From Medscape Medical News
Laurie Barclay, MD
August 7, 2009 — The Advisory Committee on Immunization Practices (ACIP) has updated its recommendations for routine poliovirus vaccination and published them in the August 7 issue of the Morbidity and Mortality Weekly Report.
The goals of the update are to highlight the importance of the booster dose in children older than 4 years, to extend the minimum interval between dose 3 and dose 4 from 4 weeks to 6 months, to include a new precaution regarding use of minimum intervals in the first 6 months of life, and to recommend schedules for poliovirus vaccination with specific combination vaccines.
"On June 17, 1999, ACIP recommended that all poliovirus vaccine administered in the United States be an inactivated poliovirus vaccine (IPV) beginning January 1, 2000," the report states. "This policy was implemented to eliminate the risk for vaccine-associated paralytic poliomyelitis, a rare condition that has been associated with use of the live oral poliovirus vaccine.... Since 1999, no [oral poliovirus vaccine] has been distributed in the United States."
The 1999 ACIP recommendations specified a routine IPV vaccination schedule of 4 doses given at ages 2 months, 4 months, 6 to 18 months, and 4 to 6 years, with 4 weeks being the minimum interval between all IPV doses. In the United States, 3 different combination vaccines containing IPV have been licensed for routine use since the 2000 ACIP recommendation was made in1999.
The updated ACIP guidelines now include the following recommendations to avoid potential confusion related to using different vaccine products for routine and catch-up immunization:
•The 4-dose IPV series should still be given at ages 2 months, 4 months, 6 to 18 months, and 4 to 6 years.
•Regardless of the number of previous doses, the final dose in the IPV series should be given at age older than 4 years.
•Between dose 3 and dose 4, the minimum interval is increased from 4 weeks to 6 months.
•Between dose 1 and dose 2, and between dose 2 and dose 3, the minimum interval is still 4 weeks.
•For dose 1, the minimum age is still 6 weeks.
Another new ACIP recommendation is that use of the minimum age and minimum intervals for vaccination in the first 6 months of life are recommended only if the vaccine recipient is at risk for imminent exposure to circulating poliovirus; for example, during an outbreak or for travel to a polio-endemic region. The rationale for this new precaution is that shorter intervals and earlier start dates result in lower seroconversion rates.
ACIP is also recommending a poliovirus vaccination schedule with specific combination vaccines, as follows:
•When DTaP-IPV/Hib (Pentacel, Sanofi Pasteur) is given at ages 2, 4, 6, and 15 to 18 months (4 doses total), children should receive an additional booster dose of age-appropriate IPV-containing vaccine (IPV [Ipol, Sanofi Pasteur] or DTaP-IPV [Kinrix, GlaxoSmithKline]) at age 4 to 6 years, resulting in a 5-dose IPV vaccine series.
•The booster dose at age 4 to 6 years should not be DTaP-IPV/Hib.
•For optimal booster response, the minimum interval between dose 4 and dose 5 should be at least 6 months.
•As per current recommendations, a booster dose should be given as soon as feasible to a child missing an IPV dose at age 4 to 6 years.
Morb Mortal Wkly Rep. 2009;58:829–830.
Sunday, August 9, 2009
Saturday, August 8, 2009
CT Scans May Not Be Helpful for Most Young Children With Emergent Headache
From Medscape Medical News
July 29, 2009 — Computed tomographic (CT) scans seldom lead to diagnosis or contribute to immediate management of young children presenting to the emergency department with headache but normal neurologic examination findings and nonworrying history, according to the results of a study reported in the July issue of Pediatrics.
"Neuroimaging because of recurrent childhood headaches has limited value; especially in the setting of normal physical examination," write Tarannum M. Lateef, MD, from George Washington University School of Medicine and Children's National Medical Center in Washington, DC, and colleagues. "The risk of radiation exposure from CT scans is highest in the youngest age group. This study addresses the diagnostic utility of CT scans, in an ED [emergency department] setting, for children <6 years of age."
