Posts filed under ‘Inmunizaciones’

Recommendations of the Advisory Committee on Immunization Practices for Use of Hepatitis A Vaccine for Postexposure Prophylaxis and for Preexposure Prophylaxis for International Travel

Morbidity and Mortality Weekly Report. 2018;67(43):1216-1220.

Update

Noele P. Nelson, MD, PhD1; Ruth Link-Gelles, PhD1; Megan G. Hofmeister, MD1; José R. Romero, MD2; Kelly L. Moore, MD3; John W. Ward, MD1; Sarah F. Schillie, MD1

Postexposure prophylaxis (PEP) with hepatitis A (HepA) vaccine or immune globulin (IG) effectively prevents infection with hepatitis A virus (HAV) when administered within 2 weeks of exposure. Preexposure prophylaxis against HAV infection through the administration of HepA vaccine or IG provides protection for unvaccinated persons traveling to or working in countries that have high or intermediate HAV endemicity. The Advisory Committee on Immunization Practices (ACIP) Hepatitis Vaccines Work Group conducted a systematic review of the evidence for administering vaccine for PEP to persons aged >40 years and reviewed the HepA vaccine efficacy and safety in infants and the benefits of protection against HAV before international travel….

PDF

https://www.cdc.gov/mmwr/volumes/67/wr/pdfs/mm6743a5-H.pdf

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December 10, 2018 at 3:44 pm

Globalization and the Changing Epidemiology of Hepatitis A Virus

Cold Spring Harbor Perspectives in Medicine March 2018

Kathryn H. Jacobsen

Increased economic interdependence, social integration, and other aspects of globalization are contributing to significant changes in hepatitis A epidemiology. Globally, the incidence of hepatitis A virus (HAV) infection is decreasing, the age at midpoint of population immunity (AMPI) is increasing, and the proportion of symptomatic cases is increasing as the average age at infection increases. In low-income countries, HAV remains endemic but improved water and sanitation systems are reducing transmission rates among young children. In high-income countries, most adults remain susceptible to HAV and foodborne outbreaks are becoming more frequent. Middle-income countries have diverse epidemiological profiles, and they play important roles in the global spread of HAV through international trade and travel. Future changes in the epidemiology of hepatitis A will be heavily influenced by globalization processes.

FULL TEXT

http://perspectivesinmedicine.cshlp.org/content/8/10/a031716.full

PDF

http://perspectivesinmedicine.cshlp.org/content/8/10/a031716.full.pdf+html

November 21, 2018 at 8:08 am

Infections in patients affected by rheumatologic diseases associated to glucocorticoid use or tumor necrosis factor-alpha inhibitors.

Rev Chilena Infectol. April 2014 V.31 N.2 P.181-95.

[Article in Spanish]

Fica A.

Abstract

A great diversity of infectious agents can affect patients that use steroids at immunosuppressive doses or tumor necrosis factor alpha (TNF-alpha) antagonists.

The list of participating microorganisms is more restricted in the case of anti TNF-alpha blockers.

Overlapping agents include intracellular bacteria, Mycobacterium tuberculosis, geographic fungal agents that have the ability to establish granulamotous infections, herpes zoster, and reactivation of chronic hepatitis B virus infection.

An important conceptual issue for these infections is the existence of a threshold prednisone daily dose for the emergence of opportunistic infections but higher levels of immunosuppression and cofactors are required in the case of Pneumocystis jiroveci and cytomegalovirus infections.

In order to prevent these threats, a detailed medical evaluation is needed before prescription to detect potential risks and manage them properly.

Prevention rules must be prescribed in every case, that include common sense behaviors, vaccines, and in selected cases, chemoprophylaxis for latent tuberculosis (TB) infection, P. jiroveci pneumonia (PCP) or other specific requirements.

Latent TB infection is probable and requires chemoprophylaxis in the case of remote or recent exposure to a patient with lung TB, a positive tuberculin or interferon-gamma release assay result or residual lung scars in a chest x-ray exam.

PCP prevention is suggested when the patient reaches a daily dose of prednisone of 30 mg but might be needed at lower doses in case of other concomitant immunosuppressive drugs or when lymphopenia arises shortly after prednisone initiation.

