Editorial
Influenza diagnosis, treatment and prophylaxis. Consensus statement
Diagnóstico, tratamiento y prevención de la gripe. Documento de consenso
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Consensus statement" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "81" "paginaFinal" => "83" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Jaime Pérez-Martín, María Fernández-Prada" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Jaime" "apellidos" => "Pérez-Martín" "email" => array:1 [ 0 => "jaimej.perez@carm.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "af0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cr0005" ] ] ] 1 => array:3 [ "nombre" => "María" "apellidos" => "Fernández-Prada" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "af0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Dirección General de Salud Pública y Adicciones, Murcia, Spain" "etiqueta" => "a" "identificador" => "af0005" ] 1 => array:3 [ "entidad" => "Departamento de Medicina Preventiva y Salud Pública, Hospital Vital Álvarez Buylla, Mieres, Asturias, Spain" "etiqueta" => "b" "identificador" => "af0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cr0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Diagnóstico, tratamiento y prevención de la gripe. Documento de consenso" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="p0005" class="elsevierStylePara elsevierViewall">Of all infectious diseases, COVID-19 and influenza are the ones which most highly relate to population mortality. Although seasonal influenza has been underestimated on numerous occasions, it is the infectious disease with the greatest burden of disease, both in terms of mild and severe cases, hospitalisations and deaths, only recently surpassed by the COVID-19 pandemic. In addition to this, influenza is a disease with pandemic potential, which makes it an absolute priority in Public Health and of interest to all professionals dedicated to infectious diseases.<a class="elsevierStyleCrossRef" href="#bb0005"><span class="elsevierStyleSup">1</span></a> All this prompted the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC for its initials in Spanish), the Spanish Society of Paediatric Infectious Diseases (SEIP), the Spanish Vaccinology Association (AEV), the Spanish Society of Family and Community Medicine (SEMFYC) and the Spanish Society of Preventive Medicine, Public Health and Public Health Management (SEMPSPGS) to join forces with the common objective of drafting a consensus document on the comprehensive approach to influenza from the perspective of diagnosis, treatment and, of course, prevention.<a class="elsevierStyleCrossRef" href="#bb0005"><span class="elsevierStyleSup">1</span></a></p><p id="p0010" class="elsevierStylePara elsevierViewall">The document is structured around more than 40 agreed upon questions and their corresponding answers, addressing the diagnosis and management of influenza in children and adults, microbiological diagnosis, treatment in outpatients and inpatients, prevention of intra- and extra-hospital transmission, as well as vaccination as the main preventive tool. Specifically, in the section on vaccination, 6 questions are addressed which we will briefly discuss below.</p><p id="p0015" class="elsevierStylePara elsevierViewall">The first question addresses child and adolescent vaccination. When this document was begun (prior to the COVID-19 pandemic), the Ministry of Health's recommendations focused on children and adolescents with at-risk pathologies, something that has remained the same until the current 2022-23<a class="elsevierStyleCrossRef" href="#bb0010"><span class="elsevierStyleSup">2</span></a> season. The consensus statement adopts the same stance as the World Health Organisation (WHO)<a class="elsevierStyleCrossRef" href="#bb0015"><span class="elsevierStyleSup">3</span></a> and the European Centre for Disease Control (ECDC)<a class="elsevierStyleCrossRef" href="#bb0020"><span class="elsevierStyleSup">4</span></a> which, since 2012, have recommended universal vaccination against influenza in children aged 6-59 months. Recently, on 20 October 2022, the Public Health Commission approved the recommendations for childhood influenza vaccination, introducing universal influenza vaccination between 6 and 59 months of age.<a class="elsevierStyleCrossRef" href="#bb0025"><span class="elsevierStyleSup">5</span></a> This same recommendation had also been incorporated by the Vaccine Advisory Committee of the Spanish Association of Paediatrics for the 2021-22<a class="elsevierStyleCrossRef" href="#bb0030"><span class="elsevierStyleSup">6</span></a> season. The recommendations reflected in the document point to universal vaccination between 6 and 59 months, and vaccination of children and adolescents between 5 and 18 years of age belonging to at-risk groups, highlighting the need for everyone to work together to achieve higher coverage (especially in at-risk groups), which unfortunately in our environment is below what is expected.