The investigators evaluated the records of 364 children aged 2 to 5 years seen between July 1, 2003, and June 30, 2006, in a large urban emergency department for evaluation of headache. Patients with headaches secondary to clearly apparent causes such as ventriculoperitoneal shunts, known brain tumor, or acute illnesses including viral syndromes, fever, probable meningitis, or trauma were identified based on initial history and examination findings. For the remaining patients, headache history, neurologic findings, results of laboratory and neuroimaging tests, discharge diagnosis, and disposition were reviewed.
Among 306 children (84%) with secondary headaches identified from initial history and physical examination, acute febrile illnesses, and viral respiratory tract syndromes were thought to be responsible for the headaches in 72%.
CT scans were performed in 16 (28%) of the 58 children (16% of the total study sample) with no evident central nervous system disease or systemic illness diagnosed at presentation. In 15 (94%) of these 16 patients, CT scans did not facilitate diagnosis or management. Only 1 scan result was abnormal, revealing a brainstem glioma, but this patient had abnormal findings on neurologic examination when first evaluated in the emergency department. Family history was not documented in 59% of children who were thought to have primary headaches.
"For young children presenting to the ED with headache but normal neurologic examination findings and nonworrying history, CT scans seldom lead to diagnosis or contribute to immediate management," the study authors write. "A family history often is contributory and should be part of the evaluation of young children with headache in the ED. CT imaging poses risk (which is greatest for the youngest children), is expensive, and usually is without benefit."
Limitations of this study include retrospective design, lack of complete follow-up monitoring, and analysis limited to information in clinical records. Most children studied did not have a documented family history or a thorough headache history.
"Studies such as this one can contribute to recognition of medical interventions for which indications need rethinking," the study authors conclude.
July 29, 2009 — Computed tomographic (CT) scans seldom lead to diagnosis or contribute to immediate management of young children presenting to the emergency department with headache but normal neurologic examination findings and nonworrying history, according to the results of a study reported in the July issue of Pediatrics.
"Neuroimaging because of recurrent childhood headaches has limited value; especially in the setting of normal physical examination," write Tarannum M. Lateef, MD, from George Washington University School of Medicine and Children's National Medical Center in Washington, DC, and colleagues. "The risk of radiation exposure from CT scans is highest in the youngest age group. This study addresses the diagnostic utility of CT scans, in an ED [emergency department] setting, for children <6 years of age."
The investigators evaluated the records of 364 children aged 2 to 5 years seen between July 1, 2003, and June 30, 2006, in a large urban emergency department for evaluation of headache. Patients with headaches secondary to clearly apparent causes such as ventriculoperitoneal shunts, known brain tumor, or acute illnesses including viral syndromes, fever, probable meningitis, or trauma were identified based on initial history and examination findings. For the remaining patients, headache history, neurologic findings, results of laboratory and neuroimaging tests, discharge diagnosis, and disposition were reviewed.
Among 306 children (84%) with secondary headaches identified from initial history and physical examination, acute febrile illnesses, and viral respiratory tract syndromes were thought to be responsible for the headaches in 72%.
CT scans were performed in 16 (28%) of the 58 children (16% of the total study sample) with no evident central nervous system disease or systemic illness diagnosed at presentation. In 15 (94%) of these 16 patients, CT scans did not facilitate diagnosis or management. Only 1 scan result was abnormal, revealing a brainstem glioma, but this patient had abnormal findings on neurologic examination when first evaluated in the emergency department. Family history was not documented in 59% of children who were thought to have primary headaches.
"For young children presenting to the ED with headache but normal neurologic examination findings and nonworrying history, CT scans seldom lead to diagnosis or contribute to immediate management," the study authors write. "A family history often is contributory and should be part of the evaluation of young children with headache in the ED. CT imaging poses risk (which is greatest for the youngest children), is expensive, and usually is without benefit."
Limitations of this study include retrospective design, lack of complete follow-up monitoring, and analysis limited to information in clinical records. Most children studied did not have a documented family history or a thorough headache history.
"Studies such as this one can contribute to recognition of medical interventions for which indications need rethinking," the study authors conclude.
