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One area of major importance in promoting health is the prevention of infectious diseases through vaccination. Vaccine is any preparation intended to generate immunity against a disease by stimulating the production of antibodies. There are two basic types: live attenuated and inactivated, with different characteristics that determine their use. The main properties of a vaccine are safety and protective efficacy. The vaccines can be administered based on individualized directions depending on various factors (personal, environmental…), or systematically as part of the immunization schedules. In Spain, the first childhood immunization schedule was implemented in 1975. The Autonomous Communities are currently responsible for establishing vaccine recommendations. The incidence of vaccine-preventable diseases and vaccination coverage are essential criteria for the evaluation of vaccination programs. In Spain the incidence of vaccine-preventable diseases is low. Vaccination coverage is high in childhood, but in adolescents, adults and groups at risk it is not always appropriate.

Resumen Objetivo El objetivo de este estudio ha sido evaluar la frecuencia y las caracteristicas de las hospitalizaciones por cancer de cuello de utero en la Comunidad de Madrid, asi como estimar el consumo de recursos y costes asociados al tratamiento hospitalario de la enfermedad. Metodos Se ha realizado un estudio retrospectivo utilizando la informacion del sistema nacional de vigilancia de datos hospitalarios (Conjunto Minimo Basico de Datos) sobre las hospitalizaciones por neoplasia maligna de cervix en la Comunidad de Madrid. Adicionalmente, se ha recogido informacion de las historias clinicas de las pacientes hospitalizadas por cancer de cuello de utero en el Hospital Universitario 12 de Octubre de Madrid para el analisis de consumo de recursos y costes Resultados Durante el periodo 1999-2002 se notificaron una media anual de 667 hospitalizaciones por cancer de cuello de utero en los hospitales de la Comunidad de Madrid. La tasa de hospitalizacion fue de 30,7 por 100.000 mujeres ≥ 20 anos y el numero medio de hospitalizaciones anuales por paciente de 2,2. Se registraron 126 defunciones entre las mujeres hospitalizadas por cancer de cuello de utero durante el periodo de estudio (media anual de 32 fallecimientos). El coste medio por paciente del tratamiento hospitalario del cancer de cuello de utero se ha estimado en 5.247 €. Conclusion Cada ano se notifican casi 700 hospitalizaciones por cancer de cuello de utero en hospitales de la Comunidad de Madrid, con un coste anual para el sistema sanitario de unos 3,5 millones de €.

A multicentre, randomized, phase III clinical trial in 5071 healthy adults was conducted to evaluate the safety and reactogenicity of a 15 microg HA dose of a candidate oil-in-water emulsion-based adjuvant system (AS)-adjuvanted split-virion H5N1 (AS-H5N1) vaccine compared to a licensed seasonal influenza vaccine, Fluarix.(1) Stringent criteria were used to evaluate adverse events and reactogenicity profile. Overall, 96.7% of the 5071 vaccinated subjects completed the study. Significantly more participants in the AS-H5N1 vaccine group reported general or local adverse events. Pain was the most common symptom in both treatment groups. Less than 1% of subjects withdrew from the study due to adverse events and no withdrawals were due to serious adverse events related to vaccination. The safety and reactogenicity profile of the AS-H5N1 candidate vaccine can be considered clinically acceptable in the context of its use against pandemic influenza.

