Heidi Splete

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.

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 latest 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 latest 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 latest 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.

Major Finding: The 30-day mortality did not differ significantly by age group and was under 1% for all age ranges.

Data Source: A multihospital study of 48,378 adults with a body mass index of 35 kg/m

Disclosures: Dr. Dorman had no financial conflicts to disclose.

Older patients undergoing bariatric surgery had longer hospital stays, but no increased risk of death or major adverse events at 30 days, according to a study of more than 48,000 adults.

Patient age older than 65 years is not a contraindication to bariatric surgery, said Dr. Robert B. Dorman at the meeting. Previous studies in older adults have been limited to Medicare patients and have not included laparoscopic procedures, he noted.

In this multihospital study, using American College of Surgeons National Surgical Quality Improvement Program, Dr. Dorman of the University of Minnesota, Minneapolis, and his colleagues analyzed data from 48,378 adults with a body mass index of 35 kg/m

The types of surgery included open and laparoscopic Roux-en-Y gastric bypass, open duodenal switch, laparoscopic adjustable gastric banding, and vertical banded gastroplasty.

The percentage of bariatric surgery patients aged at least 65 years increased from 1.9% in 2005 to 4.8% in 2009, a significant change. Among all patients, 72 deaths occurred during the study period, and 8 of these occurred in patients older than 65.

The 30-day mortality did not differ significantly by age group and was under 1% for all age ranges. Specifically, for patients aged 35-49 years, 50-64 years, and 65 years and older mortality was 0.12%, 0.21%, and 0.40%, respectively. A multivariate analysis showed a trend for advancing age as a predictor of mortality, but this was not statistically significant, the researchers noted.

However, age of 65 years or older was a significant predictor of prolonged length of stay for both open and laparoscopic procedures. In addition, older age alone was not a significant predictor of major adverse events for either procedure type. The significant predictors of major adverse events included BMI of 55 or higher, cardiac comorbidities, severe ASA [American Society of Anesthesiologists] score, albumin levels less than 3 g/dL, and creatinine levels greater than 1.5 mg/dL.

“Once corroborated, these results [will] provide important information to patients, surgeons, hospitals, and payers prior to performing bariatric surgery in older persons with obesity,” Dr. Dorman said.

Major Finding: The 30-day mortality did not differ significantly by age group and was under 1% for all age ranges.

Data Source: A multihospital study of 48,378 adults with a body mass index of 35 kg/m

Disclosures: Dr. Dorman had no financial conflicts to disclose.

Older patients undergoing bariatric surgery had longer hospital stays, but no increased risk of death or major adverse events at 30 days, according to a study of more than 48,000 adults.

Patient age older than 65 years is not a contraindication to bariatric surgery, said Dr. Robert B. Dorman at the meeting. Previous studies in older adults have been limited to Medicare patients and have not included laparoscopic procedures, he noted.

In this multihospital study, using American College of Surgeons National Surgical Quality Improvement Program, Dr. Dorman of the University of Minnesota, Minneapolis, and his colleagues analyzed data from 48,378 adults with a body mass index of 35 kg/m

The types of surgery included open and laparoscopic Roux-en-Y gastric bypass, open duodenal switch, laparoscopic adjustable gastric banding, and vertical banded gastroplasty.

The percentage of bariatric surgery patients aged at least 65 years increased from 1.9% in 2005 to 4.8% in 2009, a significant change. Among all patients, 72 deaths occurred during the study period, and 8 of these occurred in patients older than 65.

The 30-day mortality did not differ significantly by age group and was under 1% for all age ranges. Specifically, for patients aged 35-49 years, 50-64 years, and 65 years and older mortality was 0.12%, 0.21%, and 0.40%, respectively. A multivariate analysis showed a trend for advancing age as a predictor of mortality, but this was not statistically significant, the researchers noted.

However, age of 65 years or older was a significant predictor of prolonged length of stay for both open and laparoscopic procedures. In addition, older age alone was not a significant predictor of major adverse events for either procedure type. The significant predictors of major adverse events included BMI of 55 or higher, cardiac comorbidities, severe ASA [American Society of Anesthesiologists] score, albumin levels less than 3 g/dL, and creatinine levels greater than 1.5 mg/dL.

“Once corroborated, these results [will] provide important information to patients, surgeons, hospitals, and payers prior to performing bariatric surgery in older persons with obesity,” Dr. Dorman said.

Major Finding: The 30-day mortality did not differ significantly by age group and was under 1% for all age ranges.

Data Source: A multihospital study of 48,378 adults with a body mass index of 35 kg/m

Disclosures: Dr. Dorman had no financial conflicts to disclose.

Older patients undergoing bariatric surgery had longer hospital stays, but no increased risk of death or major adverse events at 30 days, according to a study of more than 48,000 adults.

Patient age older than 65 years is not a contraindication to bariatric surgery, said Dr. Robert B. Dorman at the meeting. Previous studies in older adults have been limited to Medicare patients and have not included laparoscopic procedures, he noted.

In this multihospital study, using American College of Surgeons National Surgical Quality Improvement Program, Dr. Dorman of the University of Minnesota, Minneapolis, and his colleagues analyzed data from 48,378 adults with a body mass index of 35 kg/m

The types of surgery included open and laparoscopic Roux-en-Y gastric bypass, open duodenal switch, laparoscopic adjustable gastric banding, and vertical banded gastroplasty.

The percentage of bariatric surgery patients aged at least 65 years increased from 1.9% in 2005 to 4.8% in 2009, a significant change. Among all patients, 72 deaths occurred during the study period, and 8 of these occurred in patients older than 65.

The 30-day mortality did not differ significantly by age group and was under 1% for all age ranges. Specifically, for patients aged 35-49 years, 50-64 years, and 65 years and older mortality was 0.12%, 0.21%, and 0.40%, respectively. A multivariate analysis showed a trend for advancing age as a predictor of mortality, but this was not statistically significant, the researchers noted.

However, age of 65 years or older was a significant predictor of prolonged length of stay for both open and laparoscopic procedures. In addition, older age alone was not a significant predictor of major adverse events for either procedure type. The significant predictors of major adverse events included BMI of 55 or higher, cardiac comorbidities, severe ASA [American Society of Anesthesiologists] score, albumin levels less than 3 g/dL, and creatinine levels greater than 1.5 mg/dL.

“Once corroborated, these results [will] provide important information to patients, surgeons, hospitals, and payers prior to performing bariatric surgery in older persons with obesity,” Dr. Dorman said.

ATLANTA – The Tdap vaccine should be given to pregnant women after 20 weeks' gestation to help prevent pertussis in the mothers and their newborns, the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices voted at its meeting.

The ACIP also voted that in special situations in which a pregnant women who has not previously received Tdap is in need of a tetanus booster (for wound management or if it's been more than 10 years since the previous Td), health care providers should administer Tdap during the third or late second trimester (after 20 weeks' gestation). However, the language may be revised to allow for earlier vaccination for urgent wound management in women prior to 20 weeks' gestation.

In addition, the ACIP recommended that pregnant women whose tetanus vaccination status is unknown or uncertain should received three vaccinations containing tetanus and reduced diphtheria toxoids during pregnancy. The recommended dosing schedule is 0, 4 weeks, and 6–12 months. Tdap should replace one dose of Td, preferably during the late second or third trimester.

As part of the same vote, the ACIP also voted to recommend “cocooning” (Tdap vaccination of adolescent and adult contacts of infants younger than 12 months) despite the lack of evidence for its effectiveness.

“The working group would never not recommend cocooning, but it is an insufficient national strategy to prevent pertussis morbidity and mortality for newborn infants,” noted Dr. Jennifer Liang of the CDC, who presented data on behalf of the ACIP pertussis vaccine working group. Cocooning has been recommended since 2005, but available data show poor uptake and no evidence that cocooning programs are sustainable.

The ACIP voted in favor of prenatal Tdap vaccination as preferable to postpartum vaccination when possible. “Postpartum vaccination is a suboptimal national strategy to prevent infant pertussis morbidity and mortality,” said Dr. Liang. “Vaccinating pregnant women during the late second or early third trimester is acceptably safe for both mother and fetus.”

