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Resumen El Comite Asesor de Vacunas de la Asociacion Espanola de Pediatria emite todos los anos, antes del inicio de la temporada estacional de la gripe, unas recomendaciones sobre la vacunacion frente a este virus en la edad pediatrica. Con relacion a esta edad y sus contactos, este comite sigue considerando que la vacunacion antigripal debe emplearse en los siguientes casos: 1. Grupos de riesgo: ninos a partir de los 6 meses de edad y adolescentes en determinadas situaciones o enfermedades de base. 2. Ninos sanos a partir de los 6 meses de edad y adolescentes sanos que convivan con pacientes de riesgo. 3. Adultos en contacto con ninos y adolescentes incluidos en grupos de riesgo. Se enfatiza la vacunacion del entorno familiar cuando haya lactantes menores de 6 meses de edad con factores de riesgo, ya que estos no pueden recibir la vacuna antigripal. Es especialmente importante la recomendacion de la vacunacion antigripal de todos los profesionales sanitarios.

Resumen: El Comité Asesor de Vacunas de la Asociación Española de Pediatría (CAV-AEP) actualiza anualmente el calendario de vacunaciones teniendo en cuenta tanto aspectos epidemiológicos como de seguridad, efectividad y eficiencia de las vacunas.El presente calendario incluye grados de recomendación. Se consideran vacunas sistemáticas aquellas que el CAV-AEP estima que todos los niños deberían recibir; recomendadas, las que presentan un perfil de vacuna sistemática en la edad pediátrica y que es deseable que los niños reciban, pero que pueden ser priorizadas en función de los recursos para su financiación pública; y dirigidas a grupos de riesgo, aquellas con indicación preferente para personas en ciertas situaciones especiales.Los calendarios de vacunaciones tienen que ser dinámicos y adaptarse a los cambios epidemiológicos que vayan surgiendo. Teniendo en cuenta los últimos cambios en la epidemiología de las enfermedades, el CAV-AEP recomienda la administración de la 1.a dosis de las vacunas triple vírica y varicela a los 12 meses y la 2.a dosis a los 2-3 años; la administración de la vacuna DTPa o Tdpa a los 4-6 años, siempre acompañada de otra dosis de Tdpa a los 11-12 años; y el paso a un esquema 2 meses, 12 meses y 12 años de la vacunación frente al meningococo C.Se reafirma en la recomendación de incluir la vacunación frente al neumococo en el calendario de vacunación sistemático. El CAV-AEP estima que deben incrementarse las coberturas de vacunación frente al papilomavirus humano en las niñas a los 11-12 años. La vacunación universal frente a la varicela iniciada en el segundo año de vida es una estrategia efectiva, y se solicita la inmediata disponibilidad pública de la vacuna, reclamando el derecho a la prescripción y el derecho de los niños sanos a poder ser vacunados. La vacunación frente al rotavirus, dadas la morbilidad y la elevada carga sanitaria, es recomendable en todos los lactantes. Se insiste en la necesidad de vacunar frente a la gripe y a la hepatitis A a todos los que presenten factores de riesgo para dichas enfermedades. La vacuna frente al meningococo B, recientemente autorizada, abre un capítulo de esperanza en la prevención de esta enfermedad. En espera de próximos estudios nacionales e internacionales se recomienda, por el momento, para el control de brotes epidémicos y se insiste en el deseo de que sea comercializada libremente en las oficinas de farmacia.Por último, se insiste en la necesidad de actualizar las vacunaciones incompletas con las pautas de vacunación acelerada. Abstract: The Advisory Committee on Vaccines of the Spanish Association of Paediatrics (CAV-AEP) updates the immunisation schedule every year, taking into account epidemiological data as well as evidence on safety, effectiveness and efficiency of vaccines.The present schedule includes levels of recommendation. We have graded, as routine vaccinations, those that the CAV-AEP consider all children should receive; as recommended those that fit the profile for universal childhood immunisation and would ideally be given to all children, but that can be prioritised according to the resources available for their public funding; and as risk group vaccinations those that specifically target individuals in special situations.Immunisation schedules tend to be dynamic and adaptable to ongoing epidemiological changes. Based on the latest epidemiological trends, CAV-AEP recommends the administration of the first dose of MMR and varicella vaccines at age 12 months, with the second dose at age 2-3 years; the administration of DTaP or Tdap vaccine at age 4-6 years, always followed by another Tdap dose at 11-12 years; and the three meningococcal C scheme at 2 months, 12 months and 12 years of age.It reasserts its recommendation to include vaccination against pneumococcal disease in the routine immunisation schedule. The CAV-AEP believes that the coverage of vaccination against human papillomavirus in girls aged 11-12 years must be increased. Universal vaccination against varicella in the second year of life is an effective strategy, and the immediate public availability of the vaccine is requested in order to guarantee the right of healthy children to be vaccinated. Vaccination against rotavirus is recommended in all infants due to the morbidity and elevated healthcare burden of the virus. The Committee stresses the need to vaccinate population groups considered at risk against influenza and hepatitis A. The recently authorised meningococcal B vaccine has opened a chapter of hope in the prevention of this disease. In anticipation of upcoming national and international studies, the Committee recommends the vaccine for the control of disease outbreaks, and insists on the need to be available in pharmacies.Finally, it emphasises the need to bring incomplete vaccinations up to date following the catch-up immunisation schedule.

E d e e c a C p d La extravagante situacion de Espana, con 19 calendarios con diferencias en contenidos y cronologias1, no argumentadas desde el punto de vista sanitario ni social, es unica en el mundo. En algunos paises, pero escasos, existen algunos calendarios oficiales diferentes, pero no en la cuantia y disparidad existente en Espana, lo que conduce a una penosa fotografia de la sanidad espanola, tanto en nuestra sociedad como a nivel internacional.

