Heidi Splete

WASHINGTON — Almost one-third of adolescents approved for bariatric surgery reported using psychotropic medications, but the use of substances was lower than expected, according to data from 82 subjects collected as part of a larger longitudinal study.

“Some of the worst consequences of extreme obesity are psychosocial,” Meg H. Zeller, Ph.D., a psychologist at Cincinnati Children's Hospital Medical Center, said at the annual scientific meeting of the Obesity Society.

Longitudinal psychosocial assessment helps document changes associated with bariatric surgery and identify factors that might predict optimal mental and physical health in adolescents after surgery, she said.

To determine the baseline psychosocial characteristics of teens undergoing bariatric surgery, Dr. Zeller and her colleagues reviewed data from adolescents aged 19 years and younger within 30 days before surgery. The average age of the members in study group was 17 years, and the average body mass index was 56 kg/m

The researchers used several validated questionnaires, including the Beck Depression Inventory (BDI), the Impact of Weight on Quality of Life–Kids (IWQOL-Kids), and the Questionnaire on Eating and Weight Patterns–Revised (QEWP-R). The adolescents also responded to questions about substance use and use of mental health services within the previous 12 months.

Overall, 76% of the adolescents reported depressive symptoms based on the BDI. Based the QEWP-R, 11% met screening criteria for binge eating disorder and 6% reported alcohol use, Dr. Zeller said. But 31% reported use of a psychotropic medication, 28% were taking antidepressants, and 11% were taking mood stabilizers. In addition, data from IWQOL-Kids showed significant and global impairments in weight-related quality of life issues.

The low use of drugs and alcohol in the study population may reflect less exposure to peer contacts and peer pressure because of the patients' extreme weight, and it's not unusual for very obese adolescents to be home schooled, Dr. Zeller noted.

“What is critical and ongoing is our follow-up, 6, 12, and 24 months after surgery,” Dr. Zeller added.

The adolescents are part of the ongoing Teen–Longitudinal Assessment of Bariatric Surgery (Teen-LABS). Teen-LABS includes five clinical centers collaborating to facilitate studies of bariatric surgery in adolescents, and to study the causes and effects of severe obesity in teens, according to the Web site, www.teen-LABS.org

Disclosures: The study was supported in part by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases.

WASHINGTON — Almost one-third of adolescents approved for bariatric surgery reported using psychotropic medications, but the use of substances was lower than expected, according to data from 82 subjects collected as part of a larger longitudinal study.

“Some of the worst consequences of extreme obesity are psychosocial,” Meg H. Zeller, Ph.D., a psychologist at Cincinnati Children's Hospital Medical Center, said at the annual scientific meeting of the Obesity Society.

Longitudinal psychosocial assessment helps document changes associated with bariatric surgery and identify factors that might predict optimal mental and physical health in adolescents after surgery, she said.

To determine the baseline psychosocial characteristics of teens undergoing bariatric surgery, Dr. Zeller and her colleagues reviewed data from adolescents aged 19 years and younger within 30 days before surgery. The average age of the members in study group was 17 years, and the average body mass index was 56 kg/m

The researchers used several validated questionnaires, including the Beck Depression Inventory (BDI), the Impact of Weight on Quality of Life–Kids (IWQOL-Kids), and the Questionnaire on Eating and Weight Patterns–Revised (QEWP-R). The adolescents also responded to questions about substance use and use of mental health services within the previous 12 months.

Overall, 76% of the adolescents reported depressive symptoms based on the BDI. Based the QEWP-R, 11% met screening criteria for binge eating disorder and 6% reported alcohol use, Dr. Zeller said. But 31% reported use of a psychotropic medication, 28% were taking antidepressants, and 11% were taking mood stabilizers. In addition, data from IWQOL-Kids showed significant and global impairments in weight-related quality of life issues.

The low use of drugs and alcohol in the study population may reflect less exposure to peer contacts and peer pressure because of the patients' extreme weight, and it's not unusual for very obese adolescents to be home schooled, Dr. Zeller noted.

“What is critical and ongoing is our follow-up, 6, 12, and 24 months after surgery,” Dr. Zeller added.

The adolescents are part of the ongoing Teen–Longitudinal Assessment of Bariatric Surgery (Teen-LABS). Teen-LABS includes five clinical centers collaborating to facilitate studies of bariatric surgery in adolescents, and to study the causes and effects of severe obesity in teens, according to the Web site, www.teen-LABS.org

Disclosures: The study was supported in part by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases.

WASHINGTON — Almost one-third of adolescents approved for bariatric surgery reported using psychotropic medications, but the use of substances was lower than expected, according to data from 82 subjects collected as part of a larger longitudinal study.

“Some of the worst consequences of extreme obesity are psychosocial,” Meg H. Zeller, Ph.D., a psychologist at Cincinnati Children's Hospital Medical Center, said at the annual scientific meeting of the Obesity Society.

Longitudinal psychosocial assessment helps document changes associated with bariatric surgery and identify factors that might predict optimal mental and physical health in adolescents after surgery, she said.

To determine the baseline psychosocial characteristics of teens undergoing bariatric surgery, Dr. Zeller and her colleagues reviewed data from adolescents aged 19 years and younger within 30 days before surgery. The average age of the members in study group was 17 years, and the average body mass index was 56 kg/m

The researchers used several validated questionnaires, including the Beck Depression Inventory (BDI), the Impact of Weight on Quality of Life–Kids (IWQOL-Kids), and the Questionnaire on Eating and Weight Patterns–Revised (QEWP-R). The adolescents also responded to questions about substance use and use of mental health services within the previous 12 months.

Overall, 76% of the adolescents reported depressive symptoms based on the BDI. Based the QEWP-R, 11% met screening criteria for binge eating disorder and 6% reported alcohol use, Dr. Zeller said. But 31% reported use of a psychotropic medication, 28% were taking antidepressants, and 11% were taking mood stabilizers. In addition, data from IWQOL-Kids showed significant and global impairments in weight-related quality of life issues.

The low use of drugs and alcohol in the study population may reflect less exposure to peer contacts and peer pressure because of the patients' extreme weight, and it's not unusual for very obese adolescents to be home schooled, Dr. Zeller noted.

“What is critical and ongoing is our follow-up, 6, 12, and 24 months after surgery,” Dr. Zeller added.

The adolescents are part of the ongoing Teen–Longitudinal Assessment of Bariatric Surgery (Teen-LABS). Teen-LABS includes five clinical centers collaborating to facilitate studies of bariatric surgery in adolescents, and to study the causes and effects of severe obesity in teens, according to the Web site, www.teen-LABS.org

Disclosures: The study was supported in part by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases.

Major Finding: Reducing salt by 3 g daily may reduce the annual new cases of coronary heart disease in the United States by 60,000 to 120,000, annual new cases of stroke by 32,000 to 60,000, and annual new cases of myocardial infarction by 54,000 to 99,000.

Data Source: The Coronary Heart Disease Policy Model.

Disclosures: The study was supported in part by a grant from the American Heart Association Western States Affiliate and an intramural pilot grant from the University of California, San Francisco Clinical and Translational Sciences Institute. Study investigators reported no financial disclosures. The editorialists report their financial disclosures at

A reduction in salt intake of 3 g per day could have an impact on cardiovascular disease and reduce all-cause mortality in the United States by an estimated 44,000 to 99,000 deaths each year, based on a recent study.

“A reduction in dietary salt of 3 g per day would have approximately the same effect on rates of coronary heart disease (CHD) events as a 50% reduction in tobacco use, a 5% reduction in body mass index among obese adults, or the use of statins to treat persons at low or intermediate risk for CHD events,” the researchers wrote.

Dr. Kirsten Bibbins-Domingo of the University of California, San Francisco, and her colleagues used a computer simulation model to predict the effects of a population-wide reduction of salt intake on cardiovascular events in the United States (N. Engl. J. Med. 2010 Jan. 20 [Epub doi: 10.1056/NEJMoa0907355

Reducing daily dietary salt by 3 g would reduce the number of new cases of CHD per year by an estimated 60,000-120,000, according to the computer model. New cases of stroke would be reduced by 32,000-66,000, and new cases of MI would be reduced by 54,000-99,000.

The model predicted that, although all age groups would benefit, middle-aged and older populations would likely have larger relative reductions in CHD incidence and in rates of new and recurrent MI and stroke.

In adults aged 35-64 years, the relative reduction in mortality would be approximately 7%-11% for blacks and 3%-6% for nonblacks.

In addition, a nationwide 3 g per day decrease in salt consumption would save approximately $10 billion to $24 billion in health care costs annually and add approximately 194,000-392,000 quality-adjusted life years.

The researchers acknowledged that the results were limited by the uncertainty of the data used in the model, but added that, despite those limitations, their findings build on those from previous studies.

“Our findings underscore the need for an urgent call to action that will make it possible to achieve these readily attainable cardiovascular benefits,” they said.

The results also showed positive, although less dramatic, improvements in all-cause mortality, CHD, stroke, and MI with reductions of daily salt intake by either 1 g or 2 g.

“As salt intake is reduced, people appear to prefer food with less salt, a phenomenon that is probably related to the accommodation of taste receptors over the course of weeks to months,” the researchers noted.

The benefits seen in the study may be an underestimate, according to an accompanying editorial by Dr. Lawrence J. Appel and Cheryl A.M. Anderson, Ph.D., of Johns Hopkins University in Baltimore. The study did not factor in the impact of modest daily salt reduction on reducing blood pressure in children or mitigating age-related rise in blood pressure in adults, they wrote (N. Engl. J. Med. 2010 Jan. 20 [Epub doi: 10.1056/NEJMe09103.52

Also, results from previous studies suggest that reduced salt intake may reduce the risk of other conditions not included in the computer model: gastric cancer, end-stage kidney disease, congestive heart failure, osteoporosis, and left ventricular hypertrophy, they noted.