ResumenObjetivoLos programas de inmunización sistemática dependen en gran medida del correcto mantenimiento y la manipulación de las vacunas que se aplican, es decir, del perfecto mantenimiento de la cadena del frío. Por ello, nos propusimos realizar una revisión sistemática de la literatura médica sobre la cadena del frío y las vacunas, con el objetivo de conocer las prácticas diarias en los puntos de vacunación.MétodosSe efectuó una búsqueda bibliográfica en las principales bases médicas entre 1990 y 2005. Se incluyeron los estudios que, mediante encuesta y/o inspección a puntos de vacunación, aportaban datos sobre: designación de responsable sanitario, existencia de termómetro de máximas y mínimas, temperatura del frigorífico en el momento de la visita y control y registro de la temperatura. Para todas las variables se calculó la prevalencia media con su intervalo de confianza del 95%.ResultadosSe localizaron 377 artículos, se seleccionaron inicialmente 31 y se incluyeron 13 de ellos. El 72,21% de los puntos de vacunación tenía un responsable de vacunas, pero sólo el 61,43% de ellos conocían el rango óptimo de temperaturas. Por otro lado, el 55% de estos puntos tenía un termómetro de máxima y mínima y sólo el 26,88% realizaba controles y registros de temperaturas al menos una vez al día.ConclusiónEn las publicaciones incluidas en el estudio se detectan deficiencias importantes en el mantenimiento de la cadena del frío de las vacunas, que ponen en riesgo la efectividad y la eficiencia de los programas de inmunización.AbstractObjetiveSystematic immunization programmes mostly depend on the correct maintenance and manipulation of the vaccines to be used, i.e. perfect maintenance of the cold chain. Therefore, we decided to carry out a systematic review of the literature on the cold chain and vaccines, to identify daily practices in vaccine sites.MethodsA literature search was performed in the main medical databases for documents published between 1990 and 2005, including those performed by means of a survey and/or inspection of vaccine sites that provided the following data: a designated health officer, availability of a thermometer with maximums and minimums, refrigerator temperature at the time of the visit, and temperature control and registration. For all the variables, the mean prevalence was calculated with a 95% confidence interval.ResultsThree hundred seventy-seven articles were found; 31 were initially selected and 13 were finally included. In 72.21% of the vaccine points, there was an officer responsible for the vaccines, but only 61.43% knew the optimal temperature range. Fifty-five percent of these points had a thermometer with maximums and minimums and only 26.88% carried out temperature controls and registrations at least once per day.ConclusionImportant shortfalls were detected in cold chain maintenance in all selected articles, jeopardizing the effectiveness and efficiency of immunization programs.

Fun da men to. Las va cunas son me di ca men tos ter mo lá bi les y para ga ran ti zar su in mu no ge ni ci dad y efi ca cia pro tectora, den tro de los pro gra mas de in mu ni za ción, es im pres cin di ble man te ner la ca de na de frío. El ele men to fun da men tal en esta ca de na es el per sonal res ponsable de las va cunas, que debe co - no cer las ca rac te rís ti cas de es ta bi li dad de cada pre pa ra do con el fin de evi tar erro res du ran te su ma ni pu la ción. El ob je ti vo de este tra ba jo fue co no cer cómo se rea li za el man te ni mien to de la ca de na del frío en equi pos de aten ción pri maria de un área sa ni - ta ria de la Co mu ni dad Au tó no ma de Ma drid, así como es ta ble - cer el gra do de in for ma ción que po seen los res pon sa bles de las va cu nas con res pec to a la ter moes ta bi li dad de las mis mas. Mé to dos. Se ha rea li za do un es tu dio trans ver sal en 46 pun - tos de va cu na ción en aten ción pri maria. La re cogida de los da - tos se rea li zó me dian te en tre vis ta per sonal por un úni co in ves ti - ga dor. Re sul ta dos. La tasa de par ti ci pa ción fue del 93,5% (43/46). En to dos los ca sos exis tía ter mó me tro de má xi ma y mí ni ma y re gis tro men sual de la tem pe ra tu ra. Se ob ser vó una tem pe ra tu ra ina de cua da en tres oca sio nes (6,97%). El por cen ta je de pro fe - sio na les que co no cía el efec to que la con ge la ción pro du cía so - bre las va cu nas fue muy di ver so: 53.5%, 51.2%, 44.2% y 53.5% para dif te ria-té ta nos-per tus sis (DTP), he pa ti tis B (VHB), po lio oral (VPO) y ru béo la-sa ram pión-pa pe ras (RSP) res pec ti va men te. Y sólo el 32% co no cía el test de agi ta ción. Con clu sión. La for ma ción de los pro fe sio na les so bre el efec to que las al tas tem pe ra tu ras oca sio nan en las va cu nas era co rrec ta, pero es ne cesario re for zar su for ma ción so bre la ines - ta bi li dad que pre sen tan los pre pa ra dos ad sor bi dos cuan do se so me ten a con ge la ción.

