cine Intussusception After Rotavirus Vaccines Reported to US VAERS, 2006-2012 By pediatrics.aappublications.org Published On :: 2013-05-13T00:07:02-07:00 A low-level risk of intussusception after rotavirus vaccines, ~1 to 2 cases per 100 000 vaccinees, exists in some settings. In the United States, a risk of 1 in 65 000 was excluded, but lower risk could exist.A persistent clustering of intussusception events 3 to 6 days after dose 1 indicates the possibility of a low-level risk of intussusception of ~0.8 cases per 100 000 vaccinees. The documented benefits of rotavirus vaccine far outweigh this low-level risk of intussusception. (Read the full article) Full Article
cine Comparative Effectiveness of Acellular Versus Whole-Cell Pertussis Vaccines in Teenagers By pediatrics.aappublications.org Published On :: 2013-05-20T00:07:25-07:00 The United States switched from whole-cell to acellular pertussis vaccines during the 1990s. Whether pertussis risk during a California outbreak differed between teenagers who previously received whole-cell or acellular pertussis vaccines early in life has not been reported.We evaluated pertussis risk in 10 to 17 year olds at Kaiser Permanente Northern California during a recent pertussis outbreak. Those given whole-cell pertussis vaccines in childhood were more protected than those given acellular pertussis vaccines. (Read the full article) Full Article
cine Effectiveness of Monovalent and Pentavalent Rotavirus Vaccine By pediatrics.aappublications.org Published On :: 2013-06-17T01:07:31-07:00 Monovalent rotavirus vaccine was introduced for infants in the United States in 2008. Previous US evaluations have not specifically assessed the performance of this vaccine under routine use.Using the same methodology and covering the same time period, high effectiveness (~90%) was demonstrated for the monovalent and the pentavalent rotavirus vaccine series against rotavirus disease resulting in emergency department/inpatient care, in children up to 2 years of age. (Read the full article) Full Article
cine Cost-Effectiveness of Using 2 vs 3 Primary Doses of 13-Valent Pneumococcal Conjugate Vaccine By pediatrics.aappublications.org Published On :: 2013-07-01T00:07:00-07:00 Pneumococcal conjugate vaccines are effective in preventing pneumococcal disease but are also costly. Although the current US immunization schedule recommends 4 doses, many countries have adopted 3-dose schedules that have worked well, but may provide less protection against pneumococcal disease.Changing the US 13-valent pneumococcal conjugate vaccine schedule from 3 to 2 primary doses while keeping a booster dose would save $412 million annually but might lead to moderate increases in pneumococcal disease, especially otitis media and pneumonia. (Read the full article) Full Article
cine Nonmedical Vaccine Exemptions and Pertussis in California, 2010 By pediatrics.aappublications.org Published On :: 2013-09-30T00:06:52-07:00 Previous studies have shown that nonmedical exemptions (NMEs) to immunization cluster geographically and contribute to outbreaks of vaccine-preventable diseases such as pertussis. The 2010 pertussis resurgence in California has been widely attributed to waning immunity from acellular pertussis vaccines.This study provides evidence of spatial and temporal clustering of NMEs and clustering of pertussis cases and suggests that geographic areas with high NME rates were also associated with high rates of pertussis in California in 2010. (Read the full article) Full Article
cine Off-Label Topical Calcineurin Inhibitor Use in Children By pediatrics.aappublications.org Published On :: 2013-10-14T00:07:21-07:00 In January 2006, a public health advisory and boxed warning for long-term safety and the risk of malignancies and a medication guide were issued for topical calcineurin inhibitors, tacrolimus and pimecrolimus.Evaluation of off-label use of topical calcineurin inhibitors in children before and after regulatory action by the Food and Drug Administration is important to understand the impact of regulatory action. (Read the full article) Full Article
cine Complementary and Conventional Medicine Use Among Youth With Recurrent Headaches By pediatrics.aappublications.org Published On :: 2013-10-14T00:07:21-07:00 Use of complementary and alternative medicine (CAM) is increasingly common among American youth; however, information on use of CAM among youth with recurrent headache (HA) is limited.Youth across a range of chronic conditions experience HA. These youth are more likely to use CAM. Use and expenditures for conventional medical care, and increased difficulties in activity and functioning are greater for youth with HA who use CAM. (Read the full article) Full Article
cine The Architecture of Provider-Parent Vaccine Discussions at Health Supervision Visits By pediatrics.aappublications.org Published On :: 2013-11-04T00:07:12-08:00 An increasing number of parents have concerns about childhood vaccines. Parents consistently cite their child’s provider as influential in their vaccine decision-making. Little is known about how providers communicate with parents about vaccines and which communication strategies are important.How providers initiate the vaccine recommendation at health supervision visits appears to be an important determinant of parent resistance. Also, when providers pursue their original vaccine recommendations in the face of parental resistance, many parents subsequently agree to vaccination. (Read the full article) Full Article