Major Finding: Reducing salt by 3 g daily may reduce the annual new cases of coronary heart disease in the United States by 60,000 to 120,000, annual new cases of stroke by 32,000 to 60,000, and annual new cases of myocardial infarction by 54,000 to 99,000.

Data Source: The Coronary Heart Disease Policy Model.

Disclosures: The study was supported in part by a grant from the American Heart Association Western States Affiliate and an intramural pilot grant from the University of California, San Francisco Clinical and Translational Sciences Institute. Study investigators reported no financial disclosures. The editorialists report their financial disclosures at

A reduction in salt intake of 3 g per day could have an impact on cardiovascular disease and reduce all-cause mortality in the United States by an estimated 44,000 to 99,000 deaths each year, based on a recent study.

“A reduction in dietary salt of 3 g per day would have approximately the same effect on rates of coronary heart disease (CHD) events as a 50% reduction in tobacco use, a 5% reduction in body mass index among obese adults, or the use of statins to treat persons at low or intermediate risk for CHD events,” the researchers wrote.

Dr. Kirsten Bibbins-Domingo of the University of California, San Francisco, and her colleagues used a computer simulation model to predict the effects of a population-wide reduction of salt intake on cardiovascular events in the United States (N. Engl. J. Med. 2010 Jan. 20 [Epub doi: 10.1056/NEJMoa0907355

Reducing daily dietary salt by 3 g would reduce the number of new cases of CHD per year by an estimated 60,000-120,000, according to the computer model. New cases of stroke would be reduced by 32,000-66,000, and new cases of MI would be reduced by 54,000-99,000.

The model predicted that, although all age groups would benefit, middle-aged and older populations would likely have larger relative reductions in CHD incidence and in rates of new and recurrent MI and stroke.

In adults aged 35-64 years, the relative reduction in mortality would be approximately 7%-11% for blacks and 3%-6% for nonblacks.

In addition, a nationwide 3 g per day decrease in salt consumption would save approximately $10 billion to $24 billion in health care costs annually and add approximately 194,000-392,000 quality-adjusted life years.

The researchers acknowledged that the results were limited by the uncertainty of the data used in the model, but added that, despite those limitations, their findings build on those from previous studies.

“Our findings underscore the need for an urgent call to action that will make it possible to achieve these readily attainable cardiovascular benefits,” they said.

The results also showed positive, although less dramatic, improvements in all-cause mortality, CHD, stroke, and MI with reductions of daily salt intake by either 1 g or 2 g.

“As salt intake is reduced, people appear to prefer food with less salt, a phenomenon that is probably related to the accommodation of taste receptors over the course of weeks to months,” the researchers noted.

The benefits seen in the study may be an underestimate, according to an accompanying editorial by Dr. Lawrence J. Appel and Cheryl A.M. Anderson, Ph.D., of Johns Hopkins University in Baltimore. The study did not factor in the impact of modest daily salt reduction on reducing blood pressure in children or mitigating age-related rise in blood pressure in adults, they wrote (N. Engl. J. Med. 2010 Jan. 20 [Epub doi: 10.1056/NEJMe09103.52

Also, results from previous studies suggest that reduced salt intake may reduce the risk of other conditions not included in the computer model: gastric cancer, end-stage kidney disease, congestive heart failure, osteoporosis, and left ventricular hypertrophy, they noted.

Major Finding: Reducing salt by 3 g daily may reduce the annual new cases of coronary heart disease in the United States by 60,000 to 120,000, annual new cases of stroke by 32,000 to 60,000, and annual new cases of myocardial infarction by 54,000 to 99,000.

Data Source: The Coronary Heart Disease Policy Model.

Disclosures: The study was supported in part by a grant from the American Heart Association Western States Affiliate and an intramural pilot grant from the University of California, San Francisco Clinical and Translational Sciences Institute. Study investigators reported no financial disclosures. The editorialists report their financial disclosures at

A reduction in salt intake of 3 g per day could have an impact on cardiovascular disease and reduce all-cause mortality in the United States by an estimated 44,000 to 99,000 deaths each year, based on a recent study.

“A reduction in dietary salt of 3 g per day would have approximately the same effect on rates of coronary heart disease (CHD) events as a 50% reduction in tobacco use, a 5% reduction in body mass index among obese adults, or the use of statins to treat persons at low or intermediate risk for CHD events,” the researchers wrote.

Dr. Kirsten Bibbins-Domingo of the University of California, San Francisco, and her colleagues used a computer simulation model to predict the effects of a population-wide reduction of salt intake on cardiovascular events in the United States (N. Engl. J. Med. 2010 Jan. 20 [Epub doi: 10.1056/NEJMoa0907355

Reducing daily dietary salt by 3 g would reduce the number of new cases of CHD per year by an estimated 60,000-120,000, according to the computer model. New cases of stroke would be reduced by 32,000-66,000, and new cases of MI would be reduced by 54,000-99,000.

The model predicted that, although all age groups would benefit, middle-aged and older populations would likely have larger relative reductions in CHD incidence and in rates of new and recurrent MI and stroke.

In adults aged 35-64 years, the relative reduction in mortality would be approximately 7%-11% for blacks and 3%-6% for nonblacks.

In addition, a nationwide 3 g per day decrease in salt consumption would save approximately $10 billion to $24 billion in health care costs annually and add approximately 194,000-392,000 quality-adjusted life years.

The researchers acknowledged that the results were limited by the uncertainty of the data used in the model, but added that, despite those limitations, their findings build on those from previous studies.

“Our findings underscore the need for an urgent call to action that will make it possible to achieve these readily attainable cardiovascular benefits,” they said.

The results also showed positive, although less dramatic, improvements in all-cause mortality, CHD, stroke, and MI with reductions of daily salt intake by either 1 g or 2 g.

“As salt intake is reduced, people appear to prefer food with less salt, a phenomenon that is probably related to the accommodation of taste receptors over the course of weeks to months,” the researchers noted.

The benefits seen in the study may be an underestimate, according to an accompanying editorial by Dr. Lawrence J. Appel and Cheryl A.M. Anderson, Ph.D., of Johns Hopkins University in Baltimore. The study did not factor in the impact of modest daily salt reduction on reducing blood pressure in children or mitigating age-related rise in blood pressure in adults, they wrote (N. Engl. J. Med. 2010 Jan. 20 [Epub doi: 10.1056/NEJMe09103.52

Also, results from previous studies suggest that reduced salt intake may reduce the risk of other conditions not included in the computer model: gastric cancer, end-stage kidney disease, congestive heart failure, osteoporosis, and left ventricular hypertrophy, they noted.

ORLANDO, Fla. – Growing numbers of patients with deeper skin tones are seeking cosmetic procedures involving injectable fillers.

“Many women of color do not have fine lines and wrinkles; they have loss of volume of the skin with

descent of the malar fat pads, prominence of the nasolabial folds, and prominence of the tear troughs, so those are the very areas that are appropriate for injections in women with skin of color, and men as well,” said Dr. Susan Taylor at the Orlando Dermatology Aesthetic and Clinical Conference.

Dr. Taylor, who helped to establish the Skin of Color Center at St. Luke’s–Roosevelt Hospital Center (N.Y.), is now in private practice in Philadelphia. She reviewed the characteristics of aging in patients with skin of color and evidence for the safe use of fillers in these patients.

Patients with skin of color often appear about 10 years younger than white patients of the same age, Dr. Taylor noted. As patients with skin of color age, they tend to have fewer fine and deep rhytids than white patients. But patients with deeper skin tones in their 40s and 50s do experience gravity-dependent changes and volume loss, as well as skeletal changes and soft tissue changes. Thus, these transformations lend themselves to treatment with injectable fillers.

“The options for your skin of color patients are the same options that you have for Caucasian patients,” Dr. Taylor said.

But is it just as safe for persons of color as it is for patients with fair skin? “We know that keloidal scarring develops 3-18 times as often in African American patients as in Caucasian patients,” said Dr. Taylor.

Potential adverse events from soft tissue fillers in patients with Fitzpatrick skin types IV, V, and VI could include postinflammatory hyperpigmentation, postinflammatory hypopigmentation, keloidal scarring, and hypertrophic scarring.

The Food and Drug Administration has conducted postapproval safety studies in Fitzpatrick skin types IV (brown), V (dark brown), and VI (deepest brown to black) for nine dermal fillers, including Restylane, Perlane, and Sculptra, Dr. Taylor said.

Data from three postapproval studies of three fillers each showed that none of the patients with skin of color had hypersensitivity reactions or developed keloids after one or two injections of any of the fillers. Patients in the studies were followed for up to 6 months, approximately.

Overall, 20 (6%) of the 369 patients across the studies developed hyperpigmentation, and 1 developed hypopigmentation, Dr. Taylor said.

“The pigmentation changes were very subtle,” she said.

Changes in pigmentation after injecting fillers in skin or color patients may be due to injection techniques, the use of concomitant anesthesia, or the specific product, Dr. Taylor said.

She advised physicians to look carefully at a patient’s skin prior to injecting any filler to document any pigmentation that was already present to help determine sensitivity and guide their injections techniques accordingly.

There were limitations to the postapproval studies, including the lack of controls and relatively short-term follow-up, and the need for more data.

“But what we can say now is that it’s very important that you warn your patients about the possibility of postinflammatory hyperpigmentation in particular, although hypopigmentation can occur,” Dr. Taylor said. Inform patients that there is a theoretical risk of keloidal scarring, but there have been no reports of keloids in the literature, she added.

