Posts filed under ‘Inmunizaciones’

Antibiotic Prescribing for Adults Hospitalized in the Etiology of Pneumonia in the Community Study

Open Forum Infectious Diseases April 2017 V.4 N.2

Sara Tomczyk; Seema Jain; Anna M Bramley; Wesley H Self; Evan J Anderson …


Community-acquired pneumonia (CAP) 2007 guidelines from the Infectious Diseases Society of America (IDSA)/American Thoracic Society (ATS) recommend a respiratory fluoroquinolone or beta-lactam plus macrolide as first-line antibiotics for adults hospitalized with CAP. Few studies have assessed guideline-concordant antibiotic use for patients hospitalized with CAP after the 2007 IDSA/ATS guidelines. We examine antibiotics prescribed and associated factors in adults hospitalized with CAP.


From January 2010 to June 2012, adults hospitalized with clinical and radiographic CAP were enrolled in a prospective Etiology of Pneumonia in the Community study across 5 US hospitals. Patients were interviewed using a standardized questionnaire, and medical charts were reviewed. Antibiotics prescribed were classified according to defined nonrecommended CAP antibiotics. We assessed factors associated with nonrecommended CAP antibiotics using logistic regression.


Among enrollees, 1843 of 1874 (98%) ward and 440 of 446 (99%) ICU patients received ≥1 antibiotic ≤24 hours after admission. Ward patients were prescribed a respiratory fluoroquinolone alone (n = 613; 33%), or beta-lactam plus macrolide (n = 365; 19%), beta-lactam alone (n = 240; 13%), among other antibiotics, including vancomycin (n = 235; 13%) or piperacillin/tazobactam (n = 157; 8%) ≤24 hours after admission. Ward patients with known risk for healthcare-associated pneumonia (HCAP), recent outpatient antibiotic use, and in-hospital antibiotic use <6 hours after admission were significantly more likely to receive nonrecommended CAP antibiotics.


Although more than half of ward patients received antibiotics concordant with IDSA/ATS guidelines, a number received nonrecommended CAP antibiotics, including vancomycin and piperacillin/tazobactam; risk factors for HCAP, recent outpatient antibiotic, and rapid inpatient antibiotic use contributed to this. This hypothesis-generating descriptive epidemiology analysis could help inform antibiotic stewardship efforts, reinforces the need to harmonize guidelines for CAP and HCAP, and highlights the need for improved diagnostics to better equip clinicians.



September 3, 2017 at 6:54 pm

Editor’s Choice: Effectiveness of Prenatal Versus Postpartum Tetanus, Diphtheria, and Acellular Pertussis Vaccination in Preventing Infant Pertussis

Clinical Infectious Diseases January 1, 2017 V.64 N.1 P.3-8

Kathleen Winter, Steve Nickell, Michael Powell, and Kathleen Harriman

1California Department of Public Health, Immunization Branch, Richmond

2Department of Epidemiology, University of Kentucky, Lexington


Most severe and fatal cases of pertussis occur in infants <8 weeks of age, before initiation of the primary pertussis vaccine series. Women are recommended to receive tetanus, diphtheria, and acellular pertussis (Tdap) vaccine at the start of the third trimester of each pregnancy to optimize transplacental transfer of antibodies to the fetus. This recommendation was made by the Advisory Committee for Immunization Practices based on immunogenicity data, and no studies in the United States have yet evaluated the effectiveness of this strategy in reducing pertussis incidence in infants.


We evaluated a cohort of mothers with documented Tdap vaccination histories in the California Immunization Registry to determine whether infants whose mothers received Tdap vaccine at 27–36 weeks gestation had a lower risk of pertussis at <8 weeks of age than infants born to women who received Tdap vaccine within 14 days post partum.


Tdap vaccination received at 27–36 weeks gestation was found to be 85% (95% confidence interval, 33%–98%) more effective than postpartum Tdap vaccination at preventing pertussis in infants <8 weeks of age . Vaccination at 27–36 weeks gestation was more effective at preventing pertussis in infant than vaccination during the second trimester.


