Vaccination In Spain Research Articles

Health care professionals' preference for a fully liquid, ready-to-use hexavalent vaccine in Spain.

Vaccination is an effective health intervention for the prevention of infectious diseases. This study aims to evaluate the response provided by nurses toward the use of ready-to-use (RTU) formulations of hexavalent vaccines and measures to prevent errors during the vaccination process. This observational, descriptive, cross-sectional study took place from March to May 2018. It included 201 interviews with nurses from health centers in Madrid (70), Murcia (59), and Andalusia (72), who had administered RTU vaccines in the last 12months. Approximately 91.6% of nurses provided a positive feedback for the use of RTU vaccines. The most significant concerns experienced by nurses were during the preparation and administration of vaccines; 84.1% versus 18.9% of nurses felt that the risk of making mistakes was lower while using RTU vaccines compared with non-reconstituted (lyophilized) vaccines, and 74.1% versus 22.4% of nurses felt ease at preparing RTU vaccines compared with lyophilized vaccines. A total of 66.7% of nurses believed that there were risks associated with the preparation of lyophilized vaccines (administration risk [42.8%] and risk of needle injury [42.3%]). Risk percentages reduced to 4% and 9.5%, respectively, with the use of the RTU vaccines. Therefore, nurses adopted an average of seven steps to reduce the risk of errors. The average time saved during the administration of the vaccines was 1.1min. In summary, nurses highlighted the need for administering vaccines using RTU formulations for ensuring the safety of the recipients, preventing errors, and saving time during the vaccination process.

Hospital incidence, in-hospital mortality and medical costs of pneumococcal disease in Spain (2008–2017): a retrospective multicentre study

Objective The aim of this study was to analyze the characteristics of the patients attended with a pneumococcal disease in Spanish hospitals, to evaluate trends in hospital incidence and in-hospital mortality and to quantify patients’ use of resources and medical costs. Methods Medical admission records of patients admitted due to pneumococcal disease between 1 January 2008 and 31 December 2017 were obtained from a Spanish hospital discharge database. Records were identified with the International Statistical Classification of Diseases and Related Health Problems, 9th and 10th version codes corresponding to pneumococcal pneumonia, bacteraemia, pyogenic arthritis, endocarditis, meningitis, peritonitis and unspecified pneumococcal infections. Results Admissions of 168,074 patients were analyzed, with a mean age of 63.5 years (median = 72; interquartile range = 28). Pneumococcal pneumonia was responsible for 64.1% of all admissions, with a hospital incidence of 31.1 per 10,000 patients that decreased significantly over the study period (p = .002). Hospital incidence of meningitis also displayed a decreasing trend over the study period (p = .003), whereas incidence of bacteraemia and pyogenic arthritis increased significantly (p = .001; p = .004). Mean Charlson Comorbidity Index was 3.3 (standard deviation = 2.2). In-hospital mortality was 7.0% over the study period, being the highest in patients admitted with endocarditis (17.2%). Sepsis, acute renal failure, disorders of fluid electrolyte and acid-base balance, heart failure and acute respiratory failure were strongly associated with in-hospital mortality. Mean length of hospital stay was of 11.1 days (median = 22; interquartile range = 26) and there was a majority of urgent admissions (95.0%); the most extended stays were registered in patients with endocarditis, meningitis and pyogenic arthritis. The mean hospital admission cost was €5676, €104.2 million annually for all registered patients; 50.3% of all costs were associated with pneumonia, whereas the highest admission costs were registered in patients with endocarditis (€15,991) and meningitis (€11,934). Mean admission costs increased significantly over the study period for pneumonia and bacteraemia and decreased for endocarditis. Conclusions The incidence of pneumococcal pneumonia and meningitis decreased over the study period after the introduction of vaccination in Spain. The advanced age of patients and presence of chronic comorbid conditions that are associated to in-hospital mortality must be taken into account when improving care protocols and upcoming vaccination plans.

