Papers by alfredo ballester
Journal of Infection, May 1, 2004
Objective. To identify the risk factors related to invasive disease caused by Haemophilus influen... more Objective. To identify the risk factors related to invasive disease caused by Haemophilus influenzae type b (Hib), Neisseria meningitidis, and Streptococcus pneumoniae. Methods. Case-control study. All hospitals of the region of Valencia in Spain (covering 95% of the population of Valencia). The patients are children aged less than 15 years in whom Hib, N. meningitidis or S. pneumoniae are isolated from normally sterile sites. Results. From 1995 to 1998, 275 cases of invasive disease were analysed, and 243 hospital controls were selected in the month after the onset of the case. The paediatrician completed a survey administered to the relatives at the time of admission. The risk factors related to invasive disease by Hib were exposure to tobacco smoke (number of smokers, adjusted OR (aOR) 1.74, 95% confidence interval (CI) 1.02-2.96) and living with more than four people (aOR 3.72, 95% CI 1.3-3.7). For N. meningitidis, there is a dose-response relationship; if more than 60 cigarettes are smoked daily at home, the aOR is 3.61 (95% CI 1.04-12.57). If there are more than four people living in the household, aOR 1.69 (95% CI 1.01-2.85). In children under two years of age, having siblings less than 15 years of age (OR 1.76, 95% CI 0.75-4.17) and attending a day nursery represents a risk for suffering invasive pneumococcal disease (aOR 4.21, 95% CI 1.28-13.83). Conclusions. Among the variables tested, the modifiable risk factor is smoking; if smoking was reduced at home, the number of cases of invasive disease could be reduced in children, mainly in those under 5 years of age. Identification and vaccination of these risk groups would significantly reduce these diseases.
Vaccine, Mar 1, 1999
The objective of the study was to assess varicella epidemiology and the cost of disease in Spain,... more The objective of the study was to assess varicella epidemiology and the cost of disease in Spain, in order to perform a cost± bene®t analysis of universal vaccination at 15 months of age. Epidemiological data were obtained from a survey of 150 children with varicella, from hospitalizations and from the Spanish literature. A Markov decision tree was designed with two alternatives, vaccination or nonvaccination. Direct costs derived from the disease were lower than the cost of vaccination (ratio 0.54:1), however when indirect costs, such as working time loss were taken into account, vaccination was the best alternative, with a saving of P T 2627 per vaccinated subject (P T 1.6 recovered per peseta invested in the program). Sensitivity analysis shows that decreasing vaccine coverage and ecacy to 0.7, increasing the annual discount rate to 20% and with a vaccine price less than P T 6000, vaccination is always the best alternative. In conclusion, from the economic point of view, a universal varicella vaccination program in children at 15 months of age would be justi®ed in Spain.
Acta pediátrica española
ABSTRACT
Acta pediátrica española
ABSTRACT
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Anales de Pediatría
To assess the incidence of community acquired pneumonia in the Autonomous Community of Valencia i... more To assess the incidence of community acquired pneumonia in the Autonomous Community of Valencia in Spain, and describe its treatment and complications. A retrospective cohort comprising 654 children born in 1995 and 1996 in Valencia and followed-up during the first 5 years of life by nine pediatricians was studied. The number of cases of pneumonia, treatment, complications and interventions was recorded. Ninety-nine episodes of community-acquired pneumonia in 80 children were recorded (1.24 cases/child). Fifty-one cases (51.1 %) occurred before the child's third birthday and 38 (38.4 %) occurred between the third and the fourth. Of the 99 cases, 51 were diagnosed in primary care and 46 in the emergency room. There was a mean of 2.44 visits per process in primary care (range 1-6). All the children were treated with antibiotics. The most frequently used were amoxicillin-clavulanate (43.3 %) and cefuroxime (26.3 %). Fourteen patients required a change of antibiotic. Twenty-three pe...