Resumen: El Comité Asesor de Vacunas (CAV) de la Asociación Española de Pediatría actualiza anualmente el calendario de vacunaciones teniendo en cuenta tanto aspectos epidemiológicos, como de efectividad y eficiencia de las vacunas.El presente calendario incluye grados de recomendación. Se han considerado como vacunas sistemáticas aquellas que el CAV estima que todos los niños deberían recibir, como recomendadas las que presentan un perfil de vacuna sistemática en la edad pediátrica y que es deseable que los niños reciban, pero que pueden ser priorizadas en función de los recursos para su financiación pública, y dirigidas a grupos de riesgo aquellas con indicación preferente para personas en situaciones epidemiológicas de riesgo. El CAV considera como objetivo prioritario la consecución de un calendario de vacunaciones único para toda España.El CAV se reafirma en la recomendación de incluir la vacunación frente a neumococo en el calendario de vacunación sistemática. La vacunación universal frente a varicela en el segundo año de vida es una estrategia efectiva y por tanto un objetivo deseable.La vacunación frente a rotavirus, dada la morbilidad y la elevada carga sanitaria, es recomendable en todos los lactantes. Debido a los problemas actuales de disponibilidad de las vacunas, relacionados con la presencia de circovirus, el CAV insta a que, tan pronto como sea posible, se reinicie la vacunación frente a rotavirus por considerarla una oferta de salud deseable para todos los niños en nuestro país.El CAV se adhiere a las recomendaciones del Consejo Interterritorial del Sistema Nacional de Salud en referencia al la vacunación sistemática frente al virus del papiloma humano de todas las niñas de 11 a 14 años e insiste en la necesidad de vacunar frente a la gripe y hepatitis A a todos los que presenten factores de riesgo para dichas enfermedades. Finalmente, se insiste en la necesidad de actualizar las vacunaciones incompletas con las pautas de vacunación acelerada. Abstract: The Advisory Committee on Vaccines of the Spanish Paediatric Association updates annually the immunization schedule, taking into account epidemiological data as well as evidence of the effectiveness and efficiency of vaccines.This vaccination schedule includes grades of recommendation. The committee has graded as universal vaccines those that all children should receive, as recommended, those with a profile of universal vaccines of childhood and as are desirable those that all children may receive, but that can be prioritized based on public funding resources and for risk groups, targeting those groups of people in epidemiological situations of risk. The Committee considers as a priority to achieve a common immunization schedule for Spain.The Committee reaffirms the recommendation to include pneumococcal vaccination in the routine vaccination schedule. Vaccination against varicella in the second year of life is an effective strategy and therefore a desirable goal.Given the morbidity and high burden on the health care system, vaccination against rotavirus is recommended for all infants. Due to the current problems of availability of both vaccines, associated with the recent finding of circovirus, the committee urges that rotavirus vaccination is restarted as soon as possible as it is considered a desirable health benefit for all children in our country.The Committee adheres to the recommendations of the National Health Coordination Council in reference to routine vaccination against HPV for all girls aged 11 to 14 years and stresses the need to vaccinate all patients with risk factors for these diseases against influenza and hepatitis A. Finally, it stresses the need to update incomplete immunizations using accelerated immunization schedules.

The Advisory Committee on Vaccines of the Spanish Association of Paediatrics (CAV-AEP) annually publishes the immunisation schedule which, in our opinion, estimates optimal for children resident in Spain, considering available evidence on current vaccines. We acknowledge the effort of the Ministry of Health during the last year in order to optimize the funded unified Spanish vaccination schedule, with the recent inclusion of pneumococcal and varicella vaccination in early infancy. Regarding the funded vaccines included in the official unified immunization schedule, taking into account available data, CAV-AEP recommends 2+1 strategy (2, 4 and 12 months) with hexavalent (DTPa-IPV-Hib-HB) vaccines and 13-valent pneumococcal conjugate vaccine. Administration of Tdap and poliomyelitis booster dose at the age of 6 is recommended, as well as Tdap vaccine for adolescents and pregnant women, between 27-36 weeks gestation. The two-dose scheme should be used for MMR (12 months and 2-4 years) and varicella (15 months and 2-4 years). Coverage of human papillomavirus vaccination in girls aged 11-12 with a two dose scheme (0, 6 months) should be improved. Information for male adolescents about potential beneficial effects of this immunisation should be provided as well. Regarding recommended unfunded immunisations, CAV-AEP recommends the administration of meningococcal B vaccine, due to the current availability in Spanish communitary pharmacies, with a 3+1 scheme (3, 5, 7 and 13-15 months). CAV-AEP requests the incorporation of this vaccine in the funded unified schedule. Vaccination against rotavirus is recommended in all infants. Annual influenza immunisation and vaccination against hepatitis A are indicated in population groups considered at risk.

Meningococcal invasive disease, including the main clinical presentation forms (sepsis and meningitis), is a severe and potentially lethal infection caused by different serogroups of Neisseria meningitidis. Meningococcal serogroup B is the most prevalent in Europe. Most cases occur in children, with a mortality rate of 10% and a risk of permanent sequelae of 20–30% among survivors.The highest incidence and case fatality rates are observed in healthy children under 2–3 years old, followed by adolescents, although it can occur at any age.With the arrival in Spain of the only available vaccine against meningococcus B, the Advisory Committee on Vaccines of the Spanish Association of Paediatrics has analysed its preventive potential in detail, as well as its peculiar administrative situation in Spain.The purpose of this document is to publish the statement of the Committee as regards this vaccination and the access to it by the Spanish population, taking into account that it has been only authorised for people at risk. The vaccine is available free in the rest of Europe for those who want to acquire it, and in some countries and regions it has been introduced into the systematic immunisation schedules.The Committee considers that Bexsero® has a profile of a vaccine to be included in the official schedules of all the Spanish autonomous communities and insists on the need for it to be available in pharmacies for its administration in all children older than 2 months. Resumen: La enfermedad meningocócica invasora, con sus 2 formas de presentación principales (sepsis y meningitis), es una patología grave y potencialmente mortal, causada por distintos serogrupos de Neisseria meningitidis, entre los cuales, actualmente, predomina el serogrupo B en Europa. La mayoría de los casos se producen en la edad pediátrica, con una mortalidad aproximada del 10% y un riesgo de secuelas permanentes del 20-30% entre los supervivientes. Presenta mayor incidencia y letalidad en niños sanos menores de 2-3 años, seguidos de los adolescentes, aunque puede ocurrir a cualquier edad.Hasta ahora no se contaba con ningún arma inmunopreventiva contra el meningococo B. Así, con la llegada a España de la única vacuna actualmente disponible, el Comité Asesor de Vacunas de la Asociación Española de Pediatría (CAV-AEP) ha analizado detalladamente tanto el potencial preventivo de dicha vacuna, como la situación peculiar administrativa de la misma en España. El objetivo de este documento es informar del posicionamiento del CAV-AEP en relación con la vacuna frente al meningococo B y el acceso a la misma por parte de la población infantil española, teniendo en cuenta que ha sido autorizada exclusivamente para el uso hospitalario en personas de riesgo. En Europa, la vacuna sí está disponible en farmacias, incluso incluida en calendarios oficiales de algunos países o regiones.Este comité considera que Bexsero® presenta un perfil de vacuna a incluir en todos los calendarios españoles y que debería estar disponible libremente en farmacias para su administración en todos los niños mayores de 2 meses.

