Heidi Splete

QUEBEC CITY – Men who have sex with men can self-test for chlamydia and gonorrhea as effectively as health care providers can, according to findings from a study involving 286 adult men.

Data from previous studies show that the risk of HIV infection increases in men who have sex with men (MSM) who have other sexually transmitted diseases, said Dr. Marybeth Sexton of Columbia University, New York. Therefore, regular STD testing for MSM is important, however "less than 14% of physicians routinely screen male patients for chlamydia and gonorrhea," Dr. Sexton said at a congress of the International Society for Sexually Transmitted Diseases Research. Lack of time, lack of staff, and lack of knowledge were the reasons most often given for not screening.

In this study, Dr. Sexton and colleagues in Washington, D.C. compared the results of nucleic acid amplification testing (NAAT) for chlamydia and gonorrhea when MSM administered the tests themselves and when a health care provider administered the tests.

Patients were recruited from the Whitman-Walker Clinic in Washington, and they were eligible for the study if they reported having intercourse with a man within the past 6 months and if they wanted to be screened for rectal and pharyngeal chlamydia and gonorrhea.

The screening tests were performed twice on each patient, and the patients were randomized to initially perform self-tests or to be tested by a health care provider. For the self-test, patients were given instructional cards, and a health care provider was present, but offered no additional assistance.

Overall, both providers and patients had positive test results for 12 cases of rectal gonorrhea, 15 cases of pharyngeal gonorrhea, 25 cases of rectal chlamydia, and 3 cases of pharyngeal chlamydia. Both providers and patients had negative results for rectal gonorrhea, pharyngeal gonorrhea, rectal chlamydia, and pharyngeal chlamydia in 193, 256, 183, and 277 tests, respectively.

The only time a provider’s test was positive and a patient’s test was negative was a single case of pharyngeal gonorrhea. However, patients’ tests were positive when providers’ tests were negative in six cases of rectal gonorrhea, nine cases of pharyngeal gonorrhea, three cases of rectal chlamydia, and two cases of pharyngeal chlamydia.

The prevalence of rectal gonorrhea, pharyngeal gonorrhea, rectal chlamydia, and pharyngeal chlamydia using only the provider’s positive tests was 5.7%, 5.7%, 12%, and 1.1%. The prevalence using both the patients’ and providers’ positive results was 8.5%, 8.9%, 13.3%, and 1.8%, respectively.

There were no significant differences in the detection of gonorrhea between the patients and providers, Dr. Sexton said. Patients appeared to identify significantly more cases of gonorrhea, which might be due to false positives, cross-contamination, or more rigorous testing on the part of the patient, she noted.

Test results were no different based on whether the patient or the health care provider collected samples first.

Self-administered STD tests could reduce the time burden on health care providers and expand the number of MSM who are tested, said Dr. Sexton. In addition, informal feedback from patients suggested that, for the most part, the tests were easy to perform and more acceptable than allowing a health care provider to collect the samples.

"I talked to a lot of the patients, and many of them said they would prefer to do the testing on their own," Dr. Sexton said.

The results suggest that self-testing is a feasible option. However, some modifications need to be made to the testing instructions, and more research is needed to determine the best way to incorporate self-testing into a clinical setting, she noted.

Dr. Sexton had no financial conflicts to disclose. Test kits used in the study were provided by Gen-Probe.

QUEBEC CITY – Men who have sex with men can self-test for chlamydia and gonorrhea as effectively as health care providers can, according to findings from a study involving 286 adult men.

Data from previous studies show that the risk of HIV infection increases in men who have sex with men (MSM) who have other sexually transmitted diseases, said Dr. Marybeth Sexton of Columbia University, New York. Therefore, regular STD testing for MSM is important, however "less than 14% of physicians routinely screen male patients for chlamydia and gonorrhea," Dr. Sexton said at a congress of the International Society for Sexually Transmitted Diseases Research. Lack of time, lack of staff, and lack of knowledge were the reasons most often given for not screening.

In this study, Dr. Sexton and colleagues in Washington, D.C. compared the results of nucleic acid amplification testing (NAAT) for chlamydia and gonorrhea when MSM administered the tests themselves and when a health care provider administered the tests.

Patients were recruited from the Whitman-Walker Clinic in Washington, and they were eligible for the study if they reported having intercourse with a man within the past 6 months and if they wanted to be screened for rectal and pharyngeal chlamydia and gonorrhea.

The screening tests were performed twice on each patient, and the patients were randomized to initially perform self-tests or to be tested by a health care provider. For the self-test, patients were given instructional cards, and a health care provider was present, but offered no additional assistance.

Overall, both providers and patients had positive test results for 12 cases of rectal gonorrhea, 15 cases of pharyngeal gonorrhea, 25 cases of rectal chlamydia, and 3 cases of pharyngeal chlamydia. Both providers and patients had negative results for rectal gonorrhea, pharyngeal gonorrhea, rectal chlamydia, and pharyngeal chlamydia in 193, 256, 183, and 277 tests, respectively.

The only time a provider’s test was positive and a patient’s test was negative was a single case of pharyngeal gonorrhea. However, patients’ tests were positive when providers’ tests were negative in six cases of rectal gonorrhea, nine cases of pharyngeal gonorrhea, three cases of rectal chlamydia, and two cases of pharyngeal chlamydia.

The prevalence of rectal gonorrhea, pharyngeal gonorrhea, rectal chlamydia, and pharyngeal chlamydia using only the provider’s positive tests was 5.7%, 5.7%, 12%, and 1.1%. The prevalence using both the patients’ and providers’ positive results was 8.5%, 8.9%, 13.3%, and 1.8%, respectively.

There were no significant differences in the detection of gonorrhea between the patients and providers, Dr. Sexton said. Patients appeared to identify significantly more cases of gonorrhea, which might be due to false positives, cross-contamination, or more rigorous testing on the part of the patient, she noted.

Test results were no different based on whether the patient or the health care provider collected samples first.

Self-administered STD tests could reduce the time burden on health care providers and expand the number of MSM who are tested, said Dr. Sexton. In addition, informal feedback from patients suggested that, for the most part, the tests were easy to perform and more acceptable than allowing a health care provider to collect the samples.

"I talked to a lot of the patients, and many of them said they would prefer to do the testing on their own," Dr. Sexton said.

The results suggest that self-testing is a feasible option. However, some modifications need to be made to the testing instructions, and more research is needed to determine the best way to incorporate self-testing into a clinical setting, she noted.

Dr. Sexton had no financial conflicts to disclose. Test kits used in the study were provided by Gen-Probe.

QUEBEC CITY – Men who have sex with men can self-test for chlamydia and gonorrhea as effectively as health care providers can, according to findings from a study involving 286 adult men.

Data from previous studies show that the risk of HIV infection increases in men who have sex with men (MSM) who have other sexually transmitted diseases, said Dr. Marybeth Sexton of Columbia University, New York. Therefore, regular STD testing for MSM is important, however "less than 14% of physicians routinely screen male patients for chlamydia and gonorrhea," Dr. Sexton said at a congress of the International Society for Sexually Transmitted Diseases Research. Lack of time, lack of staff, and lack of knowledge were the reasons most often given for not screening.

In this study, Dr. Sexton and colleagues in Washington, D.C. compared the results of nucleic acid amplification testing (NAAT) for chlamydia and gonorrhea when MSM administered the tests themselves and when a health care provider administered the tests.

Patients were recruited from the Whitman-Walker Clinic in Washington, and they were eligible for the study if they reported having intercourse with a man within the past 6 months and if they wanted to be screened for rectal and pharyngeal chlamydia and gonorrhea.

The screening tests were performed twice on each patient, and the patients were randomized to initially perform self-tests or to be tested by a health care provider. For the self-test, patients were given instructional cards, and a health care provider was present, but offered no additional assistance.

Overall, both providers and patients had positive test results for 12 cases of rectal gonorrhea, 15 cases of pharyngeal gonorrhea, 25 cases of rectal chlamydia, and 3 cases of pharyngeal chlamydia. Both providers and patients had negative results for rectal gonorrhea, pharyngeal gonorrhea, rectal chlamydia, and pharyngeal chlamydia in 193, 256, 183, and 277 tests, respectively.

The only time a provider’s test was positive and a patient’s test was negative was a single case of pharyngeal gonorrhea. However, patients’ tests were positive when providers’ tests were negative in six cases of rectal gonorrhea, nine cases of pharyngeal gonorrhea, three cases of rectal chlamydia, and two cases of pharyngeal chlamydia.

The prevalence of rectal gonorrhea, pharyngeal gonorrhea, rectal chlamydia, and pharyngeal chlamydia using only the provider’s positive tests was 5.7%, 5.7%, 12%, and 1.1%. The prevalence using both the patients’ and providers’ positive results was 8.5%, 8.9%, 13.3%, and 1.8%, respectively.

There were no significant differences in the detection of gonorrhea between the patients and providers, Dr. Sexton said. Patients appeared to identify significantly more cases of gonorrhea, which might be due to false positives, cross-contamination, or more rigorous testing on the part of the patient, she noted.

Test results were no different based on whether the patient or the health care provider collected samples first.

Self-administered STD tests could reduce the time burden on health care providers and expand the number of MSM who are tested, said Dr. Sexton. In addition, informal feedback from patients suggested that, for the most part, the tests were easy to perform and more acceptable than allowing a health care provider to collect the samples.

"I talked to a lot of the patients, and many of them said they would prefer to do the testing on their own," Dr. Sexton said.

The results suggest that self-testing is a feasible option. However, some modifications need to be made to the testing instructions, and more research is needed to determine the best way to incorporate self-testing into a clinical setting, she noted.

Dr. Sexton had no financial conflicts to disclose. Test kits used in the study were provided by Gen-Probe.

QUEBEC CITY – The incidence of herpes simplex virus type 2 in the United States has remained stable within gender and ethnic groups over the past two decades, with young black women remaining at the highest risk for infection, according to an analysis of data from the National Health and Nutrition Examination Surveys for 1988-1994 and 1999-2008.

Herpes simplex virus type 2 (HSV-2) infections have a 16% seroprevalence among 14- to 49-year-olds in the United States, said Dr. Sarah M. Gerver of Imperial College, London, who presented the findings at a congress of the International Society for Sexually Transmitted Diseases Research.

Dr. Gerver and her associates at Imperial College and the Centers for Disease Control and Prevention in Atlanta combined NHANES data with a predictive model to estimate HSV-2 incidence per 100 person-years at risk.