Tdap vaccination at 27–36 weeks gestation was 85% more effective than postpartum vaccination at preventing pertussis in infants <8 weeks of age. Efforts should be made by prenatal care providers to provide Tdap vaccine to pregnant women during routine prenatal visits at the earliest opportunity between 27 and 36 weeks gestation.




Clinical Infectious Diseases January 1, 2017 V.64 N.1 P.9-14

Editor’s Choice: Effectiveness of Prenatal Tetanus, Diphtheria, and Acellular Pertussis Vaccination on Pertussis Severity in Infants

Kathleen Winter, James D. Cherry, and Kathleen Harriman

1California Department of Public Health, Immunization Branch, Richmond

2Department of Epidemiology, University of Kentucky, Lexington


All US women are recommended to receive a tetanus, diphtheria, and acellular pertussis (Tdap) vaccine at 27–36 weeks gestation during each pregnancy to reduce the risk of pertussis to their infants. The impact of this strategy on severity of disease among infected infants has not been evaluated.


We use a retrospective cohort study design evaluating whether pertussis-infected infants born in 2011–2015 whose mothers received Tdap vaccine during pregnancy had less severe pertussis, resulting in a lower risk of hospitalization or intensive care unit admission compared with infants born to unvaccinated mothers.


Infected infants of vaccinated mothers were significantly less likely to be hospitalized and had significantly shorter hospital stays compared with infants born to unvaccinated mothers, after adjustment for chronological and gestational age and receipt of diphtheria and tetanus toxoids and acellular pertussis vaccine. Unadjusted and adjusted vaccine effectiveness for preventing hospitalization among infants with pertussis was 72% (95% confidence interval [CI], 49%–85%) and 58% (95% CI 15%–80%), respectively. No infants born to vaccinated mothers required intubation or died of pertussis.


Infants with pertussis whose mothers received Tdap during pregnancy had a significantly lower risk of hospitalization and intensive care unit admission and shorter hospital stays. Prenatal Tdap vaccination is a critical strategy for reducing the morbidity and mortality from pertussis.


August 19, 2017 at 10:24 am

A new paradigm in pneumococcal conjugate vaccination: moving from individual to herd protection

International Journal of Infectious Diseases July 2017 V.60 N.7 P.96-97


Gail L. Rodgers, Keith P. Klugman

Immunization programs incorporating pneumococcal conjugate vaccines (PCV) have led to a dramatic decrease in invasive pneumococcal disease (IPD) due to vaccine serotypes, pneumonia, and otitis media in children receiving these vaccines. Consistent with the conjugate Haemophilus influenzae type B vaccine (Hib) experience (Moulton et al., 2000), decreased nasopharyngeal (NP) carriage resulting in decreased transmission and the herd or indirect effect (decrease in disease in the unvaccinated) has also been seen with PCV, but the magnitude of this benefit has far surpassed initial expectations (Lexau et al., 2005, Pilishvili et al., 2010, Moore et al., 2015, Von Gottberg et al., 2014). Two years following the introduction of PCV7 into the routine vaccination program in the USA using a 3 + 1 schedule (three infant doses at 2, 4, and 6 months of age and one toddler dose at 12–15 months of age), a profound effect was found in the unvaccinated: PCV7 prevented more than twice as many invasive cases through indirect effects than through its direct effect of protecting vaccinated children (CDC, 2005). This has been documented in other countries, including those using reduced dosing schedules such as 2 + 1, as well as in countries using the extended serotype vaccines, PCV10 and PCV13 (Shiri et al., 2017). A reduction in NP carriage of vaccine serotypes, a precursor of the herd effect, was documented in the original 3 + 0 study of conjugate vaccination of infants in Africa (Mbelle et al., 1999) and was confirmed in countries using 3 + 0 schedules (Hammitt et al., 2014). The mechanism for protection in the unvaccinated is due to the decrease and/or near elimination of vaccine serotypes from the nasopharynx. This in turns leads to decreased transmission of these serotypes and decreased disease. Thus, the effect on NP carriage, a non-disease state and critical precursor to disease, is key to the control of pneumococcal disease in countries unlikely to have immunization programs able to immunize all of their children.