Moving Tdap vaccination to the third trimester of pregnancy is the most cost effective of several options to protect pregnant women and newborns against pertussis, said Garrett R. Beeler Asay, Ph.D., also of the CDC. Using a simulated birth cohort model of approximately 4 million infants, the cost per quality-of-life-year saved was $414,442 for vaccination during pregnancy, compared to $1,174,143 for postpartum vaccination.

The ACIP also voted to include the recommendations in the Vaccines for Children program, to state that adolescents who are pregnant would receive Tdap in the same manner as adult pregnant women.

Neither Dr. Liang nor Dr. Beeler Asay had any relevant financial disclosures.

ATLANTA – The Tdap vaccine should be given to pregnant women after 20 weeks' gestation to help prevent pertussis in the mothers and their newborns, the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices voted at its meeting.

The ACIP also voted that in special situations in which a pregnant women who has not previously received Tdap is in need of a tetanus booster (for wound management or if it's been more than 10 years since the previous Td), health care providers should administer Tdap during the third or late second trimester (after 20 weeks' gestation). However, the language may be revised to allow for earlier vaccination for urgent wound management in women prior to 20 weeks' gestation.

In addition, the ACIP recommended that pregnant women whose tetanus vaccination status is unknown or uncertain should received three vaccinations containing tetanus and reduced diphtheria toxoids during pregnancy. The recommended dosing schedule is 0, 4 weeks, and 6–12 months. Tdap should replace one dose of Td, preferably during the late second or third trimester.

As part of the same vote, the ACIP also voted to recommend “cocooning” (Tdap vaccination of adolescent and adult contacts of infants younger than 12 months) despite the lack of evidence for its effectiveness.

“The working group would never not recommend cocooning, but it is an insufficient national strategy to prevent pertussis morbidity and mortality for newborn infants,” noted Dr. Jennifer Liang of the CDC, who presented data on behalf of the ACIP pertussis vaccine working group. Cocooning has been recommended since 2005, but available data show poor uptake and no evidence that cocooning programs are sustainable.

The ACIP voted in favor of prenatal Tdap vaccination as preferable to postpartum vaccination when possible. “Postpartum vaccination is a suboptimal national strategy to prevent infant pertussis morbidity and mortality,” said Dr. Liang. “Vaccinating pregnant women during the late second or early third trimester is acceptably safe for both mother and fetus.”

Moving Tdap vaccination to the third trimester of pregnancy is the most cost effective of several options to protect pregnant women and newborns against pertussis, said Garrett R. Beeler Asay, Ph.D., also of the CDC. Using a simulated birth cohort model of approximately 4 million infants, the cost per quality-of-life-year saved was $414,442 for vaccination during pregnancy, compared to $1,174,143 for postpartum vaccination.

The ACIP also voted to include the recommendations in the Vaccines for Children program, to state that adolescents who are pregnant would receive Tdap in the same manner as adult pregnant women.

Neither Dr. Liang nor Dr. Beeler Asay had any relevant financial disclosures.

ATLANTA – The Tdap vaccine should be given to pregnant women after 20 weeks' gestation to help prevent pertussis in the mothers and their newborns, the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices voted at its meeting.

The ACIP also voted that in special situations in which a pregnant women who has not previously received Tdap is in need of a tetanus booster (for wound management or if it's been more than 10 years since the previous Td), health care providers should administer Tdap during the third or late second trimester (after 20 weeks' gestation). However, the language may be revised to allow for earlier vaccination for urgent wound management in women prior to 20 weeks' gestation.

In addition, the ACIP recommended that pregnant women whose tetanus vaccination status is unknown or uncertain should received three vaccinations containing tetanus and reduced diphtheria toxoids during pregnancy. The recommended dosing schedule is 0, 4 weeks, and 6–12 months. Tdap should replace one dose of Td, preferably during the late second or third trimester.

As part of the same vote, the ACIP also voted to recommend “cocooning” (Tdap vaccination of adolescent and adult contacts of infants younger than 12 months) despite the lack of evidence for its effectiveness.

“The working group would never not recommend cocooning, but it is an insufficient national strategy to prevent pertussis morbidity and mortality for newborn infants,” noted Dr. Jennifer Liang of the CDC, who presented data on behalf of the ACIP pertussis vaccine working group. Cocooning has been recommended since 2005, but available data show poor uptake and no evidence that cocooning programs are sustainable.

The ACIP voted in favor of prenatal Tdap vaccination as preferable to postpartum vaccination when possible. “Postpartum vaccination is a suboptimal national strategy to prevent infant pertussis morbidity and mortality,” said Dr. Liang. “Vaccinating pregnant women during the late second or early third trimester is acceptably safe for both mother and fetus.”

Moving Tdap vaccination to the third trimester of pregnancy is the most cost effective of several options to protect pregnant women and newborns against pertussis, said Garrett R. Beeler Asay, Ph.D., also of the CDC. Using a simulated birth cohort model of approximately 4 million infants, the cost per quality-of-life-year saved was $414,442 for vaccination during pregnancy, compared to $1,174,143 for postpartum vaccination.

The ACIP also voted to include the recommendations in the Vaccines for Children program, to state that adolescents who are pregnant would receive Tdap in the same manner as adult pregnant women.

Neither Dr. Liang nor Dr. Beeler Asay had any relevant financial disclosures.

ATLANTA – The Tdap vaccine should be given to pregnant women after 20 weeks' gestation to help prevent pertussis in the mothers and their newborns, the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices voted at its June 22 meeting.

The ACIP also voted that in special situations in which a pregnant women who has not previously received Tdap is in need of a tetanus booster (for wound management or if it's been more than 10 years since the previous Td), health care providers should administer Tdap during the third or late second trimester (after 20 weeks' gestation).

However, the language may be revised to allow for earlier vaccination for urgent wound management in women prior to 20 weeks' gestation.

In addition, the ACIP recommended that pregnant women whose tetanus vaccination status is unknown or uncertain should received three vaccinations containing tetanus and reduced diphtheria toxoids during pregnancy. The recommended dosing schedule is 0, 4 weeks, and 6-12 months. Tdap should replace one dose of Td, preferably during the late second or third trimester.

As part of the same vote, the ACIP also voted to recommend “cocooning” (Tdap vaccination of adolescent and adult contacts of infants younger than 12 months) despite the lack of evidence for its effectiveness.

“The working group would never not recommend cocooning, but it is an insufficient national strategy to prevent pertussis morbidity and mortality for newborn infants,” noted Dr. Jennifer Liang of the CDC, who presented data on behalf of the ACIP pertussis vaccine working group.

Cocooning has been recommended since 2005, but available data show poor uptake and no evidence that cocooning programs are sustainable, she said.

The ACIP voted in favor of prenatal Tdap vaccination as preferable to postpartum vaccination when possible.

“Postpartum vaccination is a suboptimal national strategy to prevent infant pertussis morbidity and mortality,” said Dr. Liang. “Vaccinating pregnant women during the late second or early third trimester is acceptably safe for both mother and fetus.”

Moving Tdap vaccination to the third trimester of pregnancy is the most cost effective of several options to protect pregnant women and newborns against pertussis, said Garrett R. Beeler Asay, Ph.D., also of the CDC.

With use of a simulated birth cohort model of approximately 4 million infants, the cost per quality-of-life-year saved was $414,442 for vaccination during pregnancy, compared with $1,174,143 for postpartum vaccination.

The ACIP also voted to include the recommendations in the Vaccines for Children program, to state that adolescents who are pregnant would receive Tdap in the same manner as adult pregnant women.

Neither Dr. Liang nor Dr. Beeler Asay had any relevant financial disclosures.

ATLANTA – The Tdap vaccine should be given to pregnant women after 20 weeks' gestation to help prevent pertussis in the mothers and their newborns, the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices voted at its June 22 meeting.

The ACIP also voted that in special situations in which a pregnant women who has not previously received Tdap is in need of a tetanus booster (for wound management or if it's been more than 10 years since the previous Td), health care providers should administer Tdap during the third or late second trimester (after 20 weeks' gestation).