Overall, the age-adjusted incidence rates over the past 20 years were stable in all sex and ethnic groups with two exceptions, the researchers noted. Incidence rates in Mexican-American women and non-Hispanic white women had decreased after 2001 and 2002, respectively.

The age-adjusted incidence of HSV-2 in non-Hispanic white men, non-Hispanic black men, and Mexican-American men remained stable at approximately 0.4, 1.4, and 0.7 per 100 person-years at risk, respectively. Non-Hispanic black women had the greatest incidence of HSV-2, which held steady over the study period at approximately 2.2 per 100 person-years at risk.

The incidence rate among 25-year-old non-Hispanic black women was more than 13 times greater than in white men of the same age, the researchers noted.

From 1988 to 2008, HSV-2 incidence rates peaked between ages 25-35 years for all sex and ethnic groups with the exception of Mexican-American men, for whom the incidence remained stable by age.

In 2007-2008, the most recent year included in the study, an estimated 753,519 new HSV-2 infections occurred among 14- to 49-year-olds in the United States, including 392,208 in men and 361,311 in women. Approximately 53% of the new infections in men occurred in non-Hispanic whites, and half of these occurred in men aged 18-29 years.

More than half of the HSV-2 infections in women occurred in those aged 14-24 years (204,550); including 40,520 in girls aged 14-17 years and 164,030 in young women aged 18-24 years.

And among women, "nearly 60% of all new infections were in non-Hispanic blacks, a group that accounts for less then 15% of the female population [in the U.S.]," the researchers noted.

The findings were limited by the researchers’ assumption of perfect comparability of the HSV-2 seroprevalence estimates across age, race, and time. But the stability of the long-term trends in HSV-2 incidence suggests a need for more targeted intervention programs, especially for those at highest risk, the researchers said.

"This information on the detailed distribution of new infections can help improve the efficiency of interventions," they wrote.

The researchers reported having no financial conflicts to disclose.

QUEBEC CITY – The incidence of herpes simplex virus type 2 in the United States has remained stable within gender and ethnic groups over the past two decades, with young black women remaining at the highest risk for infection, according to an analysis of data from the National Health and Nutrition Examination Surveys for 1988-1994 and 1999-2008.

Herpes simplex virus type 2 (HSV-2) infections have a 16% seroprevalence among 14- to 49-year-olds in the United States, said Dr. Sarah M. Gerver of Imperial College, London, who presented the findings at a congress of the International Society for Sexually Transmitted Diseases Research.

Dr. Gerver and her associates at Imperial College and the Centers for Disease Control and Prevention in Atlanta combined NHANES data with a predictive model to estimate HSV-2 incidence per 100 person-years at risk.

Overall, the age-adjusted incidence rates over the past 20 years were stable in all sex and ethnic groups with two exceptions, the researchers noted. Incidence rates in Mexican-American women and non-Hispanic white women had decreased after 2001 and 2002, respectively.

The age-adjusted incidence of HSV-2 in non-Hispanic white men, non-Hispanic black men, and Mexican-American men remained stable at approximately 0.4, 1.4, and 0.7 per 100 person-years at risk, respectively. Non-Hispanic black women had the greatest incidence of HSV-2, which held steady over the study period at approximately 2.2 per 100 person-years at risk.

The incidence rate among 25-year-old non-Hispanic black women was more than 13 times greater than in white men of the same age, the researchers noted.

From 1988 to 2008, HSV-2 incidence rates peaked between ages 25-35 years for all sex and ethnic groups with the exception of Mexican-American men, for whom the incidence remained stable by age.

In 2007-2008, the most recent year included in the study, an estimated 753,519 new HSV-2 infections occurred among 14- to 49-year-olds in the United States, including 392,208 in men and 361,311 in women. Approximately 53% of the new infections in men occurred in non-Hispanic whites, and half of these occurred in men aged 18-29 years.

More than half of the HSV-2 infections in women occurred in those aged 14-24 years (204,550); including 40,520 in girls aged 14-17 years and 164,030 in young women aged 18-24 years.

And among women, "nearly 60% of all new infections were in non-Hispanic blacks, a group that accounts for less then 15% of the female population [in the U.S.]," the researchers noted.

The findings were limited by the researchers’ assumption of perfect comparability of the HSV-2 seroprevalence estimates across age, race, and time. But the stability of the long-term trends in HSV-2 incidence suggests a need for more targeted intervention programs, especially for those at highest risk, the researchers said.

"This information on the detailed distribution of new infections can help improve the efficiency of interventions," they wrote.

The researchers reported having no financial conflicts to disclose.

QUEBEC CITY – The incidence of herpes simplex virus type 2 in the United States has remained stable within gender and ethnic groups over the past two decades, with young black women remaining at the highest risk for infection, according to an analysis of data from the National Health and Nutrition Examination Surveys for 1988-1994 and 1999-2008.

Herpes simplex virus type 2 (HSV-2) infections have a 16% seroprevalence among 14- to 49-year-olds in the United States, said Dr. Sarah M. Gerver of Imperial College, London, who presented the findings at a congress of the International Society for Sexually Transmitted Diseases Research.

Dr. Gerver and her associates at Imperial College and the Centers for Disease Control and Prevention in Atlanta combined NHANES data with a predictive model to estimate HSV-2 incidence per 100 person-years at risk.

Overall, the age-adjusted incidence rates over the past 20 years were stable in all sex and ethnic groups with two exceptions, the researchers noted. Incidence rates in Mexican-American women and non-Hispanic white women had decreased after 2001 and 2002, respectively.

The age-adjusted incidence of HSV-2 in non-Hispanic white men, non-Hispanic black men, and Mexican-American men remained stable at approximately 0.4, 1.4, and 0.7 per 100 person-years at risk, respectively. Non-Hispanic black women had the greatest incidence of HSV-2, which held steady over the study period at approximately 2.2 per 100 person-years at risk.

The incidence rate among 25-year-old non-Hispanic black women was more than 13 times greater than in white men of the same age, the researchers noted.

From 1988 to 2008, HSV-2 incidence rates peaked between ages 25-35 years for all sex and ethnic groups with the exception of Mexican-American men, for whom the incidence remained stable by age.

In 2007-2008, the most recent year included in the study, an estimated 753,519 new HSV-2 infections occurred among 14- to 49-year-olds in the United States, including 392,208 in men and 361,311 in women. Approximately 53% of the new infections in men occurred in non-Hispanic whites, and half of these occurred in men aged 18-29 years.

More than half of the HSV-2 infections in women occurred in those aged 14-24 years (204,550); including 40,520 in girls aged 14-17 years and 164,030 in young women aged 18-24 years.

And among women, "nearly 60% of all new infections were in non-Hispanic blacks, a group that accounts for less then 15% of the female population [in the U.S.]," the researchers noted.

The findings were limited by the researchers’ assumption of perfect comparability of the HSV-2 seroprevalence estimates across age, race, and time. But the stability of the long-term trends in HSV-2 incidence suggests a need for more targeted intervention programs, especially for those at highest risk, the researchers said.

"This information on the detailed distribution of new infections can help improve the efficiency of interventions," they wrote.

The researchers reported having no financial conflicts to disclose.

This October, the Food and Drug Administration is expected to approve the 13-valent pneumococcal conjugate vaccine (PCV13) for use in adults aged 50 years and older, but before it becomes widely used for that age group, more research is needed on immune response in adults, the herd effect produced by vaccinating children, and the overall preventable disease burden among adults.

That was the conclusion of the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices, which discussed whether they should expand the recommendations for the vaccine at a recent meeting. Currently, PCV13 is recommended for all children aged 2-59 months and up to 71 months, if underlying conditions put the child at higher risk.

"Licensure will be based on immunogenicity data only, comparing the immune response of PCV13 to PPSV23," said Dr. Michael Marcy, chair of the pneumococcal vaccines working group. Published immunogenicity studies have shown noninferior immune responses in adults after one dose of PCV13, compared to PPSV23 for all common serotypes.

"The models show that PCV13 in adults could be highly cost effective," said Tamara Pilishvili, who is a CDC representative on the pneumococcal vaccines working group. However, the cost-effectiveness model assumes indirect effects of PCV13 on nonbacteremic pneumonia. If PCV13 proved ineffective against nonbacteremic pneumonia, there would be less support to recommend the vaccine for use in adults.

Factors favoring the use of PCV13 in adults include the potential to reduce a large burden of adult disease, improving on the limited acceptance of PPSV23 in the adult population, and capitalizing on the success of the PCV13 vaccine in children, Ms. Pilishvili said.

Factors weighing against the use of PCV13 in adults include the potential for the herd effects from vaccinating children to curtail the overall impact of vaccinating the adult population. Few data back the efficacy of the vaccine to prevent pneumonia in adults. There also are challenges and costs are involved in attempting to expand vaccine coverage in the adult population, she noted.

The working group will evaluate new data as they become available, including results from a randomized, controlled trial of the efficacy of PCV13 against community-acquired pneumonia in adults aged 65 years and older from the Study Evaluating a 13-Valent Pneumococcal Conjugate Vaccine in Adults (CAPITA). Additional immunogenicity data will also be analyzed from a phase III of adults aged 18-49 years, as well as adults at increased risk for pneumococcal disease.

The proposed indication for PCV13 is for the prevention of disease caused by Streptococcus pneumoniae serotypes 1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F, and 23F.

Ms. Pilishvili and Dr. Marcy reported that they had no financial conflicts of interest.

This October, the Food and Drug Administration is expected to approve the 13-valent pneumococcal conjugate vaccine (PCV13) for use in adults aged 50 years and older, but before it becomes widely used for that age group, more research is needed on immune response in adults, the herd effect produced by vaccinating children, and the overall preventable disease burden among adults.

That was the conclusion of the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices, which discussed whether they should expand the recommendations for the vaccine at a recent meeting. Currently, PCV13 is recommended for all children aged 2-59 months and up to 71 months, if underlying conditions put the child at higher risk.

"Licensure will be based on immunogenicity data only, comparing the immune response of PCV13 to PPSV23," said Dr. Michael Marcy, chair of the pneumococcal vaccines working group. Published immunogenicity studies have shown noninferior immune responses in adults after one dose of PCV13, compared to PPSV23 for all common serotypes.

"The models show that PCV13 in adults could be highly cost effective," said Tamara Pilishvili, who is a CDC representative on the pneumococcal vaccines working group. However, the cost-effectiveness model assumes indirect effects of PCV13 on nonbacteremic pneumonia. If PCV13 proved ineffective against nonbacteremic pneumonia, there would be less support to recommend the vaccine for use in adults.

