Prevención de la infección respiratoria aguda baja de origen viral en menores de dos años: énfasis en el virus sincitial respiratorio en Colombia
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Las infecciones respiratorias agudas bajas (IRAB) son una causa mayor de morbimortalidad infantil. Esta guía formula recomendaciones actualizadas y con enfoque de equidad para prevenir IRA virales, con énfasis en virus sincitial respiratorio (VSR), en niños menores de 2 años en Colombia. Se elaboró mediante consenso multidisciplinario y revisión sistemática (PRISMA), evaluación de guías (AGREE II), calificación de certeza (GRADE), marcos de evidencia a la decisión y metodología RAND/UCLA para graduar la fuerza de las recomendaciones. Se respondieron siete preguntas de investigación relacionadas con: (1) definición y etiología de IRAB; (2) factores de riesgo: prematuridad, edad <6 meses, hacinamiento, ausencia de lactancia, exposición a humo y comorbilidades; (3) medidas generales y control de infección (higiene de manos, WASH, educación continua); (4) estrategias nutricionales (lactancia materna exclusiva); (5) vacunación materna RSVpreF para protección de lactantes en los primeros meses de vida; (6) inmunización pasiva con anticuerpo monoclonal de acción prolongada (nirsevimab) en menores de dos años; y (7) vigilancia específica de VSR integrada a ARI/SARI. En conclusión, combinar intervenciones no farmacológicas y farmacológicas: lactancia, higiene, control ambiental, educación, estrategia hibrida combinando vacunación materna y nirsevimab, es costo-efectivo y reduce hospitalizaciones e ingresos a UCI. Se recomienda vigilancia continua para optimizar el momento de intervención y optimizar costo-efectividad, acorde a la circulación local del virus.
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