Anales españoles de pediatría, 2001
To assess the frequency of the use of alternating antipyretics among Spanish pediatricians and to... more To assess the frequency of the use of alternating antipyretics among Spanish pediatricians and to analyze the factors that determine this practice. An anonymous survey of practicing pediatricians was conducted. Data on the use of antipyretics were collected. Factors related to alternating antipyretics were assessed by using multivariate correlation analyses. Three hundred twenty-four questionnaires were reviewed. The mean age of participants was 46.4 18.6 years (29-68 years). Of the responding pediatricians, 22.5 % worked in hospitals, 87.5 % in health centres and 24.7 % in in private practice. A total of 68.8 % of pediatricians (95 % CI: 63.4-73.8 %) alternated antipyretics. The combination of ibuprofen and acetaminophen was recommended by 96.9 %. The use of alternating antipyretics was positively associated with male sex (OR: 0.535; 95 % CI: 0.296-0.967; p 0.038), with few years' experience (OR: 0.952; 95 % CI: 0.922-0.984, p 0.005), with considering ibuprofen the drug of choi...
Atencion primaria / Sociedad Española de Medicina de Familia y Comunitaria, Jan 15, 1999
The aim of the study is to validate a tympanic thermometer (TT) use in primary care. Validation s... more The aim of the study is to validate a tympanic thermometer (TT) use in primary care. Validation study phase IV of the tympanic thermometer ThermoScan Pro LT. Measurements are compared to axillary temperature (AT) measured with a glass mercury thermometer. 412 subjects 6 months to 15 years old attended in primary care clinics were studied. Exclusion criteria were middle ear conditions, intense crying or sweating. The highest of the three measurements in each ear was used to calculate sensitivity and specificity of the TT and to analyse the concordance with AT. The impact of ambient temperature, age, gender, cerumen, presence of a febrile condition and the examiner on the results was assessed. Sensitivity of TT to detect fever (AT > 38 degrees C) was 89.7% (95% IC: 81.8-97.5) and specificity 90.7% (95% IC: 87.7-93.7). As a mean TT measures 0.5 degree C higher than AT but there was a high dispersion of the data (-1.59-0.6 degrees C). Accuracy of TT was influenced by the sex of the p...
Anales españoles de pediatría, 1999
Anales españoles de pediatría, 1998
The objective of this study was to estimate the vaccine coverage among children two years of age ... more The objective of this study was to estimate the vaccine coverage among children two years of age in the Community of Valencia, Spain, in 1997. Cluster sampling was used to assess vaccine coverage. Clusters were villages randomized according to their population < 5 years of age. At least 7 children of each of the 30 selected clusters were randomly selected from the database of newborn metabolic screening. Parents were contacted and vaccine registration cards requested by mail. Four hundred forty subjects were selected. Eight percent of the families had moved and were not contacted. Sixty-nine percent participated in the study. Coverage for three doses of DTP was 97.8% and 87.6% for four doses. MMR vaccine coverage was 96.6% and three doses of hepatitis B had been given in 95.1%. H. influenzae type b (Hib) vaccine coverage was 57%. In 70% of the studied cases of non-participants, vaccine coverage was known through vaccination centers and was very similar to that of the participants...
Atencion primaria / Sociedad Española de Medicina de Familia y Comunitaria, Jan 15, 1996
To evaluate alterations in techniques of DTP vaccination of nursing children after a two-year int... more To evaluate alterations in techniques of DTP vaccination of nursing children after a two-year intervention and analyse the reasons for reluctance to change the norms. A longitudinal and prospective study, with intervention before and after. Evaluation through two anonymous questionnaires of staff in charge of the vaccinations: a general survey for each centre and an individual one for each nurse. Primary care. The professionals in charge of vaccinations of nursing children in the 13 health centres and clinics in areas 11 and 12 of the Valencian Community in 1993. Informative meetings with paediatricians and nurses to pass on the recommendations of experts on vaccination techniques, supported by written information to the person in charge of vaccinations at each centre. Out of the 13 centres 12 returned the general survey in 1993 and 11 in 1995. The individual questionnaire was returned by 49 nurses. From the 12 centres injecting in the gluteus in 1993, 5 changed to the thigh and all...