PDF

https://scielo.conicyt.cl/pdf/rci/v31n2/art09.pdf

 

November 19, 2018 at 11:12 am

The projected timeframe until cervical cancer elimination in Australia: a modelling study

The Lancet Public Health October 20, 2018

Michaela T Hall, MMath Kate T Simms, PhDJie-Bin Lew, PhDMegan A Smith, PhDJulia ML Brotherton, PhDMarion Saville, MBChB et al.

Background

In 2007, Australia was one of the first countries to introduce a national human papillomavirus (HPV) vaccination programme, and it has since achieved high vaccination coverage across both sexes. In December, 2017, organised cervical screening in Australia transitioned from cytology-based screening every 2 years for women aged from 18–20 years to 69 years, to primary HPV testing every 5 years for women aged 25–69 years and exit testing for women aged 70–74 years. We aimed to identify the earliest years in which the annual age-standardised incidence of cervical cancer in Australia (which is currently seven cases per 100 000 women) could decrease below two annual thresholds that could be considered to be potential elimination thresholds: a rare cancer threshold (six new cases per 100 000 women) or a lower threshold (four new cases per 100 000 women), since Australia is likely to be one of the first countries to reach these benchmarks.

Methods

In this modelling study, we used Policy1-Cervix—an extensively validated dynamic model of HPV vaccination, natural history, and cervical screening—to estimate the age-standardised incidence of cervical cancer in Australia from 2015 to 2100. We incorporated age-specific coverage of the Australian National HPV Vaccination Program in girls, including the catch-up programme, and the inclusion of boys into the vaccine programme from 2013, and a change from the quadrivalent to the nonavalent vaccine from 2018. We also modelled the effects of the transition to primary HPV screening. We considered two scenarios for future screening recommendations regarding the cohorts who will be and who have been offered the nonavalent vaccine: either that HPV screening every 5 years continues, or that no screening would be offered to these women.

Findings

We estimate that, in Australia, the age-standardised annual incidence of cervical cancer will decrease to fewer than six new cases per 100 000 women by 2020 (range 2018–22), and to fewer than four new cases per 100 000 women by 2028 (2021–35). The precise year of attaining these rates is dependent on the population used for age-standardisation, HPV screening behaviour and test characteristics, the incremental effects of vaccination of men on herd immunity in women, and assumptions about the future frequency of benign hysterectomies. By 2066 (2054–77), the annual incidence of cervical cancer will decrease and remain at fewer than one case per 100 000 women if screening for HPV every 5 years continues for cohorts who have been offered the nonavalent vaccine, or fewer than three cases per 100 000 women if these cohorts are not screened. Cervical cancer mortality is estimated to decrease to less than an age-standardised annual rate of one death per 100 000 women by 2034 (2025–47), even if future screening is only offered to older cohorts that were not offered the nonavalent vaccine.

Interpretation

If high-coverage vaccination and screening is maintained, at an elimination threshold of four new cases per 100 000 women annually, cervical cancer could be considered to be eliminated as a public health problem in Australia within the next 20 years. However, screening and vaccination initiatives would need to be maintained thereafter to maintain very low cervical cancer incidence and mortality rates.

Funding: National Health and Medical Research Council (Australia).

FULL TEXT

https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(18)30183-X/fulltext

PDF

https://www.thelancet.com/action/showPdf?pii=S2468-2667%2818%2930183-X

October 4, 2018 at 7:24 am

Ending Use of Oral Poliovirus Vaccine — A Difficult Move in the Polio Endgame

N Engl J of Medic August 30, 2018

PERSPECTIVE

M.A. Pallansch

When the world embarked on a mission of global polio eradication with the adoption of a World Health Assembly resolution in 1988, there was only minimal consideration of what would happen after the eradication of wild poliovirus (WPV) had been certified …

FULL TEXT

https://www.nejm.org/doi/full/10.1056/NEJMp1808903?query=infectious-disease

PDF

https://www.nejm.org/doi/pdf/10.1056/NEJMp1808903

September 4, 2018 at 8:33 am

Ending Use of Oral Poliovirus Vaccine — A Difficult Move in the Polio Endgame

N Engl J of Medicine August 30, 2018  V.379 P.801-803

Perspective

M.A. Pallansch

When the world embarked on a mission of global polio eradication with the adoption of a World Health Assembly resolution in 1988, there was only minimal consideration of what would happen after the eradication of wild poliovirus (WPV) had been certified.

