Log del 9 de Abril de 2002

[18:07] *** pecarre (email@161-ZARA-X28.libre.retevision.es) has joined #curso
[18:09] (Castrodeza> Buenas tardes a todos!
[18:09] (pecarre> buenas
[18:10] (yolanda> Buenas tardes
[18:10] (Castrodeza> Vamos a leer despacio la revisión que hemos propuesto en el curso, para
[18:10] (Castrodeza> - Identificar los aspectos mas relevantes y las indicaciones
[18:11] (Castrodeza> - Le espaciación en el tiempo de aplicación de las vacunas
[18:11] (Castrodeza> - La conveniencia de dar dosis simultaneas y
[18:11] (Castrodeza> - la posible interferencia en esas dosis simultaneas
[18:11] (Castrodeza> Esta en ingles, pero lo revisaremos despacito para que no haya problemas y luego podamos comentarlo
[18:11] (Castrodeza> _______________________________________ _
[18:11] (Castrodeza> Spacing of Multiple Doses of the Same Antigen
[18:12] (Castrodeza> Vaccination providers are encouraged to adhere as closely as possible to the recommended childhood immunization schedule.
[18:12] (Castrodeza> Clinical studies have reported that recommended ages and intervals between doses of multidose antigens provide optimal protection or have the best evidence of efficacy.
[18:12] (Castrodeza> Recommended vaccines and recommended intervals between doses are provided in this report (Table1).
[18:12] (Castrodeza> In certain circumstances, administering doses of a multidose vaccine at shorter than the recommended intervals might be necessary.
[18:12] (Castrodeza> This can occur when a person is behind schedule and needs to be brought up-to-date as quickly as possible or when international travel is impending.
[18:13] (Castrodeza> In these situations, an accelerated schedule can be used that uses intervals between doses shorter than those recommended for routine vaccination.
[18:13] (Castrodeza> Although the effectiveness of all accelerated schedules has not been evaluated in clinical trials, the Advisory Committee on Immunization Practices (ACIP) believes that the immune response when accelerated intervals are used is acceptable and will lead to adequate protection.
[18:13] (Castrodeza> The accelerated, or minimum, intervals and ages that can be used for scheduling catch-up vaccinations is provided in this report.
[18:13] (Castrodeza> Vaccine doses should not be administered at intervals less than these minimum intervals or earlier than the minimum age.
[18:13] (Castrodeza> In clinical practice, vaccine doses occasionally are administered at intervals less than the minimum interval or at ages younger than the minimum age.
[18:13] (Castrodeza> Doses administered too close together or at too young an age can lead to a suboptimal immune response.
[18:13] (Castrodeza> However, administering a dose a limited number of days earlier than the minimum interval or age is unlikely to have a substantially negative effect on the immune response to that dose. Therefore, ACIP recommends that vaccine doses administered <4 days before the minimum interval or age be counted as valid.
[18:14] (Castrodeza> However, because of its unique schedule, this recommendation does not apply to rabies vaccine. Doses administered >5 days earlier than the minimum interval or age should not be counted as valid doses and should be repeated as age-appropriate.
[18:14] (Castrodeza> The repeat dose should be spaced after the invalid dose by the recommended minimum interval as provided in this report .
[18:14] (Castrodeza> For example, if Haemophilus influenzae type b (Hib) doses one and two were administered only 2 weeks apart, dose two is invalid and should be repeated.
[18:14] (Castrodeza> The repeat dose should be administered >4 weeks after the invalid (second) dose.
[18:14] (Castrodeza> The repeat dose would be counted as the second valid dose.
[18:14] (Castrodeza> Doses administered >5 days before the minimum age should be repeated on or after the child reaches the minimum age and >4 weeks after the invalid dose.
[18:14] (Castrodeza> For example, if varicella vaccine were administered at age 10 months, the repeat dose would be administered no earlier than the child's first birthday.
[18:15] (Castrodeza> Certain vaccines produce increased rates of local or systemic reactions in certain recipients when administered too frequently (e.g., adult tetanus-diphtheria toxoid [Td], pediatric diphtheria-tetanus toxoid [DT], and tetanus toxoid) .