July 30, 2017 at 12:44 pm

Time to re-evaluate the effect of the adolescent booster of hepatitis B vaccine

International Journal of Infectious Diseases July 2017 V.60 N.7 P.88-90

Editorial –

Ellie Carmody

Division of Infectious Diseases and Immunology, New York University School of Medicine, New York, New York, USA

Neutralizing antibodies (anti-HBs) conferred by immunization with hepatitis B virus (HBV) vaccine against HBV surface antigen (HBsAg) have been found to wane or reach undetectable levels in many individuals after 10–15 years of the vaccination (Wainwright et al., 1997, Dentinger et al., 2005).

It is uncertain whether individuals with low or absent levels of anti-HBs remain protected against HBV infection.

HBV vaccine does elicit immunologic memory, in which memory B cells can appropriately generate a robust anamnestic response to HBsAg even if the anti-HBs titer falls below 10 mIU/mL (West and Calandra, 1996, Watson et al., 2001, van der Sande et al., 2007).

However, the duration and uniformity of this immunologic memory after primary vaccination at infancy is unclear. HBV breakthrough infection in young adults may occur if the immunologic memory to HBsAg is absent upon sexual, parenteral, or horizontal (household) HBV exposure….


July 30, 2017 at 12:41 pm

High risk for invasive meningococcal disease among patients receiving eculizumab (Soliris) despite receipt of meningococcal vaccine

Morbidity and Mortalality Weekly Report July 14,  2017 V.66 N.27 P.734-737.

Lucy A. McNamara, PhD1; Nadav Topaz, MSc1; Xin Wang, PhD1; Susan Hariri, PhD1; LeAnne Fox, MD1; Jessica R. MacNeil, MPH1

Use of eculizumab (Soliris, Alexion Pharmaceuticals), a terminal complement inhibitor, is associated with a 1,000-fold to 2,000-fold increased incidence of meningococcal disease (1). Administration of meningococcal vaccines is recommended for patients receiving eculizumab before beginning treatment (2,3).

Sixteen cases of meningococcal disease were identified in eculizumab recipients in the United States during 2008–2016; among these, 11 were caused by nongroupable Neisseria meningitidis.

Fourteen patients had documentation of receipt of at least 1 dose of meningococcal vaccine before disease onset.

Because eculizumab recipients remain at risk for meningococcal disease even after receipt of meningococcal vaccines, some health care providers in the United States as well as public health agencies in other countries recommend antimicrobial prophylaxis for the duration of eculizumab treatment; a lifelong course of treatment is expected for many patients.

Heightened awareness, early care seeking, and rapid treatment of any symptoms consistent with meningococcal disease are essential for all patients receiving eculizumab treatment, regardless of meningococcal vaccination or antimicrobial prophylaxis status….


July 27, 2017 at 8:12 am

Measles Outbreak – Minnesota April-May 2017.

MMWR Morb Mortal Wkly Rep. 2017 Jul 14;66(27):713-717.

Hall V, Banerjee E, Kenyon C, Strain A, Griffith J, Como-Sabetti K, Heath J, Bahta L, Martin K, McMahon M, Johnson D, Roddy M, Dunn D, Ehresmann K.


On April 10, 2017, the Minnesota Department of Health (MDH) was notified about a suspected measles case. The patient was a hospitalized child aged 25 months who was evaluated for fever and rash, with onset on April 8.

The child had no history of receipt of measles-mumps-rubella (MMR) vaccine and no travel history or known exposure to measles. On April 11, MDH received a report of a second hospitalized, unvaccinated child, aged 34 months, with an acute febrile rash illness with onset on April 10.

The second patient’s sibling, aged 19 months, who had also not received MMR vaccine, had similar symptoms, with rash onset on March 30.

Real-time reverse transcription-polymerase chain reaction (rRT-PCR) testing of nasopharyngeal swab or throat specimens performed at MDH confirmed measles in the first two patients on April 11, and in the third patient on April 13; subsequent genotyping identified genotype B3 virus in all three patients, who attended the same child care center.

MDH instituted outbreak investigation and response activities in collaboration with local health departments, health care facilities, child care facilities, and schools in affected settings.