Poliovirus eradication efforts have targeted three distinct serotypes, using two vaccines, each containing components against all three types — a live attenuated oral poliovirus vaccine (OPV) used in more than 100 mostly low- and middle-income countries worldwide and an inactivated poliovirus vaccine (IPV) used in most of the developed world…

FULL TEXT

https://www.nejm.org/doi/full/10.1056/NEJMp1808903?query=TOC

PDF

https://www.nejm.org/doi/pdf/10.1056/NEJMp1808903

 

N Engl J of Medicine August 30, 2018  V.379 P.834-845

Type 2 Poliovirus Detection after Global Withdrawal of Trivalent Oral Vaccine

I.M. Blake and Others

BACKGROUND

Mass campaigns with oral poliovirus vaccine (OPV) have brought the world close to the eradication of wild poliovirus. However, to complete eradication, OPV must itself be withdrawn to prevent outbreaks of vaccine-derived poliovirus (VDPV). Synchronized global withdrawal of OPV began with serotype 2 OPV (OPV2) in April 2016, which presented the first test of the feasibility of eradicating all polioviruses.

METHODS

We analyzed global surveillance data on the detection of serotype 2 Sabin vaccine (Sabin-2) poliovirus and serotype 2 vaccine–derived poliovirus (VDPV2, defined as vaccine strains that are at least 0.6% divergent from Sabin-2 poliovirus in the viral protein 1 genomic region) in stool samples from 495,035 children with acute flaccid paralysis in 118 countries and in 8528 sewage samples from four countries at high risk for transmission; the samples were collected from January 1, 2013, through July 11, 2018. We used Bayesian spatiotemporal smoothing and logistic regression to identify and map risk factors for persistent detection of Sabin-2 poliovirus and VDPV2.

RESULTS

The prevalence of Sabin-2 poliovirus in stool samples declined from 3.9% (95% confidence interval [CI], 3.5 to 4.3) at the time of OPV2 withdrawal to 0.2% (95% CI, 0.1 to 2.7) at 2 months after withdrawal, and the detection rate in sewage samples declined from 71.0% (95% CI, 61.0 to 80.0) to 13.0% (95% CI, 8.0 to 20.0) during the same period. However, 12 months after OPV2 withdrawal, Sabin-2 poliovirus continued to be detected in stool samples (<0.1%; 95% CI, <0.1 to 0.1) and sewage samples (8.0%; 95% CI, 5.0 to 13.0) because of the use of OPV2 in response to VDPV2 outbreaks. Nine outbreaks were reported after OPV2 withdrawal and were associated with low coverage of routine immunization (odds ratio, 1.64 [95% CI, 1.14 to 2.54] per 10% absolute decrease) and low levels of population immunity (odds ratio, 2.60 [95% CI, 1.35 to 5.59] per 10% absolute decrease) within affected countries.

CONCLUSIONS

High population immunity has facilitated the decline in the prevalence of Sabin-2 poliovirus after OPV2 withdrawal and restricted the circulation of VDPV2 to areas known to be at high risk for transmission. The prevention of VDPV2 outbreaks in these known areas before the accumulation of substantial cohorts of children susceptible to type 2 poliovirus remains a high priority. (Funded by the Bill and Melinda Gates Foundation and the World Health Organization.)

FULL TEXT

https://www.nejm.org/doi/full/10.1056/NEJMoa1716677?query=TOC

PDF

https://www.nejm.org/doi/pdf/10.1056/NEJMoa1716677

August 30, 2018 at 8:41 am

Neisseria meningitidis Antimicrobial Resistance in Italy, 2006 to 2016

Antimicrobial Agents and Chemotherapy September 2018 V.62 N.9

Paola Vacca, Cecilia Fazio, Arianna Neri, Luigina Ambrosio, Annapina Palmieri and Paola Stefanelli

The aim of this study was to evaluate the antimicrobial susceptibilities of 866 Neisseria meningitidis invasive strains during 11 years of surveillance in Italy.

Two and six strains were resistant to ciprofloxacin and rifampin, respectively. Forty-five percent were penicillin intermediate, associated with hypervirulent serogroup C clonal complex 11.

All of the strains were susceptible to cephalosporins.

FULL TEXT

https://aac.asm.org/content/62/9/e00207-18?etoc=

PDF

https://aac.asm.org/content/aac/62/9/e00207-18.full.pdf

August 29, 2018 at 3:43 pm

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