[Safety of hexavalent combined vaccines and the principle of precaution].
Explore the source record for details and available documents.
Biomedical subjects
Publications and source records attributed to F A Moraga Llop.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
OBJECTIVE: To study the characteristics of patients diagnosed with whooping cough at a tertiary center in Barcelona, Spain. MATERIAL AND METHODS: We performed a retrospective study of patients aged less than 18 years treated for pertussis-like cough or clinically-suspected whooping cough over a 12-year period (1989-2000). Only patients with isolated Bordetella spp. were included. The variables of age, sex, vaccination status, hospitalization, clinical manifestations, severity, and lethality were analyzed. RESULTS: One hundred sixty-one patients with positive Bordetella spp. culture were identified. Of these, complete information was available in 149 (79 boys and 70 girls) with a median age of 3 months (range: 13 days-17 years); 77.2 % were aged 6 months or less. All the isolated strains corresponded to B. pertussis except three that corresponded to B. parapertussis. Three epidemic cycles (in 1989, 1992 and 2000) were observed during the study period. A total of 72.5 % of cases occurred between May and September. Bordetella spp. was associated with other bacteria in 28.2 % of the patients, viruses in 13.4 % and a bacterium and a virus in 4.7 %. One hundred twenty-one patients required hospitalization, of which 14.9 % were admitted to the intensive care unit. Age was the only factor associated with risk for hospitalization, which was more frequent in younger infants (p < 0.0001). Paroxysmal cough with cyanosis was present in 53.4 % of the patients, leucocytosis with lymphocytosis occurred in 67.5 % and apneas were present in 21.5 %. Chest X-ray revealed atelectasis in 34.1 %. The mean length of hospital stay was 11 days (range: 1-70 days). Three boys aged less than 3 months with malignant pertussis syndrome died (lethality: 2 %). More than half the patients (59.7 %) were not vaccinated (55.4 % for being under the age of 3 months) and only 16 % had received three or more vaccination doses. CONCLUSIONS: Whooping cough continues to be a severe disease in infants, with a high admission rate during the first 6 months of life. New preventive strategies are required to protect infants who have not yet developed full immunity to this infection.
Pneumococcal disease is a major cause of morbidity, hospitalization and mortality. Two age groups show a greater incidence and severity of the disease: children under the age of 5 years (mainly during the first 2 years of life) and adults aged more than 65 years. The heptavalent pneumococcal conjugate vaccine, which was commercialized in Spain in June 2001, is efficacious in children aged less than 2 years and, unlike the non-conjugate 23-valent vaccine, it induces immunological memory. In Spain the heptavalent vaccine covers 80 % of serotypes causing pneumococcal invasive disease and acute otitis media in children aged 2-59 months. The heptavalent vaccine has been shown to be immunogenic, efficacious and safe. It has proven efficacy in the prevention of invasive disease caused by the seven vaccine serotypes. In addition, it significantly decreases pneumonia and also prevent acute otitis media. The vaccine is preferably indicated in children aged less than 2 years; children aged 2-5 years may also benefit from the vaccine but those in risk groups should be prioritized. Greater knowledge of the epidemiology of pneumococcal disease and the efficiency of this vaccine in Spain will determine whether it should be included in the immunization schedule.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
BACKGROUND: Neisseria meningitidis is a uncommon cause of acute bacterial conjunctivitis. However, its diagnosis has important therapeutic implications. METHODS: From December 1993 to January 1984, a prospective study on acute bacterial conjunctivitis was performed at the Hospital Universitario Materno-Infantil Vall d'Hebron. Primary meningococcal conjunctivitis (PMC) was diagnosed in 34 patients. The diagnosis of PMC was made on the basis of consistent clinical manifestations together with isolation of Neisseria meningitidis from conjunctival exudate culture. RESULTS: There were 16 men and 18 women with a mean age of 3.5 +/- 3.3 years. PMC was bilateral in 7 patients and unilateral in 27. Initial therapy for PMC included only topical antibiotics in 24 patients and systemic antibiotic therapy in 10. Ten patients (29.4%) developed invasive meningococcal disease. None of the patients died neither developed ocular sequelae. Forty one percent of the patients who received only topical therapy and none [corrected] of those who received systemic therapy, developed invasive meningococcal disease (p = 0.04). CONCLUSIONS: PMC may represent the portal of entry for invasive meningococcal disease, which occurs in almost a third of patients. Patients with PMC and higher risk of developing invasive meningococcal disease are those treated only with topical antibiotic therapy.
We have studied 60 pediatric patients with different neoplastic diseases, treated with anthracyclines. We have followed them clinically and echocardiographically to detect the cardiotoxicity due to anthracyclines and the enhanced factors promptly. We have detected a more important incidence of cardiomyopathy in patients with non-Hodgkin's lymphoma, osteosarcoma and neuroblastoma despite cumulative doses under 550 mg/m2 of anthracyclines. The 2 first groups were treated with high doses of cyclophosphamide and methotrexate, and neuroblastomas with melphalan. The anthracyclines cardiotoxicity is evaluated around 5% in patients treated with doses under 550 mg/m2, and is increased in case of previous or simultaneous aggressive therapy. Continued echocardiography enables a premature detection of cardiotoxicity in these high risk patients.
Explore the source record for details and available documents.
Pertussis syndrome controversy induced us to study 74 hospitalized patients, with pertussis cough and Bordetella sp isolation in 29, other bacteria in 24 and viruses in 21. The most frequently isolated bacteria in the patients with negative culture for bordetella were Haemophilus influenzae, Streptococcus pneumoniae and Branhamella catarrhalis. The viruses with highest incidence were respiratory syncitial viruses. The negative culture for bordetella, the lack of antibiotherapy previous to obtention of the sample (29/45 cases), the clinical differences and their different seasonal distribution in relation to the patients with positive culture for bordetella, permit us to suppose that the bacteria/viruses isolated could be the etiologic agents of pertussis syndrome. Although Bordetella sp occupies an important place in the pertussis cough etiology, it is advisable to investigate the presence of viruses and other bacteria in these patients. However the difficulties to isolate bordetella implies the necessity of performing adequate isolation techniques and to study larger numbers of patients including control groups.
Explore the source record for details and available documents.