Vaccine strategies
Vaccination in patients with special medical situations: Where we come from and where we go
Vacunación en pacientes con situaciones médicas especiales: de dónde venimos y a dónde vamos
M. Fernández-Pradaa,b, F.A. Moraga-Llopb,c,
, J.J. Pérez-Martínb,d, G. Mirada-Masipb,e
Corresponding author
a Servicio de Medicina Preventiva y Salud Pública, Hospital Vital Álvarez Buylla, Mieres, Asturias, Spain
b Asociación Española de Vacunología, Spain
c Societat Catalana de Pediatria, Barcelona, Spain
d Servicio de Salud Pública de Lorca, Consejería de Salud, Región de Murcia, Murcia, Spain
e Servicio de Vigilancia Epidemiológica y Respuesta a Emergencias de Salud Pública de Lleida i Alt Pirineu i Aran, Agència de Salut Pública de Catalunya, Lleida, Spain
Read
Not available
Timeswas read the article
Total PDF
Total HTML
Share statistics
array:23 [ "pii" => "S2445146021000431" "issn" => "24451460" "doi" => "10.1016/j.vacune.2021.10.006" "estado" => "S300" "fechaPublicacion" => "2021-09-01" "aid" => "187" "copyrightAnyo" => "2021" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Vacunas. 2021;22:203-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:18 [ "pii" => "S1576988721000273" "issn" => "15769887" "doi" => "10.1016/j.vacun.2021.05.002" "estado" => "S300" "fechaPublicacion" => "2021-09-01" "aid" => "187" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Vacunas. 2021;22:203-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Estrategia vacunal</span>" "titulo" => "Vacunación en pacientes con situaciones médicas especiales: de dónde venimos y a dónde vamos" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "203" "paginaFinal" => "208" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Vaccination in patients with special medical situations: Where we come from and where we go" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Fernández-Prada, F.A. Moraga-Llop, J.J. Pérez-Martín, G. Mirada-Masip" "autores" => array:4 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Fernández-Prada" ] 1 => array:2 [ "nombre" => "F.A." "apellidos" => "Moraga-Llop" ] 2 => array:2 [ "nombre" => "J.J." "apellidos" => "Pérez-Martín" ] 3 => array:2 [ "nombre" => "G." "apellidos" => "Mirada-Masip" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2445146021000431" "doi" => "10.1016/j.vacune.2021.10.006" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2445146021000431?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1576988721000273?idApp=UINPBA00004N" "url" => "/15769887/0000002200000003/v3_202111020744/S1576988721000273/v3_202111020744/es/main.assets" ] ] "itemSiguiente" => array:17 [ "pii" => "S2445146021000480" "issn" => "24451460" "doi" => "10.1016/j.vacune.2021.10.011" "estado" => "S300" "fechaPublicacion" => "2021-09-01" "aid" => "199" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Vacunas. 2021;22:209-11" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "COVID-19 and primary care: A perspective from Italy" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "209" "paginaFinal" => "211" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "COVID-19 y la atención primaria: una perspectiva desde Italia" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3012 "Ancho" => 2508 "Tamanyo" => 260073 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Institution flowchart for suspect COVID-19 cases.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "F. Ghidinelli, F. Martire" "autores" => array:2 [ 0 => array:2 [ "nombre" => "F." "apellidos" => "Ghidinelli" ] 1 => array:2 [ "nombre" => "F." "apellidos" => "Martire" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2445146021000480?idApp=UINPBA00004N" "url" => "/24451460/0000002200000003/v2_202201010919/S2445146021000480/v2_202201010919/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2445146021000443" "issn" => "24451460" "doi" => "10.1016/j.vacune.2021.10.007" "estado" => "S300" "fechaPublicacion" => "2021-09-01" "aid" => "195" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "rev" "cita" => "Vacunas. 2021;22:189-202" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Review article</span>" "titulo" => "Recent advances in the prevention of meningococcal B disease: Real evidence from 4CMenB vaccination" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "189" "paginaFinal" => "202" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Avances recientes en la prevención de la enfermedad meningocócica B: evidencia real de la vacunación con 4CMenB" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1293 "Ancho" => 2508 "Tamanyo" => 187517 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Summary of vaccine effectiveness estimates in infants using 4CMenB in different healthcare settings.</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">% BCI, 95% Bayesian credible interval; CI, 95% confidence interval; NIP, national immunization program.</p> <p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">*2 doses in infants until 16 months of age, 3 doses after 16 months of age, 2 doses in children who commenced vaccination after age 12 months.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "F. Martinón-Torres, A. Banzhoff, C. Azzari, P. de Wals, R. Marlow, H. Marshall, M. Pizza, R. Rappuoli, R. Bekkat-Berkani" "autores" => array:9 [ 0 => array:2 [ "nombre" => "F." "apellidos" => "Martinón-Torres" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Banzhoff" ] 2 => array:2 [ "nombre" => "C." "apellidos" => "Azzari" ] 3 => array:2 [ "nombre" => "P." "apellidos" => "de Wals" ] 4 => array:2 [ "nombre" => "R." "apellidos" => "Marlow" ] 5 => array:2 [ "nombre" => "H." "apellidos" => "Marshall" ] 6 => array:2 [ "nombre" => "M." "apellidos" => "Pizza" ] 7 => array:2 [ "nombre" => "R." "apellidos" => "Rappuoli" ] 8 => array:2 [ "nombre" => "R." "apellidos" => "Bekkat-Berkani" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S157698872100042X" "doi" => "10.1016/j.vacun.2021.07.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S157698872100042X?