Estrategias para proteger al recién nacido y lactante menor de 6 meses de la coqueluche: Posición del Comité Consultivo de Inmunizaciones de la Sociedad Chilena de Infectología (CCI)

Abstract

, en representación del CCI Strategies to protect the newborn and infants under 6 months of age against pertussis. Statement of the Advisory Committee for Immunizations of the Chilean Infectious Diseases SocietyIn recent years there have been Pertussis outbreaks not seen in the last 50 years affecting adults, adolescents and children and causing deaths in young unvaccinated infants. In Chile an outbreak of Pertussis started in year 2011, leaving 16 infants less than 3 months dead during this year, twice the number seen in a non epidemic year. These children were infected before receiving the programmatic vaccines indicated at 2, 4 and 6 months of age, usually from close contacts, especially their mothers. Pertussis control has not been possible for several reasons, such as limited immunity duration of available vaccines and their poor impact on nasopharyngeal carriage, situation that keeps the agent's circulation and transmission, condition often asymptomatic or unrecognized. Additionally, the use of acellular vaccines appears to be a determining factor because they induce an immune response with poor immune memory and consequently a short time duration. The acellular vaccines with reduced antigen content, available for adolescents and adults, has allowed the evaluation of various strategies but none has succeeded in reducing infant mortality. Recently a new strategy of vaccinating pregnant women against Pertussis in the second or third semester has shown remarkable results reducing up to 90% infant deaths due to Pertussis infection. This strategy prevents mother´s infection avoiding child infection through respiratory droplets and also provides the child with antibodies from placental transmission. Improved pertussis vaccines are required, in the meantime the Committee considers that the pregnant immunization strategy, between the 27 and 36 weeks, with acellular pertussis vaccine should be included in our national vaccine program.Key words: Pertussis infection, whooping cough, maternal immunization. Palabras clave: Coqueluche, tos ferina, vacunación materna. Situación epidemiológicaL a coqueluche o tos convulsiva, constituye junto al sarampión, una de las dos enfermedades inmunoprevenibles de mayor transmisibilidad, siendo cada una de ellas capaz de enfermar cerca de 12 a 17 personas susceptibles. A pesar del uso de vacunas eficaces por más de 60 años, la coqueluche continúa siendo un problema de salud pública provocando anualmente unas 200.000 muertes de lactantes en el mundo 1 . En forma cíclica, cada dos a cinco años ocurren brotes epidémicos, incluso en países con altas coberturas de vacunación y entre los años 2010 y 2012 se alcanzaron las incidencias más altas de los últimos 20 a 50 años en países desarrollados como E.U.A. . Estos aumentos de la incidencia afectan a lactantes bajo 6 meses de edad, que por su edad no han iniciado la vacunación o no la han completado o tampoco poseen ya inmunidad pasiva transferida desde la madre. Los brotes también afectan a escolares o adolescentes y adultos, en los que ...