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Clones; Invasive pneumococcal disease; Serotypes Clones; Enfermedad neumocócica invasiva; Serotipos Clons; Malaltia pneumocòcica invasiva; Serotips The goal of this study was to investigate the distribution of serotypes and clonal composition of Streptococcus pneumoniae isolates causing invasive pneumococcal disease (IPD) in Catalonia, before and after systematic introduction of PCV13. Pneumococcal strains isolated from normally sterile sites obtained from patients of all ages with IPD received between 2013 and 2019 from 25 health centers of Catalonia were included. Two study periods were defined: presystematic vaccination period (2013 and 2015) and systematic vaccination period (SVP) (2017 to 2019). A total of 2,303 isolates were analyzed. In the SVP, there was a significant decrease in the incidence of IPD cases in children 5 to 17 years old (relative risk [RR] 0.61; 95% confidence interval [CI] 0.38 to 0.99), while there was a significant increase in the incidence of IPD cases in 18- to 64-year-old adults (RR 1.33; 95% CI 1.16 to 1.52) and adults over 65 years old (RR 1.23; 95% CI 1.09 to 1.38). Serotype 8 was the major emerging serotype in all age groups except in 5- to 17-year-old children. In children younger than 5 years old, the main serotypes in SVP were 24F, 15A, and 3, while in adults older than 65 years they were serotypes 3, 8, and 12F. A significant decrease in the proportions of clonal complexes CC156, CC191, and ST306 and an increase in those of CC180, CC53, and CC404 were observed. A steady decrease in the incidence of IPD caused by PCV13 serotypes indicates the importance and impact of systematic vaccination. The increase of non-PCV13 serotypes highlights the need to expand serotype coverage in future vaccines and rethink vaccination programs for older adults. IMPORTANCE We found that with the incorporation of the PCV13 vaccine, the numbers of IPD cases caused by serotypes included in this vaccine decreased in all of the age groups. Still, there was an unforeseen increase of the serotypes not included in this vaccine causing IPD, especially in the >65-year-old group. Moreover, a significant increase of serotype 3 included in the vaccine has been observed; this event has been reported by other researchers. These facts call for the incorporation of more serotypes in future vaccines and a more thorough surveillance of the dynamics of this microorganism.

INTRODUCTION: Patients with invasive pneumococcal disease (IPD) may require admission into paediatric intensive care units (PICU). The aim of this study is to analyse the epidemiological, clinical, and microbiological characteristics associated with IPD that may require admission to the PICU. MATERIAL AND METHODS: A prospective study was conducted on cases of IPD diagnosed in three Paediatric Hospitals in Barcelona between January 2012 and June 2016. An analysis was made of the associations between the admission to PICU and the epidemiological, clinical, and microbiological variables. RESULTS: A total of 263 cases with IPD were included, of which 19% (n = 50) required admission to PICU. Patients with septic shock (7; 100%), meningitis (16; 84.2%), and those with complicated pneumonia (23; 15.2%) were admitted to the PICU. The most frequent complications were pulmonary (35.2%) and neurological (39.5%). The ratio between admission and non-admission to PICU was 4.7 times higher in subjects with an underlying disease. The serotypes associated with PICU admission were 19A (23% of the total of this serotype), serotype 14 (20%), serotype 3 (17%), and serotype 1 (12.5%). CONCLUSIONS: IPD required PICU admission in cases of septic shock and meningitis, and less so with complicated pneumonia. The percentage of admissions is greater in children with an underlying disease. Admission into the PICU involves a longer stay, complications during the acute phase, as well as sequelae, particularly neurological ones. The serotypes of the patients that were admitted to PICU were predominantly vaccine serotypes.