cine Telemedicine Consultations and Medication Errors in Rural Emergency Departments By pediatrics.aappublications.org Published On :: 2013-11-25T00:07:06-08:00 Medication errors occur frequently among pediatric patients, particularly those treated in rural emergency departments (EDs). Although telemedicine has been proposed as a potential solution, there are few data supporting its clinical effectiveness and its effect on medication errors.The use of telemedicine to provide pediatric critical care consultations to rural EDs is associated with less frequent physician-related ED medication errors among seriously ill and injured children. Therefore, this model of care may improve patient safety in rural hospital EDs. (Read the full article) Full Article
cine Duration of Protection After First Dose of Acellular Pertussis Vaccine in Infants By pediatrics.aappublications.org Published On :: 2014-02-10T00:07:08-08:00 Waning effectiveness of 5 doses of acellular pertussis vaccines is well documented after 6 years of age, but data are lacking for fewer doses in younger children.In 2- to 3-month-old infants, 1 dose of the diphtheria–tetanus–acellular pertussis vaccine gave significant protection against hospitalized pertussis. The effectiveness of 3 doses decreased from 84% between 6 and 11 months to 59% after 3 years. (Read the full article) Full Article
cine Vaccine Financing From the Perspective of Primary Care Physicians By pediatrics.aappublications.org Published On :: 2014-02-24T00:07:07-08:00 Because of high costs of newer vaccines, financial risk to private vaccination providers has increased. Previous studies have shown general dissatisfaction with payment for the cost of vaccines and administration fees, with some providers considering no longer providing childhood vaccines.We show that many providers are dissatisfied with payment for vaccine purchase and administration from all types of payers and that, for new vaccines, providers are using a variety of strategies with parents to handle uncertainty about insurance coverage. (Read the full article) Full Article
cine Effective Messages in Vaccine Promotion: A Randomized Trial By pediatrics.aappublications.org Published On :: 2014-03-03T00:06:29-08:00 Maintaining high levels of measles-mumps-rubella immunization is an important public health priority that has been threatened by discredited claims about the safety of the vaccine. Relatively little is known about what messages are effective in overcoming parental reluctance to vaccinate.Pro-vaccine messages do not always work as intended. The effectiveness of those messages may vary depending on existing parental attitudes toward vaccines. For some parents, they may actually increase misperceptions or reduce vaccination intention. (Read the full article) Full Article
cine Live Vaccine Use and Safety in DiGeorge Syndrome By pediatrics.aappublications.org Published On :: 2014-03-31T00:06:58-07:00 Individuals with DiGeorge syndrome (DGS) have varying degrees of immunodeficiency. All are susceptible to vaccine-preventable infections with serious complications. Although live vaccines are generally contraindicated in this population, limited evidence suggests that they may be effective and safe for select individuals.Many individuals with DGS received live vaccines despite having a known diagnosis. Adverse events following live immunizations were typically minor and self-limited, suggesting that live vaccines may be considered for patients with DGS who exhibit mild-to-moderate immunosuppression. (Read the full article) Full Article
cine Effectiveness of Trivalent Flu Vaccine in Healthy Young Children By pediatrics.aappublications.org Published On :: 2014-04-21T00:06:57-07:00 In the United States, given the high burden of disease, influenza vaccine is recommended for all children from age 6 months. The paucity of vaccine effectiveness data in children <2 years has led some to argue against routine vaccination in this age group.This study reveals the effectiveness of trivalent influenza vaccine in young children and supports the current Advisory Committee on Immunization Practices recommendation. This study provides the strongest evidence to date confirming the effectiveness of trivalent influenza vaccine in children <2 years of age. (Read the full article) Full Article
cine Safety of Rotavirus Vaccine in the NICU By pediatrics.aappublications.org Published On :: 2014-05-19T00:07:01-07:00 Rotavirus vaccination is discouraged during hospitalization, given concerns regarding live-attenuated virus transmission; vaccination is recommended upon NICU discharge for eligible infants, however. Vaccination must be initiated before 104 days of age or infants become age-ineligible.RotaTeq vaccine administered with routine 2-month vaccinations within the NICU was tolerated in recipients, with no suggestion of symptomatic nosocomial transmission to neighboring unvaccinated infants. (Read the full article) Full Article
cine Rotavirus Vaccines and Health Care Utilization for Diarrhea in the United States (2007-2011) By pediatrics.aappublications.org Published On :: 2014-06-09T00:06:39-07:00 Since the introduction of rotavirus vaccines, diarrhea-associated health care utilization among US children has decreased substantially. Moreover, indirect benefits from rotavirus vaccination have been observed in unvaccinated children and in adults.With increasing rotavirus vaccine coverage during 2009–2011, we observed continued reductions in diarrhea-associated health care utilization and cost. Both rotavirus vaccines conferred high protection against rotavirus hospitalizations; pentavalent rotavirus vaccine provided durable protection through the fourth year of life. (Read the full article) Full Article