Introduccion: en ninos y adolescentes sanos, las vacunaciones son con frecuencia fuente de dolor y sufrimiento. Padres, ninos, adolescentes y profesionales sanitarios muestran preocupacion sobre ello. El Comite Asesor de Vacunas de la Asociacion Espanola de Pediatria (CAV-AEP) cree que abordar el dolor y el sufrimiento al vacunar es necesario, siguiendo la metodologia de la medicina basada en la evidencia. El objetivo del presente trabajo es elaborar recomendaciones basadas en el conocimiento cientifico. Material y metodos: se dividio la materia de estudio en cuatro areas: amamantamiento y soluciones azucaradas, anestesicos topicos, metodos para la administracion de vacunas y otras intervenciones (distraccion). Se realizo una sintesis de la evidencia, asumiendo las recomendaciones de la Guia de practica clinica de Anna Taddio (2010) e incorporando la evidencia de revisiones sistematicas y ensayos clinicos posteriores a los incorporados en dicha guia. Resultados: las medidas que se han mostrado efectivas en la disminucion del dolor han sido las siguientes: en lactantes, amamantar antes, durante y despues de la inyeccion; las soluciones azucaradas son una alternativa si la lactancia materna no fuera posible; los anestesicos topicos son eficaces para todas las edades, pero requieren un tiempo para mostrar su efecto y tienen un coste; no aspirar en la inyeccion intramuscular y hacerlo lo mas rapido posible; administrar las vacunas de forma que la mas dolorosa sea la ultima; cuando sea posible, es preferible inyectar simultaneamente mas de una vacuna que hacerlo de forma secuencial; sostener al nino en brazos; y utilizar maniobras de distraccion para ninos de 2-14 anos. Conclusiones: realizada una exhaustiva revision del tema, hay pruebas suficientes para afirmar que los profesionales que administran vacunas infantiles deberian poner en practica medidas para atenuar el dolor que indudablemente acompana al procedimiento de la vacunacion. Se trata ademas, en general, de medidas tecnicamente sencillas y faciles de incorporar a la practica.

Resumen: El Comité Asesor de Vacunas de la Asociación Española de Pediatría actualiza anualmente su calendario de vacunaciones, tras un análisis tanto epidemiológico como de la seguridad, efectividad y eficiencia de las vacunas actuales, incluyendo grados de recomendación. Es el calendario que se estima idóneo actualmente para los niños residentes en España.En cuanto a las vacunas oficiales incluidas en el calendario común, se recalca la posibilidad de vacunar indistintamente frente a hepatitis B desde el nacimiento o desde los 2 meses; la recomendación de la primera dosis de triple vírica y de varicela a los 12 meses y la segunda a los 2-3 años; la administración de la vacuna DTPa o Tdpa a los 6 años, con refuerzo en la adolescencia; estrategias con Tdpa en embarazadas y convivientes del recién nacido, y la inmunización frente al papilomavirus en niñas a los 11-12 años con pauta de 2 dosis (0, 6 meses).Este comité insiste en la vacunación antineumocócica universal, tal y como se está llevando a cabo en todos los países de Europa Occidental.La vacuna frente al meningococo B, autorizada pero bloqueada actualmente en España, presenta un perfil de vacuna sistemática y se reivindica que, al menos, esté disponible en las farmacias comunitarias.Se propone, igualmente, la disponibilidad pública de las vacunas frente a la varicela, ya que han demostrado ser efectivas y seguras a partir del segundo año de vida. La vacunación frente al rotavirus es recomendable en todos los lactantes. La vacunación antigripal anual y la inmunización frente a la hepatitis A están indicadas en grupos de riesgo. Abstract: The Advisory Committee on Vaccines of the Spanish Association of Paediatrics updates the immunisation schedule every year, taking into account epidemiological data as well as evidence on the safety, effectiveness and efficiency of current vaccines, including levels of recommendation. In our opinion, this is the optimal vaccination calendar for all children resident in Spain.Regarding the vaccines included in the official unified immunization schedule, the Committee emphasizes the administration of the first dose of hepatitis B either at birth or at 2 months of life; the recommendation of the first dose of MMR and varicella vaccine at the age of 12 months, with the second dose at the age of 2-3 years; DTaP or Tdap vaccine at the age of 6 years, followed by another Tdap booster dose at 11-12 years old; Tdap strategies for pregnant women and household contacts of the newborn, and immunization against human papillomavirus in girls aged 11-12 years old with a 2 dose scheme (0, 6 months).The Committee reasserts its recommendation to include vaccination against pneumococcal disease in the routine immunisation schedule, the same as it is being conducted in Western European countries.The recently authorised meningococcal B vaccine, currently blocked in Spain, exhibits the profile of a universal vaccine. The Committe insists on the need of having the vaccine available in communitary pharmacies.It has also proposed the free availability of varicella vaccines. Their efectiveness and safety have been confirmed when they are administred from the second year of life. Vaccination against rotavirus is recommended in all infants. The Committee stresses the need to vaccinate population groups considered at risk against influenza and hepatitis A.

The Advisory Committee on Vaccines of the Spanish Association of Paediatrics updates the immunisation schedule every year, taking into account epidemiological data as well as evidence on the safety, effectiveness and efficiency of current vaccines, including levels of recommendation. In our opinion, this is the optimal vaccination calendar for all children resident in Spain.Regarding the vaccines included in the official unified immunization schedule, the Committee emphasizes the administration of the first dose of hepatitis B either at birth or at 2 months of life; recommends the first dose of MMR and varicella vaccine at the age of 12 months, with the second dose at the age of 2–3 years; DTaP or Tdap vaccine at the age of 6 years, followed by another Tdap booster dose at 11–12 years; Tdap strategies for pregnant women and household contacts of the newborn, and immunization against human papillomavirus in girls aged 11–12 years with a 2-dose scheme (0, 6 months).The Committee reasserts its recommendation to include vaccination against pneumococcal disease in the routine immunisation schedule, the same as that conducted in Western European countries.The recently authorised meningococcal B vaccine, currently blocked in Spain, exhibits the profile of a universal vaccine. The Committee insists on the need to have the vaccine available in community pharmacies.It has also proposed the free availability of varicella vaccines. Their effectiveness and safety have been confirmed when they are administered from the second year of life. Vaccination against rotavirus is recommended in all infants. The Committee stresses the need to vaccinate population groups considered at risk against influenza and hepatitis A. Resumen: El Comité Asesor de Vacunas de la Asociación Española de Pediatría actualiza anualmente su calendario de vacunaciones, tras un análisis tanto epidemiológico como de la seguridad, efectividad y eficiencia de las vacunas actuales, incluyendo grados de recomendación. Es el calendario que se estima idóneo actualmente para los niños residentes en España.En cuanto a las vacunas oficiales incluidas en el calendario común, se recalca la posibilidad de vacunar indistintamente frente a hepatitis B desde el nacimiento o desde los 2 meses; la recomendación de la primera dosis de triple vírica y de varicela a los 12 meses y la segunda a los 2-3 años; la administración de la vacuna DTPa o Tdpa a los 6 años, con refuerzo en la adolescencia; estrategias con Tdpa en embarazadas y convivientes del recién nacido, y la inmunización frente al papilomavirus en niñas a los 11-12 años con pauta de 2 dosis (0, 6 meses).Este comité insiste en la vacunación antineumocócica universal, tal y como se está llevando a cabo en todos los países de Europa Occidental.La vacuna frente al meningococo B, autorizada pero bloqueada actualmente en España, presenta un perfil de vacuna sistemática y se reivindica que, al menos, esté disponible en las farmacias comunitarias.Se propone, igualmente, la disponibilidad pública de las vacunas frente a la varicela, ya que han demostrado ser efectivas y seguras a partir del segundo año de vida. La vacunación frente al rotavirus es recomendable en todos los lactantes. La vacunación antigripal anual y la inmunización frente a la hepatitis A están indicadas en grupos de riesgo.

