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Vacúnate, la serie “La vacuna es el mejor regalo de amor en la pandemia. Vacúnate por ti, por tu familia, por el país y por mantener las escuelas abiertas” Colegio de Médicos Cirujanos de Puerto Rico
Importante completar las dosis de la vacuna contra el VPH La enfermedad neumocócica es prevenible Powered by
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Vacunar “regalo de amor” a los tuyos es un
Por Glorimar Velázquez Especial para Suplementos
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a aparición de la pandemia del COVID-19 cambió la vida de todas las personas en el mundo. Muchos adultos salieron de sus espacios de trabajo para laborar desde sus hogares. Los niños abandonaron las escuelas para estudiar a distancia. El encierro obligó a todos a estar alejados de sus familiares y amistades. Sin embargo, lo peor de todo han sido las miles de vidas que se han perdido a causa del novel coronavirus. Afortunadamente, se desarrollaron vacunas que han demostrado ser efectivas contra el COVID-19. ¿Qué lecciones está dejando la pandemia del COVID-19? ¿Cómo está la isla en la meta de vacunación? A casi dos años de la llegada de los primeros casos de COVID-19 a Puerto Rico, el doctor Víctor Ramos Otero, presidente del Colegio de Médicos Cirujanos de Puerto Rico, contestó estas y otras preguntas.
¿CUÁL HA SIDO LA LABOR REALIZADA POR EL COLEGIO DE MÉDICOS CIRUJANOS DE PUERTO RICO DURANTE LA PANDEMIA?
Desde el principio de la pandemia, establecimos un call center, porque las personas tenían muchas dudas sobre el virus y no tenían con quién
comunicarse. Ahí recibimos más de 100 mil llamadas que pudimos atender. Después, empezamos a repartir equipo de protección personal para los médicos que tenían oficinas. Esto lo hicimos porque se les estaba repartiendo equipo de protección a los médicos que estaban en los hospitales, pero los que trabajaban desde sus oficinas estaban desprotegidos. Luego, establecimos el servicarro de pruebas, que aún está disponible de lunes a viernes desde las 9:00 a.m. hasta las 2:00 p.m. Para este servicarro, logramos un acuerdo con un laboratorio y comenzamos a hacer pruebas desde abril del año pasado, junto con la Asociación de IPAS de Puerto Rico. Asimismo, nuestro primer evento de vacunación fue el 24 de diciembre. Durante esa Nochebuena, vacunamos a varios profesionales de la salud como fue la recomendación inicial. También fuimos los primeros que llegamos a muchos lugares de la isla para vacunar a los profesionales de la salud. Además, nos hemos mantenido cooperando con el Departamento de Salud, trabajando en varios centros de vacunación. La clínica principal está en The Mall of San Juan, donde vacunamos a los niños de 5 a 11 años y también a los mayores de 12 con las dosis que necesiten. Los otros centros de vacunación están en el Colegio de Médicos Cirujanos, en
Víctor Ramos Otero, presidente del Colegio de Médicos Cirujanos de Puerto Rico, conversó sobre la importancia de la vacunación ●
Las Piedras, San Lorenzo, Guayama, Peñuelas, Maunabo, Loíza, Aguas Buenas, Utuado, Cataño y Barceloneta. También, debo mencionar que nosotros fuimos los que más encamados visitamos. Fueron más de 10 mil encamados. Esa vacunación se hace casa por casa y es un reto, pero lo hicimos. Otra iniciativa que tuvimos fue de educación continua con el curso obligatorio de COVID-19 que más de 8 mil médicos cogieron con el Colegio. Ese curso lo preparó la Sociedad de Enfermedades Infecciosas de Puerto Rico, y los médicos salieron muy satisfechos con todo lo que aprendieron.
¿QUÉ LECCIONES ENTIENDE SE ESTÁN APRENDIENDO EN ESTA PANDEMIA?
Una de las lecciones es que hay que trabajar en grupo, junto con el Departamento de Salud y las organizaciones privadas. Yo creo que la unión de voluntarios, tanto del sector público como del privado, ha sido beneficiosa. Otra lección aprendida es que se siguieron las recomendaciones de
la ciencia, a pesar de que había mucha presión del sector económico. Puedo decir que hubo reuniones que fueron difíciles, pero nuestra posición siempre fue que, si se afectaba la salud, más se iba a tardar en recuperar la economía. Definitivamente, el tiempo nos dio la razón. Ahora vemos cómo han aumentado el turismo y la venta de autos, entre otros sectores. Si no se hubiese sido tan estricto al principio, no tendríamos esa recuperación económica.
EN PUERTO RICO SE HAN PERDIDO MÁS DE TRES MIL VIDAS, ¿CREE QUE ALGUNAS DE ESTAS MUERTES SE PUDIERON HABER EVITADO?