Factors favoring the use of PCV13 in adults include the potential to reduce a large burden of adult disease, improving on the limited acceptance of PPSV23 in the adult population, and capitalizing on the success of the PCV13 vaccine in children, Ms. Pilishvili said.

Factors weighing against the use of PCV13 in adults include the potential for the herd effects from vaccinating children to curtail the overall impact of vaccinating the adult population. Few data back the efficacy of the vaccine to prevent pneumonia in adults. There also are challenges and costs are involved in attempting to expand vaccine coverage in the adult population, she noted.

The working group will evaluate new data as they become available, including results from a randomized, controlled trial of the efficacy of PCV13 against community-acquired pneumonia in adults aged 65 years and older from the Study Evaluating a 13-Valent Pneumococcal Conjugate Vaccine in Adults (CAPITA). Additional immunogenicity data will also be analyzed from a phase III of adults aged 18-49 years, as well as adults at increased risk for pneumococcal disease.

The proposed indication for PCV13 is for the prevention of disease caused by Streptococcus pneumoniae serotypes 1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F, and 23F.

Ms. Pilishvili and Dr. Marcy reported that they had no financial conflicts of interest.

This October, the Food and Drug Administration is expected to approve the 13-valent pneumococcal conjugate vaccine (PCV13) for use in adults aged 50 years and older, but before it becomes widely used for that age group, more research is needed on immune response in adults, the herd effect produced by vaccinating children, and the overall preventable disease burden among adults.

That was the conclusion of the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices, which discussed whether they should expand the recommendations for the vaccine at a recent meeting. Currently, PCV13 is recommended for all children aged 2-59 months and up to 71 months, if underlying conditions put the child at higher risk.

"Licensure will be based on immunogenicity data only, comparing the immune response of PCV13 to PPSV23," said Dr. Michael Marcy, chair of the pneumococcal vaccines working group. Published immunogenicity studies have shown noninferior immune responses in adults after one dose of PCV13, compared to PPSV23 for all common serotypes.

"The models show that PCV13 in adults could be highly cost effective," said Tamara Pilishvili, who is a CDC representative on the pneumococcal vaccines working group. However, the cost-effectiveness model assumes indirect effects of PCV13 on nonbacteremic pneumonia. If PCV13 proved ineffective against nonbacteremic pneumonia, there would be less support to recommend the vaccine for use in adults.

Factors favoring the use of PCV13 in adults include the potential to reduce a large burden of adult disease, improving on the limited acceptance of PPSV23 in the adult population, and capitalizing on the success of the PCV13 vaccine in children, Ms. Pilishvili said.

Factors weighing against the use of PCV13 in adults include the potential for the herd effects from vaccinating children to curtail the overall impact of vaccinating the adult population. Few data back the efficacy of the vaccine to prevent pneumonia in adults. There also are challenges and costs are involved in attempting to expand vaccine coverage in the adult population, she noted.

The working group will evaluate new data as they become available, including results from a randomized, controlled trial of the efficacy of PCV13 against community-acquired pneumonia in adults aged 65 years and older from the Study Evaluating a 13-Valent Pneumococcal Conjugate Vaccine in Adults (CAPITA). Additional immunogenicity data will also be analyzed from a phase III of adults aged 18-49 years, as well as adults at increased risk for pneumococcal disease.

The proposed indication for PCV13 is for the prevention of disease caused by Streptococcus pneumoniae serotypes 1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F, and 23F.

Ms. Pilishvili and Dr. Marcy reported that they had no financial conflicts of interest.

Approximately 80% of patients with early rheumatoid arthritis can discontinue infliximab for at least 1 year with no ill effects, according to data from 104 patients. The results were published in Annals of the Rheumatic Diseases.

"Even temporary cessation can benefit both the individual patient and, given the high costs of TNF blockers, society as a whole," said Dr. M. van den Broek of Leiden University Medical Center, the Netherlands, and colleagues.

To determine the duration of decreased disease activity after discontinuing infliximab, the researchers conducted a post hoc analysis of data from the Dutch Behandel Strategieen (BeSt) study, a multicenter, randomized, single-blind trial that compared four treatment strategies in RA patients who had not previously received disease-modifying antirheumatic drugs (DMARDs).

In the post hoc analysis, 104 adult RA patients from the BeSt study discontinued infliximab when their disease activity score (DAS) was 2.4 or less for 6 months. The follow-up period ranged from 14 to 103 months, with a median of 7 years. The average age of the patients was 56 years, and 65% were women (Ann. Rheum. Dis. 2011;70:1389-94).

After stopping infliximab, the DAS remained at 2.4 or less in 43 of 77 patients (56%) who were initially treated with infliximab and in 11 of 27 patients (41%) who were in a delayed infliximab treatment group.

In 50 patients (34 from the initial infliximab treatment group and 16 from the delayed infliximab treatment group), the DAS increased above 2.4 over a median of 17 months, and infliximab was reintroduced. But 27 of the 34 patients in the initial treatment group and 15 of the 16 patients in the delayed treatment group (84% overall) regained a DAS of 2.4 or less within 3 months of reintroducing infliximab, the researchers noted.

Radiographs of joints before and after discontinuation of infliximab were available for 90 patients. These images showed no increase in joint damage progression during the year after discontinuation of infliximab compared with the previous year.

At the time of infliximab cessation, the mean DAS was 1.3, and the median symptom duration was 23 months. The median infliximab treatment was 11 months.

Independent risk factors for infliximab reintroduction were identified as being treatment duration of 18 months or longer, the presence of a shared epitope, and smoking, judging from findings from a multivariate analysis.

"The rate of serious infections was higher after the reintroduction of infliximab compared with during the initial treatment period or the period of infliximab cessation," the researchers noted. But the difference could reflect patient selection, longer duration of symptoms, or more severe RA, they said.

The study was limited in part by patient selection and by the lack of shared epitope data for all patients. But the findings suggest that infliximab can be discontinued for at least 1 year in 80% of early RA patients, the researchers said. However, infliximab discontinuation must be considered on an individual basis, especially for patients with any of the independent risk factors, they added.

The study was funded in part by the Dutch College of Health Insurance Companies, Centocor, and Schering-Plough.

Approximately 80% of patients with early rheumatoid arthritis can discontinue infliximab for at least 1 year with no ill effects, according to data from 104 patients. The results were published in Annals of the Rheumatic Diseases.

"Even temporary cessation can benefit both the individual patient and, given the high costs of TNF blockers, society as a whole," said Dr. M. van den Broek of Leiden University Medical Center, the Netherlands, and colleagues.

To determine the duration of decreased disease activity after discontinuing infliximab, the researchers conducted a post hoc analysis of data from the Dutch Behandel Strategieen (BeSt) study, a multicenter, randomized, single-blind trial that compared four treatment strategies in RA patients who had not previously received disease-modifying antirheumatic drugs (DMARDs).

In the post hoc analysis, 104 adult RA patients from the BeSt study discontinued infliximab when their disease activity score (DAS) was 2.4 or less for 6 months. The follow-up period ranged from 14 to 103 months, with a median of 7 years. The average age of the patients was 56 years, and 65% were women (Ann. Rheum. Dis. 2011;70:1389-94).

After stopping infliximab, the DAS remained at 2.4 or less in 43 of 77 patients (56%) who were initially treated with infliximab and in 11 of 27 patients (41%) who were in a delayed infliximab treatment group.

In 50 patients (34 from the initial infliximab treatment group and 16 from the delayed infliximab treatment group), the DAS increased above 2.4 over a median of 17 months, and infliximab was reintroduced. But 27 of the 34 patients in the initial treatment group and 15 of the 16 patients in the delayed treatment group (84% overall) regained a DAS of 2.4 or less within 3 months of reintroducing infliximab, the researchers noted.

Radiographs of joints before and after discontinuation of infliximab were available for 90 patients. These images showed no increase in joint damage progression during the year after discontinuation of infliximab compared with the previous year.

At the time of infliximab cessation, the mean DAS was 1.3, and the median symptom duration was 23 months. The median infliximab treatment was 11 months.

Independent risk factors for infliximab reintroduction were identified as being treatment duration of 18 months or longer, the presence of a shared epitope, and smoking, judging from findings from a multivariate analysis.

"The rate of serious infections was higher after the reintroduction of infliximab compared with during the initial treatment period or the period of infliximab cessation," the researchers noted. But the difference could reflect patient selection, longer duration of symptoms, or more severe RA, they said.

The study was limited in part by patient selection and by the lack of shared epitope data for all patients. But the findings suggest that infliximab can be discontinued for at least 1 year in 80% of early RA patients, the researchers said. However, infliximab discontinuation must be considered on an individual basis, especially for patients with any of the independent risk factors, they added.

The study was funded in part by the Dutch College of Health Insurance Companies, Centocor, and Schering-Plough.

Approximately 80% of patients with early rheumatoid arthritis can discontinue infliximab for at least 1 year with no ill effects, according to data from 104 patients. The results were published in Annals of the Rheumatic Diseases.

"Even temporary cessation can benefit both the individual patient and, given the high costs of TNF blockers, society as a whole," said Dr. M. van den Broek of Leiden University Medical Center, the Netherlands, and colleagues.

To determine the duration of decreased disease activity after discontinuing infliximab, the researchers conducted a post hoc analysis of data from the Dutch Behandel Strategieen (BeSt) study, a multicenter, randomized, single-blind trial that compared four treatment strategies in RA patients who had not previously received disease-modifying antirheumatic drugs (DMARDs).

In the post hoc analysis, 104 adult RA patients from the BeSt study discontinued infliximab when their disease activity score (DAS) was 2.4 or less for 6 months. The follow-up period ranged from 14 to 103 months, with a median of 7 years. The average age of the patients was 56 years, and 65% were women (Ann. Rheum. Dis. 2011;70:1389-94).

After stopping infliximab, the DAS remained at 2.4 or less in 43 of 77 patients (56%) who were initially treated with infliximab and in 11 of 27 patients (41%) who were in a delayed infliximab treatment group.

In 50 patients (34 from the initial infliximab treatment group and 16 from the delayed infliximab treatment group), the DAS increased above 2.4 over a median of 17 months, and infliximab was reintroduced. But 27 of the 34 patients in the initial treatment group and 15 of the 16 patients in the delayed treatment group (84% overall) regained a DAS of 2.4 or less within 3 months of reintroducing infliximab, the researchers noted.

Radiographs of joints before and after discontinuation of infliximab were available for 90 patients. These images showed no increase in joint damage progression during the year after discontinuation of infliximab compared with the previous year.

At the time of infliximab cessation, the mean DAS was 1.3, and the median symptom duration was 23 months. The median infliximab treatment was 11 months.