Atencion primaria / Sociedad Española de Medicina de Familia y Comunitaria, Jan 30, 1994
To evaluate the techniques of DPT vaccination in the nursing child. An observation study of a cro... more To evaluate the techniques of DPT vaccination in the nursing child. An observation study of a crossover type. Evaluation by means of an anonymous survey of those responsible for administering the vaccinations. Statistical analysis using the precise Fisher test. The thirteen official vaccination centres in Health Areas 11 and 12 in the Community of Valencia. 12 centres (91%) answered the questionnaire. Four of them (41%) used different needles to aspirate the contents of the vial and give the injection to the nursing child. The DPT was always administered in the gluteal region. 33% used needles which were 16 mm long. Prophylactic paracetamol was used in two of the Centres as a matter of course. The Centre's size or length of time in use did not affect the techniques used. There is no uniformity in the technique of administering the DPT vaccine to the nursing child in the different Vaccination Centres of Areas 11 and 12 in the Community of Valencia. The techniques used for vaccina...
Resumen Objetivo: Recoger de forma sistemática todas las pruebas en relación con la eficacia, efe... more Resumen Objetivo: Recoger de forma sistemática todas las pruebas en relación con la eficacia, efectividad y seguridad del tacrolimus tópico para el tratamiento de la dermatitis atópica en niños menores de 12 años. Material: Revisión sistemática de la literatura con búsquedas sensibles en Medline, índice Médico Español, Embase, y contacto con los primeros autores de los artículos que describen ensayos clínicos y con el laboratorio de investigación. Resultados: Se encuentran 3 ensayos clínicos ya publicados y se conocen dos en vías de publicación. Se efectúan en niños con dermatitis atópica moderadas y graves. De los tres publicados dos comparan la eficacia y seguridad de la pomada de tacrolimus 0,03% frente a placebo y el tercero frente a aceponato de hidrocortisona. Eficacia: para blanqueamiento superior del 75% de las lesiones: NNT = 3 (IC 95% 3-5) con respecto al placebo, y NNT=4 (IC 95% 3-5) comparando con el aceponato de hidrocortisona. Los efectos adversos más frecuentes fueron prurito NNH = 14 y sensación de quemazón NNH = 8 a 9 frente a placebo. Aunque existe absorción cutánea, esta es muy escasa. Conclusiones: Tacrolimus tópico es un tratamiento muy eficaz en el tratamiento de las dermatitis atópicas moderadas y graves, con escaso número de efectos adversos, que son autolimitados y bien tolerados.
Vacunas, 2003
Analizar la evolución de la infección invasiva por Haemophilus influenzae tipo b (Hib) tras la in... more Analizar la evolución de la infección invasiva por Haemophilus influenzae tipo b (Hib) tras la introducción de la vacuna en sus distintas presentaciones: aislada, combinada con DTP de células completas y con DTP acelular. Sujetos y métodos. Se recogen todos los casos de enfermedad invasiva por Hib ocurridos desde enero de 1996 hasta mayo de 2002, analizándose la clínica y situación vacunal. Los datos se obtienen de sistemas de vigilancia epidemiológicos prospectivos y del registro de enfermedades de declaración obligatoria. Resultados. Durante este período se presentaron 37 casos de enfermedad invasiva en niños menores de 5 años. De ellos 30 ocurrieron en los primeros dos años de seguimiento, cuando la vacunación no era universal y la cobertura vacunal era del 57%. Posteriormente persisten casos esporádicos, sin verse una tendencia al alza de casos con la incorporación de la vacuna combinada con DTPa/Hib. Conclusiones. La enfermedad invasiva por Hib prácticamente ha desaparecido de la Comunidad Valenciana, y su evolución ha sido condicionada por la cobertura vacunal, independientemente del tipo de vacuna que se administre, separada de la DTP y combinada con la DTP de células enteras o acelular. No hay evidencia de que la vacuna combinada de DTPa y Haemophilus influenzae tipo b tenga menor efectividad que su administración separada.