One area of major importance in promoting health is the prevention of infectious diseases through vaccination. Vaccine is any preparation intended to generate immunity against a disease by stimulating the production of antibodies. There are two basic types: live attenuated and inactivated, with different characteristics that determine their use. The main properties of a vaccine are safety and protective efficacy. The vaccines can be administered based on individualized directions depending on various factors (personal, environmental…), or systematically as part of the immunization schedules. In Spain, the first childhood immunization schedule was implemented in 1975. The Autonomous Communities are currently responsible for establishing vaccine recommendations. The incidence of vaccine-preventable diseases and vaccination coverage are essential criteria for the evaluation of vaccination programs. In Spain the incidence of vaccine-preventable diseases is low. Vaccination coverage is high in childhood, but in adolescents, adults and groups at risk it is not always appropriate.

Systematic immunization programmes mostly depend on the correct maintenance and manipulation of the vaccines to be used, i.e. perfect maintenance of the cold chain. Therefore, we decided to carry out a systematic review of the literature on the cold chain and vaccines, to identify daily practices in vaccine sites.A literature search was performed in the main medical databases for documents published between 1990 and 2005, including those performed by means of a survey and/or inspection of vaccine sites that provided the following data: a designated health officer, availability of a thermometer with maximums and minimums, refrigerator temperature at the time of the visit, and temperature control and registration. For all the variables, the mean prevalence was calculated with a 95% confidence interval.Three hundred seventy-seven articles were found; 31 were initially selected and 13 were finally included. In 72.21% of the vaccine points, there was an officer responsible for the vaccines, but only 61.43% knew the optimal temperature range. Fifty-five percent of these points had a thermometer with maximums and minimums and only 26.88% carried out temperature controls and registrations at least once per day.Important shortfalls were detected in cold chain maintenance in all selected articles, jeopardizing the effectiveness and efficiency of immunization programs.

Influenza is a major cause of morbidity and mortality worldwide. Currently, licensed influenza vaccines are safe and effective. Any intervention aimed at reducing the burden of illness is worth analyzing from a clinical and economic perspective.To assess the costs and benefits of an influenza vaccination program in the Spanish working population.A theoretical model of costs and benefits in terms of productivity savings was developed to compare 2 strategies (vaccination and non-vaccination) in 2 cohorts of 1,000 workers each. The time horizon was 1 year and the study's perspective was societal.epidemiological and clinical data on the incidence of influenza and the effectiveness of the vaccine. Data on the use of direct and indirect resources were obtained from an expert panel of 5 experts in preventive medicine, microbiology, occupational health, and health economics. Unit costs (euros 2003) were extracted from local databases. A sensitivity analysis was performed with the data on incidence, effectiveness, and work absenteeism due to influenza.In the base case scenario, influenza vaccine saved 35 Euros per worker, of which 88% were savings in work loss days avoided. Threshold values in the sensitivity analysis were 6% for the incidence of influenza and 1.5 days for absence from work, above which the vaccine leads to net savings.Influenza vaccination in the Spanish working population might result in net resource savings to society at large.

Since healthcare workers can transmit the influenza virus to high risk patients, they should be vaccinated prior to the influenza season. In this study we describe the influenza vaccination coverage in healthcare workers in a general hospital and study its evolution over the last years.Descriptive epidemiological study to determine the anti-influenza vaccination coverage in healthcare workers in a hospital during 2002-2003 and 2003-2004 seasons. The variables studied in each season were sex, age and professional category.During each of the campaigns, 1,215 and 2,287 workers were vaccinated. The vaccination coverage increased significantly (p0.01) (20.2% in 2002-2003 and 38% in 2003-2004). Men were vaccinated more than women although the coverage increase was significant in both sexes (p0.01). During the 2002-2003 season, workers older than 50 years (24.4%) had the greatest coverage, while during 2003-2004 those older than 31 years (48.7%) were the ones with more coverage. By professional categories, the medical staff (33.8% in 2002-2003 and 59.9% in 2003-2004) had a greater vaccination acceptance. The coverage increase during these two years was significant in all healthcare workers (p0.01).A significant increase in the vaccination coverage has been observed during the two seasons studied. This fact can be related to the changes introduced in the informative strategies and the performance of more active vaccination campaigns which connect vaccination to employment areas.

