S1409-009020080002 Acta Pediátrica Costarricense Acta pediátr. costarric 1409-0090 Asociación Costarricense de Pediatría S1409-00902008000200001 Mitos, creencias y realidades sobre las vacunas Myths, beliefs and realities about vaccines Morice A Ávila-Agüero ML ,Ministerio de Salud Costa Rica ,Ministerio de Salud San José Costa Rica 2008 2008 20 60 64

A pesar de que la vacunación está reconocida como la estrategia de mayor beneficio en la salud pública, existen grupos anti-vacunas que se oponen a su aplicación. Este artículo presenta varias experiencias sobre este tema, analizando el origen de esa renuencia y su efecto en la salud. Las razones que argumentan estos grupos están relacionadas con mitos, creencias filosóficas o religiosas, rumores e información que no se sustenta en evidencia científica. Aun después de descartar la asociación causal entre autismo y vacuna triple viral, fue difícil revertir su efecto negativo en la población y disminuyeron las coberturas de vacunación, reduciendo la protección de inmunidad de rebaño. Los grupos anti vacunas provocaron la resurgencia de enfermedades que, como el sarampión, estaban en vías de eliminación en Inglaterra.

Even though vaccination is recognized as the strategy with highest benefits in public health, there are groups opposed to its administration. This article presents several experiences about anti vaccine groups; analyzing the origin of this reluctance and its effects on health. The reasons these groups oppose are related to myths, philosophic or religious beliefs, rumors and information not based on scientific evidence. After discharging the etiologic association between autism and Measles-Mumps-Rubella Vaccine, it was difficult to revert its negative effect on population, decreasing vaccine coverage and reducing the herd immunity protection in some countries. Due to anti-vaccine groups, diseases under elimination, such as measles, became endemic in England.

 vacunación grupos anti vacunas creencias mitos vacunas vaccination anti-vaccines groups myths, beliefs vaccines Chen RT Vaccine risks: real, perceived and unknown Vaccine 1999 17 Mellinger AK Cragan JD Atkinson WL Williams WW Kleger B Kimber RG High incidence of congenital rubella syndrome after a rubella outbreak Pediatr Infect Dis J 1995 14 Chen RT De Stefano F Davis RL The Vaccine Safety Data link: immunization research in health maintenance organizations in the USA Bull WHO 2000 78 Hughes R Rees J Smeeton N Winer J Vaccines and Guillain Barré Syndrome Lancet 1996 312 Silveira CM Salisbury DM de Quadros CA Measles vaccination and Guillain-Barré Syndrome Lancet 1997 349 Black S Risk of hospitalization because of aseptic meningitis after measles- mumps-rubella vaccination in oneto- two year old children: An analysis of the Vaccine Safety Data link (VSD) project Pediatr Infect Dis J 1997 16 Mäquelä A Pekka Nuorti J Peltola H Neurologic disorders after Measles-Mumps-Rubella vaccination Pediatrics 2002 110 White F Measles vaccine associated encephalitis in Canada Lancet 1983 2 Measles, Mumps and Rubella vaccine use and strategies for elimination of Measles, Rubella and Congenital Rubella Syndrome and control of mumps. Recommendations of the Advisory Committee on Immunization Practices (ACIP) MMWR 1998 47 Mason BW Donnelly PD Impact of a local newspaper campaign on the uptake of the measles mumps and rubella vaccine J Epidemiol Community Health 2000 54 Measles once again endemic in the United Kingdom Euro surveillance 2008 13 27 Roberts R Kiln MR Selway J MMR vaccination and autism BMJ 1998 316
S1409-009020080002 Acta Pediátrica Costarricense Acta pediátr. costarric 1409-0090 Asociación Costarricense de Pediatría S1409-00902008000200002 Vacunación: esquemas y recomendaciones generales Immunization: schedule and general recommendations Porras Oscar ,Caja Costarricense de Seguro Social Hospital Nacional de Niños Dr. Carlos Sáenz Herrera Servicio de Inmunología y Reumatología Pediátrica San José Costa Rica 2008 2008 20 65 76

Este artículo plantea la recomendación de la Asociación Costarricense de Pediatría para el esquema nacional de vacunación en diferentes grupos de edad. Se recomiendan calendarios de vacunación para los grupos de edad de 0 a 4 años, 5 a 18 años y adultos. Además se comentan los aspectos que se deben tomar en cuenta para readecuar un esquema de vacunación. En relación al esquema se discuten aspectos específicos relativos a cada vacuna. En una segunda parte se da información relacionada con aspectos generales de vacunación como intercambiabilidad, efectos adversos y contraindicaciones. En la parte final del artículo se discuten recomendaciones relacionadas con vacunación en situaciones especiales como inmunosupresión, trasplantes, recién nacidos de pretérmino, asplenia y alergia.

The article outlines the recommendations of the Costa Rican Pediatrics Association for the national vaccination schedule in different age groups. There is advice for children aged 0 through 4 years , 5 through 8 years and adults. Regarding the schedule, the article discusses specific aspects related to each vaccine. In the second part, the article provides information about general vaccination issues such as interchangeability, adverse effects and contraindications. The final part analyzes suggestions related to immunization in special situations such as immunosuppresion, transplants, preterm infants, asplenia and allergies.

