Heidi Splete

WASHINGTON — Vaccine site has little impact on the vaccine's effect, but using a 25-mm needle instead of a 16-mm needle may be more effective in administering flu vaccine to older patients, based on results of a study conducted at the Mayo Clinic in Rochester, Minn.

The Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices currently recommends influenza vaccination for all adults older than 50 years, but studies have shown that vaccine efficacy may be reduced in older adults, said Dr. Prikish Tosh, an infectious disease fellow at the Mayo Clinic.

“We wondered whether vaccine site had any effect,” said Dr. Tosh, who presented the study results at the joint annual meeting of the Interscience Conference on Antimicrobial Agents and Chemotherapy and the Infectious Diseases Society of America.

He and his colleagues also examined whether a longer needle would increase penetration into the muscle and affect immunogenicity and reactogenicity in older patients. Flu vaccine manufacturers recommend 25-mm needles, but some single-dose vials are currently packaged with 16-mm needles, Dr. Tosh said.

In this study, Dr. Tosh and colleagues randomized 133 adults aged 50–88 years to receive the trivalent inactivated influenza vaccine in either the deltoid muscle or the deltoid fat pad. The groups were similar in terms of age, gender, weight, and other demographic characteristics. Patients who were immunocompromised or had previously received the vaccine were excluded.

Antibody titers for each of the three strains of influenza in the vaccine were measured at baseline and at 4–6 weeks after vaccination.

The researchers found no significant differences in antibody response rates between the two groups. “The results … were surprising,” Dr. Tosh said. “At baseline, the antibody levels in the two groups were the same. However, after vaccination, we were expecting to see a substantial difference between the two groups. But we didn't see any difference for any of the three vaccine components.”

Similarly, the researchers found no significant differences in immunogenicity between those who seroconverted and those who did not. “Injecting in the fat pad did increase reactogenicity,” Dr. Tosh noted. The patients who received deltoid fat pad injections reported significantly more redness and swelling, compared with those who had intramuscular injections (34% and 5%, respectively).

In a subset analysis, 66 patients underwent ultrasound before vaccination to assess fat pad thickness. “Based on the ultrasound, a 25-mm needle would have worked for 97% of the subjects,” Dr. Tosh noted. A 25-mm needle would have penetrated the muscle in all of the men and all but 3% of the women, but a 16-mm needle would have failed to penetrate the muscle in 26% of men and 51% of women, he said.

Based on these findings, the use of 25-mm needles, compared with 16-mm needles, increases the likelihood of injection into the muscle, which reduces the reactogenicity of flu shots in the elderly, Dr. Tosh said. Dr. Tosh stated that he had no financial conflicts to report.

WASHINGTON — Vaccine site has little impact on the vaccine's effect, but using a 25-mm needle instead of a 16-mm needle may be more effective in administering flu vaccine to older patients, based on results of a study conducted at the Mayo Clinic in Rochester, Minn.

The Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices currently recommends influenza vaccination for all adults older than 50 years, but studies have shown that vaccine efficacy may be reduced in older adults, said Dr. Prikish Tosh, an infectious disease fellow at the Mayo Clinic.

“We wondered whether vaccine site had any effect,” said Dr. Tosh, who presented the study results at the joint annual meeting of the Interscience Conference on Antimicrobial Agents and Chemotherapy and the Infectious Diseases Society of America.

He and his colleagues also examined whether a longer needle would increase penetration into the muscle and affect immunogenicity and reactogenicity in older patients. Flu vaccine manufacturers recommend 25-mm needles, but some single-dose vials are currently packaged with 16-mm needles, Dr. Tosh said.

In this study, Dr. Tosh and colleagues randomized 133 adults aged 50–88 years to receive the trivalent inactivated influenza vaccine in either the deltoid muscle or the deltoid fat pad. The groups were similar in terms of age, gender, weight, and other demographic characteristics. Patients who were immunocompromised or had previously received the vaccine were excluded.

Antibody titers for each of the three strains of influenza in the vaccine were measured at baseline and at 4–6 weeks after vaccination.

The researchers found no significant differences in antibody response rates between the two groups. “The results … were surprising,” Dr. Tosh said. “At baseline, the antibody levels in the two groups were the same. However, after vaccination, we were expecting to see a substantial difference between the two groups. But we didn't see any difference for any of the three vaccine components.”