Independent risk factors for infliximab reintroduction were identified as being treatment duration of 18 months or longer, the presence of a shared epitope, and smoking, judging from findings from a multivariate analysis.

"The rate of serious infections was higher after the reintroduction of infliximab compared with during the initial treatment period or the period of infliximab cessation," the researchers noted. But the difference could reflect patient selection, longer duration of symptoms, or more severe RA, they said.

The study was limited in part by patient selection and by the lack of shared epitope data for all patients. But the findings suggest that infliximab can be discontinued for at least 1 year in 80% of early RA patients, the researchers said. However, infliximab discontinuation must be considered on an individual basis, especially for patients with any of the independent risk factors, they added.

The study was funded in part by the Dutch College of Health Insurance Companies, Centocor, and Schering-Plough.

Preterm births, births to teenage mothers, and injury-related deaths to teenagers in the United States have declined, but the number of children with asthma is steadily rising, according to federal data released July 6.

"I am particularly encouraged by changes in two of the indicators in this year’s report," Dr. Alan E. Guttmacher, director of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, said in a telebriefing.

"The rate of preterm birth has declined for the third year in a row," Dr. Guttmacher said. The preterm birth rate in the United States reached a high of 12.8% in 2006; in 2009, it dropped to 12.2%. "The change is especially welcome," given the increased risk for early death and developmental problems in preterm infants, he said, adding that, while the reasons for the improvement are unclear, research is ongoing.

"We are also encouraged by the decline in the adolescent birth rate," said Dr. Guttmacher. In 2009, the rate was 20.1 per 1,000 girls aged 15-17 years, down from 22.1 per 1,000 in 2006.

"We feel this annual report is an important tool for monitoring the well-being of our nation’s children," said Edward Sondik, Ph.D., director of the National Center for Health Statistics at the Centers for Disease Control and Prevention.

Injury-related death, the leading cause of deaths among adolescents aged 15-19 years, dropped by 10% – from 44 per 100,000 in 2008 to 39 per 100,000 in 2009. "One of the major reasons for this decline was a decline in motor vehicle accidents," Dr. Sondik said.

Binge drinking, however, remains a concern. Although the number of 12th graders who reported binge drinking – defined as five or more alcoholic beverages in a row or during a single occasion within the past 2 weeks – declined from 25% in 2009 to 23% in 2010, there was no significant change in the percent of 8th and 10th graders who reported binge drinking, Dr. Sondik said.

In addition, although the percentage of children aged 0-17 years living in areas with above-allowable levels of at least one air pollutant declined from 69% in 2008 to 59% in 2009, the percentage of children with asthma was not significantly different, and data show a steady rise in asthma rates between 2001 and 2009, according to the report.

"In some ways, I think the take-home message is that childhood is a dynamic phenomenon," Dr. Guttmacher said.

Long-term trends over time suggest that a pediatrician’s focus has shifted from treating infectious diseases to treating injuries, he said.

Dr. Guttmacher noted, however, that immunization rates fell from the previous year. "That certainly bears attention, since immunization in children is hugely important to their well-being," he said.

Dr. Sondik said that children’s health care providers can find insight in many sections of the report, including behavioral data on smoking, drinking, and drug use, as well as family data. For example, when compared with all children, adopted children were more likely to be read to every day, but they were also more likely than children overall to have moderate to severe health problems (29% vs. 12%), he said.

"America’s Children: Key National Indicators of Well-Being, 2011" is a compendium of federal statistics on the health of children and youth, with data from multiple federal agencies. The report includes 41 indicators of child well-being in areas including physical environment and safety, behavior, education, and health. The statistics reflect year-to-year changes and longer-term trends.

Selected findings from the report were presented at the telebriefing. The full report will be available July 8 at http://childstats.gov.

Preterm births, births to teenage mothers, and injury-related deaths to teenagers in the United States have declined, but the number of children with asthma is steadily rising, according to federal data released July 6.

"I am particularly encouraged by changes in two of the indicators in this year’s report," Dr. Alan E. Guttmacher, director of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, said in a telebriefing.

"The rate of preterm birth has declined for the third year in a row," Dr. Guttmacher said. The preterm birth rate in the United States reached a high of 12.8% in 2006; in 2009, it dropped to 12.2%. "The change is especially welcome," given the increased risk for early death and developmental problems in preterm infants, he said, adding that, while the reasons for the improvement are unclear, research is ongoing.

"We are also encouraged by the decline in the adolescent birth rate," said Dr. Guttmacher. In 2009, the rate was 20.1 per 1,000 girls aged 15-17 years, down from 22.1 per 1,000 in 2006.

"We feel this annual report is an important tool for monitoring the well-being of our nation’s children," said Edward Sondik, Ph.D., director of the National Center for Health Statistics at the Centers for Disease Control and Prevention.

Injury-related death, the leading cause of deaths among adolescents aged 15-19 years, dropped by 10% – from 44 per 100,000 in 2008 to 39 per 100,000 in 2009. "One of the major reasons for this decline was a decline in motor vehicle accidents," Dr. Sondik said.

Binge drinking, however, remains a concern. Although the number of 12th graders who reported binge drinking – defined as five or more alcoholic beverages in a row or during a single occasion within the past 2 weeks – declined from 25% in 2009 to 23% in 2010, there was no significant change in the percent of 8th and 10th graders who reported binge drinking, Dr. Sondik said.

In addition, although the percentage of children aged 0-17 years living in areas with above-allowable levels of at least one air pollutant declined from 69% in 2008 to 59% in 2009, the percentage of children with asthma was not significantly different, and data show a steady rise in asthma rates between 2001 and 2009, according to the report.

"In some ways, I think the take-home message is that childhood is a dynamic phenomenon," Dr. Guttmacher said.

Long-term trends over time suggest that a pediatrician’s focus has shifted from treating infectious diseases to treating injuries, he said.

Dr. Guttmacher noted, however, that immunization rates fell from the previous year. "That certainly bears attention, since immunization in children is hugely important to their well-being," he said.

Dr. Sondik said that children’s health care providers can find insight in many sections of the report, including behavioral data on smoking, drinking, and drug use, as well as family data. For example, when compared with all children, adopted children were more likely to be read to every day, but they were also more likely than children overall to have moderate to severe health problems (29% vs. 12%), he said.

"America’s Children: Key National Indicators of Well-Being, 2011" is a compendium of federal statistics on the health of children and youth, with data from multiple federal agencies. The report includes 41 indicators of child well-being in areas including physical environment and safety, behavior, education, and health. The statistics reflect year-to-year changes and longer-term trends.

Selected findings from the report were presented at the telebriefing. The full report will be available July 8 at http://childstats.gov.

Preterm births, births to teenage mothers, and injury-related deaths to teenagers in the United States have declined, but the number of children with asthma is steadily rising, according to federal data released July 6.

"I am particularly encouraged by changes in two of the indicators in this year’s report," Dr. Alan E. Guttmacher, director of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, said in a telebriefing.

"The rate of preterm birth has declined for the third year in a row," Dr. Guttmacher said. The preterm birth rate in the United States reached a high of 12.8% in 2006; in 2009, it dropped to 12.2%. "The change is especially welcome," given the increased risk for early death and developmental problems in preterm infants, he said, adding that, while the reasons for the improvement are unclear, research is ongoing.

"We are also encouraged by the decline in the adolescent birth rate," said Dr. Guttmacher. In 2009, the rate was 20.1 per 1,000 girls aged 15-17 years, down from 22.1 per 1,000 in 2006.

"We feel this annual report is an important tool for monitoring the well-being of our nation’s children," said Edward Sondik, Ph.D., director of the National Center for Health Statistics at the Centers for Disease Control and Prevention.

Injury-related death, the leading cause of deaths among adolescents aged 15-19 years, dropped by 10% – from 44 per 100,000 in 2008 to 39 per 100,000 in 2009. "One of the major reasons for this decline was a decline in motor vehicle accidents," Dr. Sondik said.

Binge drinking, however, remains a concern. Although the number of 12th graders who reported binge drinking – defined as five or more alcoholic beverages in a row or during a single occasion within the past 2 weeks – declined from 25% in 2009 to 23% in 2010, there was no significant change in the percent of 8th and 10th graders who reported binge drinking, Dr. Sondik said.

In addition, although the percentage of children aged 0-17 years living in areas with above-allowable levels of at least one air pollutant declined from 69% in 2008 to 59% in 2009, the percentage of children with asthma was not significantly different, and data show a steady rise in asthma rates between 2001 and 2009, according to the report.

"In some ways, I think the take-home message is that childhood is a dynamic phenomenon," Dr. Guttmacher said.

Long-term trends over time suggest that a pediatrician’s focus has shifted from treating infectious diseases to treating injuries, he said.

Dr. Guttmacher noted, however, that immunization rates fell from the previous year. "That certainly bears attention, since immunization in children is hugely important to their well-being," he said.

Dr. Sondik said that children’s health care providers can find insight in many sections of the report, including behavioral data on smoking, drinking, and drug use, as well as family data. For example, when compared with all children, adopted children were more likely to be read to every day, but they were also more likely than children overall to have moderate to severe health problems (29% vs. 12%), he said.

"America’s Children: Key National Indicators of Well-Being, 2011" is a compendium of federal statistics on the health of children and youth, with data from multiple federal agencies. The report includes 41 indicators of child well-being in areas including physical environment and safety, behavior, education, and health. The statistics reflect year-to-year changes and longer-term trends.

Selected findings from the report were presented at the telebriefing. The full report will be available July 8 at http://childstats.gov.

Preterm births, births to teenage mothers, and injury-related deaths to teenagers in the United States have declined, but the number of children with asthma is steadily rising, according to federal data released July 6.

"I am particularly encouraged by changes in two of the indicators in this year’s report," Dr. Alan E. Guttmacher, director of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, said in a telebriefing.

"The rate of preterm birth has declined for the third year in a row," Dr. Guttmacher said. The preterm birth rate in the United States reached a high of 12.8% in 2006; in 2009, it dropped to 12.2%. "The change is especially welcome," given the increased risk for early death and developmental problems in preterm infants, he said, adding that, while the reasons for the improvement are unclear, research is ongoing.

"We are also encouraged by the decline in the adolescent birth rate," said Dr. Guttmacher. In 2009, the rate was 20.1 per 1,000 girls aged 15-17 years, down from 22.1 per 1,000 in 2006.

"We feel this annual report is an important tool for monitoring the well-being of our nation’s children," said Edward Sondik, Ph.D., director of the National Center for Health Statistics at the Centers for Disease Control and Prevention.