Objetivo: Conocer la incidencia, así como los serotipos implicados y los patrones de resistencia antibiótica de meningitis producidas por Streptococcus pneumoniae en niños españoles. Material y método: Estudio prosp ectivo, multicéntrico, realizado en 5 comunidades autónomas (Cataluña, Galicia, Madrid, Navarra y País Vasco) a lo largo de 1 año (1 de febrero de 2000 a 31 de enero de 2001). Se incluyeron todos los niños entre 0 y 14 años con meningitis neumocócica diagnosticados por sintomatología y líquido cefalorraquídeo (LCR) sugerente con aislamiento de S. pneumoniae en LCR/sangre por métodos habituales o por técnica de reacción en cadena de la polimerasa (PCR), de la totalidad de hospitales de las comunidades autónomas estudiadas. La serotipia se realizó mediante la reacción de quellung y/o immunoblotting y susceptibilidad a antibióticos por la técnica de dilución en agar. La población infantil de 0–14 años de estas comunidades es de 2.290.304 niños. Resultados: Se encontraron 52 casos. Uno tenía menos de 2meses de edad, 25 (48 %) entre 2 y 12 meses y 12 (23 %) entre 12 y 24 meses. La incidencia anual por 100.000 niños en el primer y segundo año de vida fue de 17,75 casos (intervalo de confianza [IC] al 95 %, 11,59–26,01) y 8,39 casos (IC 95 %, 4,67–15,79) respectivamente, siendo en los primeros 2 y 5 años de vida de 13,13 (IC 95 %, 9,29–18,02) y 6,29 (IC 95 %, 4,57–8,45) casos, respectivamente. Casi la mitad de las cepas aisladas (47,6 %) mostraron sensibilidad disminuida a la penicilina. El serotipo 19F fue el más frecuente (12 casos: 28,6%). El 80 % de los serotipos aislados estuvieron incluidos en la formulación de la vacuna conjugada heptavalente. Conclusión: La incidencia de meningitis neumocócica en niños de las 5 comunidades autónomas españolas es elevada, casi el doble que la encontrada en un estudio previo de diseño retrospectivo, realizado en la misma población 1–3 años antes. Casi todos los serotipos aislados están incluidos en la vacuna conjugada heptavalente. La mitad de las cepas mostraron sensibilidad disminuida a la penicilina. : Objective: To determine the incidence, as well as the implicated serotypes and patterns of antibiotic resistance of Streptococcus pneumoniae meningitis in Spanish children. Material and method: We performed a prospective, multicenter study in five Autonomous Communities (Catalonia, Galicia, Madrid, Navarre and the Basque Country) for 1 year (1 February 2000 – 31 January 2001). All children aged 0–14 years with pneumococcal meningitis from all the hospitals in the Autonomous Communities studied were included. Diagnosis was based on clinical findings and isolation of S. pneumonia in the cerebrospinal fluid/blood using routine methods or polymerase chain reaction. Serotyping was performed using the guellung reaction and/or immunoblotting and susceptibility to antibiotics was evaluated by the technique of agar dilution. The pediatric population aged 0–14 years in the Autonomous Communities studied comprises 2,290,304 children. Results: Fifty-two cases were identified. One patient was aged less than 2 months old, 25 (48 %) were aged 2–12 months, and 12 patients (23 %) were aged 12–24 months. The annual incidence per 100,000 children aged between 1 and 2 years was 17.75 cases (95 % CI: 11.59 – 26.01) and 8.39 cases (95 % CI: 4.67 – 15.79) respectively, and that for children in the first 2 and 5 years of life was 13.13 (95% CI: 9.29 – 18.02) and 6.29 (95 % CI: 4.57 – 8.,45) cases respectively. Nearly half the strains isolated (47.6%) showed reduced sensitivity to penicillin. The most frequent serotype was 19F (12 cases [28.6 %]). Eighty percent of the isolated serotypes were included in the formula of the heptavalent conjugate vaccine. Conclusion: The incidence of pneumococcal meningitis in children from five Spanish Autonomous Communities is high, nearly twice that found in a prior retrospective studied performed in the same population 1–3 years previously. Almost all the isolated serotypes were included in the heptavalent conjugate vaccine. Half the strains showed reduced sensitivity to penicillin.

The Advisory Committee on Vaccines of the Spanish Association of Paediatrics updates the immunisation schedule every year, taking into account epidemiological data as well as evidence on the safety, effectiveness and efficiency of current vaccines, including levels of recommendation. In our opinion, this is the optimal vaccination calendar for all children resident in Spain. Regarding the vaccines included in the official unified immunization schedule, the Committee emphasizes the administration of the first dose of hepatitis B either at birth or at 2 months of life; the recommendation of the first dose of MMR and varicella vaccine at the age of 12 months, with the second dose at the age of 2-3 years; DTaP or Tdap vaccine at the age of 6 years, followed by another Tdap booster dose at 11-12 years old; Tdap strategies for pregnant women and household contacts of the newborn, and immunization against human papillomavirus in girls aged 11-12 years old with a 2 dose scheme (0, 6 months). The Committee reasserts its recommendation to include vaccination against pneumococcal disease in the routine immunisation schedule, the same as it is being conducted in Western European countries. The recently authorised meningococcal B vaccine, currently blocked in Spain, exhibits the profile of a universal vaccine. The Committe insists on the need of having the vaccine available in communitary pharmacies. It has also proposed the free availability of varicella vaccines. Their efectiveness and safety have been confirmed when they are administred from the second year of life. Vaccination against rotavirus is recommended in all infants. The Committee stresses the need to vaccinate population groups considered at risk against influenza and hepatitis A.

Meningococcal invasive disease, including the main clinical presentation forms (sepsis and meningitis), is a severe and potentially lethal infection caused by different serogroups of Neisseria meningitidis. Meningococcal serogroup B is the most prevalent in Europe. Most cases occur in children, with a mortality rate of 10% and a risk of permanent sequelae of 20-30% among survivors. The highest incidence and case fatality rates are observed in healthy children under 2-3 years old, followed by adolescents, although it can occur at any age. With the arrival in Spain of the only available vaccine against meningococcus B, the Advisory Committee on Vaccines of the Spanish Association of Paediatrics has analysed its preventive potential in detail, as well as its peculiar administrative situation in Spain. The purpose of this document is to publish the statement of the Committee as regards this vaccination and the access to it by the Spanish population, taking into account that it has been only authorized for people at risk. The vaccine is available free in the rest of Europe for those who want to acquire it, and in some countries and regions it has been introduced into the systematic immunisation schedules. The Committee considers that Bexsero® has a profile of a vaccine to be included in the official schedules of all the Spanish autonomous communities and insists on the need for it to be available in pharmacies for its administration in all children older than 2 months.