Similarly, the researchers found no significant differences in immunogenicity between those who seroconverted and those who did not. “Injecting in the fat pad did increase reactogenicity,” Dr. Tosh noted. The patients who received deltoid fat pad injections reported significantly more redness and swelling, compared with those who had intramuscular injections (34% and 5%, respectively).

In a subset analysis, 66 patients underwent ultrasound before vaccination to assess fat pad thickness. “Based on the ultrasound, a 25-mm needle would have worked for 97% of the subjects,” Dr. Tosh noted. A 25-mm needle would have penetrated the muscle in all of the men and all but 3% of the women, but a 16-mm needle would have failed to penetrate the muscle in 26% of men and 51% of women, he said.

Based on these findings, the use of 25-mm needles, compared with 16-mm needles, increases the likelihood of injection into the muscle, which reduces the reactogenicity of flu shots in the elderly, Dr. Tosh said. Dr. Tosh stated that he had no financial conflicts to report.

WASHINGTON — Vaccine site has little impact on the vaccine's effect, but using a 25-mm needle instead of a 16-mm needle may be more effective in administering flu vaccine to older patients, based on results of a study conducted at the Mayo Clinic in Rochester, Minn.

The Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices currently recommends influenza vaccination for all adults older than 50 years, but studies have shown that vaccine efficacy may be reduced in older adults, said Dr. Prikish Tosh, an infectious disease fellow at the Mayo Clinic.

“We wondered whether vaccine site had any effect,” said Dr. Tosh, who presented the study results at the joint annual meeting of the Interscience Conference on Antimicrobial Agents and Chemotherapy and the Infectious Diseases Society of America.

He and his colleagues also examined whether a longer needle would increase penetration into the muscle and affect immunogenicity and reactogenicity in older patients. Flu vaccine manufacturers recommend 25-mm needles, but some single-dose vials are currently packaged with 16-mm needles, Dr. Tosh said.

In this study, Dr. Tosh and colleagues randomized 133 adults aged 50–88 years to receive the trivalent inactivated influenza vaccine in either the deltoid muscle or the deltoid fat pad. The groups were similar in terms of age, gender, weight, and other demographic characteristics. Patients who were immunocompromised or had previously received the vaccine were excluded.

Antibody titers for each of the three strains of influenza in the vaccine were measured at baseline and at 4–6 weeks after vaccination.

The researchers found no significant differences in antibody response rates between the two groups. “The results … were surprising,” Dr. Tosh said. “At baseline, the antibody levels in the two groups were the same. However, after vaccination, we were expecting to see a substantial difference between the two groups. But we didn't see any difference for any of the three vaccine components.”

Similarly, the researchers found no significant differences in immunogenicity between those who seroconverted and those who did not. “Injecting in the fat pad did increase reactogenicity,” Dr. Tosh noted. The patients who received deltoid fat pad injections reported significantly more redness and swelling, compared with those who had intramuscular injections (34% and 5%, respectively).

In a subset analysis, 66 patients underwent ultrasound before vaccination to assess fat pad thickness. “Based on the ultrasound, a 25-mm needle would have worked for 97% of the subjects,” Dr. Tosh noted. A 25-mm needle would have penetrated the muscle in all of the men and all but 3% of the women, but a 16-mm needle would have failed to penetrate the muscle in 26% of men and 51% of women, he said.

Based on these findings, the use of 25-mm needles, compared with 16-mm needles, increases the likelihood of injection into the muscle, which reduces the reactogenicity of flu shots in the elderly, Dr. Tosh said. Dr. Tosh stated that he had no financial conflicts to report.

WASHINGTON — Blood type AB appears to be a risk factor for preeclampsia, based on the findings of a population-based study of 100,000 consecutive pregnancies in Finland.

Maternal blood type, routinely recorded in pregnancy, may be another way of identifying women at risk for preterm preeclampsia, especially those with other risk factors such as a high body mass index, first pregnancy, or twin pregnancy, said Dr. Hannele Laivuori of the department of medical genetics at the University of Helsinki and colleagues. The results were presented as a poster at the annual congress of the International Society for the Study of Hypertension in Pregnancy.

To examine whether ABO blood type and factor V Leiden clotting factor are associated with preeclampsia risk, the researchers reviewed data from a national registry of blood types of pregnant women and a national registry of medical records.

