Bien, somos podólogos. ¿Tenemos que saber algo sobre inmunizaciones o vacunas? Claro que sí. Seguramente la que más nos interese es la vacuna del tétanos, pero hay alguna más que debería ser de nuestro interés. Veamos porqué.
El concepto de inmunización hace referencia a un estado de resistencia o protección frente a agentes infecciosos y sus consecuencias. Se puede conseguir de manera artificial con las vacunas, «preparados de proteinas, polisacáridos o ácidos nucleicos de los microorganismos patógenos que son suministradas al sistema inmunitario como entidades simples, como partes de moléculas complejas, o por medio de agentes vivos atenuados o vectores, con el objeto de introducir respuestas inmunitarias específicas protectoras que inactiven, destruyan o supriman el agente infeccioso patógeno».
BREVE REPASO A LA INMUNIDAD
Un antígeno es «aquella sustancia capaz de estimular al sistema inmunitario para que elabore una respuesta específica llamada anticuerpo».
Los anticuerpos son «sustancias protectoras producidas por el sistema inmunitario a partir de glicoproteinas que actuan como receptores de los linfocitos B al reconocer un antígeno».
El sistema inmune es el encargado de afrontar la invasión de agentes patógenos. Tiene como características la especificidad y la memoria inmunológica. El sistema linfoide se clasifica en primario y secundario. El primario es el timo y la médula ósea. El secundario son los ganglios linfáticos y el bazo. Los linfocitos son células formadas en la médula osea. Hay varios tipos:
– Linfocitos B. Producen anticuerpos llamados inmunoglobulinas específicas para cada antígeno. Son proteinas y se clasifican en cinco tipos. Es la inmunidad humoral, y es una respuesta rápida y con memoria.
- IgM. Las primeras que se forman ante un antígeno. Altos niveles al comienzo de una infección.
- IgG. Atraviesan la placenta. Proporcionan la inmunidad pasiva adquirida al bebé.
- IgA. Son las encargadas de producir la inmunidad humoral. Son las más abundantes en la leche materna.
- IgD. Función no muy conocida.
- IgE. Alergias.
. Linfocitos T. Necesitan al timo para su maduración. Inmunidad celular, que desarrolla macrófagos. Respuesta tardía a la infección.
– Linfocitos T. Que necesitan al timo para su maduración
Como resumen, en el cuerpo hay varios tipos de inmunidad:
| ACTIVA | PASIVA | |||
| NATURAL | Enfermedad | Lactancia maternaTransplacentaria | ||
| ARTIFICIAL | Vacuna | Gamma globulina | ||
Recuerdo que en secundaria me comentaron que las vacuna fueron descubiertas por Edgard Jenner en 1796. Este señor consiguió la primera vacuna sintetizada contra la viruela, enfermedad que actualmente está erradicada.
CLASIFICACIÓN DE LAS VACUNAS
Se pueden clasificar de varias formas: según su naturaleza microbiológica, composición antigénica, composición de la vacuna… etcétera.
Así tenemos vacunas víricas y bacterianas, vivas o atenuadas, toxoides, antigénicas, recombinantes, monovalente, polivalente…
La diferencia principal entre agentes vivos o agentes muertos es:
| AGENTES VIVOS | AGENTES MUERTOS |
|
. |
Yo uso una regla memotécnica para saberme también cuales son bacterianas vivas y cuáles son víricas vivas, pues son las vacunas que pueden dar más complicaciones.
TU tuberculosis COCHE colera TIENE tifus SALPICADERO sarampión RUEDAS rubeola PARA parotiditis AMAR A fiebre amarilla VANE varicela SA polio oral (esta última no pega, lo sé)
Las tres primeras son bacterianas, el resto son víricas.
CALENDARIOS VACUNALES DE MADRID
Calendario de vacunación infantil. 1 de enero de 2014
| EDAD | VACUNA |
Recién Nacido | Hepatitis B* |
2 meses | Hepatitis B |
4 meses | Difteria – Tétanos- Tos ferina acelular |
6 meses | Hepatitis B |
12 meses | Rubéola-Parotiditis-Sarampión Meningococo C |
18 meses | Difteria-Tétanos-Tos ferina acelular |
4 años | Sarampión-Rubéola-Parotiditis |
| 6 años | Difteria-Tétanos-Tos ferina (b) |
12 años | Varicela ** |
14 años | Difteria-Tétanos-Tos ferina (b) |
(b) baja carga
* En hijos de madre portadora de AgHBs se administrará la vacuna HB más gammaglobulina dentro de las 12 horas que siguen al nacimiento. Se continuará la vacunación con vacuna combinada hexavalente a los 2-4-6 meses y la determinación de anticuerpos de 1 a 3 meses después de la vacunación. En caso de screening no realizado se administrará la vacuna HB dentro de las 12 horas que siguen al nacimiento, se determinará AgHBs de la madre lo antes posible y si fuera positivo se administrará gammaglobulina al recién nacido (no después de 1 semana de vida). Se continuará con la pauta de vacunación del calendario infantil. Actualmente no es necesaria la revacunación en población inmunocompetente, si se han recibido 3 dosis de la vacuna de la hepatitis B, ni realizar determinación de anticuerpos postvacunales.
** Personas que refieran no haber pasado la enfermedad ni haber sido vacunados con anterioridad. Pauta de dos dosis separadas como mínimo 1 mes (0-1)
*** Sólo niñas. La pauta de vacunación son 2 o 3 dosis, según la vacuna administrada).
¿QUÉ HACER CON UN PACIENTE QUE ACUDE CON UNA HERIDA O QUEMADURA?
Ante un paciente que acude con una herida o quemadura, contaminada por estiercol, mordeduras, fracturas abiertas, congelaciones… Hay que seguir el siguiente esquema y prescribir la vacuna o la inmunoglobulina según precise. Os recuerdo que los podólogos somos prescriptores de pleno derecho.
¿QUÉ PASA CON NOSOTROS, LOS PODÓLOGOS?
Nosotros nos debemos vacunar de la gripe anualmente para no contagiar a nuestros pacientes, dada la cantidad de gente que vemos en nuestras consultas, centros de mayores, etcétera.
Así mismo, si hemos nacido antes de 1985 debemos estar vacunados de la hepatitis B, pues en nuestra profesión eventualmente entraremos en contacto con sangre de nuestros pacientes.
CONTRAINDICACIONES
Hay dos tipos de contraindicaciones, las absolutas, las relativas y las «falsas contraindicaciones».
Absolutas:
- Reacción anafiláctica previa.
- Embarazadas: no administrar vacunas de agentes vivos.
- Transtornos neurológicos no filiados.
Relativas:
- Fiebre mayor de 38º.
- Inmunodeficiencia adquirida.
- Corticoides a dosis altas de dos semanas o más de tratamiento.
- Transfusión de hemoderivados.
Falsas contraindicaciones:
- Patología neurológica filiada.
- Alergia inespecífica.
- Reacción local intensa.
- Enfermedad aguda leve.
- Tratamiento antibiótico.
- Prematuridad o bajo peso al nacer.
- Las embarazadas pueden recibir vacunación siempre que no sean atenuadas. Pueden dar lactancia, y se aconseja que sea a partir del segundo trimestre de gestación.
Para acabar me gustaría decir que muchas veces no somos conscientes como colectivo de que somos profesionales de la salud facultativos y con poder de prescripción completo, y que debemos ejercer nuestras labores profesionales al 100% de conocimientos científicos, farmacológicos y de patología general y podológica. Por eso repaso con vosotros estas cosas. Así estudiamos todos para ser unos mejores profesionales.
¡¡BUENA SEMANA!!
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