cine Invasive Pneumococcal Disease After Implementation of 13-Valent Conjugate Vaccine By pediatrics.aappublications.org Published On :: 2014-07-07T05:07:01-07:00 Invasive pneumococcal disease causes enormous morbidity in children. The spectrum and severity of illness caused by pneumococcal serotypes not present in the current vaccine, and whether the clinical profile and severity of disease have changed, are largely unknown.Initial data suggest that nonvaccine serotypes are more common in children with underlying conditions, who have greater morbidity from disease. In the post-PCV13 era, a larger proportion of patients are hospitalized, but mortality rates are unchanged. (Read the full article) Full Article
cine Stool Microbiota and Vaccine Responses of Infants By pediatrics.aappublications.org Published On :: 2014-07-07T05:07:04-07:00 Oral vaccine responses are low in children from less-developed countries perhaps as a result of intestinal dysbiosis. New high-throughput DNA-based methods allow characterization of intestinal microbiota as a predictor of vaccine responses.High abundance of stool Actinobacteria, including Bifidobacterium, was associated with higher responses to oral and parenteral vaccines and a larger thymus in Bangladeshi infants. Conversely, high abundance of Clostridiales, Enterobacteriales, and Pseudomonadales was associated with neutrophilia and lower vaccine responses. (Read the full article) Full Article
cine Increasing Provision of Adolescent Vaccines in Primary Care: A Randomized Controlled Trial By pediatrics.aappublications.org Published On :: 2014-07-07T05:07:02-07:00 The Centers for Disease Control and Prevention recommends that health departments in all 50 states deliver AFIX (Assessment, Feedback, Incentives, and eXchange) consultations to 25% of federally funded vaccine providers each year. AFIX effectively raises vaccination coverage among young children.AFIX consultations achieved short-term gains in coverage for 11- to 12-year-olds for vaccines in the adolescent platform. No gains occurred for older adolescents or over the long term. Consultations were equally effective when delivered in-person or by webinar. (Read the full article) Full Article
cine Vaccine Message Framing and Parents' Intent to Immunize Their Infants for MMR By pediatrics.aappublications.org Published On :: 2014-08-18T00:07:03-07:00 Messages emphasizing societal benefits of vaccines have been linked to increased vaccination intentions in adults. It is unclear if this pattern holds for parents deciding whether to vaccinate their children.Findings suggest that health care providers should emphasize the direct benefits of MMR vaccination to the child. Mentioning societal benefits seems to neither add value to, nor interfere with, information highlighting benefits directly to the child. (Read the full article) Full Article
cine Long-term Study of a Quadrivalent Human Papillomavirus Vaccine By pediatrics.aappublications.org Published On :: 2014-08-18T00:07:02-07:00 The short-term immunogenicity and safety of a HPV4 vaccine have been previously evaluated in preadolescents and adolescents. To date, no long-term studies of the safety, effectiveness, and immunogenicity of the HPV4 vaccine have been reported in this age group.The HPV4 vaccine administered to adolescents demonstrated durability in clinically effective protection and sustained antibody titers over 8 years. These data, along with extensive postapproval safety surveillance data, should help reinforce national recommendations for HPV vaccination of preadolescents and adolescents. (Read the full article) Full Article
cine Adolescent Vaccine Co-administration and Coverage in New York City: 2007-2013 By pediatrics.aappublications.org Published On :: 2014-11-10T00:06:18-08:00 National adolescent vaccination coverage estimates in 2013 among 13- to 17-year-olds are 86% for Tdap vaccine and 78% for MCV4. Comparatively, coverage with ≥3 doses of HPV vaccine is 38% among girls and 14% among boys.One-fourth of 11-year-olds had HPV vaccine co-administered with Tdap vaccine, compared with two-thirds who had MCV4 co-administered. Whereas by age 17 years, >92% received Tdap vaccine and MCV4, only half of girls and one-fifth of boys completed HPV vaccination. (Read the full article) Full Article
cine Sinusitis and Pneumonia Hospitalization After Introduction of Pneumococcal Conjugate Vaccine By pediatrics.aappublications.org Published On :: 2014-11-10T00:06:19-08:00 Pneumococcal conjugated vaccines (PCVs) are known to decrease invasive pneumococcal disease in children, but their effect on pneumonia necessitating hospitalization is more variable across study sites, and effects on hospitalization for sinusitis have not been shown previously.There was a significant decrease in hospitalizations for sinusitis in children <2 years of age, and hospitalization for pneumonia decreased in children aged <5 years after sequential introduction of PCV7 and PCV13. (Read the full article) Full Article
cine Text Message Reminders for Second Dose of Influenza Vaccine: A Randomized Controlled Trial By pediatrics.aappublications.org Published On :: 2014-12-29T00:06:47-08:00 Influenza vaccine coverage is low, and young children in need of 2 doses in a given season are at particular risk, with less than half receiving both doses. Text message vaccine reminders increase receipt of first dose of influenza vaccine.Little is known about what types of text message reminders are most effective, including embedding educational information. We demonstrate that text message reminders increase timely receipt of the second dose of influenza vaccine and embedding health literacy information improves effectiveness. (Read the full article) Full Article