Injury-related death, the leading cause of deaths among adolescents aged 15-19 years, dropped by 10% – from 44 per 100,000 in 2008 to 39 per 100,000 in 2009. "One of the major reasons for this decline was a decline in motor vehicle accidents," Dr. Sondik said.

Binge drinking, however, remains a concern. Although the number of 12th graders who reported binge drinking – defined as five or more alcoholic beverages in a row or during a single occasion within the past 2 weeks – declined from 25% in 2009 to 23% in 2010, there was no significant change in the percent of 8th and 10th graders who reported binge drinking, Dr. Sondik said.

In addition, although the percentage of children aged 0-17 years living in areas with above-allowable levels of at least one air pollutant declined from 69% in 2008 to 59% in 2009, the percentage of children with asthma was not significantly different, and data show a steady rise in asthma rates between 2001 and 2009, according to the report.

"In some ways, I think the take-home message is that childhood is a dynamic phenomenon," Dr. Guttmacher said.

Long-term trends over time suggest that a pediatrician’s focus has shifted from treating infectious diseases to treating injuries, he said.

Dr. Guttmacher noted, however, that immunization rates fell from the previous year. "That certainly bears attention, since immunization in children is hugely important to their well-being," he said.

Dr. Sondik said that children’s health care providers can find insight in many sections of the report, including behavioral data on smoking, drinking, and drug use, as well as family data. For example, when compared with all children, adopted children were more likely to be read to every day, but they were also more likely than children overall to have moderate to severe health problems (29% vs. 12%), he said.

"America’s Children: Key National Indicators of Well-Being, 2011" is a compendium of federal statistics on the health of children and youth, with data from multiple federal agencies. The report includes 41 indicators of child well-being in areas including physical environment and safety, behavior, education, and health. The statistics reflect year-to-year changes and longer-term trends.

Selected findings from the report were presented at the telebriefing. The full report will be available July 8 at http://childstats.gov.

Preterm births, births to teenage mothers, and injury-related deaths to teenagers in the United States have declined, but the number of children with asthma is steadily rising, according to federal data released July 6.

"I am particularly encouraged by changes in two of the indicators in this year’s report," Dr. Alan E. Guttmacher, director of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, said in a telebriefing.

"The rate of preterm birth has declined for the third year in a row," Dr. Guttmacher said. The preterm birth rate in the United States reached a high of 12.8% in 2006; in 2009, it dropped to 12.2%. "The change is especially welcome," given the increased risk for early death and developmental problems in preterm infants, he said, adding that, while the reasons for the improvement are unclear, research is ongoing.

"We are also encouraged by the decline in the adolescent birth rate," said Dr. Guttmacher. In 2009, the rate was 20.1 per 1,000 girls aged 15-17 years, down from 22.1 per 1,000 in 2006.

"We feel this annual report is an important tool for monitoring the well-being of our nation’s children," said Edward Sondik, Ph.D., director of the National Center for Health Statistics at the Centers for Disease Control and Prevention.

Injury-related death, the leading cause of deaths among adolescents aged 15-19 years, dropped by 10% – from 44 per 100,000 in 2008 to 39 per 100,000 in 2009. "One of the major reasons for this decline was a decline in motor vehicle accidents," Dr. Sondik said.

Binge drinking, however, remains a concern. Although the number of 12th graders who reported binge drinking – defined as five or more alcoholic beverages in a row or during a single occasion within the past 2 weeks – declined from 25% in 2009 to 23% in 2010, there was no significant change in the percent of 8th and 10th graders who reported binge drinking, Dr. Sondik said.

In addition, although the percentage of children aged 0-17 years living in areas with above-allowable levels of at least one air pollutant declined from 69% in 2008 to 59% in 2009, the percentage of children with asthma was not significantly different, and data show a steady rise in asthma rates between 2001 and 2009, according to the report.

"In some ways, I think the take-home message is that childhood is a dynamic phenomenon," Dr. Guttmacher said.

Long-term trends over time suggest that a pediatrician’s focus has shifted from treating infectious diseases to treating injuries, he said.

Dr. Guttmacher noted, however, that immunization rates fell from the previous year. "That certainly bears attention, since immunization in children is hugely important to their well-being," he said.

Dr. Sondik said that children’s health care providers can find insight in many sections of the report, including behavioral data on smoking, drinking, and drug use, as well as family data. For example, when compared with all children, adopted children were more likely to be read to every day, but they were also more likely than children overall to have moderate to severe health problems (29% vs. 12%), he said.

"America’s Children: Key National Indicators of Well-Being, 2011" is a compendium of federal statistics on the health of children and youth, with data from multiple federal agencies. The report includes 41 indicators of child well-being in areas including physical environment and safety, behavior, education, and health. The statistics reflect year-to-year changes and longer-term trends.

Selected findings from the report were presented at the telebriefing. The full report will be available July 8 at http://childstats.gov.

Preterm births, births to teenage mothers, and injury-related deaths to teenagers in the United States have declined, but the number of children with asthma is steadily rising, according to federal data released July 6.

"I am particularly encouraged by changes in two of the indicators in this year’s report," Dr. Alan E. Guttmacher, director of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, said in a telebriefing.

"The rate of preterm birth has declined for the third year in a row," Dr. Guttmacher said. The preterm birth rate in the United States reached a high of 12.8% in 2006; in 2009, it dropped to 12.2%. "The change is especially welcome," given the increased risk for early death and developmental problems in preterm infants, he said, adding that, while the reasons for the improvement are unclear, research is ongoing.

"We are also encouraged by the decline in the adolescent birth rate," said Dr. Guttmacher. In 2009, the rate was 20.1 per 1,000 girls aged 15-17 years, down from 22.1 per 1,000 in 2006.

"We feel this annual report is an important tool for monitoring the well-being of our nation’s children," said Edward Sondik, Ph.D., director of the National Center for Health Statistics at the Centers for Disease Control and Prevention.

Injury-related death, the leading cause of deaths among adolescents aged 15-19 years, dropped by 10% – from 44 per 100,000 in 2008 to 39 per 100,000 in 2009. "One of the major reasons for this decline was a decline in motor vehicle accidents," Dr. Sondik said.

Binge drinking, however, remains a concern. Although the number of 12th graders who reported binge drinking – defined as five or more alcoholic beverages in a row or during a single occasion within the past 2 weeks – declined from 25% in 2009 to 23% in 2010, there was no significant change in the percent of 8th and 10th graders who reported binge drinking, Dr. Sondik said.

In addition, although the percentage of children aged 0-17 years living in areas with above-allowable levels of at least one air pollutant declined from 69% in 2008 to 59% in 2009, the percentage of children with asthma was not significantly different, and data show a steady rise in asthma rates between 2001 and 2009, according to the report.

"In some ways, I think the take-home message is that childhood is a dynamic phenomenon," Dr. Guttmacher said.

Long-term trends over time suggest that a pediatrician’s focus has shifted from treating infectious diseases to treating injuries, he said.

Dr. Guttmacher noted, however, that immunization rates fell from the previous year. "That certainly bears attention, since immunization in children is hugely important to their well-being," he said.

Dr. Sondik said that children’s health care providers can find insight in many sections of the report, including behavioral data on smoking, drinking, and drug use, as well as family data. For example, when compared with all children, adopted children were more likely to be read to every day, but they were also more likely than children overall to have moderate to severe health problems (29% vs. 12%), he said.

"America’s Children: Key National Indicators of Well-Being, 2011" is a compendium of federal statistics on the health of children and youth, with data from multiple federal agencies. The report includes 41 indicators of child well-being in areas including physical environment and safety, behavior, education, and health. The statistics reflect year-to-year changes and longer-term trends.

Selected findings from the report were presented at the telebriefing. The full report will be available July 8 at http://childstats.gov.

The incidence of colorectal cancer among adults aged 50-75 years in the United States decreased by a significant 3.4% per year between 2003 and 2007, according to data from the Centers for Disease Control and Prevention in Atlanta. The statistics were published online in the CDC’s Morbidity and Mortality Weekly Report Early Release on July 5.

"Colon cancer is largely preventable," CDC Director Dr. Thomas R. Frieden said in a July 5 telebriefing.

"Because of the increased screening as well as other improvements in our health system and health status, colon cancer rates have decreased by more than 10% over the past 5 years," he said.

"This decrease accounts for nearly 66,000 fewer people who got colon cancer and more than 30,000 people who didn’t die from colon cancer who would have died otherwise," he said. About half of those decreases were attributable to increased colon cancer screening, Dr. Frieden said (MMWR 2011; 60:1-6).

Overall, combined colorectal cancer screening rates (including lower endoscopy and fecal occult blood testing) increased from 52.3% in 2002 to 65.4% in 2010. Age-adjusted colorectal cancer incidence rates dropped from 52.3/100,000 in 2003 to 45.5/100,000 in 2007.

In addition, the overall age-adjusted mortality from colorectal cancer decreased from 19/100,000 in 2003 to 16.7/100,000 in 2007. At the state level, colorectal cancer incidence dropped significantly in 35 states, and colorectal cancer death rates dropped significantly in 49 states and the District of Columbia. In 2007, the District of Columbia reported the highest colorectal cancer death rate (21.1/100,000), while Montana and Colorado tied for the lowest rate (14.1/100,000).

The CDC’s findings were based on 2002-2010 survey data from the Behavioral Risk Factor Surveillance System and from the United States Cancer Statistics state-specific databases.

Dr. Frieden emphasized the important role of health care providers in talking to their adult patients about colorectal screening and identifying those at risk. The increased use of electronic medical records should make it easier for doctors to identify patients in need of screening, he said.

"There is certainly enormous potential to improve adherence to preventive recommendations," said Dr. Frieden. For example, medical registries allow providers to simply click a mouse and identify any of their patients at risk for colon cancer who have not been screened, he noted.

An electronic medical records system is "one of the examples of what practices can do to improve colon cancer screening," Dr. Frieden said. "It is a high-tech way, but there are also high-touch ways of improving colon cancer screening: by talking to patients and addressing any concerns they may have about the process, and by exploring different options for different screenings that could be done," he said. All types of improvements in medical systems are important to improve the health care system and get more health value for the dollars spent on health care, he added.

"Screening is highly effective, and by preventing colon cancer we can help people live longer, healthier, more productive lives while reducing health care costs associated with the treatment of colon cancer," Dr. Frieden said.

Dr. Frieden had no financial conflicts to disclose.

The incidence of colorectal cancer among adults aged 50-75 years in the United States decreased by a significant 3.4% per year between 2003 and 2007, according to data from the Centers for Disease Control and Prevention in Atlanta. The statistics were published online in the CDC’s Morbidity and Mortality Weekly Report Early Release on July 5.