BACKGROUND: Invasive pneumococcal disease (IPD) is the most important bacterial infection in young children, and the introduction of pneumococcal conjugate vaccines has changed its presentation. This study compared the incidence, characteristics and serotype distribution of IPD before and after the introduction of the pneumococcal conjugate vaccine (PCV13). METHODS: Prospective enrolment of patients with IPD aged less than 60 months and admitted to either of 2 tertiary care hospitals between January 2007 and December 2009 (pre-PCV13 period) and January 2012 and June-2016 (PCV13 period). RESULTS: We identified 493 cases, 319 in the pre-PCV13 period and 174 in the PCV13 period. The incidence of IPD decreased from 89.7 to 34.4 cases per 100,000 population (-62%; P

BACKGROUND: Some studies have observed an increased incidence of necrotizing pneumonia (NP) in recent years. This might be related to the emergence of non-vaccine S. pneumoniae serotypes after PCV7 introduction although it is suggested that evolutionary factors may have modified the virulence and the interactions of pneumococci. The aim of this study was to clinically and microbiologically define NP in the population served by the three major paediatric hospitals in Barcelona (Catalonia, Spain). METHODS: A prospective observational study was conducted in patients

Vaccination with the 13-valent conjugated pneumococcal disease (PCV13) has reduced invasive pneumococcal disease (IPD), but there have been reports of vaccine failures. We performed a prospective study in children aged 2-59 months who received diagnoses of IPD during January 2012-June 2016 in 3 pediatric hospitals in Catalonia, Spain, a region with a PCV13 vaccination coverage of 63%. We analyzed patients who had been age-appropriately vaccinated but who developed IPD caused by PCV13 serotypes. We detected 24 vaccine failure cases. The serotypes involved were 3 (16 cases); 19A (5 cases); and 1, 6B, and 14 (1 case each). Cases were associated with children without underlying conditions, with complicated pneumonia (OR 6.65, 95% CI 1.91-23.21), and with diagnosis by PCR (OR 5.18, 95% CI 1.84-14.59). Vaccination coverage should be increased to reduce the circulation of vaccine serotypes. Continuous surveillance of cases of IPD using both culture and PCR to characterize vaccine failures is necessary.

The aim was to analyse invasive pneumococcal disease (IPD) serotypes in children aged ⩽17 years according to clinical presentation and antimicrobial susceptibility. We conducted a prospective study (January 2012–June 2016). IPD cases were diagnosed by culture and/or real-time polymerase chain reaction (PCR). Demographic, microbiological and clinical data were analysed. Associations were assessed using the odds ratio (OR) and 95% confidence intervals (CI). Of the 253 cases, 34.4% were aged

BACKGROUND: The objective of this study is to describe incidence and shifts of serotype and clonal distribution of invasive Streptococcus pneumoniae strains in four different age groups (65 years) during a period of intermediate PCV13 vaccination coverage (2011-2016) in Catalonia, Spain. METHODS: We included all pneumococcal strains systematically sent to the Catalan support laboratory for molecular surveillance of invasive pneumococcal disease (IPD) located at Hospital Sant Joan de Deu, Barcelona. Two study periods were considered: 2011-13, early PCV13 vaccination period (EVP) and 2014-2016, late vaccination period (LVP). RESULTS: A total of 2142 strains were included in the study. Five years after intermediate introduction of PCV13 in our population, a significant decrease of overall incidence of IPD in children 65 years. Results found when comparing both periods were consistent with IRRs observed year by year. In children 65 years the most frequently isolated serotypes were 3, 19A and 7F vs 3, 14 and 12F, respectively. Regarding clonal complexes (CCs) expressing mainly PCV13 serotypes, significant decreases of the proportions of CC306, CC191 and CC320 were observed, while CC156 showed a significant increase. As for CCs expressing mostly non-PCV13 serotypes, significant increases in ST989, CC53 and CC404 were showed. CONCLUSIONS: Despite low vaccine coverage in our setting a significant decrease of incidence of IPD was observed in children younger than 5 years. The modest indirect protection against vaccine serotypes causing IPD in elderly indicate the need for the inclusion of more serotypes in future high-valent PCV and vaccinating old adults should be considered.