The Advisory Committee on Vaccines of the Spanish Association of Paediatrics (CAV-AEP) updates the immunisation schedule every year, taking into account epidemiological data as well as evidence on safety, effectiveness and efficiency of vaccines. The present schedule includes levels of recommendation. We have graded, as routine vaccinations, those that the CAV-AEP consider all children should receive; as recommended those that fit the profile for universal childhood immunisation and would ideally be given to all children, but that can be prioritised according to the resources available for their public funding; and as risk group vaccinations those that specifically target individuals in special situations. Immunisation schedules tend to be dynamic and adaptable to ongoing epidemiological changes. Based on the latest epidemiological trends, CAV-AEP recommends the administration of the first dose of MMR and varicella vaccines at age 12 months, with the second dose at age 2-3 years; the administration of DTaP or Tdap vaccine at age 4-6 years, always followed by another Tdap dose at 11-12 years; and the three meningococcal C scheme at 2 months, 12 months and 12 years of age. It reasserts its recommendation to include vaccination against pneumococcal disease in the routine immunisation schedule. The CAV-AEP believes that the coverage of vaccination against human papillomavirus in girls aged 11-12 years must be increased. Universal vaccination against varicella in the second year of life is an effective strategy, and the immediate public availability of the vaccine is requested in order to guarantee the right of healthy children to be vaccinated. Vaccination against rotavirus is recommended in all infants due to the morbidity and elevated healthcare burden of the virus. The Committee stresses the need to vaccinate population groups considered at risk against influenza and hepatitis A. The recently authorised meningococcal B vaccine has opened a chapter of hope in the prevention of this disease. In anticipation of upcoming national and international studies, the Committee recommends the vaccine for the control of disease outbreaks, and insists on the need to be available in pharmacies. Finally, it emphasises the need to bring incomplete vaccinations up to date following the catch-up immunisation schedule.

Resumen: El Comité Asesor de Vacunas de la Asociación Española de Pediatría (CAV-AEP) actualiza anualmente el calendario de vacunaciones teniendo en cuenta tanto aspectos epidemiológicos, como de seguridad, efectividad y eficiencia de las vacunas.El presente calendario incluye grados de recomendación. Se han considerado como vacunas sistemáticas aquellas que el CAV-AEP estima que todos los niños deberían recibir; como recomendadas las que presentan un perfil de vacuna sistemática en la edad pediátrica y que es deseable que los niños reciban, pero que pueden ser priorizadas en función de los recursos para su financiación pública; y dirigidas a grupos de riesgo aquellas con indicación preferente para personas en situaciones de riesgo. Los calendarios de vacunaciones tienen que ser dinámicos y adaptarse a los cambios epidemiológicos que vayan surgiendo. El CAV-AEP considera como objetivo prioritario la consecución de un calendario de vacunación único para toda España.Teniendo en cuenta los últimos cambios en la epidemiología de las enfermedades, el CAV-AEP mantiene las novedades propuestas la temporada anterior, como la administración de las primeras dosis de las vacunas triple vírica y varicela a los 12 meses y las segundas dosis a los 2-3 años, así como la administración de la vacuna Tdpa a los 4-6 años, siempre acompañada de otra dosis a los 11-14 años, con preferencia a los 11-12 años.El CAV-AEP estima que deben incrementarse las coberturas de vacunación frente al papilomavirus humano en las niñas de 11 a 14 años, con preferencia a los 11-12 años. Se reafirma en la recomendación de incluir la vacunación frente al neumococo en el calendario de vacunación sistemático. La vacunación universal frente a la varicela en el segundo año de vida es una estrategia efectiva y, por tanto, un objetivo deseable. La vacunación frente al rotavirus, dadas la morbilidad y la elevada carga sanitaria, es recomendable en todos los lactantes. Se insiste en la necesidad de vacunar frente a la gripe y a la hepatitis A a todos los que presenten factores de riesgo para dichas enfermedades.Finalmente, se insiste en la necesidad de actualizar las vacunaciones incompletas con las pautas de vacunación acelerada. Abstract: The Advisory Committee on Vaccines of the Spanish Association of Paediatrics (CAV-AEP) updates the immunisation schedule every year, taking into account epidemiological data as well as evidence on the safety, effectiveness and efficiency of vaccines.The present schedule includes levels of recommendation. We have graded as routine vaccinations those that the CAV-AEP consider all children should receive; as recommended those that fit the profile for universal childhood immunisation and would ideally be given to all children, but that can be prioritised according to the resources available for their public funding; and as risk group vaccinations those that specifically target individuals in situations of risk. Immunisation schedules tend to be dynamic and adaptable to ongoing epidemiological changes. Nevertheless, the achievement of a unified immunisation schedule in all regions of Spain is a top priority for the CAV-AEP.Based on the latest epidemiological trends, CAV-AEP follows the innovations proposed in the last year's schedule, such as the administration of the first dose of the MMR and the varicella vaccines at age 12 months and the second dose at age 2-3 years, as well as the administration of the Tdap vaccine at age 4-6 years, always followed by another dose at 11-14 years of age, preferably at 11-12 years.The CAV-AEP believes that the coverage of vaccination against human papillomavirus in girls aged 11-14 years, preferably at 11-12 years, must increase. It reasserts its recommendation to include vaccination against pneumococcal disease in the routine immunisation schedule. Universal vaccination against varicella in the second year of life is an effective strategy and therefore a desirable objective.Vaccination against rotavirus is recommended in all infants due to the morbidity and elevated healthcare burden of the virus. The Committee stresses the need to vaccinate population groups considered at risk against influenza and hepatitis A.Finally, it emphasizes the need to bring incomplete vaccinations up to date following the catch-up immunisation schedule.