The nested study population included 248 women who met criteria for preeclampsia and 679 women without preeclampsia who were control subjects. The women gave blood samples and completed questionnaires to supplement the information from their medical records.

Overall, women with the AB blood type were more than twice as likely to develop preeclampsia (odds ratio, 2.1) and nearly four times as likely to develop preterm preeclampsia (OR, 3.8) as were women with blood types A, B, or O. Preterm preeclampsia was defined as preeclampsia at less than 34 weeks' gestation. When only a first pregnancy was analyzed, the association between blood type AB and preeclampsia was significant only for preterm preeclampsia.

“Factor V Leiden was not a risk factor for preeclampsia in this study population,” the researchers noted.

Age, education level, and place of residence (rural vs. urban) were similar for those with and without preeclampsia. After investigators controlled for confounding factors, a high body mass index before pregnancy, first pregnancy, and twin pregnancy were significantly associated with an increased risk of preeclampsia.

The findings support those of the few previous studies on this topic, including an Italian study that found women with blood type AB were three times as likely to develop preeclampsia as were women with other blood types (J. Hum. Hypertens. 1995;9:623–5).

The study was supported in part by the Red Cross Finland Blood Service.

Dr. Laivuori stated that she had no relevant financial conflicts to disclose.

WASHINGTON — Blood type AB appears to be a risk factor for preeclampsia, based on the findings of a population-based study of 100,000 consecutive pregnancies in Finland.

Maternal blood type, routinely recorded in pregnancy, may be another way of identifying women at risk for preterm preeclampsia, especially those with other risk factors such as a high body mass index, first pregnancy, or twin pregnancy, said Dr. Hannele Laivuori of the department of medical genetics at the University of Helsinki and colleagues. The results were presented as a poster at the annual congress of the International Society for the Study of Hypertension in Pregnancy.

To examine whether ABO blood type and factor V Leiden clotting factor are associated with preeclampsia risk, the researchers reviewed data from a national registry of blood types of pregnant women and a national registry of medical records.

The nested study population included 248 women who met criteria for preeclampsia and 679 women without preeclampsia who were control subjects. The women gave blood samples and completed questionnaires to supplement the information from their medical records.

Overall, women with the AB blood type were more than twice as likely to develop preeclampsia (odds ratio, 2.1) and nearly four times as likely to develop preterm preeclampsia (OR, 3.8) as were women with blood types A, B, or O. Preterm preeclampsia was defined as preeclampsia at less than 34 weeks' gestation. When only a first pregnancy was analyzed, the association between blood type AB and preeclampsia was significant only for preterm preeclampsia.

“Factor V Leiden was not a risk factor for preeclampsia in this study population,” the researchers noted.

Age, education level, and place of residence (rural vs. urban) were similar for those with and without preeclampsia. After investigators controlled for confounding factors, a high body mass index before pregnancy, first pregnancy, and twin pregnancy were significantly associated with an increased risk of preeclampsia.

The findings support those of the few previous studies on this topic, including an Italian study that found women with blood type AB were three times as likely to develop preeclampsia as were women with other blood types (J. Hum. Hypertens. 1995;9:623–5).

The study was supported in part by the Red Cross Finland Blood Service.

Dr. Laivuori stated that she had no relevant financial conflicts to disclose.

WASHINGTON — Blood type AB appears to be a risk factor for preeclampsia, based on the findings of a population-based study of 100,000 consecutive pregnancies in Finland.

Maternal blood type, routinely recorded in pregnancy, may be another way of identifying women at risk for preterm preeclampsia, especially those with other risk factors such as a high body mass index, first pregnancy, or twin pregnancy, said Dr. Hannele Laivuori of the department of medical genetics at the University of Helsinki and colleagues. The results were presented as a poster at the annual congress of the International Society for the Study of Hypertension in Pregnancy.

To examine whether ABO blood type and factor V Leiden clotting factor are associated with preeclampsia risk, the researchers reviewed data from a national registry of blood types of pregnant women and a national registry of medical records.

The nested study population included 248 women who met criteria for preeclampsia and 679 women without preeclampsia who were control subjects. The women gave blood samples and completed questionnaires to supplement the information from their medical records.

