DR.BERCOVICH: DIABETES Y VACUNA CONTRA FIEBRE AMARILLA

DIABETES Y VACUNA CONTRA FIEBRE AMARILLA

Vacunación contra fiebre amarilla en pacientes con diabetes – Sociedad Brasileña de Diabetes

La Sociedad Brasileña de Diabetes publicó la NOTA TÉCNICA Nº 01/18 con un posicionamiento sobre la vacunación contra la fiebre amarilla en pacientes con diabetes:

Un estudio retrospectivo, conducido por R. Mad’aire y colaboradores (1), evaluó 402 pacientes con diabetes en cuanto a la seguridad de uso de vacunas con virus vivos y concluyó que, con base en los resultados de este estudio retrospectivo, que la vacunación en pacientes diabéticos está libre de cualquier riesgo, desde que no existan otras contraindicaciones, por ejemplo, alergia a componentes de la vacuna o enfermedad febril aguda grave.

En el caso de glicemia inestable y del sistema inmunológico comprometido de forma significativa por diabetes la vacunación con vacunas vivas atenuadas debe ser cuidadosamente considerada y evaluada con relación a los riesgos de exposición a todos y cada agente infeccioso específico.

No hay motivo para tener miedo de la vacunación en pacientes diabéticos, desde que sean respetadas las contraindicaciones generales. Por el contrario, este grupo de riesgo puede se beneficiar de la vacunación de forma más notable, porque hay algún potencial para salvar vidas.

El Doctor Pedro Tauil, renombrado especialista y Profesor de la Universidad de Brasilia, resume las recomendaciones aplicables a la evaluación de la seguridad de uso de la vacuna contra fiebre amarilla en pacientes con diabetes en tres tópicos:

1.    Evaluar riesgo / beneficio       

3.    No hay registro de mayor número o mayor gravedad de eventos adversos en personas con diabetes      

4.    Así, si la persona eventualmente se expone al riesgo de adquirir la enfermedad (vivir o dirigirse para áreas rurales, donde circula el virus entre monos y mosquitos silvestres o visitar países africanos al sur del Sahara), la vacuna es recomendada.

Referencia bibliográfica: (1) Mad’ar R. et al. Vaccination of patients with diabetes mellitus: a retrospective study. Cent Eur J Public Health 2011; 19(2):98-101

Vaccination of patients with diabetes mellitus,

a retrospective study.

Mad'ar R¹, Benesová D, Brandejská D, Cermáková M, Dvorková A, Gazárková O, Jakubalová S, Kochová I, Lastovicková J, Nebáznivá D, Orolinová M, Polomis K, Rehka V, Sattranová L, Schejbalová M, Slámová A, Skalleová D, Sevcíková H, Tkadlecová H, Tmejová M, Trmal J, Turková D

Abstract

402 subjects with diabetes mellitus have been vaccinated of the total of 34,000 vaccinees immunized during the study period of 9 and half months. Altogether 229 diabetic patients (56.97%) have been vaccinated'against tick-borne encephalitis (TBE) and 74 (18.4%) against viral hepatitis (41 types A+B, 30 type A, 3 type B). The average age in four most commonly administered vaccines (FSME IMMUN 0.5 ML, Twinrix Adult, Typhim Vi, and Havrix 1440) was 65, 52, 56, and 54 years, respectively. Live attenuated vaccines have been given to 6 patients with diabetes (1.49%)--- 5 travellers to endemic countries received the yellow fever vaccine Stamaril (1 female, 4 male) and one male patient varicella vaccine Varilrix. Among the least common vaccines in diabetic patients were those against invasive pneumococcal and meningococcal infections. Not a single unexpected side effect has been observed following the vaccination procedure in any diabetic patient. Based on the results of this retrospective study we can conclude that vaccination in diabetic patients is free of any ri-k- provided that there are no other contraindications, e.g. allergy to vaccine components or severe acute febrile illness. In the case of unstable glycaemia and significantly impaired immune system due to diabetes mellitus, vaccination with live attenuated vaccines should be carefully considered and measured against the risks of exposure to each and every specific infectious agent. There is no reason to be afraid of vaccination in diabetic patients provided that general contraindications are respected. On the contrary, this risk group can benefit from vaccination more remarkably since it may have some life-saving potential.

Updates on yellow fever vaccination recommendations for international travelers related to the current situation in Brazil

Information for international travellers

16 January 2018

This is an update to the WHO advice posted in the Disease Outbreak News of 27 January 2017, 6 March 2017, 20 March 2017, 4 April 2017, and 24 November 2017; and on the WHO International Travel and Health website on 31 January 2017, 14 February 2017, 6 March 2017, 17 March 2017, and 4 April 2017.