[18:15] (MiNombre> hola
[18:15] (Castrodeza> Such reactions are thought to result from the formation of antigen-antibody complexes. Optimal record keeping, maintaining patient histories, and adhering to recommended schedules can decrease the incidence of such reactions without adversely affecting immunity.
[18:15] (Castrodeza> Simultaneous Administration
[18:15] (Castrodeza> Experimental evidence and extensive clinical experience have strengthened the scientific basis for administering vaccines simultaneously (i.e., during the same office visit, not combined in the same syringe).
[18:15] (Castrodeza> Simultaneously administering all vaccines for which a person is eligible is critical, including for childhood vaccination programs, because simultaneous administration increases the probability that a child will be fully immunized at the appropriate age.
[18:15] (Castrodeza> A study conducted during a measles outbreak demonstrated that approximately one third of measles cases among unvaccinated but vaccine-eligible preschool children could have been prevented if MMR had been administered at the same visit when another vaccine was administered .
[18:16] (Castrodeza> Simultaneous administration also is critical when preparing for foreign travel and if uncertainty exists that a person will return for further doses of vaccine.
[18:16] (Castrodeza> Simultaneously administering the most widely used live and inactivated vaccines have produced seroconversion rates and rates of adverse reactions similar to those observed when the vaccines are administered separately.
[18:16] (Castrodeza> Routinely administering all vaccines simultaneously is recommended for children who are the appropriate age to receive them and for whom no specific contraindications exist at the time of the visit.
[18:16] (Castrodeza> Administering combined MMR vaccine yields results similar to administering individual measles, mumps, and rubella vaccines at different sites.
[18:16] (Castrodeza> Therefore, no medical basis exists for administering these vaccines separately for routine vaccination instead of the preferred MMR combined vaccine.
[18:16] (Castrodeza> Administering separate antigens would result in a delay in protection for the deferred components.
[18:16] (Castrodeza> Response to MMR and varicella vaccines administered on the same day is identical to vaccines administered a month apart.
[18:17] (Castrodeza> No evidence exists that OPV interferes with parenterally administered live vaccines.
[18:17] (Castrodeza> OPV can be administered simultaneously or at any interval before or after parenteral live vaccines.
[18:17] (Castrodeza> No data exist regarding the immunogenicity of oral Ty21a typhoid vaccine when administered concurrently or within 30 days of live virus vaccines.
[18:17] (Castrodeza> In the absence of such data, if typhoid vaccination is warranted, it should not be delayed because of administration of virus vaccines.
[18:17] (Castrodeza> Simultaneously administering pneumococcal polysaccharide vaccine and inactivated influenza vaccine elicits a satisfactory antibody response without increasing the incidence or severity of adverse reactions.
[18:17] (Castrodeza> Simultaneously administering pneumococcal polysaccharide vaccine and inactivated influenza vaccine is strongly recommended for all persons for whom both vaccines are indicated.
[18:18] (Castrodeza> Hepatitis B vaccine administered with yellow fever vaccine is as safe and immunogenic as when these vaccines are administered separately.
[18:18] (Castrodeza> Measles and yellow fever vaccines have been administered safely at the same visit and without reduction of immunogenicity of each of the components.
[18:18] (Castrodeza> Depending on vaccines administered in the first year of life, children aged 12--15 months can receive <7 injections during a single visit (MMR, varicella, Hib, pneumococcal conjugate, diphtheria and tetanus toxoids and acellular pertussis [DTaP], IPV, and hepatitis B vaccines).
[18:18] (Castrodeza> To help reduce the number of injections at the 12--15-month visit, the IPV primary series can be completed before the child's first birthday.
[18:18] (Castrodeza> MMR and varicella vaccines should be administered at the same visit that occurs as soon as possible on or after the first birthday.
[18:18] (Castrodeza> The majority of children aged 1 year who have received two (polyribosylribitol phosphate-meningoc occal outer membrane protein [PRP-OMP]) or three (PRP-tetanus [PRP-T], diphtheria CRM197 [CRM, cross-reactive material] protein conjugate [HbOC]) prior doses of Hib vaccine, and three prior doses of DTaP and pneumococcal conjugate vaccine have developed protection.