cine Registry-Linked Electronic Influenza Vaccine Provider Reminders: A Cluster-Crossover Trial By pediatrics.aappublications.org Published On :: 2014-12-29T00:06:46-08:00 Frequency of influenza vaccination is low, partially because of missed opportunities to vaccinate. Barriers to implementing successful influenza vaccination reminders in the electronic health record include alert fatigue and incomplete vaccination information due to scattered records.A noninterruptive, immunization information system–linked influenza vaccination reminder can increase vaccination late in the winter when fewer vaccine doses are usually administered. Tailoring the reminder to clinicians’ needs can increase its use. (Read the full article) Full Article
cine Safety of Measles-Containing Vaccines in 1-Year-Old Children By pediatrics.aappublications.org Published On :: 2015-01-05T00:06:54-08:00 Measles-containing vaccines are associated with several types of adverse events. Because measles-mumps-rubella-varicella (MMRV) versus separate measles-mumps-rubella (MMR) and varicella (MMR + V) vaccine increases a toddler’s risk for febrile seizures, we investigated whether MMRV is riskier than MMR + V and whether either vaccine elevates risk for additional safety outcomes.Comparing MMRV with MMR + V, no increased risk of immune thrombocytopenia purpura, anaphylaxis, ataxia, arthritis, meningitis/encephalitis, acute disseminated encephalomyelitis, and Kawasaki disease was detected. No new safety concerns were identified after either vaccine, and most outcomes studied were unlikely after either vaccine. (Read the full article) Full Article
cine Variation in Rotavirus Vaccine Coverage by Provider Location and Subsequent Disease Burden By pediatrics.aappublications.org Published On :: 2015-01-12T00:05:26-08:00 Uptake of rotavirus vaccines has increased steadily since introduction. Despite their demonstrated impact, rotavirus vaccine coverage is lower than for other vaccines recommended in infancy and disease continues to occur.We observed higher rotavirus detection rates among patients from provider locations with lower rotavirus vaccine coverage; providers who do not offer rotavirus vaccine to age-eligible children may create pockets of susceptible children that serve as reservoirs of ongoing disease transmission. (Read the full article) Full Article
cine Geographic Clusters in Underimmunization and Vaccine Refusal By pediatrics.aappublications.org Published On :: 2015-01-19T00:05:33-08:00 Parent refusal and delay of childhood vaccines has increased in recent years and is believed to cluster in communities. Such clustering could pose public health risks and barriers to achieving quality benchmarks for immunization coverage.We found that underimmunization and vaccine refusal cluster geographically. Spatial scan analysis may be a useful tool to identify locations where clinicians may face challenges to achieving benchmarks for immunization coverage and that deserve special focus for interventions. (Read the full article) Full Article
cine Physician Response to Parental Requests to Spread Out the Recommended Vaccine Schedule By pediatrics.aappublications.org Published On :: 2015-03-02T00:05:25-08:00 Some parents choose to "spread out" the recommended vaccine schedule for their child by decreasing the number of simultaneous vaccines or delaying certain vaccines until an older age. Epidemiologic studies demonstrate increasing numbers of parents are choosing to delay vaccines.We demonstrate that almost all providers encounter requests to spread out vaccines in a typical month and, despite concerns, increasing numbers are agreeing to do so. Providers report many strategies in response to requests but think few are effective. (Read the full article) Full Article
cine 13-Valent Pneumococcal Conjugate Vaccine (PCV13) in Preterm Versus Term Infants By pediatrics.aappublications.org Published On :: 2015-03-16T00:05:25-07:00 Preterm infants are at an increased risk of infections; therefore, vaccination is of particular importance. Because immune response data reported for preterm infants may vary according to gestational age and vaccination timing, vaccine responses in this population warrant additional research.This study evaluated 13-valent pneumococcal conjugate vaccine in preterm infants. Results suggest that this vaccine was well tolerated and immunogenic; most subjects achieved serotype-specific immunoglobulin G antibody levels and functional antibody responses likely to correlate with protection against invasive disease. (Read the full article) Full Article
cine First Use of a Serogroup B Meningococcal Vaccine in the US in Response to a University Outbreak By pediatrics.aappublications.org Published On :: 2015-04-27T00:05:19-07:00 Outbreaks of serogroup B meningococcal disease occur at universities and other organizations. Until October 2014, options for control of serogroup B outbreaks were limited by the absence of a licensed vaccine for serogroup B meningococcal disease in the United States.We describe a serogroup B outbreak at a university in 2013 and the campaign with investigational serogroup B vaccine held in response. This was the first use of a serogroup B vaccine as an outbreak response in the United States. (Read the full article) Full Article
cine Tdap Vaccine Effectiveness in Adolescents During the 2012 Washington State Pertussis Epidemic By pediatrics.aappublications.org Published On :: 2015-05-04T00:05:18-07:00 Although waning immunity with the childhood pertussis vaccination series has been reported, there are limited data on duration of protection of the adolescent pertussis vaccine (Tdap), especially among those who have received only acellular vaccines.This study reports that protection from Tdap wanes substantially 2 to 4 years after vaccination among adolescents who received all acellular vaccines during childhood. This waning protection is likely contributing to the increase in adolescent pertussis. (Read the full article) Full Article