The lack of invasive pneumococcal disease (IPD) cost studies may underestimate the effect of pneumococcal polysaccharide conjugated vaccines (PCV). The objective of this study was to estimate the direct costs of hospitalized IPD cases. A prospective study

High-risk populations; Human papillomavirus infection; Vaccines Poblacions d'alt risc; Virus del papil·loma humà; Vacunes Poblaciones de alto riesgo; Virus del papiloma humano; Vacunas INTRODUCTION: Although human papillomavirus (HPV) routine vaccination programmes have been implemented around the world and recommendations have been expanded to include other high-risk individuals, current recommendations often differ between countries in Europe, as well as worldwide. AIM: To find and summarise the best available evidence of HPV vaccination in high-risk patients aiding clinicians and public health workers in the day-to-day vaccine decisions relating to HPV in Spain. METHODS: We conducted a systematic review of the immunogenicity, safety and efficacy/effectiveness of HPV vaccination in high-risk populations between January 2006 and June 2016. HPV vaccination recommendations were established with levels of evidence according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. RESULTS: A strong recommendation about HPV vaccination was made in the following groups: HIV infected patients aged 9-26 years; men who have sex with men aged 9-26 years; women with precancerous cervical lesions; patients with congenital bone marrow failure syndrome; women who have received a solid organ transplant or hematopoietic stem cell transplantation aged 9-26 years; and patients diagnosed with recurrent respiratory papillomatosis. CONCLUSIONS: Data concerning non-routine HPV vaccination in populations with a high risk of HPV infection and associated lesions were scarce. We have developed a document to evaluate and establish evidence-based guidelines on HPV vaccination in high-risk populations in Spain, based on best available scientific evidence.

The objective of this study was to analyze the incidence, clinical presentation, and severity of invasive pneumococcal disease (IPD)-causing serotypes and the impact of the 13-valent pneumococcal conjugate vaccination during epidemic and nonepidemic influenza periods in Catalonia, Spain. This was a prospective study in persons aged

BACKGROUND: The 13-valent pneumococcal conjugate vaccine (PCV13) was licensed based on the results of immunogenicity studies and correlates of protection derived from randomized clinical trials of the 7-valent conjugate pneumococcal vaccine. We assessed the vaccination effectiveness (VE) of the PCV13 in preventing invasive pneumococcal disease (IPD) in children aged 7-59 months in a population with suboptimal vaccination coverage of 55%. METHODS: The study was carried out in children with IPD admitted to three hospitals in Barcelona (Spain) and controls matched by hospital, age, sex, date of hospitalization and underlying disease. Information on the vaccination status was obtained from written medical records. Conditional logistic regression was made to estimate the adjusted VE and 95% confidence intervals (CI). RESULTS: 169 cases and 645 controls were included. The overall VE of =1 doses of PCV13 in preventing IPD due to vaccine serotypes was 75.8% (95% CI, 54.1-87.2) and 90% (95% CI, 63.9-97.2) when =2 doses before 12 months, two doses on or after 12 months or one dose on or after 24 months, were administered. The VE of =1 doses was 89% (95% CI, 42.7-97.9) against serotype 1 and 86.0% (95% CI, 51.2-99.7) against serotype 19A. Serotype 3 showed a non-statistically significant effectiveness (25.9%; 95% CI, -65.3 to 66.8). CONCLUSIONS: The effectiveness of =1 doses of PCV13 in preventing IPD caused by all PCV13 serotypes in children aged 7-59 months was good and, except for serotype 3, the effectiveness of =1 doses against the most frequent PCV13 serotypes causing IPD was high when considered individually.

