RESUMEN
Fundamento: Recientemente se han registrado brotes de parotiditis en España y en otros países desarrollados. Los motivos barajados son la baja cobertura vacunal de las poblaciones afectadas y/o la baja efectividad de las cepas vacunales empleadas. Este trabajo describe un brote de parotiditis ocurrido en Bizkaia y valora la efectividad de las cepas vacunales y la utilidad de las pruebas diagnósticas actualmente empleadas. Métodos: Se etiquetaron como casos aquéllos con clínica compatible y vínculo epidemiológico en el periodo de estudio (febrero-mayo-2006). Se recogieron muestras de sangre para estudio de IgM e IgG y de saliva para detección de RNA y genotipo. Se averiguó el estado vacunal y la cepa empleada mediante los registros del reparto vacunal. Se realizó un análisis univariante de los datos y se obtuvieron riesgos relativos según las cepas vacunales empleadas. Resultados: Se detectaron 63 casos; 52 eran alumnos del mismo colegio. El 50% tenía entre 9 y 13 años. El 88,5% de los casos del colegio estaba correctamente vacunado. La sensibilidad de la IgM fue del 9% y la de la PCR del 37%. El riesgo relativo de los alumnos vacunados con una primera dosis de cepa Rubini frente a los vacunados con cepa Jeryl-Lynn fue de 3,8 (IC95% 2,27-6,49). Conclusiones: La elevada cobertura vacunal no impide el desarrollo de brotes en lugares con un alto grado de exposición. La IgM se muestra poco sensible para el diagnóstico de parotiditis. Parece necesario replantearse las estrategias vacunales y los métodos diagnósticos actuales
Background: Outbreaks of parotiditis have recently been recorded in Spain and in other developed countries. The possible reasons currently under consideration are the low degree of immunization coverage among the populations involved and/or the low degree of effectiveness of the vaccine strains employed. This study describes one outbreak of parotiditis having occurred in Bizkaia and assesses the effectiveness of the vaccine strains and the usefulness of the diagnostic tests currently used. Methods: Those cases having compatible clinical symptoms and an epidemiological link within the period under study (February-May 2006) were labeled as cases. Blood samples were taken to study IgM and IgG and saliva for genotype and RNA detection. The immunization status and the strain used were found through the vaccine distribution records. A univariate analysis was conducted on the data and relative risks calculated according to the vaccine strains used. Results: A total of 63 cases were detected, 52 being students from one school. Fifty percent were 9-13 years of age. A total of 88.5% of the cases detected at the school had been properly immunized. The IgM sensitivity was 9% , PCR sensitivity being 37%. The relative risk of those students immunized with an initial dose of Rubini strain as compared to those immunized with Jeryl-Lynn strain was 3.8 (95% CI:2.27-6.49). Conclusions: The high degree of immunization coverage does not prevent outbreaks from occurring in places having a high degree of exposure. The IgM reveals itself to be sensitive to a very small degree for the diagnosis of parotiditis. It seems necessary that the current immunization strategies and diagnostic methods be reconsidered
Asunto(s)
Masculino , Femenino , Niño , Adolescente , Humanos , Parotiditis/epidemiología , Paperas/epidemiología , Vacuna contra la Parotiditis/farmacocinética , Vacuna contra la Parotiditis/administración & dosificación , Brotes de Enfermedades/estadística & datos numéricos , Inmunoglobulina M/análisis , Estudios EpidemiológicosRESUMEN
OBJECTIVE: Following the introduction of a national measles and subsequent MMR vaccination programme, to determine the susceptibility of 3-14-year-old children to measles, mumps and rubella and to relate the results to the epidemiology of measles and the need for vaccination policy changes. DESIGN: Cross-sectional sero-survey and trends in measles notifications and mortality. SETTING: Paediatric hospital outpatient departments in Dublin. SUBJECTS: Sera were collected from 837 children attending the clinics in 1991 and 1992. RESULTS: The prevalence of antibodies in children aged 3-6, 7-10 and 11-14 years was 84, 83 and 95% for measles; 48, 60 and 65% for mumps; and 78, 63 and 74% for rubella, respectively. The prevalence of mumps antibodies may be underestimated. Ninety-six per cent of girls aged 13-14 years had rubella antibodies. A widespread outbreak of measles occurred in 1993. Over recent years, an increasing proportion of measles notifications were in older children. CONCLUSION: Given sub-optimal uptake of MMR vaccine, outbreaks of infection in pre- and primary school children are inevitable. In such circumstances, a 2-shot MMR vaccine programme with high uptake is essential to prevent a shift of disease into older age groups.
Asunto(s)
Vacuna Antisarampión/uso terapéutico , Sarampión/epidemiología , Vacuna contra la Parotiditis/uso terapéutico , Vacuna contra la Rubéola/uso terapéutico , Vacunación , Adolescente , Factores de Edad , Anticuerpos Antivirales/sangre , Niño , Preescolar , Estudios Transversales , Susceptibilidad a Enfermedades , Femenino , Humanos , Inmunoglobulina G/sangre , Inmunoglobulina M/sangre , Irlanda/epidemiología , Masculino , Sarampión/prevención & control , Vacuna Antisarampión/farmacocinética , Vacuna contra el Sarampión-Parotiditis-Rubéola , Paperas/epidemiología , Paperas/prevención & control , Vacuna contra la Parotiditis/farmacocinética , Rubéola (Sarampión Alemán)/epidemiología , Rubéola (Sarampión Alemán)/prevención & control , Vacuna contra la Rubéola/farmacocinética , Estudios Seroepidemiológicos , Vacunas Combinadas/farmacocinética , Vacunas Combinadas/uso terapéuticoAsunto(s)
Inmunoglobulinas Intravenosas/sangre , Vacuna Antisarampión/farmacocinética , Vacuna contra la Parotiditis/farmacocinética , Vacuna contra la Rubéola/farmacocinética , Formación de Anticuerpos , Niño , Esquema de Medicación , Combinación de Medicamentos , Interacciones Farmacológicas , Humanos , Inmunoglobulinas Intravenosas/administración & dosificación , Vacuna Antisarampión/sangre , Vacuna contra el Sarampión-Parotiditis-Rubéola , Vacuna contra la Parotiditis/sangre , Vacuna contra la Rubéola/sangreRESUMEN
A survey of all general practitioners in Fife conducted prior to the introduction of measles-mumps-rubella immunization on a pilot basis in May 1987 showed that 85% considered mumps worth preventing and 94% believed the rubella programme worth augmenting with universal childhood immunization. Ninety seven per cent considered measles worth preventing and 98% were prepared to recommend measles-mumps-rubella immunization to parents instead of measles vaccine. One year after introducing the measles-mumps-rubella vaccine in Fife, 91% of children had been immunized with the combined vaccine or measles vaccine before their second birthday. This compares with the 83% that received measles vaccine before the combined vaccine was introduced. Eighty per cent of preschool children were also immunized with the combined vaccine at school entry in a catch-up exercise. This study demonstrates that there are few major professional barriers to achieving a high uptake of the measles-mumps-rubella vaccine in this area. The vaccine was introduced nationally on 1 October 1988 and its uptake is likely to exceed the current unsatisfactory level achieved with measles vaccine. However, this outcome will largely depend on the commitment of doctors to the programme.