Siempre es posible evitar muertes, sobre todo después de la vacuna. Muchos de los fallecimientos que se dieron en personas que podían vacunarse, pero no lo hicieron, se podían evitar. Las personas que no se vacunan tienen menos posibilidades de pelear contra el virus. A veces, la gente piensa que 3 mil vidas es poco y que Puerto Rico lo hizo mejor, en com-
BrandStudio Lead Manager: Milvia Ramírez Rivera Editora: Jannette Hernández Hernández ● Subeditora: Lucía A. Lozada Laracuente Coordinadora de Suplementos y Publicaciones Especiales: Sharian Maldonado Rodríguez
paración con otras jurisdicciones, y es verdad, pero, cada persona que muere, duele; cada una tiene su historia y hay historias bien tristes. Hay que ponerles rostros a los fallecidos, tanto de las personas como de los médicos. Yo tuve amigos cercanos que murieron, como cinco que fueron compañeros pediatras, y cada uno nos afecta. Pero, la mortalidad del virus es de [aproximadamente] un 2 %, y si tomas 3.2 millones de personas, serían unas 64 mil vidas que se podían perder, si no se hubiesen tomado las medidas que se implementaron cuando inició la pandemia. Las medidas, como el toque de queda y los cierres de negocios, funcionaron y nos ayudaron a minimizar las muertes.
AL INICIO DE LA PANDEMIA, MUCHAS PERSONAS COMENTABAN EN LAS REDES SOCIALES QUE NO SE QUERÍAN VACUNAR, ¿ENTIENDE QUE HA CAMBIADO EL ESCEPTICISMO QUE HABÍA HACIA LAS VACUNAS?
En Puerto Rico, a diferencia de Estados Unidos, los movimientos antivacunas nunca han sido grandes. Afortunadamente, nosotros siempre hemos tenido una alta tasa de vacunación pediátrica, la más grande de Estados Unidos. A pesar de estos movimientos antivacunas, hemos notado que la
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gente ha escuchado a la ciencia. Mi intención es convencer al que se puede vacunar. Yo no pierdo mi foco ni entro en discusiones con estos grupos. Ellos tienen una postura firme y clara; no voy a entrar en polémica, solo quiero convencer a los que podemos vacunar y aclarar las dudas que las personas puedan tener.
¿CÓMO VAMOS CON EL PORCENTAJE DE VACUNACIÓN EN PUERTO RICO?
Vamos muy bien. De la población elegible, más del 90 % tiene una dosis y más del 80 % tiene la serie completa. El porcentaje baja a 70 cuando tomamos toda la población, incluyendo los no elegibles, pero entendemos que eso va a aumentar, según se vayan vacunando los niños. Actualmente, hay unos mandatos de vacunación que a mucha gente no les gustan, pero han sido muy efectivos. Se han utilizado desde 1905 para la viruela, que se logró erradicar del mundo. Hay personas que piensan que es onerosa la obligación de vacunarse, pero si pensamos en el caso de Jacobson vs. Massachusetts, en 1905, en el que el demandante se negó a cumplir con el requisito de vacunación y el tribunal ordenó que estuviera detenido hasta que pagara la multa, eso sí es oneroso. Ahora eso no lo hacemos, así que esperamos que reine la sensatez y que dejen a los científicos hacer su trabajo.
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¿CUÁL ES LA META DE VACUNACIÓN?
La meta es vacunar a todo el que podamos. Nunca va a haber un 100 %, porque hay personas que no se pueden vacunar por condiciones de salud o por alguna razón ideológica, pero la meta es vacunar a todo el que podamos.
¿CUÁL ES LA EXHORTACIÓN QUE HACE DURANTE ESTA TEMPORADA FESTIVA?
Yo, como pediatra, pienso que la vacuna es el mejor regalo de amor que los padres pueden darles a sus hijos, para tener una Navidad y un regreso a clases seguro. No se ha detectado ningún efecto secundario serio en niños, solo dolor en el brazo y un poco de malestar. Mi exhortación a todos —adultos y niños— es que se vacunen tanto con la primera, como con la segunda dosis y los refuerzos, que es la parte donde más atrás estamos. Para aclarar dudas sobre las dosis de refuerzo, la fórmula de la vacuna de Pfizer y de Janssen es igual. En el caso de la de Moderna, es la mitad de la dosis, porque esa cantidad demostró que tiene el efecto protector de refuerzo. Así que, además de seguir vacunando a nuestros niños, exhortamos a todos a estar pendientes a las variantes nuevas, como ómicron, de la que, al cierre de esta edición, ya se han detectado casos en varios estados de Estados Unidos, así como en otros países, como: Bélgica, Alemania, Reino Unido y Brasil.
