Consensus
Consensus document for the prevention of respiratory infections in adults
Documento de Consenso para a prevenção das infeções respiratórias no adulto
F. Froes
, A. Diniz, C. Robalo Cordeiro, M. Serrado, A. Ramalho de Almeida
Corresponding author
Working Group for the Commission of Respiratory Infections of the Portuguese Pulmonology Society, Portugal
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Reis, L. Nascimento, A. Fernandes" "autores" => array:3 [ 0 => array:2 [ "nombre" => "R." "apellidos" => "Reis" ] 1 => array:2 [ "nombre" => "L." "apellidos" => "Nascimento" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Fernandes" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S087321591300158X?idApp=UINPBA00004E" "url" => "/08732159/0000002000000002/v4_201509041359/S087321591300158X/v4_201509041359/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S0873215914000038" "issn" => "08732159" "doi" => "10.1016/j.rppneu.2013.07.007" "estado" => "S300" "fechaPublicacion" => "2014-03-01" "aid" => "204" "copyright" => "Sociedade Portuguesa de Pneumologia" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "sco" "cita" => "Rev Port Pneumol. 2014;20:107-10" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 8677 "formatos" => array:3 [ "EPUB" => 275 "HTML" => 6564 "PDF" => 1838 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "A new case of Job's syndrome at the clinic: A diagnostic challenge" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "pt" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "107" "paginaFinal" => "110" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Um novo caso de síndrome de Job na clínica: um desafio de diagnóstico" ] ] "contieneResumen" => array:2 [ "en" => true "pt" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 591 "Ancho" => 1300 "Tamanyo" => 86573 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Chest radiograph on admission (A: posteroanterior and B: lateral view) showing multiple thin‐walled cyst (pneumatoceles) with air‐fluid level (*).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Cruz‐Portelles, D. Estopiñan‐Zuñiga" "autores" => array:2 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Cruz‐Portelles" ] 1 => array:2 [ "nombre" => "D." "apellidos" => "Estopiñan‐Zuñiga" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0873215914000038?idApp=UINPBA00004E" "url" => "/08732159/0000002000000002/v4_201509041359/S0873215914000038/v4_201509041359/en/main.assets" ] "en" => array:17 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Consensus</span>" "titulo" => "Consensus document for the prevention of respiratory infections in adults" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "111" "paginaFinal" => "114" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "F. Froes, A. Diniz, C. Robalo Cordeiro, M. Serrado, A. Ramalho de Almeida" "autores" => array:5 [ 0 => array:4 [ "nombre" => "F." "apellidos" => "Froes" "email" => array:1 [ 0 => "filipe.froes@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Diniz" ] 2 => array:2 [ "nombre" => "C. Robalo" "apellidos" => "Cordeiro" ] 3 => array:2 [ "nombre" => "M." "apellidos" => "Serrado" ] 4 => array:2 [ "nombre" => "A. Ramalho" "apellidos" => "de Almeida" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Working Group for the Commission of Respiratory Infections of the Portuguese Pulmonology Society, Portugal" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Documento de Consenso para a prevenção das infeções respiratórias no adulto" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 781 "Ancho" => 1583 "Tamanyo" => 54924 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Schedule for antipneumococcal vaccination in non‐vaccinated individuals or previously vaccinated with VPP23.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Respiratory infections are among the principal causes of morbidity, mortality and of demands on health resources at a global level.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Apart from the direct and indirect costs, what is of major concern is the associated high consumption of antimicrobial drugs and the consequent increased growth in resistance to this class of medicines, which could affect the use of some types of antibiotics in the near future.</p><p id="par0010" class="elsevierStylePara elsevierViewall">In continental Portugal, recently published data relating to the period of 2000–2009 document the significant impact of respiratory infections and, in particular, of pneumonias. In this period hospital admissions for Community Acquired Pneumonia (CAP) represent 3.7% of the total number of adult hospital admission for all causes in National Health Service institutions.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> In the age groups ≥50 and ≥65, hospitalization for CAP represents 5.5% and 7.0% of total admissions respectively.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Given this national situation, there is a general consensus about the necessity for a rapid implementation of measures to prevent respiratory infections in adults.</p><p id="par0020" class="elsevierStylePara elsevierViewall">These preventive measures against respiratory infection cover general measures and specific measures: vaccination against flu and antipneumococcal.