Trends, Coverage and Influencing Determinants of Influenza Vaccination in the Elderly: A Population-Based National Survey in Spain (2006-2017).

Influenza is a significant public health problem and the elderly are at a greater risk of contracting the disease. The vaccination coverage of the elderly is below the Spanish target of 65% for each influenza season. The aims of this study were to report the coverage of influenza vaccination in Spain among the population aged ≥65 years and high-risk groups for suffering chronic diseases, to analyze the time trends from 2006 to 2017 and to identify the factors which affect vaccination coverage. A nationwide cross-sectional study was conducted including 20,753 non-institutionalized individuals aged ≥65 years who had participated in the Spanish National Health Surveys in 2006, 2011/2012, and 2017. Sociodemographic, health-related variables, and influenza vaccination data were used. A logistic regression analysis was performed to determine the variables associated with influenza vaccination. Influenza vaccination coverage was 60%. By chronic condition, older people with high cholesterol levels and cancer had the lowest vaccination coverage (62.41% and 60.73%, respectively). This coverage declined from 2006 to 2017 in both groups. Higher influenza vaccination was associated with males, Spanish nationality, normal social support perceived, polypharmacy, worse perceived health, participation in other preventive measures, and increasing age and the number of chronic diseases.

Organización de los servicios de Vacunación Internacional en España

Los Centros de Vacunación Internacional en España son los encargados de la atención sanitaria preventiva de los viajeros internacionales en todo el territorio nacional. Son centros de titularidad pública, pero de dependencia administrativa diferente, según sean centros de Sanidad Exterior, dependientes del Gobierno central (Ministerio de Sanidad) o centros de los servicios autonómicos de salud, que funcionan en las diferentes Comunidades Autónomas bajo la figura de la encomienda de gestión, ya que en España se considera la vacunación internacional como parte intrínseca de la Sanidad Exterior y, como tal, es una competencia exclusiva del Estado. Esta organización ha dado lugar a diferentes prestaciones, sistemas de atención al usuario y costes, según la región y el tipo de centro al que acude cada viajero, resultando en un sistema complejo de entender y poco equitativo. La organización de la vacunación internacional en España, además, difiere de la mayoría de los países del mundo, ya que no existen en la práctica centros privados que ofrezcan este servicio, siendo únicamente un servicio de la sanidad pública, con lo que el coste para los usuarios es sensiblemente menor que en la gran mayoría de los países de Europa o en EEUU y Canadá. La falta de centros privados de vacunación internacional en España se debe fundamentalmente a la imposibilidad de prescribir y administrar la vacuna contra la fiebre amarilla, ya que, hasta ahora, el Ministerio de Sanidad no concede autorización para dicha administración a ningún centro privado.

MVA-B COMO CANDIDATO VACUNAL FRENTE AL VIH/SIDA: DE LA INVESTIGACIÓN BÁSICA A LOS ENSAYOS CLÍNICOS PROFILÁCTICO Y TERAPÉUTICO

The highly attenuated poxvirus strain modified vaccinia virus Ankara (MVA) has reached maturity as antigen delivery system and as a vaccine candidate against a broad spectrum of infectious diseases. This has been largely recognized from research on virus–host cell interactions, gene expression profiling, virus distribution and immunological studies in preclinical and clinical trials. This review includes our main contributions from the basic knowledge of the biology of the MVA vector, both in vitro and in vivo, in comparison with the attenuated NYVAC strain, to its evaluation as a vaccine candidate against HIV/AIDS in clinical trials. We will detail the generation and characterization of the recombinant poxvirus vector MVA expressing the HIV-1 Env, Gag, Pol and Nef antigens from clade B (referred as MVA-B) and review the preclinical data that supported the evaluation of MVA-B as the first in human HIV-1 prophylactic and therapeutic vaccine in Spain. In addition, we will assess the results of clinical trials and discuss the research projects we are currently working on considering the latest scientific advances in the HIV vaccine field.