The Advisory Committee on Vaccines of the Spanish Association of Paediatrics (CAV-AEP) annually publishes the immunisation schedule which, in our opinion, estimates optimal for children resident in Spain, considering available evidence on current vaccines. We acknowledge the effort of the Ministry of Health during the last year in order to optimise the funded unified Spanish vaccination schedule, with the recent inclusion of pneumococcal and varicella vaccination in early infancy.Regarding the funded vaccines included in the official unified immunisation schedule, taking into account available data, CAV-AEP recommends 2 + 1 strategy (2, 4 and 12 months) with hexavalent (DTPa-IPV-Hib-HB) vaccines and 13-valent pneumococcal conjugate vaccine.Administration of Tdap and poliomyelitis booster dose at the age of 6 is recommended, as well as Tdap vaccine for adolescents and pregnant women, between 27 and 36 weeks gestation.The two-dose scheme should be used for MMR (12 months and 2–4 years) and varicella (15 months and 2–4 years).Coverage of human papillomavirus vaccination in girls aged 11–12 with a two dose scheme (0, 6 months) should be improved. Information for male adolescents about potential beneficial effects of this immunisation should be provided as well.Regarding recommended unfunded immunisations, CAV-AEP recommends the administration of meningococcal B vaccine, due to the current availability in Spanish communitary pharmacies, with a 3 + 1 scheme (3, 5, 7 and 13–15 months). CAV-AEP requests the incorporation of this vaccine in the funded unified schedule. Vaccination against rotavirus is recommended in all infants.Annual influenza immunisation and vaccination against hepatitis A are indicated in population groups considered at risk. Resumen: El CAV-AEP publica anualmente el calendario de vacunaciones que estima idóneo para los niños residentes en España, teniendo en cuenta la evidencia disponible sobre las vacunas. Reconocemos el esfuerzo del Ministerio de Sanidad, en el último año, por optimizar el calendario común, con la inclusión de la vacunación frente al neumococo y la varicela en la primera infancia.En cuanto a las vacunas financiadas incluidas en el calendario común, con los datos disponibles actualmente, y dada la falta de disponibilidad del componente de tosferina, se recomienda emplear esquemas 2 + 1 (2, 4 y 12 meses) con las vacunas hexavalentes y con la antineumocócica conjugada 13-valente.Se aconseja un refuerzo de Tdpa a los 6 años, junto con una dosis de polio, así como vacunación con Tdpa en adolescentes y embarazadas, entre las semanas 27–36.Se emplearán esquemas de 2 dosis para triple vírica (12 meses y 2–4 años) y varicela (15 meses y 2–4 años).Se deben incrementar las coberturas frente al papilomavirus en niñas de 11–12 años con 2 dosis (0–6 meses), así como informar a los varones de los beneficios potenciales de la vacunación.Respecto a las vacunas recomendadas no financiadas, dada su disponibilidad en las farmacias comunitarias, se recomienda la vacuna frente al meningococo B, con esquema 3 + 1 (3, 5, 7 y 13–15 meses), solicitando su entrada en el calendario. Es recomendable vacunar a todos los lactantes frente al rotavirus.La vacunación antigripal anual y la inmunización frente a la hepatitis A están indicadas en grupos de riesgo.

Resumen: El CAV-AEP publica anualmente el calendario de vacunaciones que estima idóneo para los niños residentes en España, teniendo en cuenta la evidencia disponible sobre las vacunas. Reconocemos el esfuerzo del Ministerio de Sanidad, en el último año, por optimizar el calendario común, con la inclusión de la vacunación frente al neumococo y la varicela en la primera infancia.En cuanto a las vacunas financiadas incluidas en el calendario común, con los datos disponibles actualmente, y dada la falta de disponibilidad del componente de tosferina, se recomienda emplear esquemas 2 + 1 (2, 4 y 12 meses) con las vacunas hexavalentes y con la antineumocócica conjugada 13-valente.Se aconseja un refuerzo de Tdpa a los 6 años, junto con una dosis de polio, así como vacunación con Tdpa en adolescentes y embarazadas, entre las semanas 27-36.Se emplearán esquemas de 2 dosis para triple vírica (12 meses y 2-4 años) y varicela (15 meses y 2-4 años).Se deben incrementar las coberturas frente al papilomavirus en niñas de 11-12 años con 2 dosis (0-6 meses), así como informar a los varones de los beneficios potenciales de la vacunación.Respecto a las vacunas recomendadas no financiadas, dada su disponibilidad en las farmacias comunitarias, se recomienda la vacuna frente al meningococo B, con esquema 3 + 1 (3, 5, 7 y 13-15 meses), solicitando su entrada en el calendario. Es recomendable vacunar a todos los lactantes frente al rotavirus.La vacunación antigripal anual y la inmunización frente a la hepatitis A están indicadas en grupos de riesgo. Abstract: The Advisory Committee on Vaccines of the Spanish Association of Paediatrics (CAV-AEP) annually publishes the immunisation schedule which, in our opinion, estimates optimal for children resident in Spain, considering available evidence on current vaccines. We acknowledge the effort of the Ministry of Health during the last year in order to optimize the funded unified Spanish vaccination schedule, with the recent inclusion of pneumococcal and varicella vaccination in early infancy.Regarding the funded vaccines included in the official unified immunization schedule, taking into account available data, CAV-AEP recommends 2 + 1 strategy (2, 4 and 12 months) with hexavalent (DTPa-IPV-Hib-HB) vaccines and 13-valent pneumococcal conjugate vaccine.Administration of Tdap and poliomyelitis booster dose at the age of 6 is recommended, as well as Tdap vaccine for adolescents and pregnant women, between 27-36 weeks gestation.The two-dose scheme should be used for MMR (12 months and 2-4 years) and varicella (15 months and 2-4 years).Coverage of human papillomavirus vaccination in girls aged 11-12 with a two dose scheme (0, 6 months) should be improved. Information for male adolescents about potential beneficial effects of this immunisation should be provided as well.Regarding recommended unfunded immunisations, CAV-AEP recommends the administration of meningococcal B vaccine, due to the current availability in Spanish communitary pharmacies, with a 3 + 1 scheme (3, 5, 7 and 13-15 months). CAV-AEP requests the incorporation of this vaccine in the funded unified schedule. Vaccination against rotavirus is recommended in all infants.Annual influenza immunisation and vaccination against hepatitis A are indicated in population groups considered at risk.

The Advisory Committee on Vaccines of the Spanish Association of Paediatrics (CAV-AEP) updates the immunisation schedule every year, taking into account epidemiological data as well as evidence on the safety, effectiveness and efficiency of vaccines. The present schedule includes levels of recommendation. We have graded as routine vaccinations those that the CAV-AEP consider all children should receive; as recommended those that fit the profile for universal childhood immunisation and would ideally be given to all children, but that can be prioritised according to the resources available for their public funding; and as risk group vaccinations those that specifically target individuals in situations of risk. Immunisation schedules tend to be dynamic and adaptable to ongoing epidemiological changes. Nevertheless, the achievement of a unified immunisation schedule in all regions of Spain is a top priority for the CAV-AEP. Based on the latest epidemiological trends, CAV-AEP follows the innovations proposed in the last year's schedule, such as the administration of the first dose of the MMR and the varicella vaccines at age 12 months and the second dose at age 2-3 years, as well as the administration of the Tdap vaccine at age 4-6 years, always followed by another dose at 11-14 years of age, preferably at 11-12 years. The CAV-AEP believes that the coverage of vaccination against human papillomavirus in girls aged 11-14 years, preferably at 11-12 years, must increase. It reasserts its recommendation to include vaccination against pneumococcal disease in the routine immunisation schedule. Universal vaccination against varicella in the second year of life is an effective strategy and therefore a desirable objective. Vaccination against rotavirus is recommended in all infants due to the morbidity and elevated healthcare burden of the virus. The Committee stresses the need to vaccinate population groups considered at risk against influenza and hepatitis A. Finally, it emphasizes the need to bring incomplete vaccinations up to date following the catch-up immunisation schedule.