To reduce the risk of hyperpigmentation, try a linear threading technique or injecting a bit more deeply to reduce the risk of hyperpigmentation, and note any pigmentation changes over a long-term follow-up period, she said.

Dr. Taylor has served as an investigator, speaker, and/or advisory board member for Allergan, Bioform, Genzyme, Johnson & Johnson, Medicis, Mentor, and Merz.

_{Image above is of Dr. Susan Taylor/Photo Credit: Heidi Splete}

ORLANDO, Fla. – Growing numbers of patients with deeper skin tones are seeking cosmetic procedures involving injectable fillers.

“Many women of color do not have fine lines and wrinkles; they have loss of volume of the skin with

descent of the malar fat pads, prominence of the nasolabial folds, and prominence of the tear troughs, so those are the very areas that are appropriate for injections in women with skin of color, and men as well,” said Dr. Susan Taylor at the Orlando Dermatology Aesthetic and Clinical Conference.

Dr. Taylor, who helped to establish the Skin of Color Center at St. Luke’s–Roosevelt Hospital Center (N.Y.), is now in private practice in Philadelphia. She reviewed the characteristics of aging in patients with skin of color and evidence for the safe use of fillers in these patients.

Patients with skin of color often appear about 10 years younger than white patients of the same age, Dr. Taylor noted. As patients with skin of color age, they tend to have fewer fine and deep rhytids than white patients. But patients with deeper skin tones in their 40s and 50s do experience gravity-dependent changes and volume loss, as well as skeletal changes and soft tissue changes. Thus, these transformations lend themselves to treatment with injectable fillers.

“The options for your skin of color patients are the same options that you have for Caucasian patients,” Dr. Taylor said.

But is it just as safe for persons of color as it is for patients with fair skin? “We know that keloidal scarring develops 3-18 times as often in African American patients as in Caucasian patients,” said Dr. Taylor.

Potential adverse events from soft tissue fillers in patients with Fitzpatrick skin types IV, V, and VI could include postinflammatory hyperpigmentation, postinflammatory hypopigmentation, keloidal scarring, and hypertrophic scarring.

The Food and Drug Administration has conducted postapproval safety studies in Fitzpatrick skin types IV (brown), V (dark brown), and VI (deepest brown to black) for nine dermal fillers, including Restylane, Perlane, and Sculptra, Dr. Taylor said.

Data from three postapproval studies of three fillers each showed that none of the patients with skin of color had hypersensitivity reactions or developed keloids after one or two injections of any of the fillers. Patients in the studies were followed for up to 6 months, approximately.

Overall, 20 (6%) of the 369 patients across the studies developed hyperpigmentation, and 1 developed hypopigmentation, Dr. Taylor said.

“The pigmentation changes were very subtle,” she said.

Changes in pigmentation after injecting fillers in skin or color patients may be due to injection techniques, the use of concomitant anesthesia, or the specific product, Dr. Taylor said.

She advised physicians to look carefully at a patient’s skin prior to injecting any filler to document any pigmentation that was already present to help determine sensitivity and guide their injections techniques accordingly.

There were limitations to the postapproval studies, including the lack of controls and relatively short-term follow-up, and the need for more data.

“But what we can say now is that it’s very important that you warn your patients about the possibility of postinflammatory hyperpigmentation in particular, although hypopigmentation can occur,” Dr. Taylor said. Inform patients that there is a theoretical risk of keloidal scarring, but there have been no reports of keloids in the literature, she added.

To reduce the risk of hyperpigmentation, try a linear threading technique or injecting a bit more deeply to reduce the risk of hyperpigmentation, and note any pigmentation changes over a long-term follow-up period, she said.

Dr. Taylor has served as an investigator, speaker, and/or advisory board member for Allergan, Bioform, Genzyme, Johnson & Johnson, Medicis, Mentor, and Merz.

_{Image above is of Dr. Susan Taylor/Photo Credit: Heidi Splete}

ORLANDO, Fla. – Growing numbers of patients with deeper skin tones are seeking cosmetic procedures involving injectable fillers.

“Many women of color do not have fine lines and wrinkles; they have loss of volume of the skin with

descent of the malar fat pads, prominence of the nasolabial folds, and prominence of the tear troughs, so those are the very areas that are appropriate for injections in women with skin of color, and men as well,” said Dr. Susan Taylor at the Orlando Dermatology Aesthetic and Clinical Conference.

Dr. Taylor, who helped to establish the Skin of Color Center at St. Luke’s–Roosevelt Hospital Center (N.Y.), is now in private practice in Philadelphia. She reviewed the characteristics of aging in patients with skin of color and evidence for the safe use of fillers in these patients.

Patients with skin of color often appear about 10 years younger than white patients of the same age, Dr. Taylor noted. As patients with skin of color age, they tend to have fewer fine and deep rhytids than white patients. But patients with deeper skin tones in their 40s and 50s do experience gravity-dependent changes and volume loss, as well as skeletal changes and soft tissue changes. Thus, these transformations lend themselves to treatment with injectable fillers.

“The options for your skin of color patients are the same options that you have for Caucasian patients,” Dr. Taylor said.

But is it just as safe for persons of color as it is for patients with fair skin? “We know that keloidal scarring develops 3-18 times as often in African American patients as in Caucasian patients,” said Dr. Taylor.

Potential adverse events from soft tissue fillers in patients with Fitzpatrick skin types IV, V, and VI could include postinflammatory hyperpigmentation, postinflammatory hypopigmentation, keloidal scarring, and hypertrophic scarring.

The Food and Drug Administration has conducted postapproval safety studies in Fitzpatrick skin types IV (brown), V (dark brown), and VI (deepest brown to black) for nine dermal fillers, including Restylane, Perlane, and Sculptra, Dr. Taylor said.

Data from three postapproval studies of three fillers each showed that none of the patients with skin of color had hypersensitivity reactions or developed keloids after one or two injections of any of the fillers. Patients in the studies were followed for up to 6 months, approximately.

Overall, 20 (6%) of the 369 patients across the studies developed hyperpigmentation, and 1 developed hypopigmentation, Dr. Taylor said.

“The pigmentation changes were very subtle,” she said.

Changes in pigmentation after injecting fillers in skin or color patients may be due to injection techniques, the use of concomitant anesthesia, or the specific product, Dr. Taylor said.

She advised physicians to look carefully at a patient’s skin prior to injecting any filler to document any pigmentation that was already present to help determine sensitivity and guide their injections techniques accordingly.

There were limitations to the postapproval studies, including the lack of controls and relatively short-term follow-up, and the need for more data.

“But what we can say now is that it’s very important that you warn your patients about the possibility of postinflammatory hyperpigmentation in particular, although hypopigmentation can occur,” Dr. Taylor said. Inform patients that there is a theoretical risk of keloidal scarring, but there have been no reports of keloids in the literature, she added.

To reduce the risk of hyperpigmentation, try a linear threading technique or injecting a bit more deeply to reduce the risk of hyperpigmentation, and note any pigmentation changes over a long-term follow-up period, she said.

Dr. Taylor has served as an investigator, speaker, and/or advisory board member for Allergan, Bioform, Genzyme, Johnson & Johnson, Medicis, Mentor, and Merz.

_{Image above is of Dr. Susan Taylor/Photo Credit: Heidi Splete}

ORLANDO — "There is no perfect lip," according to Dr. Deborah Sarnoff. Instead, the perfect lip is a lip that is aesthetically pleasing to each patient.

She advised dermatologists to keep Leonardo da Vinci's classic proportions in mind when evaluating a patient for perioral rejuvenation. Leonardo's proportions translate approximately to dividing the face into thirds. Consider the area from the base of the nose to the tip of the chin as the lower third of the face, Dr. Sarnoff said at the Orlando Dermatology Aesthetic and Clinical Conference.

Although everyone is different, and cosmetic trends (including lip size) come and go, "we can agree that certain things are more aesthetic," said Dr. Sarnoff, a dermatologic surgeon in Greenvale, N.Y., and clinical professor of dermatology at New York University.

Many younger women are focused on fuller lips, while older women are usually more concerned about fine lines around the lips. Listen to what the patient wants, but "when you analyze someone, think beyond what they are asking for," Dr. Sarnoff said.

Be mindful of trends, and use Leonardo's classic proportions as a guide.

Theoretically, the ratio of the vertical height of the lower lip to the vertical height of the upper lip should be 1.4:1. "Analyze the person's face and see what they want to achieve, and give it the best aesthetic sense you can," she said.

To create the best lip for each patient, start by identifying the cause of the patient's concerns, Dr. Sarnoff said.

She described three factors to consider in perioral aging to help dermatologists and patients decide which treatment or combination of treatments will yield the most aesthetic result:

• Photodamage. If photodamage is the primary problem in the perioral area, consider using dermabrasion, a chemical peel, or a nonablative, erbium, or CO2 laser (standard and fractional).
• Muscle loss. If muscle is the problem, botulinum toxin remains the treatment of choice for dynamic rhytids, including "lipstick bleed lines" and lines that turn down at the corners of the mouth, she said.
• Fat loss. If volume loss due to loss of fat is the problem, choose fillers. Replacement fillers, including hyaluronic acid and collagen, can be injected in the perioral area to add volume to the face, or into the lips themselves.

"Think about what would be the ideal program to rejuvenate around the mouth," Dr. Sarnoff said. It may be that a combination strategy using fillers, laser treatment, and an injection of neurotoxin as a final step to prevent migration of the filler may be the blueprint for the perfect lip for some patients, rather than a single procedure.