cine First Pertussis Vaccine Dose and Prevention of Infant Mortality By pediatrics.aappublications.org Published On :: 2015-05-04T00:05:17-07:00 Few studies have established the protective efficacy of 1 to 3 primary doses of diphtheria-tetanus-whole-cell pertussis (DTwP)/diphtheria-tetanus-acellular pertussis (DTaP) vaccines against pertussis, hospitalization, or pertussis complications in infants. However, vaccine effectiveness against infant pertussis death has not been previously reported.This is the first study to report the protective role of ≥1 DTwP/DTaP doses among vaccine-eligible infants aged ≥6 weeks against death, hospitalization, and complications from pertussis. It describes risk markers for death among vaccine-ineligible infants aged <6 weeks. (Read the full article) Full Article
cine Physician Communication Training and Parental Vaccine Hesitancy: A Randomized Trial By pediatrics.aappublications.org Published On :: 2015-06-01T06:07:55-07:00 Parental hesitancy about childhood vaccines is prevalent and related to delay or refusal of immunizations. Physicians are highly influential in parental vaccine decision-making, but may lack confidence in addressing parents’ vaccine concerns.A physician-targeted communications intervention designed to reduce maternal vaccine hesitancy through the parent-physician relationship did not affect maternal hesitancy or physician confidence communicating with parents. Further research should determine the most effective approaches to addressing vaccine hesitancy. (Read the full article) Full Article
cine Simulation in Pediatric Emergency Medicine Fellowships By pediatrics.aappublications.org Published On :: 2015-06-08T00:07:17-07:00 Simulation-based education is increasing but its use in pediatric emergency medicine (PEM) fellowships has not been recently documented. Previous studies identified barriers including equipment and space, but growth of simulation centers and equipment has been widespread.Simulation is widely used in PEM fellowships, and current barriers include faculty and learner time, implementation of best practices in simulation; equipment is less significant. Future work should focus on curriculum and evaluation development, aligning with the milestones. (Read the full article) Full Article
cine Pneumococcal Conjugate Vaccine and Clinically Suspected Invasive Pneumococcal Disease By pediatrics.aappublications.org Published On :: 2015-06-15T00:06:46-07:00 Conventional invasive pneumococcal disease (IPD) definition using laboratory confirmation lacks sensitivity. Using a vaccine-probe design, the FinIP trial showed that IPD disease burden and vaccine-preventable disease incidence were fourfold higher when a more sensitive outcome, clinically suspected IPD, was used.Vaccine-preventable disease incidence (ie, absolute reduction due to PCV10 vaccination) during routine vaccination program was threefold with the more sensitive outcome of clinically suspected IPD compared with the conventional IPD definition. This has major implications for cost-effectiveness of PCVs. (Read the full article) Full Article
cine Immunogenicity and Safety of a 9-Valent HPV Vaccine By pediatrics.aappublications.org Published On :: 2015-06-22T00:06:54-07:00 Prophylactic vaccination of young women 16 to 26 years of age with the 9-valent human papillomavirus (HPV)–like particle (9vHPV) vaccine prevents infection and disease with vaccine HPV types.These data support bridging the efficacy findings with 9vHPV vaccine in young women 16 to 26 years of age to girls and boys 9 to 15 years of age and implementation of gender-neutral HPV vaccination programs in preadolescents and adolescents. (Read the full article) Full Article
cine Immunogenicity, Safety, and Tolerability of a Hexavalent Vaccine in Infants By pediatrics.aappublications.org Published On :: 2015-07-27T00:08:20-07:00 The routine childhood immunization schedule is crowded during the first 2 years, leading to deferred doses and limiting the addition of new vaccines. Combination vaccines can reduce the "shot burden" and improve coverage rates and timeliness.Antibody response rates to antigens contained in an investigational hexavalent vaccine (DTaP5-IPV-Hib-HepB) were noninferior to licensed comparator vaccines when given as a 3-dose infant series. The safety profile was similar to control except for increased rates of mild-to-moderate, self-limited fever. (Read the full article) Full Article
cine Coadministration of a 9-Valent Human Papillomavirus Vaccine With Meningococcal and Tdap Vaccines By pediatrics.aappublications.org Published On :: 2015-08-03T00:07:19-07:00 Previous studies have shown that concomitant administration of the quadrivalent human papillomavirus vaccine with MCV4 and Tdap was generally well tolerated and did not interfere with the immune responses to the respective vaccines.Concomitant administration of the novel 9-valent human papillomavirus vaccine with MCV4 and Tdap, 2 vaccines that are currently recommended for routine vaccination of adolescents, did not compromise the safety, tolerability, and immunogenicity of the individual vaccines. (Read the full article) Full Article