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">General measures</span><p id="par0025" class="elsevierStylePara elsevierViewall">In the general measures, related to host defences, the following are recommended<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">‐</span><p id="par0030" class="elsevierStylePara elsevierViewall">smoking cessation;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">‐</span><p id="par0035" class="elsevierStylePara elsevierViewall">control of chronic illnesses (diabetes mellitus, COPD, congestive heart failure, chronic renal failure, chronic liver disease, HIV/AIDS infection, etc.);</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">‐</span><p id="par0040" class="elsevierStylePara elsevierViewall">judicious use of immunosuppressive therapies (including corticosteroids);</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">‐</span><p id="par0045" class="elsevierStylePara elsevierViewall">alcohol counselling (including acute intoxication and chronic alcoholism);</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">‐</span><p id="par0050" class="elsevierStylePara elsevierViewall">advice about dealing with cases of drug addiction;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">‐</span><p id="par0055" class="elsevierStylePara elsevierViewall">adequate nutritional status;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">‐</span><p id="par0060" class="elsevierStylePara elsevierViewall">gamma globulin IV immunotherapy in selected patients (IgG deficiency, multiple myeloma, chronic lymphocytic leukaemia, transplant patients).</p></li></ul></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Anti‐flu vaccination</span><p id="par0065" class="elsevierStylePara elsevierViewall">This endorses the Directorate‐General of Health recommendation for vaccination against seasonal flu for the current season.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Health professionals and other professionals involved in front‐line health care are a priority group for vaccination, because of the increased risk of contracting the illness and transmitting it to their families and their patients. Setting an example and the counselling about vaccination given by health professionals represent one of the principle success factors in keeping to vaccination targets.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Pneumococcal vaccination</span><p id="par0070" class="elsevierStylePara elsevierViewall">In Portugal two pneumococcal vaccines are available for adults aged 18 and above, a pneumococcal polysaccharide vaccine 23‐valente [(<span class="elsevierStyleItalic">Pneumo 23</span><span class="elsevierStyleSup">®</span>) VPP23] with 23 serotypes (1, 2, 3, 4, 5, 6B, 7F, 8, 9N, 9V, 10A, 11A, 12F, 14, 15B, 17F, 18C, 19A, 19F, 20, 22F, 23F, 33F) and a pneumococcal conjugate vaccine 13‐valente [(<span class="elsevierStyleItalic">Prevenar 13</span><span class="elsevierStyleSup">®</span>) VPC13] with13 serotypes (1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F, 23F). Both vaccines are intramuscular and VPP23 can also be administered subcutaneously.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">For adults, vaccines are indicated for the prevention of invasive pneumococcal diseases by the serotypes included in the vaccine. The bacteraemia secondary to pneumonia is the main manifestation of invasive pneumococcal disease in adults, representing about 75% of cases of invasive disease in the adult population<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> and more than 80% in those ≥65.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">At the present time, we are waiting for the results of studies about the efficacy of VPC13 in the prevention of pneumonia in adults.</p><p id="par0085" class="elsevierStylePara elsevierViewall">Epidemiological surveillance programmes on invasive pneumococcal disease and its serotypes at a national level are crucial for the evaluation of the effectiveness of anti‐pneumococcal vaccines and recommendations for their utilization. According to the latest data available at a national level, relating to the period 2006–2008, from a total of 1100 isolates of <span class="elsevierStyleItalic">Streptococcus pneumoniae</span> in adults with an invasive pneumococcal disease, 68% of the serotypes identified were included in VPC13 and 84% in VPP23.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> presents recommendations for antipneumococcal vaccinations according to the risk of invasive pneumococcal disease.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7,8,10–13</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">In adults who are indicated for antipneumococcal vaccination, the following dosing schedule is suggested<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>:<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">‐</span><p id="par0100" class="elsevierStylePara elsevierViewall">adults who have not previously been vaccinated should first receive VPC13 followed by a dose of VPP23 at least 8 weeks later;</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">‐</span><p id="par0105" class="elsevierStylePara elsevierViewall">adults who have already been vaccinated with VPP23 should only receive VPC13 at least one year after the last vaccination of VPP23;</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">‐</span><p id="par0110" class="elsevierStylePara elsevierViewall">for adults with indication for revaccination with VPP23, the second dose must only be given at least 5 years after the first dose of VPP23 and at least 8 weeks after administration of VPC13.