During a live demonstration, Dr. Sarnoff shared some additional tips for injecting fillers in the perioral area. The filler should be injected as the needle is pulled out, she suggested, and the injected area should be molded. Physicians should not feel like they have to use the whole syringe in one area—consider adding a bit at the nasolabial fold.

When performing some perioral rejuvenation procedures, she prefers to stand behind the patient's head, instead of standing beside the patient.

Dr. Sarnoff has served as an investigator for Cynosure and DEKA/Eclipse Med. She also has served as a consultant to Allergan, Bioform Medical, Beiersdorf, Home Skinovations, and Abbe Laboratories.

Watch a video interview with Dr. Sarnoff discussing the three keys to lip rejuvenation.

ORLANDO — "There is no perfect lip," according to Dr. Deborah Sarnoff. Instead, the perfect lip is a lip that is aesthetically pleasing to each patient.

She advised dermatologists to keep Leonardo da Vinci's classic proportions in mind when evaluating a patient for perioral rejuvenation. Leonardo's proportions translate approximately to dividing the face into thirds. Consider the area from the base of the nose to the tip of the chin as the lower third of the face, Dr. Sarnoff said at the Orlando Dermatology Aesthetic and Clinical Conference.

Although everyone is different, and cosmetic trends (including lip size) come and go, "we can agree that certain things are more aesthetic," said Dr. Sarnoff, a dermatologic surgeon in Greenvale, N.Y., and clinical professor of dermatology at New York University.

Many younger women are focused on fuller lips, while older women are usually more concerned about fine lines around the lips. Listen to what the patient wants, but "when you analyze someone, think beyond what they are asking for," Dr. Sarnoff said.

Be mindful of trends, and use Leonardo's classic proportions as a guide.

Theoretically, the ratio of the vertical height of the lower lip to the vertical height of the upper lip should be 1.4:1. "Analyze the person's face and see what they want to achieve, and give it the best aesthetic sense you can," she said.

To create the best lip for each patient, start by identifying the cause of the patient's concerns, Dr. Sarnoff said.

She described three factors to consider in perioral aging to help dermatologists and patients decide which treatment or combination of treatments will yield the most aesthetic result:

• Photodamage. If photodamage is the primary problem in the perioral area, consider using dermabrasion, a chemical peel, or a nonablative, erbium, or CO2 laser (standard and fractional).
• Muscle loss. If muscle is the problem, botulinum toxin remains the treatment of choice for dynamic rhytids, including "lipstick bleed lines" and lines that turn down at the corners of the mouth, she said.
• Fat loss. If volume loss due to loss of fat is the problem, choose fillers. Replacement fillers, including hyaluronic acid and collagen, can be injected in the perioral area to add volume to the face, or into the lips themselves.

"Think about what would be the ideal program to rejuvenate around the mouth," Dr. Sarnoff said. It may be that a combination strategy using fillers, laser treatment, and an injection of neurotoxin as a final step to prevent migration of the filler may be the blueprint for the perfect lip for some patients, rather than a single procedure.

During a live demonstration, Dr. Sarnoff shared some additional tips for injecting fillers in the perioral area. The filler should be injected as the needle is pulled out, she suggested, and the injected area should be molded. Physicians should not feel like they have to use the whole syringe in one area—consider adding a bit at the nasolabial fold.

When performing some perioral rejuvenation procedures, she prefers to stand behind the patient's head, instead of standing beside the patient.

Dr. Sarnoff has served as an investigator for Cynosure and DEKA/Eclipse Med. She also has served as a consultant to Allergan, Bioform Medical, Beiersdorf, Home Skinovations, and Abbe Laboratories.

Watch a video interview with Dr. Sarnoff discussing the three keys to lip rejuvenation.

ORLANDO — "There is no perfect lip," according to Dr. Deborah Sarnoff. Instead, the perfect lip is a lip that is aesthetically pleasing to each patient.

She advised dermatologists to keep Leonardo da Vinci's classic proportions in mind when evaluating a patient for perioral rejuvenation. Leonardo's proportions translate approximately to dividing the face into thirds. Consider the area from the base of the nose to the tip of the chin as the lower third of the face, Dr. Sarnoff said at the Orlando Dermatology Aesthetic and Clinical Conference.

Although everyone is different, and cosmetic trends (including lip size) come and go, "we can agree that certain things are more aesthetic," said Dr. Sarnoff, a dermatologic surgeon in Greenvale, N.Y., and clinical professor of dermatology at New York University.

Many younger women are focused on fuller lips, while older women are usually more concerned about fine lines around the lips. Listen to what the patient wants, but "when you analyze someone, think beyond what they are asking for," Dr. Sarnoff said.

Be mindful of trends, and use Leonardo's classic proportions as a guide.

Theoretically, the ratio of the vertical height of the lower lip to the vertical height of the upper lip should be 1.4:1. "Analyze the person's face and see what they want to achieve, and give it the best aesthetic sense you can," she said.

To create the best lip for each patient, start by identifying the cause of the patient's concerns, Dr. Sarnoff said.

She described three factors to consider in perioral aging to help dermatologists and patients decide which treatment or combination of treatments will yield the most aesthetic result:

• Photodamage. If photodamage is the primary problem in the perioral area, consider using dermabrasion, a chemical peel, or a nonablative, erbium, or CO2 laser (standard and fractional).
• Muscle loss. If muscle is the problem, botulinum toxin remains the treatment of choice for dynamic rhytids, including "lipstick bleed lines" and lines that turn down at the corners of the mouth, she said.
• Fat loss. If volume loss due to loss of fat is the problem, choose fillers. Replacement fillers, including hyaluronic acid and collagen, can be injected in the perioral area to add volume to the face, or into the lips themselves.

"Think about what would be the ideal program to rejuvenate around the mouth," Dr. Sarnoff said. It may be that a combination strategy using fillers, laser treatment, and an injection of neurotoxin as a final step to prevent migration of the filler may be the blueprint for the perfect lip for some patients, rather than a single procedure.

During a live demonstration, Dr. Sarnoff shared some additional tips for injecting fillers in the perioral area. The filler should be injected as the needle is pulled out, she suggested, and the injected area should be molded. Physicians should not feel like they have to use the whole syringe in one area—consider adding a bit at the nasolabial fold.

When performing some perioral rejuvenation procedures, she prefers to stand behind the patient's head, instead of standing beside the patient.

Dr. Sarnoff has served as an investigator for Cynosure and DEKA/Eclipse Med. She also has served as a consultant to Allergan, Bioform Medical, Beiersdorf, Home Skinovations, and Abbe Laboratories.

Watch a video interview with Dr. Sarnoff discussing the three keys to lip rejuvenation.

More than half of the adults hospitalized in the early days of the influenza A(H1N1) pandemic in New York City were obese, and 92% of the obese patients had underlying medical conditions, according a review published in the Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report.

To quickly assess the severity of illness and identify those at greatest risk from the emerging virus, researchers at the New York City Department of Health and Mental Hygiene reviewed data from the first 99 patients with polymerase chain reaction–confirmed H1N1 influenza admitted to any hospital in the city during April 25–May 24, 2009.

The study population of 54 men and 45 women was disproportionately young, compared with the general population, the researchers indicated (MMWR 2010;58:1436-40).

A total of 95 patients had fevers when they were admitted to the hospital, and 89 complained of cough. In addition, 37 children and 36 adults had at least one underlying medical condition known to increase the risk of complications from flu, and 7 children and 10 adults had more than one such condition.

Asthma, the most common underlying medical condition, was noted in 29 children (50%) and 19 adults (46%). Chronic metabolic disorders, including diabetes, were reported in 11 patients (11%).

Body mass index data were available for 28 children and 20 adults. Five children and 12 adults were obese (BMI between 30 and 40 kg/m

Three of the four patients who died were obese, and their underlying medical conditions included asthma and Down syndrome, according to the investigators.

A total of 76 patients (77%) were treated with oseltamivir, and 36 (47%) of these were treated within 2 days of the onset of symptoms, but the median time to treatment from the onset of illness was 3 days. Hospital stays were significantly shorter for patients who started antiviral therapy within 2 days, the researchers noted.

The study was limited by several factors including the potential underreporting of cases and the difference in reporting protocol later in the pandemic, when data were collected from sentinel hospitals only.

But H1N1 data collection from sentinel hospitals is underway, with an emphasis on gathering height and weight information to better determine the impact of obesity on hospitalization.

Meanwhile, “public education campaigns should encourage patients at high risk of severe illness to be vaccinated,” the researchers said.

More than half of the adults hospitalized in the early days of the influenza A(H1N1) pandemic in New York City were obese, and 92% of the obese patients had underlying medical conditions, according a review published in the Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report.

To quickly assess the severity of illness and identify those at greatest risk from the emerging virus, researchers at the New York City Department of Health and Mental Hygiene reviewed data from the first 99 patients with polymerase chain reaction–confirmed H1N1 influenza admitted to any hospital in the city during April 25–May 24, 2009.

The study population of 54 men and 45 women was disproportionately young, compared with the general population, the researchers indicated (MMWR 2010;58:1436-40).

A total of 95 patients had fevers when they were admitted to the hospital, and 89 complained of cough. In addition, 37 children and 36 adults had at least one underlying medical condition known to increase the risk of complications from flu, and 7 children and 10 adults had more than one such condition.

Asthma, the most common underlying medical condition, was noted in 29 children (50%) and 19 adults (46%). Chronic metabolic disorders, including diabetes, were reported in 11 patients (11%).

Body mass index data were available for 28 children and 20 adults. Five children and 12 adults were obese (BMI between 30 and 40 kg/m

Three of the four patients who died were obese, and their underlying medical conditions included asthma and Down syndrome, according to the investigators.