Thursday, August 6, 2009
Recognizing Child Abuse: Slideshow
http://www.medscape.com/features/slideshow/child-abuse?src=mp&spon=9&uac=71630FV
Learn how to identify telltale findings of child abuse from patient history and physical and radiographic examination while avoiding false accusations and losing the trust of the patient's family.
Learn how to identify telltale findings of child abuse from patient history and physical and radiographic examination while avoiding false accusations and losing the trust of the patient's family.
Monday, July 27, 2009
H1N1 Flu Linked to Neurologic Complications in Children
From Medscape Medical News
by Allison Gandey
July 24, 2009 — Children with flulike symptoms and unexplained seizures or mental changes should be tested for H1N1 influenza, says a Centers for Disease Control and Prevention (CDC) report, published in the July 24 issue of the Morbidity and Mortality Weekly Report . It suggests that patients may benefit from prompt treatment with antivirals.
Concern was first sparked in May, when the Dallas County Department of Health and Human Services reported 4 children with neurologic complications associated with H1N1 flu.
Patients were aged 7 to 17 years and were admitted with flulike symptoms and seizures or altered mental status. In all 4 patients, clinicians detected H1N1 viral RNA in nasopharyngeal specimens, but not in cerebrospinal fluid. Three patients had abnormal electroencephalograms.
All patients received the antiviral oseltamivir and 3 received rimantadine. The patients fully recovered and had no neurologic sequelae at discharge.
Patients Fully Recovered
According to the CDC, just like with the seasonal flu, neurologic complications can occur after respiratory-tract infection with H1N1. Considering that clusters of influenza-associated encephalopathy in children have been reported during previous community outbreaks of seasonal flu and that children appear to be infected with H1N1 more frequently than adults, officials anticipate that additional neurologic complications are likely to be reported as the pandemic continues.
The CDC recommends that healthcare providers also consider a diagnosis of Reye's syndrome in patients with viral illness and altered mental status.
Clinicians should not administer salicylates or salicylate-containing products to children with influenza or other viral infections because this may also increase the risk for Reye's syndrome.
The CDC recommends that all children at least 6 months of age receive annual seasonal influenza vaccinations to prevent illness and complications from infection. No vaccination against H1N1 influenza is currently available.
MMWR Morb Mortal Wkly Rep. 2009;58;773-778.
by Allison Gandey
July 24, 2009 — Children with flulike symptoms and unexplained seizures or mental changes should be tested for H1N1 influenza, says a Centers for Disease Control and Prevention (CDC) report, published in the July 24 issue of the Morbidity and Mortality Weekly Report . It suggests that patients may benefit from prompt treatment with antivirals.
Concern was first sparked in May, when the Dallas County Department of Health and Human Services reported 4 children with neurologic complications associated with H1N1 flu.
Patients were aged 7 to 17 years and were admitted with flulike symptoms and seizures or altered mental status. In all 4 patients, clinicians detected H1N1 viral RNA in nasopharyngeal specimens, but not in cerebrospinal fluid. Three patients had abnormal electroencephalograms.
All patients received the antiviral oseltamivir and 3 received rimantadine. The patients fully recovered and had no neurologic sequelae at discharge.
Patients Fully Recovered
According to the CDC, just like with the seasonal flu, neurologic complications can occur after respiratory-tract infection with H1N1. Considering that clusters of influenza-associated encephalopathy in children have been reported during previous community outbreaks of seasonal flu and that children appear to be infected with H1N1 more frequently than adults, officials anticipate that additional neurologic complications are likely to be reported as the pandemic continues.
The CDC recommends that healthcare providers also consider a diagnosis of Reye's syndrome in patients with viral illness and altered mental status.
Clinicians should not administer salicylates or salicylate-containing products to children with influenza or other viral infections because this may also increase the risk for Reye's syndrome.
The CDC recommends that all children at least 6 months of age receive annual seasonal influenza vaccinations to prevent illness and complications from infection. No vaccination against H1N1 influenza is currently available.