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¿Por qué es importante completar las dosis de la vacuna contra el VPH? Si no se completan las dosis, no se puede garantizar una protección óptima y de larga duración Por Carmen I. Suárez Martínez, MD, FAAP Especial para Suplementos
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arias cepas del virus del papiloma humano, conocido como el VPH, pueden causar enfermedades muy serias como los cánceres de cérvix, vagina, vulva, pene, ano, y cabeza y cuello, además de verrugas genitales. Afortunadamente, existe la posibilidad de vacunarse y prevenir las complicaciones que produce esta infección cuando el cuerpo no es capaz de eliminarla. La vacuna contra el virus del papiloma humano incluye protección específica contra las cepas del virus asociadas a estas condiciones. Se recomienda que se vacunen a todas las niñas y los niños a los once años, aunque se puede comenzar desde los 9 años. Es importante recalcar que es preferible vacunar antes de que comience la actividad sexual, ya que esta infección se adquiere por contacto con piel infectada y en relaciones sexuales que involucren área genital/genital o genital/oral. El virus del papiloma humano es muy común y por eso el riesgo es real. Entonces, es importante saber que las vacunas estimulan al sistema inmunológico a crear defensas específicas contra los agentes infecciosos para los cuales existen vacunas. Existen varios tipos de vacunas. Es posible utilizar el germen, pero en su estado muerto. A este tipo de vacuna se le conoce como vacuna inactivada. También hay vacunas que utilizan el germen completo, pero debilitado, cosa de que produzca inmunidad, pero no cause la enfermedad. A estas vacunas se les conoce como vivas atenuadas. Otras vacunas utilizan una parte del germen como una proteína o parte de la cápsula y, en ocasiones, se pega una parte del germen a un adyuvante para lograr la inmunidad. Hay vacunas que utilizan las toxinas que produce el germen como método de inducir inmunidad.
Las vacunas pueden administrarse de manera oral, nasal o inyectable. Al administrar una vacuna, el cuerpo —y específicamente el sistema inmunológico—, reconoce ese agente como extraño y crea defensas o anticuerpos específicos contra el agente infeccioso. Estas defensas tienen el potencial de atacar la infección real, si, en algún momento, tiene contacto con la persona. Las células blancas del torrente sanguíneo son esa línea de defensa. Existen recomendaciones específicas en cuanto a la cantidad de dosis de cada vacuna. Estas recomendaciones se basan en estudios científicos donde se busca saber cuántas dosis son necesarias para asegurar una respuesta inmune robusta y duradera. En ciertas vacunas, también se sugieren refuerzos para mantener la inmunidad a largo plazo. En el caso del VPH, se recomienda poner dos dosis separadas por seis meses en pacientes menores de 15 años. Luego de los 15 años, la recomendación es administrar tres dosis. En este caso, la segunda dosis se administra dos meses luego de la primera y la tercera dosis a los seis meses de la primera. Con estos esquemas, los pacientes deben de estar protegidos contra las cepas causantes de verrugas genitales o los cánceres causados por el VPH. Actualmente, esta vacuna tiene indicación para personas de hasta 45 años de edad. Es importante recalcar que, si no se completan las dosis, no se puede garantizar una protección óptima y de larga duración. Es por este motivo que debemos estar bien pendientes de no olvidar la segunda o la tercera dosis, según sea el caso. Esta vacuna es muy bien tolerada. Los efectos adversos tienden a ser dolor en el área de la inyección y en
algunos jóvenes se reportan desmayos. De ocurrir un desmayo, se espera una recuperación rápida. Por esta razón, recomendamos que el paciente esté sentado y se observe. Esta vacuna ha demostrado una reducción significativa en los cánceres que se asocian al virus del papiloma humano y en verrugas genitales. Tenemos una herramienta efectiva y segura para combatir un problema de salud muy serio. No olvidemos utilizarla a la edad indicada y con las dosis recomendadas. Fuentes de información: Academia Americana de Pediatría, Centros para el Control y la Prevención de Enfermedades, Sociedad Americana Contra el Cáncer. La autora es presidenta de la Sociedad Puertorriqueña de Pediatría.