Overall, women with the AB blood type were more than twice as likely to develop preeclampsia (odds ratio, 2.1) and nearly four times as likely to develop preterm preeclampsia (OR, 3.8) as were women with blood types A, B, or O. Preterm preeclampsia was defined as preeclampsia at less than 34 weeks' gestation. When only a first pregnancy was analyzed, the association between blood type AB and preeclampsia was significant only for preterm preeclampsia.

“Factor V Leiden was not a risk factor for preeclampsia in this study population,” the researchers noted.

Age, education level, and place of residence (rural vs. urban) were similar for those with and without preeclampsia. After investigators controlled for confounding factors, a high body mass index before pregnancy, first pregnancy, and twin pregnancy were significantly associated with an increased risk of preeclampsia.

The findings support those of the few previous studies on this topic, including an Italian study that found women with blood type AB were three times as likely to develop preeclampsia as were women with other blood types (J. Hum. Hypertens. 1995;9:623–5).

The study was supported in part by the Red Cross Finland Blood Service.

Dr. Laivuori stated that she had no relevant financial conflicts to disclose.

WASHINGTON — Two types of newly recognized coronavirus were identified in stool samples of patients with gastrointestinal disease, and more than half of those patients also had respiratory symptoms, based on data from more than 400 adults and children.

A total of nine stool samples that tested negative for Clostridium difficile instead tested positive for one of two strains of human coronavirus, HCoV-NL63 and HCoV-HKU1, said Dr. Frank Esper, a pediatrician and infectious disease specialist at the Rainbow Babies and Children's Hospital in Cleveland.

Dr. Esper presented the findings at the jointly held annual Interscience Conference on Antimicrobial Agents and Chemotherapy and the annual meeting of the Infectious Diseases Society of America.

These two coronaviruses have been associated with upper and lower respiratory tract disease in previous studies, he said.

During the severe acute respiratory syndrome (SARS) outbreak in 2002–2003, enteric involvement was reported in more than 70% of patients during their illnesses, and coronavirus RNA was found in stool samples from SARS patients, Dr. Esper noted.

In the current study, Dr. Esper and his colleagues examined the association of coronaviruses with gastrointestinal illness in children and adults.

The researchers collected stool samples at a single hospital between Dec. 1, 2007, and March 31, 2008. They examined samples from 328 adults (average age 62 years) and 151 children younger than 18 years (average age 4 years). They extracted nucleic acid from each stool sample and screened for coronavirus using a polymerase chain reaction test.

Nine samples (2.7%) screened positive for coronaviruses, including four samples from adults and five from children. Overall, 78% of the positive samples were HKU1 and 22% were NL63. None of the stool samples screened positive for norovirus or rotavirus, but two samples with coronavirus were also positive for enteric adenovirus, Dr. Esper said.

All of the samples that tested positive for NL63 came from adults, but the majority (five of seven samples) that tested positive for HKU1 came from children.

Clinical gastrointestinal characteristics in patients with coronavirus-positive stool included gastrointestinal illness, diarrhea, and abdominal pain. “Over 50% of the patients with coronavirus also had respiratory tract findings,” Dr. Esper noted. Respiratory symptoms included difficulty breathing, coughing, and rhinorrhea.

More research is needed, but the current study is an important step toward understanding a link between respiratory disease and gastrointestinal disease in coronavirus infections, he said.

Dr. Esper stated that he had no financial conflicts to disclose.

WASHINGTON — Two types of newly recognized coronavirus were identified in stool samples of patients with gastrointestinal disease, and more than half of those patients also had respiratory symptoms, based on data from more than 400 adults and children.

A total of nine stool samples that tested negative for Clostridium difficile instead tested positive for one of two strains of human coronavirus, HCoV-NL63 and HCoV-HKU1, said Dr. Frank Esper, a pediatrician and infectious disease specialist at the Rainbow Babies and Children's Hospital in Cleveland.

Dr. Esper presented the findings at the jointly held annual Interscience Conference on Antimicrobial Agents and Chemotherapy and the annual meeting of the Infectious Diseases Society of America.

These two coronaviruses have been associated with upper and lower respiratory tract disease in previous studies, he said.

During the severe acute respiratory syndrome (SARS) outbreak in 2002–2003, enteric involvement was reported in more than 70% of patients during their illnesses, and coronavirus RNA was found in stool samples from SARS patients, Dr. Esper noted.

In the current study, Dr. Esper and his colleagues examined the association of coronaviruses with gastrointestinal illness in children and adults.