 vacunas inmunizaciones inmunoglobulina readecuación de esquema esquema de vacunación autismo timerosal embarazo vaccines immunization immunoglobulin catch up vaccine schedule autism thimerosal pregnancy Siegrist CA Aspinall R B-cell responses to vaccination at the extremes of age Nature Rev Immunol 2009 9 Pickering LK Baker CJ Long SS McMillan JA Active immunization Red Book. 2006 Report of the Committee on Infectious Diseases Red Book. 2006 Report of the Committee on Infectious Diseases 2006 27th Elk Grove Village, IL American Academy of Pediatrics Hanson LÅ Silfverdal SA Vaccination immunology Scan J Infect Dis 2008 40 Porras O Abdelnour A Artavia E Baltodano A Barrantes M Fernández J Esquema de vacunación para el grupo de edad de 0-18 años Acta méd costarric 2006 48 Recommended immunization schedules for persons aged 0 through 18 years-United States, 2009 MMWR 2008 57 Zimmerman RK Middleton DB Burns IT Clover RD Kimmel SR Routine vaccines across the life span, 2007 J Fam Pract 2007 Pickering LK Baker CJ Long SS McMillan JA Tuberculosis Red Book. 2006 Report of the Committee on Infectious Diseases. Red Book. 2006 Report of the Committee on Infectious Diseases. 2006 27th Elk Grove Village, IL American Academy of Pediatrics Sandoval Borrás CI Quevedo L BCG Vacunas en pediatría Vacunas en pediatría 2004 2da Bogotá Editorial Médica Panamericana Vacunas sistémicas: vacunación contra la tuberculosis (BCG) Manual de vacunas, edición latinoamericana Manual de vacunas, edición latinoamericana 2000 2da Ed. EGRAF S.A Atkinson W Hamborsky J McIntyre L Wolfe S Hepatitis B 2008 10th Washington DC Public Health Foundation Hepatitis B: immunizations of infants, children and adolescents MMWR 2005 54 Chumakov K Ehrenfeld E New generation of inactivated poliovirus vaccines for universal immunization after eradication of poliomyelitis Clin Infect Dis 2008 47 Atkinson W Hamborsky J McIntyre L Wolfe S Varicella 2008 10th Washington DC Public Health Foundation Prevention of varicella. Recommendations of the advisory committee on immunization practices (ACIP) MMWR 2007 56 Stebbins S Rotavirus: disease and vaccine update, 2007 J Fam Pract 2007 Prevention of rotavirus gastroenteritis among infants and children. Recommendations of the advisory committee on immunization practices (ACIP) MMWR 2009 58 Prevention and control of Influenza. Recommendations of the advisory committee on immunization practices (ACIP) MMWR 2008 20 08 57 Preventing tetanus, diphtheria, and pertussis among adolescents: use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccines. Recommendations of the advisory committee on immunization practices (ACIP) MMWR 2009 55 Ulloa-Gutierrez R Pertussis vaccination in newborns Expert Rev Vaccines 2009 8 Prevention of pertussis, tetanus, and diphtheria among pregnant and postpartum women and their infants. Recommendations of the advisory committee on immunization practices (ACIP) MMWR 2008 57 Zimmerman RK HPV vaccine and its recommendations, 2007 J Fam Pract 2007 56 Quadrivalent human papillomavirus vaccine. Recommendations of the advisory committee on immunization practices (ACIP) MMWR 2007 56 Recommended adult immunization schedule-United States, 2009 MMWR 2008 57 General recommendations on immunization. Recommendations of the advisory committee on immunization practices (ACIP) MMWR 2006 55 Saari TN Immunization of preterm and low birth weight infants Pediatrics 2003 112 Pickering LK Baker CJ Long SS McMillan JA Immunization in special clinical circumstances Red Book. 2006 Report of the Committee on Infectious Diseases Red Book. 2006 Report of the Committee on Infectious Diseases 2006 27th Elk Grove Village, IL American Academy of Pediatrics Buttery JP Graham SM Immunization timing: the protective layer in vaccine coverage Lancet 2009 Clark A Sanderson C Timing of children’s vaccinations in 45 low-income and middle-income countries: an analysis of survey data Lancet 2009 Immunization safety review: vaccines and autism Immunization safety review: vaccines and autism 2004 ^eWashington, DC National Academies Press Baird G Pickles A Siminoff E Charman T Sullivan P Chandler S Measles vaccination and antibody response in autism spectrum disorders Arch Dis Child 2008 93 Gerber JS Offit PA Vaccines and autism: a tale of shifting hypotheses Clin Infect Dis 2009 48 Hornig M Briese T Buie T Bauman ML Lauwers G Siemetzki U Lack of association between measles virus vaccine and autism with enteropathy: a case- control study PloS ONE 2008 3 Peacock G Yeargin-Allsopp M Autism spectrum disorders: prevalence and vaccines Pediatr Ann 2009 38 Baker JP Mercury, vaccines and autism. One controversy, three histories Am J Public Health 2008 98 Thompson WW Price C Goodson B Shay DK Benson P Hinrichsen VL Early thimerosal exposure and neuropsychological outcomes at 7 to 10 years N Engl J Med 2007 357 Zimmerman RK Middleton DB Vaccines for persons at high risk, 2007 J Fam Pract 2007 Guidelines for vaccinating pregnant women, from recommendations of the Advisory Committee on Immunization Practices (ACIP) US Department of Health & Human Services 2007 Conti F Rezai S Valesini G Vaccination and autoimmune rheumatic diseases Autoimmun Rev 2008 8 Glück T Müller-Ladner U Vaccination in patients with chronic rheumatic or autoimmune diseases Clin Infect Dis 2008 46 Brezinschek HP Hofstaetter T Leeb BF Haindl P Graninger WB Immunization of patients with rheumatoid arthritis with antitumor necrosis factor alpha therapy and methotrexate Curr Opin Rheumatol 2008 20
S1409-009020080002 Acta Pediátrica Costarricense Acta pediátr. costarric 1409-0090 Asociación Costarricense de Pediatría S1409-00902008000200003 Vacunación contra neumococo Vaccination against pneumococci Abdelnour Arturo ,Instituto de Atención Pediátrica 2008 2008 20 77 79

El neumococo es responsable de aproximadamente 1.600.000 muertes al año, la mayoría de los cuales ocurren en países menos desarrollados. Se ha estimado que en Latino América el Streptococcus pneumoniae es responsable de la muerte de 2 niños cada minuto en esta región; 11 millones de casos de otitis media aguda; 204,400 casos de neumonía; 102,200 casos de bacteriemia y 15,300 casos de meningitis. Los neumococos son habitantes normales de las vías respiratorias altas. Se estima que entre 20% a 60% de los niños en edad preescolar albergan neumococos en su nasofaringe, 29-35% de los niños en edad escolar y 9% a 25% de los adolescentes. Mientras que sólo el 6% y entre el 18% a 29% de los adultos sin hijos y con hijos, respectivamente, son colonizados. Hoy en día contamos con dos vacunas seguras y efectivas, la vacuna polisacárido 23 valente y la 7 valente conjugada. La vacuna polisacárido 23 valente esta compuesta por los 23 polisacáridos (serotipos) de S. pneumoniae más prevalentes causantes de infección neumocócica invasora. Estos 23 serotipos constituyen más del 90% de los neumococos aislados de infecciones invasoras graves. La vacuna 7 valente conjugada contiene 7 serotipos de neumococo conjugados con una proteína que es una variante no tóxica de la toxina diftérica llamada CRM. La vacuna 7 valente (PCV-7) demostró en los estudios clínicos ser inmunogénica, además demostró tener un efecto de inmunidad de rebaño, reduciendo la incidencia de la enfermedad neumocócica invasora en poblaciones de personas que no recibieron directamente la vacuna.