</p></li></ul></p><p id="par0115" class="elsevierStylePara elsevierViewall">Revaccination with VPC13 is not recommended and in the case of VPP23, revaccination should only be done once (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">Pneumococcal vaccines should be administered at the most propitious time for the immune system to respond; <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> presents an optimization calendar of vaccinations for certain clinical conditions (adapted<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">The influenza and pneumococcal vaccines can be given at the same time, preferably in different arms.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusions</span><p id="par0130" class="elsevierStylePara elsevierViewall">The recommendations presented in this document should be subject to clinical judgement in relation to the individual cases.</p><p id="par0135" class="elsevierStylePara elsevierViewall">This document will be subject to periodic revisions in order to include the scientific evidence of future studies and knowledge about other measures and vaccines like, for example, the whooping cough which is available and recommended in some European countries.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14,15</span></a></p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:3 [ "identificador" => "xres547649" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec565529" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres547648" "titulo" => "Resumo" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec565528" "titulo" => "Palavras‐chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "General measures" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Anti‐flu vaccination" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Pneumococcal vaccination" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conclusions" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec565529" "palabras" => array:5 [ 0 => "Prevention" 1 => "Respiratory infections" 2 => "Pneumonia" 3 => "Flu vaccination" 4 => "Pneumococcal vaccination" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras‐chave" "identificador" => "xpalclavsec565528" "palabras" => array:5 [ 0 => "Prevenção" 1 => "Infeções respiratórias" 2 => "Pneumonia" 3 => "Vacina da gripe" 4 => "Vacina pneumocócica" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Infectious diseases are one of the principle causes of morbidity, mortality and drain on health resources worldwide. In recent years there has been an increase in the impact of respiratory infections, particularly in the Portuguese population. It is for this reason that the Portuguese Respiratory Society has presented a series of recommendations for the prevention of respiratory infections in adults. These recommendations include both general measures and vaccinations for flu and pneumococcal pneumonia.</p></span>" ] "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">As infeções respiratórias são uma das principais causas de morbilidade, mortalidade e consumo de recursos de saúde a nível global. Nos últimos anos tem‐se assistido a um crescente impacto das infeções respiratórias, nomeadamente na população portuguesa. Assim, a Sociedade Portuguesa de Pneumologia apresenta um conjunto de recomendações para a prevenção das infeções respiratórias no adulto. Estas recomendações englobam medidas gerais e de vacinação antigripal e antipneumocócica.</p></span>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 781 "Ancho" => 1583 "Tamanyo" => 54924 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Schedule for antipneumococcal vaccination in non‐vaccinated individuals or previously vaccinated with VPP23.</p>" ] ] 1 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col">Age \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Groups at risk of invasive pneumococcal disease \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">VPC13 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">VPP23</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Vaccination \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Vaccination \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Revaccination (after 5 years) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " rowspan="4" align="left" valign="top">≥18</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">Immunocompromised</span>:<span class="elsevierStyleHsp" style=""></span>Congenital or acquired immunodeficiency<span class="elsevierStyleHsp" style=""></span>HIV/AIDS<span class="elsevierStyleHsp" style=""></span>Chronic renal failure<span class="elsevierStyleHsp" style=""></span>Nephrotic syndrome<span class="elsevierStyleHsp" style=""></span>Neoplastic diseases (e.g., haematological malignancies, lymphomas, multiple myeloma)<span class="elsevierStyleHsp" style=""></span>Iatrogenic immunosuppression (e,g., long‐term systemic corticotherapy, chemotherapy and radiotherapy)<span class="elsevierStyleHsp" style=""></span>Solid organ transplant \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Recommended \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Recommended \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Recommended \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">Anatomical or functional asplenia</span><span class="elsevierStyleHsp" style=""></span>(e.g., sickle cell anaemia and other hemoglobinopathies, congenital or acquired asplenia) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Recommended \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Recommended \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Recommended \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Cerebrospinal fluid leaks \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Recommended \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Recommended \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Recommended \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Cochlear implants \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Recommended \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Recommended \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Recommended \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">≥50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">Chronic co‐morbidities</span>:<span class="elsevierStyleHsp" style=""></span>Chronic respiratory diseases (includes chronic asthma under inhaled corticosteroid)<span class="elsevierStyleHsp" style=""></span>Chronic cardiac diseases (excludes hypertension alone)<span class="elsevierStyleHsp" style=""></span>Chronic liver diseases (e.g., cirrhosis)<span class="elsevierStyleHsp" style=""></span>Diabetes mellitus (excludes patients controlled by diet only) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Recommended \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Recommended \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Recommended \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">≥65 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">Individuals aged ≥65</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Recommended \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Recommended \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Not recommended \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab884603.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Recommendations for adult antipneumococcal vaccination.</p>" ] ] 2 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Condition \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Vaccination recommendations (individuals not vaccinated) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">HIV/AIDS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Early, preferably with lymphocytes TCD4<span class="elsevierStyleSup">+</span><span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>200/mm<span class="elsevierStyleSup">3</span>; if TCD4<span class="elsevierStyleSup">+</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>200/mm<span class="elsevierStyleSup">3</span>, vaccinate without waiting for immune reconstruction and consider revaccination after TCD4<span class="elsevierStyleSup">+</span><span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>200/mm<span class="elsevierStyleSup">3</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Surgical splenectomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">In elective surgery, at least 2 weeks before surgery; in unplanned surgery, vaccinate 2 weeks after surgery \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Autoimmune diseases \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Early and before starting immunosuppressive therapy \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Waiting for a solid organ transplant \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Early, at least 2–4 weeks before transplant \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Solid organ transplant \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Start vaccination 6 months after transplant \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Transplant of hematopoietic cells \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Start vaccination 3–6 months after transplant \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Neoplastic diseases in chemotherapy and/or radiotherapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10–14 days before treatment or 3 months after finishing chemotherapy or radiotherapy. If the vaccine is administered during the course of chemotherapy consider whether to revaccinate 3 months after finishing treatment \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab884602.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Recommendations for antipneumococcal vaccination in specific circumstances (adapted from<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,13</span></a>).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:15 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community‐acquired pneumonia in adults" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L.A. 