Editorial
An ounce of prevention is worth a pound of cure
Mais vale prevenir do que remediar
Department of Pathophysiology and Transplantation, University of Milan, IRCCS Fondazione Ca‘Granda Milano, Milan, Italy
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Blasi, M. Mantero" "autores" => array:2 [ 0 => array:4 [ "nombre" => "F." "apellidos" => "Blasi" "email" => array:1 [ 0 => "francesco.blasi@unimi.it" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Mantero" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Department of Pathophysiology and Transplantation, University of Milan, IRCCS Fondazione Ca‘Granda Milano, Milan, Italy" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Mais vale prevenir do que remediar" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Influenza and pneumococcal infections are major causes of death and disability in Europe, mainly affecting children between 2 and 24 months of age and people >65 years of age.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Despite the clear effectiveness of the vaccination approach, it has to be one of the major achievements of public health for population protection, both the general population and health-care workers have a low level of acceptance of vaccinations.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Vaccination programs in children with 7-valent pneumococcal conjugate vaccine have reduced the incidence of invasive pneumococcal disease (IPD) by almost 70%, with the herd effect in adults leading to an 18% reduction of IPD incidence in non-vaccinated adults aged 65 years or more.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Moreover, the use of such vaccinations in children has reduced the incidence of antibiotic resistance, according to records for 1999 and 2002, from 40.8% to 26.4% for penicillin, from 34.9% to 9.4% for cephalosporin and from 29.5% to 18.1% for erythromycin.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The introduction of 10- and 13-valent vaccines, increasing serotype coverage, may expand the clinical benefits in adult populations at risk for pneumococcal disease. The results of a large Dutch randomized controlled trial designed to test the efficacy and effectiveness of 13-valent vaccine in adults will be available soon, hopefully supporting indication for universal vaccination.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Epidemiological evidence indicates that influenza contributes to all-cause mortality and to cardiovascular and respiratory hospitalisations and recent studies confirm that vaccination not only prevents influenza but also brings significant preventive benefits for patients at risk for acute myocardial infarction.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,9</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The Consensus Document for the prevention of respiratory infections in adults, published in this issue, underlines the importance of a comprehensive approach to prevention: for general measures and vaccinations.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Smoking, high alcohol intake, being underweight, suffering from chronic diseases, living in a large household or having regular contact with children are associated with an increased risk of pneumonia.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Smoking cessation (and prevention) is clearly a major step towards reducing the burden of respiratory infections including tuberculosis and deserves comprehensive tobacco-control strategies including strong public campaigns as indicated by WHO and by ATS and ERS.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12,13</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">On the other hand, better management of chronic diseases is a cornerstone of prevention of respiratory infections and vaccinations are a cornerstone of the best management of these diseases.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Vaccination strategies based on the use of more effective vaccines are expected to have a substantial public health impact on respiratory infections and health services costs by reducing the burden of influenza and pneumococcal infections.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Another important issue that should be taken into account when considering prevention of respiratory infections is the role of health disparities.