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2445146021000443?idApp=UINPBA00004N" "url" => "/24451460/0000002200000003/v2_202201010919/S2445146021000443/v2_202201010919/en/main.assets" ] "en" => array:18 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Vaccine strategies</span>" "titulo" => "Vaccination in patients with special medical situations: Where we come from and where we go" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "203" "paginaFinal" => "208" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "M. Fernández-Prada, F.A. Moraga-Llop, J.J. Pérez-Martín, G. Mirada-Masip" "autores" => array:4 [ 0 => array:3 [ "nombre" => "M." "apellidos" => "Fernández-Prada" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 1 => array:4 [ "nombre" => "F.A." "apellidos" => "Moraga-Llop" "email" => array:1 [ 0 => "fmoraga@acmcb.es" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 2 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "J.J." "apellidos" => "Pérez-Martín" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 3 => array:3 [ "nombre" => "G." "apellidos" => "Mirada-Masip" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Servicio de Medicina Preventiva y Salud Pública, Hospital Vital Álvarez Buylla, Mieres, Asturias, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Asociación Española de Vacunología, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Societat Catalana de Pediatria, Barcelona, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Salud Pública de Lorca, Consejería de Salud, Región de Murcia, Murcia, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Servicio de Vigilancia Epidemiológica y Respuesta a Emergencias de Salud Pública de Lleida i Alt Pirineu i Aran, Agència de Salut Pública de Catalunya, Lleida, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Vacunación en pacientes con situaciones médicas especiales: de dónde venimos y a dónde vamos" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Vaccination in patients with special medical situations (immunodepression and chronic diseases) continues to be a serious challenge for healthcare professionals.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Historic achievements such as water purification and vaccinations, plus advances in methods of diagnosis and pharmacological therapy has led to an increase in life expectancy, which has achieved higher preventative needs for people of all ages and in varied medical situations.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The aim of this paper is to provide an overall view of vaccination in patients with special medical situations, analyse their development during recent years and highlight possible future lines of research and challenges for healthcare teams. To do this, the following points will be developed:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">•</span><p id="par0015" class="elsevierStylePara elsevierViewall">From the “paediatric-centred” to the “vaccinated-centred” model.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">•</span><p id="par0020" class="elsevierStylePara elsevierViewall">The “X” and X+Y vaccination universe”.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">•</span><p id="par0025" class="elsevierStylePara elsevierViewall">The definition of new vaccination risks and medical indications.</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">•</span><p id="par0030" class="elsevierStylePara elsevierViewall">Towards a common reference vaccination document.</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">•</span><p id="par0035" class="elsevierStylePara elsevierViewall">The evolution of preventative medical and public health services.</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">•</span><p id="par0040" class="elsevierStylePara elsevierViewall">Virtual support as a support tool.</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">•</span><p id="par0045" class="elsevierStylePara elsevierViewall">Information systems and indirect indicators of the target group.</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">•</span><p id="par0050" class="elsevierStylePara elsevierViewall">Anyone, anytime, anywhere</p></li></ul></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">From the “paediatric-centred” to “vaccination-centred” model</span><p id="par0055" class="elsevierStylePara elsevierViewall">Since the beginning of vaccinations until a few years ago, vaccines were almost exclusively centred upon paediatric age groups: a “paediatric-centred” model predominated. In medical faculties, child medicine was taught in the subject called <span class="elsevierStyleItalic">Paediatrics and childcare,</span> with the latter being the preventative aspect of the former, where vaccinations occupied a highly significant topic despite the low number of available vaccines at the time. Equally, in the child’s medical file diet and vaccines were key. Furthermore, the first vaccines to be included in the vaccine schedule (poliomyelitis, diphtheria, whooping cough and measles) prevented childhood diseases.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a> They were so-called because they were understood to be the most commonly, but not exclusively, known diseases affecting children.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Both from the viewpoint of healthcare and health and from the social sphere, vaccines were proposed as a significant preventative tool during childhood.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> It seems logical to think that this was so, given that children are a vulnerable risk group due to the immaturity of their immune system and because they have not previously been in contact with the microorganisms causing these infectious diseases. The paediatric approach in Spain means that there is a comprehensive health vision of the child, with great entrenchment in training towards “health childcare” in healthcare programmes among paediatrists and paediatric nurses.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7,8</span></a> Numerous opportunities for access to the child population also exist, through high healthcare system usage during the first stages of life.</p><p id="par0065" class="elsevierStylePara elsevierViewall">At the same time, and due to issues which are also related to anthropology, society has always had to protect the most vulnerable or defenceless individuals, which include children.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> This leads to the demand for health-related information from the parents to their healthcare professionals of reference and to strengthening their confidence in issues regarding health and upbringing.</p><p id="par0070" class="elsevierStylePara elsevierViewall">However, during recent years we are witnessing how a “vaccine-centred model” is being positively imposed, i.e. vaccination as a healthy lifestyle, a concept which has been extended to vaccines throughout life and in different situations, and the use of this tool as a cross-sectional and multi-faceted element.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10–13</span></a> Vaccines are therefore now at the centre of preventative strategies and it is the healthcare professionals of different medical specialists and nurses who comprehensively contemplate prevention through vaccinations.