cine Febrile Seizures After 2010-2011 Trivalent Inactivated Influenza Vaccine By pediatrics.aappublications.org Published On :: 2015-09-14T00:07:39-07:00 Previous studies found that 2010–2011 trivalent inactivated influenza vaccine (TIV) and 13-valent pneumococcal conjugate vaccine (PCV13) were associated with statistically significant increased risks of febrile seizures (FS) in the United States.Estimated FS relative risks after TIV or PCV13 adjusted for DTaP were >1, although not statistically significant and lower than previous estimates. Same-day administration of TIV and PCV13 did not result in more FS compared with separate-day vaccination. (Read the full article) Full Article
cine Effectiveness and Cost of Bidirectional Text Messaging for Adolescent Vaccines and Well Care By pediatrics.aappublications.org Published On :: 2015-10-05T00:07:47-07:00 Adolescent vaccination rates lag behind other childhood vaccines. Text messaging to improve uptake of adolescent vaccines has been shown to be effective in academic centers but has not been studied in other settings.This study, done in 5 private and 2 safety-net practices, used a bidirectional text message as a behavioral prompt and showed text messaging was effective at increasing uptake of all adolescent vaccines. Costs were similar to other reminder/recall methods. (Read the full article) Full Article
cine Characteristics of Physicians Who Dismiss Families for Refusing Vaccines By pediatrics.aappublications.org Published On :: 2015-11-02T00:06:44-08:00 The American Academy of Pediatrics discourages providers from dismissing families who refuse vaccines for their children, yet some providers continue to do so.We show that ~1 in 5 pediatricians dismiss families who refuse vaccines, and there is significant regional variation in the practice. Dismissing families for refusing vaccines was also associated with stricter state nonmedical exemption policies. (Read the full article) Full Article
cine Should I keep my child's vaccine appointments? By news.psu.edu Published On :: Fri, 01 May 2020 14:19 -0400 Full Article
cine Comparison of Cefepime/Cefpirome and Carbapenem Therapy for Acinetobacter Bloodstream Infection: A Multicentre Study [Clinical Therapeutics] By aac.asm.org Published On :: 2020-03-16T08:17:37-07:00 Carbapenems are currently the preferred agents for the treatment of serious Acinetobacter infections. However, whether cefepime/cefpirome can be used to treat Acinetobacter bloodstream infection (BSI) if it is active against the causative pathogens is not clear. This study aimed to compare the efficacy of cefepime/cefpirome and carbapenem monotherapy in patients with Acinetobacter BSI. The population included 360 patients with monomicrobial Acinetobacter BSI receiving appropriate antimicrobial therapy admitted to four medical centres in Taiwan in 2012–2017. The predictors of 30-day mortality were determined by Cox regression analysis. The overall 30-day mortality rate in the appropriate antibiotic treatment group was 25.0% (90/360 patients), respectively. The crude 30-day mortality rates for cefepime/cefpirome and carbapenem therapy were 11.5% (7/61 patients) and 26.3% (21/80 patients), respectively. The patients receiving cefepime/cefpirome/carbapenem therapy were infected by Acinetobacter nosocomialis (51.8%), A. baumannii (18.4%) and A. pittii (12.1%). After adjusting for age, Sequential Organ Failure Assessment (SOFA) score, invasive procedures, and underlying diseases, cefepime/cefpirome therapy was not independently associated with a higher or lower 30-day mortality compared to the carbapenem therapy. SOFA score (hazard ratio [HR], 1.324; 95% confidence interval [CI], 1.137–1.543; P < 0.001) and neutropenia (HR, 7.060; 95% CI, 1.607–31.019; P = 0.010) were independent risk factors for 30-day mortality of patients receiving cefepime/cefpirome or carbapenem monotherapy. The incidence density of 30-day mortality for cefepime/cefpirome versus carbapenem therapy was 0.40% versus 1.04%. The therapeutic response of cefepime/cefpirome therapy was comparable to that of carbapenems among patients with Acinetobacter BSI receiving appropriate antimicrobial therapy. Full Article
cine The Impact of Intrinsic Resistance Mechanisms on Potency of QPX7728, a New Ultra-Broad-Spectrum Beta-lactamase Inhibitor of Serine and Metallo Beta-Lactamases in Enterobacteriaceae, Pseudomonas aeruginosa, and Acinetobacter baumannii. [Mechanisms of Resis By aac.asm.org Published On :: 2020-03-30T10:04:32-07:00 QPX7728 is an ultra-broad-spectrum boronic acid beta-lactamase inhibitor that demonstrates inhibition of key serine and metallo beta-lactamases at a nano molar range in biochemical assays with purified enzymes. The broad-spectrum inhibitory activity of QPX7728 observed in biochemical experiments translates into enhancement of the potency of many beta-lactams against strains of target pathogens producing beta-lactamases. The impact of bacterial efflux and permeability on inhibitory potency were determined using isogenic panels of KPC-3 producing isogenic strains of K. pneumoniae and P. aeruginosa and OXA-23-producing strains of A. baumannii with various combinations of efflux and porin mutations. QPX7728 was minimally affected by multi-drug resistance efflux pumps in either Enterobacteriaceae, or in non-fermenters such as P. aeruginosa or A. baumannii. In P. aeruginosa, the potency of QPX7728 was further enhanced when the outer membrane is permeabilized. The potency of QPX7728 in P. aeruginosa is not affected by inactivation of the carbapenem porin OprD. While changes in OmpK36 (but not OmpK35) reduced the potency of QPX7728 (8-16-fold), QPX7728 (4 μg/ml) nevertheless completely reversed KPC-mediated meropenem resistance in strains with porin mutations, consistent with a lesser effect of these mutations on the potency of QPX7728 compared to other agents. The ultra-broad-spectrum beta-lactamase inhibition profile combined with enhancement of the activity of multiple beta-lactam antibiotics with varying sensitivity to the intrinsic resistance mechanisms of efflux and permeability indicate QPX7728 is a useful inhibitor for use with multiple beta-lactam antibiotics. Full Article