<a class="elsevierStyleCrossRef" href="#bb0035"><span class="elsevierStyleSup">7</span></a></p><p id="p0020" class="elsevierStylePara elsevierViewall">With regard to adult vaccination, the document recommends vaccination of the entire population aged 65 years and over and those in at-risk groups aged 18-64 years, stressing the need for both health professionals and authorities to work together to achieve better vaccination coverage. The recommendations are based on the fact that 88% of severe cases and 98% of deaths occur in people who had at least one risk factor.<a class="elsevierStyleCrossRef" href="#bb0040"><span class="elsevierStyleSup">8</span></a></p><p id="p0025" class="elsevierStylePara elsevierViewall">The document also addresses the type of vaccines that should be recommended in each group, currently recommending the use of quadrivalent vaccines in all groups (remember that work began at a time when trivalent vaccines were still in use), based on the significant burden of disease caused by the type B virus.<a class="elsevierStyleCrossRef" href="#bb0045"><span class="elsevierStyleSup">9</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0050"><span class="elsevierStyleSup">10</span></a> Furthermore, although the cross-protection that one type B strain can provide against the other is recognized,<a class="elsevierStyleCrossRef" href="#bb0055"><span class="elsevierStyleSup">11</span></a> protection is ensured by the use of vaccines that directly include two type B strains.<a class="elsevierStyleCrossRef" href="#bb0060"><span class="elsevierStyleSup">12</span></a> The recommendation in the population aged 65 years and older is to use vaccines with enhanced immunogenicity (adjuvanted, recombinant or high load), something that some health authorities have taken a position on, including the US, which has made the same recommendation since the last influenza vaccination season 2022-23.<a class="elsevierStyleCrossRef" href="#bb0065"><span class="elsevierStyleSup">13</span></a></p><p id="p0030" class="elsevierStylePara elsevierViewall">Another of the issues discussed is the dosage. In this regard, two doses with an interval of 4 weeks between them are recommended in children under 9 years of age in the first year of immunisation, with a position in favour of the use of whole doses in all age groups. The use of half doses, recommended by different health authorities, in the group of children under 36 months derives from when the vaccines used were whole virus vaccines in which case greater reactogenicity could be recorded; however, with current vaccines, the use of full doses achieves greater immunogenicity with a similar reactogenicity to half doses.<a class="elsevierStyleCrossRef" href="#bb0060"><span class="elsevierStyleSup">12</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0070"><span class="elsevierStyleSup">14</span></a> The optimal period for vaccination is October-November, as immunisation at this time provides better protection during the period of greatest influenza virus circulation, which usually occurs in January and February.</p><p id="p0035" class="elsevierStylePara elsevierViewall">Finally, the document closes with contraindications to vaccination, severe allergic reactions (e.g., anaphylaxis) to previous doses of influenza vaccine or to any of its components, also assessing the evolution of vaccination recommendations in people with egg allergy<a class="elsevierStyleCrossRef" href="#bb0075"><span class="elsevierStyleSup">15</span></a> or Guillain-Barre syndrome.<a class="elsevierStyleCrossRef" href="#bb0080"><span class="elsevierStyleSup">16</span></a></p><p id="p0040" class="elsevierStylePara elsevierViewall">We hope that the Consensus Statement will be of interest to all healthcare professionals and that it will serve to improve the diagnosis, treatment and, in our case, especially the prevention of influenza. The executive summary is a quick read. However, those professionals who wish for greater depth on the subject can refer to the full consensus, which has more than 250 bibliographic citations, in which approximately 30 references focus on influenza vaccination.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bs0005" "bibliografiaReferencia" => array:16 [ 0 => array:3 [ "identificador" => "bb0005" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Executive summary. Diagnosis, treatment and prophylaxis of influenza virus infection. 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