Because the outbreak occurred in a community with low MMR vaccination coverage, measles spread rapidly, resulting in thousands of exposures in child care centers, schools, and health care facilities.

By May 31, 2017, a total of 65 confirmed measles cases had been reported to MDH (Figure 1); transmission is ongoing.


July 27, 2017 at 8:11 am

European consensus-based (S2k) Guideline on the Management of Herpes Zoster – guided by the European Dermatology Forum (EDF) in cooperation with the European Academy of Dermatology and Venereology (EADV), Part 2: TREATMENT.

J Eur Acad Dermatol Venereol. January 2017 V.31 N.1 P.20-29.                        

Werner RN1, Nikkels AF2, Marinović B3, Schäfer M4, Czarnecka-Operacz M5, Agius AM6, Bata-Csörgő Z7, Breuer J8, Girolomoni G9, Gross GE10, Langan S11, Lapid-Gortzak R12, Lesser TH13, Pleyer U14, Sellner J15, Verjans GM16, Wutzler P17, Dressler C1, Erdmann R1, Rosumeck S1, Nast A1.

Author information

1 Department of Dermatology, Venereology and Allergology, Division of Evidence-Based Medicine in Dermatology (dEBM), Charité – Universitätsmedizin Berlin, Berlin, Germany.

2 Department of Dermatology, University Medical Center of Liège, Liège, Belgium.

3 Department of Dermatology and Venereology, University Hospital Center Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia.

4 Department of Anesthesiology, Charité – Universitätsmedizin Berlin, Berlin, Germany.

5 Department of Dermatology, Poznan University of Medical Sciences, Poznan, Poland.

6 Department of Otorhinolaryngology, The Medical School, University of Malta, Msida, Malta.

7 Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary.

8 Division of Infection and Immunity, University College London, London, United Kingdom.

9 Department of Medicine, Section of Dermatology and Venereology, University of Verona, Verona, Italy.

10 Department of Dermatology and Venerology, Universitätsklinik Rostock, Rostock, Germany.

11 Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.

12 Department of Ophthalmology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.

13 Department of Otolaryngology, University Hospital Aintree NHS Foundation Trust, Liverpool, UK.

14 Department of Ophthalmology, Charité – Universitätsmedizin Berlin, Berlin, Germany.

15 Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.

16 Department of Viroscience, Erasmus MC, Rotterdam, The Netherlands.

17 Department of Virology and Antiviral Therapy, Jena University Hospital, Jena, Germany.


Herpes zoster (HZ, shingles) is a frequent medical condition which may severely impact the quality of life of affected patients. Different therapeutic approaches to treat acute HZ are available.

The aim of this European project was the elaboration of a consensus-based guideline on the management of patients who present with HZ, considering different patient populations and different localizations.

This interdisciplinary guideline aims at an improvement of the outcomes of the acute HZ management concerning disease duration, acute pain and quality of life of the affected patients and at a reduction in the incidence of postherpetic neuralgia (PHN) and other complications.

The guideline development followed a structured and pre-defined process, considering the quality criteria for guidelines development as suggested by the AGREE II instrument.

The steering group was responsible for the planning and the organization of the guideline development process (Division of Evidence-Based Medicine, dEBM).

The expert panel was nominated by virtue of clinical expertise and/or scientific experience and included experts from the fields of dermatology, virology/infectiology, ophthalmology, otolaryngology, neurology and anaesthesiology.

Recommendations for clinical practice were formally consented during the consensus conference, explicitly considering different relevant aspects.

The guideline was approved by the commissioning societies after an extensive internal and external review process. In this second part of the guideline, therapeutic interventions have been evaluated.

The expert panel formally consented recommendations for the treatment of patients with HZ (antiviral medication, pain management, local therapy), considering various clinical situations.

Users of the guideline must carefully check whether the recommendations are appropriate for the context of intended application.

In the setting of an international guideline, it is generally important to consider different national approaches and legal circumstances with regard to the regulatory approval, availability and reimbursement of diagnostic and therapeutic interventions.



June 28, 2017 at 8:53 am

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