Posts filed under ‘Inmunizaciones’

Correlation between universal BCG vaccination policy and reduced morbidity and mortality for COVID-19 – an epidemiological study

Aaron Miller, Mac Josh Reandelar, Kimberly Fasciglione, Violeta Roumenova, Yan Li, Gonzalo H Otazu

COVID-19 se ha extendido a la mayoría de los países del mundo. Curiosamente, el impacto de la enfermedad no es igual en todos los países.

Estas diferencias se atribuyen a ciertas normas culturales, los esfuerzos de mitigación y la infraestructura de salud.

Los investigadores proponen que las diferencias nacionales en el impacto de COVID-19 podrían explicarse en parte por las diferentes políticas nacionales con respecto a la vacunación infantil Bacillus Calmette-Guerin (BCG).

Se ha informado que la vacuna BCG ofrece una amplia protección a las infecciones respiratorias.

Comparan un gran número de países con políticas de vacunación BCG con la morbi-mortalidad de COVID-19.

Descubren que los países sin políticas universales de vacunación con BCG (Italia, Países Bajos, EEUU.) se han visto más gravemente afectados en comparación con los países con políticas de BCG universales de larga data.

Los países que tienen un comienzo tardío de la política universal de BCG (Irán, 1984) tuvieron una alta mortalidad, en consonancia con la idea de que BCG protege a la población de ancianos vacunados.

También encontraron que la vacuna BCG también redujo el número de casos reportados de COVID-19 en un país. La combinación de reducción de la morbi-mortalidad hace que la vacuna BCG sea una nueva herramienta potencial en la lucha contra COVID-19.

PDF

https://www.medrxiv.org/content/10.1101/2020.03.24.20042937v1.full.pdf

April 4, 2020 at 11:57 am

REVIEW ARTICLE – PCT to Distinguish Viral From Bacterial Pneumonia – Systematic Review and Meta-analysis 

Clin Infect Dis, 1 February 2020, V.70 N.3, P.538–542

Because of the diverse etiologies of community-acquired pneumonia (CAP) and the limitations of current diagnostic modalities, serum procalcitonin levels have been proposed as a novel tool to guide antibiotic therapy. Outcome data from procalcitonin-guided therapy trials have shown similar mortality, but the essential question is whether the sensitivity and specificity of procalcitonin levels enable the practitioner to distinguish bacterial pneumonia, which requires antibiotic therapy, from viral pneumonia, which does not. In this meta-analysis of 12 studies in 2408 patients with CAP that included etiologic diagnoses and sufficient data to enable analysis, the sensitivity and specificity of serum procalcitonin were 0.55 (95% confidence interval [CI], .37–.71; I2 = 95.5%) and 0.76 (95% CI, .62–.86; I2 = 94.1%), respectively. Thus, a procalcitonin level is unlikely to provide reliable evidence either to mandate administration of antibiotics or to enable withholding such treatment in patients with CAP.

FULL TEXT

https://academic.oup.com/cid/article/70/3/538/5523199

PDF (CLIC en PDF)

March 24, 2020 at 8:47 pm

Detection of Influenza and Other Respiratory Viruses in Air Sampled From a University Campus: A Longitudinal Study

Clinical Infectious Diseases March 2020 V.70 N.5 P.850–858

Background

Respiratory virus–laden particles are commonly detected in the exhaled breath of symptomatic patients or in air sampled from healthcare settings. However, the temporal relationship of detecting virus-laden particles at nonhealthcare locations vs surveillance data obtained by conventional means has not been fully assessed.

Methods

From October 2016 to June 2018, air was sampled weekly from a university campus in Hong Kong. Viral genomes were detected and quantified by real-time reverse-transcription polymerase chain reaction. Logistic regression models were fitted to examine the adjusted odds ratios (aORs) of ecological and environmental factors associated with the detection of virus-laden airborne particles.

Results

Influenza A (16.9% [117/694]) and influenza B (4.5% [31/694]) viruses were detected at higher frequencies in air than rhinovirus (2.2% [6/270]), respiratory syncytial virus (0.4% [1/270]), or human coronaviruses (0% [0/270]). Multivariate analyses showed that increased crowdedness (aOR, 2.3 [95% confidence interval {CI}, 1.5–3.8]; P < .001) and higher indoor temperature (aOR, 1.2 [95% CI, 1.1–1.3]; P < .001) were associated with detection of influenza airborne particles, but absolute humidity was not (aOR, 0.9 [95% CI, .7–1.1]; P = .213). Higher copies of influenza viral genome were detected from airborne particles >4 μm in spring and <1 μm in autumn. Influenza A(H3N2) and influenza B viruses that caused epidemics during the study period were detected in air prior to observing increased influenza activities in the community.

Conclusions

Air sampling as a surveillance tool for monitoring influenza activity at public locations may provide early detection signals on influenza viruses that circulate in the community.

FULL TEXT

https://academic.oup.com/cid/article/70/5/850/5432328

PDF (CLIC en PDF)

March 24, 2020 at 8:45 pm

Severe Illnesses Associated With Outbreaks of Respiratory Syncytial Virus and Influenza in Adults

Clinical Infectious Diseases March 2020 V.70 N.5 P.773–779

Background

Recent reports have described the contribution of adult respiratory syncytial virus (RSV) infections to the use of advanced healthcare resources and death.