 vacunas neumococo vacuna no conjugada contra neumococo vacuna conjugada contra neumococo pneumococo epidemilogía 19A Black S Shinefield H Baxter R Postlicensure surveillance for pneumococcal invasive disease after use of heptavalent pneumococcal conjugated vaccine in Northern California Kaiser Permanent Ped Inf Dis J 2004 23 Whitney CG Farley MM Hadler J Decline in invasive pneumocoocal disease after the introduction of proteinpolysaccharide conjugated vaccine N Engl J Med 2003 348 Oosterhuis-Kafeja F Beuters P Van Damme P Immunogenicity, efficacy, safety and effectiveness of pneumococcal conjugated vaccines (1998-2206) Vaccine 2007 Pelton S Huot H Finkelstein J Emergence of 19A as virulent and multidrug resistant pneumococcus in Massachusets following universal immunization of infants with pneumococcal conjugated vaccine Ped Inf Dis J 2007 26
S1409-009020080002 Acta Pediátrica Costarricense Acta pediátr. costarric 1409-0090 Asociación Costarricense de Pediatría S1409-00902008000200004 Estrategias actuales de vacunación contra tos ferina en niños y adultos Current vaccination strategies against pertussis in children and adults Ulloa-Gutiérrez Rolando ,Caja Costarricense de Seguro Social Hospital Nacional de Niños Dr. Carlos Sáenz Herrera Servicio de Infetología Pediátrica San José Costa Rica 2008 2008 20 81 87

Alrededor del mundo, Bordetella pertussis representa la quinta causa de muertes prevenibles por vacunación en niños menores de 5 años. Durante las últimas décadas se ha producido un cambio importante en la epidemiología de la enfermedad, donde actualmente los adolescentes y adultos son la fuente de transmisión más importante para infantes menores de 6 meses de edad. La morbimortalidad, complicaciones y número de hospitalizaciones son mayores sobre todo en infantes menores de 2 meses, quienes aún no han recibido su primera inmunización. Por esta razón, dentro de las recomendaciones actuales para tratar de disminuir el impacto de esta enfermedad en este grupo etario, se incluyen la vacunación a personas de alto riesgo de transmisión tales como los adolescentes, adultos, y mujeres en posparto inmediato (estrategia "capullo"). Esta revisión analiza las últimas recomendaciones al respecto, y se discuten otras estrategias potenciales como la vacunación a embarazadas, recién nacidos, ó el aceleramiento del esquema de vacunación contra tosferina. Igualmente se discute su potencial impacto en Costa Rica, donde desde finales del año 2005 se ha presentado el brote más severo de tosferina durante las últimas 4 décadas, con 18 infantes fallecidos a la fecha.

Bordetella pertussis represents the fifth cause of death among vaccine-preventable diseases in children younger than 5 years of age worldwide. During the last decades an important change in pertussis epidemiology has occurred, where adolescents and adults are now the most important source of transmission to infants younger than 6 months of age. Morbidity, mortality, hospitalizations, and complications rates are higher in infants younger than 2 months of age, who have not received yet their first vaccine dose. For these reasons, current recommendations to try to decrease the impact of pertussis in this age group include vaccination to adults at high risk of transmission such as adolescents, adults, and women in immediate postpartum ("cocoon strategy"). This review analyses the latest updated recommendations in pertussis vaccination, as well as other potential strategies including vaccination to pregnant women, newborns, and vaccine acceleratedschedules. Its potential impact in Costa Rica is also discussed, where the most severe outbreak in the last 4 decades has occurred since the end of year 2005, with now 18 confirmed pertussis infant deaths until today.