However, the language may be revised to allow for earlier vaccination for urgent wound management in women prior to 20 weeks' gestation.

In addition, the ACIP recommended that pregnant women whose tetanus vaccination status is unknown or uncertain should received three vaccinations containing tetanus and reduced diphtheria toxoids during pregnancy. The recommended dosing schedule is 0, 4 weeks, and 6-12 months. Tdap should replace one dose of Td, preferably during the late second or third trimester.

As part of the same vote, the ACIP also voted to recommend “cocooning” (Tdap vaccination of adolescent and adult contacts of infants younger than 12 months) despite the lack of evidence for its effectiveness.

“The working group would never not recommend cocooning, but it is an insufficient national strategy to prevent pertussis morbidity and mortality for newborn infants,” noted Dr. Jennifer Liang of the CDC, who presented data on behalf of the ACIP pertussis vaccine working group.

Cocooning has been recommended since 2005, but available data show poor uptake and no evidence that cocooning programs are sustainable, she said.

The ACIP voted in favor of prenatal Tdap vaccination as preferable to postpartum vaccination when possible.

“Postpartum vaccination is a suboptimal national strategy to prevent infant pertussis morbidity and mortality,” said Dr. Liang. “Vaccinating pregnant women during the late second or early third trimester is acceptably safe for both mother and fetus.”

Moving Tdap vaccination to the third trimester of pregnancy is the most cost effective of several options to protect pregnant women and newborns against pertussis, said Garrett R. Beeler Asay, Ph.D., also of the CDC.

With use of a simulated birth cohort model of approximately 4 million infants, the cost per quality-of-life-year saved was $414,442 for vaccination during pregnancy, compared with $1,174,143 for postpartum vaccination.

The ACIP also voted to include the recommendations in the Vaccines for Children program, to state that adolescents who are pregnant would receive Tdap in the same manner as adult pregnant women.

Neither Dr. Liang nor Dr. Beeler Asay had any relevant financial disclosures.

ATLANTA – The Tdap vaccine should be given to pregnant women after 20 weeks' gestation to help prevent pertussis in the mothers and their newborns, the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices voted at its June 22 meeting.

The ACIP also voted that in special situations in which a pregnant women who has not previously received Tdap is in need of a tetanus booster (for wound management or if it's been more than 10 years since the previous Td), health care providers should administer Tdap during the third or late second trimester (after 20 weeks' gestation).

However, the language may be revised to allow for earlier vaccination for urgent wound management in women prior to 20 weeks' gestation.

In addition, the ACIP recommended that pregnant women whose tetanus vaccination status is unknown or uncertain should received three vaccinations containing tetanus and reduced diphtheria toxoids during pregnancy. The recommended dosing schedule is 0, 4 weeks, and 6-12 months. Tdap should replace one dose of Td, preferably during the late second or third trimester.

As part of the same vote, the ACIP also voted to recommend “cocooning” (Tdap vaccination of adolescent and adult contacts of infants younger than 12 months) despite the lack of evidence for its effectiveness.

“The working group would never not recommend cocooning, but it is an insufficient national strategy to prevent pertussis morbidity and mortality for newborn infants,” noted Dr. Jennifer Liang of the CDC, who presented data on behalf of the ACIP pertussis vaccine working group.

Cocooning has been recommended since 2005, but available data show poor uptake and no evidence that cocooning programs are sustainable, she said.

The ACIP voted in favor of prenatal Tdap vaccination as preferable to postpartum vaccination when possible.

“Postpartum vaccination is a suboptimal national strategy to prevent infant pertussis morbidity and mortality,” said Dr. Liang. “Vaccinating pregnant women during the late second or early third trimester is acceptably safe for both mother and fetus.”

Moving Tdap vaccination to the third trimester of pregnancy is the most cost effective of several options to protect pregnant women and newborns against pertussis, said Garrett R. Beeler Asay, Ph.D., also of the CDC.

With use of a simulated birth cohort model of approximately 4 million infants, the cost per quality-of-life-year saved was $414,442 for vaccination during pregnancy, compared with $1,174,143 for postpartum vaccination.

The ACIP also voted to include the recommendations in the Vaccines for Children program, to state that adolescents who are pregnant would receive Tdap in the same manner as adult pregnant women.

Neither Dr. Liang nor Dr. Beeler Asay had any relevant financial disclosures.

ATLANTA – The meningococcal vaccine MCV4-D (Menactra) is now recommended for use in certain subgroups of high-risk children aged 9-23 months, ACIP voted at its June meeting.

Dr. Amanda Cohn of the CDC's meningitis and vaccine preventable disease branch noted that the recommendations involve a very small subset of the population, and that they do not apply to this age group in general.

ACIP voted that specific groups of children aged 9-23 months at increased risk for meningococcal disease receive a two-dose series of MCV4-D taken 3 months apart:

▸ Infants needing protection prior to traveling or moving to an area where meningococcal disease is epidemic or highly endemic. Travelers can receive their two doses 2 months apart to accommodate travel schedules.

▸ Infants with complement component deficiencies such as C3, C5-9, properdin, factor H, and factor D deficiencies.

▸ Infants in a defined risk group for a community or institutional outbreak.

▸ Infants with HIV, if another indication for vaccination exists.

The committee, however, opted to postpone voting on whether infants aged 9-23 months with functional or anatomic asplenia, including those with sickle cell anemia, should receive the MCV4-D vaccine.

“This will be on the agenda to consider at a future time when more information becomes available,” said Dr. Carol Baker, ACIP chair and professor of pediatrics at Baylor College of Medicine, Houston. “We are not just a rubber stamp for the FDA licensing.”

ACIP also voted unanimously to include the recommendations in the Vaccines for Children Program.

The indication for MCV4-D as a two-dose primary series for infants aged 9-23 months was approved by the U.S. Food and Drug Administration in March 2011, Dr. Cohn said. “This is the first meningococcal vaccine licensed in children under 24 months, but others are likely to be available within the year.” Prelicensure safety data met noninferiority criteria, with no serious adverse events, and postlicensure safety surveillance will be conducted for children through age 23 months.

The recommendations were based on immunogenicity and safety data presented by Dr. David R. Johnson of Sanofi Pasteur, manufacturer of Menactra. He presented several phase III studies that included immunogenicity data from 1,561 infants and safety data from 3,267 infants.

In one study of 147 children, the protective response rates after two doses of MCV4-D (defined as the percent achieving serum bactericidal assay with human complement [SBA-HC] immune titers of at least a ratio of 1:8) against meningococcal serogroups A, C, Y, and W-135 were 91%, 100%, 95%, and 82%, respectively, Dr. Johnson said. Seroprotection rates when MCV4-D was given with MMRV (measles, mumps, rubella, varicella) were higher than when PCV7 was given with MMRV. However, pneumococcal geometric mean concentrations when PVC7 was given with MCV4-D were lower than with PCV7 given with MMRV.

The impact of MCV4-D on the effectiveness of the pneumococcal vaccine was cause for concern. “We don't want to do anything to impact the burden of pneumococcal disease in the high-risk patients” Dr. Michael Brady, chair of the American Academy of Pediatrics committee on infectious disease, said during the discussion period prior to voting. He also is chair of the department of pediatrics at Ohio State University in Columbus.

Many ACIP members expressed similar concerns about the risks of interference that could occur with the coadministration of a pneumococcal vaccine and meningococcal vaccine in the specific subset of children with functional or anatomic asplenia, including sickle cell anemia, and the vote was postponed based on these concerns. The rate of medically significant adverse events from 30 days to 6 months after MCV4-D plus concomitant vaccines was less than 5%. No data were presented on safety or immunogenicity data for MCV4-D and PCV13.

Dr. Cohn had no relevant financial disclosures.

ATLANTA – The meningococcal vaccine MCV4-D (Menactra) is now recommended for use in certain subgroups of high-risk children aged 9-23 months, ACIP voted at its June meeting.

