Letter to the Editor
Obsolete Anti-pneumoccal Vaccination Recommendations in the Spanish Guidelines for the Management of Asthma (GEMA 4.0)
La guía española del manejo del asma (GEMA 4.0) está obsoleta en lo que a vacunación antineumocócica se refiere
Enrique Mascarósa,
, Daniel Ocañab, Federico Martinón-Torresc, en nombre de Neumoexpertos en Prevención ◊
Corresponding author
a Departamento de Salud, Hospital Dr. Peset, Centro de Atención Primaria Fuente de San Luis, Valencia, Spain
b Grupo Respiratorio de Atención Primaria, Centro de Salud de Algeciras, Algeciras, Cádiz, Spain
c Pediatría Clínica, Infectológica y Traslacional, Hospital Clínico Universitario de Santiago, Santiago de Compostela, A Coruña, Spain
Read
5333
Timeswas read the article
1833
Total PDF
3500
Total HTML
Share statistics
array:24 [ "pii" => "S1579212916301185" "issn" => "15792129" "doi" => "10.1016/j.arbr.2016.06.014" "estado" => "S300" "fechaPublicacion" => "2016-08-01" "aid" => "1318" "copyright" => "SEPAR" "copyrightAnyo" => "2016" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Arch Bronconeumol. 2016;52:448" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2073 "formatos" => array:3 [ "EPUB" => 136 "HTML" => 1466 "PDF" => 471 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0300289616000284" "issn" => "03002896" "doi" => "10.1016/j.arbres.2016.01.009" "estado" => "S300" "fechaPublicacion" => "2016-08-01" "aid" => "1318" "copyright" => "SEPAR" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Arch Bronconeumol. 2016;52:448" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3029 "formatos" => array:3 [ "EPUB" => 98 "HTML" => 2251 "PDF" => 680 ] ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta al Director</span>" "titulo" => "La guía española del manejo del asma (GEMA 4.0) está obsoleta en lo que a vacunación antineumocócica se refiere" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "448" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Obsolete anti-pneumoccal vaccination recommendations in the Spanish guidelines for the management of asthma (GEMA 4.0)" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Enrique Mascarós, Daniel Ocaña, Federico Martinón-Torres" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Enrique" "apellidos" => "Mascarós" ] 1 => array:2 [ "nombre" => "Daniel" "apellidos" => "Ocaña" ] 2 => array:2 [ "nombre" => "Federico" "apellidos" => "Martinón-Torres" ] 3 => array:1 [ "colaborador" => "en nombre de Neumoexpertos en Prevención" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1579212916301185" "doi" => "10.1016/j.arbr.2016.06.014" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212916301185?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289616000284?idApp=UINPBA00003Z" "url" => "/03002896/0000005200000008/v1_201607230338/S0300289616000284/v1_201607230338/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S1579212916301252" "issn" => "15792129" "doi" => "10.1016/j.arbr.2016.06.021" "estado" => "S300" "fechaPublicacion" => "2016-08-01" "aid" => "1367" "copyright" => "SEPAR" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Arch Bronconeumol. 2016;52:449" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1724 "formatos" => array:3 [ "EPUB" => 123 "HTML" => 1073 "PDF" => 528 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Obsolete Anti-Pneumococcal Vaccination Recommendations in the Spanish Guidelines for the Management of Asthma (GEMA 4.0): The Authors Reply" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "449" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "La guía española del manejo del asma (GEMA 4.0) está obsoleta en lo que a vacunación antineumocócica se refiere. Respuesta de los autores" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Vicente Plaza Moral, Cesáreo Álvarez Rodríguez, Antonio Gómez-Outes, Fernando Gómez Ruiz, Antolín López Viña, Francisco Javier Pellegrini Belinchón, Javier Plaza Zamora, José Antonio Quintano Jiménez, Santiago Quirce Gancedo, José Sanz Ortega, Ramona Soler Vilarrasa, José Ramón Villa Asensi" "autores" => array:13 [ 0 => array:2 [ "nombre" => "Vicente" "apellidos" => "Plaza Moral" ] 1 => array:2 [ "nombre" => "Cesáreo" "apellidos" => "Álvarez Rodríguez" ] 2 => array:2 [ "nombre" => "Antonio" "apellidos" => "Gómez-Outes" ] 3 => array:2 [ "nombre" => "Fernando" "apellidos" => "Gómez Ruiz" ] 4 => array:2 [ "nombre" => "Antolín" "apellidos" => "López Viña" ] 5 => array:2 [ "nombre" => "Francisco Javier" "apellidos" => "Pellegrini Belinchón" ] 6 => array:2 [ "nombre" => "Javier" "apellidos" => "Plaza Zamora" ] 7 => array:2 [ "nombre" => "José Antonio" "apellidos" => "Quintano Jiménez" ] 8 => array:2 [ "nombre" => "Santiago" "apellidos" => "Quirce Gancedo" ] 9 => array:2 [ "nombre" => "José" "apellidos" => "Sanz Ortega" ] 10 => array:2 [ "nombre" => "Ramona" "apellidos" => "Soler Vilarrasa" ] 11 => array:2 [ "nombre" => "José Ramón" "apellidos" => "Villa Asensi" ] 12 => array:1 [ "colaborador" => "en representación del Comité Ejecutivo de la Guía Española para el Manejo del Asma (GEMA)" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S030028961630059X" "doi" => "10.1016/j.arbres.2016.03.011" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S030028961630059X?