 Bordetella pertussis tosferina estrategias vacunación población pediátrica adolescentes adultos estrategia capullo Bordetella pertussis whooping cough strategies vaccination children adolescents adults cocoon strategy Challenges in global immunization and the Global Immunization Vision and Strategy 2006-2015 Wkly Epidemiol Rec 2006 81 Vaccine preventable deaths and the Global Immunization Vision and Strategy, 2006-2015 MMWR 2006 55 Tan T Trindade E Skowronski D Epidemiology of pertussis Pediatr Infect Dis J 2005 24 Halperin SA Wang EE Law B Epidemiological features of pertussis in hospitalized patients in Canada, 1991-1997: report of the Immunization Monitoring Program--Active (IMPACT) Clin Infect Dis 1999 28 Celentano LP Massari M Paramatti D Salmaso S Tozzi AE EUVAC-NET Group. Resurgence of pertussis in Europe Pediatr Infect Dis J 2005 24 Wendelboe AM Van Rie A Salmaso S Englund JA Duration of immunity against pertussis after natural infection or vaccination Pediatr Infect Dis J 2005 24 He Q Mertsola J Factors contributing to pertussis resurgence Future Microbiol 2008 3 Bisgard KM Pascual FB Ehresmann KR Infant pertussis: who was the source? Pediatr Infect Dis J 2004 23 Senzilet LD Halperin SA Spika JS Pertussis is a frequent cause of prolonged cough illness in adults and adolescents Clin Infect Dis 2001 32 Ulloa-Gutierrez R Hernández de Mezerville M Avila-Agüero ML Bordetella pertussis en Latinoamérica: ¿estamos reconociendo el problema? An Pediatr (Barc) 2008 69 Ulloa-Gutierrez R Avila-Agüero ML Pertussis in Latin America: current situation and future vaccination challenges Expert Rev Vaccines 2008 7 Pertussis Pertussis Donoso F A Wegner A A León B J Ramírez A M Carrasco O JA Coqueluche en niños menores de seis meses de vida Rev Chil Pediatr 2001 72 Wortis N Strebel PM Wharton M Bardenheier B Hardy IR Pertussis deaths: report of 23 cases in the United States, 1992 and 1993 Pediatrics 1996 97 Crowcroft NS Andrews N Rooney C Brisson M Miller E Deaths from pertussis are underestimated in England Arch Dis Child 2002 86 Vitek CR Pascual FB Baughman AL Murphy TV Increase in deaths from pertussis among young infants in the United States in the 1990s Pediatr Infect Dis J 2003 22 Mikelova LK Halperin SA Scheifele D Predictors of death in infants hospitalized with pertussis: a case-control study of 16 pertussis deaths in Canada J Pediatr 2003 143 Donoso AF Cruces PI Camacho JF León JA Kong JA Exchange transfusion to reverse severe pertussis-induced cardiogenic shock Pediatr Infect Dis J 2006 25 Halasa NB Barr FE Johnson JE Edwards KM Fatal pulmonary hypertension associated with pertussis in infants: does extracorporeal membrane oxygenation have a role Pediatrics 112 Namachivayam P Shimizu K Butt W Pertussis: severe clinical presentation in pediatric intensive care and its relation to outcome Pediatr Crit Care Med 2007 8 Surridge J Segedin ER Grant CC Pertussis requiring intensive care Arch Dis Child 2007 92 Romano MJ Weber MD Weisse ME Siu BL Pertussis pneumonia, hypoxemia, hyperleukocytosis, and pulmonary hypertension: improvement in oxygenation after a double volume exchange transfusion Pediatrics 2004 114 Grzeszczak MJ Churchwell KB Edwards KM Pietsch J Leukopheresis therapy for severe infantile pertussis with myocardial and pulmonary failure Pediatr Crit Care Med 2006 7 De Berry BB Lynch JE Chung DH Zwischenberger JB Pertussis with severe pulmonary hypertension and leukocytosis treated with extracorporeal membrane oxygenation Pediatr Surg Int 2005 21 Avila-Agüero ML Soto-Martinez ME Hernandez V Change of the epidemiology and clinical manifestations of Bordetella sp. infection in Costa Rica 39th Annual Meeting of the Infectious Diseases Society of America (IDSA) Octubre 25-28, 2001 San Francisco, CA Boza R Ulloa-Gutierrez R Garita K Pertussis deaths in infants admitted to a pediatric intensive care unit (PICU) in Costa Rica 45th Annual Meeting of the Infectious Diseases Society of America (IDSA) Octubre 4-7, 2007 San Diego California Ulloa-Gutierrez R Boza R Umaña MA Parental unawareness, misconceptions, and poor knowledge about pertussis: a contributor to late or misdiagnosis in the developing world 44th Infectious Diseases Society of America’s (IDSA) Annual Meeting Octubre12-15, 2006 TorontoOntario Ulloa-Gutierrez R Pertussis mortality and public misperceptions CMAJ 2008 179 Deeks S De Serres G Boulianne N Duval B Rochette L Déry P Failure of physicians to consider the diagnosis of pertussis in children Clin Infect Dis 1999 28 Klass P Index case N Engl J Med 2004 350 Dworkin MS Adults are whooping, but are internists listening Ann Intern Med 2005 142 Le Saux N Barrowman NJ Moore DL Decrease in hospital admissions for febrile seizures and reports of hypotonic-hyporesponsive episodes presenting to hospital emergency departments since switching to acellular pertussis vaccine in Canada: a report from IMPACT Pediatrics 2003 112 ^s348 Moore DL Le Saux N Scheifele D Halperin SA Members of the Canadian Paediatric Society/Health Canada Immunization Monitoring Program Active (IMPACT). Lack of evidence of encephalopathy related to pertussis vaccine: active surveillance by IMPACT, Canada, 1993-2002 Pediatr Infect Dis J 2004 23 Bettinger JA Halperin SA De Serres G Scheifele DW Tam T The effect of changing from whole-cell to acellular pertussis vaccine on the epidemiology of hospitalized children with pertussis in Canada Pediatr Infect Dis J 2007 26 Fingermann M Fernández J Sisti F Rodríguez ME Gatti B Bottero D Differences of circulating Bordetella pertussis population in Argentina from the strain used in vaccine production Vaccine 2006 24 Elomaa A Advani A Donnelly D Strain variation among Bordetella pertussis isolates in Finland, where the whole-cell pertussis vaccine has been used for 50 years J Clin Microbiol 2005 43 Ward JI Cherry JD Chang SJ Efficacy of an acellular pertussis vaccine among adolescents and adults N Engl J Med 2005 353 Halperin SA Canadian experience with implementation of an acellular pertussis vaccine booster-dose program in adolescents: implications for the United States Pediatr Infect Dis J 2005 24 Forsyth KD Campins-Marti M Caro J New pertussis vaccination strategies beyond infancy: recommendations by the Global Pertussis Initiative Clin Infect Dis 2004 39 Forsyth KD Wirsing von Konig CH Tan T Caro J Plotkin S Prevention of pertussis: recommendations derived from the second Global Pertussis Initiative roundtable meeting Vaccine 2007 25 Forsyth K Nagai M Lepetic A Trindade E Pertussis immunization in the global pertussis initiative international region: recommended strategies and implementation considerations Pediatr Infect Dis J 2005 24 Wirsing von König CH Campins-Marti M Finn A Guiso N Mertsola J Liese J Pertussis immunization in the global pertussis initiative European region: recommended strategies and implementation considerations Pediatr Infect Dis J 2005 24 Tan T Halperin S Cherry JD Pertussis immunization in the global pertussis initiative North American region: recommended strategies and implementation considerations Pediatr Infect Dis J 2005 24 Prevention of pertussis among adolescents: recommendations for use of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine Pediatrics 2006 117 Kretsinger K Broder KR Cortese MM Preventing tetanus, diphtheria, and pertussis among adults: use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine recommendations of the Advisory Committee on Immunization Practices (ACIP) and recommendation of ACIP, supported by the Healthcare Infection Control Practices Advisory Committee (HICPAC), for use of Tdap among health-care personnel MMWR 2006 55 Murphy TV Slade BA Broder KR Prevention of pertussis, tetanus, and diphtheria among pregnant and postpartum women and their infants recommendations of the Advisory Committee on Immunization Practices (ACIP) MMWR 2008 57 Edwards KM Pertussis: an important target for maternal immunization Vaccine 2003 21 Mooi FR de Greeff SC The case for maternal vaccination against pertussis Lancet Infect Dis 2007 7 Belloni C De Silvestri A Tinelli C Immunogenicity of a three-component acellular pertussis vaccine administered at birth Pediatrics 2003 111 Knuf M Schmitt HJ Wolter J Neonatal vaccination with an acellular pertussis vaccine accelerates the acquisition of pertussis antibodies in infants J Pediatr 2008 152 Halasa NB O’Shea A Shi JR Lafleur BJ Edwards KM Poor Immune Responses to a Birth Dose of Diphtheria, Tetanus, and Acellular Pertussis Vaccine J Pediatr 2008 153 Siegrist CA Blame vaccine interference, not neonatal immunization, for suboptimal responses after neonatal diphtheria, tetanus, and acellular pertussis immunization J Pediatr 2008 153 Shinall MC Jr Peters TR Zhu Y Chen Q Poehling KA Potential impact of acceleration of the pertussis vaccine primary series for infants Pediatrics 2008 122 Edwards KM Talbot TR The challenges of pertussis outbreaks in healthcare facilities: is there a light at the end of the tunnel Infect Control Hosp Epidemiol 2006 27 Sandora TJ Gidengil CA Lee GM Pertussis vaccination for health care workers Clin Microbiol Rev 2008 21 Calugar A Ortega-Sánchez IR Tiwari T Oakes L Jahre JA Murphy TV Nosocomial pertussis: costs of an outbreak and benefits of vaccinating health care workers Clin Infect Dis 2006 42 Shah S Caprio M Mally P Hendricks-Munoz K Rationale for the administration of acellular pertussis vaccine to parents of infants in the neonatal intensive care unit J Perinatol 2007 27 Gangarosa EJ Galazka AM Wolfe CR Impact of antivaccine movements on pertussis control: the untold story Lancet 1998 351 Schuchat A Bell BP Monitoring the impact of vaccines postlicensure: new challenges, new opportunities Expert Rev Vaccines 2008 7
S1409-009020080002 Acta Pediátrica Costarricense Acta pediátr. costarric 1409-0090 Asociación Costarricense de Pediatría S1409-00902008000200005 Vacunas contra Rotavirus Rotavirus vaccines Arguedas-Arguedas Olga ,Caja Costarricense de Seguro Social Hospital Nacional de Niños Dr. Carlos Saénz Herrera Servicio de Inmunología y Reumatología San José Costa Rica 2008 2008 20 89 91

