Incidencia de la infección neumocócica invasora en niños menores de dos años. Vacuna neumocócica conjugada heptavalente. Situación en España

[Clinicoepidemiological characteristics of community-acquired pneumonia in children aged less than 6 years old]

INTRODUCTION

Acute respiratory infections are an important cause of consultations in primary care and hospitals. Most published epidemiological studies have analyzed pneumonia in hospitals and very few include information on primary care.

MATERIAL AND METHODS

We performed a multicenter, prospective, epidemiological study in 17 primary care centers and four hospital pediatric emergency rooms. All children under 6 years of age with a clinical diagnosis of pneumonia were included.

RESULTS

There were 311 patients with a mean age of 32.2 months. The incidence of community-acquired pneumonia was 3,600 cases/100,000 children/year under 6 years old in primary care centers. Of these, 136 were diagnosed in hospitals (43.7 %). The most common clinical signs and symptoms were fever (95.4 %), cough (94.4 %), tachypnea (58.2 %), and auscultation abnormalities (90.2 %). Antibiotic therapy was started in 298 patients (98 %). The most frequent antibiotic was amoxicillin-clavulanate (39.5 %), followed by cefuroxime (32.7 %) and clarithromycin (8.3 %). The most frequently isolated microorganism was respiratory syncytial virus followed by Streptococcus pneumoniae. Hospital admission was required in 15.6 % of patients. Only 24.6 % of the patients had been vaccinated with the heptavalent pneumococcal conjugate vaccine and 12.7 % of the children with underlying respiratory diseases had been vaccinated with the influenza virus vaccine.

CONCLUSIONS

In our milieu, the diagnosis and treatment of community-acquired pneumonia is usually carried out in primary care and the incidence is high. Although most patients do not require hospitalization, etiological diagnosis of community-acquired pneumonia and optimal antibiotic therapy remain difficult goals to achieve.

Reduction in pediatric invasive pneumococcal disease in the Basque Country and Navarre, Spain, after introduction of the heptavalent pneumococcal conjugate vaccine

This study evaluated the incidence of invasive pneumococcal disease, identified the causal serotypes, and tracked the evolution of the antibiotic susceptibility of Streptococcus pneumoniae isolates in the regions of the Basque Country and Navarre, Spain, before and after the introduction of the heptavalent pneumococcal conjugate vaccine. The study included all children aged between birth and 5 years diagnosed with bacteremia, meningitis, or bacteremic pneumonia caused by pneumococci. By the second year after introduction of the heptavalent pneumococcal conjugate vaccine, compared with the period 1998-2001, the incidence of invasive disease decreased by 64.3% in children less than 12 months of age, by 39.7% in children less than 24 months of age, and by 37.5% in children less than 60 months of age. The prevalence of clinical isolates of S. pneumoniae that lacked susceptibility to penicillin decreased by 58.2% among children less than 60 months of age. With an estimated coverage by four-dose heptavalent pneumococcal conjugate vaccine of 28-45% in 2003, the number of invasive pneumococcal infections in the Basque Country and in Navarre fell significantly after just 2 years of immunization, underscoring the importance of improving vaccination coverage under a universal childhood immunization program.

Calendario de vacunación de la Asociación Española de Pediatría: recomendaciones 2006

Based on the evidence available, the Vaccines Advisory Committee (VAC) of the Spanish Association of Pediatrics reports and comments on the new developments in vaccines that have taken place in 2005 and recommends some modifications to the vaccination schedule for 2006. In agreement with changes in the product monographs for the meningococcal C vaccine, the VAC recommends two doses for the three commercially available preparations with a booster dose in the second year of life. The European Medicines Evaluation Agency (EMEA) has temporarily suspended the sale of the Hexavac vaccine due to doubts about its long-term protection against hepatitis B. The VAC continues to support the use of these combined vaccines. Currently only Infranrix Hexa is available in Spain. The recommendation of vaccinating adolescents with a booster dose of pertussis vaccine via the administration of an acellular preparation of low antigenic load together with the adult diphtheria and tetanus vaccine remains valid. Vaccination against chickenpox in susceptible children aged more than 12 months old continues to be recommended. There is wide coverage for the 7-valent pneumococcal conjugate vaccine in many areas of Spain. In view of the studies published, the VAC reiterates the need for universal immunization by introducing this vaccine in the official vaccination schedule. Finally, other vaccines not included in this schedule are discussed, with special mention of the advisability of influenza vaccination in children, according to the recommendations of the VAC available at the beginning of each season on the web site of the Spanish Association of Pediatrics www.aeped.es; www. vacunasaep.org.