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212916301252?idApp=UINPBA00003Z" "url" => "/15792129/0000005200000008/v1_201607230336/S1579212916301252/v1_201607230336/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1579212916301100" "issn" => "15792129" "doi" => "10.1016/j.arbr.2016.06.006" "estado" => "S300" "fechaPublicacion" => "2016-08-01" "aid" => "1288" "copyright" => "SEPAR" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Arch Bronconeumol. 2016;52:447" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1749 "formatos" => array:3 [ "EPUB" => 136 "HTML" => 1105 "PDF" => 508 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Extravascular Lung Water Index as a Predictive Factor for Non-Invasive Ventilation Failure. The Last Chance to Make the Right Decision?" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "447" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Índice de agua pulmonar extravascular y fracaso de la ventilación no invasiva. ¿Es la última frontera para una correcta decisión?" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Antonio M. Esquinas, Fernanda Tagliaferri, Maria Barbagallo" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Antonio M." "apellidos" => "Esquinas" ] 1 => array:2 [ "nombre" => "Fernanda" "apellidos" => "Tagliaferri" ] 2 => array:2 [ "nombre" => "Maria" "apellidos" => "Barbagallo" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0300289615004822" "doi" => "10.1016/j.arbres.2015.11.011" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289615004822?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212916301100?idApp=UINPBA00003Z" "url" => "/15792129/0000005200000008/v1_201607230336/S1579212916301100/v1_201607230336/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Obsolete Anti-pneumoccal Vaccination Recommendations in the Spanish Guidelines for the Management of Asthma (GEMA 4.0)" "tieneTextoCompleto" => true "saludo" => "To the Editor:" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "448" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Enrique Mascarós, Daniel Ocaña, Federico Martinón-Torres" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Enrique" "apellidos" => "Mascarós" "email" => array:2 [ 0 => "enmasba@gmail.com" 1 => "enmasba@sociedadgrap.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Daniel" "apellidos" => "Ocaña" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Federico" "apellidos" => "Martinón-Torres" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:2 [ "colaborador" => "en nombre de Neumoexpertos en Prevención" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">◊</span>" "identificador" => "fn1" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Departamento de Salud, Hospital Dr. Peset, Centro de Atención Primaria Fuente de San Luis, Valencia, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Grupo Respiratorio de Atención Primaria, Centro de Salud de Algeciras, Algeciras, Cádiz, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Pediatría Clínica, Infectológica y Traslacional, Hospital Clínico Universitario de Santiago, Santiago de Compostela, A Coruña, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "La guía española del manejo del asma (GEMA 4.0) está obsoleta en lo que a vacunación antineumocócica se refiere" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The most recent version of the Spanish Guidelines for the Management of Asthma (GEMA 4.0) states in the section on recommendations for vaccination that: “Influenza and pneumococcal vaccination have shown no efficacy in preventing asthma exacerbations. However, since it is a cost-effective strategy, and the risk of complications in chronic patients in high, annual influenza vaccination should be considered in pediatric and adult patients with moderate-to-severe asthma.”<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> This statement (supported by a reference from the year 2002) omits the recommendation of pneumococcal vaccination, making it obsolete in the light of current knowledge.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Numerous papers, some of which were published by the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) itself, recommend pneumococcal vaccination in asthma patients.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">2–4</span></a> Specifically, the consensus document on anti-pneumococcal vaccination in adults with underlying disease, signed by 16 scientific societies, states that “In addition to COPD, asthma is another chronic respiratory disease which appears to act as a risk factor”. Several specific recommendations and recent systematic reviews on pneumococcal vaccination in subjects with respiratory diseases refer to the need to prevent pneumococcal disease in these patients due to their increased risk.