (0.8%) was Y, and only 10 (8%) were not able to be serogrouped. Of the 10 patients with serogroup C, 4 were not vaccinated, and in 3, the course was not complete as regards the number of doses. The other 3 received the complete course according to age and current calendar, and thus were considered vaccine failures. A total of 6 patients died (mortality rate: 4.7%), 5 due to serogroup B (mortality: 4.8%), and one due to serogroup C (mortality: 10%). CONCLUSIONS: Serogroup C only represented 8% of IMD cases in the period studied, with 30% of cases due to this serogroup being vaccine failures.

Púrpura en los pies: Meningococcemia? Reporte de caso clínico y revisión de la literatura / Purpura in the feet: Meningococcemia? Clinical case report and literature review

Neisseria meningitidis es la etiología de infecciones severas incluso letales, afectando principalmente a la población joven. No obstante, dado que el único reservorio es la nasofaringe humana, hay portadores asintomáticos. El meningococo es sensible a los antibióticos de uso habitual, como: cefalosporinas de tercera generación y quinolonas, pero el retraso en el diagnóstico por presentaciones clínicas infrecuentes y la administración tardía de la terapia, se asocian a elevada morbimortalidad. Presentamos una paciente de 18 años, con un cuadro de rápida evolución, con parámetros inflamatorios de laboratorio alterados, asociado a lesiones cutáneas purpúricas, que evolucionó con falla multiorgánica y desenlace fatal, lográndose la confirmación etiológica por el Instituto de Salud Pública. Reportamos el caso para tener en consideración el diagnóstico de meningococcemia, frente a pacientes con cuadro clínico y exámenes de laboratorio sugerentes de sepsis, que presentan lesiones cutáneas compatibles.

Neisseria meningitidis is the etiology of severe, even lethal infections, affecting mainly the young population. However, since the only reservoir is the human nasopharynx, there are asymptomatic carriers. Meningococcus is sensitive to commonly used antibiotics such as third generation cephalosporins and quinolones, but delayed diagnosis due to infrequent clinical presentation and delayed therapy are associated with high morbidity and mortality. We present an 18-year-old female patient with a rapid evolution, with altered inflammatory laboratory parameters, associated with purpuric skin lesions, which evolved with multiorgan failure and fatal outcome, and the etiological confirmation was obtained by the Public Health Institute. We report the case to take into account the diagnosis of meningococcemia in patients with clinical symptoms and laboratory tests suggestive of sepsis and compatible skin lesions.

Enfermedad invasiva por Neisseria Meningitidis, alerta epidemiológica / Neisseria Meningitidis invasive disease, epidemiological alert

En países que han incorporado vacunas conjugadas contra Streptococcus pneumoniae y Haemophilus influenzae, la Neisseria meningitidis es el principal patógeno bacteriano causante de enfermedad invasiva. La enfermedad invasiva por meningoco se asocia con una alta tasa de letalidad. Objetivos. Describir una agregación inesperada de casos de enfermedad invasiva por Neisseria meningitidis en los Municipio Salmeron Acosta y Sucre, Estado Sucre,Venezuela. Metodos. Cohorte de inicio. Casos con diagnóstico definido o probable de infección por Neisseria meningitidis. Se registraron datos pertinentes acerca del paciente, de su enfermedad, del agente causal y del medio ambiente. Se determinó la tasa de incidencia por grupos de edad y municipio de residencia, serogrupos de Neisseria meningitidis, y patron de susceptibilidad a antibióticos. Resultados. Entre las semanas epidemiológicas 1-41 de 2012 se detectaron 15 casos de enfermedad invasiva por meningococo en niños menores de 15 años con residencia en el Estado Sucre, Venezuela. La tasa de incidencia para los Municipios Cruz Salmerón Acosta y Sucre del Estado Sucre fue 33,7 x 105 y 6,7 x 105 niños <15 años respectivamente. La enfermedad muestra mayor dispersión en la tasa de ataque de niños de 5-14 años, agregación en espacio y tiempo así como tendencia cíclica. Los casos confirmados fueron 10 de 15, Neisseria meningitidis serogrupo B, 4 casos y Neisseria meningitidis serogrupo C, 6 casos. La letalidad observada fue 6 de 15; se observaron secuelas en un tercio de los sobrevivientes. Conclusiones. Se describe una frecuencia inesperada de enfermedad invasiva por Neisseria meningitidis en los Municipio Salmeron Acosta y Sucre, Estado Sucre,Venezuela. La información generada puede orientar el diseño de medidas de intervención y control.

In countries were conjugate vaccines against Streptococcus pneumoniae and Haemophilus influenzae, have been incorporated, Neisseria meningitidis is the major bacterial pathogen causing invasive disease. Invasive meningococcal disease is associated with a high mortality rate. Objectives. To describe unexpected aggregation of invasive meningococcal disease. Methods. Inception cohort: Definite or probable cases of infection with Neisseria meningitidis. Information about the patient and his disease, the causative agent and the environment was registered. Incidence rate by age and municipality of residence, serogroups of Neisseria meningitidis, and antibiotic susceptibility pattern were determined. Results. Between the epidemiological weeks 1-41 of 2012, 15 cases of invasive meningococcal disease in children under 15 years of age, living in the state of Sucre, Venezuela were identified. The incidence rate for Cruz Salmerón Acosta and Sucre municipalities was 33.7 x 105 and 6.7 x 105 children <15 years of age, respectively. The disease shows greater dispersion in incidence by age group, aggregation in space and time and a cyclical trend. Confirmed cases were 10 of 15, 4 cases of Neisseria meningitidis serogroup B and 6 cases of Neisseria meningitidis serogroup C. Overall mortality rate was 6 of 15; sequelae were present in one third of the survivors. Conclusions. This study describes an unexpected frequency of invasive meningococcal disease in the Sucre and Salmeron Acosta Municipalities, Sucre State, Venezuela. This information may be useful to guide intervention measures design.