MMWR Morb Mortal Wkly Rep. 2009;58;773-778.
Dilute Bleach Baths Plus Intranasal Mupirocin Eases Eczema Severity in Children
From Reuters Health Information
Apr 28 - In children with severe atopic dermatitis prone to infections, a regimen of dilute sodium hypochlorite baths and intermittent intranasal mupirocin reduces disease severity, according to physicians at the Feinberg School of Medicine in Chicago.
"We and others have found anecdotally the addition of dilute sodium hypochlorite baths to be helpful in decreasing infection rates and disease severity" in children with eczema, Dr. Amy S. Paller and associates note, but theirs is the first controlled trial of this strategy.
Their study in the May issue of Pediatrics included 22 patients ages 9 months to 17 years with moderate to severe atopic dermatitis and bacterial skin infections. On average, one third of body surface area was affected, and the mean Eczema Area and Severity Index (EASI) score was 19.7. Lesions in most patients were positive for Staphylococcus aureus.
All patients were initially treated for 2 weeks with oral cephalexin, and continued topical anti-inflammatory medication and emollient therapy throughout the 3-month trial.
Nine patients were assigned to the treatment arm, and they bathed in a dilute bleach solution for 5-10 minutes twice a week; the dilution was 0.5 cup of 6% bleach in 40 gallons water, with final concentration 0.005%. Additional plain-water baths were not restricted. In this group, mupirocin ointment was applied intranasally twice daily for 5 consecutive days per month.
Thirteen control patients bathed in plain water and used petrolatum instead of mupirocin.
Compared to the control group, the treatment group showed significantly greater improvement on the EASI scores: -10.4 vs -2.5 at 1 month (p = 0.017) and -15.3 vs -3.2 at 3 months (p = 0.004).
The percentage of body surface area affected also significantly declined in the treatment group, by 23.7% at 3 months, versus 3% in the placebo group (p = 0.004).
Tolerability to the dilute bleach baths was "excellent," the authors say, although early on, infected lesions were made more painful. One patient who complained of skin irritation stopped the baths. However, after he developed a methicillin-resistant S. aureus skin infection requiring hospitalization, he resumed treatment, with no reported adverse effects.
Active treatment did not eradicate S. aureus, however, leading Dr. Paller and her team to suggest that longer duration of this treatment strategy may be required.
Pediatrics 2009;123:e808-e814.
Apr 28 - In children with severe atopic dermatitis prone to infections, a regimen of dilute sodium hypochlorite baths and intermittent intranasal mupirocin reduces disease severity, according to physicians at the Feinberg School of Medicine in Chicago.
"We and others have found anecdotally the addition of dilute sodium hypochlorite baths to be helpful in decreasing infection rates and disease severity" in children with eczema, Dr. Amy S. Paller and associates note, but theirs is the first controlled trial of this strategy.
Their study in the May issue of Pediatrics included 22 patients ages 9 months to 17 years with moderate to severe atopic dermatitis and bacterial skin infections. On average, one third of body surface area was affected, and the mean Eczema Area and Severity Index (EASI) score was 19.7. Lesions in most patients were positive for Staphylococcus aureus.
All patients were initially treated for 2 weeks with oral cephalexin, and continued topical anti-inflammatory medication and emollient therapy throughout the 3-month trial.
Nine patients were assigned to the treatment arm, and they bathed in a dilute bleach solution for 5-10 minutes twice a week; the dilution was 0.5 cup of 6% bleach in 40 gallons water, with final concentration 0.005%. Additional plain-water baths were not restricted. In this group, mupirocin ointment was applied intranasally twice daily for 5 consecutive days per month.
Thirteen control patients bathed in plain water and used petrolatum instead of mupirocin.
Compared to the control group, the treatment group showed significantly greater improvement on the EASI scores: -10.4 vs -2.5 at 1 month (p = 0.017) and -15.3 vs -3.2 at 3 months (p = 0.004).
The percentage of body surface area affected also significantly declined in the treatment group, by 23.7% at 3 months, versus 3% in the placebo group (p = 0.004).