Methods

Data regarding patients aged ≥18 years admitted to any of Maryland’s 50 acute-care hospitals were evaluated over 12 consecutive years (2001–2013). We examined RSV and influenza (flu) surveillance data from the US National Respiratory and Enteric Virus Surveillance System and the Centers for Disease Control and Prevention and used this information to define RSV and flu outbreak periods in the Maryland area. Outbreak periods consisted of consecutive individual weeks during which at least 10% of RSV and/or flu diagnostic tests were positive. We examined relationships of RSV and flu outbreaks to occurrence of 4 advanced medical outcomes (hospitalization, intensive care unit admission, intubated mechanical ventilation, and death) due to medically attended acute respiratory illness (MAARI).

Results

Occurrences of all 4 MAARI-related hospital advanced medical outcomes were consistently greater for all adult ages during RSV, flu, and combined RSV–flu outbreak periods compared to nonoutbreak periods and tended to be greatest in adults aged ≥65 years during combined RSV–flu outbreak periods. Rate ratios for all 4 MAARI-related advanced medical outcomes ranged from 1.04 to 1.38 during the RSV, flu, or combined RSV–flu outbreaks compared to the nonoutbreak periods, with all 95% lower confidence limits >1.

Conclusions

Both RSV and flu outbreaks were associated with surges in MAARI-related advanced medical outcomes (hospitalization, intensive care unit admission, intubated mechanical ventilation, and death) for adults of all ages.

FULL TEXT

https://academic.oup.com/cid/article/70/5/773/5427067

PDF (CLIC en PDF)

March 24, 2020 at 8:43 pm

Advisory Committee on Immunization Practices Recommended Immunization Schedule for Adults Aged 19 Years or Older – United States, 2020.

MMWR Morb Mortal Wkly Rep. February 7, 2020 V.69 N.5 P.133-135.

Freedman MS, Hunter P, Ault K, Kroger A.

Abstract

At its October 2019 meeting, the Advisory Committee on Immunization Practices (ACIP)* voted to recommend approval of the 2020 Recommended U.S.

Adult Immunization Schedule for Persons Aged 19 Years and Older. The 2020 adult immunization schedule, available at https://www.cdc.gov/vaccines/schedules/index.html ,† summarizes ACIP recommendations in two tables and accompanying notes.

This 2020 adult immunization schedule has been approved by the CDC Director, the American College of Physicians, the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, and the American College of Nurse-Midwives. Health care providers are advised to use the tables and the notes together…

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7004400/pdf/mm6905a4.pdf

March 5, 2020 at 9:01 am

Emergence of Ceftriaxone Resistance during a Case of Pneumococcal Meningitis with Fatal Evolution

Antimicrob. Agents Chemother. March 2020 V.64 N.3

We report a case of a 62-year-old man treated for Streptococcus pneumoniae meningitis by ceftriaxone and dexamethasone. After neurological improvement, neurological degradation by vasculitis occurred, despite effective concentrations of ceftriaxone in the serum and cerebrospinal fluid (CSF). S. pneumoniae with increased MICs to third-generation-cephalosporins (3GC) was isolated from the ventricular fluid 10 days after the isolation of the first strain. Isolate analysis showed that a mutation in the penicillin-binding protein 2X (PBP2X) has occurred under treatment.

This Journal section presents a real, challenging case involving a multidrug-resistant organism. The case authors present the rationale for their therapeutic strategy and discuss the impact of mechanisms of resistance on clinical outcome. An expert clinician then provides a commentary on the case.

FULL TEXT

https://aac.asm.org/content/64/3/e01958-19.abstract?etoc

PDF

https://aac.asm.org/content/aac/64/3/e01958-19.full.pdf

 

 

Antimicrob. Agents Chemother. March 2020 V.64 N.3

Case Commentary: Delayed Cerebral Vasculitis Associated with the Development of Ceftriaxone-Resistant Pneumococcal Meningitis

Mizrahi and colleagues present a well-described case of the emergence of drug resistance in Streptococcus pneumoniae meningitis during therapy with ceftriaxone monotherapy with a low bactericidal concentration in the cerebrospinal fluid. Adherence to international guidelines could possibly have prevented the emergence of this resistant isolate and the adverse outcome.

FULL TEXT

https://aac.asm.org/content/64/3/e02251-19.abstract?etoc

PDF

https://aac.asm.org/content/aac/64/3/e02251-19.full.pdf

 

February 25, 2020 at 10:41 am

Use of Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis Vaccines: Updated Recommendations of the Advisory Committee on Immunization Practices – US 2019

MMWR January 24, 2020 V.69 N.3 P.77–83

Summary

What is already known about this topic?

Repeat doses of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine at 5- and 10-year intervals are safe and immunogenic.

What is added by this report?

ACIP recommendations have been updated to allow either tetanus and diphtheria toxoids (Td) vaccine or Tdap to be used for the decennial Td booster, tetanus prophylaxis for wound management, and for additional required doses in the catch-up immunization schedule if a person has received at least 1 Tdap dose.

What are the implications for public health practice?

Allowing either Tdap or Td to be used in situations where Td only was previously recommended increases provider point-of-care flexibility.

FULL TEXT

https://www.cdc.gov/mmwr/volumes/69/wr/mm6903a5.htm

PDF

https://www.cdc.gov/mmwr/volumes/69/wr/pdfs/mm6903a5-H.pdf

January 24, 2020 at 7:27 am

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