Journal of Infection, 2004
To determine the incidence of pertussis in persons # 15 years in age in Valencia, Spain. To asses... more To determine the incidence of pertussis in persons # 15 years in age in Valencia, Spain. To assess the prevalence of IgG antibodies to pertussis toxin (PT) in children, adolescents and adults. Methods. Prospective study conducted at paediatric primary care centres. All persons #15 years in age presented with persistent cough were enrolled. Parents completed a brief questionnaire and immunization history was obtained from paediatrician records. A blood sample was obtained, for determination of IgG antibodies to Bordetella pertussis toxin (PT) by an ELISA method. A study confirmedcase was the presence of two conditions: (1) cough illness of $14 days duration; and (2) ELISA absorbance value of IgG to PT $ 2. Two subjects per clinical-case (same centre and range of age) and parents were asked to participate in the prevalence study. Results. Sixty-one children #15 years in age presented with symptoms leading to a clinical diagnosis of pertussis were detected. Serological evidence of recent pertussis was found in five of these patients (incidence of 46.0/100 000 persons # 15 years in age). Prevalence of antiobodies to B. pertussis ($ 0.3) in children # 15 years in age and adults was 39 and 33%, respectively. Only a minority of children, adolescents and adults had absorbance values indicative of immunity ($ 1). Conclusions. These incidence and seroprevalence results show that despite high immunization rates in infancy, B. pertussis is circulating in Spain.
International Journal of Infectious Diseases, 2008
Two telephone surveys were conducted during October 3-11 and December 15-17, 2007 targeting peopl... more Two telephone surveys were conducted during October 3-11 and December 15-17, 2007 targeting people aged 65 and older randomly sampled by the Computer Assisted Telephone Interview (CATI). Questionnaires were developed under the theoretical framework of the health belief model. Among 1,115 effective samples of pre-survey, 512 (45.9%) were successfully followed. 512 people of post-survey were representative of pre-survey population because of their comparability of demographic characteristics. 62.6% (698/1,115) expressed their willingness to receive vaccination and 61.0% (312/512) among post-survey samples actually received vaccination. Important factors influencing their willingness were their beneficial belief in vaccination (OR = 19.8, 95% CI = 10.0-39.2), with obstacles of vaccination (OR = 8.0, 95% CI = 5.0-12.7), awareness of disease seriousness (OR = 1.9, 95% CI = 1.2-3.0). The relevant factors for actual vaccination were living with chronic disease (OR = 2.2, 95% CI = 1.1-4.1), fear of contracting influenza (OR = 3.2, 95%CI = 1.8-5.8, fear of health impairment OR = 3.3, 95% CI = 1.7-6.7, fear of adverse effects of vaccination (OR = 0.2, 95% CI = 0.1-0.3) and unawareness of disease threat (OR = 0.5, 95% CI = 0.30.9). The rate of willingness, approximately to the actual rate of vaccination, and the similar attitude and beliefs on influenza vaccination between two survey population demonstrate the difficulty of conducting propaganda for the elderly. However, target-oriented, focusing relevant factors and selecting appropriate media channels would be the solution for the challenge of high vaccination rate of the elderly.
Human Vaccines, 2005
This study assessed the seroprevalence of varicella antibodies in children and adolescents in Spa... more This study assessed the seroprevalence of varicella antibodies in children and adolescents in Spain and evaluated the reliability of two methods for detecting susceptible individuals: (1) parental-reported history of varicella and (2) medically-documented histories maintained by the pediatrician. A total of 186 children (6 to 15 years of age) were recruited in 13 pediatric offices of Valencia, Spain. A brief case report form was completed including previous history of varicella referred by the parents, and a 5 mL blood sample was obtained. The pediatrician medical file was reviewed for antecedent of varicella. The overall prevalence of varicella antibodies was 84% and 88% in the 6-9 years and 10-15 years age brackets, respectively. The predictive value of a negative history of varicella disease was 48% by parental recall (52% &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;false negative&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;), and only 26% by medical record (74% &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;false negative&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;). However, the positive predictive value of a positive parental reported history or a positive medically-documented history was 95%. The most effective strategy for varicella vaccination of older children and adolescents in Spain will be to immunize those individuals with a lack of positive (unknown or negative) history of disease.