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Enfermedad neumocócica: un mal prevenible Las vacunas son la mejor manera de evitarla ●
Por Vanessa Olivo Echavarry, MD Especial para Suplementos
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a enfermedad neumocócica es causada por la bacteria Streptococcus pneumoniae (neumococo) y aunque esta contiene más de 90 serotipos, los diez tipos más comunes causan el 62 % de la enfermedad invasiva a nivel mundial. La enfermedad se transmite de persona a persona por gotas de saliva suspendidas en el aire. El neumococo es un habitante común del tracto respiratorio humano. Puede ser ais-
lado de la nasofaringe en un 5 a un 90 % de las personas saludables. Muchas personas pueden portar la bacteria en su nariz y garganta sin desarrollar enfermedad invasiva. Hay dos síndromes clínicos principales de enfermedad neumocócica invasiva: bacteriemia (infección del torrente sanguíneo) y meningitis (infección en las membranas del cerebro). Ambos son causados por una infección con la misma bacteria, pero tienen diferentes manifestaciones. Sin embargo, es la pulmonía neumocócica la enfermedad más común causada por la infección neumocócica. Se estima que, anualmente, ocurren 400,000 hospitalizaciones por pulmonía neumocócica en Estados Unidos. Esta pulmonía puede ocurrir en combinación con bacteriemia o meningitis, o
puede ocurrir sola. La pulmonía neumocócica aislada no se considera una enfermedad invasiva, pero puede ser grave. Los síntomas incluyen: fiebre repentina, escalofríos, dolor de pecho, tos, dificultad para respirar, respiración rápida, frecuencia cardíaca y debilidad. La tasa de mortalidad es del 5 al 7 % y puede ser mucho mayor en los adultos mayores. La bacteriemia neumocócica se presenta en alrededor del 25 al 30 % de los pacientes con pulmonía neumocócica. Más de 5,000 casos de bacteriemia neumocócica sin pulmonía ocurren cada año en Estados Unidos. La bacteriemia es la presentación clínica más común entre los niños menores de dos años y representa el 70 % de la enfermedad invasiva en este grupo. Los neumococos causan el 50 % de
todos los casos de meningitis bacteriana en Estados Unidos. Se estima que hay 2,000 casos de meningitis neumocócica cada año. Los síntomas y los signos pueden incluir: dolor de cabeza, cansancio, vómitos, irritabilidad, fiebre, convulsiones y coma. La tasa de letalidad de la meningitis neumocócica es de aproximadamente el 8 % entre los niños y del 22 % entre los adultos. El daño neurológico permanente es común entre los sobrevivientes. La enfermedad neumocócica es una afección grave que causa mucha enfermedad y muerte. Los niños pequeños y los ancianos (menores de dos años y mayores de 50) tienen la mayor incidencia de enfermedades graves.
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Las tasas de letalidad son más altas para la meningitis neumocócica y la bacteriemia, y la mortalidad más alta se produce entre los ancianos y los pacientes con enfermedades subyacentes. La tasa global de letalidad por bacteriemia neumocócica es de alrededor del 20 % entre los adultos. Entre los pacientes de edad avanzada, esta tasa puede llegar al 60 %. Las vacunas son la mejor manera de prevenir la enfermedad neumocócica. Existen dos tipos de vacunas para la prevención de la enfermedad neumocócica en Estados Unidos: vacuna antineumocócica conjugada (PCV13) y vacuna antineumocócica polisacárida (PPSV23). Ambas han demostrado ser eficaces y seguras. El Comité Asesor sobre Prácticas de Inmunización (ACIP, en inglés) hace sus recomendaciones para la prevención de enfermedad neumocócica por grupos de edad y factores de riesgo. En cuanto a la vacunación del adulto, el ACIP actualizó su recomendación el 22 de noviembre de 2019, por lo que la vacuna PCV13 ya no se recomienda de forma rutinaria para todos los adultos de 65 años o más. La PCV13 se sigue recomendando para todos los adultos que sean pacientes inmunocomprometidos, con fuga de líquido cefalorraquídeo o implante coclear. El ACIP continúa recomendando que todos los adultos de 65 años o más reciban habitualmente una dosis de la vacuna antineumocócica de polisacáridos (PPSV23). La PPSV23 contiene doce serotipos en común con la PCV13 y once serotipos adicionales. Los once serotipos adicionales representan entre el 32 y el 37 % de la enfermedad neumocócica invasiva entre los adultos de 65 años o más. El ACIP recomendó que los fumadores y las personas con diabetes reciban solo la PPSV23 una vez antes de los 65 años y nuevamente a los 65 años o más. Se recomienda la PPSV23 (pero no la PCV13) para adultos de 19 a 64 años con todos los tipos de asma. Ahora, más que nunca, queda demostrada la efectividad de las vacunas para prevenir enfermedades potencialmente mortales. Conversa con tu médico o farmacéutico sobre los riesgos de la enfermedad neumocócica y qué tipo de vacuna es la apropiada para prevenirla. Fuente: Immunization Action Coalition: Ask the experts. https://www.cdc.gov/pneumococcal/vaccination-sp.html La autora es infectóloga.