Since December 2016, Brazil is experiencing an upsurge of yellow fever virus activity. Between 1 December 2016 and 30 June 2017, 1659 epizootics in non-human primates were registered in 21 states (Alagoas, Amazonas, Bahia, Goiás, Espírito Santo, Mato Grosso, Mato Grosso do Sul, Minas Gerais, Pará, Paraíba, Paraná, Pernambuco, Rio Grande do Norte, Rio Grande do Sul, Rio de Janeiro, Rondônia, Roraima, Santa Catarina, São Paulo, Sergipe, and Tocantins), and in the Federal District; a total of 777 human cases were reported, including 261 fatal, in eight states (Espírito Santo, Goiás, Mato Grosso, Minas Gerais, Pará, Rio de Janeiro, São Paulo, and Tocantins), as well as in the Federal District. On 9 September 2017, the government of Brazil declared that seasonal yellow fever virus activity has subsided.

Following the 2017 winter season in the Southern hemisphere, an increased yellow fever virus activity was again observed. Between 1 July 2017 to 8 January 2018, yellow fever virus infection was confirmed in relation to 358 epizootics in non-human primates in the states of Mato Grosso do Sul (0.3% of cases), Minas Gerais (9%), Rio de Janeiro (0.7%), and São Paulo (90%). As of 8 January 2018, 687 epizootics were under investigation for yellow fever in 17 states (Alagoas, Bahia, Goiás, Espírito Santo, Mato Grosso, Mato Grosso do Sul, Minas Gerais, Pará, Paraná, Pernambuco, Rio Grande do Norte, Rio Grande do Sul, Rio de Janeiro, Santa Catarina, São Paulo, Sergipe, and Tocantins), and in the Federal District. Over the same period of time, yellow fever virus infection was laboratory confirmed in 11 human patients, including four who died, from the states of Minas Gerais (one fatal case), Rio de Janeiro (one case), São Paulo (8 cases, including two fatal), and the Federal District (one fatal case). As of 8 January 2018, 92 additional human cases were under investigation for yellow fever virus infection in 15 states (Bahia, Goiás, Espírito Santo, Mato Grosso do Sul, Minas Gerais, Pará, Paraíba, Paraná, Pernambuco, Piauì, Rio Grande do Norte, Rio Grande do Sul, Santa Catarina, São Paulo, and Tocantins), as well as in the Federal District.

Considering the increased level of yellow fever virus activity observed across the state of São Paulo, the WHO Secretariat has determined that, in addition to the areas listed in previous updates, the entire state of São Paulo should also be considered at risk for yellow fever transmission.

Consequently, vaccination against yellow fever is recommended for international travellers visiting any area in the state of São Paulo.

The determination of new areas considered to be at risk for the yellow fever transmission is an ongoing process and updates will be provided regularly.

The current advice by the WHO Secretariat for international travellers going to areas in Brazil deemed to be at risk is the following:

·         Vaccination against yellow fever at least 10 days prior to the travel. Note that, as per Annex 7 of the International Health Regulations (2005), a single dose of a yellow fever vaccine approved by WHO is sufficient to confer sustained immunity and life-long protection against yellow fever disease. Travellers with contraindications for yellow fever vaccine (children below 9 months, pregnant or breastfeeding women, people with severe hypersensitivity to egg antigens, and severe immunodeficiency) or, over 60 years of age should consult their health professional for advice;

·         Adoption of measures to avoid mosquito bites;

·         Awareness of symptoms and signs of yellow fever;

·         Seeking care in case of symptoms and signs of yellow fever, while travelling and upon return from areas at risk for yellow fever transmission.

For 2017, updates on country requirements for the International Certificate of Vaccination or Prophylaxis, with proof of vaccination against yellow fever, and WHO vaccination recommendations for international travellers, are available on the WHO International Travel and Health website: Annex 1 and country list . More specific information about requirements for the International Certificate of Vaccination or Prophylaxis, with proof of vaccination against yellow fever, implemented by Member States related to the current situation in Brazil in the Region of the Americas is available on the PAHO yellow fever website.

NOTA: Fuera del destino habitual de Brasil para turistas Argentinos, hay que tener en cuenta que muchos países de Asia y Africa, requieren como requisito para entrar a sus paises diversas vacunas, especialmente inmunización contra Fiebre Amarilla y, Difteria y Tetanos ( Doble Adultos). La fecha de la inmunización debe preceder al menos 15 días previo a dicho ingreso en la mayoría de los casos. Es importante portar el Certificado Internacional de Vacunación.
Actualmente se aplica de 15 a 30 días antes de su viaje en cualquier hospital de CABA, previo pedido de turno. Esto se debe a que los envases hospitalarios de vacuna son multidosis y cuando se habren se deben utilizar todas las dosis.

1. Mosquito Aedes Aegypti vector de Fiebre Amarilla