Dr. Amanda Cohn of the CDC's meningitis and vaccine preventable disease branch noted that the recommendations involve a very small subset of the population, and that they do not apply to this age group in general.

ACIP voted that specific groups of children aged 9-23 months at increased risk for meningococcal disease receive a two-dose series of MCV4-D taken 3 months apart:

▸ Infants needing protection prior to traveling or moving to an area where meningococcal disease is epidemic or highly endemic. Travelers can receive their two doses 2 months apart to accommodate travel schedules.

▸ Infants with complement component deficiencies such as C3, C5-9, properdin, factor H, and factor D deficiencies.

▸ Infants in a defined risk group for a community or institutional outbreak.

▸ Infants with HIV, if another indication for vaccination exists.

The committee, however, opted to postpone voting on whether infants aged 9-23 months with functional or anatomic asplenia, including those with sickle cell anemia, should receive the MCV4-D vaccine.

“This will be on the agenda to consider at a future time when more information becomes available,” said Dr. Carol Baker, ACIP chair and professor of pediatrics at Baylor College of Medicine, Houston. “We are not just a rubber stamp for the FDA licensing.”

ACIP also voted unanimously to include the recommendations in the Vaccines for Children Program.

The indication for MCV4-D as a two-dose primary series for infants aged 9-23 months was approved by the U.S. Food and Drug Administration in March 2011, Dr. Cohn said. “This is the first meningococcal vaccine licensed in children under 24 months, but others are likely to be available within the year.” Prelicensure safety data met noninferiority criteria, with no serious adverse events, and postlicensure safety surveillance will be conducted for children through age 23 months.

The recommendations were based on immunogenicity and safety data presented by Dr. David R. Johnson of Sanofi Pasteur, manufacturer of Menactra. He presented several phase III studies that included immunogenicity data from 1,561 infants and safety data from 3,267 infants.

In one study of 147 children, the protective response rates after two doses of MCV4-D (defined as the percent achieving serum bactericidal assay with human complement [SBA-HC] immune titers of at least a ratio of 1:8) against meningococcal serogroups A, C, Y, and W-135 were 91%, 100%, 95%, and 82%, respectively, Dr. Johnson said. Seroprotection rates when MCV4-D was given with MMRV (measles, mumps, rubella, varicella) were higher than when PCV7 was given with MMRV. However, pneumococcal geometric mean concentrations when PVC7 was given with MCV4-D were lower than with PCV7 given with MMRV.

The impact of MCV4-D on the effectiveness of the pneumococcal vaccine was cause for concern. “We don't want to do anything to impact the burden of pneumococcal disease in the high-risk patients” Dr. Michael Brady, chair of the American Academy of Pediatrics committee on infectious disease, said during the discussion period prior to voting. He also is chair of the department of pediatrics at Ohio State University in Columbus.

Many ACIP members expressed similar concerns about the risks of interference that could occur with the coadministration of a pneumococcal vaccine and meningococcal vaccine in the specific subset of children with functional or anatomic asplenia, including sickle cell anemia, and the vote was postponed based on these concerns. The rate of medically significant adverse events from 30 days to 6 months after MCV4-D plus concomitant vaccines was less than 5%. No data were presented on safety or immunogenicity data for MCV4-D and PCV13.

Dr. Cohn had no relevant financial disclosures.

ATLANTA – The meningococcal vaccine MCV4-D (Menactra) is now recommended for use in certain subgroups of high-risk children aged 9-23 months, ACIP voted at its June meeting.

Dr. Amanda Cohn of the CDC's meningitis and vaccine preventable disease branch noted that the recommendations involve a very small subset of the population, and that they do not apply to this age group in general.

ACIP voted that specific groups of children aged 9-23 months at increased risk for meningococcal disease receive a two-dose series of MCV4-D taken 3 months apart:

▸ Infants needing protection prior to traveling or moving to an area where meningococcal disease is epidemic or highly endemic. Travelers can receive their two doses 2 months apart to accommodate travel schedules.

▸ Infants with complement component deficiencies such as C3, C5-9, properdin, factor H, and factor D deficiencies.

▸ Infants in a defined risk group for a community or institutional outbreak.

▸ Infants with HIV, if another indication for vaccination exists.

The committee, however, opted to postpone voting on whether infants aged 9-23 months with functional or anatomic asplenia, including those with sickle cell anemia, should receive the MCV4-D vaccine.

“This will be on the agenda to consider at a future time when more information becomes available,” said Dr. Carol Baker, ACIP chair and professor of pediatrics at Baylor College of Medicine, Houston. “We are not just a rubber stamp for the FDA licensing.”

ACIP also voted unanimously to include the recommendations in the Vaccines for Children Program.

The indication for MCV4-D as a two-dose primary series for infants aged 9-23 months was approved by the U.S. Food and Drug Administration in March 2011, Dr. Cohn said. “This is the first meningococcal vaccine licensed in children under 24 months, but others are likely to be available within the year.” Prelicensure safety data met noninferiority criteria, with no serious adverse events, and postlicensure safety surveillance will be conducted for children through age 23 months.

The recommendations were based on immunogenicity and safety data presented by Dr. David R. Johnson of Sanofi Pasteur, manufacturer of Menactra. He presented several phase III studies that included immunogenicity data from 1,561 infants and safety data from 3,267 infants.

In one study of 147 children, the protective response rates after two doses of MCV4-D (defined as the percent achieving serum bactericidal assay with human complement [SBA-HC] immune titers of at least a ratio of 1:8) against meningococcal serogroups A, C, Y, and W-135 were 91%, 100%, 95%, and 82%, respectively, Dr. Johnson said. Seroprotection rates when MCV4-D was given with MMRV (measles, mumps, rubella, varicella) were higher than when PCV7 was given with MMRV. However, pneumococcal geometric mean concentrations when PVC7 was given with MCV4-D were lower than with PCV7 given with MMRV.

The impact of MCV4-D on the effectiveness of the pneumococcal vaccine was cause for concern. “We don't want to do anything to impact the burden of pneumococcal disease in the high-risk patients” Dr. Michael Brady, chair of the American Academy of Pediatrics committee on infectious disease, said during the discussion period prior to voting. He also is chair of the department of pediatrics at Ohio State University in Columbus.

Many ACIP members expressed similar concerns about the risks of interference that could occur with the coadministration of a pneumococcal vaccine and meningococcal vaccine in the specific subset of children with functional or anatomic asplenia, including sickle cell anemia, and the vote was postponed based on these concerns. The rate of medically significant adverse events from 30 days to 6 months after MCV4-D plus concomitant vaccines was less than 5%. No data were presented on safety or immunogenicity data for MCV4-D and PCV13.

Dr. Cohn had no relevant financial disclosures.

Motivational text messages doubled the rate of smoking cessation, according to data from a randomized trial of 5,800 smokers published online June 30 in the Lancet.

"Because of the widespread ownership of mobile phones, fully automated smoking cessation support can be delivered to large numbers of people at low cost," said Caroline Free, Ph.D., of the London School of Hygiene and Tropical Medicine, and her colleagues.

Photo credit: © agmit/istockphoto.com

After 6 months of an intervention text message or a placebo text message, 10.7% of the intervention group showed biochemically verified smoking abstinence, compared with 4.9% of the placebo group.

The researchers randomized 2,915 smokers to receive the "txt2stop" intervention messages and 2,885 to receive a placebo message.

The study participants were aged 16 years and older, and the demographics were similar between the two groups (Lancet 2011 June 30 [doi: 10.1016/S0140-6736(11)60701-0]).

In addition, participants in the intervention group were significantly more likely than those in the placebo group to self-report 28 straight days of not smoking (20% vs. 14%, respectively) and not smoking in the past 7 days (24% vs. 18%) after 6 months.

The study participants received five text messages daily for the first 5 weeks of the program, followed by three messages per week for the next 26 weeks. Participants in both groups were encouraged to use any additional smoking cessation services they wanted.

The intervention text messages focused on several topics. A sample text for a specific concern such as weight gain read: "Think you’ll put on weight when you quit? We’re here to help. We’ll TXT weight control and exercise tips, recipes, and motivation tips." In addition, participants were able to request targeted messages when they texted CRAVE or LAPSE. For example: "Cravings last less than 5 minutes on average. To help distract yourself, try sipping a drink slowly until the craving is over."