"Colon cancer is largely preventable," CDC Director Dr. Thomas R. Frieden said in a July 5 telebriefing.

"Because of the increased screening as well as other improvements in our health system and health status, colon cancer rates have decreased by more than 10% over the past 5 years," he said.

"This decrease accounts for nearly 66,000 fewer people who got colon cancer and more than 30,000 people who didn’t die from colon cancer who would have died otherwise," he said. About half of those decreases were attributable to increased colon cancer screening, Dr. Frieden said (MMWR 2011; 60:1-6).

Overall, combined colorectal cancer screening rates (including lower endoscopy and fecal occult blood testing) increased from 52.3% in 2002 to 65.4% in 2010. Age-adjusted colorectal cancer incidence rates dropped from 52.3/100,000 in 2003 to 45.5/100,000 in 2007.

In addition, the overall age-adjusted mortality from colorectal cancer decreased from 19/100,000 in 2003 to 16.7/100,000 in 2007. At the state level, colorectal cancer incidence dropped significantly in 35 states, and colorectal cancer death rates dropped significantly in 49 states and the District of Columbia. In 2007, the District of Columbia reported the highest colorectal cancer death rate (21.1/100,000), while Montana and Colorado tied for the lowest rate (14.1/100,000).

The CDC’s findings were based on 2002-2010 survey data from the Behavioral Risk Factor Surveillance System and from the United States Cancer Statistics state-specific databases.

Dr. Frieden emphasized the important role of health care providers in talking to their adult patients about colorectal screening and identifying those at risk. The increased use of electronic medical records should make it easier for doctors to identify patients in need of screening, he said.

"There is certainly enormous potential to improve adherence to preventive recommendations," said Dr. Frieden. For example, medical registries allow providers to simply click a mouse and identify any of their patients at risk for colon cancer who have not been screened, he noted.

An electronic medical records system is "one of the examples of what practices can do to improve colon cancer screening," Dr. Frieden said. "It is a high-tech way, but there are also high-touch ways of improving colon cancer screening: by talking to patients and addressing any concerns they may have about the process, and by exploring different options for different screenings that could be done," he said. All types of improvements in medical systems are important to improve the health care system and get more health value for the dollars spent on health care, he added.

"Screening is highly effective, and by preventing colon cancer we can help people live longer, healthier, more productive lives while reducing health care costs associated with the treatment of colon cancer," Dr. Frieden said.

Dr. Frieden had no financial conflicts to disclose.

The incidence of colorectal cancer among adults aged 50-75 years in the United States decreased by a significant 3.4% per year between 2003 and 2007, according to data from the Centers for Disease Control and Prevention in Atlanta. The statistics were published online in the CDC’s Morbidity and Mortality Weekly Report Early Release on July 5.

"Colon cancer is largely preventable," CDC Director Dr. Thomas R. Frieden said in a July 5 telebriefing.

"Because of the increased screening as well as other improvements in our health system and health status, colon cancer rates have decreased by more than 10% over the past 5 years," he said.

"This decrease accounts for nearly 66,000 fewer people who got colon cancer and more than 30,000 people who didn’t die from colon cancer who would have died otherwise," he said. About half of those decreases were attributable to increased colon cancer screening, Dr. Frieden said (MMWR 2011; 60:1-6).

Overall, combined colorectal cancer screening rates (including lower endoscopy and fecal occult blood testing) increased from 52.3% in 2002 to 65.4% in 2010. Age-adjusted colorectal cancer incidence rates dropped from 52.3/100,000 in 2003 to 45.5/100,000 in 2007.

In addition, the overall age-adjusted mortality from colorectal cancer decreased from 19/100,000 in 2003 to 16.7/100,000 in 2007. At the state level, colorectal cancer incidence dropped significantly in 35 states, and colorectal cancer death rates dropped significantly in 49 states and the District of Columbia. In 2007, the District of Columbia reported the highest colorectal cancer death rate (21.1/100,000), while Montana and Colorado tied for the lowest rate (14.1/100,000).

The CDC’s findings were based on 2002-2010 survey data from the Behavioral Risk Factor Surveillance System and from the United States Cancer Statistics state-specific databases.

Dr. Frieden emphasized the important role of health care providers in talking to their adult patients about colorectal screening and identifying those at risk. The increased use of electronic medical records should make it easier for doctors to identify patients in need of screening, he said.

"There is certainly enormous potential to improve adherence to preventive recommendations," said Dr. Frieden. For example, medical registries allow providers to simply click a mouse and identify any of their patients at risk for colon cancer who have not been screened, he noted.

An electronic medical records system is "one of the examples of what practices can do to improve colon cancer screening," Dr. Frieden said. "It is a high-tech way, but there are also high-touch ways of improving colon cancer screening: by talking to patients and addressing any concerns they may have about the process, and by exploring different options for different screenings that could be done," he said. All types of improvements in medical systems are important to improve the health care system and get more health value for the dollars spent on health care, he added.

"Screening is highly effective, and by preventing colon cancer we can help people live longer, healthier, more productive lives while reducing health care costs associated with the treatment of colon cancer," Dr. Frieden said.

Dr. Frieden had no financial conflicts to disclose.

The incidence of colorectal cancer among adults aged 50-75 years in the United States decreased by a significant 3.4% per year between 2003 and 2007, according to data from the Centers for Disease Control and Prevention in Atlanta. The statistics were published online in the CDC’s Morbidity and Mortality Weekly Report Early Release on July 5.

"Colon cancer is largely preventable," CDC Director Dr. Thomas R. Frieden said in a July 5 telebriefing.

"Because of the increased screening as well as other improvements in our health system and health status, colon cancer rates have decreased by more than 10% over the past 5 years," he said.

"This decrease accounts for nearly 66,000 fewer people who got colon cancer and more than 30,000 people who didn’t die from colon cancer who would have died otherwise," he said. About half of those decreases were attributable to increased colon cancer screening, Dr. Frieden said (MMWR 2011; 60:1-6).

Overall, combined colorectal cancer screening rates (including lower endoscopy and fecal occult blood testing) increased from 52.3% in 2002 to 65.4% in 2010. Age-adjusted colorectal cancer incidence rates dropped from 52.3/100,000 in 2003 to 45.5/100,000 in 2007.

In addition, the overall age-adjusted mortality from colorectal cancer decreased from 19/100,000 in 2003 to 16.7/100,000 in 2007. At the state level, colorectal cancer incidence dropped significantly in 35 states, and colorectal cancer death rates dropped significantly in 49 states and the District of Columbia. In 2007, the District of Columbia reported the highest colorectal cancer death rate (21.1/100,000), while Montana and Colorado tied for the lowest rate (14.1/100,000).

The CDC’s findings were based on 2002-2010 survey data from the Behavioral Risk Factor Surveillance System and from the United States Cancer Statistics state-specific databases.

Dr. Frieden emphasized the important role of health care providers in talking to their adult patients about colorectal screening and identifying those at risk. The increased use of electronic medical records should make it easier for doctors to identify patients in need of screening, he said.

"There is certainly enormous potential to improve adherence to preventive recommendations," said Dr. Frieden. For example, medical registries allow providers to simply click a mouse and identify any of their patients at risk for colon cancer who have not been screened, he noted.

An electronic medical records system is "one of the examples of what practices can do to improve colon cancer screening," Dr. Frieden said. "It is a high-tech way, but there are also high-touch ways of improving colon cancer screening: by talking to patients and addressing any concerns they may have about the process, and by exploring different options for different screenings that could be done," he said. All types of improvements in medical systems are important to improve the health care system and get more health value for the dollars spent on health care, he added.

"Screening is highly effective, and by preventing colon cancer we can help people live longer, healthier, more productive lives while reducing health care costs associated with the treatment of colon cancer," Dr. Frieden said.

Dr. Frieden had no financial conflicts to disclose.

The incidence of colorectal cancer among adults aged 50-75 years in the United States decreased by a significant 3.4% per year between 2003 and 2007, according to data from the Centers for Disease Control and Prevention in Atlanta. The statistics were published online in the CDC’s Morbidity and Mortality Weekly Report Early Release on July 5.

"Colon cancer is largely preventable," CDC Director Dr. Thomas R. Frieden said in a July 5 telebriefing.

"Because of the increased screening as well as other improvements in our health system and health status, colon cancer rates have decreased by more than 10% over the past 5 years," he said.

"This decrease accounts for nearly 66,000 fewer people who got colon cancer and more than 30,000 people who didn’t die from colon cancer who would have died otherwise," he said. About half of those decreases were attributable to increased colon cancer screening, Dr. Frieden said (MMWR 2011; 60:1-6).

Overall, combined colorectal cancer screening rates (including lower endoscopy and fecal occult blood testing) increased from 52.3% in 2002 to 65.4% in 2010. Age-adjusted colorectal cancer incidence rates dropped from 52.3/100,000 in 2003 to 45.5/100,000 in 2007.

In addition, the overall age-adjusted mortality from colorectal cancer decreased from 19/100,000 in 2003 to 16.7/100,000 in 2007. At the state level, colorectal cancer incidence dropped significantly in 35 states, and colorectal cancer death rates dropped significantly in 49 states and the District of Columbia. In 2007, the District of Columbia reported the highest colorectal cancer death rate (21.1/100,000), while Montana and Colorado tied for the lowest rate (14.1/100,000).

The CDC’s findings were based on 2002-2010 survey data from the Behavioral Risk Factor Surveillance System and from the United States Cancer Statistics state-specific databases.

Dr. Frieden emphasized the important role of health care providers in talking to their adult patients about colorectal screening and identifying those at risk. The increased use of electronic medical records should make it easier for doctors to identify patients in need of screening, he said.

"There is certainly enormous potential to improve adherence to preventive recommendations," said Dr. Frieden. For example, medical registries allow providers to simply click a mouse and identify any of their patients at risk for colon cancer who have not been screened, he noted.

An electronic medical records system is "one of the examples of what practices can do to improve colon cancer screening," Dr. Frieden said. "It is a high-tech way, but there are also high-touch ways of improving colon cancer screening: by talking to patients and addressing any concerns they may have about the process, and by exploring different options for different screenings that could be done," he said. All types of improvements in medical systems are important to improve the health care system and get more health value for the dollars spent on health care, he added.

"Screening is highly effective, and by preventing colon cancer we can help people live longer, healthier, more productive lives while reducing health care costs associated with the treatment of colon cancer," Dr. Frieden said.

Dr. Frieden had no financial conflicts to disclose.