A total of 76 patients (77%) were treated with oseltamivir, and 36 (47%) of these were treated within 2 days of the onset of symptoms, but the median time to treatment from the onset of illness was 3 days. Hospital stays were significantly shorter for patients who started antiviral therapy within 2 days, the researchers noted.

The study was limited by several factors including the potential underreporting of cases and the difference in reporting protocol later in the pandemic, when data were collected from sentinel hospitals only.

But H1N1 data collection from sentinel hospitals is underway, with an emphasis on gathering height and weight information to better determine the impact of obesity on hospitalization.

Meanwhile, “public education campaigns should encourage patients at high risk of severe illness to be vaccinated,” the researchers said.

More than half of the adults hospitalized in the early days of the influenza A(H1N1) pandemic in New York City were obese, and 92% of the obese patients had underlying medical conditions, according a review published in the Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report.

To quickly assess the severity of illness and identify those at greatest risk from the emerging virus, researchers at the New York City Department of Health and Mental Hygiene reviewed data from the first 99 patients with polymerase chain reaction–confirmed H1N1 influenza admitted to any hospital in the city during April 25–May 24, 2009.

The study population of 54 men and 45 women was disproportionately young, compared with the general population, the researchers indicated (MMWR 2010;58:1436-40).

A total of 95 patients had fevers when they were admitted to the hospital, and 89 complained of cough. In addition, 37 children and 36 adults had at least one underlying medical condition known to increase the risk of complications from flu, and 7 children and 10 adults had more than one such condition.

Asthma, the most common underlying medical condition, was noted in 29 children (50%) and 19 adults (46%). Chronic metabolic disorders, including diabetes, were reported in 11 patients (11%).

Body mass index data were available for 28 children and 20 adults. Five children and 12 adults were obese (BMI between 30 and 40 kg/m

Three of the four patients who died were obese, and their underlying medical conditions included asthma and Down syndrome, according to the investigators.

A total of 76 patients (77%) were treated with oseltamivir, and 36 (47%) of these were treated within 2 days of the onset of symptoms, but the median time to treatment from the onset of illness was 3 days. Hospital stays were significantly shorter for patients who started antiviral therapy within 2 days, the researchers noted.

The study was limited by several factors including the potential underreporting of cases and the difference in reporting protocol later in the pandemic, when data were collected from sentinel hospitals only.

But H1N1 data collection from sentinel hospitals is underway, with an emphasis on gathering height and weight information to better determine the impact of obesity on hospitalization.

Meanwhile, “public education campaigns should encourage patients at high risk of severe illness to be vaccinated,” the researchers said.

Major findings: TPN-induced hyperglycemia is associated with longer hospital stay, more complications, and higher mortality rates.

Data source: A review of 276 adult medical and surgical patients who received TPN at a single hospital.

Disclosures: Co-author Dr. Guillermo Umpierrez has received research support from the American Diabetes Association and the National Institutes of Health. The other researchers had no financial conflicts to disclose.

Hyperglycemia caused by total parenteral nutrition is significantly associated with increased length of stay, risk of complications, and mortality, according to a study of 276 hospitalized adults.

Furthermore, the best predictors of death and complications in total parenteral nutrition (TPN) patients were blood glucose levels both before and within the first 24 hours of TPN, said Dr. Francisco J. Pasquel of Emory University, Atlanta, and his colleagues.

In this study, the researchers reviewed data from 276 consecutive patients at a single hospital. The average age of the patients was 51 years, and 19% had diabetes before entering the hospital. The patients received TPN for an average of 15 days, and most (65%) were surgical patients (Diabetes Care 2009 Dec. 29 [doi: 10.2337/dc09-1748

After the researchers controlled for age, sex, and diabetes history, mortality was significantly associated with a pre-TPN blood glucose level of 121-150 mg/dL, 151-180 mg/dL, or greater than 180 mg/dL. In addition, blood glucose within 24 hours of TPN was a significant predictor of mortality. Compared with patients who did not die, deceased patients had significantly higher blood glucose within 24 hours of TPN (162 mg/dL vs. 139 mg/dL) and during days 2-10 of TPN (161 mg/dL vs. 142 mg/dL).

Patients with blood glucose greater than 180 mg/dL within 24 hours of TPN were more than three times as likely to develop pneumonia and more than twice as likely to develop acute renal failure, compared with patients with blood glucose levels below 120 mg/dL.

In addition, patients with higher blood glucose levels during TPN treatment spent significantly more time in both the ICU and the hospital compared with patients with lower blood glucose levels.

The results suggest that early intervention against hyperglycemia may improve outcomes for TPN patients.

“Our study indicates that blood glucose values prior to and within 24 hours of TPN are better predictors of hospital mortality and complications than the mean blood glucose during the entire duration of TPN,” the researchers said.

Major findings: TPN-induced hyperglycemia is associated with longer hospital stay, more complications, and higher mortality rates.

Data source: A review of 276 adult medical and surgical patients who received TPN at a single hospital.

Disclosures: Co-author Dr. Guillermo Umpierrez has received research support from the American Diabetes Association and the National Institutes of Health. The other researchers had no financial conflicts to disclose.

Hyperglycemia caused by total parenteral nutrition is significantly associated with increased length of stay, risk of complications, and mortality, according to a study of 276 hospitalized adults.

Furthermore, the best predictors of death and complications in total parenteral nutrition (TPN) patients were blood glucose levels both before and within the first 24 hours of TPN, said Dr. Francisco J. Pasquel of Emory University, Atlanta, and his colleagues.

In this study, the researchers reviewed data from 276 consecutive patients at a single hospital. The average age of the patients was 51 years, and 19% had diabetes before entering the hospital. The patients received TPN for an average of 15 days, and most (65%) were surgical patients (Diabetes Care 2009 Dec. 29 [doi: 10.2337/dc09-1748

After the researchers controlled for age, sex, and diabetes history, mortality was significantly associated with a pre-TPN blood glucose level of 121-150 mg/dL, 151-180 mg/dL, or greater than 180 mg/dL. In addition, blood glucose within 24 hours of TPN was a significant predictor of mortality. Compared with patients who did not die, deceased patients had significantly higher blood glucose within 24 hours of TPN (162 mg/dL vs. 139 mg/dL) and during days 2-10 of TPN (161 mg/dL vs. 142 mg/dL).

Patients with blood glucose greater than 180 mg/dL within 24 hours of TPN were more than three times as likely to develop pneumonia and more than twice as likely to develop acute renal failure, compared with patients with blood glucose levels below 120 mg/dL.

In addition, patients with higher blood glucose levels during TPN treatment spent significantly more time in both the ICU and the hospital compared with patients with lower blood glucose levels.

The results suggest that early intervention against hyperglycemia may improve outcomes for TPN patients.

“Our study indicates that blood glucose values prior to and within 24 hours of TPN are better predictors of hospital mortality and complications than the mean blood glucose during the entire duration of TPN,” the researchers said.

Major findings: TPN-induced hyperglycemia is associated with longer hospital stay, more complications, and higher mortality rates.

Data source: A review of 276 adult medical and surgical patients who received TPN at a single hospital.

Disclosures: Co-author Dr. Guillermo Umpierrez has received research support from the American Diabetes Association and the National Institutes of Health. The other researchers had no financial conflicts to disclose.

Hyperglycemia caused by total parenteral nutrition is significantly associated with increased length of stay, risk of complications, and mortality, according to a study of 276 hospitalized adults.

Furthermore, the best predictors of death and complications in total parenteral nutrition (TPN) patients were blood glucose levels both before and within the first 24 hours of TPN, said Dr. Francisco J. Pasquel of Emory University, Atlanta, and his colleagues.

In this study, the researchers reviewed data from 276 consecutive patients at a single hospital. The average age of the patients was 51 years, and 19% had diabetes before entering the hospital. The patients received TPN for an average of 15 days, and most (65%) were surgical patients (Diabetes Care 2009 Dec. 29 [doi: 10.2337/dc09-1748

After the researchers controlled for age, sex, and diabetes history, mortality was significantly associated with a pre-TPN blood glucose level of 121-150 mg/dL, 151-180 mg/dL, or greater than 180 mg/dL. In addition, blood glucose within 24 hours of TPN was a significant predictor of mortality. Compared with patients who did not die, deceased patients had significantly higher blood glucose within 24 hours of TPN (162 mg/dL vs. 139 mg/dL) and during days 2-10 of TPN (161 mg/dL vs. 142 mg/dL).

Patients with blood glucose greater than 180 mg/dL within 24 hours of TPN were more than three times as likely to develop pneumonia and more than twice as likely to develop acute renal failure, compared with patients with blood glucose levels below 120 mg/dL.

In addition, patients with higher blood glucose levels during TPN treatment spent significantly more time in both the ICU and the hospital compared with patients with lower blood glucose levels.

The results suggest that early intervention against hyperglycemia may improve outcomes for TPN patients.

“Our study indicates that blood glucose values prior to and within 24 hours of TPN are better predictors of hospital mortality and complications than the mean blood glucose during the entire duration of TPN,” the researchers said.

Major Finding: Oral misoprostol may be an alternative to intravenous oxytocin for controlling postpartum hemorrhage.

Data Source: Efficacy of oral misoprostol as an alternative to intravenous oxytocin was studied in 978 women in four hospitals in one trial, and in another 809 women who had received prophylactic oxytocin during the third stage of labor in five hospitals in a second trial.

Disclosures: Both studies were funded by the Bill and Melinda Gates Foundation. Dr. Winikoff and Ms. Blum said they had no financial conflicts to disclose.