The findings were limited in part by a lack of information about the mechanism by which the text messages helped people stop smoking and by occasional flaws in the biochemical tests for smoking cessation, the researchers noted. The results suggest, however, that "the txt2stop intervention should be considered as an addition to existing smoking cessation services," Dr. Free and her colleagues wrote.

In an accompanying editorial, Derrick A. Bennett, Ph.D., and Dr. Jonathan R. Emberson of the University of Oxford (England) noted that, although the cessation rates in the intervention group were twice those of the control group, the overall rate of 10.7% was low.

The smoking cessation rate in the text-messaging intervention group was similar to that seen in other intervention programs, and the text-messaging method might be especially helpful when targeting smokers in low- and middle-income countries, where death rates from smoking-related diseases are high and mobile phones are common, they said (Lancet 2011 June 30 [doi: 10.1016/S0140-6736(11)60882-9]).

"The lessons learned from the txt2stop trial could therefore not only provide a new approach to smoking cessation in high-income and middle-income countries, but could also provide a useful starting point for implementing behavioural change in resource-poor settings," Dr. Bennett and Dr. Emberson wrote.

The researchers and the editorial authors stated that they had no financial conflicts to disclose.

Motivational text messages doubled the rate of smoking cessation, according to data from a randomized trial of 5,800 smokers published online June 30 in the Lancet.

"Because of the widespread ownership of mobile phones, fully automated smoking cessation support can be delivered to large numbers of people at low cost," said Caroline Free, Ph.D., of the London School of Hygiene and Tropical Medicine, and her colleagues.

Photo credit: © agmit/istockphoto.com

After 6 months of an intervention text message or a placebo text message, 10.7% of the intervention group showed biochemically verified smoking abstinence, compared with 4.9% of the placebo group.

The researchers randomized 2,915 smokers to receive the "txt2stop" intervention messages and 2,885 to receive a placebo message.

The study participants were aged 16 years and older, and the demographics were similar between the two groups (Lancet 2011 June 30 [doi: 10.1016/S0140-6736(11)60701-0]).

In addition, participants in the intervention group were significantly more likely than those in the placebo group to self-report 28 straight days of not smoking (20% vs. 14%, respectively) and not smoking in the past 7 days (24% vs. 18%) after 6 months.

The study participants received five text messages daily for the first 5 weeks of the program, followed by three messages per week for the next 26 weeks. Participants in both groups were encouraged to use any additional smoking cessation services they wanted.

The intervention text messages focused on several topics. A sample text for a specific concern such as weight gain read: "Think you’ll put on weight when you quit? We’re here to help. We’ll TXT weight control and exercise tips, recipes, and motivation tips." In addition, participants were able to request targeted messages when they texted CRAVE or LAPSE. For example: "Cravings last less than 5 minutes on average. To help distract yourself, try sipping a drink slowly until the craving is over."

The findings were limited in part by a lack of information about the mechanism by which the text messages helped people stop smoking and by occasional flaws in the biochemical tests for smoking cessation, the researchers noted. The results suggest, however, that "the txt2stop intervention should be considered as an addition to existing smoking cessation services," Dr. Free and her colleagues wrote.

In an accompanying editorial, Derrick A. Bennett, Ph.D., and Dr. Jonathan R. Emberson of the University of Oxford (England) noted that, although the cessation rates in the intervention group were twice those of the control group, the overall rate of 10.7% was low.

The smoking cessation rate in the text-messaging intervention group was similar to that seen in other intervention programs, and the text-messaging method might be especially helpful when targeting smokers in low- and middle-income countries, where death rates from smoking-related diseases are high and mobile phones are common, they said (Lancet 2011 June 30 [doi: 10.1016/S0140-6736(11)60882-9]).

"The lessons learned from the txt2stop trial could therefore not only provide a new approach to smoking cessation in high-income and middle-income countries, but could also provide a useful starting point for implementing behavioural change in resource-poor settings," Dr. Bennett and Dr. Emberson wrote.

The researchers and the editorial authors stated that they had no financial conflicts to disclose.

Motivational text messages doubled the rate of smoking cessation, according to data from a randomized trial of 5,800 smokers published online June 30 in the Lancet.

"Because of the widespread ownership of mobile phones, fully automated smoking cessation support can be delivered to large numbers of people at low cost," said Caroline Free, Ph.D., of the London School of Hygiene and Tropical Medicine, and her colleagues.

Photo credit: © agmit/istockphoto.com

After 6 months of an intervention text message or a placebo text message, 10.7% of the intervention group showed biochemically verified smoking abstinence, compared with 4.9% of the placebo group.

The researchers randomized 2,915 smokers to receive the "txt2stop" intervention messages and 2,885 to receive a placebo message.

The study participants were aged 16 years and older, and the demographics were similar between the two groups (Lancet 2011 June 30 [doi: 10.1016/S0140-6736(11)60701-0]).

In addition, participants in the intervention group were significantly more likely than those in the placebo group to self-report 28 straight days of not smoking (20% vs. 14%, respectively) and not smoking in the past 7 days (24% vs. 18%) after 6 months.

The study participants received five text messages daily for the first 5 weeks of the program, followed by three messages per week for the next 26 weeks. Participants in both groups were encouraged to use any additional smoking cessation services they wanted.

The intervention text messages focused on several topics. A sample text for a specific concern such as weight gain read: "Think you’ll put on weight when you quit? We’re here to help. We’ll TXT weight control and exercise tips, recipes, and motivation tips." In addition, participants were able to request targeted messages when they texted CRAVE or LAPSE. For example: "Cravings last less than 5 minutes on average. To help distract yourself, try sipping a drink slowly until the craving is over."

The findings were limited in part by a lack of information about the mechanism by which the text messages helped people stop smoking and by occasional flaws in the biochemical tests for smoking cessation, the researchers noted. The results suggest, however, that "the txt2stop intervention should be considered as an addition to existing smoking cessation services," Dr. Free and her colleagues wrote.

In an accompanying editorial, Derrick A. Bennett, Ph.D., and Dr. Jonathan R. Emberson of the University of Oxford (England) noted that, although the cessation rates in the intervention group were twice those of the control group, the overall rate of 10.7% was low.

The smoking cessation rate in the text-messaging intervention group was similar to that seen in other intervention programs, and the text-messaging method might be especially helpful when targeting smokers in low- and middle-income countries, where death rates from smoking-related diseases are high and mobile phones are common, they said (Lancet 2011 June 30 [doi: 10.1016/S0140-6736(11)60882-9]).

"The lessons learned from the txt2stop trial could therefore not only provide a new approach to smoking cessation in high-income and middle-income countries, but could also provide a useful starting point for implementing behavioural change in resource-poor settings," Dr. Bennett and Dr. Emberson wrote.

The researchers and the editorial authors stated that they had no financial conflicts to disclose.

Motivational text messages doubled the rate of smoking cessation, according to data from a randomized trial of 5,800 smokers published online June 30 in the Lancet.

"Because of the widespread ownership of mobile phones, fully automated smoking cessation support can be delivered to large numbers of people at low cost," said Caroline Free, Ph.D., of the London School of Hygiene and Tropical Medicine, and her colleagues.

Photo credit: © agmit/istockphoto.com

After 6 months of an intervention text message or a placebo text message, 10.7% of the intervention group showed biochemically verified smoking abstinence, compared with 4.9% of the placebo group.

The researchers randomized 2,915 smokers to receive the "txt2stop" intervention messages and 2,885 to receive a placebo message.

The study participants were aged 16 years and older, and the demographics were similar between the two groups (Lancet 2011 June 30 [doi: 10.1016/S0140-6736(11)60701-0]).

In addition, participants in the intervention group were significantly more likely than those in the placebo group to self-report 28 straight days of not smoking (20% vs. 14%, respectively) and not smoking in the past 7 days (24% vs. 18%) after 6 months.

