Canarias tendrá el calendario de vacunas más avanzado de España con la inclusión de nuevas vacunas contra la meningitis bacteriana

La Estrategia Global Frente a las Enfermedades Transmisibles contempla la inclusión de la vacuna frente a la enfermedad meningocócica por serogrupo B, y la vacuna conjugada tetravalente antimeningocócica.

Con esta Estrategia quedan cubiertos todos los serogrupos que producen el 95 por ciento de la meningitis bacteriana.

La inclusión de la vacuna frente a la enfermedad meningocócica por serogrupo B busca también garantizar la equidad en el acceso a las vacunas para evitar desigualdades.

Se mejora también la oferta frente al Virus del Papiloma Humanos con la inclusión en el Calendario Vacunal, de una vacuna que incluye 9 genotipos oncogénicos del VPH.

La Consejería de Sanidad del Gobierno de Canarias ha reunido esta mañana al Comité Asesor de Vacunas, en el que están representados todas las sociedades científicas, para presentar la propuesta de incorporación de nuevas vacunas en el Calendario Vacunal para todas las edades de la vida de la Comunidad Autónoma de Canarias, con el fin de incluir la vacuna conjugada tetravalente frente al meningococo, la vacuna frente a la enfermedad meningocócica por serogrupo B, y la mejora de la oferta vacunal frente al Virus del Papiloma Humano con la incorporación de una vacuna frente a 9 genotipos del VPH.

Estos cambios, que fueron presentados por el director del SCS, Conrado Domínguez, el director general de Salud Pública, José Juan Alemán y el presidente de la Asociación Española de Vacunología, Amós García, obligan a una modificación del Calendario Vacunal y suponen un fuerte esfuerzo inversor, de entorno a tres millones y medio de euros más y un incremento de la inversión en torno al 33 por ciento. El objetivo fundamental es garantizar la equidad en el acceso a las vacunas, dentro de una Estrategia Global Frente a las enfermedades transmisibles.  De esta manera, y junto a la implementación de las vacunas antigripales tetravalentes, Canarias se configura como la Comunidad Autónoma con el Calendario Vacunal más avanzado del país

Este cambio en el calendario vacunal estará disponible previsiblemente antes del verano, tras la realización de los trámites administrativos para las adquisiciones correspondientes de las nuevas vacunas y afectará a una cohorte de 8.500 niñas susceptibles de vacunación con el VPH, a los que habría que añadir adultos en determinados grupos de riesgo, tales como hombres que mantienen sexo con hombres, transexuales, etc.; 18.000 niños y niñas preadolescentes de 12 años de la Vacuna Meningocócica Conjugada Tetravalente y 17.000 niños y niñas de menos de un año de vida frente a la Meningitis B.

Vacuna conjugada tetravalente antimeningocócica

Aunque en la actualidad hay 12 serogrupos de meningococo descritos, la gran mayoría de los casos de Enfermedad Meningocócica Invasiva (el 95% de los casos a nivel mundial) son producidos solo por 6 serogrupos: A, B, C, W, X e Y.

La incidencia de EMI aumentó en las cuatro últimas temporadas (entre 2014-2015 y 2017-2018) después de un periodo de descenso continuado desde el año 2000. En la temporada 2017-2018 se registró un incremento del 27,6% con respecto a la temporada previa a expensas del aumento de los casos debidos a los serogrupos C,  W, Y,

Frente a la Enfermedad Meningocócica Invasiva, Canarias propone la introducción de la vacuna conjugada tetravalente antimeningocócica, que protege frente a los serotipos A,C,W, Y,  y que sustituirá a la vacuna antimeningocócica C y se justifica por el importante aumento que se está observando en Europa de enfermedad meningocócica de determinados tipos incluidos en esa vacuna, que además pueden tener un mayor virulencia.

La vacuna conjugada tetravalente frente al meningococo se administrará a los 12 años de edad, sustituyendo a las dosis de vacuna antimeningocócica C que actualmente se administran a esa edad.

Vacuna frente al meningococo B

La introducción de la vacuna frente al meningococo B se justifica en la gravedad de esta enfermedad junto a las secuelas a las que puede dar lugar, y en lo impredecible del comportamiento del meningococo B, ya que, si bien hoy hay una escasa presencia de casos, mañana puede ocurrir lo contrario. Pero, sobre todo, se justifica como una medida de salvaguarda de la equidad.

No hay que olvidar que esta vacuna ya está presente desde hace tiempo en las oficinas de farmacias y es prescrita por muchos pediatras, lo que genera inequidad en relación a la misma, ya que mientras los niños y niñas que viven en barrios más favorecidos se encuentran vacunados en un alto número, los de zonas más desfavorecidos se encuentran, en la mayoría de los casos, sin vacunar, y en ocasiones dadas las posibles condiciones de vida son, además un grupo con mayor riesgo de sufrir este problema. La introducción de la vacuna frente al meningococo B evitará esa desigualdad.

La vacuna antimeningocócica B se administrará en una pauta de dos dosis mas uno. Las dos primeras dosis en el primer año de vida, y la tercera, como recuerdo, en el segundo año de vida.

Vacuna frente a 9 genotipos de VPH

La mejora de la oferta vacunas frente al VPH está justificada por el incremento de protección directa que se obtendría frente a 9 genotipos oncogénicos del VPH, incluidos en la nueva vacuna Gardasyl 9. Las dosis de Gardasyl 9 sustituirán a las dosis de vacuna frente al VPH que actualmente se incluyen en el calendario vacunal infantil, en el mismo número y secuencia temporal.

Enfermedad Meningocócica Invasiva EMI

La EMI es una enfermedad bacteriana aguda causada por Neisseria meningitidis o meningococo. Los síndromes clínicos que la caracterizan son meningitis, bacteriemia y sepsis8. Otras presentaciones menos frecuentes son neumonía, artritis séptica, pericarditis, uretritis y conjuntivitis. El inicio de la clínica más común es la aparición repentina de fiebre, náuseas y vómitos, cefalea intensa, alteración del estado mental, rigidez de nuca y fotofobia.

A veces, la presentación de EMI puede ser inespecífica (fiebre, mialgias, vómitos y otros síntomas gastrointestinales) y evolucionar rápidamente a shock séptico, sobre todo en la población infantil o en la producida por algunos serogrupos. Recientemente se ha descrito un aumento de la presentación con sintomatología gastrointestinal. La letalidad por EMI es del 8-15%, generalmente en las primeras 24 a 48 horas tras la aparición de los síntomas. Un 10-15% de los que sobreviven sufren secuelas a largo plazo incluyendo déficit neurológico, sordera y amputaciones.

La enfermedad se transmite de forma directa de persona a persona a través de las secreciones respiratorias. La propagación de la enfermedad se ve facilitada por el contacto estrecho y prolongado con un caso o una persona portadora (besar, estornudar, toser, dormitorios colectivos, compartir cubiertos y vajillas). El periodo de incubación medio es de 4 días, pero puede oscilar entre 2 y 10 días. El periodo de transmisibilidad persiste mientras el microorganismo permanezca en la nasofaringe de las personas portadoras, pudiendo prolongarse durante semanas o incluso meses, así como estar presente en la vía superior de manera intermitente.

El único reservorio conocido de N. meningitidis es el ser humano; no hay reservorios animales. La infección meningocócica puede limitarse a la nasofaringe sin producir síntomas, como estado de portador (10% de media en población general), o progresar a enfermedad invasiva y producir un cuadro de púrpura fulminante con postración súbita y shock.

 

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