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">4–6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Asthma patients have been reported in various studies to have a higher incidence of invasive pneumococcal disease (IPD), correlating with the degree of asthma severity. A greater risk of developing IPD is seen in the high risk group, defined as asthmatics with 1 or more hospitalizations or visits to the emergency room, long-term use of rescue treatment or oral corticosteroids, or use of beta-agonists ≥3 times during the previous year. A systematic review of IPD in asthma patients concluded that in view of the high risk of these patients, pneumococcal vaccination should be recommended in this population.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Similarly, available data on pneumococcal pneumonia, the most common form of pneumococcal disease in adults, show a significant increase in the incidence and risk of this entity in asthmatics compared to the healthy population.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a> Okapuu et al.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a> calculated the number of asthma patients who needed to be vaccinated (NNV) to prevent 1 case of IPD, using both the 13-valent pneumococcal conjugated vaccine (PVC13) and the 23-valent pneumococcal polysaccharide vaccine (PPV23). Assuming a vaccine efficacy of 65%, the NNV ranged between 135 and 839 adults, a number comparable to that found for other diseases considered high-risk for which pneumococcal vaccination with both vaccines is recommended. Moreover, the CAPiTA study (clinical efficacy of PCV13 pneumococcal vaccination against pneumococcal pneumonia), with more than 84,000 subjects ≥65 years of age, including patients with asthma and other respiratory diseases, demonstrated that PVC13 is effective for preventing both IPD and pneumococcal pneumonia caused by the vaccine serotypes.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In the light of this evidence, pneumococcal vaccination is currently recommended in asthma patients, preferably with a single dose of PCV13, subsequently followed by PPV23 vaccination. In view of the importance, prestige and clinical utility of the GEMA guidelines, we request a rectification and update of the vaccination section which takes into account the current recommendations summarized in the indication for pneumococcal vaccination in asthma patients, particularly those with severe forms of the disease.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Mascarós E, Ocaña D, Martinón-Torres F, en nombre de Neumoexpertos en Prevención. La guía española del manejo del asma (GEMA 4.0) está obsoleta en lo que a vacunación antineumocócica se refiere. Arch Bronconeumol. 2016;52:448.</p>" ] 1 => array:3 [ "etiqueta" => "◊" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Pneumo experts prevention is a national working group on the prevention of pneumonia, sponsored by the Health Research Institute of Santiago, Spain. More information see: <a class="elsevierStyleInterRef" id="intr0010" href="http://www.neumoexpertos.com/">http://www.neumoexpertos.com</a></p>" "identificador" => "fn1" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0040" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "GEMA 4.0. Asma y enfermedad pulmonar obstructiva crónica. Guía española para el manejo del asma. Available from: <a id="intr0015" class="elsevierStyleInterRef" href="http://www.gemasma.com/">http://www.gemasma.com</a> [accessed 01.06.15]" ] ] ] 1 => array:3 [ "identificador" => "bib0045" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Consenso sobre la vacunación anti-neumocócica en el adulto con patología de base" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.J. Picazo" 1 => "L.M. Alonso" 2 => "J. Arístegui" 3 => "J.M. Bayas" 4 => "J. Sanz" 5 => "P. del Amo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Esp Quimioter" "fecha" => "2013" "volumen" => "26" "paginaInicial" => "232" "paginaFinal" => "252" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24080892" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0050" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Recomendación de la vacuna antineumocócica en las enfermedades respiratorias crónicas" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "F. Casas Maldonado" 1 => "I. Alfageme Michavila" 2 => "V.S. Barchilón Cohen" 3 => "J.I. Peis Redondo" 4 => "D.A. Vargas Ortega" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.semerg.2014.06.012" "Revista" => array:6 [ "tituloSerie" => "Semergen" "fecha" => "2014" "volumen" => "40" "paginaInicial" => "313" "paginaFinal" => "325" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25107494" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0055" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "La vacuna antineumocócica conjugada en la patología respiratoria" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "I. Alfageme