Human Immunodeficiency Virus (HIV) is an occupational hazard among healthcare professionals accidentally contaminated with HIV-positive blood. This study is aimed at describing the characteristics of the accidents involving blood of HIV-positive patients recorded over a sixteen-year period at a general hospital.Epidemiological study of the accidents reported in 2001 involving biological material from an HIV-positive source by the healthcare personnel of a general hospital throughout the 1986-2001 period entailing the presence of biological material from HIV-positive serology individuals. Individual, time and place-related variables, in addition to the initial serologies and those throughout the protocolized follow-up were studied for those individuals involved in these accidents.A total 550 accidents entailing an HIV-positive source were reported. The average number of accidents was 34.4/year. The accidental exposure rate for the period under study was 7.5/1000 workers/year. The professional group showing the highest accident rate was the nursing staff (54.4%). Percutaneous injuries were the most frequent (80.2%). The mean exposure rate was 2.6/100 beds/year. The anatomical areas involved to the greatest degree were the fingers (75.6%). A total 53.4% of those injured completed the serological follow-up without having shown any seroconversion.Throughout the sixteen-year period under study, the annual incidence of accidents involving an HIV-positive source increased from the 27 accidents reported in 1986 to the 60 accidents reported in 1990, there having been a downward trend as of that point in time, to the point of 12 accidents having been recorded in 2001.

Today nobody doubts about the need of maintaining adults and teenagers dully vaccinated, among other reasons because they had not been vaccinated when they were young, due to the need of a booster dose, or due to the availability of new vaccines. Several international organisms recommend the vaccination to teenagers and adults bearing in mind several factors, such as the type of vaccine, age, sex, occupation and medical situation of the person to be vaccinated. The recommended vaccines will produce a positive effect, reducing the morbi-mortality rates among the vaccinated.

Vaccines are heat-labile medications, and to guarantee their immunogenicity and safeguarding effectiveness as part of immunization programs, it is absolutely essential that the "Cold Chain" go unbroken. Fundamental thereto is the personnel responsible for the vaccines, who must know the stability-related characteristics of each preparation so as to prevent handling errors. The purpose of this study was that of ascertaining how the cold chain is kept intact in primary care systems in one healthcare area of the Autonomous Community of Madrid, as well as determining the degree of information possessed by those responsible for vaccines as far as their heat-stability is concerned.A cross-sectional study has been made at 46 primary care vaccination points. The data was gathered by means of a personal interview by one single researcher.The participation rate was 93.5% (43/46). In all cases, there was a maximum and minimum thermometer and monthly temperature record. An unsuitable temperature was found in three cases (6.97%). The percentage of professionals who were aware of the effect freezing has on vaccines varied greatly: 53.5%, 51.2%, 44.2% and 53.5% for diphtheria-tetanus-pertussis (DTP), hepatitis B (HBV), oral polio (OPV) and measles-mumps-rubella (MMR) respectively. And only 32% were familiar with the shake test.The professionals were found to be properly trained regarding the effect which high temperatures have on vaccines, but it is necessary for their training with regard to the instability of adsorbed preparations when frozen must be further strengthened.