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">The “X” and the “X+Y vaccine universe”</span><p id="par0075" class="elsevierStylePara elsevierViewall">The research and development of vaccines aimed at the first years of life has, conventionally, been a vaccinology priority (“vaccine universe X”). This has meant that, faced with the determination of patients in special medical situations, vaccines initially aimed at the paediatric population will be applied to these groups and over time new scientific evidence will be consolidated on its use in these groups. Numerous examples could be highlighted, such as the application of the anti-pneumococcus vaccine comprised of 13 serotypes in chronically ill patients with or without imunodepression,<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> vaccines against meningococcus in patients whose spleen does not function properly<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> or the indication of the hexavalent vaccine (DTPa+Hib+HB+polio), authorised by the fact sheet up to 7 years of age,<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> but recommended by the healthcare authorities for patients who are recipients of haematopoietic progenitors.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17,18</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">In recent years and based on the modification of epidemiology and the adaptation of scientific evidence we have observed that patients with special medical situations are exposed to risks which the “X” vaccine universe cannot cover, which is why there is the need for a vaccine spectrum and to open new lines of research and development of specific vaccines for risk groups (“X +Y” vaccine universe).<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17,19,20</span></a> This is the case of the adjuvant formulation vaccine against hepatitis B for patients in dialysis or pre-dialysis,<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> vaccines against herpes zóster<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">22,23</span></a> and the new flu vaccines.<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">24,25</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">The definition of new vaccination risks and new medical indications</span><p id="par0085" class="elsevierStylePara elsevierViewall">The group of patients with special situations has conventionally included people aged 60–65 for their relationship with immunosenescence, patients with anatomical or functional splenia, patients with viral infection from human immunodeficiency, patients who receive immunosuppressant drugs (including chemotherapy) and the recipients of haematopoietic progenitor or solid organ transplants.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">The before-mentioned group has now been extended due to the appearance of new infection risks owing to advances in immunosuppressant drugs and immunomodulating drugs, the improvement of epidemiological surveillance tools and the potential benefits of vaccines. To these may be added patients with autoimmune diseases treated with new immunosuppressant drugs and immunomodulating drugs which affect the target cells with interference in the immune response, women subjected to cervical conisation from human papilloma virus-associated pre-neoplastic or neoplastic lesions, men who have sex with men and celiac patients, among others.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Furthermore, it should also be noted that there are increasingly more immunosuppressant drugs and immunomodulating drugs where the product specification sheet includes patient vaccination status awareness, and where therapy should not be started without its assessment. This is the case of fingolimod and natalizumab for multiple sclerosis and the immune evaluation of chickenpox,<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">27,28</span></a> or of eculizumab, a drug prescribed in haemolytic-uremic syndrome and nocturnal paroxysmal haemoglobinuria, and the vaccination prescription against meningococcus.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Towards a common reference vaccine document</span><p id="par0100" class="elsevierStylePara elsevierViewall">Vaccination recommendations in patients with special medical situations have been characterised by being heterogeneous and changing over time. Some scientific societies were lacking in opinions in consensual documents or those of individual ownership,<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">30–32</span></a> whilst at the same time the vaccination programmes of autonomous communities published their official medical indications.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">If we look at the recommendations from the <span class="elsevierStyleItalic">Advisory Committee on Immunization Practices</span> of the United States, a pioneer country in systematic vaccination schedules, it was not until 2002 when the first 2002–2003 adult Schedule was published (for people from 19 years of age onwards) which also included a specific schedule for different special medical situations, including ten vaccine preventable diseases.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a> Notwithstanding, in the paediatric schedule (in the United States up to 18 years of age), this new vaccination concept for patients in special medical situations was not included until 2017.</p><p id="par0110" class="elsevierStylePara elsevierViewall">In Spain, it was the Spanish Society of Preventable Medicine, Public Health and Hygiene which published the systematic vaccination schedule in 2014 and recommendations for vaccination for adults who presented with certain medical conditions, exposures, risk behaviours or special situations.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> Furthermore, the Ministry of Health, Consumption and Social Wellbeing published a document in 2018 entitled vaccination in risk groups of all ages and in certain situations,<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> which represents a necessary updating of the one published in the year 2004.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">The evolution of preventative medicine and public health services</span><p id="par0115" class="elsevierStylePara elsevierViewall">Ten years ago, the vaccination units which were dependent upon the Preventative Medicine and Public Health Services were present almost exclusively in benchmark hospitals and referral of patients was carried out from specialities which controlled the special medical situations.