TOS FERINA EN LA INFANCIA

(especial para SIIC © Derechos reservados)
Reseña de la epidemiología cambiante de la tos ferina en los países desarrollados y comparación de las estrategias potenciales para evitar la infección por Bodetella pertussis en los lactantes.
wood9.jpg Autor:
Nicholas Wood
Columnista Experto de SIIC
Artículos publicados por Nicholas Wood
Coautores
Peter McIntyre* Elizabeth Elliot** 
MB, BS, FRACP, FAFPHM, PhD, Westmead, Australia*
MD, FRACP, FRCP, FRCPCH, Westmead, Australia**
Recepción del artículo
26 de Septiembre, 2006
Aprobación
18 de Noviembre, 2006
Primera edición
29 de Mayo, 2007
Segunda edición, ampliada y corregida
7 de Junio, 2021

Resumen
Los lactantes menores de 6 meses tienen las tasas más elevadas de infección por Bordetella pertussis y la morbimortalidad más alta secundaria a la enfermedad, pero son demasiado pequeños para estar protegidos por los esquemas de vacunación actuales. En los países con programas de inmunización bien establecidos contra la tos ferina en la infancia, la principal fuente de infección para los lactantes son los adultos y adolescentes. La inmunidad luego de un curso primario de vacunación contra la tos ferina disminuye después de 5 a 10 años. Este artículo reseña la epidemiología cambiante de la tos ferina en los países desarrollados y compara las estrategias potenciales para evitar la infección por B. pertussis en los lactantes. La vacunación universal de adultos y adolescentes probablemente evite en mayor medida los casos de enfermedad, pero está limitada por los costos y las dificultades en la implementación. Las estrategias de vacunación selectivas dirigidas a los padres y otros contactos cercanos de los bebés son menos costosas y tienen ventajas potenciales en cuanto a la implementación; aunque no se instituyeron a nivel poblacional en ningún país. La inmunización más temprana en los lactantes también es dificultosa ya que los pocos estudios sobre vacunación en los recién nacidos mostraron que si bien los niveles de anticuerpos ascienden más rápidamente, no son tan persistentes a los 7 a 12 meses en comparación con los esquemas actuales; no se realizaron ensayos sobre la inmunización con la vacuna acelular en embarazadas. Es necesario contar con datos adicionales y una evaluación formal de la costo-efectividad antes de establecer la preferencia de una estrategia sobre otra.

Palabras clave
tos ferina, lactante, prevención, estrategias de vacunación


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Abstract
Infants under 6 months of age, have the highest rates of pertussis infection and the highest morbidity and mortality from pertussis, but are too young to be protected by current vaccination schedules. In countries with well-developed childhood pertussis immunisation programs, adults and adolescents are now the primary sources of infection for infants. Immunity following a primary course of pertussis vaccine wanes after 5-10 years. This paper reviews the changing epidemiology of pertussis in developed countries and compares potential strategies to prevent pertussis infection in infants. Universal adult/adolescent vaccination probably would prevent most disease but is challenging because of cost and implementation problems; "cocoon" strategies targeting parents and other close contacts of new babies are less costly and have potential advantages for implementation but have not been instituted at population level in any country. Earlier infant vaccination, is also problematic as the few studies of pertussis vaccination in the newborn show that although antibody levels rise earlier, they do not persist well at 7-12 months compared to current schedules and no acellular pertussis vaccine trials in pregnant women have been conducted. Additional trial data and formal evaluation of cost-effectiveness is needed before any strategy can be clearly preferred.

Key words
pertussis, infant, prevention, vaccination strategies


Full text
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Clasificación en siicsalud
Artículos originales > Expertos del Mundo >
página   www.siicsalud.com/des/expertocompleto.php/

Especialidades
Principal: Pediatría
Relacionadas: Atención Primaria, Medicina Familiar, Medicina Interna, Salud Pública



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Enviar correspondencia a:
Nicholas Wood, National Centre for Immunisation Research and Surveillance The Children's Hospital at Westmead, NSW 2145, Locked Bag 4001, Westmead, Australia
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