Michavila" 1 => "J. Hilares Vera" 2 => "I. Alfageme" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Monogr Arch Bronconeumol" "fecha" => "2014" "volumen" => "1" "paginaInicial" => "109" "paginaFinal" => "117" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0060" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rates of pneumococcal disease in adults with chronic medical conditions" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "K.M. Shea" 1 => "J. Edelsberg" 2 => "D. Weycker" 3 => "R.A. Farkouh" 4 => "D.R. Strutton" 5 => "S.I. Pelton" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Open Forum Infect Dis" "fecha" => "2014" "volumen" => "27" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0065" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "How many individuals with asthma need to be vaccinated to prevent one case of invasive pneumococcal disease?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.M. Okapuu" 1 => "E. Chétrit" 2 => "B. Lefebvre" 3 => "C. Quach" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Can J Infect Dis Med Microbiol" "fecha" => "2014" "volumen" => "25" "paginaInicial" => "147" "paginaFinal" => "150" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25285110" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0070" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Polysaccharide conjugate vaccine against pneumococcal pneumonia in adults" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.J. Bonten" 1 => "S.M. Huijts" 2 => "M. Bolkenbaas" 3 => "C. Webber" 4 => "S. Patterson" 5 => "S. Gault" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa1408544" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2015" "volumen" => "372" "paginaInicial" => "1114" "paginaFinal" => "1125" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25785969" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005200000008/v1_201607230336/S1579212916301185/v1_201607230336/en/main.assets" "Apartado" => array:4 [ "identificador" => "45358" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005200000008/v1_201607230336/S1579212916301185/v1_201607230336/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212916301185?idApp=UINPBA00003Z" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 1 | 5 |
| 2024 October | 42 | 18 | 60 |
| 2024 September | 38 | 16 | 54 |
| 2024 August | 68 | 32 | 100 |
| 2024 July | 34 | 18 | 52 |
| 2024 June | 59 | 40 | 99 |
| 2024 May | 70 | 24 | 94 |
| 2024 April | 41 | 27 | 68 |
| 2024 March | 44 | 20 | 64 |
| 2024 February | 33 | 20 | 53 |
| 2023 March | 9 | 3 | 12 |
| 2023 February | 29 | 20 | 49 |
| 2023 January | 32 | 25 | 57 |
| 2022 December | 49 | 28 | 77 |
| 2022 November | 41 | 23 | 64 |
| 2022 October | 56 | 41 | 97 |
| 2022 September | 35 | 33 | 68 |
| 2022 August | 33 | 46 | 79 |
| 2022 July | 36 | 46 | 82 |
| 2022 June | 40 | 40 | 80 |
| 2022 May | 52 | 30 | 82 |
| 2022 April | 69 | 30 | 99 |
| 2022 March | 74 | 46 | 120 |
| 2022 February | 65 | 32 | 97 |
| 2022 January | 66 | 40 | 106 |
| 2021 December | 49 | 39 | 88 |
| 2021 November | 46 | 41 | 87 |
| 2021 October | 46 | 40 | 86 |
| 2021 September | 32 | 50 | 82 |
| 2021 August | 42 | 34 | 76 |
| 2021 July | 24 | 29 | 53 |
| 2021 June | 31 | 49 | 80 |
| 2021 May | 46 | 39 | 85 |
| 2021 April | 76 | 107 | 183 |
| 2021 March | 38 | 24 | 62 |
| 2021 February | 27 | 16 | 43 |
| 2021 January | 21 | 19 | 40 |
| 2020 December | 21 | 18 | 39 |
| 2020 November | 35 | 13 | 48 |
| 2020 October | 18 | 15 | 33 |
| 2020 September | 40 | 15 | 55 |
| 2020 August | 81 | 15 | 96 |
| 2020 July | 80 | 25 | 105 |
| 2020 June | 24 | 11 | 35 |
| 2020 May | 43 | 21 | 64 |
| 2020 April | 62 | 22 | 84 |
| 2020 March | 27 | 14 | 41 |
| 2020 February | 25 | 18 | 43 |
| 2020 January | 30 | 27 | 57 |
| 2019 December | 31 | 13 | 44 |
| 2019 November | 38 | 22 | 60 |
| 2019 October | 23 | 11 | 34 |
| 2019 September | 15 | 10 | 25 |
| 2019 August | 27 | 13 | 40 |
| 2019 July | 23 | 17 | 40 |
| 2019 June | 45 | 9 | 54 |
| 2019 May | 44 | 17 | 61 |
| 2019 April | 57 | 32 | 89 |
| 2019 March | 29 | 16 | 45 |
| 2019 February | 36 | 16 | 52 |
| 2019 January | 28 | 11 | 39 |
| 2018 December | 35 | 11 | 46 |
| 2018 November | 83 | 18 | 101 |
| 2018 October | 82 | 28 | 110 |
| 2018 September | 18 | 10 | 28 |
| 2018 August | 3 | 0 | 3 |
| 2018 June | 1 | 0 | 1 |
| 2018 May | 10 | 0 | 10 |
| 2018 April | 27 | 6 | 33 |
| 2018 March | 40 | 7 | 47 |
| 2018 February | 38 | 6 | 44 |
| 2018 January | 164 | 8 | 172 |
| 2017 December | 161 | 5 | 166 |
| 2017 November | 42 | 4 | 46 |
| 2017 October | 27 | 3 | 30 |
| 2017 September | 28 | 6 | 34 |
| 2017 August | 24 | 9 | 33 |
| 2017 July | 23 | 11 | 34 |
| 2017 June | 35 | 28 | 63 |
| 2017 May | 32 | 7 | 39 |
| 2017 April | 32 | 12 | 44 |
| 2017 March | 21 | 7 | 28 |
| 2017 February | 8 | 8 | 16 |
| 2017 January | 11 | 2 | 13 |
| 2016 December | 31 | 18 | 49 |
| 2016 November | 43 | 28 | 71 |
| 2016 October | 1 | 3 | 4 |
| 2016 August | 1 | 1 | 2 |
Show all