</p><p id="par0120" class="elsevierStylePara elsevierViewall">Now, all benchmark hospitals and a great many district hospitals have vaccination units for these patients, and in some cases are also responsible for the vaccination indications for international travellers. In addition to this, more active work is being undertaken in the definition of referral circuits by hospital specialities and primary care units, and training in vaccines is intensified cross-sectionally for all healthcare profiles. In the future, bearing in mind the dynamic nature of schedules and the constant incorporation of new medical indications and vaccines, it would be of interest to propose strategies for the continuous review and updating of the vaccination schedules for these patients.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Virtual support as a support tool</span><p id="par0125" class="elsevierStylePara elsevierViewall">The application of computerised health tools has greatly advanced in recent years. Whilst interlevel and interprofessional possibilities of communication were previously complicated and were limited to paper or telephone support, nowadays there are other options to improve and speed these up. There are now numerous publications relating to the application of telemedicine to different medical specialties.<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">36–38</span></a> It is known that this mode of healthcare offers advantages both for professionals and patients, given that it shortens waiting lists, avoids travel and promotes patient safety in providing an automated record to consult and a response report in the electronic clinical record of the patient. Virtual consultation on vaccines promoted by the vaccination units of the Preventative Medical Services and Public Health are profiled as a viable and optimisation tool.<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">39,40</span></a></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Information systems and indirect indicators for target group identification</span><p id="par0130" class="elsevierStylePara elsevierViewall">Being aware of vaccination coverage in a country is key to assessing how vaccination programmes work, and the health status of the population in this regard.<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">41</span></a> In general, Spain has a good information system on child vaccination coverage, but not in the area of patients with special medical situations. The situation is such that, currently, there are no records with vaccination profiles in this group and it is difficult to discover overall, specific, vaccination coverage. Only studies relating to the coverages of certain vaccines in specific medical situations and in specific contexts have been published.<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19,42</span></a> This pending issue is therefore already being approached by a workgroup of the Paper on Vaccination Programmes and Records of the Ministry of Health.<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">43</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">From an operative viewpoint and in expectation of having better information systems and identification of target groups, there are valid options with which to work. This is the case of the antiretroviral drug records, immunosuppressants, biologic therapies or chemotherapy, administered through electronic prescription and the dispensation of which is carried out through the Hospital Pharmacy Services, or from the coding of certain pathologies or surgical interventions, such as splenectomy, undertaken by hospital clinical documentation services.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Anyone, anytime, anywhere</span><p id="par0140" class="elsevierStylePara elsevierViewall">Populations have always had doubts about vaccination.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">44</span></a> Until now, the main social networks have focused on family, friends, and work colleagues. Medical information was channelled through healthcare professionals, who the population perceived as the main sources of information and documentation.</p><p id="par0145" class="elsevierStylePara elsevierViewall">In recent years, this situation has significantly changed. The appearance and empowering of social networks have improved information access, but by doing so scientific thoroughness and quality filters have been lost. Such is this case that although other factors may also be having an impact, the World Health Organisation has identified reticence towards vaccination as one of the most relevant threats to world health in the last 2 years.<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">45</span></a> This warning should be monitored but should not trigger a state of alarm.</p><p id="par0150" class="elsevierStylePara elsevierViewall">The goal is to continue working so that “anyone” may be “the trained professionals” who, “at any time” become “the appropriate forums” and who “from anywhere” may become the “technical and scientific areas”.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Conclusions</span><p id="par0155" class="elsevierStylePara elsevierViewall">Vaccinology and the application of vaccines to groups at risk and in special medical situations has favourably evolved in recent years. The new vision of vaccines as epidemiological tools and their applications based on new definitions of risk are serving to better project people with specific risks. Homogenisation of vaccine usage and the broadening of preventative medicine and public health service portfolios help to improve vaccination coverage in these groups. Information systems related to vaccines in risk groups should work together in a coordinated manner.</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Conflict of interests</span><p id="par0160" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare.</p><p id="par0165" class="elsevierStylePara elsevierViewall">FAMLL states they form part of the drafting committee of the journal <span class="elsevierStyleItalic">Vacunas</span>.