Decreasing influenza vaccine coverage among adults with high-risk chronic diseases in Spain from 2014 to 2017

ABSTRACTThe objectives of this study were to estimate coverage of influenza vaccination in Spain among adults suffering chronic conditions, to assess time trends from 2014 to 2017 and to identify vaccine uptake predictors. We used individualized data of persons ≥15 y interviewed in the 2017 Spanish National Health Survey. Vaccine uptake and the presence of the chronic conditions analyzed (diabetes; cancer; chronic respiratory disease; chronic heart disease and cerebrovascular disease) were self-reported. Independent variables included sex, age and nationality. In 2017 overall influenza vaccination uptake among subjects with high-risk chronic conditions remained low (40.3%) and decreased significantly from 2014 (41.7%, adjusted OR 0.98 95%CI 0.84–0.98). The highest coverage was found among those with cerebrovascular disease (52.2%), diabetes (51.5%) and heart disease (51.4%) and the lowest figures for those suffering cancer (34.9%) and respiratory disease (35.1%). Coverage for cancer patients declined a 25% from 2014 to 2017. Older persons had higher coverages whereas females and immigrant population had lower uptakes.We conclude that influenza vaccination coverage among the high-risk population in Spain for suffering chronic conditions remains at a low level and has decreased significantly from 2014 to 2017, this affects more intensely to females and immigrants.

The beginnings of smallpox vaccination in Spain seen through the correspondence of Ignacio María Ruiz de Luzuriaga (1801–1802)

Edward Jenner’s discovery of the smallpox vaccine spread rapidly across Europe. In Spain, vaccinations first took place in December 1800 and the practice flourished upon the private initiative of doctors, surgeons, state officials and members of the nobility in different parts of the country. Ignacio María Ruiz de Luzuriaga, secretary of the Royal Academy of Medicine of Madrid, is considered in medical historiography as a key figure of the introduction of the smallpox vaccine in Spain. Ruiz de Luzuriaga had a major role as a disseminator of the Jennerian technique and as a distributor of the vaccine fluid. Given his prestige as a doctor and his position in the Royal Academy, he was commissioned to establish a scientific and academic corpus on preventive measures to foster their understanding, uptake and good practice among Spanish vaccinators. He also attempted to create a Central Vaccine Committee, such as that existing in other European countries. The Royal Academy kept records of his activity which have been filed and catalogued in a documentary set entitled ‘Papeles sobre la vacuna’ [Vaccine Papers]. This archive has not been studied in depth to date. These documents allow identifying a network of correspondents set up by Ruiz de Luzuriaga. He provided these correspondents with the vaccine and asked them to report back on the vaccination progress made in their municipalities. This correspondence provides an account of how the first immunisations in Spain unravelled, as well as of the initial concerns that accompanied the introduction of the vaccine.

Estimating the epidemiological impact and cost-effectiveness profile of a nonavalent HPV vaccine in Spain

ABSTRACT Human papillomavirus (HPV) is one of the main causes of infection-related cancer. The bivalent vaccine (2vHPV) (16/18) and quadrivalent (6/11/16/18) HPV vaccine (4vHPV) have been included in the Spanish vaccination calendar since 2007. The new nonavalent HPV vaccine (9vHPV), approved in Europe in 2015, includes nine HPV types 6/11/16/18/31/33/45/52/58 and has been available in Spain since May 2017. Our study aims to estimate the epidemiological impact and the cost-effectiveness of a girls-only and a gender-neutral vaccination program with 9vHPV compared to the current vaccination program in Spain. A dynamic transmission model simulating the natural history of HPV infections was calibrated to the Spanish setting and applied to estimate costs and quality-adjusted life years (QALYs) associated with vaccination strategies using a payer perspective and a 100-year time horizon. A girls-only vaccination strategy at age 12 years with 9vHPV was found to be a cost-effective strategy compared with 4vHPV (incremental cost-effectiveness ratio (ICER) of €7,718 per QALY). Compared with girls-only vaccination with 4vHPV, gender-neutral vaccination with 9vHPV was associated with further reductions of up to 28.5% in the incidence of cervical intraepithelial neoplasia (CIN) 2/3 and 17.1% in the incidence of cervical cancer, as well as with a 14.0% reduction in cervical cancer mortality. Furthermore, a gender-neutral vaccination program with 9vHPV could potentially be cost-effective considering some parameters as head and neck protection or discount rates, leading to a reduction in the burden of HPV-related diseases in both sexes in the Spanish population.