La infección por rotavirus es la causa más frecuente de diarrea grave en niños costarricenses y del mundo entero, también es la primera causa de muertes por diarrea en niños en países en vías de desarrollo. Existen en la actualidad dos vacunas orales de virus vivos contra el rotavirus disponibles en nuestro país, de amplio uso en varias naciones del mundo, en muchas de las cuales ya han sido incluidas en los esquemas nacionales de vacunación. Una de las vacunas se deriva de una cepa humana atenuada de rotavirus, se administra en un esquema de dos dosis y la otra combina cinco cepas reacomodadas de origen bovinohumano y se administra en un esquema de tres dosis. Ambas vacunas se dan por vía oral y han mostrado tener una elevada eficacia en la prevención de diarrea grave por rotavirus y seguridad con respecto a la posible complicación de intususcepción intestinal. En Costa Rica, se realizan en la actualidad las gestiones necesarias para la inclusión de estas nuevas inmunizaciones en el esquema nacional de vacunación.

Rotavirus is the most common cause of severe diarrhea in Costa Rican children and worldwide, also is the first cause of diarrhea deaths in children in developing countries. Currently, two live oral rotavirus vaccines are available in Costa Rica, they have been used in many countries, in some of them have been included in the national immunization programs. One of these vaccines is derived from an attenuated human strain of rotavirus, is administered in a 2 doses schedule and the other combines five bovine-human reassortant strains and is administered in an schedule of 3 doses. Both vaccines should be given by the oral route. Each vaccine has proven highly effective in preventing severe rotavirus diarrhea in children and safe from the possible complication of intussusception. In Costa Rica, there are currently efforts ongoing to include these new vaccines in the National Immunization Schedule.

 vacunación inmunizaciones rotavirus población pediátrica diarrea Rotarix RotaTeq vaccination immunizations rotavirus children diarrhea Rotarix RotaTeq Black RE Morris SS Bryce J Where and why are 10 million children dying every year Lancet 2003 81 Parashar UD Hummelman EG Bresee JS Miller MA Glass RI Global illness and deaths caused by rotavirus disease in children Emerg Infect Dis 2003 9 Glass RI Bresee JS Turcios R Fischer TK Parashar UD Steele AD Rotavirus vaccines: targeting the developing worl J Infect Dis 2005 192 ^s1 Glass RI Parashar UD Bresee JS Turcios R Fischer TK Widdowson MA Rotavirus vaccines: current prospects and future challenges Lancet 2006 368 Biologicals Epi Study 023 Biologicals Epi Study 023 Apri l 28 Vaccines for Enteric Diseases congress Montego Bay Gentsch JR Laird AR Biefelt B Serotype diversity and reassortment between human and animal rotavirus strains: implications for rotavirus vaccine programs J Infect Dis 2005 192 ^s1 Grimwood K Kirkwood CD Human Rotavirus vaccines: too early for the strain to tell Lancet 2008 371 Velázquez FR Matson DO Calva JJ Guerrero L Morrow AL Carter-Campbell S Rotavirus infection in infants as protection against subsequent infections New Engl J Med 1996 335 Ruiz-Palacios GM Pérez-Schael I Velázquez FR Abate H Breuer T Costa Clemens AS Safety and efficacy of an attenuated vaccine against severe rotavirus gastroenteritis N Engl J Med 2006 354 Vesikari T Karvonen A Puustinen L Zeng SQ Szakal ED Delem A Efficacy of RIX 4414 live attenuated human rotavirus vaccine in Finish infants Pediatr Infect Dis J 2004 23 Salinas B Perez Schael I Linhares AC Evaluation of safety, immunogenicity and efficacy of an attenuate rotavirus vaccine, RIX 4414: a randomized placebo- controlled trial in Latin American Infants Pediatr Infect Dis J 2005 24 Vesikari T Marsson DO Dennehy P Van Damme P Santosham M Rodriguez Z Safety and efficacy of a pentavalent human-bovine (WC3) reassortant virus vaccine N Engl J Med 2006 354 Reisinger KS Block SL Characteristics on an ideal rotavirus vaccine Clin Pediatr (Phila) 2008 47 Stebbins S Rotavirus: Disease and vaccine update, 2007 J Fam Pract 2007 56
S1409-009020080002 Acta Pediátrica Costarricense Acta pediátr. costarric 1409-0090 Asociación Costarricense de Pediatría S1409-00902008000200006 Vacunación en el paciente expuesto al Virus de la Inmunodeficiencia Humana Vaccination in patients exposed to the Human Immunodeficiency Virus Lazo-Páez Gustavo ,Caja Costarricense de Seguro Social Hospital Nacional de Niños Dr. Carlos Sáenz Herrera Servicio de Inmunología y Reumatología Pediátrica 2008 2008 20 92 96

Las recomendaciones para la vacunación del paciente pediátrico expuesto a VIH no son muy diferentes a la población general. En términos generales se debe evitar la exposición de este grupo de pacientes a la vacuna BCG en aquellos países con baja incidencia de tuberculosis, además se debe evitar la exposición a vacuna de polio por vía oral, siendo contraindicada la aplicación al niño y a su grupo familiar, dado el riesgo de polio paralítico en pacientes con infección por VIH. La vacuna contra sarampión, rubéola y paperas, así como la vacuna de varicela está indicada en todo niño expuesto a VIH que tenga conteos superiores de células CD4+ al 15%. La mayoría de las vacunas inactivadas son efectivas en los pacientes infectados por VIH, sin embargo, para la mayoría de los antígenos inactivados se reportan títulos más bajos de anticuerpos, comparados a los que se obtienen en población no infectada por VIH, por lo cual se sugiere considerar dosis adicionales en aquellos pacientes que muestren reconstitución inmunológica con el uso de terapia antiretroviral altamente efectiva. No hay suficiente evidencia para recomendar la aplicación rutinaria de vacuna contra el rotavirus y contra el virus de papiloma humano. La vacuna contra la fiebre amarilla es segura pero ineficaz en pacientes infectados por VIH.

The current recommendations for vaccination of pediatric HIV- exposed patients are not very different from the general population. In general terms, we must avoid the exposure of this group to the BCG vaccine, in countries were tuberculosis incidence is low. We also should avoid the exposure to oral polio vaccine; witch is contraindicated not only in the HIV- exposed patient but also in his family members, given the risk of paralytic polio in these children. The measles, mumps and rubella vaccine, as well as the varicella vaccine are indicated for every child exposed to HIV that has CD4 + cells level over 15%. Most of the inactivated vaccines are effective in HIV-infected patients, but for most of theses vaccines, lower antibody levels have been reported, compared to those obtained in people not infected by HIV; so we suggest you to consider additional doses in patients with immune reconstitution while using highly effective antiretroviral therapy. There is insufficient evidence to recommend the routine administration of rotavirus and human papillomavirus vaccines. The yellow fever vaccine is safe but ineffective in children infected with HIV.