Tolerability to the dilute bleach baths was "excellent," the authors say, although early on, infected lesions were made more painful. One patient who complained of skin irritation stopped the baths. However, after he developed a methicillin-resistant S. aureus skin infection requiring hospitalization, he resumed treatment, with no reported adverse effects.
Active treatment did not eradicate S. aureus, however, leading Dr. Paller and her team to suggest that longer duration of this treatment strategy may be required.
Pediatrics 2009;123:e808-e814.
Monday, July 20, 2009
Vit D - how much do you need
American Academy of Dermatology Issues Updated Position Statement on Vitamin D
Laurie Barclay, MD From Medscape Medical News
July 16, 2009 — The American Academy of Dermatology (AAD) has issued an updated position statement on vitamin D after reviewing more recent evidence regarding the role of vitamin D in maintaining optimal health. The National Council on Skin Care Prevention also released its own position statement on July 14.
Individuals who regularly and properly practice sun protection may be at risk for vitamin D insufficiency and may require a higher dose of vitamin D, either from dietary sources or from supplements. Because of skin cancer risk from ultraviolet (UV) radiation, AAD does not recommend unprotected exposure to radiation from the sun or from indoor tanning devices.
"The vitamin D position statement supports the Academy's long-held conviction on safe ways to get this important vitamin — through a healthy diet which incorporates foods naturally rich in vitamin D, vitamin D-fortified foods and beverages, and vitamin D supplements," dermatologist and AAD president David M. Pariser, MD, FAAD, said in a news release.
"The updated recommendation for individuals who practice daily sun protection acknowledges that while protecting the skin from the damaging rays of the sun is important, so is maintaining adequate vitamin D levels," Dr. Pariser said. "Concern about vitamin D should not lead people to forego sun protection, but rather prompt a conversation with their physician about how to ensure adequate and safe vitamin D intake while guarding against skin cancer."
In addition to individuals who protect themselves from sun or other UV exposure by daily use of sunscreen on exposed skin or by wearing sun-protective clothing, others at risk for vitamin D insufficiency include elderly individuals or those who have dark skin, photosensitivity, obesity, or fat malabsorption. These at-risk individuals should consult their physician regarding options for ensuring adequate vitamin D levels through dietary intake or supplement use, and physicians should be equipped to advise them properly.
Although serum vitamin D level (25-hydroxyvitamin D) can be easily measured and is a widely available blood test, further studies are required to identify appropriate serum concentrations of vitamin D needed for optimal health.
The standard reference now recommended by the AAD to advise patients regarding their needed minimum intake levels is the National Academy of Sciences Institute of Medicine guidelines for vitamin D. Because of new developments regarding knowledge of the clinical benefit of vitamin D, current recommendations for adequate vitamin D intake levels established by the Institute of Medicine may be increased in the near future.
The US Department of Agriculture Dietary Guidelines recommend that those at risk for vitamin D insufficiency receive supplementation with a total daily dose of 1000 IU vitamin D, according to the AAD statement.
The AAD recommends supplementation with 200 IU vitamin D from birth to age 50 years for those who are not at increased risk for vitamin D insufficiency. However, the American Academy of Pediatrics recommends supplementation with 400 IU vitamin D per day for children younger than 18 years of age, including infants.
Because vitamin D can be toxic in high doses, the US Food and Nutrition Board has set an upper limit for safety for vitamin D intake of 2000 IU per day for individuals older than 12 months of age and 1000 IU per day for infants.
For vitamin D supplementation, vitamin D3 (cholecalciferol), which is the form of vitamin D naturally produced in the skin, is preferred to vitamin D2 (ergocalciferol).
The updated AAD statement now emphasizes that there is no scientifically proven safe threshold for exposure to the sun or indoor tanning devices that optimizes vitamin D synthesis in the skin without increasing skin cancer risk. Laboratory research has shown that UV radiation from either the sun or tanning devices can cause oncogenic mutations in skin cells, and use of sunbeds has also been associated with increased risk for melanoma and squamous cell carcinoma. UV radiation exposure has also been linked to cataracts, premature aging, and immune suppression.