El Derecho a la Salud y la Vacunación en España y en el Derecho Comparado

El Derecho a la Salud y la Vacunación en España y en el Derecho Comparado

PIN5 - 10 YEARS OF HUMAN PAPILLOMAVIRUS SYSTEMATIC VACCINATION IN SPAIN: FORECASTING HEALTH OUTCOMES CONSIDERING AS04-HPV16/18 VACCINE EFFECTIVENESS DATA

The human papillomavirus (HPV) vaccine for adolescent females was included in the immunization calendar in Spain in 2007 for prevention of cervical cancer (CC). Since its inclusion, no evidence was available on the effectiveness of the vaccine against cervical lesions. Currently, new data have been published in other countries that allow us to assess the impact and potential benefit of vaccines against HPV and related diseases. The objective of this analysis is to estimate the impact of HPV vaccination 10 years after its introduction in Spain. Using demography data and vaccination coverage from Ministry of Health, the total HPV vaccinated population over the past 10 years was calculated. Applying most recent incidence of CC and mortality, the expected burden of disease if these girls had not been vaccinated against HPV was estimated. The difference between estimated burden of disease and observed vaccine effectiveness (AS04-adjuvanted HPV-16/18 vaccine data in Scotland, Pollock 2017) informed the potential impact of vaccination on CC cases, surgeries avoided, and lives saved. Considering 75% vaccination coverage, an estimated 1,581,857 girls have been HPV-vaccinated in Spain over the past 10 years. In absence of vaccination, this cohort would have suffered 123 CC cases leading to 74 hysterectomies and 34 deaths. Considering effectiveness data recently published for AS04-adjuvanted HPV-16/18 vaccine data in Scotland (Pollock 2017) vaccination in this cohort could avoid 116 CC cases, 70 hysterectomies and save 32 lives. If vaccination coverage would have reached 90%, vaccination would have prevented an additional 24 CC cases, 13 hysterectomies and 6 lives saved. It is necessary to re-analyze the expected impact of vaccination programs when new data from experiences in other countries are available. In the case of HPV, these data indicate that AS04-adjuvanted HPV-16/18 vaccine in Spain may avoid a considerable burden of cervical lesions and HPV related disease.

Executive summary of the update and reflection document on influenza vaccination in Spain

Influenza is the most common infectious disease preventable by vaccination in developed countries; it can affect people of all ages and cause epidemics. Although the symptoms are usually mild, complications may arise that require a hospital admission and might cause the patient's death in some cases. Vaccination is the most effective way to prevent influenza, and the World Health Organization recommends reaching immunization coverages against influenza of at least 75% in people over 65 years of age and in the high-risk population, as well as among healthcare professionals. This document summarizes the key points of a recent document containing information updates and considerations regarding influenza vaccination in Spain and the present recommendations. The document was issued by the Influenza Study Group and the signing scientific societies and professional organizations.

Resumen ejecutivo del documento de actualización y reflexión sobre vacunación antigripal en España

Influenza is the most common infectious disease preventable by vaccination in developed countries; it can affect people of all ages and cause epidemics. Although the symptoms are usually mild, complications may arise that require a hospital admission and might cause the patient's death in some cases. Vaccination is the most effective way to prevent influenza, and the World Health Organization recommends reaching immunization coverages against influenza of at least 75% in people over 65 years of age and in the high-risk population, as well as among healthcare professionals. This document summarizes the key points of a recent document containing information updates and considerations regarding influenza vaccination in Spain and the present recommendations. The document was issued by the Influenza Study Group and the signing scientific societies and professional organizations.