The study participants received five text messages daily for the first 5 weeks of the program, followed by three messages per week for the next 26 weeks. Participants in both groups were encouraged to use any additional smoking cessation services they wanted.

The intervention text messages focused on several topics. A sample text for a specific concern such as weight gain read: "Think you’ll put on weight when you quit? We’re here to help. We’ll TXT weight control and exercise tips, recipes, and motivation tips." In addition, participants were able to request targeted messages when they texted CRAVE or LAPSE. For example: "Cravings last less than 5 minutes on average. To help distract yourself, try sipping a drink slowly until the craving is over."

The findings were limited in part by a lack of information about the mechanism by which the text messages helped people stop smoking and by occasional flaws in the biochemical tests for smoking cessation, the researchers noted. The results suggest, however, that "the txt2stop intervention should be considered as an addition to existing smoking cessation services," Dr. Free and her colleagues wrote.

In an accompanying editorial, Derrick A. Bennett, Ph.D., and Dr. Jonathan R. Emberson of the University of Oxford (England) noted that, although the cessation rates in the intervention group were twice those of the control group, the overall rate of 10.7% was low.

The smoking cessation rate in the text-messaging intervention group was similar to that seen in other intervention programs, and the text-messaging method might be especially helpful when targeting smokers in low- and middle-income countries, where death rates from smoking-related diseases are high and mobile phones are common, they said (Lancet 2011 June 30 [doi: 10.1016/S0140-6736(11)60882-9]).

"The lessons learned from the txt2stop trial could therefore not only provide a new approach to smoking cessation in high-income and middle-income countries, but could also provide a useful starting point for implementing behavioural change in resource-poor settings," Dr. Bennett and Dr. Emberson wrote.

The researchers and the editorial authors stated that they had no financial conflicts to disclose.

Motivational text messages doubled the rate of smoking cessation, according to data from a randomized trial of 5,800 smokers published online June 30 in the Lancet.

"Because of the widespread ownership of mobile phones, fully automated smoking cessation support can be delivered to large numbers of people at low cost," said Caroline Free, Ph.D., of the London School of Hygiene and Tropical Medicine, and her colleagues.

Photo credit: © agmit/istockphoto.com

After 6 months of an intervention text message or a placebo text message, 10.7% of the intervention group showed biochemically verified smoking abstinence, compared with 4.9% of the placebo group.

The researchers randomized 2,915 smokers to receive the "txt2stop" intervention messages and 2,885 to receive a placebo message.

The study participants were aged 16 years and older, and the demographics were similar between the two groups (Lancet 2011 June 30 [doi: 10.1016/S0140-6736(11)60701-0]).

In addition, participants in the intervention group were significantly more likely than those in the placebo group to self-report 28 straight days of not smoking (20% vs. 14%, respectively) and not smoking in the past 7 days (24% vs. 18%) after 6 months.

The study participants received five text messages daily for the first 5 weeks of the program, followed by three messages per week for the next 26 weeks. Participants in both groups were encouraged to use any additional smoking cessation services they wanted.

The intervention text messages focused on several topics. A sample text for a specific concern such as weight gain read: "Think you’ll put on weight when you quit? We’re here to help. We’ll TXT weight control and exercise tips, recipes, and motivation tips." In addition, participants were able to request targeted messages when they texted CRAVE or LAPSE. For example: "Cravings last less than 5 minutes on average. To help distract yourself, try sipping a drink slowly until the craving is over."

The findings were limited in part by a lack of information about the mechanism by which the text messages helped people stop smoking and by occasional flaws in the biochemical tests for smoking cessation, the researchers noted. The results suggest, however, that "the txt2stop intervention should be considered as an addition to existing smoking cessation services," Dr. Free and her colleagues wrote.

In an accompanying editorial, Derrick A. Bennett, Ph.D., and Dr. Jonathan R. Emberson of the University of Oxford (England) noted that, although the cessation rates in the intervention group were twice those of the control group, the overall rate of 10.7% was low.

The smoking cessation rate in the text-messaging intervention group was similar to that seen in other intervention programs, and the text-messaging method might be especially helpful when targeting smokers in low- and middle-income countries, where death rates from smoking-related diseases are high and mobile phones are common, they said (Lancet 2011 June 30 [doi: 10.1016/S0140-6736(11)60882-9]).

"The lessons learned from the txt2stop trial could therefore not only provide a new approach to smoking cessation in high-income and middle-income countries, but could also provide a useful starting point for implementing behavioural change in resource-poor settings," Dr. Bennett and Dr. Emberson wrote.

The researchers and the editorial authors stated that they had no financial conflicts to disclose.

Motivational text messages doubled the rate of smoking cessation, according to data from a randomized trial of 5,800 smokers published online June 30 in the Lancet.

"Because of the widespread ownership of mobile phones, fully automated smoking cessation support can be delivered to large numbers of people at low cost," said Caroline Free, Ph.D., of the London School of Hygiene and Tropical Medicine, and her colleagues.

Photo credit: © agmit/istockphoto.com

After 6 months of an intervention text message or a placebo text message, 10.7% of the intervention group showed biochemically verified smoking abstinence, compared with 4.9% of the placebo group.

The researchers randomized 2,915 smokers to receive the "txt2stop" intervention messages and 2,885 to receive a placebo message.

The study participants were aged 16 years and older, and the demographics were similar between the two groups (Lancet 2011 June 30 [doi: 10.1016/S0140-6736(11)60701-0]).

In addition, participants in the intervention group were significantly more likely than those in the placebo group to self-report 28 straight days of not smoking (20% vs. 14%, respectively) and not smoking in the past 7 days (24% vs. 18%) after 6 months.

The study participants received five text messages daily for the first 5 weeks of the program, followed by three messages per week for the next 26 weeks. Participants in both groups were encouraged to use any additional smoking cessation services they wanted.

The intervention text messages focused on several topics. A sample text for a specific concern such as weight gain read: "Think you’ll put on weight when you quit? We’re here to help. We’ll TXT weight control and exercise tips, recipes, and motivation tips." In addition, participants were able to request targeted messages when they texted CRAVE or LAPSE. For example: "Cravings last less than 5 minutes on average. To help distract yourself, try sipping a drink slowly until the craving is over."

The findings were limited in part by a lack of information about the mechanism by which the text messages helped people stop smoking and by occasional flaws in the biochemical tests for smoking cessation, the researchers noted. The results suggest, however, that "the txt2stop intervention should be considered as an addition to existing smoking cessation services," Dr. Free and her colleagues wrote.

In an accompanying editorial, Derrick A. Bennett, Ph.D., and Dr. Jonathan R. Emberson of the University of Oxford (England) noted that, although the cessation rates in the intervention group were twice those of the control group, the overall rate of 10.7% was low.

The smoking cessation rate in the text-messaging intervention group was similar to that seen in other intervention programs, and the text-messaging method might be especially helpful when targeting smokers in low- and middle-income countries, where death rates from smoking-related diseases are high and mobile phones are common, they said (Lancet 2011 June 30 [doi: 10.1016/S0140-6736(11)60882-9]).

"The lessons learned from the txt2stop trial could therefore not only provide a new approach to smoking cessation in high-income and middle-income countries, but could also provide a useful starting point for implementing behavioural change in resource-poor settings," Dr. Bennett and Dr. Emberson wrote.

The researchers and the editorial authors stated that they had no financial conflicts to disclose.

Motivational text messages doubled the rate of smoking cessation, according to data from a randomized trial of 5,800 smokers published online June 30 in the Lancet.

"Because of the widespread ownership of mobile phones, fully automated smoking cessation support can be delivered to large numbers of people at low cost," said Caroline Free, Ph.D., of the London School of Hygiene and Tropical Medicine, and her colleagues.

Photo credit: © agmit/istockphoto.com

After 6 months of an intervention text message or a placebo text message, 10.7% of the intervention group showed biochemically verified smoking abstinence, compared with 4.9% of the placebo group.

The researchers randomized 2,915 smokers to receive the "txt2stop" intervention messages and 2,885 to receive a placebo message.