cine Efficacy and Effectiveness of the PCV-10 and PCV-13 Vaccines Against Invasive Pneumococcal Disease By pediatrics.aappublications.org Published On :: 2020-04-01T01:00:57-07:00 CONTEXT: Pneumococcal conjugate vaccines (PCVs) (pneumococcal 13-valent conjugate vaccine [PCV-13] and pneumococcal 10-valent conjugate vaccine [PCV-10]) are available for prevention of pneumococcal infections in children. OBJECTIVE: To determine the vaccine effectiveness (VE) of PCV-13 and PCV-10 in preventing invasive pneumococcal disease (IPD) and acute otitis media (AOM) in children <5 years. DATA SOURCES: Systematic searches of Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, Web of Science, and Cochrane. STUDY SELECTION: Eligible studies examined the direct effectiveness and/or efficacy of PCV-10 and PCV-13 in reducing the incidence of disease in healthy children <5 years. DATA EXTRACTION: Two reviewers independently conducted data extraction and methodologic quality assessment. RESULTS: Significant effectiveness against vaccine-type IPD in children ≤5 years was reported for ≥1 dose of PCV-13 in the 3 + 1 (86%–96%) and 2 + 1 schedule (67.2%–86%) and for PCV-10 for the 3 + 1 (72.8%–100%) and 2 + 1 schedules (92%–97%). In children <12 months of age, PCV-13 VE against serotype 19A post–primary series was significant for the 3 + 1 but not the 2 + 1 schedule. PCV-10 crossprotection against 19A was significant in children ≤5 years with ≥1 dose (82.2% and 71%). Neither PCVs were found effective against serotype 3. PCV-13 was effective against AOM (86%; 95% confidence interval [CI]: 61 to 94). PCV-10 was effective against clinically defined (26.9%; 95% CI: 5.9 to 43.3) and bacteriologically confirmed AOM (43.3%; 95% CI: 1.7 to 67.3). LIMITATIONS: Because of the large heterogeneity in studies, a meta-analysis for pooled estimates was not done. CONCLUSIONS: Both PCVs afford protection against pneumococcal infections, with PCV-10 protecting against 19A IPD, but this VE has not been verified in the youngest age groups. Full Article
cine Vancouver archbishop donates to coronavirus vaccine research By feedproxy.google.com Published On :: Tue, 28 Apr 2020 17:17:00 -0600 Denver Newsroom, Apr 28, 2020 / 05:17 pm (CNA).- Archbishop Michael Miller of Vancouver has announced that he is donating to the University of British Columbia’s research toward a COVID-19 vaccine. “May the search for COVID-19 solutions also be a moment of solidarity, of collaboration, and of growing together as a visible sign to the world of the healing and reconciliation so needed right now,” Archbishop Miller said April 27 as reported by the B.C. Catholic. Ryan Thomas, a special advisor to the archdiocese, told CNA that Archbishop Miller wanted to express, through his donation, the Catholic Church’s support for science and medicine that contribute to the common good. “The Church— as Pope Francis has said from the beginning of his pontificate— is called to go out, we're called to engage, not called to retreat,” Thomas told CNA. “From a scientific standpoint, that means identifying the research that is worthy of our investment, that meets the high standards that we have to protect life,” he said. Thomas declined to specify the amount of the donation, but said that it was in the thousands of dollars. The global effort to develop a COVID-19 vaccine includes at least 50 other research teams, the university says, many of which in the U.S. and Canada have received government funding and are being conducted by large pharmaceutical companies. Pro-life leaders have warned in recent months that among the many COVID-19 vaccines currently in development worldwide, in some cases researchers are using old cell lines derived from the cells of aborted babies. It was important to Archbishop Miller, Thomas said, that the Church be seen to be promoting research into a vaccine that Catholics can support in good conscience. A group of Evangelical Christians and Catholics in Vancouver began to rally around the idea of supporting a vaccine that corresponded to Christian ethical standards, and eventually presented the idea of supporting UBC’s research to Archbishop Miller. Thomas said Miller made sure to inquire about whether UBC’s vaccine research makes use of aborted fetal cells, which it does not. Dr. Wilf Jefferies, the project’s lead researcher, told CNA via email that his research team is currently in the process of validating the potency of vaccine candidates in preclinical trials, in order to assess their potential toxicity before trying them in human subjects. The UBC lab is using immune-boosting components called adjuvants in its vaccine candidate, with the hopes of reducing the dosage of vaccine required for complete protection against the disease. In addition, Jefferies hopes that UBC’s vaccine will continue to provide protection against COVID-19 even if the virus mutates over time. “I am heartened by the unity and kindness that is being demonstrated during this pandemic,” Jefferies told CNA. “I think the response by the archdiocese is an affirmative and practical way to address the critical need in our society to develop a vaccine...I am sincerely humbled by the support we have received from the archdiocese and from other groups and individuals.” So far, Jefferies’ lab has received grants from the government-funded Michael Smith Health Research Foundation and the Sullivan Urology Foundation affiliated with the University of British Columbia, as well