Pertussis cost reduction through vaccination in Spain

Pertussis cost reduction through vaccination in Spain

Ruiz de Luzuriaga response to concerns about the preservation of the vaccine in Spain (1803)

In an initial period of some excitement in the spread of smallpox vaccine in Spain (1800–1802), to which were added provaccine physicians and surgeons and the publication of several texts that reinforced its dissemination, was followed by a more thoughtful stage where they raised questions of a technical nature related to the best way of practicing the vaccination. A good practice is supposed to have the necessary means to produce, store and transport the vaccine fluid. Question that had been well identified in view of the preparatory reports of the Royal Philanthropic Expedition of the Vaccine. Coinciding with the departure of the expedition, among the members of the Royal Academy of Medicine of Madrid raised reasonable doubts on this matter were discussed, receiving the secretary of that institution, Ignacio María Ruiz de Luzuriaga, the job of preparing a report that will present the conclusions of this discussion and will dispel the doubts to avoid shortages of the vaccine fluid.

Respuesta de Ruiz de Luzuriaga a las preocupaciones sobre la preservación de la vacuna en España (1803)

In an initial period of some excitement in the spread of smallpox vaccine in Spain (1800-1802), to which were added provaccine physicians and surgeons and the publication of several texts that reinforced its dissemination, was followed by a more thoughtful stage where they raised questions of a technical nature related to the best way of practicing the vaccination. A good practice is supposed to have the necessary means to produce, store and transport the vaccine fluid. Question that had been well identified in view of the preparatory reports of the Royal Philanthropic Expedition of the Vaccine. Coinciding with the departure of the expedition, among the members of the Royal Academy of Medicine of Madrid raised reasonable doubts on this matter were discussed, receiving the secretary of that institution, Ignacio María Ruiz de Luzuriaga, the job of preparing a report that will present the conclusions of this discussion and will dispel the doubts to avoid shortages of the vaccine fluid.

Reduction in the burden of hospital admissions due to cervical disease from 2003–2014 in Spain

ABSTRACTBackground: Cervix uteri cancer is the 4th most common cancer among women worldwide and the second most frequent cancer in women under 45 years old in Spain. We aimed to describe the burden of hospital admissions by malignant neoplasia (MN) and in situ carcinoma (ISC) of the cervix in Spain from 2003 to 2014, a 12-year period that included the first years after introduction of an HPV vaccination program.Methods: This epidemiological study reviewed data from the Ministry of Health National Surveillance System, which includes more than 98% of Spanish hospitals. Hospitalization rate, mortality rate, and case fatality rates were calculated per year and age group.Results: We found 74,933 hospitalizations due to MN and ISC of the cervix. The average age at hospitalization increased significantly during the study period. The average length of hospital stay decreased significantly (p<0.001), while hospitalization costs increased. The mean hospitalization rate was 27.532 cases per 100,000 women (95% CI: 27.335-27.729). This rate decreased significantly during the study period. The mean mortality rate was 1.418 deaths per 100,000 women (95% CI: 1.373-1.463) and the mean case-fatality rate was 5.150% (95% CI: 4.992-5.308).Conclusion: Our study showed a substantial decrease in the hospitalization burden due to cervical disease. This decrease could be attributable to different causes including cervical cancer prevention measures, and changes in disease management. Further research is needed to confirm the cause. This information could contribute to further evaluations of the impact and cost effectiveness analysis of HPV vaccination in Spain.