The study participants were aged 16 years and older, and the demographics were similar between the two groups (Lancet 2011 June 30 [doi: 10.1016/S0140-6736(11)60701-0]).

In addition, participants in the intervention group were significantly more likely than those in the placebo group to self-report 28 straight days of not smoking (20% vs. 14%, respectively) and not smoking in the past 7 days (24% vs. 18%) after 6 months.

The study participants received five text messages daily for the first 5 weeks of the program, followed by three messages per week for the next 26 weeks. Participants in both groups were encouraged to use any additional smoking cessation services they wanted.

The intervention text messages focused on several topics. A sample text for a specific concern such as weight gain read: "Think you’ll put on weight when you quit? We’re here to help. We’ll TXT weight control and exercise tips, recipes, and motivation tips." In addition, participants were able to request targeted messages when they texted CRAVE or LAPSE. For example: "Cravings last less than 5 minutes on average. To help distract yourself, try sipping a drink slowly until the craving is over."

The findings were limited in part by a lack of information about the mechanism by which the text messages helped people stop smoking and by occasional flaws in the biochemical tests for smoking cessation, the researchers noted. The results suggest, however, that "the txt2stop intervention should be considered as an addition to existing smoking cessation services," Dr. Free and her colleagues wrote.

In an accompanying editorial, Derrick A. Bennett, Ph.D., and Dr. Jonathan R. Emberson of the University of Oxford (England) noted that, although the cessation rates in the intervention group were twice those of the control group, the overall rate of 10.7% was low.

The smoking cessation rate in the text-messaging intervention group was similar to that seen in other intervention programs, and the text-messaging method might be especially helpful when targeting smokers in low- and middle-income countries, where death rates from smoking-related diseases are high and mobile phones are common, they said (Lancet 2011 June 30 [doi: 10.1016/S0140-6736(11)60882-9]).

"The lessons learned from the txt2stop trial could therefore not only provide a new approach to smoking cessation in high-income and middle-income countries, but could also provide a useful starting point for implementing behavioural change in resource-poor settings," Dr. Bennett and Dr. Emberson wrote.

The researchers and the editorial authors stated that they had no financial conflicts to disclose.

Motivational text messages doubled the rate of smoking cessation, according to data from a randomized trial of 5,800 smokers published online June 30 in the Lancet.

"Because of the widespread ownership of mobile phones, fully automated smoking cessation support can be delivered to large numbers of people at low cost," said Caroline Free, Ph.D., of the London School of Hygiene and Tropical Medicine, and her colleagues.

Photo credit: © agmit/istockphoto.com

After 6 months of an intervention text message or a placebo text message, 10.7% of the intervention group showed biochemically verified smoking abstinence, compared with 4.9% of the placebo group.

The researchers randomized 2,915 smokers to receive the "txt2stop" intervention messages and 2,885 to receive a placebo message.

The study participants were aged 16 years and older, and the demographics were similar between the two groups (Lancet 2011 June 30 [doi: 10.1016/S0140-6736(11)60701-0]).

In addition, participants in the intervention group were significantly more likely than those in the placebo group to self-report 28 straight days of not smoking (20% vs. 14%, respectively) and not smoking in the past 7 days (24% vs. 18%) after 6 months.

The study participants received five text messages daily for the first 5 weeks of the program, followed by three messages per week for the next 26 weeks. Participants in both groups were encouraged to use any additional smoking cessation services they wanted.

The intervention text messages focused on several topics. A sample text for a specific concern such as weight gain read: "Think you’ll put on weight when you quit? We’re here to help. We’ll TXT weight control and exercise tips, recipes, and motivation tips." In addition, participants were able to request targeted messages when they texted CRAVE or LAPSE. For example: "Cravings last less than 5 minutes on average. To help distract yourself, try sipping a drink slowly until the craving is over."

The findings were limited in part by a lack of information about the mechanism by which the text messages helped people stop smoking and by occasional flaws in the biochemical tests for smoking cessation, the researchers noted. The results suggest, however, that "the txt2stop intervention should be considered as an addition to existing smoking cessation services," Dr. Free and her colleagues wrote.

In an accompanying editorial, Derrick A. Bennett, Ph.D., and Dr. Jonathan R. Emberson of the University of Oxford (England) noted that, although the cessation rates in the intervention group were twice those of the control group, the overall rate of 10.7% was low.

The smoking cessation rate in the text-messaging intervention group was similar to that seen in other intervention programs, and the text-messaging method might be especially helpful when targeting smokers in low- and middle-income countries, where death rates from smoking-related diseases are high and mobile phones are common, they said (Lancet 2011 June 30 [doi: 10.1016/S0140-6736(11)60882-9]).

"The lessons learned from the txt2stop trial could therefore not only provide a new approach to smoking cessation in high-income and middle-income countries, but could also provide a useful starting point for implementing behavioural change in resource-poor settings," Dr. Bennett and Dr. Emberson wrote.

The researchers and the editorial authors stated that they had no financial conflicts to disclose.

Motivational text messages doubled the rate of smoking cessation, according to data from a randomized trial of 5,800 smokers published online June 30 in the Lancet.

"Because of the widespread ownership of mobile phones, fully automated smoking cessation support can be delivered to large numbers of people at low cost," said Caroline Free, Ph.D., of the London School of Hygiene and Tropical Medicine, and her colleagues.

Photo credit: © agmit/istockphoto.com

After 6 months of an intervention text message or a placebo text message, 10.7% of the intervention group showed biochemically verified smoking abstinence, compared with 4.9% of the placebo group.

The researchers randomized 2,915 smokers to receive the "txt2stop" intervention messages and 2,885 to receive a placebo message.

The study participants were aged 16 years and older, and the demographics were similar between the two groups (Lancet 2011 June 30 [doi: 10.1016/S0140-6736(11)60701-0]).

In addition, participants in the intervention group were significantly more likely than those in the placebo group to self-report 28 straight days of not smoking (20% vs. 14%, respectively) and not smoking in the past 7 days (24% vs. 18%) after 6 months.

The study participants received five text messages daily for the first 5 weeks of the program, followed by three messages per week for the next 26 weeks. Participants in both groups were encouraged to use any additional smoking cessation services they wanted.

The intervention text messages focused on several topics. A sample text for a specific concern such as weight gain read: "Think you’ll put on weight when you quit? We’re here to help. We’ll TXT weight control and exercise tips, recipes, and motivation tips." In addition, participants were able to request targeted messages when they texted CRAVE or LAPSE. For example: "Cravings last less than 5 minutes on average. To help distract yourself, try sipping a drink slowly until the craving is over."

The findings were limited in part by a lack of information about the mechanism by which the text messages helped people stop smoking and by occasional flaws in the biochemical tests for smoking cessation, the researchers noted. The results suggest, however, that "the txt2stop intervention should be considered as an addition to existing smoking cessation services," Dr. Free and her colleagues wrote.

In an accompanying editorial, Derrick A. Bennett, Ph.D., and Dr. Jonathan R. Emberson of the University of Oxford (England) noted that, although the cessation rates in the intervention group were twice those of the control group, the overall rate of 10.7% was low.

The smoking cessation rate in the text-messaging intervention group was similar to that seen in other intervention programs, and the text-messaging method might be especially helpful when targeting smokers in low- and middle-income countries, where death rates from smoking-related diseases are high and mobile phones are common, they said (Lancet 2011 June 30 [doi: 10.1016/S0140-6736(11)60882-9]).

"The lessons learned from the txt2stop trial could therefore not only provide a new approach to smoking cessation in high-income and middle-income countries, but could also provide a useful starting point for implementing behavioural change in resource-poor settings," Dr. Bennett and Dr. Emberson wrote.

The researchers and the editorial authors stated that they had no financial conflicts to disclose.

CHICAGO – Significantly more polyps were detected during colonoscopies when an anesthesiologist was present, compared with colonoscopies without an anesthesiologist, based on data from more than 4.5 million index colonoscopies. The findings were presented at the annual Digestive Disease Week.

Use of an anesthesiologist during colonoscopy has been associated with improved patient and provider satisfaction, but the diagnostic impact on polyp detection has not been well studied, said Dr. Brooks D. Cash of the National Naval Medical Center in Bethesda, Md.