The researchers collected stool samples at a single hospital between Dec. 1, 2007, and March 31, 2008. They examined samples from 328 adults (average age 62 years) and 151 children younger than 18 years (average age 4 years). They extracted nucleic acid from each stool sample and screened for coronavirus using a polymerase chain reaction test.

Nine samples (2.7%) screened positive for coronaviruses, including four samples from adults and five from children. Overall, 78% of the positive samples were HKU1 and 22% were NL63. None of the stool samples screened positive for norovirus or rotavirus, but two samples with coronavirus were also positive for enteric adenovirus, Dr. Esper said.

All of the samples that tested positive for NL63 came from adults, but the majority (five of seven samples) that tested positive for HKU1 came from children.

Clinical gastrointestinal characteristics in patients with coronavirus-positive stool included gastrointestinal illness, diarrhea, and abdominal pain. “Over 50% of the patients with coronavirus also had respiratory tract findings,” Dr. Esper noted. Respiratory symptoms included difficulty breathing, coughing, and rhinorrhea.

More research is needed, but the current study is an important step toward understanding a link between respiratory disease and gastrointestinal disease in coronavirus infections, he said.

Dr. Esper stated that he had no financial conflicts to disclose.

WASHINGTON — Two types of newly recognized coronavirus were identified in stool samples of patients with gastrointestinal disease, and more than half of those patients also had respiratory symptoms, based on data from more than 400 adults and children.

A total of nine stool samples that tested negative for Clostridium difficile instead tested positive for one of two strains of human coronavirus, HCoV-NL63 and HCoV-HKU1, said Dr. Frank Esper, a pediatrician and infectious disease specialist at the Rainbow Babies and Children's Hospital in Cleveland.

Dr. Esper presented the findings at the jointly held annual Interscience Conference on Antimicrobial Agents and Chemotherapy and the annual meeting of the Infectious Diseases Society of America.

These two coronaviruses have been associated with upper and lower respiratory tract disease in previous studies, he said.

During the severe acute respiratory syndrome (SARS) outbreak in 2002–2003, enteric involvement was reported in more than 70% of patients during their illnesses, and coronavirus RNA was found in stool samples from SARS patients, Dr. Esper noted.

In the current study, Dr. Esper and his colleagues examined the association of coronaviruses with gastrointestinal illness in children and adults.

The researchers collected stool samples at a single hospital between Dec. 1, 2007, and March 31, 2008. They examined samples from 328 adults (average age 62 years) and 151 children younger than 18 years (average age 4 years). They extracted nucleic acid from each stool sample and screened for coronavirus using a polymerase chain reaction test.

Nine samples (2.7%) screened positive for coronaviruses, including four samples from adults and five from children. Overall, 78% of the positive samples were HKU1 and 22% were NL63. None of the stool samples screened positive for norovirus or rotavirus, but two samples with coronavirus were also positive for enteric adenovirus, Dr. Esper said.

All of the samples that tested positive for NL63 came from adults, but the majority (five of seven samples) that tested positive for HKU1 came from children.

Clinical gastrointestinal characteristics in patients with coronavirus-positive stool included gastrointestinal illness, diarrhea, and abdominal pain. “Over 50% of the patients with coronavirus also had respiratory tract findings,” Dr. Esper noted. Respiratory symptoms included difficulty breathing, coughing, and rhinorrhea.

More research is needed, but the current study is an important step toward understanding a link between respiratory disease and gastrointestinal disease in coronavirus infections, he said.

Dr. Esper stated that he had no financial conflicts to disclose.

WASHINGTON — Serotype 19A of Streptococcus pneumoniae is the culprit behind some complicated cases of necrotizing pneumonia in young children, based on findings from four cases that occurred between September 7, 2007, and March 30, 2008, at a single hospital.

“Severe necrotizing pneumonia caused by this serotype had not previously been reported in children,” explained Dr. Susan Wootton of the University of Texas, Houston, who presented the cases with her associates in a poster at the jointly held annual meeting of the Interscience Conference on Antimicrobial Agents and Chemotherapy and the annual meeting of the Infectious Diseases Society of America.

The 19A strain is one of several that are not included in the current pneumococcal conjugate vaccine, PCV7. Data from the Centers for Disease Control and Prevention that also were presented at the meeting showed an increase in invasive pneumococcal disease from nonvaccine serotypes in all age groups.