Resumen: Entre las infecciones por hongos, las micosis superficiales, adquiridas por contacto directo o indirecto con un animal o con una persona infectados, son las más habituales en la infancia. Los patógenos más frecuentes en el niño inmunocompetente son las levaduras (Candida y Malasezzia) y los dermatofitos. La morbilidad de las micosis superficiales es tan importante como poco considerada, pues existe la falsa impresión de que constituyen un problema menor pese a su gran incidencia en la práctica habitual. En el presente documento de consenso, elaborado por el Grupo de Trabajo de Infecciones de Manejo Ambulatorio de la Sociedad Española de Infectología Pediátrica (SEIP), la Asociación Española de Pediatría de Atención Primaria (AEPap) y la Sociedad Española de Pediatría Extrahospitalaria y Atención Primaria (SEPEAP), se abordan los aspectos esenciales de la infección micótica superficial en el niño inmunocompetente. Abstract: Superficial mycoses, acquired by direct or indirect contact with an infected animal or person, are frequent in childhood. The most common pathogens in immunocompetent children are yeasts (Candida and Malasezzia) and dermatophytes. The morbidity of the superficial mycoses is as important as trivialized, which gives the false impression that it constitutes a minor problem despite its high incidence in routine practice. In this consensus document of the Spanish Society of Pediatric Infectious Diseases (SEIP), the Spanish Association of Primary Care Pediatrics (AEPap) and the Spanish Society of Pediatric Outpatient and Primary Care (SEPEAP), the essential aspects of superficial fungal infection in the immunocompetent child are addressed.

Resumen: Entre las infecciones por hongos, las micosis superficiales, adquiridas por contacto directo o indirecto con un animal o con una persona infectados, son las más habituales en la infancia. Los patógenos más frecuentes en el niño inmunocompetente son las levaduras (Candida y Malasezzia) y los dermatofitos. La morbilidad de las micosis superficiales es tan importante como poco considerada, pues existe la falsa impresión de que constituyen un problema menor pese a su gran incidencia en la práctica habitual. En el presente documento de consenso, elaborado por el Grupo de Trabajo de Infecciones de Manejo Ambulatorio de la Sociedad Española de Infectología Pediátrica (SEIP), la Asociación Española de Pediatría de Atención Primaria (AEPap) y la Sociedad Española de Pediatría Extrahospitalaria y Atención Primaria (SEPEAP), se abordan los aspectos esenciales de la infección micótica superficial en el niño inmunocompetente.

Presentamos el Documento de consenso sobre sinusitis de la Sociedad de Infectología Pediátrica (SEIP), la Asociación Española de Pediatría de Atención Primaria (AEPap), la Sociedad Española de Pediatría Extrahospitalaria y de Atención Primaria (SEPEAP) y la Sociedad Española de Otrorrinolaringología Pediátrica (SEORL). La sinusitis es una enfermedad de diagnóstico difícil, a menudo no reconocida. Se analiza la etiología, la clínica y los criterios diagnósticos más aceptados, y se realizan recomendaciones terapéuticas acordes con la situación epidemiológica actual. Se propone la amoxicilina por vía oral como tratamiento antibiótico de elección en dosis de 80 mg/kg/día repartidas cada 8 horas. Se indican tratamientos alternativos en casos especiales y en ausencia de eficacia de la amoxicilina. Se revisan las principales complicaciones de esta entidad. The Spanish National Consensus (Spanish Society of Pediatric Infectious Diseases, Spanish Association of Primary Care Pediatrics, Spanish Society of Pediatric Outpatient and Primary Care, Spanish Society of Otorhinolaryngology and Cervical-Facial Pathology) on Sinusitisis presented. Rhinosinusitis is a difficult to diagnose and often unrecognised disease. The document discusses the aetiology, the clinical signs and symptoms, and the diagnostic criteria. Aproposal for treatment is made based on the epidemiological situation in our country. Oral amoxicillin is the treatment of choice (80 mg/kg/day divided every 8 hours). Alternative treatment is proposed in special cases and when amoxicillin is not sufficient. The main complications are reviewed.

