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Algunas cepas de tos ferina podrían esquivar a la vacuna
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Algunas cepas de tos ferina podrían esquivar a la vacuna

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Algunas cepas de tos ferina podrían esquivar a la vacuna

La bacteria responsable de la tos ferina podría estar evolucionando en distintas cepas, y la vacuna actual no puede ofrecer una protección completa contra esas cepas nuevas, informan los investigadores.

En años recientes, los casos de tos ferina han aumentado dramáticamente. Decenas de miles han enfermado, y se han reportado 18 muertes, sobre todo de bebés, según los Centros para el Control y la Prevención de Enfermedades (CDC) de EE. UU.

Varios estudios recientes se han enfocado en el potencial de una inmunidad decreciente a partir de la vacuna contra la tos ferina con el tiempo. En una carta que aparece en la revista New England Journal of Medicine ( doi: 10.1056/NEJMc1212006), los investigadores apuntaron que quizás haya otro culpable: una evolución del germen en sí.

La vacuna contiene varios componentes que ayudan a dar al organismo inmunidad contra la bacteria de la tos ferina (la Bordetella pertussis). Uno de esos componentes se conoce como pertactina.

Se han encontrado cepas de la bacteria de la tos ferina que resultan negativas para la pertactina en Japón, Francia, Finlandia, y ahora en Estados Unidos, reportaron los investigadores en la carta. Esto significa que al menos un componente de la vacuna actual no es efectivo contra esas cepas recién halladas.

"Hay varias teorías sobre por qué estamos viendo más pertussis", comentó el Dr. Kenneth Bromberg, presidente de pediatría y director del Centro de Investigación de Vacunas del Centro Hospitalario de Brooklyn, en la ciudad de Nueva York. "Una teoría es un mejor diagnóstico. Una segunda (teoría) es que las vacunas no son tan buenas en términos de la longevidad como cuando se usaba la vacuna de célula completa. La tercera teoría es que ha habido cambios genéticos en las cepas de pertussis, de forma tal que las nuevas cepas son inmunes o relativamente inmunes a las vacunas actuales".

"Se piensa que las bacterias han cambiado y eliminan la pertactina que contienen en sí mismas", señaló Bromberg, quien no participó en la investigación actual.

Una segunda carta en la misma edición de la revista abordó otra de las teorías descritas por Bromberg: la efectividad de la vacuna actual.

A finales de los 90, la vacuna se cambió de una vacuna con la célula completa a lo que se conoce como una vacuna acelular.

"La vacuna de célula completa contiene la célula completa de la bacteria muerta, de forma que contiene todas las proteínas que la bacterias producen, obligando a la persona a lanzar un ataque contra todas las partes de la bacteria", explicó el coautor de la carta, el Dr. Paul Cieslak, director médico del Programa de Inmunización de Oregón, en Portland. "Con la nueva vacuna acelular, eligieron las proteínas que pensaban que eran más importantes. Sin la célula completa, hay menos efectos secundarios, pero quizás sea un poco menos efectiva".

Oregón experimentó un aumento significativo en el número de casos de tos ferina el año pasado. Oregón mantiene registros estatales de las inmunizaciones, además de registros de quién ha tenido un caso confirmado de tos ferina. Esta información permitió a Cieslak y a sus colegas revisar qué tipo de vacuna había sido administrada a los que luego se vieron infectados con tos ferina.

Hallaron que los casos reportados de tos ferina eran significativamente menos en los jóvenes que habían recibido su primera inmunización con la vacuna de la célula completa en lugar de la vacuna acelular.

¿Significa eso que se debería volver a usar la vacuna de la célula completa? "Nadie está defendiendo la vacuna de célula completa", enfatizó Cieslak. "Sin la vacuna de célula completa, hay menos efectos secundarios. Quizás sea un poco menos efectiva, pero tiene que ser segura".

Bromberg se mostró de acuerdo. "La vacuna de célula completa no volverá. La vacuna acelular es significativamente mejor, ya que no causa reacciones, pero no funciona durante tanto tiempo como creíamos", comentó.

Cieslak señaló que aunque la vacuna actual no es perfecta, "ciertamente recomendamos vacunarse. Estar vacunado sigue siendo mucho mejor".

Bromberg añadió que los expertos intentan averiguar formas para usar mejor la vacuna actual. Por ejemplo, los CDC añadieron hace poco una recomendación de que todas las mujeres embarazadas reciban la vacuna contra la tos ferina a finales del embarazo para ofrecer protección a sus hijos recién nacidos.

febrero 7/2013 (Medlineplus); Infomed.cu

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