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:16 [ 0 => array:3 [ "identificador" => "xres1639940" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1462287" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1639941" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1462288" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "From the “paediatric-centred” to “vaccination-centred” model" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "The “X” and the “X+Y vaccine universe”" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "The definition of new vaccination risks and new medical indications" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Towards a common reference vaccine document" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "The evolution of preventative medicine and public health services" ] 10 => array:2 [ "identificador" => "sec0035" "titulo" => "Virtual support as a support tool" ] 11 => array:2 [ "identificador" => "sec0040" "titulo" => "Information systems and indirect indicators for target group identification" ] 12 => array:2 [ "identificador" => "sec0045" "titulo" => "Anyone, anytime, anywhere" ] 13 => array:2 [ "identificador" => "sec0050" "titulo" => "Conclusions" ] 14 => array:2 [ "identificador" => "sec0055" "titulo" => "Conflict of interests" ] 15 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2021-05-03" "fechaAceptado" => "2021-05-26" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1462287" "palabras" => array:4 [ 0 => "Vaccine" 1 => "Vaccination" 2 => "Immunosuppression" 3 => "Special medical situations" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1462288" "palabras" => array:4 [ 0 => "Vacuna" 1 => "Vacunación" 2 => "Inmunodepresión" 3 => "Situaciones especiales" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Vaccination in patients with special medical situations remains a major challenge for health professionals. In recent years, vaccination of these groups has gained special importance because of the conceptual expansion of vaccines associated with early stages of life and the availability of specific vaccines for these patients (adjuvanted or high-burden). On the other hand, new scientific evidence on the definition of new immunopreventable risks is improving the indications and uses of vaccines. In addition, the use of new technologies, as well as indirect information sources for the identification of these patients, contribute significantly to the increase in vaccination coverage.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La vacunación en los pacientes con situaciones médicas especiales sigue siendo un reto para los profesionales sanitarios. En los últimos años, la vacunación de estos grupos ha cobrado más importancia gracias a la ampliación conceptual de las vacunas asociadas a las edades más tempranas de la vida y la disponibilidad de vacunas específicas para estos pacientes (adyuvadas o de alta carga). Por otro lado, las evidencias científicas sobre la definición de nuevos riesgos inmunoprevenibles hacen que se optimicen las indicaciones y los usos de las vacunas. Además, las nuevas tecnologías, así como las fuentes de información indirectas para la identificación de estos pacientes, contribuyen de manera significativa al incremento de las coberturas vacunales.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Fernández-Prada M, Moraga-Llop FA, Pérez-Martín JJ, Mirada-Masip G. Vacunación en pacientes con situaciones médicas especiales: de dónde venimos y a dónde vamos. Vacunas. 2021;22:203–208.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:45 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Vaccination of special populations: protecting the vulnerable" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Doherty" 1 => "R. Schmidt-Ott" 2 => "J.I. Santos" 3 => "L.R. Stanberry" 4 => "A.M. Hofstetter" 5 => "S.L. Rosenthal" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.vaccine.2016.11.015" "Revista" => array:7 [ "tituloSerie" => "Vaccine" "fecha" => "2016" "volumen" => "34" "paginaInicial" => "6681" "paginaFinal" => "6690" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27876197" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S073510971600228X" "estado" => "S300" "issn" => "07351097" ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Evolución de la esperanza de vida al nacimiento por periodo y sexo. Brecha de género. España. [Internet]. INE. [Accessed 11 July 2020]. Available from: <a target="_blank" href="https://www.ine.es/jaxi/Datos.htm?path=/t00/mujeres_hombres/tablas_1/l0/&file=d01001.px#!tabs-tabla">https://www.ine.es/jaxi/Datos.htm?path=/t00/mujeres_hombres/tablas_1/l0/&file=d01001.px#!tabs-tabla</a>." ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:1 [ "host" => array:2 [ 0 => array:1 [ "Libro" => array:3 [ "titulo" => "Vaccination resources for adult patients with chronic conditions" "fecha" => "2019" "editorial" => "CDC" ] ] 1 => array:1 [ "WWW" => array:1 [ "link" => "https://www.cdc.gov/vaccines/hcp/adults/for-patients/health-conditions.html" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "La vacunación reduce considerablemente la morbilidad, las discapacidades, la mortalidad y las inequidades en todo el mundo" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F.E. Andre" 1 => "R. Booy" 2 => "H.L. Bock" 3 => "J. Clemens" 4 => "S.K. Datta" 5 => "T.J. John" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "WWW" => array:2 [ "link" => "https://www.who.int/bulletin/volumes/86/2/07-040089-ab/es/" "fecha" => "2008" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Ministerio de Sanidad, Gobierno de España. Calendarios de vacunación en España 1975-2015. [Accessed 4 May 2020]. Available from: <a target="_blank" href="https://www.mscbs.gob.es/profesionales/saludPublica/prevPromocion/vacunaciones/docs/CalendariosVacunacion1975_2015.pdf">https://www.mscbs.gob.es/profesionales/saludPublica/prevPromocion/vacunaciones/docs/CalendariosVacunacion1975_2015.pdf</a>." ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Plan de acción mundial sobre vacunas 2011-2020" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Organización Mundial de la Salud" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "WWW" => array:2 [ "link" => "https://www.who.int/immunization/global_vaccine_action_plan/DoV_GVAP_2012_2020/es/" "fecha" => "2013" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Orden SCO/3148/2006, de 20 de septiembre, por la que se aprueba y publica el programa formativo de la especialidad de Pediatría y sus Áreas Específicas [Internet]. Boletín Oficial del Estado, 14 de octubre de 2006, núm. 246, pp. 35257 a 35261. [Accessed 20 May 2020]. Available from: <a target="_blank" href="https://www.boe.es/eli/es/o/2006/09/20/sco3148">https://www.boe.es/eli/es/o/2006/09/20/sco3148</a>." ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Orden SAS/1730/2010, de 17 de junio, por la que se aprueba y publica el programa formativo de la especialidad de Enfermería Pediátrica [Internet]. Boletín Oficial del Estado, 29 de junio de 2010, núm. 157, pp. 57251 a 57276. [Accessed 20 May 2020]. Available from: <a target="_blank" href="https://www.boe.es/diario_boe/txt.php?id=BOE-A-2010-10365">https://www.boe.es/diario_boe/txt.php?id=BOE-A-2010-10365</a>." ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Vulnerabilidad y riesgo en salud: ¿dos conceptos concomitantes?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "R. Araujo González" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "RNPS" "fecha" => "2015" "volumen" => "11" "paginaInicial" => "89" "paginaFinal" => "96" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Fundación de Ciencias del Medicamento y Productos Sanitarios. La calidad en los procesos de vacunación frente a la gripe estacional. Innovación e impacto en el SNS. [Accessed 20 May 2020]. Available from: <a target="_blank" href="https://www.fundacionfundamed.org/doc/THINK_TANK_Vacunacion_Gripe.pdf">https://www.fundacionfundamed.org/doc/THINK_TANK_Vacunacion_Gripe.pdf</a>." ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Ministerio de Sanidad, Gobierno de España. Beneficios de la vacunación. [Accessed 15 June 2020]. Available from: <a target="_blank" href="https://www.mscbs.gob.es/campannas/campanas16/vacunacionBeneficios.htm">https://www.mscbs.gob.es/campannas/campanas16/vacunacionBeneficios.htm</a>." ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Organización Mundial de la Salud. Promoción de la Salud. 9.<span class="elsevierStyleSup">a</span> Conferencia Mundial de Promoción de la Salud, Shanghai 2016. [Accessed 15 June 2020]. Available from: <a target="_blank" href="http://www.who.int/healthpromotion/conferences/9gchp/es/">http://www.who.int/healthpromotion/conferences/9gchp/es/</a>." ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Organización Mundial de la Salud. Semana Mundial de la Inmunización de 2019. [Accessed 20 June 2020]. Available from: <a target="_blank" href="https://www.who.int/es/news-room/events/detail/2019/04/24/default-calendar/world-immunization-week-2019">https://www.who.int/es/news-room/events/detail/2019/04/24/default-calendar/world-immunization-week-2019</a>." ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Use of PCV13 and PPSV23 vaccine for adults with immunocompromising conditions" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Centers for Disease Control and Prevention" ] ] ] ] ] "host" => array:2 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "MMWR" "fecha" => "2012" "volumen" => "61" "paginaInicial" => "816" "paginaFinal" => "819" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23051612" "web" => "Medline" ] ] ] ] 1 => array:1 [ "WWW" => array:1 [ "link" => "https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6140a4.htm" ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "2013 IDSA Clinical Practice Guideline for Vaccination of the Immunocompromised Host" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L.G. Rubin" 1 => "M.J. Levin" 2 => "P. Ljungman" 3 => "E.G. Davies" 4 => "R. Avery" 5 => "M. Tomblyn" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/cid/cit684" "Revista" => array:6 [ "tituloSerie" => "Clin Infect Dis" "fecha" => "2014" "volumen" => "58" "paginaInicial" => "e44" "paginaFinal" => "e100" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24311479" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Informe de la AEMPS sobre el uso de vacunas hexavalentes para la inmunización activa en menores de 7 años" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Agencia Española de Medicamentos y Productos Sanitarios" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "WWW" => array:2 [ "link" => "https://www.mscbs.gob.es/profesionales/saludPublica/prevPromocion/vacunaciones/docs/VacunasHexavalentes_menores7anos.pdf" "fecha" => "2019" ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Ministerio de Sanidad, Gobierno de España. Grupo de trabajo de vacunación en población adulta y grupos de riesgo de la Ponencia de Programa y Registro de Vacunaciones. Vacunación en grupos de riesgo de todas las edades y en determinadas situaciones. Comisión de Salud Pública del Consejo Interterritorial del Sistema Nacional de Salud. Ministerio de Sanidad, Consumo y Bienestar Social; julio 2018. [Accessed 1 July 2020]. Available from: <a target="_blank" href="https://www.mscbs.gob.es/profesionales/saludPublica/prevPromocion/vacunaciones/VacGruposRiesgo/Vac_GruposRiesgo_todasEdades.htm">https://www.mscbs.gob.es/profesionales/saludPublica/prevPromocion/vacunaciones/VacGruposRiesgo/Vac_GruposRiesgo_todasEdades.htm</a>." ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Respuesta inmune frente a hepatitis B en trasplantados de progenitores hematopoyéticos vacunados con hexavalente" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Fernández-Prada" 1 => "S. Rodríguez-Vega" 2 => "I. Fernández-Peón" 3 => "C. Martínez-Ortega" 4 => "M.J. Cuervo-Lage" 5 => "F. Fernández-Noval" ] ] ] ] ] "host" => array:2 [ 0 => array:1 [ "Libro" => array:2 [ "titulo" => "Libro de resúmenes del IX Congreso de la Asociación Española de Vacunología" "fecha" => "2017" ] ] 1 => array:1 [ "WWW" => array:1 [ "link" => "http://viajeselcorteinglesvalencia.symposium.events/_files/_event/_8635/_editorFiles/file/LIBRO_COMUNICACIONES_AEV_2017_1a.pdf" ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Uso de vacuna frente a hepatitis B adyuvada con AS04C en pacientes VIH" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. Fernández-Prada" 1 => "O.D. Rodríguez-Fonseca" 2 => "A.M. Brandy-García" 3 => "P. Alonso-Penanes" 4 => "I. Huerta-González" 5 => "F. Fernández-Noval" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Esp Quimioterap" "fecha" => "2018" "volumen" => "31" "paginaInicial" => "105" "paginaFinal" => "109" ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0100" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Strategies to increase responsiveness to hepatitis B vaccination in adults with HIV-1" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J.A. Whitaker" 1 => "N.G. Rouphael" 2 => "S. Edupuganti" 3 => "L. Lai" 4 => "M.J. Mulligan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S1473-3099(12)70243-8" "Revista" => array:6 [ "tituloSerie" => "Lancet Infect Dis" "fecha" => "2012" "volumen" => "12" "paginaInicial" => "966" "paginaFinal" => "976" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23174382" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0105" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:1 [ "host" => array:2 [ 0 => array:1 [ "Libro" => array:2 [ "titulo" => "Ficha técnica FENDRIX, suspensión inyectable" "fecha" => "2009" ] ] 1 => array:1 [ "WWW" => array:1 [ "link" => "https://cima.aemps.es/cima/dochtml/ft/04299001/FT_04299001.html" ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0110" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:1 [ "host" => array:2 [ 0 => array:1 [ "Libro" => array:2 [ "titulo" => "Ficha técnica ZOSTAVAX, polvo y disolvente para suspensión inyectable en jeringa precargada" "fecha" => "2016" ] ] 1 => array:1 [ "WWW" => array:1 [ "link" => "https://cima.aemps.es/cima/dochtml/ft/06341011/FT_06341011.html" ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0115" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Immunogenicity and safety of the adjuvanted recombinant zoster vaccine in patients with solid tumors, vaccinated before or during chemotherapy: a randomized trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Vink" 1 => "I. Delgado Mingorance" 2 => "C. Maximiano Alonso" 3 => "B. Rubio-Viqueira" 4 => "K.H. Jung" 5 => "J.F. Rodríguez Moreno" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/cncr.31909" "Revista" => array:6 [ "tituloSerie" => "Cancer" "fecha" => "2019" "volumen" => "125" "paginaInicial" => "1301" "paginaFinal" => "1312" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30707761" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0120" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparative effectiveness of high dose versus adjuvanted influenza vaccine: a retrospective cohort study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Van Aalst" 1 => "S. Gravenstein" 2 => "V. Mor" 3 => "S.M. Mahmud" 4 => "J. Wilschut" 5 => "M. Postma" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Vaccine" "fecha" => "2020" "volumen" => "30" "paginaInicial" => "372" "paginaFinal" => "379" "itemHostRev" => array:3 [ "pii" => "S0735109710014373" "estado" => "S300" "issn" => "07351097" ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0125" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Aprobación de la primera vacuna tetravalente adyuvada frente a la gripe" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Asociación Española de Vacunología" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "WWW" => array:2 [ "link" => "https://www.vacunas.org/aprobacion-de-la-primera-vacuna-tetravalente-adyuvada-frente-a-la-gripe/" "fecha" => "2020" ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0130" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Calendario de vacunaciones sistemáticas del adulto y recomendaciones de vacunación para los adultos que presentan determinadas condiciones médicas, exposiciones, conductas de riesgo o situaciones especiales. Consenso 2014 Comité de Vacunas de la Sociedad Española de Medicina Preventiva, Salud Pública e Higiene. Available from: <a target="_blank" href="http://sempsph.com/images/stories/recursos/pdf/Consenso%20sobre%20Vacunas%202014/cap%C3%ADtulos%201%20a%2010.pdf">http://sempsph.com/images/stories/recursos/pdf/Consenso%20sobre%20Vacunas%202014/cap%C3%ADtulos%201%20a%2010.pdf</a>." ] ] ] 26 => array:3 [ "identificador" => "bib0135" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:1 [ "host" => array:2 [ 0 => array:1 [ "Libro" => array:2 [ "titulo" => "Ficha técnica GILENYA 0,5 mg cápsulas duras" "fecha" => "2015" ] ] 1 => array:1 [ "WWW" => array:1 [ "link" => "https://cima.aemps.es/cima/dochtml/ft/11677005/FT_11677005.html" ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0140" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:1 [ "host" => array:2 [ 0 => array:1 [ "Libro" => array:2 [ "titulo" => "Ficha técnica TYSABRI 300 mg concentrado para solución para perfusión" "fecha" => "2016" ] ] 1 => array:1 [ "WWW" => array:1 [ "link" => "https://cima.aemps.es/cima/pdfs/ft/06346001/FT_06346001.pdf" ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0145" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:1 [ "host" => array:2 [ 0 => array:1 [ "Libro" => array:2 [ "titulo" => "Ficha técnica SOLIRIS 300 mg concentrado para solución para perfusión" "fecha" => "2012" ] ] 1 => array:1 [ "WWW" => array:1 [ "link" => "https://cima.aemps.es/cima/pdfs/es/ft/07393001/FT_07393001.pdf" ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0150" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "titulo" => "Consenso sobre la vacunación anti-neumocócica en el adulto por riesgo de edad y patología de base. Actualización 2017" ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Esp Quimioterap" "fecha" => "2017" "volumen" => "30" "paginaInicial" => "142" "paginaFinal" => "168" ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0155" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Documento de consenso de la Sociedad Española de Infectología Pediátrica y el Comité Asesor de la Asociación Española de Pediatría para la vacunación en inmunodeprimidos" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M.J. Mellado Peña" 1 => "D. Moreno-Pérez" 2 => "J. Ruiz Contretas" 3 => "T. Hernández-Sampelayo Matos" 4 => "M.L. Navarro Gómez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "An Ped" "fecha" => "2011" "volumen" => "75" "paginaInicial" => "413.e1" "paginaFinal" => "413.e22" ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib0160" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Documento de consenso sobre la prevención de herpes zóster y neuralgia post-herpética" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Cisterna Cáncer R" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "WWW" => array:2 [ "link" => "https://www.semfyc.es/wp-content/uploads/2016/05/ConsensoHerpesZoster.pdf" "fecha" => "2014" ] ] ] ] ] ] 32 => array:3 [ "identificador" => "bib0165" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Calendario de vacunaciones del adulto y vacunación en situaciones especiales [Internet]" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "I. Huerta" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "WWW" => array:2 [ "link" => "https://www.astursalud.es/noticias/-/noticias/nuevo-calendario-de-vacunaciones-del-adulto-y-en-situaciones-especiales-para-asturias-2014" "fecha" => "2014" ] ] ] ] ] ] 33 => array:3 [ "identificador" => "bib0170" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Recommended adult immunization schedule – United States, 2002-2003" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Centers for Disease Control and Prevention (CDC)" ] ] ] ] ] "host" => array:2 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "MMWR Morb Mortal Wkly