Se presenta el documento de consenso sobre otitis media aguda (OMA) de la Sociedad Española de Infectología Pediátrica (SEIP), la Sociedad Española de Pediatría Extrahospitalaria y Atención Primaria (SEPEAP), la Sociedad Española de Urgencias Pediátricas (SEUP) y la Asociación Española de Pediatría de Atención Primaria (AEPap). Se analizan la etiología de la enfermedad y los posibles cambios de esta después de la introducción de la vacunas antineumocócicas 7-valente, 10-valente y 13-valente. Se hace una propuesta diagnóstica basada en la clasificación de la OMA en confirmada o probable. Se considera OMA confirmada si hay coincidencia de tres criterios: comienzo agudo, signos de ocupación del oído medio (u otorrea) y signos o síntomas inflamatorios, como otalgia o intensa hiperemia timpánica, y OMA probable cuando existan solo dos criterios. Se propone como tratamiento antibiótico de elección la amoxicilina oral en dosis de 80 mg/kg/día repartidas cada ocho horas. El tratamiento con amoxicilina-ácido clavulánico en dosis de 80 mg/kg/día se indica si el niño es menor de seis meses, en lactantes con clínica grave (fiebre >39 ºC o dolor muy intenso), cuando haya historia familiar de secuelas óticas por OMA o un fracaso terapéutico de la amoxicilina. We present the consensus document on acute otitis media (AOM) written by the Spanish Society of Pediatric Infectology (SEIP), the Spanish Society of Outpatient and Primary Care Pediatrics (SEPEAP), the Spanish Society of Pediatric Emergency Care (SEUP) and the Spanish Association of Primary Care Pediatrics (AEPAP). The document analyses the etiology of the disease and the possible shifts in it following the introduction of the 7-valent, 10-valent, and 13-valent pneumococcal vaccines. The document proposes diagnosing AOM as confirmed or probable. The AOM diagnosis is considered confirmed if three criteria are met: acute onset, signs of fluid in the middle ear (or otorrhea), and symptoms of inflammation, such as otalgia or marked erythema in the middle ear, and considered probable when only two of these criteria are met. The proposed first choice for antibiotic treatment is 80 mg/kg/day of amoxicillin administered orally in doses at eight hour intervals. Treatment with amoxicillin-clavulanic acid in doses of 80 mg/kg/day are indicated in children younger than six months, in infants with a severe presentation (fever >39 ºC or acute pain), when there is a family history of AOM sequelae, or in cases of amoxicillin treatment failure.

Streptococcus pneumoniae; Cuidados intensivos pediátricos; Enfermedad neumocócica invasora Streptococcus pneumoniae; Paediatric intensive care; Invasive pneumococcal disease Streptococcus pneumoniae; Cures intensives pediàtriques; Malaltia pneumocòcica invasora Introducción La enfermedad neumocócica invasora (ENI) puede requerir ingreso en la unidad de cuidados intensivos pediátricos (UCIP). El objetivo de este trabajo es analizar las características epidemiológicas, clínicas y microbiológicas asociadas a la ENI que predisponen el ingreso en la UCIP. Material y métodos Estudio prospectivo de casos diagnosticados con ENI en tres hospitales pediátricos de Barcelona entre enero de 2012 y junio de 2016. Se analizaron las asociaciones entre el ingreso en la UCIP y las variables epidemiológicas, clínicas y microbiológicas. Resultados Se incluyeron 263 casos con ENI. El 19% (n = 50) requirió ingreso en la UCIP. El 100% (7) de los pacientes con shock séptico, 84,2% (16) con meningitis y 15,2% (23) con neumonía complicada ingresaron en la UCIP. Las complicaciones más frecuentes fueron pulmonares (35,2%) y neurológicas (39,5%). La razón entre ingreso y no ingreso en la UCIP fue 4,17 veces mayor en los sujetos con enfermedad de base. Los serotipos asociados al ingreso en la UCIP fueron el 19A (23% del total de este serotipo), el 14 (20%), el 3 (17%) y el serotipo 1 (12,5%). Conclusiones La ENI requiere ingreso en la UCIP en caso de shock séptico y meningitis, no así, de entrada, la neumonía complicada. El porcentaje de ingresos es mayor en los niños con enfermedad de base. El ingreso en la UCIP conlleva una estancia más prolongada, así como complicaciones durante la fase aguda y secuelas, sobre todo, neurológicas. Los serotipos de los pacientes que ingresaron en la UCIP fueron, predominantemente, serotipos vacunales. Introduction Patients with invasive pneumococcal disease (IPD) may require admission into paediatric intensive care units (PICU). The aim of this study is to analyse the epidemiological, clinical, and microbiological characteristics associated with IPD that may require admission to the PICU. Material and methods A prospective study was conducted on cases of IPD diagnosed in three Paediatric Hospitals in Barcelona between January 2012 and June 2016. An analysis was made of the associations between the admission to PICU and the epidemiological, clinical, and microbiological variables. Results A total of 263 cases with IPD were included, of which 19% (n = 50) required admission to PICU. Patients with septic shock (7; 100%), meningitis (16; 84.2%), and those with complicated pneumonia (23; 15.2%) were admitted to the PICU. The most frequent complications were pulmonary (35.2%) and neurological (39.5%). The ratio between admission and non-admission to PICU was 4.7 times higher in subjects with an underlying disease. The serotypes associated with PICU admission were 19A (23% of the total of this serotype), serotype 14 (20%), serotype 3 (17%), and serotype 1 (12.5%). Conclusions IPD required PICU admission in cases of septic shock and meningitis, and less so with complicated pneumonia. The percentage of admissions is greater in children with an underlying disease. Admission into the PICU involves a longer stay, complications during the acute phase, as well as sequelae, particularly neurological ones. The serotypes of the patients that were admitted to PICU were predominantly vaccine serotypes. Plan Nacional I + D + I, ISCIII-Subdirección general de Evaluación y Fomento de la Investigación Sanitaria. Beca número: P111/02081, PI 11/2345; Fondo Europeo de Desarrollo regional (FEDER) y AGAUR. Beca número 2017 SGR 1342.