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¿Refuerzo, booster o tercera dosis? Es una herramienta necesaria para mantener los anticuerpos a niveles óptimos por más tiempo ●
Por Lemuel Martínez, MD Especial para Suplementos
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n medio de cualquier crisis, buscamos cuál sería la mejor solución para salir de la misma lo antes posible. Una crisis, de por sí, es retante, pero, más aún si el problema va evolucionando o mutando constantemente. Este es el asunto que tenemos ante nosotros: que estamos batallando con un virus que no es estático, sino cambiante. Por eso, surgen las discusiones públicas del tema de las variantes del COVID-19. Primero surgió la variante alfa, pero también se escuchó de la beta y la gamma. Estas variantes no resultaron en mayores complicaciones para la salud pública, hasta la aparición de delta. Países que parecían haber domado la pandemia (como India y Rusia) se toparon con lo que ya Italia, Brasil y Nueva York habían vivido: sistemas de salud colapsados, mientras pacientes esperaban en las afueras de los hospitales por tratamientos. La variante delta resultó ser altamente contagiosa, aunque no más severa. Mucha preocupación surgió sobre qué tan efectiva se mantendrían las vacunas. Un análisis muy bien preparado por el doctor Rafael Irizarry junto con el Departamento de Salud de Puerto Rico (datos de nuestro país, de nuestros ciudadanos y por nuestros científicos), logró darnos la respuesta que buscábamos y un poco más. Las vacunas actuales son muy potentes, inclusive contra la variante delta, pero su efectividad disminuye a través del tiempo y esto es más marcado en personas mayores de 65 años. Con Janssen/Johnson & Johnson, la efectividad baja a partir de los dos meses de vacunación. En el caso de las vacunas de mRNA (Pfizer y Moderna), la efectividad disminuye luego de seis meses. Pero, en aquel momento, no estábamos autorizados a ofrecer dosis adicionales a las personas, lo que nos causaba mucha ansiedad. Recientemente, la Administración de Alimentos y Medicamentos (FDA, en inglés) y los
Centros para el Control y la Prevención de Enfermedades (CDC, en inglés) autorizaron el ofrecimiento de dosis adicionales a las personas. Ese booster o tercera dosis es una herramienta necesaria para mantener los anticuerpos a niveles óptimos por más tiempo. Es importante tener en cuenta lo siguiente: no podemos comparar la estrategia de vacunación contra la influenza con la del COVID-19. La influenza es un virus que ha adquirido un patrón de infecciones por temporada. Es decir, sabemos que en los meses de diciembre, enero y febrero ocurre la temporada alta de contagios. Por lo tanto, nos vacunamos una vez al año (desde octubre, ¡aún están a tiempo!). En el caso actual con el COVID-19, este virus no ha tomado temporadas. Es decir, no podemos predecir cuándo esperamos una alta transmisión. La estrategia de vacunar una vez al año, entonces, sería difícil de utilizar en estos momentos. Una manera de simplificar la conversación sería entender que hay cosas que sabemos y cosas que no sabemos. No sabemos qué impacto, por ejemplo, traería la variante ómicron. No sabemos si pronto viene otro repunte de contagios y no sabemos cuándo nos expondremos a una persona contagiada. Lo que sí sabemos es que las vacunas de mRNA han mantenido alta efectividad contra las variantes que ha presentado el COVID-19 hasta ahora, pero óptimamente por seis meses. Sabemos que el virus seguirá su esfuerzo por mutar, por lo que, en algún momento, tendremos que reformular la vacuna. Pero, hoy, hay que entender que la dosis adicional a los seis meses es parte del proceso para mantenerse óptimamente protegido. Es por eso que se quitaron las restricciones y ahora se permite a toda persona mayor de 18 años acceder a una tercera dosis. Inclusive, esa dosis podemos cambiarla de Pfizer a Moderna y viceversa. Más importante aún, toda persona vacunada con Janssen/Johnson & Johnson que pueda moverse a vacunas de mRNA logrará protección por más tiempo. Tenemos la oportunidad de crear una comunidad altamente vacunada, aprovechémoslo y vacunémosnos con la misma voluntad y sentido de urgencia como cuando llegaron las primeras vacunas. El autor es infectólogo, presidente de la Sociedad de Enfermedades Infecciosas de Puerto Rico y miembro del Comité Científico COVID-19 de Puerto Rico.
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Los menores entre 5 a 11 años deben tener sus dosis completadas para lograr admisión escolar presencial en o antes del 31 de enero del 2022. También se incluyen los estudiantes del sistema público y privado de 12 años en adelante, cursando escuela intermedia, superior, vocacional o universitario ●
Los derechos y responsabilidades de vacunar a los hijos Por Linette Sánchez, J.D. Especial para Suplementos
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n Puerto Rico, la mayoría de la población está consciente de la importancia de las vacunas contra el COVID-19. Entienden los fundamentos médico-científicos que demuestran que la vacuna es el instrumento más efectivo para
protegernos contra la severidad de la enfermedad del COVID-19. Aquellos que no necesariamente comprenden la ciencia, asumen su responsabilidad, buscando información y recomendaciones de expertos en inmunidad a través del Departamento de Salud, organizaciones privadas con credibilidad, médicos y personal de enfermería.