The four children ranged in age from 3 to 4 years (mean age, 3.4 years). Of these, three were previously healthy and one had asthma. All four had been vaccinated with PCV7. S. pneumoniae was isolated from pleural fluid in three cases and from blood in three cases.

Chest radiographs revealed multilobar infiltrates in four children, empyema in three children, and pneumatoceles in two children. Overall, three children were admitted to the intensive care unit and intubated 5–22 days, with an average of 11 days. In addition, three children had abscesses that required surgical drainage. The hospital stays ranged from 11 to 28 days (average stay, 19 days).

Serotype 19A has not previously been reported as a cause of complicated pneumonia in children, but these cases suggest that it should now be considered in the differential diagnosis, Dr. Wootton and her associates noted.

This study was limited by its small size and narrow geographical scope, and more research is needed to assess the large-scale impact of serotype 19A on necrotizing pneumonia. But the results support the need for an expanded pneumococcal vaccine for children in the United States, they said.

Dr. Wootton stated that she had no financial conflicts to disclose.

WASHINGTON — Serotype 19A of Streptococcus pneumoniae is the culprit behind some complicated cases of necrotizing pneumonia in young children, based on findings from four cases that occurred between September 7, 2007, and March 30, 2008, at a single hospital.

“Severe necrotizing pneumonia caused by this serotype had not previously been reported in children,” explained Dr. Susan Wootton of the University of Texas, Houston, who presented the cases with her associates in a poster at the jointly held annual meeting of the Interscience Conference on Antimicrobial Agents and Chemotherapy and the annual meeting of the Infectious Diseases Society of America.

The 19A strain is one of several that are not included in the current pneumococcal conjugate vaccine, PCV7. Data from the Centers for Disease Control and Prevention that also were presented at the meeting showed an increase in invasive pneumococcal disease from nonvaccine serotypes in all age groups.

The four children ranged in age from 3 to 4 years (mean age, 3.4 years). Of these, three were previously healthy and one had asthma. All four had been vaccinated with PCV7. S. pneumoniae was isolated from pleural fluid in three cases and from blood in three cases.

Chest radiographs revealed multilobar infiltrates in four children, empyema in three children, and pneumatoceles in two children. Overall, three children were admitted to the intensive care unit and intubated 5–22 days, with an average of 11 days. In addition, three children had abscesses that required surgical drainage. The hospital stays ranged from 11 to 28 days (average stay, 19 days).

Serotype 19A has not previously been reported as a cause of complicated pneumonia in children, but these cases suggest that it should now be considered in the differential diagnosis, Dr. Wootton and her associates noted.

This study was limited by its small size and narrow geographical scope, and more research is needed to assess the large-scale impact of serotype 19A on necrotizing pneumonia. But the results support the need for an expanded pneumococcal vaccine for children in the United States, they said.

Dr. Wootton stated that she had no financial conflicts to disclose.

WASHINGTON — Serotype 19A of Streptococcus pneumoniae is the culprit behind some complicated cases of necrotizing pneumonia in young children, based on findings from four cases that occurred between September 7, 2007, and March 30, 2008, at a single hospital.

“Severe necrotizing pneumonia caused by this serotype had not previously been reported in children,” explained Dr. Susan Wootton of the University of Texas, Houston, who presented the cases with her associates in a poster at the jointly held annual meeting of the Interscience Conference on Antimicrobial Agents and Chemotherapy and the annual meeting of the Infectious Diseases Society of America.

The 19A strain is one of several that are not included in the current pneumococcal conjugate vaccine, PCV7. Data from the Centers for Disease Control and Prevention that also were presented at the meeting showed an increase in invasive pneumococcal disease from nonvaccine serotypes in all age groups.

The four children ranged in age from 3 to 4 years (mean age, 3.4 years). Of these, three were previously healthy and one had asthma. All four had been vaccinated with PCV7. S. pneumoniae was isolated from pleural fluid in three cases and from blood in three cases.

Chest radiographs revealed multilobar infiltrates in four children, empyema in three children, and pneumatoceles in two children. Overall, three children were admitted to the intensive care unit and intubated 5–22 days, with an average of 11 days. In addition, three children had abscesses that required surgical drainage. The hospital stays ranged from 11 to 28 days (average stay, 19 days).

Serotype 19A has not previously been reported as a cause of complicated pneumonia in children, but these cases suggest that it should now be considered in the differential diagnosis, Dr. Wootton and her associates noted.