The incidence of colorectal cancer among adults aged 50-75 years in the United States decreased by a significant 3.4% per year between 2003 and 2007, according to data from the Centers for Disease Control and Prevention in Atlanta. The statistics were published online in the CDC’s Morbidity and Mortality Weekly Report Early Release on July 5.

"Colon cancer is largely preventable," CDC Director Dr. Thomas R. Frieden said in a July 5 telebriefing.

"Because of the increased screening as well as other improvements in our health system and health status, colon cancer rates have decreased by more than 10% over the past 5 years," he said.

"This decrease accounts for nearly 66,000 fewer people who got colon cancer and more than 30,000 people who didn’t die from colon cancer who would have died otherwise," he said. About half of those decreases were attributable to increased colon cancer screening, Dr. Frieden said (MMWR 2011; 60:1-6).

Overall, combined colorectal cancer screening rates (including lower endoscopy and fecal occult blood testing) increased from 52.3% in 2002 to 65.4% in 2010. Age-adjusted colorectal cancer incidence rates dropped from 52.3/100,000 in 2003 to 45.5/100,000 in 2007.

In addition, the overall age-adjusted mortality from colorectal cancer decreased from 19/100,000 in 2003 to 16.7/100,000 in 2007. At the state level, colorectal cancer incidence dropped significantly in 35 states, and colorectal cancer death rates dropped significantly in 49 states and the District of Columbia. In 2007, the District of Columbia reported the highest colorectal cancer death rate (21.1/100,000), while Montana and Colorado tied for the lowest rate (14.1/100,000).

The CDC’s findings were based on 2002-2010 survey data from the Behavioral Risk Factor Surveillance System and from the United States Cancer Statistics state-specific databases.

Dr. Frieden emphasized the important role of health care providers in talking to their adult patients about colorectal screening and identifying those at risk. The increased use of electronic medical records should make it easier for doctors to identify patients in need of screening, he said.

"There is certainly enormous potential to improve adherence to preventive recommendations," said Dr. Frieden. For example, medical registries allow providers to simply click a mouse and identify any of their patients at risk for colon cancer who have not been screened, he noted.

An electronic medical records system is "one of the examples of what practices can do to improve colon cancer screening," Dr. Frieden said. "It is a high-tech way, but there are also high-touch ways of improving colon cancer screening: by talking to patients and addressing any concerns they may have about the process, and by exploring different options for different screenings that could be done," he said. All types of improvements in medical systems are important to improve the health care system and get more health value for the dollars spent on health care, he added.

"Screening is highly effective, and by preventing colon cancer we can help people live longer, healthier, more productive lives while reducing health care costs associated with the treatment of colon cancer," Dr. Frieden said.

Dr. Frieden had no financial conflicts to disclose.

The incidence of colorectal cancer among adults aged 50-75 years in the United States decreased by a significant 3.4% per year between 2003 and 2007, according to data from the Centers for Disease Control and Prevention in Atlanta. The statistics were published online in the CDC’s Morbidity and Mortality Weekly Report Early Release on July 5.

"Colon cancer is largely preventable," CDC Director Dr. Thomas R. Frieden said in a July 5 telebriefing.

"Because of the increased screening as well as other improvements in our health system and health status, colon cancer rates have decreased by more than 10% over the past 5 years," he said.

"This decrease accounts for nearly 66,000 fewer people who got colon cancer and more than 30,000 people who didn’t die from colon cancer who would have died otherwise," he said. About half of those decreases were attributable to increased colon cancer screening, Dr. Frieden said (MMWR 2011; 60:1-6).

Overall, combined colorectal cancer screening rates (including lower endoscopy and fecal occult blood testing) increased from 52.3% in 2002 to 65.4% in 2010. Age-adjusted colorectal cancer incidence rates dropped from 52.3/100,000 in 2003 to 45.5/100,000 in 2007.

In addition, the overall age-adjusted mortality from colorectal cancer decreased from 19/100,000 in 2003 to 16.7/100,000 in 2007. At the state level, colorectal cancer incidence dropped significantly in 35 states, and colorectal cancer death rates dropped significantly in 49 states and the District of Columbia. In 2007, the District of Columbia reported the highest colorectal cancer death rate (21.1/100,000), while Montana and Colorado tied for the lowest rate (14.1/100,000).

The CDC’s findings were based on 2002-2010 survey data from the Behavioral Risk Factor Surveillance System and from the United States Cancer Statistics state-specific databases.

Dr. Frieden emphasized the important role of health care providers in talking to their adult patients about colorectal screening and identifying those at risk. The increased use of electronic medical records should make it easier for doctors to identify patients in need of screening, he said.

"There is certainly enormous potential to improve adherence to preventive recommendations," said Dr. Frieden. For example, medical registries allow providers to simply click a mouse and identify any of their patients at risk for colon cancer who have not been screened, he noted.

An electronic medical records system is "one of the examples of what practices can do to improve colon cancer screening," Dr. Frieden said. "It is a high-tech way, but there are also high-touch ways of improving colon cancer screening: by talking to patients and addressing any concerns they may have about the process, and by exploring different options for different screenings that could be done," he said. All types of improvements in medical systems are important to improve the health care system and get more health value for the dollars spent on health care, he added.

"Screening is highly effective, and by preventing colon cancer we can help people live longer, healthier, more productive lives while reducing health care costs associated with the treatment of colon cancer," Dr. Frieden said.

Dr. Frieden had no financial conflicts to disclose.

The incidence of colorectal cancer among adults aged 50-75 years in the United States decreased by a significant 3.4% per year between 2003 and 2007, according to data from the Centers for Disease Control and Prevention in Atlanta. The statistics were published online in the CDC’s Morbidity and Mortality Weekly Report Early Release on July 5.

"Colon cancer is largely preventable," CDC Director Dr. Thomas R. Frieden said in a July 5 telebriefing.

"Because of the increased screening as well as other improvements in our health system and health status, colon cancer rates have decreased by more than 10% over the past 5 years," he said.

"This decrease accounts for nearly 66,000 fewer people who got colon cancer and more than 30,000 people who didn’t die from colon cancer who would have died otherwise," he said. About half of those decreases were attributable to increased colon cancer screening, Dr. Frieden said (MMWR 2011; 60:1-6).

Overall, combined colorectal cancer screening rates (including lower endoscopy and fecal occult blood testing) increased from 52.3% in 2002 to 65.4% in 2010. Age-adjusted colorectal cancer incidence rates dropped from 52.3/100,000 in 2003 to 45.5/100,000 in 2007.

In addition, the overall age-adjusted mortality from colorectal cancer decreased from 19/100,000 in 2003 to 16.7/100,000 in 2007. At the state level, colorectal cancer incidence dropped significantly in 35 states, and colorectal cancer death rates dropped significantly in 49 states and the District of Columbia. In 2007, the District of Columbia reported the highest colorectal cancer death rate (21.1/100,000), while Montana and Colorado tied for the lowest rate (14.1/100,000).

The CDC’s findings were based on 2002-2010 survey data from the Behavioral Risk Factor Surveillance System and from the United States Cancer Statistics state-specific databases.

Dr. Frieden emphasized the important role of health care providers in talking to their adult patients about colorectal screening and identifying those at risk. The increased use of electronic medical records should make it easier for doctors to identify patients in need of screening, he said.

"There is certainly enormous potential to improve adherence to preventive recommendations," said Dr. Frieden. For example, medical registries allow providers to simply click a mouse and identify any of their patients at risk for colon cancer who have not been screened, he noted.

An electronic medical records system is "one of the examples of what practices can do to improve colon cancer screening," Dr. Frieden said. "It is a high-tech way, but there are also high-touch ways of improving colon cancer screening: by talking to patients and addressing any concerns they may have about the process, and by exploring different options for different screenings that could be done," he said. All types of improvements in medical systems are important to improve the health care system and get more health value for the dollars spent on health care, he added.

"Screening is highly effective, and by preventing colon cancer we can help people live longer, healthier, more productive lives while reducing health care costs associated with the treatment of colon cancer," Dr. Frieden said.

Dr. Frieden had no financial conflicts to disclose.

The incidence of colorectal cancer among adults aged 50-75 years in the United States decreased by a significant 3.4% per year between 2003 and 2007, according to data from the Centers for Disease Control and Prevention in Atlanta. The statistics were published online in the CDC’s Morbidity and Mortality Weekly Report Early Release on July 5.

"Colon cancer is largely preventable," CDC Director Dr. Thomas R. Frieden said in a July 5 telebriefing.

"Because of the increased screening as well as other improvements in our health system and health status, colon cancer rates have decreased by more than 10% over the past 5 years," he said.

"This decrease accounts for nearly 66,000 fewer people who got colon cancer and more than 30,000 people who didn’t die from colon cancer who would have died otherwise," he said. About half of those decreases were attributable to increased colon cancer screening, Dr. Frieden said (MMWR 2011; 60:1-6).

Overall, combined colorectal cancer screening rates (including lower endoscopy and fecal occult blood testing) increased from 52.3% in 2002 to 65.4% in 2010. Age-adjusted colorectal cancer incidence rates dropped from 52.3/100,000 in 2003 to 45.5/100,000 in 2007.

In addition, the overall age-adjusted mortality from colorectal cancer decreased from 19/100,000 in 2003 to 16.7/100,000 in 2007. At the state level, colorectal cancer incidence dropped significantly in 35 states, and colorectal cancer death rates dropped significantly in 49 states and the District of Columbia. In 2007, the District of Columbia reported the highest colorectal cancer death rate (21.1/100,000), while Montana and Colorado tied for the lowest rate (14.1/100,000).

The CDC’s findings were based on 2002-2010 survey data from the Behavioral Risk Factor Surveillance System and from the United States Cancer Statistics state-specific databases.

Dr. Frieden emphasized the important role of health care providers in talking to their adult patients about colorectal screening and identifying those at risk. The increased use of electronic medical records should make it easier for doctors to identify patients in need of screening, he said.

"There is certainly enormous potential to improve adherence to preventive recommendations," said Dr. Frieden. For example, medical registries allow providers to simply click a mouse and identify any of their patients at risk for colon cancer who have not been screened, he noted.

An electronic medical records system is "one of the examples of what practices can do to improve colon cancer screening," Dr. Frieden said. "It is a high-tech way, but there are also high-touch ways of improving colon cancer screening: by talking to patients and addressing any concerns they may have about the process, and by exploring different options for different screenings that could be done," he said. All types of improvements in medical systems are important to improve the health care system and get more health value for the dollars spent on health care, he added.

"Screening is highly effective, and by preventing colon cancer we can help people live longer, healthier, more productive lives while reducing health care costs associated with the treatment of colon cancer," Dr. Frieden said.