Son pocos, pero muy vocales y activos en las redes sociales, los que desvían el mensaje de protección y medidas de seguridad contra el COVID-19. Sin evidencia, provocan equivocaciones en el análisis y el balance de riesgos versus beneficios de la vacunación ante un virus que puede ser letal. Ciertamente, las constituciones de Estados Unidos y de Puerto
Rico protegen los derechos individuales a la libertad y la autonomía. Estos derechos nos permiten expresar nuestras ideas en el campo de la libertad de expresión y la autonomía para elegir si autorizamos o rechazamos un tratamiento médico como la vacuna. No obstante, debemos reconocer que los derechos individuales constitucionalmente protegidos no
son absolutos. El Gobierno tiene un interés apremiante en proteger a sus ciudadanos y visitantes de peligros a la salud pública. La pandemia ocasionada por el virus SARS-CoV-2 es un peligro inminente que ha terminado la vida de más de 5 millones de personas alrededor del mundo y más de 3,200 en Puerto Rico. Con el fin de proteger al mayor número de personas, el Gobierno establece medidas de seguridad para todos y mandatos de vacunación con énfasis en la población laboral y estudiantil. En Puerto Rico, desde la década de 1970, tradicional e históricamente la Asamblea Legislativa designó a la Rama Ejecutiva, por conducto del Secretario de Salud, la autoridad y el deber de escoger las vacunas requisito para la admisión escolar. Recientemente, el gobernador Pedro Pierluisi, en la Orden Ejecutiva 2021-075, como medida de emergencia, ordenó que los menores entre 5 a 11 años deben tener sus dosis completadas para lograr admisión escolar presencial en o antes del 31 de enero del 2022. También se incluyen los estudiantes del sistema público y privado entre las edades de 12 años en adelante, cursando escuela intermedia, superior, vocacional o universitario originalmente bajo la Orden Administrativa del Departamento de Salud 2021-509. El derecho y la responsabilidad de los padres, tutores y/o encargados de los menores de edad se expresa al lograr acceso y llevar a sus hijos al proveedor pediátrico de su preferencia, aclarar sus dudas sobre la vacuna y tomar una decisión ilustrada basada en evidencia médico-científica y el bienestar de su hijo. Deben llevar la identificación con foto del adulto, el número de Seguro Social del menor (si tiene) y estar presentes en todo momento con el menor. Si papá o mamá no pueden ir, deben redactar una carta sencilla autorizando a un adulto encargado a completar el consentimiento para la vacuna del menor y copia de la identificación con foto de quien firma la carta. Si tienes dudas, puedes comunicarte con el Colegio de Médicos Cirujanos de Puerto Rico para una orientación, llamando al 787-751-5979, extensión 122 o pasar por el Centro de Vacunación del Colegio en The Mall of San Juan. Conoce tu derecho de acceso a la vacunación y ejerce tu responsabilidad. La autora es experta en Derecho de Salud. Para información, llama al 787-763-0838 o escribe a Lsanchezlaw@gmail.com.
09 SUPLEMENTOS | viernes, 10 de diciembre de 2021
LAS ABUELAS HÍPSTERS DEBERÍAN PONERSE UNA De hecho, los CDC RECOMIENDAN que casi todas las personas de 65 AÑOS O MÁS se vacunen con PNEUMOVAX 23, incluso si ya han recibido una vacuna antineumocócica diferente.
Después de los 65 años, su riesgo de enfermedad neumocócica es
CASI EL DOBLE
en comparación con los adultos sanos de 50 a 64 años.
Representación actoral
Para casi todos los mayores de 65,
ESTA ES SU OPORTUNIDAD Acerca de PNEUMOVAX 23 PNEUMOVAX 23 es una vacuna para personas de 50 años de edad en adelante que se administra en forma de inyección. Ayuda a protegerle de la infección por ciertos gérmenes o bacterias denominados neumococos.
Información de Seguridad Importante 31(8029$;b SXHGH QR SURWHJHU D WRGRV ORV TXH VH OD DSOLTXHQ 1R SURWHJH contra enfermedades que sean causadas por tipos de bacterias que no están en la vacuna. 1R GHEH DSOLFDUVH 31(8029$;b VL HV DO«UJLFR D DOJXQR GH VXV LQJUHGLHQWHV R WXYR XQD UHDFFLµQ DO«UJLFD D 31(8029$;b HQ HO SDVDGR $QWHV GH DSOLFDUVH 31(8029$;b FRPXQ¯TXHOH D VX SURYHHGRU GH DWHQFLµQ P«GLFD VL XVWHG HV DO«UJLFR D OD YDFXQD WLHQH SUREOHPDV FDUG¯DFRV R SXOPRQDUHV WLHQH ĆHEUH WLHQH SUREOHPDV LQPXQLWDULRV R HVW£ UHFLELHQGR UDGLR R TXLPLRWHUDSLD (V SRVLEOH TXH 31(8029$;b QR SUHYHQJD OD PHQLQJLWLV QHXPRFµFLFD HQ ORV SDFLHQWHV FRQ GHUUDPH GH O¯TXLGR FHIDORUUDTX¯GHR FDXVDGR SRU XQD ĆVXUD R OHVLµQ del cráneo o por una operación.