[18:18] (MiNombre> #nick lourdes
[18:18] (Castrodeza> The third (PRP-OMP) or fourth (PRP-T, HbOC) dose of the Hib series, and the fourth doses of DTaP and pneumococcal conjugate vaccines are critical in boosting antibody titer and ensuring continued protection.
[18:19] (Castrodeza> However, the booster dose of the Hib or pneumococcal conjugate series can be deferred until ages 15--18 months for children who are likely to return for future visits.
[18:19] (Castrodeza> The fourth dose of DTaP is recommended to be administered at ages 15--18 months, but can be administered as early as age 12 months under certain circumstances.
[18:19] (Castrodeza> For infants at low risk for infection with hepatitis B virus (i.e., the mother tested negative for hepatitis B surface antigen [HBsAg] at the time of delivery and the child is not of Asian or Pacific Islander descent), the hepatitis B vaccine series can be completed at any time during ages 6--18 months.
[18:19] (Castrodeza> Recommended spacing of doses should be maintained.
[18:19] (Castrodeza> Use of combination vaccines can reduce the number of injections required at an office visit. Licensed combination vaccines can be used whenever any components of the combination are indicated and its other components are not contraindicated.
[18:19] (Castrodeza> Use of licensed combination vaccines is preferred over separate injection of their equivalent component vaccines.
[18:19] (Castrodeza> Only combination vaccines approved by the Food and Drug Administration (FDA) should be used.
[18:20] (Castrodeza> Individual vaccines must never be mixed in the same syringe unless they are specifically approved for mixing by FDA.
[18:20] (Castrodeza> Only one vaccine (DTaP and PRP-T Hib vaccine, marketed as TriHIBit® [manufactured by Aventis Pasteur]) is FDA-approved for mixing in the same syringe.
[18:20] (Castrodeza> This vaccine should not be used for primary vaccination in infants aged 2, 4, and 6 months, but it can be used as a booster after any Hib vaccine.
[18:20] (Castrodeza> Nonsimultaneous Administration
[18:20] (Castrodeza> Inactivated vaccines do not interfere with the immune response to other inactivated vaccines or to live vaccines.
[18:20] (Castrodeza> An inactivated vaccine can be administered either simultaneously or at any time before or after a different inactivated vaccine or live vaccine (Table 2).
[18:21] (Castrodeza> The immune response to one live-virus vaccine might be impaired if administered within 30 days of another live-virus vaccine.
[18:21] (Castrodeza> Data are limited concerning interference between live vaccines.
[18:21] (Castrodeza> In a study conducted in two U.S. health maintenance organizations, persons who received varicella vaccine <30 days after MMR vaccination had an increased risk for varicella vaccine failure (i.e., varicella disease in a vaccinated person) of 2.5-fold compared with those who received varicella vaccine before or >30 days after MMR.
[18:21] (Castrodeza> In contrast, a 1999 study determined that the response to yellow fever vaccine is not affected by monovalent measles vaccine administered 1--27 days earlier.
[18:21] (Castrodeza> The effect of nonsimultaneously administering rubella, mumps, varicella, and yellow fever vaccines is unknown.
[18:21] (Castrodeza> To minimize the potential risk for interference, parenterally administered live vaccines not administered on the same day should be administered >4 weeks apart whenever possible.
[18:21] (Castrodeza> If parenterally administered live vaccines are separated by <4 weeks, the vaccine administered second should not be counted as a valid dose and should be repeated.
[18:22] (Castrodeza> The repeat dose should be administered >4 weeks after the last, invalid dose.
[18:22] (Castrodeza> Yellow fever vaccine can be administered at any time after single-antigen measles vaccine.
[18:22] (Castrodeza> Ty21a typhoid vaccine and parenteral live vaccines (i.e., MMR, varicella, yellow fever) can be administered simultaneously or at any interval before or after each other, if indicated.
[18:22] (Castrodeza> HASTA AQUI....
[18:23] (Castrodeza> pregunto yo primero,a todos los que estan en la clase:
[18:23] (Castrodeza> ¿se pueden administrar vacunas *vivas* e inactivadas conjuntamente ?
[18:24] (pecarre> no, se debe pasar 4 semanas
[18:24] (Castrodeza> por qué, Pedro ?
[18:24] (Castrodeza> y en que casos ?