This study was limited by its small size and narrow geographical scope, and more research is needed to assess the large-scale impact of serotype 19A on necrotizing pneumonia. But the results support the need for an expanded pneumococcal vaccine for children in the United States, they said.

Dr. Wootton stated that she had no financial conflicts to disclose.

WASHINGTON — Parents are right to suspect that pediatric waiting room toys are germy: Researchers found viral RNA on 20% of toys in a sick child waiting room, based on samples from three different days in different seasons.

“Mothers in waiting rooms across the country are very concerned that their children play with these toys and will pick up something, although this belief has never been confirmed,” said Dr. Diane Pappas of the University of Virginia, Charlottesville.

“Our study was set up to look for respiratory viral RNA on toys in the waiting room,” she said at the jointly held annual Interscience Conference on Antimicrobial Agents and Chemotherapy and the annual meeting of the Infectious Diseases Society of America.

The researchers took 20 swab samples from the sick and well waiting rooms in a general pediatric office on three occasions: October 2006, January 2007, and March 2007. These time periods corresponded with a high community prevalence of rhinovirus, respiratory syncytial virus, and influenza viruses, respectively. “We tested a little differently depending on what was in the community at the time,” Dr. Pappas said.

Overall, 12 (20%) of 60 samples were positive for viral RNA. Of these, 11 were picornavirus and 1 was influenza B. When the results were broken down by location, 3 (30%) of 10 new toys in the “grab bag” (in which packages were handled repeatedly by children in the process of selecting 1 toy), were positive, as were 6 (20%) of 30 toys in the sick child waiting room, and 2 (17%) of 12 toys in the well child waiting room. And one of three (33%) samples from a pediatrician's stethoscope was positive.

The researchers also tested the effectiveness of the office cleaning protocol, which involved wiping the toys with a disinfectant cloth, and they collected 15 samples from the sick waiting room before and after cleaning.

Before cleaning, viral RNA was found on 6 (40%) of 15 toys in the office waiting room, including the yellow dump truck and the “very popular stegosaurus,” said Dr. Pappas. After cleaning, 4 (27%) of the 15 toys were still positive for viral RNA.

The results suggest that pediatric office toys often are contaminated with viral RNA, even when they are cleaned. But the presence of viral RNA does not mean that the virus is infectious—whether viral remnants left on toys can cause infections in children who play with the toys remains unknown, Dr. Pappas said.

Dr. Pappas stated that she had no financial conflicts of interest to disclose.

After being wiped down with a disinfectant cloth, 4 of 15 toys in a sick waiting room still tested positive for viral RNA. Vivian E. Lee/Elsevier Global Medical News

WASHINGTON — Parents are right to suspect that pediatric waiting room toys are germy: Researchers found viral RNA on 20% of toys in a sick child waiting room, based on samples from three different days in different seasons.

“Mothers in waiting rooms across the country are very concerned that their children play with these toys and will pick up something, although this belief has never been confirmed,” said Dr. Diane Pappas of the University of Virginia, Charlottesville.

“Our study was set up to look for respiratory viral RNA on toys in the waiting room,” she said at the jointly held annual Interscience Conference on Antimicrobial Agents and Chemotherapy and the annual meeting of the Infectious Diseases Society of America.

The researchers took 20 swab samples from the sick and well waiting rooms in a general pediatric office on three occasions: October 2006, January 2007, and March 2007. These time periods corresponded with a high community prevalence of rhinovirus, respiratory syncytial virus, and influenza viruses, respectively. “We tested a little differently depending on what was in the community at the time,” Dr. Pappas said.

Overall, 12 (20%) of 60 samples were positive for viral RNA. Of these, 11 were picornavirus and 1 was influenza B. When the results were broken down by location, 3 (30%) of 10 new toys in the “grab bag” (in which packages were handled repeatedly by children in the process of selecting 1 toy), were positive, as were 6 (20%) of 30 toys in the sick child waiting room, and 2 (17%) of 12 toys in the well child waiting room. And one of three (33%) samples from a pediatrician's stethoscope was positive.

The researchers also tested the effectiveness of the office cleaning protocol, which involved wiping the toys with a disinfectant cloth, and they collected 15 samples from the sick waiting room before and after cleaning.