Ocaso de la Medicina Social en España: el caso de la leptospirosis

Con el presente trabajo pretendo explorar el agotamiento de la Sanidad franquista en torno a un ejemplo concreto, el de la lucha contra la leptospirosis en el mundo rural, en especial en torno al cultivo del arroz, comprobando las semejanzas y diferencias de dicho empeño con el de otros anteriores surgidos de la matriz médico-social. Dicha enfermedad endemoepidémica rural fue singularizada como enemigo en la posguerra, por sus consecuencias sobre la producción en momentos delicados del cultivo de arroz, como la siega, si bien no fue hasta 1953 cuando se comenzó a actuar con algún sistema, merced al primer acuerdo de asistencia técnica firmado con la OMS, que permitió la venida de Brenno Babudieri, un microbiólogo italiano de fama mundial en este campo, quien probó en España una vacuna. Pero las iniciativas fueron provinciales y no coordinadas, dependientes aparentemente de la voluntad de los Jefes Provinciales de Sanidad y centradas sólo en medidas de laboratorio.

Prevalence and factors associated with influenza vaccination of persons over 65 years old in Spain (2009-2014).

Influenza is a major public health problem. Achieving 65% coverage in people over 65 years old is a health policy priority in Spain. To determine the coverage of influenza vaccination in Spain in 2014 for people over 65 years and to analyze the factors associated with coverage and its progression between 2009 and 2014. A descriptive cross-sectional study was conducted that included 18,442 non-institutionalized individuals over 65 years who had participated in the National Health Survey in Spain in 2011 and in the European Health Survey in Spain in 2009 and 2014. Socio-demographic variables, health variables, and influenza vaccination data were used. A logistic regression analysis was performed to determine the variables associated with anti-influenza vaccination. Influenza vaccination coverage has declined from 2009 (74.5%) to 2014 (57.4%). There are significant differences in the vaccination coverage among the different Spanish autonomous communities in the different years studied. Influenza vaccination was associated with males, low social class, and low level of education. There is greater participation in other preventive measures, such as assessing blood pressure, blood glucose, and cholesterol, than in influenza vaccination. Fewer people over 65 years old than recommended by the WHO participated in the influenza vaccination campaign in Spain in 2014. This coverage declined progressively from 2009 to 2014.

Propagación de la vacuna contra la viruela en Bilbao (1801-1802), el papel de Lope de Mazarredo (1769-1820)

The dissemination of the Jennerian vaccine in Spain began with similar readiness to that of other European countries. However, this expansion did not occur simultaneously in Spain. Several groups of illustrious physicians and surgeons linked to academic institutions, and with contacts in France and England took the initiative to practice vaccination. The pioneers of vaccine distribution emerged in Catalonia, Madrid, and the Basque Country. The enthusiasm of the first vaccinators was supported by the bourgeoisie, aristocrats, and state officials. Ignacio María Ruiz de Luzuriaga, secretary of the Royal Academy of Medicine of Madrid, had a prominent role as a coordinator between those interested in administering or receiving the vaccine, whether they were health workers or parents. The correspondence between them allows to determine the circumstances of that expansion. This case study analyses the introduction of the vaccine in Bilbao, through a series of letters from Juan Antonio de Ugalde, surgeon of the town, and Lope García de Mazarredo sent to Ruiz de Luzuriaga.

Spread of the smallpox vaccine in Bilbao (1801–1802), the role of Lope de Mazarredo (1769–1820)

The dissemination of the Jennerian vaccine in Spain began with similar readiness to that of other European countries. However, this expansion did not occur simultaneously in Spain. Several groups of illustrious physicians and surgeons linked to academic institutions, and with contacts in France and England took the initiative to practice vaccination. The pioneers of vaccine distribution emerged in Catalonia, Madrid, and the Basque Country. The enthusiasm of the first vaccinators was supported by the bourgeoisie, aristocrats, and state officials. Ignacio María Ruiz de Luzuriaga, secretary of the Royal Academy of Medicine of Madrid, had a prominent role as a coordinator between those interested in administering or receiving the vaccine, whether they were health workers or parents. The correspondence between them allows to determine the circumstances of that expansion. This case study analyses the introduction of the vaccine in Bilbao, through a series of letters from Juan Antonio de Ugalde, surgeon of the town, and Lope García de Mazarredo sent to Ruiz de Luzuriaga.