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Gil-de Miguel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.eimc.2012.12.011" "Revista" => array:6 [ "tituloSerie" => "Enferm Infecc Microbiol Clin" "fecha" => "2013" "volumen" => "31" "paginaInicial" => "240" "paginaFinal" => "253" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23411362" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rationale for pertussis booster vaccination throughout life in Europe" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F. Zepp" 1 => "U. Heininger" 2 => "J. Mertsola" 3 => "E. Bernatowska" 4 => "N. Guiso" 5 => "J. Roord" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S1473-3099(11)70007-X" "Revista" => array:6 [ "tituloSerie" => "Lancet Infect Dis" "fecha" => "2011" "volumen" => "11" "paginaInicial" => "557" "paginaFinal" => "570" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21600850" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/08732159/0000002000000002/v4_201509041359/S0873215914000099/v4_201509041359/en/main.assets" "Apartado" => array:4 [ "identificador" => "23501" "tipo" => "SECCION" "pt" => array:2 [ "titulo" => "Consensus" "idiomaDefecto" => true ] "idiomaDefecto" => "pt" ] "PDF" => "https://static.elsevier.es/multimedia/08732159/0000002000000002/v4_201509041359/S0873215914000099/v4_201509041359/en/main.pdf?idApp=UINPBA00004E&text.app=https://journalpulmonology.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0873215914000099?idApp=UINPBA00004E" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 22 | 12 | 34 |
| 2024 October | 56 | 57 | 113 |
| 2024 September | 60 | 59 | 119 |
| 2024 August | 74 | 62 | 136 |
| 2024 July | 65 | 38 | 103 |
| 2024 June | 39 | 23 | 62 |
| 2024 May | 66 | 51 | 117 |
| 2024 April | 68 | 41 | 109 |
| 2024 March | 55 | 24 | 79 |
| 2024 February | 37 | 32 | 69 |
| 2024 January | 36 | 29 | 65 |
| 2023 December | 38 | 25 | 63 |
| 2023 November | 53 | 48 | 101 |
| 2023 October | 45 | 46 | 91 |
| 2023 September | 32 | 35 | 67 |
| 2023 August | 25 | 21 | 46 |
| 2023 July | 24 | 27 | 51 |
| 2023 June | 26 | 11 | 37 |
| 2023 May | 51 | 40 | 91 |
| 2023 April | 50 | 16 | 66 |
| 2023 March | 74 | 20 | 94 |
| 2023 February | 41 | 26 | 67 |
| 2023 January | 41 | 22 | 63 |
| 2022 December | 56 | 20 | 76 |
| 2022 November | 80 | 68 | 148 |
| 2022 October | 83 | 39 | 122 |
| 2022 September | 39 | 77 | 116 |
| 2022 August | 47 | 45 | 92 |
| 2022 July | 46 | 59 | 105 |
| 2022 June | 26 | 33 | 59 |
| 2022 May | 45 | 41 | 86 |
| 2022 April | 30 | 38 | 68 |
| 2022 March | 45 | 53 | 98 |
| 2022 February | 40 | 43 | 83 |
| 2022 January | 37 | 50 | 87 |
| 2021 December | 51 | 54 | 105 |
| 2021 November | 48 | 43 | 91 |
| 2021 October | 50 | 53 | 103 |
| 2021 September | 23 | 42 | 65 |
| 2021 August | 26 | 28 | 54 |
| 2021 July | 31 | 25 | 56 |
| 2021 June | 39 | 32 | 71 |
| 2021 May | 46 | 37 | 83 |
| 2021 April | 129 | 58 | 187 |
| 2021 March | 55 | 16 | 71 |
| 2021 February | 57 | 11 | 68 |
| 2021 January | 51 | 22 | 73 |
| 2020 December | 49 | 24 | 73 |
| 2020 November | 58 | 25 | 83 |
| 2020 October | 72 | 29 | 101 |
| 2020 September | 83 | 35 | 118 |
| 2020 August | 95 | 22 | 117 |
| 2020 July | 115 | 16 | 131 |
| 2020 June | 122 | 15 | 137 |
| 2020 May | 120 | 25 | 145 |
| 2020 April | 144 | 8 | 152 |
| 2020 March | 90 | 15 | 105 |
| 2020 February | 95 | 20 | 115 |
| 2020 January | 125 | 29 | 154 |
| 2019 December | 85 | 19 | 104 |
| 2019 November | 129 | 21 | 150 |
| 2019 October | 124 | 32 | 156 |
| 2019 September | 98 | 24 | 122 |
| 2019 August | 113 | 20 | 133 |
| 2019 July | 102 | 19 | 121 |
| 2019 June | 107 | 17 | 124 |
| 2019 May | 170 | 31 | 201 |
| 2019 April | 145 | 34 | 179 |
| 2019 March | 147 | 20 | 167 |
| 2019 February | 120 | 24 | 144 |
| 2019 January | 168 | 31 | 199 |
| 2018 December | 88 | 3 | 91 |
| 2018 November | 37 | 1 | 38 |
| 2018 October | 39 | 6 | 45 |
| 2018 September | 38 | 8 | 46 |
| 2018 August | 43 | 43 | 86 |
| 2018 July | 49 | 25 | 74 |
| 2018 June | 41 | 23 | 64 |
| 2018 May | 75 | 28 | 103 |
| 2018 April | 70 | 30 | 100 |
| 2018 March | 60 | 19 | 79 |
| 2018 February | 38 | 22 | 60 |
| 2018 January | 36 | 18 | 54 |
| 2017 December | 42 | 19 | 61 |
| 2017 November | 56 | 31 | 87 |
| 2017 October | 46 | 21 | 67 |
| 2017 September | 54 | 30 | 84 |
| 2017 August | 61 | 22 | 83 |
| 2017 July | 42 | 34 | 76 |
| 2017 June | 46 | 24 | 70 |
| 2017 May | 62 | 34 | 96 |
| 2017 April | 29 | 35 | 64 |
| 2017 March | 27 | 41 | 68 |
| 2017 February | 22 | 15 | 37 |
| 2017 January | 30 | 9 | 39 |
| 2016 December | 23 | 20 | 43 |
| 2016 November | 36 | 21 | 57 |
| 2016 October | 29 | 28 | 57 |
| 2016 September | 8 | 14 | 22 |
| 2016 August | 2 | 12 | 14 |
| 2016 July | 9 | 25 | 34 |
| 2016 June | 0 | 19 | 19 |
| 2016 May | 10 | 0 | 10 |
| 2016 April | 42 | 4 | 46 |
| 2016 March | 73 | 80 | 153 |
| 2016 February | 75 | 96 | 171 |
| 2016 January | 61 | 89 | 150 |
| 2015 December | 80 | 75 | 155 |
| 2015 November | 65 | 167 | 232 |
| 2015 October | 85 | 180 | 265 |
| 2015 September | 69 | 165 | 234 |
| 2015 August | 72 | 124 | 196 |
| 2015 July | 69 | 94 | 163 |
| 2015 June | 56 | 71 | 127 |
| 2015 May | 109 | 163 | 272 |
| 2015 April | 85 | 137 | 222 |
| 2015 March | 75 | 119 | 194 |
| 2015 February | 74 | 116 | 190 |
| 2015 January | 64 | 101 | 165 |
| 2014 December | 71 | 96 | 167 |
| 2014 November | 68 | 92 | 160 |
| 2014 October | 107 | 92 | 199 |
| 2014 September | 75 | 76 | 151 |
| 2014 August | 40 | 40 | 80 |
| 2014 July | 55 | 47 | 102 |
| 2014 June | 59 | 38 | 97 |
| 2014 May | 64 | 57 | 121 |
| 2014 April | 99 | 81 | 180 |
| 2014 March | 22 | 36 | 58 |
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