 Vacunas población pediátrica Virus de la Inmunodeficiencia Humana vacunación VIH Sida. inmunosupresión Vaccines children Human Immunodeficiency Virus vaccination AIDS immunosuppression Situación de la epidemia de SIDA: Informe especial sobre la prevención del VIH Situación de la epidemia de SIDA: Informe especial sobre la prevención del VIH 2007 Staprans SI Mamiltion BL Follansbee SE Elbeik T Barbosa P Activation of virus replication after vaccination of HIV-1-infected individuals J Exp Med 1995 182 Moss WJ Clements CJ Halsey NA Immunization of children at risk of infection with human immunodeficiency virus Bull World Health Organ 2003 81 Martin F Vacunaciones en el niño inmunodeprimido. Recomendaciones del comité asesor de vacunas de la AEP 2005 Vacunaciones en el niño inmunodeprimido. Recomendaciones del comité asesor de vacunas de la AEP 2005 Bhat GJ Diwan VK Chintu C Kabika M Masona J HIV, BCG and TB in children: A case control study in Lusaka, Zambia J Trop Pediatr 1993 39 Zuccoti GV Riva E Flumine P Locatelli V Fiocchi A Hepatitis B vaccination in infants of mothers infected with human immunodeficiency virus J Pediatr 1994 125 Mahoney FJ Kane M Plotkin SA Orenstein WA Hepatitis B vaccine Vaccines Vaccines 1999 3rd Philadelphia WB Saunders Company Rey D Krantz V Partisani M Achmitt MP Meyer P Increasing the number of hepatitis B vaccine injections augments anti-HBs response rate in HIV-1 infected patients Effects on HIV-1 viral load. Vaccine 2000 18 Agosti JM Pediatric vaccines in HIV-infected children Curr Opin HIV AIDS 2007 2 Abzug MJ Song LY Fenton T Nachman SA Levin MJ Pertussis booster vaccination in HIV-infected children receiving highly active antiretroviral therapy Pediatrics 2007 120 Ion-Nedelcu N Dobrescu A Strebel PM Sutter RW Vaccine associated paralytic poliomyelitis and HIV infection Lancet 1994 343 Flannery B Heffernan RT Harrison LH Ray SM Reingold AL Changes in invasive neumococcal disease among HIVinfected adults living in the era of childhood pneumococcal immunization Ann Intern Med 2006 144 Bliss SJ O’Brien KL Janoff EN Cotton MF Musake P The evidence of using conjugate vaccines to protect HIVinfected children against pneumococcal disease Lancet 2008 8 Kamchaisatian W Wanwatsuntikul W Sleasman JW Tangsinmankong N Validation of current joint American Academy of Allergy, Asthma & Immunology and American College of Allergy, Asthma and Immunology guidelines for antibody response to the 23-valent pneumococcal vaccine using a population of HIV-infected children J Allergy Clin Immunol 118 Moss WJ Cutts F Griffin DE Implications of the human immunodeficiency virus epidemic for control and eradication of measles Clin Infect Dis 1999 29 Measles, mumps, and rubella vaccine use and strategies for elimination of measles, rubella, and congenital rubella syndrome and control of mumps: Recommendations of the Advisory Committee on Immunization Practices (ACIP) MMWR 1998 47 Knorr A Hutchinson E Finn A Varicella vaccination for HIVinfected children Arch Dis Child 2008 93 Prevention of varicella: Recommendations of the Advisory Committee on Immunization Practices (ACIP) MMWR 2007 56 Prevention of rotavirus gastroenteritis among infants and children: Recommendations of the Advisory Committee on Immunization Practices (ACIP) MMWR 2006 55 Atashily J Kalilani L Adimora AA Efficacy and clinical effectiveness of influenza vaccines in HIV-infected individuals: a meta-analysis BMC Infect Dis 2006 6 Weinberg A Philimon G Nachman SA Defechereux P Yogev R Antibody responses to hepatitis A virus vaccine in HIV-infected children with evidence of immunologic reconstitution while receiving highly active antiretroviral therapy JID 2006 193 Sibailly TS Wiktor SZ Tsai TF Cropp BC Ekpini ER Poor antibody response to yellow fever vaccination in children infected with human immunodeficiency virus type 1 Pediatr Infect Dis 1997 16 De Vuyst H Franceschi S Human papillomavirus vaccines in HIV-positive men and women Curr Opin Oncol 2007 19
S1409-009020080002 Acta Pediátrica Costarricense Acta pediátr. costarric 1409-0090 Asociación Costarricense de Pediatría S1409-00902008000200007 Estado actual de la vacuna recombinante contra el virus del papiloma humano State of the art on human papilloma virus vaccine Chan Acón Wendy Aguilar Morales Lara Soley Carolina Arguedas Mohs Adriano ,Instituto de Pediatría ,Universidad de Ciencias Médicas San José 2008 2008 20 97 105

La infección por el virus del papiloma humano (VPH) es una enfermedad de transmisión sexual común. Alrededor del mundo millones de personas están infectadas y el resto de la población en general tiene un riesgo de contraer la infección superior al 50%. El virus se asocia aproximadamente a un 100% de los casos de cáncer cervical; a un 100% de las neoplasias cervicales intraepiteliales grados 1, 2, 3; a un 40% de los casos de cáncer de vulva, vagina y pene, 100% de las verrugas genitales; a un 100% de las papilomatosis respiratorias recurrentes; a un 90% del cáncer anal y a un 12% del cáncer de cabeza y cuello, predominantemente en orofaringe y amígdala. Actualmente, el uso de dos vacunas está aprobado en diversos países: Gardasil® y Cervarix®. Ambas están compuestas por proteínas L1 de VPH, en forma de partículas no infecciosas similares al virus (VLPs) producidas por tecnología de ADN recombinante, adsorbidas en adyuvantes que contienen aluminio. La eficacia hallada en diversos estudios en sujetos no expuestos previamente al virus se encuentran en el rango del 98.8% al 100.0% para la prevención de neoplasias cervicales, vulvares y vaginales intraepiteliales, grados 2 y 3, relacionados con el VPH-16/18, además de los adenocarcinomas in situ y verrugas genitales causadas por VPH-16/18/6/11 en el caso de Gardasil® y una eficacia del 100% en el caso de Cervarix® para la prevención de neoplasias cervicales grado 2 y 3 relacionados con el VPH-16/18. La eficacia de ambas se mantiene alrededor de los 5 años. Hasta el momento no se le ha atribuido a la vacuna ningún efecto terapéutico, solo se administra con fines profilácticos, sin embargo, esta no debe ser considerada como un sustituto de las pruebas de tamizaje para la prevención del cáncer cervical.