Virus del Zika; Obstetrícia; Pediatria Zika virus; Obstetrics; Pediatrics Obstetricia; Pediatría Aquest document dóna recomanacions d'actuació per a la prevenció, detecció i tractament del virus del Zika a Catalunya.

Estudis de control de casos; Pneumònia; Vacunació i immunització Estudios de casos y controles; Neumonía; Vacunación e inmunización Case-control studies; Pneumonia; Vaccination and immunization Background The 13-valent pneumococcal conjugate vaccine (PCV13) was licensed based on the results of immunogenicity studies and correlates of protection derived from randomized clinical trials of the 7-valent conjugate pneumococcal vaccine. We assessed the vaccination effectiveness (VE) of the PCV13 in preventing invasive pneumococcal disease (IPD) in children aged 7–59 months in a population with suboptimal vaccination coverage of 55%. Methods The study was carried out in children with IPD admitted to three hospitals in Barcelona (Spain) and controls matched by hospital, age, sex, date of hospitalization and underlying disease. Information on the vaccination status was obtained from written medical records. Conditional logistic regression was made to estimate the adjusted VE and 95% confidence intervals (CI). Results 169 cases and 645 controls were included. The overall VE of ≥1 doses of PCV13 in preventing IPD due to vaccine serotypes was 75.8% (95% CI, 54.1–87.2) and 90% (95% CI, 63.9–97.2) when ≥2 doses before 12 months, two doses on or after 12 months or one dose on or after 24 months, were administered. The VE of ≥1 doses was 89% (95% CI, 42.7–97.9) against serotype 1 and 86.0% (95% CI, 51.2–99.7) against serotype 19A. Serotype 3 showed a non-statistically significant effectiveness (25.9%; 95% CI, -65.3 to 66.8). Conclusions The effectiveness of ≥1 doses of PCV13 in preventing IPD caused by all PCV13 serotypes in children aged 7–59 months was good and, except for serotype 3, the effectiveness of ≥1 doses against the most frequent PCV13 serotypes causing IPD was high when considered individually. This work was supported by the Plan Nacional I+D+I, ISCIII – Subdirección General de Evaluación y Fomento de la Investigación Sanitaria (Projects PI 11/02081, PI 11/2345) and cofounded by Fondo Europeo de Desarrollo Regional (FEDER) and AGAUR (Grant 2014 SGR 1403).