Resumen: El Comité Asesor de Vacunas de la Asociación Española de Pediatría (CAV-AEP) actualiza anualmente el calendario de vacunaciones teniendo en cuenta tanto aspectos epidemiológicos, como de efectividad y eficiencia de las vacunas.El presente calendario incluye grados de recomendación. Se han considerado como vacunas sistemáticas aquellas que el CAV-AEP estima que todos los niños deberían recibir; como recomendadas las que presentan un perfil de vacuna sistemática en la edad pediátrica y que es deseable que los niños reciban, pero que pueden ser priorizadas en función de los recursos para su financiación pública; y dirigidas a grupos de riesgo aquellas con indicación preferente para personas en situaciones de riesgo. Los calendarios de vacunaciones tienen que ser dinámicos y adaptarse a los cambios epidemiológicos que vayan surgiendo, pero el CAV-AEP considera como objetivo prioritario la consecución de un calendario de vacunación único para toda España.Teniendo en cuenta los últimos cambios en la epidemiología de las enfermedades, las principales novedades propuestas en este calendario son la administración de la primera dosis de las vacunas triple vírica y varicela a los 12 meses (12-15 meses) y la segunda dosis a los 2-3 años, así como la administración de la vacuna Tdpa a los 4-6 años siempre acompañada de otra dosis a los 11-14 años.El CAV-AEP estima que deben incrementarse las coberturas de vacunación frente al papilomavirus humano en las niñas de 11 a 14 años. Se reafirma en la recomendación de incluir la vacunación frente al neumococo en el calendario de vacunación sistemática. La vacunación universal frente a la varicela en el segundo año de vida es una estrategia efectiva y por tanto un objetivo deseable. La vacunación frente al rotavirus, dada la morbilidad y la elevada carga sanitaria, es recomendable en todos los lactantes. Se insiste en la necesidad de vacunar frente a la gripe y la hepatitis A a todos los que presenten factores de riesgo para dichas enfermedades. Finalmente, se insiste en la necesidad de actualizar las vacunaciones incompletas con las pautas de vacunación acelerada. Abstract: The Advisory Committee on Vaccines of the Spanish Association of Pediatrics (CAV-AEP) updates the immunization schedule every year, taking into account epidemiological data as well as evidence on the effectiveness and efficency of vaccines.The present schedule includes grades of recommendation. We have graded as routine vaccinations those that the CAV-AEP believes all children should receive; as recommended those that fit the profile for universal childhood immunization and would ideally be given to all children, but that can be prioritized according to the resources available for their public funding; and as risk group vaccinations those that specifically target individuals in situations of risk. Immunization schedules tend to be dynamic and adaptable to ongoing epidemiological changes. Nevertheless, the achievement of a unified immunization schedule in all regions of Spain is a top priority for the CAV-AEP.Based on the latest epidemiological trends, the main changes introduced to the schedule are the administration of the first dose of the MMR and the varicella vaccines at age 12 months (12–15 months) and the second dose at age 2–3 years, as well as the administration of the Tdap vaccine at age 4–6 years, always followed by another dose at 11–14 years of age.The CAV-AEP believes that the coverage of vaccination against human papillomavirus in girls aged 11–14 years must increase. It reasserts its recommendation to include vaccination against pneumococcal disease in the routine immunization schedule. Universal vaccination against varicella in the second year of life is an effective strategy and therefore a desirable objective. Vaccination against rotavirus is recommended in all infants due to the morbidity and elevated healthcare burden of the virus. The Committee stresses the need to vaccinate population groups considered at risk against influenza and hepatitis A. Finally, it emphasizes the need to bring incomplete vaccinations up to date following the catch-up immunization schedule.

The Advisory Committee on Vaccines of the Spanish Association of Paediatrics establishes annual recommendations on influenza vaccination in childhood before the onset of influenza season. Routine influenza vaccination is particularly beneficial when the strategy is aimed at children older than 6 months of age with high-risk conditions and their home contacts. The recommendation of influenza vaccination in health workers with children is also emphasized.

The Advisory Committee on Vaccines of the Spanish Paediatric Association updates annually the immunization schedule, taking into account epidemiological data as well as evidence of the effectiveness and efficiency of vaccines. This vaccination schedule includes grades of recommendation. The committee has graded as universal vaccines those that all children should receive, as recommended, those with a profile of universal vaccines of childhood and as are desirable those that all children may receive, but that can be prioritized based on public funding resources and for risk groups, targeting those groups of people in epidemiological situations of risk. The Committee considers as a priority to achieve a common immunization schedule for Spain. The Committee reaffirms the recommendation to include pneumococcal vaccination in the routine vaccination schedule. Vaccination against varicella in the second year of life is an effective strategy and therefore a desirable goal. Given the morbidity and high burden on the health care system, vaccination against rotavirus is recommended for all infants. Due to the current problems of availability of both vaccines, associated with the recent finding of circovirus, the committee urges that rotavirus vaccination is restarted as soon as possible as it is considered a desirable health benefit for all children in our country. The Committee adheres to the recommendations of the National Health Coordination Council in reference to routine vaccination against HPV for all girls aged 11 to 14 years and stresses the need to vaccinate all patients with risk factors for these diseases against influenza and hepatitis A. Finally, it stresses the need to update incomplete immunizations using accelerated immunization schedules.

Resumen: La enfermedad meningocócica invasora, con sus 2 formas de presentación principales (sepsis y meningitis), es una patología grave y potencialmente mortal, causada por distintos serogrupos de Neisseria meningitidis, entre los cuales, actualmente, predomina el serogrupo B en Europa. La mayoría de los casos se producen en la edad pediátrica, con una mortalidad aproximada del 10% y un riesgo de secuelas permanentes del 20-30% entre los supervivientes. Presenta mayor incidencia y letalidad en niños sanos menores de 2-3 años, seguidos de los adolescentes, aunque puede ocurrir a cualquier edad.Hasta ahora no se contaba con ningún arma inmunopreventiva contra el meningococo B. Así, con la llegada a España de la única vacuna actualmente disponible, el Comité Asesor de Vacunas de la Asociación Española de Pediatría (CAV-AEP) ha analizado detalladamente tanto el potencial preventivo de dicha vacuna, como la situación peculiar administrativa de la misma en España. El objetivo de este documento es informar del posicionamiento del CAV-AEP en relación con la vacuna frente al meningococo B y el acceso a la misma por parte de la población infantil española, teniendo en cuenta que ha sido autorizada exclusivamente para el uso hospitalario en personas de riesgo. En Europa, la vacuna sí está disponible en farmacias, incluso incluida en calendarios oficiales de algunos países o regiones.Este comité considera que Bexsero® presenta un perfil de vacuna a incluir en todos los calendarios españoles y que debería estar disponible libremente en farmacias para su administración en todos los niños mayores de 2 meses. Abstract: Meningococcal invasive disease, including the main clinical presentation forms (sepsis and meningitis), is a severe and potentially lethal infection caused by different serogroups of Neisseria meningitidis. Meningococcal serogroup B is the most prevalent in Europe. Most cases occur in children, with a mortality rate of 10% and a risk of permanent sequelae of 20-30% among survivors.The highest incidence and case fatality rates are observed in healthy children under 2-3 years old, followed by adolescents, although it can occur at any age.With the arrival in Spain of the only available vaccine against meningococcus B, the Advisory Committee on Vaccines of the Spanish Association of Paediatrics has analysed its preventive potential in detail, as well as its peculiar administrative situation in Spain.The purpose of this document is to publish the statement of the Committee as regards this vaccination and the access to it by the Spanish population, taking into account that it has been only authorized for people at risk. The vaccine is available free in the rest of Europe for those who want to acquire it, and in some countries and regions it has been introduced into the systematic immunisation schedules.The Committee considers that Bexsero® has a profile of a vaccine to be included in the official schedules of all the Spanish autonomous communities and insists on the need for it to be available in pharmacies for its administration in all children older than 2 months.