Rep" "fecha" => "2002" "volumen" => "51" "paginaInicial" => "904" "paginaFinal" => "908" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12418546" "web" => "Medline" ] ] ] ] 1 => array:1 [ "WWW" => array:1 [ "link" => "https://www.cdc.gov/mmwr/PDF/wk/mm5140.pdf" ] ] ] ] ] ] 34 => array:3 [ "identificador" => "bib0175" "etiqueta" => "35" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Grupo de trabajo de Vacunación de Adultos de la Ponencia de Programas y Registro de Vacunaciones" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Ministerio de Sanidad y Consumo" 1 => "Gobierno de España" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "WWW" => array:2 [ "link" => "https://www.mscbs.gob.es/profesionales/saludPublica/prevPromocion/vacunaciones/docs/recoVacunasAdultos.pdf" "fecha" => "2004" ] ] ] ] ] ] 35 => array:3 [ "identificador" => "bib0180" "etiqueta" => "36" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Nephrology eConsults for Primary Care Providers: original investigation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "E. Keely" 1 => "J. Li" 2 => "P. Magner" 3 => "A. Afkham" 4 => "C. Liddy" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Can J Kidney Health Dis" "fecha" => "2018" "volumen" => "5" ] ] ] ] ] ] 36 => array:3 [ "identificador" => "bib0185" "etiqueta" => "37" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "eConsults to endocrinologists improve access and change primary care provider behavior" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "C.S. Tran" 1 => "C.E. Liddy" 2 => "D.M. Liu" 3 => "A. Afkham" 4 => "E.J. Keely" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4158/E161321.OR" "Revista" => array:7 [ "tituloSerie" => "Endocr Pract" "fecha" => "2016" "volumen" => "22" "paginaInicial" => "1145" "paginaFinal" => "1150" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27732095" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0002914918302650" "estado" => "S300" "issn" => "00029149" ] ] ] ] ] ] ] 37 => array:3 [ "identificador" => "bib0190" "etiqueta" => "38" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ask a neurologist: what primary care providers ask, and reducing referrals through eConsults" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A.C. Bradi" 1 => "L. Sitwell" 2 => "C. Liddy" 3 => "A. Afkham" 4 => "E. Keely" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Neurol Clin Pract" "fecha" => "2018" "volumen" => "8" "paginaInicial" => "189" "paginaFinal" => "191" ] ] ] ] ] ] 38 => array:3 [ "identificador" => "bib0195" "etiqueta" => "39" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Televacuna: ¿a qué estás esperando?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M.J. Zapico Baragaño" 1 => "M. Fernández Prada" 2 => "P. Giménez Gómez" 3 => "G. Valcárcel Piedra" 4 => "J. Álvarez Santiago" 5 => "L.M. Martínez Escotet" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Vacunas" "fecha" => "2019" "volumen" => "20" "numero" => "S1" "paginaInicial" => "28" ] ] ] ] ] ] 39 => array:3 [ "identificador" => "bib0200" "etiqueta" => "40" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Preliminary evaluation o fan inter-professional e-consultation on vaccines" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. Fernández-Prada" 1 => "P. Cano-García" 2 => "P. Alonso-Penanes" 3 => "M.J. Zapico-Baragaño" 4 => "P. Giménez-Gómez" 5 => "A. Lana" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/1357633X13512061" "Revista" => array:3 [ "tituloSerie" => "J Telemed Telecare" "fecha" => "2020" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24197398" "web" => "Medline" ] ] ] ] ] ] ] ] 40 => array:3 [ "identificador" => "bib0205" "etiqueta" => "41" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Coberturas de vacunación. Datos estadísticos" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Ministerio de Sanidad y Consumo" 1 => "Gobierno de España" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "WWW" => array:2 [ "link" => "https://www.mscbs.gob.es/profesionales/saludPublica/prevPromocion/vacunaciones/coberturas.htm" "fecha" => "2019" ] ] ] ] ] ] 41 => array:3 [ "identificador" => "bib0210" "etiqueta" => "42" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cobertura de vacunación antigripal en niños con condiciones de riesgo en Cataluña" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "R. González" 1 => "M. Campins" 2 => "J.A. Rodrigo" 3 => "S. Uriona" 4 => "L.M. Vilca" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.eimc.2013.12.010" "Revista" => array:6 [ "tituloSerie" => "Enferm Infecc Microbiol Clin" "fecha" => "2015" "volumen" => "33" "paginaInicial" => "22" "paginaFinal" => "26" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24556268" "web" => "Medline" ] ] ] ] ] ] ] ] 42 => array:3 [ "identificador" => "bib0215" "etiqueta" => "43" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Grupo de trabajo vacunación de sistemas de información en vacunación" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Ministerio de Sanidad" 1 => "Gobierno de España" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "WWW" => array:2 [ "link" => "https://www.mscbs.gob.es/profesionales/saludPublica/prevPromocion/vacunaciones/Ponencia.htm" "fecha" => "2019" ] ] ] ] ] ] 43 => array:3 [ "identificador" => "bib0220" "etiqueta" => "44" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Anti-vaccinationists past and present" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R.M. Wolfe" 1 => "L.K. Sharp" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/bmj.325.7361.430" "Revista" => array:6 [ "tituloSerie" => "BMJ" "fecha" => "2002" "volumen" => "325" "paginaInicial" => "430" "paginaFinal" => "432" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12193361" "web" => "Medline" ] ] ] ] ] ] ] ] 44 => array:3 [ "identificador" => "bib0225" "etiqueta" => "45" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ten threats to global health in 2019" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "World Health Organization" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "WWW" => array:2 [ "link" => "https://www.who.int/news-room/feature-stories/ten-threats-to-global-health-in-2019" "fecha" => "2019" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/24451460/0000002200000003/v2_202201010919/S2445146021000431/v2_202201010919/en/main.assets" "Apartado" => array:4 [ "identificador" => "87215" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Vaccine strategies" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/24451460/0000002200000003/v2_202201010919/S2445146021000431/v2_202201010919/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2445146021000431?idApp=UINPBA00004N" ]