«En la Argentina está erradicada, pero hay regiones donde la cobertura del plan de vacunación con Sabin es de apenas el 70% y necesitamos por lo menos una cobertura del 95%», aseguran desde la SAP. Sobre el caso dek bebé en San Luis, aseguran que no se trata de «polio salvaje», sino de un virus derivado.

La Sociedad Argentina de Pediatría (SAP) aconsejó que la vacunación en los niños complete al menos el 95% de cobertura y al referirse al caso del bebé que enfermó en San Luis de poliomielitis recordó que lo importante es que no se trata de «polio salvaje», sino de un virus Sabín derivado.

«En la Argentina la polio está erradicada, pero hay regiones donde la cobertura del plan de vacunación con Sabin es de apenas el 70%, y necesitamos por lo menos una cobertura del 95% en cada departamento de cada provincia del país», aseguró Angela Gentile, secretaria de la SAP y jefa de Epidemiología del Hospital de Niños Ricardo Gutiérrez.

En diálogo con Télam, Gentile dijo que la SAP se reunió para «considerar la situación epidemiológica actual» y que se valoró como «muy importante que el caso del chiquito de San Luis no es de polio salvaje sino un virus Sabin derivado».

Los estudios de laboratorio confirmaron efectivamente que el poliovirus derivado provino de «un virus Sabin vacunal que mutó en más de 1% respecto de la cepa original Sabin (VDPV) y que ha revertido a la neurovirulencia».

El bebé fue contagiado al vacunarse, debido a que posee una inmunodeficiencia de base llamada agamaglobulinemia.

En 2000 y 2001, en Haití y República Dominicana, un virus Sabin derivado produjo aproximadamente 21 casos de poliomielitis y el brote terminó después de campañas masivas con vacunación.

La Sabin «es una vacuna a virus atenuado, que va mutando, cambiando, a medida que circula en áreas de bajo contenido de vacunación», explicó Gentile.

«Para evitar que la polio vuelva hay que aumentar la vacunación en áreas de baja cobertura de dosis, es decir, de vacunación incompleta, incluso por afuera del esquema regular», sostuvo.

La poliomielitis fue durante siglos una importante causa de invalidez y muerte en la infancia, hasta el advenimiento de la vacuna a mediados de la década del 50.

En América, la Comisión Internacional para la Certificación de la Erradicación de la Poliomielitis certificó la interrupción de la circulación de poliovirus salvaje en el año 1994.

La ausencia de circulación del poliovirus salvaje, sin embargo, no descarta la posibilidad de su reintroducción a través de un caso importado de países como Afganistán o India, donde persiste.

También, eventualmente, el virus atenuado de la vacuna Sabin puede realizar una mutación y revertir a la neurovirulencia, para lo cual debe infectar a personas susceptibles, es decir, no vacunadas, inmunosusceptibles o que no han completado el plan de vacunación.

Frente a estas posibilidades, el Ministerio de Salud de la Nación ordenó realizar una vigilancia activa de la ocurrencia de casos de Parálisis Fláccida Aguda (PFA), tal como el del bebé de San Luis, en menores de 15 años, para descartar que puedan ser debidos a cualquiera de estas situaciones.

Es difícil confirmar la poliomielitis paralítica en la fase aguda sobre la base de los signos y síntomas clínicos solamente, ya que muchas otras enfermedades y trastornos pueden causar síntomas similares; por lo tanto, la confirmación del laboratorio es indispensable para el diagnóstico definitivo.

Las dos enfermedades que más se le asemejan son el síndrome de Guillain-Barré (SGB) y la mielitis transversa.

En mayo de 2009 el Departamento de Epidemiología de la ciudad Buenos Aires recibió la notificación de un caso de parálisis fláccida aguda en un bebé de 1 año y 3 meses residente en San Luis, que fue internado en el Hospital Garrahan el 8 de abril pasado para estudio y diagnóstico.

Durante su internación se le diagnosticó agamaglobulinemia y comenzó un tratamiento en el servicio de inmunología del que fue dado de alta el 30 de abril.

Pero el 3 de mayo comenzó a tener dificultades para deambular, por lo que el 8 fue reinternado, tras lo cual se le diagnosticó Parálisis Fláccida Aguda (PAF).

La Dirección de Epidemiología de San Luis realizó las medidas de control de foco tras recibir la notificación del caso, lo que incluyó la visita al domicilio y el control de todos los carnets de vacunación de los contactos familiares, para garantizar que tuvieran el esquema de Sabin completo, lo que así resultó.

Sin embargo, el esquema de cobertura con Sabin del año 2008 para toda la provincia de San Luis no alcanzó en promedio al 95% recomendado por la SAP: fue del 93,3% para la tercera dosis, del 87,2% para el primer refuerzo y del 98,3% para el refuerzo de ingreso escolar, informó la entidad.

(Telam)

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