ResumenSe estudia la prevalencia de aulomedicación y cumplimiento farmacológico comunicados, asi como los factores asociados, en los usuarios mayores de 25 años de una consulta de Atención Primaria. mediante un método de búsqueda de casos, desde marzo a diciembre de 1987.El 48 % de los pacientes declaró automedicarse, de los cuales el 41 % tomaban un fármaco y el 7 % dos fármacos, siendo el grupo farmacológico mas consumido el de sistema nervioso. Respecto al cumplimiento de la medicación prescrita, el 81 % de los pacientes declaró tomarse la medicación adecuadamente al menos tres de cada cuatro ocasiones. Los jóvenes practicaban más automedicación y los incumplidores se caracterizaban por tener un mayor tamaño familiar, como únicas diferencias estadisticas.Se concluye que esta población comunica un alto nivel de automedicación y también de cumplimiento farmacológico de la medicación prescrita. Estos datos deben tenerse en cuenta en la planificación de futuros programas educativos para mejorar el uso de los fármacos en la comunidad.SummaryThe prevalence of reported self-medication and campliance and some associated factors in patients 25 and over years of age attending a primary health center is studied using the case finding method, during the period of March-December. 1987.Self-medication was reported by 48 % of patients (41 % were taking one drug and 7 % two drugs). Nervous system drugs were the most common pharmacologic group over the counter. As for compliance of prescribed drugs, 81 % reported to take their medication in the prescribed way al least 3 out of 4 times. Younger patients reported more self-medicalion. Non compliance was more frequent in members of larger families. No other statistical differences were found.We conclude that the patients in our practice report a high level of self-medication and also a high level of compliance of prescribed drugs. These data are to be taken into account for the planning of future health programs targeted to the use of drugs in our community.

ResumenIntroducciónLa gripe es la mayor causa de morbimortalidad en el mundo. Actualmente, las vacunas contra la gripe son efectivas y seguras. Las intervenciones que reduzcan la carga de la enfermedad deben analizarse desde el punto de vista clínico y económico.ObjetivosEvaluar la eficiencia de un programa de vacunación contra la gripe en la población laboral española.MétodosModelo teórico de análisis de costes y beneficios en términos de ahorro para una cohorte de 1.000 trabajadores entre 16 y 65 años de edad vacunada, y otra no vacunada, a 1 año desde la perspectiva social. Intervenciones: vacunación contra la gripe respecto a no vacunación. Mediciones principales datos epidemiológicos y clínicos de incidencia de gripe y efectividad de la vacuna. Datos de uso de recursos directos (de atención primaria y especializada) e indirectos obtenidos por consenso de 5 expertos en medicina preventiva, microbiología, medicina del trabajo y economía de la salud. Datos de costes unitarios (euros de 2003). Se realizó un análisis de sensibilidad con la incidencia de gripe, la efectividad de la vacuna y los días de ausencia del trabajo por gripe.ResultadosEn el escenario base, la vacuna permite ahorrar 35 euros netos por trabajador (el 88% corresponde al ahorro en pérdidas de productividad evitadas). El análisis de sensibilidad indica que los valores umbral de incidencia de gripe y de ausencia del trabajo son del 6% y de 1,5 días, respectivamente, a partir de los cuales la vacunación se asocia con el ahorro neto.ConclusionesVacunar contra la gripe a la población laboral española puede comportar un ahorro neto a la sociedad.AbstractIntroductionInfluenza is a major cause of morbidity and mortality worldwide. Currently, licensed influenza vaccines are safe and effective. Any intervention aimed at reducing the burden of illness is worth analyzing from a clinical and economic perspective.ObjectiveTo assess the costs and benefits of an influenza vaccination program in the Spanish working population.MethodsA theoretical model of costs and benefits in terms of productivity savings was developed to compare 2 strategies (vaccination and non-vaccination) in 2 cohorts of 1,000 workers each. The time horizon was 1 year and the study’s perspective was societal. Main outcome measures: epidemiological and clinical data on the incidence of influenza and the effectiveness of the vaccine. Data on the use of direct and indirect resources were obtained from an expert panel of 5 experts in preventive medicine, microbiology, occupational health, and health economics. Unit costs (euros 2003) were extracted from local databases. A sensitivity analysis was performed with the data on incidence, effectiveness, and work absenteeism due to influenza.ResultsIn the base case scenario, influenza vaccine saved 35 Euros per worker, of which 88% were savings in work loss days avoided. Threshold values in the sensitivity analysis were 6% for the incidence of influenza and 1.5 days for absence from work, above which the vaccine leads to net savings.ConclusionsInfluenza vaccination in the Spanish working population might result in net resource savings to society at large.