"It is well documented in the medical literature that unprotected exposure to UV radiation from natural sunlight or indoor tanning devices causes skin damage," Dr. Pariser said. "There is no current research available that provides a safe limit for sun exposure to maximize vitamin D production that does not put the individual's health at risk for developing skin cancer."
Low levels of vitamin D have been linked in numerous studies to greater risk for certain cancers and for some neurologic, autoimmune, and cardiovascular diseases, but clinical trials have not yet been performed to show a causal relationship of vitamin D to these diseases.
"Contrary to some reported information about vitamin D and the prevention of certain cancers and diseases — other than for bone health — we simply need more clinical data to determine what role, if any, vitamin D plays in these conditions," Dr. Pariser said.
The AAD still recommends avoiding use of tanning beds. The National Council on Skin Cancer Prevention recommends protection from UV exposure when outdoors by seeking the shade between 10 am and 4 pm whenever possible, generously applying sunscreen with a sun protection factor of at least 15, and wearing sun-protective clothing, including wide-brimmed hats, long sleeves, pants, and UV-protective sunglasses.
"For those who are concerned about vitamin D insufficiency, diet and vitamin D supplementation are the most appropriate methods to obtain adequate vitamin D — it is not appropriate to seek exposure to ultraviolet radiation," said National Council on Skin Cancer Prevention co-chair Henry Lim, MD, FAAD, chairman of dermatology at Henry Ford Hospital in Detroit, Michigan.
Laurie Barclay, MD From Medscape Medical News
July 16, 2009 — The American Academy of Dermatology (AAD) has issued an updated position statement on vitamin D after reviewing more recent evidence regarding the role of vitamin D in maintaining optimal health. The National Council on Skin Care Prevention also released its own position statement on July 14.
Individuals who regularly and properly practice sun protection may be at risk for vitamin D insufficiency and may require a higher dose of vitamin D, either from dietary sources or from supplements. Because of skin cancer risk from ultraviolet (UV) radiation, AAD does not recommend unprotected exposure to radiation from the sun or from indoor tanning devices.
"The vitamin D position statement supports the Academy's long-held conviction on safe ways to get this important vitamin — through a healthy diet which incorporates foods naturally rich in vitamin D, vitamin D-fortified foods and beverages, and vitamin D supplements," dermatologist and AAD president David M. Pariser, MD, FAAD, said in a news release.
"The updated recommendation for individuals who practice daily sun protection acknowledges that while protecting the skin from the damaging rays of the sun is important, so is maintaining adequate vitamin D levels," Dr. Pariser said. "Concern about vitamin D should not lead people to forego sun protection, but rather prompt a conversation with their physician about how to ensure adequate and safe vitamin D intake while guarding against skin cancer."
In addition to individuals who protect themselves from sun or other UV exposure by daily use of sunscreen on exposed skin or by wearing sun-protective clothing, others at risk for vitamin D insufficiency include elderly individuals or those who have dark skin, photosensitivity, obesity, or fat malabsorption. These at-risk individuals should consult their physician regarding options for ensuring adequate vitamin D levels through dietary intake or supplement use, and physicians should be equipped to advise them properly.
Although serum vitamin D level (25-hydroxyvitamin D) can be easily measured and is a widely available blood test, further studies are required to identify appropriate serum concentrations of vitamin D needed for optimal health.
The standard reference now recommended by the AAD to advise patients regarding their needed minimum intake levels is the National Academy of Sciences Institute of Medicine guidelines for vitamin D. Because of new developments regarding knowledge of the clinical benefit of vitamin D, current recommendations for adequate vitamin D intake levels established by the Institute of Medicine may be increased in the near future.
The US Department of Agriculture Dietary Guidelines recommend that those at risk for vitamin D insufficiency receive supplementation with a total daily dose of 1000 IU vitamin D, according to the AAD statement.