Dr. Frieden had no financial conflicts to disclose.

ATLANTA – No changes are being made to the current recommendation of herpes zoster vaccination for adults aged 60 years and older, the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices reported at its June meeting.

The Food and Drug Administration licensed the herpes zoster vaccine (Zostavax) for use in adults aged 50-59 years in March 2011, said Dr. Paul Cieslak, chair of the zoster working group. However, the working group does not currently propose changes to the current recommendations.

Data from studies conducted by Merck, the maker of Zostavax, have shown vaccine efficacy in the 50-59 age group, but there is insufficient evidence regarding the duration of vaccine protection when it is given well before the peak age for zoster incidence, Dr. Cieslak noted.

Also, "it might be inappropriate to expand recommendations while the vaccine remains in short supply," he said, adding that the incidence could increase "if limited supply is used at time of low incidence." He also pointed out, however, that "the decision of the working group at this time is not intended to prejudice future deliberations."

ACIP currently recommends the herpes zoster vaccine (HZV) for all adults aged 60 years and older with no contraindications and for adults older than 80 years with chronic illnesses.

James Robinson, vice president of vaccine product and technology operations at Merck, spoke to the committee about the company’s plans to address production issues that limited the vaccine supply in recent years. According to Mr. Robinson, Merck distributed 2 million doses of zoster vaccine in the first 7 months of 2011 and expects to distribute another 2 million doses between July and December 2011, which approximately doubles the production from previous years.

New Study Results: Duration of Protection

ACIP’s research, however, suggests that more data are needed before a vote is reconsidered. The duration of the vaccine’s protection in younger adults is a key unknown factor, as is the cost effectiveness, said Dr. Rafael Harpaz of the CDC.

Dr. Harpaz presented data that showed protection of 3-4 years after zoster vaccination and possibly a few years longer. "What we don’t know: Will HZV protect 15 years or 30 years when it really counts?" he asked. Government data estimate that the average 50-year-old man in the United States can expect to live another 29 years, and the average 50-year-old woman can expect to live another 32 years, so there would be a substantial excess of zoster in older adults if a limited supply were diverted to younger adults, he noted.

Studies of the cost effectiveness of the zoster vaccine show a J-shaped curve. "Among adults aged 60 years and older, cost effectiveness of HZV is less favorable at the youngest and oldest ages of that range," Dr. Harpaz said. Cost effectiveness is reduced at younger ages because the protection is likely to wane by the time the recipient reaches the age when the disease burden of herpes zoster is highest. Cost effectiveness is also reduced in the elderly because of death and the decline in vaccine effectiveness over time.

Dr. Harpaz also addressed past supply shortages. Expanding recommendations before sustainable supplies are assured "can jeopardize the credibility of all players in the vaccine enterprise," he said. "ACIP has never adopted an expansion of a vaccination program in the midst of a supply shortage."

Other factors that prompted ACIP to refrain from recommending the zoster vaccine for adults aged 50-59 years include price, storage and handling issues, and complicated relationships of drug plans with pharmacies, he said.

The next steps include a Notice to Readers from the CDC that will appear on the CDC herpes zoster website to alert health care providers and the public to the change in licensure for the zoster vaccine and to emphasize that the ACIP recommendations have not changed.

The zoster working group recognized that some providers might wish to use the zoster vaccine for some patients aged 50-59 years, said Dr. Harpaz. The working group suggested that the CDC provide limited technical guidance for nonrecommended use in these patients, based on the current ACIP recommendations for adults aged 60 years and older.

Neither Dr. Cieslak nor Dr. Harpaz had any relevant financial conflicts to disclose.

ATLANTA – No changes are being made to the current recommendation of herpes zoster vaccination for adults aged 60 years and older, the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices reported at its June meeting.

The Food and Drug Administration licensed the herpes zoster vaccine (Zostavax) for use in adults aged 50-59 years in March 2011, said Dr. Paul Cieslak, chair of the zoster working group. However, the working group does not currently propose changes to the current recommendations.

Data from studies conducted by Merck, the maker of Zostavax, have shown vaccine efficacy in the 50-59 age group, but there is insufficient evidence regarding the duration of vaccine protection when it is given well before the peak age for zoster incidence, Dr. Cieslak noted.

Also, "it might be inappropriate to expand recommendations while the vaccine remains in short supply," he said, adding that the incidence could increase "if limited supply is used at time of low incidence." He also pointed out, however, that "the decision of the working group at this time is not intended to prejudice future deliberations."

ACIP currently recommends the herpes zoster vaccine (HZV) for all adults aged 60 years and older with no contraindications and for adults older than 80 years with chronic illnesses.

James Robinson, vice president of vaccine product and technology operations at Merck, spoke to the committee about the company’s plans to address production issues that limited the vaccine supply in recent years. According to Mr. Robinson, Merck distributed 2 million doses of zoster vaccine in the first 7 months of 2011 and expects to distribute another 2 million doses between July and December 2011, which approximately doubles the production from previous years.

New Study Results: Duration of Protection

ACIP’s research, however, suggests that more data are needed before a vote is reconsidered. The duration of the vaccine’s protection in younger adults is a key unknown factor, as is the cost effectiveness, said Dr. Rafael Harpaz of the CDC.

Dr. Harpaz presented data that showed protection of 3-4 years after zoster vaccination and possibly a few years longer. "What we don’t know: Will HZV protect 15 years or 30 years when it really counts?" he asked. Government data estimate that the average 50-year-old man in the United States can expect to live another 29 years, and the average 50-year-old woman can expect to live another 32 years, so there would be a substantial excess of zoster in older adults if a limited supply were diverted to younger adults, he noted.

Studies of the cost effectiveness of the zoster vaccine show a J-shaped curve. "Among adults aged 60 years and older, cost effectiveness of HZV is less favorable at the youngest and oldest ages of that range," Dr. Harpaz said. Cost effectiveness is reduced at younger ages because the protection is likely to wane by the time the recipient reaches the age when the disease burden of herpes zoster is highest. Cost effectiveness is also reduced in the elderly because of death and the decline in vaccine effectiveness over time.

Dr. Harpaz also addressed past supply shortages. Expanding recommendations before sustainable supplies are assured "can jeopardize the credibility of all players in the vaccine enterprise," he said. "ACIP has never adopted an expansion of a vaccination program in the midst of a supply shortage."

Other factors that prompted ACIP to refrain from recommending the zoster vaccine for adults aged 50-59 years include price, storage and handling issues, and complicated relationships of drug plans with pharmacies, he said.

The next steps include a Notice to Readers from the CDC that will appear on the CDC herpes zoster website to alert health care providers and the public to the change in licensure for the zoster vaccine and to emphasize that the ACIP recommendations have not changed.

The zoster working group recognized that some providers might wish to use the zoster vaccine for some patients aged 50-59 years, said Dr. Harpaz. The working group suggested that the CDC provide limited technical guidance for nonrecommended use in these patients, based on the current ACIP recommendations for adults aged 60 years and older.

Neither Dr. Cieslak nor Dr. Harpaz had any relevant financial conflicts to disclose.

ATLANTA – No changes are being made to the current recommendation of herpes zoster vaccination for adults aged 60 years and older, the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices reported at its June meeting.

The Food and Drug Administration licensed the herpes zoster vaccine (Zostavax) for use in adults aged 50-59 years in March 2011, said Dr. Paul Cieslak, chair of the zoster working group. However, the working group does not currently propose changes to the current recommendations.

Data from studies conducted by Merck, the maker of Zostavax, have shown vaccine efficacy in the 50-59 age group, but there is insufficient evidence regarding the duration of vaccine protection when it is given well before the peak age for zoster incidence, Dr. Cieslak noted.

Also, "it might be inappropriate to expand recommendations while the vaccine remains in short supply," he said, adding that the incidence could increase "if limited supply is used at time of low incidence." He also pointed out, however, that "the decision of the working group at this time is not intended to prejudice future deliberations."

ACIP currently recommends the herpes zoster vaccine (HZV) for all adults aged 60 years and older with no contraindications and for adults older than 80 years with chronic illnesses.

James Robinson, vice president of vaccine product and technology operations at Merck, spoke to the committee about the company’s plans to address production issues that limited the vaccine supply in recent years. According to Mr. Robinson, Merck distributed 2 million doses of zoster vaccine in the first 7 months of 2011 and expects to distribute another 2 million doses between July and December 2011, which approximately doubles the production from previous years.

New Study Results: Duration of Protection

ACIP’s research, however, suggests that more data are needed before a vote is reconsidered. The duration of the vaccine’s protection in younger adults is a key unknown factor, as is the cost effectiveness, said Dr. Rafael Harpaz of the CDC.

Dr. Harpaz presented data that showed protection of 3-4 years after zoster vaccination and possibly a few years longer. "What we don’t know: Will HZV protect 15 years or 30 years when it really counts?" he asked. Government data estimate that the average 50-year-old man in the United States can expect to live another 29 years, and the average 50-year-old woman can expect to live another 32 years, so there would be a substantial excess of zoster in older adults if a limited supply were diverted to younger adults, he noted.

Studies of the cost effectiveness of the zoster vaccine show a J-shaped curve. "Among adults aged 60 years and older, cost effectiveness of HZV is less favorable at the youngest and oldest ages of that range," Dr. Harpaz said. Cost effectiveness is reduced at younger ages because the protection is likely to wane by the time the recipient reaches the age when the disease burden of herpes zoster is highest. Cost effectiveness is also reduced in the elderly because of death and the decline in vaccine effectiveness over time.

Dr. Harpaz also addressed past supply shortages. Expanding recommendations before sustainable supplies are assured "can jeopardize the credibility of all players in the vaccine enterprise," he said. "ACIP has never adopted an expansion of a vaccination program in the midst of a supply shortage."

Other factors that prompted ACIP to refrain from recommending the zoster vaccine for adults aged 50-59 years include price, storage and handling issues, and complicated relationships of drug plans with pharmacies, he said.

The next steps include a Notice to Readers from the CDC that will appear on the CDC herpes zoster website to alert health care providers and the public to the change in licensure for the zoster vaccine and to emphasize that the ACIP recommendations have not changed.

The zoster working group recognized that some providers might wish to use the zoster vaccine for some patients aged 50-59 years, said Dr. Harpaz. The working group suggested that the CDC provide limited technical guidance for nonrecommended use in these patients, based on the current ACIP recommendations for adults aged 60 years and older.

Neither Dr. Cieslak nor Dr. Harpaz had any relevant financial conflicts to disclose.