Current Therapeutic Research, 1998
The aim of this study was to determine the effectiveness of ibuprofen prophylaxis in reducing the... more The aim of this study was to determine the effectiveness of ibuprofen prophylaxis in reducing the adverse effects of diphtheriatetanus-pertussis (DTP) and oral polio vaccination in children 3,6, and 7 months of age and to compare its effects with those of the present policy of treating adverse reactions when they occur. This 12-month, multicenter, randomized, open-label trial was conducted in siz ambulatory, primary care centers. A total of 256 healthy children aged 3 months (*16 days) receiving DTP vaccine were studied at that age and at 6 and 7 months (ie, at the second and third DPT doses). Adverse effects of 719 vaccine doses were studied; 219 infants received all three doses. Patients were randomized to receive either ibuprofen prophylaxis (20 mg/kg per day in three equally divided doses over 24 hours, the first dose given together with the vaccine) or treatment (ibuprofen 7.5 mg/kg) for the adverse reactions when they occurred. The same therapeutic regimen was followed after the second and third DTP doses. Adverse effects after immunization were recorded by parents or guardians in a previously validated questionnaire and included elevated rectal temperature, systemic reactions (crying, drowsiness, fretfulness, vomiting, diarrhea, and anorexia), and local reactions (redness, edema, induration, and pain). None of the patients were withdrawn from the study because of adverse effects. The results of the study suggest that children given ibuprofen prophylazis had temperature increases after DTP vaccination similar to those who received treatment when reactions occurred, but they had fewer systemic and local effects. No remarkable adverse effects such as seizures, collapse, or shocklike state (hypotonic-hyporesponse episodes) occurred. One sterile abscess was seen at the injection site in the prophylaxis group. Thus ibuprofen prophylaxis after DTP vaccination at 3,5, and 7 months of age slightly decreased the occurrence of systemic and local adverse effects but did not reduce temperature.
Anales de Pediatría, 2001
Objetivo Analizar la frecuencia de utilización de la administración alternante de antitérmicos en... more Objetivo Analizar la frecuencia de utilización de la administración alternante de antitérmicos entre los pediatras españoles, y los factores que determinan este uso. Métodos Se llevó a cabo una encuesta anónima a pediatras en ejercicio activo. Se recogieron los datos de utilización de antitérmicos. Se realizó un análisis de los factores relacionados con la alternancia de antipiréticos con técnicas multivariantes. Resultados Se obtuvieron 324 encuestas. La edad media de los participantes fue de 46,4 ؎ 18,6 años (29-68 años de edad). El 22,5 % de los pediatras ejercían en un hospital, el 87,5 % en un centro de salud y el 24,7 % tenía su consulta privada. El 68,8 % (IC 95 %, 63,4-73,8 %) utilizaban la pauta alternante de antipiréticos, siendo la combinación de ibuprofeno y paracetamol la recomendada por el 96,9 %. Se relaciona con la utilización secuencial de antitérmicos el hecho de ser varón (OR, 0,535; IC 95 %, 0,296-0,967; p ؍ 0,038), con pocos años de experiencia (OR, 0,952; IC 95 %, 0,922-0,984; p ؍ 0,005), considerar el ibuprofeno como fármaco de primera elección (OR, 2,324; IC 95 %, 1,235-4,372; p ؍ 0,009) y recomendar una nueva dosis de antitérmico ante leves ascensos de temperatura (OR, 0,529; IC 95 %, 0,310-0,901; p ؍ 0,019). Conclusiones A pesar de la falta de evidencia científica que lo justifique, la utilización combinada de antitérmicos es una pauta habitual de tratamiento de la fiebre infantil, siendo factores que predisponen a esta práctica que el pediatra sea varón y con pocos años de ejercicio, que el fármaco utilizado de entrada sea el ibuprofeno, y que se recomiende la utili-zación de antitérmicos para el tratamiento de fiebre de leve intensidad.
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Papers by alfredo ballester