The objective of this study was to perform a pooled analysis of the immunogenicity and reactivity results obtained in 2 trials carried out in Spain with a combined DTP-HB vaccine.Vaccine was administered according to one of two existing vaccination schedules: 2-4-6 and 3-5-7 months of age. Blood samples for antibody determination were obtained 3-6 weeks after the third dose. Anti-diphtheria, anti-tetanus and anti- B. pertussis antibodies were measured by ELISA and anti-HB by radioimmunoassay. Local and general signs and symptoms were recorded by the parents on diary cards for a 4-day follow-up period after each vaccination.A total of 231 infants received three doses of DTP-HB vaccine. All of these doses were accompanied by the corresponding diary card (693 data points for the evaluation of reactogenicity). Two-hundred and nineteen subjects ere included in the analysis of immunogenicity. After the full vaccination course, all subjects had sero-protective titers against diphtheria, tetanus and hepatitis B and were sero-positive of B. pertussis. Geometric mean titers of anti-HB antibodies was 1986 mIU/ml. Pain at the injection site (64%) and unusual crying (71.5%) were the most frequently reported local and general symptoms, respectively. Fever (rectal temperatureor = 38 degrees C) was reported after 46% of the doses, but was considered as severe (39.5 degrees C) only in 5 cases.These results show that this combined DTP-HB vaccine induced a strong immune response to all vaccine components. The safety profile of this DTP-HB is similar to that of classical DTP vaccines.

The immunogenicity of oral diphtheria, pertussis, tetanus, (DPT) and polio vaccines was examined. Six hundred seventy-seven children (Group I) were given hepatitis B vaccine at 0, 2, and 6 months of age and the oral DPT-polio vaccines were administered at 2, 4 and 6 months of age. A control group of 731 children (Group II) received only oral DPT-polio vaccines. In both groups the vaccine efficacy against poliomyelitis was 96% for serotype I and 100% for serotype II. For serotype III, the vaccine efficacy was 98% and 97% for groups I and II, respectively. In both groups 97% of the children had antibodies against B. pertussis and all children were positive for tetanus and diphtheria. No immune interference between the oral DPT and polio vaccines and the hepatitis B vaccine when they were given simultaneously could be demonstrated as the immune response to the DPT and polio vaccines were identical in both groups. It can be concluded that the simultaneous administration of the hepatitis B vaccine with the DPT and polio vaccines did not interfere with the immune response to the other antigens.

Resumen: El Comité Asesor de Vacunas (CAV) de la Asociación Española de Pediatría actualiza anualmente el calendario de vacunaciones teniendo en cuenta, tanto aspectos epidemiológicos como de efectividad y eficiencia de las vacunas.El presente calendario incluye grados de recomendación. Se han considerado como vacunas sistemáticas aquellas que el CAV estima que todos los niños deberían recibir, como recomendadas las que presentan un perfil de vacuna sistemática en la edad pediátrica y que es deseable que los niños reciban, pero que pueden ser priorizadas en función de los recursos para su financiación pública y dirigidas a grupos de riesgo aquellas con indicación preferente para personas en situaciones epidemiológicas de riesgo. El CAV considera como objetivo prioritario la consecución de un calendario de vacunaciones único.El CAV se reafirma en la recomendación de incluir la vacunación frente a neumococo en el calendario de vacunación sistemática. La vacunación universal frente a varicela en el segundo año de vida es una estrategia efectiva y por tanto un objetivo deseable. La vacunación frente a rotavirus, dada la morbilidad y la elevada carga sanitaria, es recomendable en todos los lactantes.El CAV se adhiere a las recomendaciones del Consejo Interterritorial del Sistema Nacional de Salud en referencia a la vacunación sistemática frente a VPH de todas las niñas de 11 a 14 años e insiste en la necesidad de vacunar frente a la gripe y hepatitis A a todos los pacientes que presentan factores de riesgo para dichas enfermedades. Finalmente se insiste en la necesidad de actualizar las vacunaciones incompletas con las pautas de vacunación acelerada. Abstract: The Vaccine Advisory Committee of the Spanish Association of Paediatrics updates annually, the immunization schedule, taking into account epidemiological data, as well as evidence of the effectiveness and efficiency of vaccines.This vaccination schedule includes grades of recommendation. The committee has graded as universal vaccines those that all children should receive, as recommended those with a profile of universal vaccination in childhood and which are desirable that all children receive, but that can be prioritized based on resources for its public funding and for risk groups those targeting groups of people in situations of epidemiological risk. The Committee considers as a priority to achieve a common immunization schedule.The Committee reaffirms the recommendation to include pneumococcal vaccination in the routine vaccination schedule. Vaccination against varicella in the second year of life is an effective strategy and therefore a desirable goal. Vaccination against rotavirus is recommended for all infants given the morbidity and high burden on the health care system.The Committee adheres to the recommendations of the Interterritorial Council of the National Health Care System in reference to routine vaccination against HPV for all girls aged 11 to 14 years and stresses the need to vaccinate against influenza and hepatitis A all patients with risk factors for these diseases. Finally, it stresses the need to update incomplete immunization schedules using accelerated immunization schedules.

The cases of tuberculosis in the Pediatric Units of the Basque Autonomous Community during the period of 1980-89 were studied. The annual incidence rate in the 0-4 year old age group was 5.8 per 100.00 in Biscay (95% confidence interval: 4.0-7.6), 5.9 (2.3-9.5) in Alava and 16.7 (12.7-20.7) in Guipúzcoa. Out of the 263 registered cases, 55 (21%) corresponded to meningitis and/or miliaria, 194 (74%) to respiratory tuberculosis and 14 (5%) to other clinical forms. Of these cases, the diagnosis in 83 (32%) was based on results from microbiological cultures, in 8 (3%) on histological examinations and in the remaining 172 (65%) on other diagnostic criteria. In 226 cases (86%) no scars were found nor were there any antecedents of BCG vaccination. In 32 patients (12%), there were scars or antecedents of BCG vaccinations and in 5 cases no information was available. The estimated protective effect of the BCG vaccination in the 0-4 year old group was 88% and in the 5-14 year old group 63%. We recommend that the efficiency of the BCG vaccination program be studied in order to assess the need of this program.

Five cases of perinatal HBV infections of vertical transmission (mother-child) are reported. The authors comments the most important clinical and epidemiological characteristics of this way of transmission in paediatrics patients and emphasized the interest that has the screening in pregnant women. Finally, the guide-lines of neonatal prophylaxis recommended is described.