The AAD recommends supplementation with 200 IU vitamin D from birth to age 50 years for those who are not at increased risk for vitamin D insufficiency. However, the American Academy of Pediatrics recommends supplementation with 400 IU vitamin D per day for children younger than 18 years of age, including infants.
Because vitamin D can be toxic in high doses, the US Food and Nutrition Board has set an upper limit for safety for vitamin D intake of 2000 IU per day for individuals older than 12 months of age and 1000 IU per day for infants.
For vitamin D supplementation, vitamin D3 (cholecalciferol), which is the form of vitamin D naturally produced in the skin, is preferred to vitamin D2 (ergocalciferol).
The updated AAD statement now emphasizes that there is no scientifically proven safe threshold for exposure to the sun or indoor tanning devices that optimizes vitamin D synthesis in the skin without increasing skin cancer risk. Laboratory research has shown that UV radiation from either the sun or tanning devices can cause oncogenic mutations in skin cells, and use of sunbeds has also been associated with increased risk for melanoma and squamous cell carcinoma. UV radiation exposure has also been linked to cataracts, premature aging, and immune suppression.
"It is well documented in the medical literature that unprotected exposure to UV radiation from natural sunlight or indoor tanning devices causes skin damage," Dr. Pariser said. "There is no current research available that provides a safe limit for sun exposure to maximize vitamin D production that does not put the individual's health at risk for developing skin cancer."
Low levels of vitamin D have been linked in numerous studies to greater risk for certain cancers and for some neurologic, autoimmune, and cardiovascular diseases, but clinical trials have not yet been performed to show a causal relationship of vitamin D to these diseases.
"Contrary to some reported information about vitamin D and the prevention of certain cancers and diseases — other than for bone health — we simply need more clinical data to determine what role, if any, vitamin D plays in these conditions," Dr. Pariser said.
The AAD still recommends avoiding use of tanning beds. The National Council on Skin Cancer Prevention recommends protection from UV exposure when outdoors by seeking the shade between 10 am and 4 pm whenever possible, generously applying sunscreen with a sun protection factor of at least 15, and wearing sun-protective clothing, including wide-brimmed hats, long sleeves, pants, and UV-protective sunglasses.
"For those who are concerned about vitamin D insufficiency, diet and vitamin D supplementation are the most appropriate methods to obtain adequate vitamin D — it is not appropriate to seek exposure to ultraviolet radiation," said National Council on Skin Cancer Prevention co-chair Henry Lim, MD, FAAD, chairman of dermatology at Henry Ford Hospital in Detroit, Michigan.
Thursday, July 16, 2009
Reduced Doses of PCV-7 May Reduce Nasopharyngeal Carriage of Pneumococcus in Infants
Laurie Barclay, MD
July 15, 2009 — Infants who receive 2 or 3 primary doses of 7-valent pneumococcal conjugate vaccine (PCV-7) have a decreased rate of nasopharyngeal carriage of pneumococcus vs infants who are not vaccinated, according to the results of a randomized controlled trial reported in the July 8 issue of the Journal of the American Medical Association.
"The effects of reduced-dose schedules of...PCV-7 on pneumococcal carriage in children are largely unknown, although highly relevant in the context of subsequent herd effects," write Elske J.M. van Gils, MD, from Wilhelmina Children's Hospital, University Medical Center Utrecht in Utrecht, the Netherlands, and colleagues.
The goal of this study was to determine the effects of a 2-dose and 2 plus 1-dose PCV-7 schedule on nasopharyngeal pneumococcal carriage in infants vs those who did not receive the vaccine.
Between July 7, 2005, and February 14, 2008, in a general community in the Netherlands, 1003 healthy newborns, each with one of their parents, were enrolled, randomly selected to 1 of 3 groups, and followed up to age 24 months. The 3 study groups were 2 doses of PCV-7 at 2 and 4 months; 2 plus 1 doses of PCV-7 at 2, 4, and 11 months; or no dosage (control group). The primary endpoint of the study was rates of vaccine serotype pneumococcal carriage in infants in the second year of life.