The report "represents one of the first products of the new AGA [American Gastroenterological Association] Digestive Health Outcomes Registry," said Dr. Cash. "It has become increasingly important to have registries that look at quality and effectiveness of what we do as gastroenterologists," he said.

In this study, Dr. Cash and colleagues reviewed data from 4,539,547 index colonoscopies performed between 2001 and 2010. Based on coding data, approximately one-third of the colonoscopies involved an anesthesiologist.

Overall, the polyp detection rate was 37.7% for procedures with an anesthesiologist present, compared with 37% in procedures without an anesthesiologist. Because of the large numbers in the study, this difference was statistically significant (P less than .05).

In addition, significantly more individuals were diagnosed with colorectal cancer within 3 years of the index colonoscopy with an anesthesiologist present than without an anesthesiologist (1.97% vs. 1.71%).

Among men, the polyp detection rate was 43.18% with an anesthesiologist and 43.08% without an anesthesiologist. Among women, these rates were 33.17% and 31.95%, respectively. The differences were significant for both sexes.

The differences in colorectal cancer diagnosis after 3 years also remained significant by sex, the researchers noted. Among men, 2.12% of those who had an anesthesiologist present for their colonoscopies were diagnosed with colorectal cancer within 3 years, compared with 1.93% of those without an anesthesiologist present. Among women, 1.84% of those who had an anesthesiologist present at their colonoscopies were diagnosed with colorectal cancer within 3 years, compared with 1.54% of those without an anesthesiologist present.

The trends held constant for age as well as sex: Both polyp detection and colon cancer incidence after 3 years were slightly higher when an anesthesiologist was present for patients aged younger than 65 years and for those aged 65 years and older.

The study is important because there are significant costs – up to $700 per case – when an anesthesiologist is involved in a colonoscopy, although the cost varies by region, Dr. Cash said.

The use of anesthesiologists for colonoscopies began with comorbid patients who had a higher risk of moderate sedation complications, Dr. Cash said. "We have seen that the use of anesthesiologists has become more common, even for patients who are at average risk," he noted.

"What we are going to have to figure out as a society and as professional organizations is whether those additional costs merit the very slight increases in polyp detection rate," said Dr. Cash. "We also need to figure out why the colorectal cancer incidence 3 years after index colonoscopies with anesthesia providers is slightly higher," he said.

Dr. Cash had no financial conflicts to disclose.

CHICAGO – Significantly more polyps were detected during colonoscopies when an anesthesiologist was present, compared with colonoscopies without an anesthesiologist, based on data from more than 4.5 million index colonoscopies. The findings were presented at the annual Digestive Disease Week.

Use of an anesthesiologist during colonoscopy has been associated with improved patient and provider satisfaction, but the diagnostic impact on polyp detection has not been well studied, said Dr. Brooks D. Cash of the National Naval Medical Center in Bethesda, Md.

The report "represents one of the first products of the new AGA [American Gastroenterological Association] Digestive Health Outcomes Registry," said Dr. Cash. "It has become increasingly important to have registries that look at quality and effectiveness of what we do as gastroenterologists," he said.

In this study, Dr. Cash and colleagues reviewed data from 4,539,547 index colonoscopies performed between 2001 and 2010. Based on coding data, approximately one-third of the colonoscopies involved an anesthesiologist.

Overall, the polyp detection rate was 37.7% for procedures with an anesthesiologist present, compared with 37% in procedures without an anesthesiologist. Because of the large numbers in the study, this difference was statistically significant (P less than .05).

In addition, significantly more individuals were diagnosed with colorectal cancer within 3 years of the index colonoscopy with an anesthesiologist present than without an anesthesiologist (1.97% vs. 1.71%).

Among men, the polyp detection rate was 43.18% with an anesthesiologist and 43.08% without an anesthesiologist. Among women, these rates were 33.17% and 31.95%, respectively. The differences were significant for both sexes.

The differences in colorectal cancer diagnosis after 3 years also remained significant by sex, the researchers noted. Among men, 2.12% of those who had an anesthesiologist present for their colonoscopies were diagnosed with colorectal cancer within 3 years, compared with 1.93% of those without an anesthesiologist present. Among women, 1.84% of those who had an anesthesiologist present at their colonoscopies were diagnosed with colorectal cancer within 3 years, compared with 1.54% of those without an anesthesiologist present.

The trends held constant for age as well as sex: Both polyp detection and colon cancer incidence after 3 years were slightly higher when an anesthesiologist was present for patients aged younger than 65 years and for those aged 65 years and older.

The study is important because there are significant costs – up to $700 per case – when an anesthesiologist is involved in a colonoscopy, although the cost varies by region, Dr. Cash said.

The use of anesthesiologists for colonoscopies began with comorbid patients who had a higher risk of moderate sedation complications, Dr. Cash said. "We have seen that the use of anesthesiologists has become more common, even for patients who are at average risk," he noted.

"What we are going to have to figure out as a society and as professional organizations is whether those additional costs merit the very slight increases in polyp detection rate," said Dr. Cash. "We also need to figure out why the colorectal cancer incidence 3 years after index colonoscopies with anesthesia providers is slightly higher," he said.

Dr. Cash had no financial conflicts to disclose.

CHICAGO – Significantly more polyps were detected during colonoscopies when an anesthesiologist was present, compared with colonoscopies without an anesthesiologist, based on data from more than 4.5 million index colonoscopies. The findings were presented at the annual Digestive Disease Week.

Use of an anesthesiologist during colonoscopy has been associated with improved patient and provider satisfaction, but the diagnostic impact on polyp detection has not been well studied, said Dr. Brooks D. Cash of the National Naval Medical Center in Bethesda, Md.

The report "represents one of the first products of the new AGA [American Gastroenterological Association] Digestive Health Outcomes Registry," said Dr. Cash. "It has become increasingly important to have registries that look at quality and effectiveness of what we do as gastroenterologists," he said.

In this study, Dr. Cash and colleagues reviewed data from 4,539,547 index colonoscopies performed between 2001 and 2010. Based on coding data, approximately one-third of the colonoscopies involved an anesthesiologist.

Overall, the polyp detection rate was 37.7% for procedures with an anesthesiologist present, compared with 37% in procedures without an anesthesiologist. Because of the large numbers in the study, this difference was statistically significant (P less than .05).

In addition, significantly more individuals were diagnosed with colorectal cancer within 3 years of the index colonoscopy with an anesthesiologist present than without an anesthesiologist (1.97% vs. 1.71%).

Among men, the polyp detection rate was 43.18% with an anesthesiologist and 43.08% without an anesthesiologist. Among women, these rates were 33.17% and 31.95%, respectively. The differences were significant for both sexes.

The differences in colorectal cancer diagnosis after 3 years also remained significant by sex, the researchers noted. Among men, 2.12% of those who had an anesthesiologist present for their colonoscopies were diagnosed with colorectal cancer within 3 years, compared with 1.93% of those without an anesthesiologist present. Among women, 1.84% of those who had an anesthesiologist present at their colonoscopies were diagnosed with colorectal cancer within 3 years, compared with 1.54% of those without an anesthesiologist present.

The trends held constant for age as well as sex: Both polyp detection and colon cancer incidence after 3 years were slightly higher when an anesthesiologist was present for patients aged younger than 65 years and for those aged 65 years and older.

The study is important because there are significant costs – up to $700 per case – when an anesthesiologist is involved in a colonoscopy, although the cost varies by region, Dr. Cash said.

The use of anesthesiologists for colonoscopies began with comorbid patients who had a higher risk of moderate sedation complications, Dr. Cash said. "We have seen that the use of anesthesiologists has become more common, even for patients who are at average risk," he noted.

"What we are going to have to figure out as a society and as professional organizations is whether those additional costs merit the very slight increases in polyp detection rate," said Dr. Cash. "We also need to figure out why the colorectal cancer incidence 3 years after index colonoscopies with anesthesia providers is slightly higher," he said.

Dr. Cash had no financial conflicts to disclose.