[18:25] (pecarre> la razon es para minimizar los efectos secundarios
[18:26] (Castrodeza> entonces, ¿desaconsejarias la vacunacion conjunta actual de polio y DTP ?
[18:26] (pecarre> nooooooo, por supuesto no en todos los casos
[18:27] (Castrodeza> sería recomentable revisar la tabla 2 y tabla 3 de "normas ACIP"
[18:28] (Castrodeza> a ver yolanda... y albert, identificais que vacunas son vivas de las denominadas sistemáticas en el calendario vacunal ?
[18:29] (Castrodeza> (todo esto está en las diapositivas y normas ACIP que estan colocadas en la web y que corresponden tambien al tema de hoy
[18:29] (Castrodeza> y mañana veremos un ejercicio al respecto
[18:29] (agarcia> DTP, polio?
[18:30] (Castrodeza> la DTP es una vacuna muerta
[18:30] (Castrodeza> fundamentalmente de tipo toxoide
[18:30] (Castrodeza> y la polio, si está viva, aunque
[18:30] (Castrodeza> en el futuro va ser probablente sustituída por otra muerta
[18:31] (Castrodeza> (denominada SALK)
[18:31] (Castrodeza> MiNombre, quien eres ?
[18:32] (Castrodeza> bueno, ahora te toca, yolanda
[18:32] (yolanda> la triple virica quizás?
[18:33] (Castrodeza> preguntas si forma parte del calendario Yolanda ??
[18:33] (Castrodeza> la respuesta es que si....
[18:33] (Castrodeza> si preguntas otra cosa... depende
[18:33] (Castrodeza> por cierto., ¿has leído algo sobre vacunas vivas frente a la fiebre tifoidea?
[18:34] (yolanda> no
[18:34] (agarcia> NO
[18:35] (Castrodeza> bueno, aun queda tiempo para leerlo, venga....
[18:35] (Castrodeza> en el informe ACIP se hace referencia a esta vacuna: Ty21a
[18:35] (Castrodeza> es una vacuna comercializada en España
[18:36] (Castrodeza> con el nombre de VIVOTIF
[18:36] (Castrodeza> MENSAJE Y TAREA PARA MAÑANA:
[18:36] (Castrodeza> 1.- revisar como se calcula la efectividad de un programa de vacunaciones
[18:37] (Castrodeza> bueno, con ese uno terminamos
[18:37] (Castrodeza> preguntas ?
[18:37] (Castrodeza> comentarios ?
[18:37] (pecarre> Yo tengo una
[18:38] (Castrodeza> adelante
[18:38] (Castrodeza> adelante Pedro, pregunta
[18:38] (pecarre> Hace anños se vacunaba contra la tuberculosis, cosa que se dejo de hacer. Con el aumento de la incidencia de esta enfermedad
[18:38] (pecarre> habria que volver a vacunar?
[18:39] (Castrodeza> La preguntal del millón
[18:39] (Castrodeza> .
[18:39] (pecarre> je je
[18:39] (Castrodeza> En el momento actual, no se aconseja la vacunación
[18:39] (Castrodeza> sistemática de la población
[18:39] (Castrodeza> salvo el poblaciones especiales
[18:39] (Castrodeza> salvo *en poblaciones especiales*
[18:39] (Castrodeza> estas son:
[18:40] (Castrodeza> las que no quieran cumpliar las normas de quimioprofilaxis
[18:40] (Castrodeza> o poblaciones de profesiones de riesgo
[18:40] (Castrodeza> por ejemplo...
[18:40] (Castrodeza> los aqui presentes
[18:40] (Castrodeza> o comunidades cerradas con elevados niveles de infeccion
[18:41] (Castrodeza> Creo, que el Gobierno Vasco contempla la vacunación en recien nacidos
[18:41] (Castrodeza> Mas cosas ??
[18:42] (Castrodeza> Bueno, quedan los paneles para que pregunten o comenten lo que se les ocurra en adelante,
[18:42] (Castrodeza> vale ?
[18:42] (pecarre> vale
[18:42] (Castrodeza> nos vemos ahi todos, y mañana trabajaremos con eso
[18:42] (Castrodeza> hasta mañana a todos
[18:42] (yolanda> adios
[18:42] (pecarre> adios

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