Oral misoprostol may be as effective as intravenous oxytocin for controlling postpartum hemorrhage, based on data from two studies. Both studies involved an off-label use of misoprostol, and each study included more than 800 women.

Oxytocin is the drug of choice for postpartum bleeding, but misoprostol may be more feasible in areas with limited resources, said Dr. Beverly Winikoff of Gynuity Health Projects in New York City and her colleagues.

The first study, conducted by Dr. Winikoff and her colleagues, assessed the effectiveness of oral misoprostol as an alternative to oxytocin at four hospitals: one in Ecuador, one in Egypt, and two in Vietnam. The researchers randomized 488 women to receive four 200-mcg tablets of misoprostol and an intravenous saline placebo, while 490 women received 40 IU of intravenous oxytocin and placebo tablets. The average age of the patients was 25 years, and the median blood loss at the time of treatment was 700 mL (Lancet 2010 Jan. 7 [doi:10.1016/S0140-6736(09)61924-3]).

Within 20 minutes of administration, active bleeding was controlled in 440 (90%) of the women in the misoprostol group and 468 (96%) of the women in the oxytocin group. This difference was statistically significant. In addition, significantly more women in the misoprostol group bled at least 300 mL after treatment, compared with the oxytocin group (30% vs. 17%).

Oxytocin stopped active bleeding 2 minutes faster, on average, than did misoprostol, and women in the oxytocin group lost approximately 50 mL less blood than did women in the misoprostol group, the researchers noted. Women in the misoprostol group were significantly more likely than those in the oxytocin group to report shivering (47% vs. 17%) and fever (44% vs. 6%). No women in this study had hysterectomies and no deaths were reported.

Although the difference in treatments was statistically significant, misoprostol could substitute for oxytocin in certain settings, Dr. Winikoff and her colleagues said. “Since many women in developing countries deliver at home or at low-level facilities, misoprostol provides a potential for immediate treatment of postpartum hemorrhage.”

In a second study conducted by Gynuity Health Projects, lead author Jennifer Blum and her colleagues compared 800 mcg of oral misoprostol to 40 IU of intravenous oxytocin for primary postpartum hemorrhage in women who had received prophylactic oxytocin during the third stage of labor. This study included 407 women in the misoprostol group and 402 women in the oxytocin group. As in the first study, the average age of the patients was 25 years, and the median blood loss at the time of treatment was 700 mL. The study was conducted at five hospitals: one in Egypt, one in Turkey, one in Burkina Faso, and two in Vietnam (Lancet 2010 Jan. 7 [doi:10.1016/S0140-6736(09)61923-1]).

Within 20 minutes of administration, active bleeding was controlled in 363 (89%) of the misoprostol group and 360 (90%) of the oxytocin group. Additional blood loss of at least 300 mL occurred in 139 women (34%) in the misoprostol group and 123 women (31%) in the oxytocin group. The differences in bleeding between the two groups were not significant. But women in the misoprostol group were significantly more likely than those in the oxytocin group to report shivering (37% vs. 15%) and fever (22% vs. 15%). In this study, six women had hysterectomies (four with misoprostol and two with oxytonin), and two of these women died because of uncontrolled postpartum bleeding (both with misoprostol).

Major Finding: Oral misoprostol may be an alternative to intravenous oxytocin for controlling postpartum hemorrhage.

Data Source: Efficacy of oral misoprostol as an alternative to intravenous oxytocin was studied in 978 women in four hospitals in one trial, and in another 809 women who had received prophylactic oxytocin during the third stage of labor in five hospitals in a second trial.

Disclosures: Both studies were funded by the Bill and Melinda Gates Foundation. Dr. Winikoff and Ms. Blum said they had no financial conflicts to disclose.

Oral misoprostol may be as effective as intravenous oxytocin for controlling postpartum hemorrhage, based on data from two studies. Both studies involved an off-label use of misoprostol, and each study included more than 800 women.

Oxytocin is the drug of choice for postpartum bleeding, but misoprostol may be more feasible in areas with limited resources, said Dr. Beverly Winikoff of Gynuity Health Projects in New York City and her colleagues.

The first study, conducted by Dr. Winikoff and her colleagues, assessed the effectiveness of oral misoprostol as an alternative to oxytocin at four hospitals: one in Ecuador, one in Egypt, and two in Vietnam. The researchers randomized 488 women to receive four 200-mcg tablets of misoprostol and an intravenous saline placebo, while 490 women received 40 IU of intravenous oxytocin and placebo tablets. The average age of the patients was 25 years, and the median blood loss at the time of treatment was 700 mL (Lancet 2010 Jan. 7 [doi:10.1016/S0140-6736(09)61924-3]).

Within 20 minutes of administration, active bleeding was controlled in 440 (90%) of the women in the misoprostol group and 468 (96%) of the women in the oxytocin group. This difference was statistically significant. In addition, significantly more women in the misoprostol group bled at least 300 mL after treatment, compared with the oxytocin group (30% vs. 17%).

Oxytocin stopped active bleeding 2 minutes faster, on average, than did misoprostol, and women in the oxytocin group lost approximately 50 mL less blood than did women in the misoprostol group, the researchers noted. Women in the misoprostol group were significantly more likely than those in the oxytocin group to report shivering (47% vs. 17%) and fever (44% vs. 6%). No women in this study had hysterectomies and no deaths were reported.

Although the difference in treatments was statistically significant, misoprostol could substitute for oxytocin in certain settings, Dr. Winikoff and her colleagues said. “Since many women in developing countries deliver at home or at low-level facilities, misoprostol provides a potential for immediate treatment of postpartum hemorrhage.”

In a second study conducted by Gynuity Health Projects, lead author Jennifer Blum and her colleagues compared 800 mcg of oral misoprostol to 40 IU of intravenous oxytocin for primary postpartum hemorrhage in women who had received prophylactic oxytocin during the third stage of labor. This study included 407 women in the misoprostol group and 402 women in the oxytocin group. As in the first study, the average age of the patients was 25 years, and the median blood loss at the time of treatment was 700 mL. The study was conducted at five hospitals: one in Egypt, one in Turkey, one in Burkina Faso, and two in Vietnam (Lancet 2010 Jan. 7 [doi:10.1016/S0140-6736(09)61923-1]).

Within 20 minutes of administration, active bleeding was controlled in 363 (89%) of the misoprostol group and 360 (90%) of the oxytocin group. Additional blood loss of at least 300 mL occurred in 139 women (34%) in the misoprostol group and 123 women (31%) in the oxytocin group. The differences in bleeding between the two groups were not significant. But women in the misoprostol group were significantly more likely than those in the oxytocin group to report shivering (37% vs. 15%) and fever (22% vs. 15%). In this study, six women had hysterectomies (four with misoprostol and two with oxytonin), and two of these women died because of uncontrolled postpartum bleeding (both with misoprostol).

Major Finding: Oral misoprostol may be an alternative to intravenous oxytocin for controlling postpartum hemorrhage.

Data Source: Efficacy of oral misoprostol as an alternative to intravenous oxytocin was studied in 978 women in four hospitals in one trial, and in another 809 women who had received prophylactic oxytocin during the third stage of labor in five hospitals in a second trial.

Disclosures: Both studies were funded by the Bill and Melinda Gates Foundation. Dr. Winikoff and Ms. Blum said they had no financial conflicts to disclose.

Oral misoprostol may be as effective as intravenous oxytocin for controlling postpartum hemorrhage, based on data from two studies. Both studies involved an off-label use of misoprostol, and each study included more than 800 women.

Oxytocin is the drug of choice for postpartum bleeding, but misoprostol may be more feasible in areas with limited resources, said Dr. Beverly Winikoff of Gynuity Health Projects in New York City and her colleagues.

The first study, conducted by Dr. Winikoff and her colleagues, assessed the effectiveness of oral misoprostol as an alternative to oxytocin at four hospitals: one in Ecuador, one in Egypt, and two in Vietnam. The researchers randomized 488 women to receive four 200-mcg tablets of misoprostol and an intravenous saline placebo, while 490 women received 40 IU of intravenous oxytocin and placebo tablets. The average age of the patients was 25 years, and the median blood loss at the time of treatment was 700 mL (Lancet 2010 Jan. 7 [doi:10.1016/S0140-6736(09)61924-3]).

Within 20 minutes of administration, active bleeding was controlled in 440 (90%) of the women in the misoprostol group and 468 (96%) of the women in the oxytocin group. This difference was statistically significant. In addition, significantly more women in the misoprostol group bled at least 300 mL after treatment, compared with the oxytocin group (30% vs. 17%).

Oxytocin stopped active bleeding 2 minutes faster, on average, than did misoprostol, and women in the oxytocin group lost approximately 50 mL less blood than did women in the misoprostol group, the researchers noted. Women in the misoprostol group were significantly more likely than those in the oxytocin group to report shivering (47% vs. 17%) and fever (44% vs. 6%). No women in this study had hysterectomies and no deaths were reported.

Although the difference in treatments was statistically significant, misoprostol could substitute for oxytocin in certain settings, Dr. Winikoff and her colleagues said. “Since many women in developing countries deliver at home or at low-level facilities, misoprostol provides a potential for immediate treatment of postpartum hemorrhage.”

In a second study conducted by Gynuity Health Projects, lead author Jennifer Blum and her colleagues compared 800 mcg of oral misoprostol to 40 IU of intravenous oxytocin for primary postpartum hemorrhage in women who had received prophylactic oxytocin during the third stage of labor. This study included 407 women in the misoprostol group and 402 women in the oxytocin group. As in the first study, the average age of the patients was 25 years, and the median blood loss at the time of treatment was 700 mL. The study was conducted at five hospitals: one in Egypt, one in Turkey, one in Burkina Faso, and two in Vietnam (Lancet 2010 Jan. 7 [doi:10.1016/S0140-6736(09)61923-1]).

