I CONGRESO DIGITAL AEP. Libro de comunicaciones y casos clínicos

481 ISBN: 978-84-09-24491-1 ÁREA DE ESPECIALIDAD • INFECTOLOGÍA ASOCIACIÓN ESPAÑOLA DE PEDIATRÍA ESTUDIO. Haemophilus influenza type b vaccine failure in a second-level hospital – 2010-2018 Mafalda Casinhas Santos 1 , Sara Mâncio Limão 2 , Florbela María Cunha 1 1 Pediatric Service of Hospital Vila Franca de Xira, Lisboa, Portugal 2 Portugal, Lisboa, Portugal INTRODUCCIÓN Y OBJETIVOS Haemophilus influenza (Hi) is a nasopharynx colonizer in children, responsible for upper respiratory tract in- fections, and rarely causes invasive disease, namely meningitis, pneumonia, arthritis or bacteremia. Al- though routine immunization against Haemophilus in- fluenza type b (Hib) had been included in the National Vaccination Program (NVP) in 1994, vaccine failures have been reported in the pediatric population. Our study aims to identify and characterize Hib vaccine failures admitted in a second-level Hospital. MÉTODOS Retrospective observational study describing all pediatric cases of invasive Haemophilus influenza type b disease in a second-level hospital between 2010 and 2018. Vaccine failure was defined as inva- sive Hib disease occurring ≥2 weeks after one dose, given after the first birthday, or ≥1 week after ≥2 dos- es, given at < 1 year of age. RESULTADOS Seven cases of Hi invasive disease were identified, three were by Hib, of which two were vaccine fail- ures. The first one was a healthy 5-year-old girl, submit- ted to a tonsillectomy two days before the admission at the hospital, who presented with a suppurative acute otitis media and a torticolis. She was treated with amoxicillin-clavulanic acid for eight days. Hib, isolated from blood culture, was resistant to oral cefuroxime (mic 0,25 mg/l; R >0,125). The prognosis was good, with no reported sequelae. The second case was a healthy 4-year-old girl who presented with sepsis, meningitis complicated with cerebral empyema. Hib was isolated from Lcr and blood culture and was susceptible to tested antibi- otics. She was admitted in Intensive Care Unit for two days and received 21 days of intravenous ceftriaxone. During the follow-up, permanent neurosensorial hear loss was reported, with the need of a cochlear implantation. Both patients had completed four vaccinal anti- Hib dosis (2-4-6-18 months), normal immunity stud- ies, with protective levels of Hib specific antibodies. CONCLUSIONES Hib vaccine failures are rare and the majority occur in healthy children like presented cases. Neverthe- less, immunoglobulin deficiencies, prematurity, Down-syndrome and chromosomal anomalies may increase the risk. Vaccine production, storage and administration can also reduce efficacy. In Portu- gal nine cases have been reported between 2010 and 2017. National epidemiological surveillance is of crucial importance and may help the development of new preventive strategies.