RESUMEN
BACKGROUND AND OBJECTIVES: In the 2023-2024 respiratory syncytial virus (RSV) season, Spain became one of the first countries to introduce universal RSV prophylaxis, during which all infants born at this time were eligible to receive nirsevimab. Locally, most Spanish regions also immunized infants younger than age 6 months at the start of the season (extended catch-up). The aim of this study was to assess how RSV prophylaxis affected the number of infants presenting to pediatric emergency departments with acute respiratory infections. METHODS: A retrospective study was conducted in 15 Spanish pediatric emergency departments from 9 different regions between the 2018 and 2024 epidemic seasons (November-January). We compared the seasons occurring in 2018-2023 and the 2023-2024 season regarding the number of episodes of lower respiratory tract infection and acute bronchiolitis, acute bronchiolitis-related hospital admissions, and PICU admissions. RESULTS: A comparison with the average rates for the previous epidemic seasons revealed a 57.7% decrease in episodes of lower respiratory tract infection in 2023-2024 (95% CI, 56.5-58.8; P < .001; range among hospitals, 4.8-82.8), a 59.2% decrease in episodes of acute bronchiolitis (95% CI, 57.9-60.4; P < .001; range, 6.9-84.1), a 63.1% reduction in acute bronchiolitis-related hospital admissions (95% CI, 60.9-65.2; P < .001; range, 31.4-86.8), and a 63.1% reduction in PICU admissions (95% CI, 58.1-67.9; P < .001; range, 18.2-81.8). Hospitals in regions applying extended catch-up showed better results. CONCLUSIONS: Nirsevimab can protect a broad infant population against RSV infection with high effectiveness. Approaches including extended catch-up are the most effective, although cost- effectiveness must be considered.
RESUMEN
Introducción: dada la escasez de pediatras de nuestro sistema de salud y la necesidad de estos en Atención Primaria, donde cerca del 25% de las plazas están ocupadas por no especialistas en Pediatría, se quiso conocer el destino laboral inicial de los residentes que habían finalizado su periodo de formación en los últimos cuatro años. Metodología: se han recogido las salidas laborales de los residentes que han finalizado su periodo de rotación durante los años 2014-2017 en los hospitales españoles. La recogida se ha realizado por medio de los representantes de residentes de las comunidades autónomas y los vocales autonómicos de la Asociación de Pediatría de Atención Primaria. Resultados: se han recogido datos de las salidas laborales del 75,7% de los residentes, lo que supone conocer el destino laboral de 1263 residentes de los últimos cuatro años. La elección de Atención Primaria en el transcurso de estos años ha disminuido del 30,77 al 24,5%; igualmente han disminuido los trabajos en hospitalización o consultas hospitalarias que han descendido de un 43,8 a un 32,85%, mientras que la realización de guardias o cobertura de Urgencias ha aumentado y también ha subido el porcentaje de los que se dedican a la medicina privada. Conclusiones: el porcentaje de residentes que acude a Atención Primaria es insuficiente. El trabajo del pediatra está siendo de peor calidad, con aumento de los contratos de guardias y Urgencias. Está aumentando el porcentaje de residentes que se dirigen hacia la sanidad privada
Introduction: given the shortage of paediatricians in the Spanish health care system and the high demand for them in primary care, where approximately 25% of positions are filled by non-specialists in paediatrics, we wanted to know the initial employment destination of residents who had finished his training period in the last 4 years. Methodology: the work exits of residents who have completed their rotation period during the years 2014-2017 in Spanish hospitals have been collected. The collection was made through the representatives of residents of autonomous communities and auton mous members of the Primary Care Pediatric Association. Results: data were collected on the work exits of 75.7% of the residents, which means knowing the employment destination of 1263 residents of the last 4 years. The choice of primary care during these years has decreased from 30.77 to 24.5%, while hospitalization or hospital consultations have decreased from 43.8 to 32.85%, while the realization of guards or emergency coverage has increased and the percentage of those who dedicate themselves to private medicine has also increased. Conclusions: the percentage of residents who attend primary care is insufficient. The work of pediatrician is being of worse quality, with increased contracts of guards and emergencies. The percentage of residents heading towards private healthcare is increasing