Within 20 minutes of administration, active bleeding was controlled in 363 (89%) of the misoprostol group and 360 (90%) of the oxytocin group. Additional blood loss of at least 300 mL occurred in 139 women (34%) in the misoprostol group and 123 women (31%) in the oxytocin group. The differences in bleeding between the two groups were not significant. But women in the misoprostol group were significantly more likely than those in the oxytocin group to report shivering (37% vs. 15%) and fever (22% vs. 15%). In this study, six women had hysterectomies (four with misoprostol and two with oxytonin), and two of these women died because of uncontrolled postpartum bleeding (both with misoprostol).

Three Chilean patients had confirmed reinfection with the 2009 pandemic influenza A (H1N1) virus after successful treatment with oseltamivir, according to a letter published in the January 2010 issue of Emerging Infectious Diseases.

“Reinfection is rarely seen in nonpandemic influenza A,” said Dr. Carlos M. Perez of Pontificia Universidad Catolica de Chile (Santiago) and colleagues.

The first patient was a healthy 14-year-old girl who had a fever, sore throat, and nasal congestion when H1N1 infection was confirmed by polymerase chain reaction (PCR) testing. She was treated with oseltamivir, and her symptoms resolved after 2 days.

“Twenty days later, fever, muscle aches, and vomiting developed in the patient,” the researchers said. The patient was treated with amantadine, and she recovered. Subsequent PCR testing confirmed reinfection with pandemic influenza (EID 2010;16:156-7).

The second patient was a 62-year-old woman who developed a high fever, cough, and nasal congestion while she was hospitalized prior to surgery. PCR testing and viral culture confirmed infection with the pandemic H1N1 virus. She received oseltamivir starting 5 days after the onset of symptoms, and the symptoms resolved within the next 5 days.

Two weeks later, while she was still hospitalized, the patient again developed fever, bronchial obstruction, and productive cough; PCR testing again was positive for pandemic H1N1. “The patient was again treated with oseltamivir, and PCR results were negative for influenza after 48 hours of antiviral treatment,” the researchers said.

The third patient was a previously healthy 38-year-old man hospitalized for mitral and aortic valve replacement following acute endocarditis caused by Staphylococcus aureus. The patient developed a sore throat, nasal congestion, cough, and a low-grade fever 11 days after surgery, while he was still hospitalized.

PCR testing confirmed pandemic H1N1 infection, and the patient was treated with oseltamivir. His respiratory symptoms resolved after 5 days. “He was discharged from the hospital, but readmitted 18 days later with nasal congestion, cough, and high fever,” the researchers said. Repeat testing again was positive for pandemic flu; he was successfully retreated with oseltamivir.

H1N1 reinfection in these patients could be due to the high rate of infection in the community at the time, as well as the immunocompromised status of the second and third patients, the researchers noted. The occurrence of two reinfections in hospitalized patients raises the possibility of nosocomial transmission, they added, but more information is needed.

Disclosures: None was reported.

Three Chilean patients had confirmed reinfection with the 2009 pandemic influenza A (H1N1) virus after successful treatment with oseltamivir, according to a letter published in the January 2010 issue of Emerging Infectious Diseases.

“Reinfection is rarely seen in nonpandemic influenza A,” said Dr. Carlos M. Perez of Pontificia Universidad Catolica de Chile (Santiago) and colleagues.

The first patient was a healthy 14-year-old girl who had a fever, sore throat, and nasal congestion when H1N1 infection was confirmed by polymerase chain reaction (PCR) testing. She was treated with oseltamivir, and her symptoms resolved after 2 days.

“Twenty days later, fever, muscle aches, and vomiting developed in the patient,” the researchers said. The patient was treated with amantadine, and she recovered. Subsequent PCR testing confirmed reinfection with pandemic influenza (EID 2010;16:156-7).

The second patient was a 62-year-old woman who developed a high fever, cough, and nasal congestion while she was hospitalized prior to surgery. PCR testing and viral culture confirmed infection with the pandemic H1N1 virus. She received oseltamivir starting 5 days after the onset of symptoms, and the symptoms resolved within the next 5 days.

Two weeks later, while she was still hospitalized, the patient again developed fever, bronchial obstruction, and productive cough; PCR testing again was positive for pandemic H1N1. “The patient was again treated with oseltamivir, and PCR results were negative for influenza after 48 hours of antiviral treatment,” the researchers said.

The third patient was a previously healthy 38-year-old man hospitalized for mitral and aortic valve replacement following acute endocarditis caused by Staphylococcus aureus. The patient developed a sore throat, nasal congestion, cough, and a low-grade fever 11 days after surgery, while he was still hospitalized.

PCR testing confirmed pandemic H1N1 infection, and the patient was treated with oseltamivir. His respiratory symptoms resolved after 5 days. “He was discharged from the hospital, but readmitted 18 days later with nasal congestion, cough, and high fever,” the researchers said. Repeat testing again was positive for pandemic flu; he was successfully retreated with oseltamivir.

H1N1 reinfection in these patients could be due to the high rate of infection in the community at the time, as well as the immunocompromised status of the second and third patients, the researchers noted. The occurrence of two reinfections in hospitalized patients raises the possibility of nosocomial transmission, they added, but more information is needed.

Disclosures: None was reported.

Three Chilean patients had confirmed reinfection with the 2009 pandemic influenza A (H1N1) virus after successful treatment with oseltamivir, according to a letter published in the January 2010 issue of Emerging Infectious Diseases.

“Reinfection is rarely seen in nonpandemic influenza A,” said Dr. Carlos M. Perez of Pontificia Universidad Catolica de Chile (Santiago) and colleagues.

The first patient was a healthy 14-year-old girl who had a fever, sore throat, and nasal congestion when H1N1 infection was confirmed by polymerase chain reaction (PCR) testing. She was treated with oseltamivir, and her symptoms resolved after 2 days.

“Twenty days later, fever, muscle aches, and vomiting developed in the patient,” the researchers said. The patient was treated with amantadine, and she recovered. Subsequent PCR testing confirmed reinfection with pandemic influenza (EID 2010;16:156-7).

The second patient was a 62-year-old woman who developed a high fever, cough, and nasal congestion while she was hospitalized prior to surgery. PCR testing and viral culture confirmed infection with the pandemic H1N1 virus. She received oseltamivir starting 5 days after the onset of symptoms, and the symptoms resolved within the next 5 days.

Two weeks later, while she was still hospitalized, the patient again developed fever, bronchial obstruction, and productive cough; PCR testing again was positive for pandemic H1N1. “The patient was again treated with oseltamivir, and PCR results were negative for influenza after 48 hours of antiviral treatment,” the researchers said.

The third patient was a previously healthy 38-year-old man hospitalized for mitral and aortic valve replacement following acute endocarditis caused by Staphylococcus aureus. The patient developed a sore throat, nasal congestion, cough, and a low-grade fever 11 days after surgery, while he was still hospitalized.

PCR testing confirmed pandemic H1N1 infection, and the patient was treated with oseltamivir. His respiratory symptoms resolved after 5 days. “He was discharged from the hospital, but readmitted 18 days later with nasal congestion, cough, and high fever,” the researchers said. Repeat testing again was positive for pandemic flu; he was successfully retreated with oseltamivir.

H1N1 reinfection in these patients could be due to the high rate of infection in the community at the time, as well as the immunocompromised status of the second and third patients, the researchers noted. The occurrence of two reinfections in hospitalized patients raises the possibility of nosocomial transmission, they added, but more information is needed.

Disclosures: None was reported.

Main Finding: One dose of adjuvant vaccine may protect young children against 2009 H1N1 influenza.

Data Source: A randomized trial of three dosing regimens of H1N1 vaccines, including 194 children aged 3-8 years.

Disclosures: The study was sponsored by Novartis, which manufactured the vaccines used. Study coauthor Dr. Kelly Lindert is an employee of Novartis Vaccines and Diagnostics in Cambridge, Mass.

A single dose of a 7.5-mcg adjuvant vaccine met immunogenicity criteria for protection against the 2009 H1N1 influenza in children aged 3-8 years, based on preliminary data from 390 children in one study.

“The use of adjuvant may provide a rapid immune response at a lower hemagglutinin dose than that required in vaccine without adjuvant,” said Dr. Adriano Arguedas of the Instituto de Atención Pediátrica in San José, Costa Rica, and associates.

They conducted a randomized trial of three dosing regimens of H1N1 vaccines in individuals aged 3-64 years, including 194 children aged 3-8 years and 196 children aged 9-17 years.

The children were randomized to receive one 7.5-mcg hemagglutinin dose with adjuvant, one 15-mcg hemagglutinin dose without adjuvant, or two 15-mcg hemagglutinin doses without adjuvant (N. Engl. J. Med. 2009 Dec. 30 [doi: 10.1056/NEJMc0909988

At 22 days after vaccination, hemagglutinin-inhibition (HI) titers had increased in both age groups for all three vaccine regimens.

After a single dose of each vaccine, children aged 9-17 years met the Food and Drug Administration's Center for Biologics Evaluation and Research (CBER) criteria for immunogenicity, but “in children 3-8 years of age, only the 7.5-mcg dose of 2009 H1N1 vaccine with adjuvant met both the immunogenicity criteria after one dose,” Dr. Arguedas and colleagues wrote.

Neither one nor two 15-mcg doses of unadjuvanted vaccine met the immunogenicity criteria in this younger age group.