Genital human papillomavirus (HPV) is one of the most common sexually transmitted infections worldwide. Millions of persons are now infected and the lifetime risk of HPV infection exceeds 50%. HPV is approximately 100% related to the total cases of cervical cancer, 100% of cervical intraepithelial neoplasias grade 1, 2, and 3; 40% of vulva, vagina and penile cancer, 100% of genital warts, 100% of recurrent respiratory papillomatosis and 12% of head and neck cancer. Licensed vaccines, Gardasil® and Cervarix®, are composed of a noninfectious mixture of HPV type-specific virus-like particles prepared from the L1 proteins produced by recombinant DNA technology and adsorbed in a aluminum-containing adjuvant. Data from several studies of both vaccines reported a range of efficacy of 98,9 % to 100.0% for the prevention of cervical, vulvar and vaginal intraepithelial neoplasias degrees 2 and 3, and therefore, cervical, vulvar and vaginal cancer related to the VPH-16/18; in addition to in situ adenocarcinomas and genital warts caused by VPH-16/18/6/11. The effectiveness for both vaccines is maintained for at least 5 years. At the moment no therapeutic effect has been attributed and the vaccine use is prophylactic, nevertheless, vaccination should not be considered as a substitute for cervical cancer screening.

 Virus papiloma humano VPH vacuna recombinante Gardasil Cervarix genital human papillomavirus HPV recombinant vaccine Gardasil Cervarix Human papillomavirus infection and cervical cancer Human papillomavirus infection and cervical cancer 2004 Genital HPV Infection-CDC Fact Sheet Genital HPV Infection-CDC Fact Sheet 2004 Clifford G Smith J Aguado T Franceschi S Comparison of HPV type distribution in high-grade cervical lesions and cervical cancer: a meta-analysis Br J Cancer 2003 89 Clifford G Rana R Franceschi S Smith J Gough G Pimenta J Human papillomavirus genotype distribution in low-grade cervical lesions: comparison by geographic region and with cervical cancer Cancer Epidemiol Biomarkers Prev 2005 14 Parkin D The global health burden of infection-associated cancers in the year 2002 Int J Cancer 2006 118 Greer C Wheeler C Ladner M Beutner K Coyne MY Liang H Human papillomavirus (HPV) type distribution and serological response to HPV type 6 virus- like particles in patients with genital warts J Clin Microbiol 1995 33 Wiatrak B Wiatrak D Broker T Lews L Recurrent respiratory papillomatosis: a longitudinal study comparing severity associated with human papilloma viral types 6 and 11 and other risk factors in large pediatric population Laryngoscope 2004 114 Jansen K Shaw A Human papillomavirus vaccines and prevention of cervical cancer Annu Rev Med 2004 55 Barr E Tamms G Quadrivalent Human Papillomavirus Vaccine Clin Infect Dis 2007 45 Ball E Virus Papiloma Humano. Biología Molecular, Genética y Mecanismo Oncogénico, Parte II Derm Venez 1999 37 Adams M Borysiewicz L Fiander A Man S Jasani B Navabi H Clinical studies of human papilloma vaccines in pre-invasive and invasive cancer Vaccine 2001 19 Walboomers J Jacobs M Manos M Bosch FX Kummer JA Shah KV Human papillomavirus is a necessary cause of invasive cervical cancer worldwide J Pathol 1999 189 Bosch F de Sanjosé S Human papillomavirus and cervical cancer-burden and assessment of casuality J Natl Cancer Inst Monogr 2003 31 Muñoz N Bosch F de Sanjosé S Herrero R Castellsagué X Shah KV Epidemiologic classification of human papillomavirus types associated with cervical cancer N Engl J Med 2003 348 Draganov P Todorov S Todorov I Karcher T Kalvatchev Z Identification of HPV DNA in patients with juvenile-onset recurrent respiratory papillomatosis using SYBR Green realtime PCR Int J Pediatr Otorhinolaryngol 2006 70 Major T Szarka K Sziklai I Gergely L Czeglédy J The characteristics of human papillomavirus DNA in head and neck cancers and papillomas J Clin Pathol 2005 58 Smith E Swarbavel S Ritchie J Wang D Haugen T Turek L Prevalence of human papillomavirus in the oral cavity/ oropharynx in a Large population of children and adolescents Pediatr Infect Dis J 2007 26 Markowitz L Dunne E Saraiya M Lawson H Chesson H Unger E Quadrivalent Human Papillomavirus Vaccine: Recommendations of the advisory committee on inmunization practices (ACIP) MMWR: Morbidity & Mortality Weekly Report 2007 56 ^sRR-2 Alexander K Diagnosis and management of human papillomavirus infections Pediatr Infect Dis J 2005 24 Carter J Koutsky L Hughes J Lee SK Kuypers J Kiviat N Galloway DA Comparison of human papillomavirus types 16, 18, and 6 capsid antibody responses following incident infection J Infect Dis 2000 181 Ho G Bierman R Beardsley L Chang C Burk R Natural history of cervicovaginal papillomavirus infection in young women N Engl J Med 1998 338 Franco E Villa L Sobrinho J Prado JM Rousseau MC Désy M Rohan TE Epidemiology of adquisition and clearance of cervical human papillomavirus infection in women from a high-risk area for cervical cancer J Infect Dis 1999 180 Plummer M Schiffman M Castle P Maucort-Boulch D Wheeler C A 2 Year prospective study of human papillomavirus persistence among women with a cytological diagnosis of atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesion J Infect Dis 2007 195 Wheeler C Hunt W Schiffman M Castle P Human papillomavirus genotypes and the cumulative 2-year risk of cervical precancer J Infect Dis 2006 194 Zelmanowicz A Schiffman M Herrero R Goldstein AM Sherman ME Burk RD Family history as a co-factor for adenocarcinoma and squamous cell carcinoma of the uterine cervix: results from two studies conducted in Costa Rica and the United States Int J Cancer 2005 116 Bosch F Lorincz A Muñoz N Meijer C Shah K The causal relation between human papillomavirus and cervical cancer J Clin Pathol 2002 55 Summary report on HPV and cervical cancer statistics in Spain Summary report on HPV and cervical cancer statistics in Spain 2007 Incidencias de cáncer 1999-2003: Cáncer de cérvix Incidencias de cáncer 1999-2003: Cáncer de cérvix 2005 Herrero R Castle P Schiffman M Bratti M Hildesheim A Morales J Epidemiologic profile of type-specific human papillomavirus infection and cervical neoplasia in Guanacaste, Costa Rica J Infect Dis 2005 191 Castle P Schiffman M Herrero R Hildesheim A Rodríguez A Bratti M A prospective study of age trends in cervical human papillomavirus acquisition and persistence in Guanacaste, Costa Rica J Infect Dis 2005 191 Hernandez B Wilkens L Zhu X McDuffie K Thompson P Shvetsov Y Circumcision and human papillomavirus infection in men: a site-specific comparison J Infect Dis 2008 197 Dunne E Nielson C Stone K Markowitz L Giuliano A HPV Infection among men: a systematic review of the literature J Infect Dis 2006 194 Partridge J Koutsky L Genital human papillomavirus infection in men Lancet Infect Dis 2006 6 Gardasil: Quadrivalent Human Papillomavirus (Types 6, 11, 16, 18) ecombinant Vaccine Product Information Gardasil: Quadrivalent Human Papillomavirus (Types 6, 11, 16, 18) ecombinant Vaccine Product Information Whitehouse Station, NJ Merck & Co., Inc Informe Público Europeo de Evaluación (EPAR) Cervarix Informe Público Europeo de Evaluación (EPAR) Cervarix 2007 Stanley M Lowy D Frazer I Prophylactic HPV vaccines: underlying mechanisms Vaccine 2006 24 Lowy D Schiller J Prophylactic human papillomavirus vaccines J Clin Invest 2006 116 Sharma R Sharma C Quadrivalent human papillomavirus recombinant vaccine: The first vaccine for cervical cancers J Cancer Res Ther 2007 3 Garland S Hernández M Wheleer C Pérez G Harper D Leodolter S N Engl J Med 2007 356 Quadrivalent vaccine against human papillomavirus to prevent high-grade cervical lesions N Engl J Med 2007 356 Prophylactic efficacy of a quadrivalent HPV vaccine in women with virologic evidence of HPV infection J Infect Dis 2007 196 Ault K Effect of prophylactic human papillomavirus L1 virus-like particle vaccine on risk of cervical intraepithelial neoplasia grade 2, grade 3, and adenocarcinoma in situ: a combined analysis of four randomized clinical trials Lancet 2007 369 European Public Assessment Report. Gardasil Scientific Discussion European Public Assessment Report. Gardasil Scientific Discussion 2006 Stanberry L Spruance SL Cunningham AL Bernstein DI Mindel A Sacks S Tyring S Glycoprotein-D-adjuvant vaccine to prevent genital herpes N Engl J Med 2002 347 Olson S Villa L Costa R Induction of immune memory following administration of a prophylactic quadrivalent human papillomavirus (HPV) types 6/11/16/18 L1 virus-like particle vaccine Vaccine 2007 25 European Public Assessment Report. Cervarix Scientific Discussion European Public Assessment Report. Cervarix Scientific Discussion 2007 Hildesheim A Herrero R Wacholder S Rodriguez AC Solomon D Bratti MC Effect of human papillomavirus 16/18 L1 viruslike particle vaccine among young women with preexisting infection: a randomized trial JAMA 2007 298 European Public Assessment Report. EPARs for authorised medicinal products for human use European Public Assessment Report. EPARs for authorised medicinal products for human use 2007 Australian Drug Evaluation Committee - 251st meeting recommendations Australian Drug Evaluation Committee - 251st meeting recommendations 2007 Sanders G Taira A Cost-effectiveness of a potential vaccine for human papillomavirus Emerg Infect Dis 2003 9 Goldie S Kohli M Grima D Weinstein MC Wright TC Bosch FX Franco E Projected clinical benefits and costeffectiveness of a human papillomavirus 16/18 vaccine J Natl Cancer Inst 2004 96 Brisson M Van de Velde N De Wals P Boily M Estimating the number needed to vaccinate to prevent diseases and death related to human papillomavirus infection CMAJ 2007 177 Elbasha E Dasbach E insinga R Model for assessing human papillomavirus vaccination strategies Emerg Infect Dis 2007 13 Dempsey A Freed G Human papillomavirus vaccination: expected impacts and unresolved issues J Pediatr 2008 152
S1409-009020080002 Acta Pediátrica Costarricense Acta pediátr. costarric 1409-0090 Asociación Costarricense de Pediatría S1409-00902008000200008 Vademecum Vademecum Porras-Zamora Caterina Porras Oscar ,Universidad de Iberoamérica Escuela de Farmacia ,Caja Costarricense de Seguro Social Hospital Nacional de Niños Dr. Carlos Sáenz Herrera Servicio de Inmunología y Reumatología Pediátrica 2008 2008 20 106 118