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Lower socioeconomic status and belonging to ethnic minorities are associated with higher prevalence of tobacco smoking, environmental exposures, occupational hazards, poor nutrition and lack of access to quality healthcare including vaccinations.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">As stated in the consensus document, a comprehensive approach to prevention and a proactive policy to implementing the recommendations are mandatory and of paramount importance in reducing the present and future burden of respiratory infections.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:13 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "The European lung white book: respiratory health and disease in Europe. 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| 2023 February | 35 | 24 | 59 |
| 2023 January | 26 | 14 | 40 |
| 2022 December | 30 | 18 | 48 |
| 2022 November | 47 | 23 | 70 |
| 2022 October | 45 | 75 | 120 |
| 2022 September | 19 | 35 | 54 |
| 2022 August | 35 | 35 | 70 |
| 2022 July | 32 | 44 | 76 |
| 2022 June | 14 | 21 | 35 |
| 2022 May | 35 | 37 | 72 |
| 2022 April | 27 | 40 | 67 |
| 2022 March | 30 | 39 | 69 |
| 2022 February | 28 | 29 | 57 |
| 2022 January | 33 | 27 | 60 |
| 2021 December | 27 | 41 | 68 |
| 2021 November | 27 | 35 | 62 |
| 2021 October | 26 | 38 | 64 |
| 2021 September | 36 | 44 | 80 |
| 2021 August | 18 | 16 | 34 |
| 2021 July | 29 | 24 | 53 |
| 2021 June | 29 | 23 | 52 |
| 2021 May | 42 | 33 | 75 |
| 2021 April | 113 | 78 | 191 |
| 2021 March | 76 | 17 | 93 |
| 2021 February | 53 | 14 | 67 |
| 2021 January | 53 | 14 | 67 |
| 2020 December | 38 | 7 | 45 |
| 2020 November | 59 | 20 | 79 |
| 2020 October | 47 | 24 | 71 |
| 2020 September | 66 | 17 | 83 |
| 2020 August | 54 | 21 | 75 |
| 2020 July | 58 | 20 | 78 |
| 2020 June | 44 | 25 | 69 |
| 2020 May | 55 | 21 | 76 |
| 2020 April | 60 | 11 | 71 |
| 2020 March | 51 | 10 | 61 |
| 2020 February | 48 | 22 | 70 |
| 2020 January | 67 | 22 | 89 |
| 2019 December | 43 | 21 | 64 |
| 2019 November | 42 | 14 | 56 |
| 2019 October | 49 | 13 | 62 |
| 2019 September | 48 | 15 | 63 |
| 2019 August | 80 | 17 | 97 |
| 2019 July | 71 | 20 | 91 |
| 2019 June | 109 | 20 | 129 |
| 2019 May | 109 | 17 | 126 |
| 2019 April | 132 | 22 | 154 |
| 2019 March | 182 | 10 | 192 |
| 2019 February | 128 | 10 | 138 |
| 2019 January | 161 | 25 | 186 |
| 2018 December | 107 | 4 | 111 |
| 2018 November | 71 | 1 | 72 |
| 2018 October | 73 | 10 | 83 |
| 2018 September | 43 | 4 | 47 |
| 2018 August | 44 | 30 | 74 |
| 2018 July | 55 | 21 | 76 |
| 2018 June | 83 | 20 | 103 |
| 2018 May | 81 | 23 | 104 |
| 2018 April | 122 | 20 | 142 |
| 2018 March | 92 | 22 | 114 |
| 2018 February | 48 | 12 | 60 |
| 2018 January | 88 | 10 | 98 |
| 2017 December | 90 | 17 | 107 |
| 2017 November | 53 | 17 | 70 |
| 2017 October | 23 | 14 | 37 |
| 2017 September | 37 | 14 | 51 |
| 2017 August | 36 | 26 | 62 |
| 2017 July | 35 | 12 | 47 |
| 2017 June | 28 | 24 | 52 |
| 2017 May | 53 | 25 | 78 |
| 2017 April | 16 | 9 | 25 |
| 2017 March | 23 | 12 | 35 |
| 2017 February | 17 | 6 | 23 |
| 2017 January | 18 | 6 | 24 |
| 2016 December | 15 | 9 | 24 |
| 2016 November | 15 | 7 | 22 |
| 2016 October | 13 | 9 | 22 |
| 2016 September | 12 | 2 | 14 |
| 2016 August | 6 | 1 | 7 |
| 2016 July | 6 | 6 | 12 |
| 2016 May | 0 | 6 | 6 |
| 2016 April | 22 | 3 | 25 |
| 2016 March | 26 | 17 | 43 |
| 2016 February | 57 | 32 | 89 |
| 2016 January | 37 | 31 | 68 |
| 2015 December | 45 | 20 | 65 |
| 2015 November | 51 | 33 | 84 |
| 2015 October | 37 | 15 | 52 |
| 2015 September | 78 | 32 | 110 |
| 2015 August | 57 | 30 | 87 |
| 2015 July | 38 | 20 | 58 |
| 2015 June | 24 | 4 | 28 |
| 2015 May | 59 | 30 | 89 |
| 2015 April | 35 | 14 | 49 |
| 2015 March | 52 | 18 | 70 |
| 2015 February | 33 | 16 | 49 |
| 2015 January | 40 | 19 | 59 |
| 2014 December | 52 | 39 | 91 |
| 2014 November | 53 | 21 | 74 |
| 2014 October | 59 | 19 | 78 |
| 2014 September | 40 | 27 | 67 |
| 2014 August | 45 | 21 | 66 |
| 2014 July | 36 | 18 | 54 |
| 2014 June | 36 | 24 | 60 |
| 2014 May | 36 | 22 | 58 |
| 2014 April | 86 | 45 | 131 |
| 2014 March | 30 | 12 | 42 |
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