as a number of private donations. There are at least 1,000 clinical trials currently taking place around the world to test potential COVID-19 vaccines. A group of pro-life leaders in a letter to the Trump administration earlier this month reiterated that development of a COVID-19 vaccine should avoid unethical links to abortion. “No American should be forced to choose between being vaccinated against this potentially deadly virus and violating his or her conscience,” reads the April 17 letter to Dr. Stephen M. Hahn, commissioner of the U.S. Food and Drug Administration. “Fortunately, there is no need to use ethically problematic cell lines to produce a COVID vaccine, or any vaccine, as other cell lines or processes that do not involve cells from abortions are available and are regularly being used to produce other vaccines,” it continued. The letter’s signers include Archbishop Joseph Naumann of Kansas City in Kansas, chair of the U.S. Conference of Catholic Bishops’ Committee on Pro-Life Activities; the heads of three other bishops’ conference committees; and leaders of many other Catholic and non-Catholic groups. The Pontifical Academy for Life has noted that Catholics have an obligation to use ethically-sourced vaccines when available, and have an obligation to speak up and request the development of new cell lines that are not derived from aborted fetuses. The 2008 Vatican document Dignitatis personae strongly criticized aborted fetal tissue research. However, as regards common vaccines, such as those for chicken pox and measles, mumps, and rubella (MMR), that may be derived from cell lines of aborted babies, the Vatican said they could be used by parents for “grave reasons” such as danger to their children’s health. In a 2017 document on vaccines, the academy noted a “moral obligation to guarantee the vaccination coverage necessary for the safety of others… especially the safety of more vulnerable subjects such as pregnant women and those affected by immunodeficiency who cannot be vaccinated against these diseases.” Full Article Americas
cine College of Medicine celebrates student achievements virtually By news.psu.edu Published On :: Wed, 06 May 2020 08:52 -0400 The spring season at Penn State College of Medicine is packed full of research presentations, awards and ceremonies. Since experts cannot predict when social distancing guidelines will be relaxed, College of Medicine leaders plan on celebrating many of these springtime celebrations virtually — including commencement. Full Article
cine 1 in 4 Americans Would Refuse COVID-19 Vaccine from Government By www.thegatewaypundit.com Published On :: Fri, 08 May 2020 15:40:28 GMT Source: www.thegatewaypundit.com - Friday, May 08, 2020 One in Four Americans would refuse a COVID-19 vaccine according to a new ABC News/Ipsos poll. The news comes as Americans trust in the medical community continues to plunge thanks to overblown predictions on the extent of the coronavirus pandemic, fake news reporting and the continued attacks on hydroxychloroquine treatments that are showing great success. HUGE UPDATE: Dr. Fauci and Dr. Birx Used Imperial College Model — NOW CONFIRMED AS A COMPLETE FRAUD — To Persuade President Trump to Lock Down Entire US Economy! After losing your business and livelihood due to faulty models and predictions why would you trust the government with a COVID-19 vaccine? Via ABC Action News : Americans, by a large 30-point margin, are resistant to re-opening the country now, believing the risk to human life of opening the country outweighs the economic toll of remaining under restrictive lockdowns — a concern that starkly divides along partisan lines, according to a new ABC News/Ipsos released Friday. In the new poll, conducted by Ipsos in partnership with ABC News using Ipsos’ Knowledge Panel, nearly two-thirds of Americans said they more closely align with the view that opening the county now is not advantageous since it will result in a higher death toll, while slightly more than one-third agree with the belief that an immediate reopening is beneficial to minimize the negative impact on the economy. But those attitudes show deep partisan divisioAll Related Full Article
cine A Centralized Approach for Practicing Genomic Medicine By pediatrics.aappublications.org Published On :: 2020-03-02T01:00:55-08:00 Next-generation sequencing has revolutionized the diagnostic process, making broadscale testing affordable and applicable to almost all specialties; however, there remain several challenges in its widespread implementation. Barriers such as lack of infrastructure or expertise within local health systems and complex result interpretation or counseling make it harder for frontline clinicians to incorporate genomic testing in their existing workflow. The general population is more informed and interested in pursuing genetic testing, and this has been coupled with the increasing accessibility of direct-to-consumer testing. As a result of these changes, primary care physicians and nongenetics specialty providers find themselves seeing patients for whom genetic testing would be beneficial but managing genetic test results that are out of their scope of practice. In this report, we present a practical and centralized approach to providing genomic services through an independent, enterprise-wide clinical service model. We present 4 years of clinical experience, with >3400 referrals, toward designing and implementing the clinical service, maximizing resources, identifying barriers, and improving patient care. We provide a framework that can be implemented at other institutions to support and integrate genomic services across the enterprise. Full Article