En este artículo se presenta una revisión de la literatura disponible sobre la farmacología de las diferentes preparaciones farmacéuticas en la oferta de vacunas de Costa Rica. Se identifican las vacunas que están disponibles en la Caja Costarricense de Seguro Social. Se presentan cuadros de registro de las vacunas disponibles en las farmacias de Costa Rica, ordenadas por nombre, indicación y fabricante. En una secuencia de cuadros se presenta en detalle los antígenos y excipientes de las vacunas disponibles en Costa Rica.

This article is a review of the existing literature on the pharmacology of the different vaccine preparations offered in Costa Rica. It identifies the available vaccines at Caja Costarricense del Seguro Social [Costa Rican Social Security Institution]. It presents tables of the registered vaccines available in Costa Rica´s drugstores, organised by name, indication and manufacturing company. In a series of tables, it shows the details of antigens and excipients of vaccines available in Costa Rica.

 vacunas adyuvantes dosificación excipientes nombre comercial fabricante almacenamiento vaccines adyuvants dosage excipients trade name manufacturer storage European Public Assessment Report (EPAR) European Public Assessment Report (EPAR) Vaccines, blood and biologics Vaccines, blood and biologics The internet drug index. Drugs A-Z The internet drug index. Drugs A-Z Vaccines and immunizations Vaccines and immunizations Immunization against infectious diseases Immunization against infectious diseases 2009 Atkinson W Wolfe S Hamborsky J McIntyre L Centers for Disease Control and Prevention. Epidemiology and prevention of vaccine-preventable diseases Centers for Disease Control and Prevention. Epidemiology and prevention of vaccine-preventable diseases 2009 11 ^eWashington DC Public Health Foundation Canadian immunization guide 2006 Canadian immunization guide 2006 Lineamientos para la Vacunación contra neumococo (VCN-7) "catch up" Lineamientos para la Vacunación contra neumococo (VCN-7) "catch up" abri l 20 Taketomo C Hodding JH Kraus DM Pediatric dosage handbook Pediatric dosage handbook 2008 15 Hudson^eOhio Lexi-comp Lacy CF Armstrong LL Goldman MP Lance LL Drug information handbook Drug information handbook 2008 17 Hudson^eOhio Lexi-comp
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S1409-009020080002 Acta Pediátrica Costarricense Acta pediátr. costarric 1409-0090 Asociación Costarricense de Pediatría S1409-00902008000200010 Indice anual por tema , 2008 2008 20 121 121