According to the CBER criteria, immunogenicity is reached when the lower bound of the two-sided 95% confidence interval was at least 40% in individuals who showed seroconversion on HI assays, and when the lower bound of the two-sided 95% confidence interval was at least 70% in individuals with an HI antibody titer of at least 1:40.

No serious adverse events related to the vaccine were reported in any of the age groups.

The study is ongoing, but the results suggest that use of an adjuvant vaccine could accelerate the process of vaccinating young children (a high-risk group) against H1N1 influenza, the researchers said.

Main Finding: One dose of adjuvant vaccine may protect young children against 2009 H1N1 influenza.

Data Source: A randomized trial of three dosing regimens of H1N1 vaccines, including 194 children aged 3-8 years.

Disclosures: The study was sponsored by Novartis, which manufactured the vaccines used. Study coauthor Dr. Kelly Lindert is an employee of Novartis Vaccines and Diagnostics in Cambridge, Mass.

A single dose of a 7.5-mcg adjuvant vaccine met immunogenicity criteria for protection against the 2009 H1N1 influenza in children aged 3-8 years, based on preliminary data from 390 children in one study.

“The use of adjuvant may provide a rapid immune response at a lower hemagglutinin dose than that required in vaccine without adjuvant,” said Dr. Adriano Arguedas of the Instituto de Atención Pediátrica in San José, Costa Rica, and associates.

They conducted a randomized trial of three dosing regimens of H1N1 vaccines in individuals aged 3-64 years, including 194 children aged 3-8 years and 196 children aged 9-17 years.

The children were randomized to receive one 7.5-mcg hemagglutinin dose with adjuvant, one 15-mcg hemagglutinin dose without adjuvant, or two 15-mcg hemagglutinin doses without adjuvant (N. Engl. J. Med. 2009 Dec. 30 [doi: 10.1056/NEJMc0909988

At 22 days after vaccination, hemagglutinin-inhibition (HI) titers had increased in both age groups for all three vaccine regimens.

After a single dose of each vaccine, children aged 9-17 years met the Food and Drug Administration's Center for Biologics Evaluation and Research (CBER) criteria for immunogenicity, but “in children 3-8 years of age, only the 7.5-mcg dose of 2009 H1N1 vaccine with adjuvant met both the immunogenicity criteria after one dose,” Dr. Arguedas and colleagues wrote.

Neither one nor two 15-mcg doses of unadjuvanted vaccine met the immunogenicity criteria in this younger age group.

According to the CBER criteria, immunogenicity is reached when the lower bound of the two-sided 95% confidence interval was at least 40% in individuals who showed seroconversion on HI assays, and when the lower bound of the two-sided 95% confidence interval was at least 70% in individuals with an HI antibody titer of at least 1:40.

No serious adverse events related to the vaccine were reported in any of the age groups.

The study is ongoing, but the results suggest that use of an adjuvant vaccine could accelerate the process of vaccinating young children (a high-risk group) against H1N1 influenza, the researchers said.

Main Finding: One dose of adjuvant vaccine may protect young children against 2009 H1N1 influenza.

Data Source: A randomized trial of three dosing regimens of H1N1 vaccines, including 194 children aged 3-8 years.

Disclosures: The study was sponsored by Novartis, which manufactured the vaccines used. Study coauthor Dr. Kelly Lindert is an employee of Novartis Vaccines and Diagnostics in Cambridge, Mass.

A single dose of a 7.5-mcg adjuvant vaccine met immunogenicity criteria for protection against the 2009 H1N1 influenza in children aged 3-8 years, based on preliminary data from 390 children in one study.

“The use of adjuvant may provide a rapid immune response at a lower hemagglutinin dose than that required in vaccine without adjuvant,” said Dr. Adriano Arguedas of the Instituto de Atención Pediátrica in San José, Costa Rica, and associates.

They conducted a randomized trial of three dosing regimens of H1N1 vaccines in individuals aged 3-64 years, including 194 children aged 3-8 years and 196 children aged 9-17 years.

The children were randomized to receive one 7.5-mcg hemagglutinin dose with adjuvant, one 15-mcg hemagglutinin dose without adjuvant, or two 15-mcg hemagglutinin doses without adjuvant (N. Engl. J. Med. 2009 Dec. 30 [doi: 10.1056/NEJMc0909988

At 22 days after vaccination, hemagglutinin-inhibition (HI) titers had increased in both age groups for all three vaccine regimens.

After a single dose of each vaccine, children aged 9-17 years met the Food and Drug Administration's Center for Biologics Evaluation and Research (CBER) criteria for immunogenicity, but “in children 3-8 years of age, only the 7.5-mcg dose of 2009 H1N1 vaccine with adjuvant met both the immunogenicity criteria after one dose,” Dr. Arguedas and colleagues wrote.

Neither one nor two 15-mcg doses of unadjuvanted vaccine met the immunogenicity criteria in this younger age group.

According to the CBER criteria, immunogenicity is reached when the lower bound of the two-sided 95% confidence interval was at least 40% in individuals who showed seroconversion on HI assays, and when the lower bound of the two-sided 95% confidence interval was at least 70% in individuals with an HI antibody titer of at least 1:40.

No serious adverse events related to the vaccine were reported in any of the age groups.

The study is ongoing, but the results suggest that use of an adjuvant vaccine could accelerate the process of vaccinating young children (a high-risk group) against H1N1 influenza, the researchers said.

Data from 19 studies support the safety of thimerosal, which is used as a preservative in multidose vials of the pandemic 2009 H1N1 influenza vaccine, according to an updated fact sheet on the Centers for Disease Control and Prevention's Web site.

As with the seasonal flu vaccine, the H1N1 vaccine is produced in single-dose units, which do not contain thimerosal, and in multidose vials, which do contain a small amount of thimerosal to prevent contamination and bacterial growth.

The nasal spray version of the H1N1 vaccine, which contains a live-attenuated influenza vaccine (LAIV), does not contain thimerosal, but also is not approved for many populations at high risk for pandemic flu, such as children aged 6–23 months, pregnant women, or adults with certain other health conditions.

Recent recalls of some single-dose thimerosal-free H1N1 vaccines mean that individuals in H1N1 vaccine priority groups may have trouble finding a thimerosal-free vaccine. However, “it is safe for pregnant women and children to receive a flu vaccine that contains thimerosal,” the agency stressed.

The CDC acknowledged that misconceptions persist about a connection between the thimerosal in some vaccines and the occurrence of autism in children.

“Most research done in the United States, and around the world, shows no link between the thimerosal in vaccines and autism,” according to the CDC. “In fact, sadly, autism rates have actually gone up since thimerosal was taken out of childhood vaccines in 2001, providing further evidence that thimerosal-containing vaccines are not related to autism.”

For the latest information on the H1N1 flu, visit cdc.gov/h1n1flu

Data from 19 studies support the safety of thimerosal, which is used as a preservative in multidose vials of the pandemic 2009 H1N1 influenza vaccine, according to an updated fact sheet on the Centers for Disease Control and Prevention's Web site.

As with the seasonal flu vaccine, the H1N1 vaccine is produced in single-dose units, which do not contain thimerosal, and in multidose vials, which do contain a small amount of thimerosal to prevent contamination and bacterial growth.

The nasal spray version of the H1N1 vaccine, which contains a live-attenuated influenza vaccine (LAIV), does not contain thimerosal, but also is not approved for many populations at high risk for pandemic flu, such as children aged 6–23 months, pregnant women, or adults with certain other health conditions.

Recent recalls of some single-dose thimerosal-free H1N1 vaccines mean that individuals in H1N1 vaccine priority groups may have trouble finding a thimerosal-free vaccine. However, “it is safe for pregnant women and children to receive a flu vaccine that contains thimerosal,” the agency stressed.

The CDC acknowledged that misconceptions persist about a connection between the thimerosal in some vaccines and the occurrence of autism in children.

“Most research done in the United States, and around the world, shows no link between the thimerosal in vaccines and autism,” according to the CDC. “In fact, sadly, autism rates have actually gone up since thimerosal was taken out of childhood vaccines in 2001, providing further evidence that thimerosal-containing vaccines are not related to autism.”

For the latest information on the H1N1 flu, visit cdc.gov/h1n1flu

Data from 19 studies support the safety of thimerosal, which is used as a preservative in multidose vials of the pandemic 2009 H1N1 influenza vaccine, according to an updated fact sheet on the Centers for Disease Control and Prevention's Web site.

As with the seasonal flu vaccine, the H1N1 vaccine is produced in single-dose units, which do not contain thimerosal, and in multidose vials, which do contain a small amount of thimerosal to prevent contamination and bacterial growth.

The nasal spray version of the H1N1 vaccine, which contains a live-attenuated influenza vaccine (LAIV), does not contain thimerosal, but also is not approved for many populations at high risk for pandemic flu, such as children aged 6–23 months, pregnant women, or adults with certain other health conditions.

Recent recalls of some single-dose thimerosal-free H1N1 vaccines mean that individuals in H1N1 vaccine priority groups may have trouble finding a thimerosal-free vaccine. However, “it is safe for pregnant women and children to receive a flu vaccine that contains thimerosal,” the agency stressed.

The CDC acknowledged that misconceptions persist about a connection between the thimerosal in some vaccines and the occurrence of autism in children.

“Most research done in the United States, and around the world, shows no link between the thimerosal in vaccines and autism,” according to the CDC. “In fact, sadly, autism rates have actually gone up since thimerosal was taken out of childhood vaccines in 2001, providing further evidence that thimerosal-containing vaccines are not related to autism.”

For the latest information on the H1N1 flu, visit cdc.gov/h1n1flu