After both PCV-7 schedules, vaccine serotype pneumococcal carriage was significantly decreased at 12 months. In the 2-dose and 2 plus 1-dose schedule groups, vaccine serotype pneumococcal carriage rates were 25% and 20%, respectively, vs 38% in the control group (both P < .001).
In the 2 plus 1-dose schedule group, vaccine serotype pneumococcal carriage had decreased further at 18 months to 16% and to 14% at 24 months both P < .001. In the 2-dose schedule group, however, vaccine serotype pneumococcal carriage was stable at 18 months 24%; but decreased further to 15% at 24 months. Vaccine serotype pneumococcal carriage in the control group remained approximately 36% to 38% until 24 months.
"The reduction of pneumococcal carriage obviously reduces the number of cases of invasive pneumococcal disease," said Fernando Artiles-Campelo, MD, a microbiologist in molecular epidemiology at Dr. NegrÃn University Hospital, Las Palmas de Gran Canaria, Canary Islands, Spain, told Medscape Pediatrics. "The fact that reduction occurs in both vaccination schedules is important in order to design a possible universal vaccination, because the total number of doses would be reduced if we use the 2-doses schedule."
JAMA. 2009;302:159-167.
source:http://www.medscape.com/viewarticle/705854?sssdmh=dm1.499929&src=nldne
note: PCV7 is not used in childhood vaccination in Malaysia
July 15, 2009 — Infants who receive 2 or 3 primary doses of 7-valent pneumococcal conjugate vaccine (PCV-7) have a decreased rate of nasopharyngeal carriage of pneumococcus vs infants who are not vaccinated, according to the results of a randomized controlled trial reported in the July 8 issue of the Journal of the American Medical Association.
"The effects of reduced-dose schedules of...PCV-7 on pneumococcal carriage in children are largely unknown, although highly relevant in the context of subsequent herd effects," write Elske J.M. van Gils, MD, from Wilhelmina Children's Hospital, University Medical Center Utrecht in Utrecht, the Netherlands, and colleagues.
The goal of this study was to determine the effects of a 2-dose and 2 plus 1-dose PCV-7 schedule on nasopharyngeal pneumococcal carriage in infants vs those who did not receive the vaccine.
Between July 7, 2005, and February 14, 2008, in a general community in the Netherlands, 1003 healthy newborns, each with one of their parents, were enrolled, randomly selected to 1 of 3 groups, and followed up to age 24 months. The 3 study groups were 2 doses of PCV-7 at 2 and 4 months; 2 plus 1 doses of PCV-7 at 2, 4, and 11 months; or no dosage (control group). The primary endpoint of the study was rates of vaccine serotype pneumococcal carriage in infants in the second year of life.
After both PCV-7 schedules, vaccine serotype pneumococcal carriage was significantly decreased at 12 months. In the 2-dose and 2 plus 1-dose schedule groups, vaccine serotype pneumococcal carriage rates were 25% and 20%, respectively, vs 38% in the control group (both P < .001).
In the 2 plus 1-dose schedule group, vaccine serotype pneumococcal carriage had decreased further at 18 months to 16% and to 14% at 24 months both P < .001. In the 2-dose schedule group, however, vaccine serotype pneumococcal carriage was stable at 18 months 24%; but decreased further to 15% at 24 months. Vaccine serotype pneumococcal carriage in the control group remained approximately 36% to 38% until 24 months.
"The reduction of pneumococcal carriage obviously reduces the number of cases of invasive pneumococcal disease," said Fernando Artiles-Campelo, MD, a microbiologist in molecular epidemiology at Dr. NegrÃn University Hospital, Las Palmas de Gran Canaria, Canary Islands, Spain, told Medscape Pediatrics. "The fact that reduction occurs in both vaccination schedules is important in order to design a possible universal vaccination, because the total number of doses would be reduced if we use the 2-doses schedule."
JAMA. 2009;302:159-167.
source:http://www.medscape.com/viewarticle/705854?sssdmh=dm1.499929&src=nldne
note: PCV7 is not used in childhood vaccination in Malaysia
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