Calendario vacunal de la Asociación Española de Pediatría: recomendaciones 2005

The Advisory Committee on Vaccines of the Spanish Association of Pediatrics provides information and comments on the new developments in vaccines that have taken place in 2004 and recommends a few modifications to the Immunization Schedule for 2005. Concerning the meningococcal C vaccine, no change is made to the possibility of administering two doses for the first vaccination with one of the available formulations. The existence of immunization failure in children who have received a first vaccination with three vaccine doses before the age of 12 months is discussed, and the health authorities will probably include a booster dose in the second year of life throughout 2005. The recommendations of the European Medicines Evaluation Agency (EMEA) on hexavalent vaccines continue to be valid and consequently the use of these vaccines should not be stopped. This year the need for adolescents to receive a booster dose of the pertussis vaccine, with administration of an acellular, low antigenic load preparation together with the adult diphtheria and tetanus vaccine is stressed.

Calendario vacunal de la Asociación Española de Pediatría: recomendaciones 2004

The Vaccine Assessment Committee of the Spanish Association of Pediatrics discusses vaccine developments in 2003 and recommends some modifications to the vaccination schedule. The recommendation of substituting the oral polio vaccine for the inactivated polio vaccine, suppressing the fifth dose, is maintained. The introduction of the conjugate pneumococcal vaccine and the varicella vaccine is stressed. Concerning the meningococcal C vaccine, the improvement introduced by being able to immunize with just two doses is discussed. In agreement with the information received from the European Medicines Agency, there appear to be no well-founded reasons to abandon hexavalent preparations.

Enfermedad invasiva por Streptococcus pneumoniae y Haemophilus influenzae serotipo b. Estudio retrospectivo de 12 años

BACKGROUND

Streptococcus pneumoniae and Haemophilus influenzae serotype b (Hib) are two of the most common causes of invasive bacterial disease in children. The introduction of a successful Hib vaccine and the emergence of penicillin-resistant pneumococci have changed the epidemiology of these bacteria over the last few years.

OBJECTIVES

To evaluate the incidence of S. pneumoniae and Hib invasive disease in children (0-15 years) admitted to our hospital during a 12-year period (January 1991-December 2002).

METHODS

We retrospectively reviewed the medical records of 101 children with isolation of S. pneumoniae and Hib in blood, cerebrospinal fluid (CSF) or synovial fluid samples during the study period.

RESULTS

SP was isolated in 81 samples (72 in blood and nine in CSF) from 73 children (72.6 % were aged < 2 years). The annual incidence per 100,000 children aged 0-2 years was 53.76 cases (95 % CI: 40.7-70.9). The most common clinical diagnosis was bacteremia (67 %). The percentage of penicillin-resistant strains was 44 %. Hib was isolated in 38 samples (26 in blood, 10 in CSF and two in synovial fluid) from 28 children (82.1 % were aged < 2 years). The most common clinical diagnosis was meningitis (35.7 %). The annual incidence per 100,000 children aged between 0-5 years dropped from 21.52 cases (95 % CI: 14.4-32) to 1.7 cases (95 % CI: 0.1-10.8) after systematic vaccination. The percentage of ampicillin-resistant strains was 63.1 %.

CONCLUSIONS

The incidence of invasive pneumococcal disease and the increased antimicrobial resistance rates of pneumococcus are two major reasons to support the routine use of pneumococcal conjugate vaccination in children. Systematic Hib vaccination since October 1998 has dramatically reduced the incidence of this disease.