HDEOH FRQ VX SURYHHGRU GH DWHQFLµQ P«GLFD VL SODQHD UHFLELU 31(8029$;b DO mismo tiempo que otras vacunas. /RV HIHFWRV VHFXQGDULRV P£V FRPXQHV GH 31(8029$;b VRQ ORV VLJXLHQWHV dolor, sensación de calor, sensibilidad, enrojecimiento, hinchazón y endurecimiento en el lugar de inyección; dolor de cabeza, debilidad y sensación de cansancio, y dolor muscular. Informe a su proveedor de atención médica o pida ayuda inmediatamente si tiene cualquiera de los siguientes problemas, que pueden ser signos de una UHDFFLµQ DO«UJLFD GLILFXOWDG SDUD UHVSLUDU VLELODQFLD VDUSXOOLGR XUWLFDULD Los efectos secundarios en el lugar de inyección pueden ser más frecuentes y pueden sentirse con más intensidad después de una segunda inyección que después de la primera inyección. Informe a su proveedor de atención médica si tiene efectos secundarios que le causan molestias o no desaparecen. Se le aconseja informar los efectos secundarios negativos de los fármacos recetados a la FDA. Visite www.fda.gov/medwatch, o llame al 1-800-FDA-1088. Lea la Información para Pacientes de PNEUMOVAX 23 adjunta y analícela con su proveedor de atención médica o farmacéutico.
CDC = Centros para el Control y la Prevención de Enfermedades
¿Tiene problemas para pagar su vacuna de Merck? Quizás Merck pueda ayudarle. Visite merckhelps.com. &RS\ULJKW kb 0HUFN 6KDUS 'RKPH &RUS XQD VXEVLGLDULD GH Merck & Co., Inc. Todos los derechos reservados. US-PNX-02208 9/21
Consulte con su médico o farmacéutico para saber si la vacunación antineumocócica es adecuada para usted.
PNEUMOVAX23.COM
viernes, 10 de diciembre de 2021 | SUPLEMENTOS 10
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SUPLEMENTOS | PRIMERA HORA viernes, 10 de diciembre de 2021
Por Mayra Vélez, MD Especial para Suplementos
T
ras un año y casi nueve meses viviendo en esta emergencia sin precedentes en el siglo XXI que es la pandemia del COVID-19, son muchas las lecciones que hemos aprendido. Pero, todavía nos queda mucho camino por recorrer juntos, como puertorriqueños y como parte de la humanidad. Soy infectóloga, estoy en un ambiente hospitalario que siempre es una zona de alto riesgo para la transmisión de enfermedades, pero, en la situación actual, es el riesgo exponencial que se amplifica dramáticamente. Lo mismo ocurre con las personas cuya salud es frágil o que padecen alguna condición que provoca que su sistema inmunológico esté débil, por nombrar algunos ejemplos, que temerariamente acudan a lugares públicos, con aglomeración de personas, entre otros escenarios posibles. Su riesgo es exponencial y su vida literalmente depende de la prevención y la precaución, y el buen juicio es esencial. Los médicos no queremos que nadie sufra lo que hemos visto y vemos constantemente en los hospitales con el embate del COVID-19. Estamos en un momento en el cual parte del control lo tenemos nosotros, los ciudadanos. Aunque las autoridades concernidas como el Departamento de Salud y otras entidades realicen su trabajo, a la ciudadanía también le toca hacer el suyo. Es por ello que, en esta etapa de la pandemia, es imperativo que las personas con distintas condiciones y con otras características que las hacen parte de una población más vulnerable aún, de alto riesgo, tomen medidas para cuidarse y tengan conciencia plena del peligro que representa para su salud y su vida visitar lugares que en este momento representan peligro de contagio.
VACÚNATE: LA SERIE
COVID-19 y la población en alto riesgo: lugares que deben evitar
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¿QUIÉNES ESTÁN EN LA CATEGORÍA DE POBLACIÓN DE ALTO RIESGO?
● Personas que no se han vacunado contra el COVID-19, o están parcialmente vacunadas. ● Pacientes con el sistema inmune débil con condiciones autoinmunes tales como: lupus eritematoso sistémico, diabetes tipo 1, esclerosis múltiple, artritis reumatoide y tiroiditis de Hashimoto, entre otras ● Pacientes de cáncer, en tratamiento o en remisión ● Pacientes con enfermedades respiratorias crónicas: asma, enfisema, enfermedad obstructiva pulmonar, otras ● Niños menores de 12 años: no se pueden vacunar aún ●Ancianos: por lo general su sistema inmune es más débil
¿CUÁLES LUGARES DEBEN EVITAR?
● Sitios cerrados con acondicionador de aire: numerosos estudios han evidenciado que el riesgo de contagio es mayor: 1. Restaurantes 2. Cines 3. Aeropuertos, aviones 4.Transportación pública 5. Escuelas 6.Universidades 7.Gimnasios 8.Otros ● Si tienes que visitar un supermercado o farmacia, procura hacerlo en las horas que haya la menor cantidad de gente posible ● Lugares con aglomeración de personas, tanto cerrados como abiertos ● Hospitales: son un foco de infección potencialmente ● Nunca olvides las medidas básicas de prevención: lavado de manos, uso correcto de mascarilla, distancia física El buen juicio y la prudencia salvan vidas. Vamos a usarlos.
La autora es infectóloga del Centro Médico Menonita de Cayey.
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SUPLEMENTOS | PRIMERA HORA viernes, 10 de diciembre de 2021
VACÚNATE: LA SERIE
Vacúnalos antes de que lleguen los Reyes El mejor regalo para la familia es que los niños de 5 a 11 estén vacunados ●
Por Cindy Calderón, MD, FAAP Especial para Suplementos
D
e diciembre a enero, Puerto Rico se destaca por su alegría, festividades y celebraciones familiares, las cuales han sido opacadas los pasados dos años debido a las medidas de precaución que adoptamos para protegernos del contagio del virus del COVID-19. Este año, la ciencia nos brinda la oportunidad de añadir la vacunación contra el COVID-19 como otra herramienta para proteger a nuestros seres queridos, permitiendo el reencuentro entre los familiares y retomar algunas de nuestras tradiciones. En el 2021 se aprobó la vacunación contra el COVID-19 para la población de 12 años y mayores, y, finalmente en el mes de noviembre, se aprobó la vacunación para nuestros niños de 5 a 11 años. Muchas familias recibieron esta noticia con gran alegría y esperanza de que, este año, podrán celebrar las festividades familiares con mayor protección. Al tomar la decisión de vacunar a sus niños, la familia necesita conocer cómo se diferencia la vacuna para niños de la vacuna para los mayores y los beneficios de la vacuna versus los riesgos de la enfermedad. Es importante que obtengan información de fuentes basadas en datos y evidencia, y que reconozcan información incorrecta de fuentes basadas en malinterpretaciones u opiniones sin ninguna evidencia. Distinguir entre estas fuentes a veces puede ser difícil, por lo que es aconsejable buscar orientación del médico del niño. La vacuna aprobada para niños de 5 a 11 años, la Pfizer-BioNTech COVID-19 para prevenir la enfermedad del coronavirus
2019 (COVID-19), contiene una concentración y se administra intramuscularmente en un volumen menor que la vacuna para mayores. Cada vacuna es de 0.2 ml de volumen y contiene 10 ug. de ARNm. Esta es la dosis mínima que provoca una respuesta efectiva de anticuerpos por el sistema inmunológico, apoyando una respuesta inmediata para detener la propagación del virus en caso de contagio. Similar a los adultos, requiere dos dosis con un intervalo mínimo de 21 días para adquirir una respuesta adecuada. La mayoría de los niños toleran muy bien la vacuna. Los efectos secundarios más comunes son similares a otras vacunas y se observan con mayor frecuencia luego de la segunda dosis. Incluyen: dolor en el lugar de la inyección, cansancio, dolor de cabeza, dolor muscular y escalofríos. Estos síntomas desaparecen en 24 a 48 horas. Al comparar la ayuda que provee la vacuna a nuestro sistema inmunológico para combatir el COVID-19, disminuyendo el riesgo de hospitalizaciones y muerte versus el riesgo de los no vacunados podemos tomar una decisión informada de cuál es la mejor decisión para nuestra familia. Además, los vacunados protegen a los que aún no se pueden vacunar, disminuyendo la prevalencia de infección y la probabilidad de que surjan nuevas variantes. Debemos considerar los beneficios de proteger a los miembros de la familia, vacunando a todos los que son elegibles. La autora es pediatra general, directora de la Clínica Programa Vacunación contra el COVID-19 del Colegio de Médicos Cirujanos de Puerto Rico y pasada presidenta de la Academia Americana de Pediatría Capítulo de Puerto Rico.