Before cleaning, viral RNA was found on 6 (40%) of 15 toys in the office waiting room, including the yellow dump truck and the “very popular stegosaurus,” said Dr. Pappas. After cleaning, 4 (27%) of the 15 toys were still positive for viral RNA.

The results suggest that pediatric office toys often are contaminated with viral RNA, even when they are cleaned. But the presence of viral RNA does not mean that the virus is infectious—whether viral remnants left on toys can cause infections in children who play with the toys remains unknown, Dr. Pappas said.

Dr. Pappas stated that she had no financial conflicts of interest to disclose.

After being wiped down with a disinfectant cloth, 4 of 15 toys in a sick waiting room still tested positive for viral RNA. Vivian E. Lee/Elsevier Global Medical News

WASHINGTON — Parents are right to suspect that pediatric waiting room toys are germy: Researchers found viral RNA on 20% of toys in a sick child waiting room, based on samples from three different days in different seasons.

“Mothers in waiting rooms across the country are very concerned that their children play with these toys and will pick up something, although this belief has never been confirmed,” said Dr. Diane Pappas of the University of Virginia, Charlottesville.

“Our study was set up to look for respiratory viral RNA on toys in the waiting room,” she said at the jointly held annual Interscience Conference on Antimicrobial Agents and Chemotherapy and the annual meeting of the Infectious Diseases Society of America.

The researchers took 20 swab samples from the sick and well waiting rooms in a general pediatric office on three occasions: October 2006, January 2007, and March 2007. These time periods corresponded with a high community prevalence of rhinovirus, respiratory syncytial virus, and influenza viruses, respectively. “We tested a little differently depending on what was in the community at the time,” Dr. Pappas said.

Overall, 12 (20%) of 60 samples were positive for viral RNA. Of these, 11 were picornavirus and 1 was influenza B. When the results were broken down by location, 3 (30%) of 10 new toys in the “grab bag” (in which packages were handled repeatedly by children in the process of selecting 1 toy), were positive, as were 6 (20%) of 30 toys in the sick child waiting room, and 2 (17%) of 12 toys in the well child waiting room. And one of three (33%) samples from a pediatrician's stethoscope was positive.

The researchers also tested the effectiveness of the office cleaning protocol, which involved wiping the toys with a disinfectant cloth, and they collected 15 samples from the sick waiting room before and after cleaning.

Before cleaning, viral RNA was found on 6 (40%) of 15 toys in the office waiting room, including the yellow dump truck and the “very popular stegosaurus,” said Dr. Pappas. After cleaning, 4 (27%) of the 15 toys were still positive for viral RNA.

The results suggest that pediatric office toys often are contaminated with viral RNA, even when they are cleaned. But the presence of viral RNA does not mean that the virus is infectious—whether viral remnants left on toys can cause infections in children who play with the toys remains unknown, Dr. Pappas said.

Dr. Pappas stated that she had no financial conflicts of interest to disclose.

After being wiped down with a disinfectant cloth, 4 of 15 toys in a sick waiting room still tested positive for viral RNA. Vivian E. Lee/Elsevier Global Medical News

WASHINGTON — The 7-valent pneumococcal conjugate vaccine (PCV7) has prevented about 210,000 cases of invasive pneumococcal disease and 14,000 disease-related deaths in the United States since its introduction 7 years ago, according to data from the Centers for Disease Control and Prevention in Atlanta.

“This far into our program, the effects have been very sustainable,” said Dr. Cynthia Whitney of the Centers for Disease Control and Prevention, adding that overall disease rates dropped after vaccination and have remained stable since 2002.

Dr. Whitney presented data based on a surveillance population of 18.5 million people at the jointly held annual Interscience Conference on Antimicrobial Agents and Chemotherapy and the annual meeting of the Infectious Diseases Society of America.

From 1998 to 2007, she and her colleagues identified cases of laboratory-confirmed invasive pneumococcal disease (IPD) through eight U.S. sites that continuously participated in Active Bacterial Core surveillance, a nationwide program to track vaccination rates and collect isolates.

Children younger than age 5 years were the target age group for disease reduction with PCV7. The disease rates in this age group dropped from 100 cases per 100,000 at a baseline measurement in 1998 to about 25 cases per 100,000 in 2007. For disease caused by PCV7 serotypes (4, 6B, 9V, 14, 18C, 19F, 23F), the rate was less than a single case per 100,000 in 2007, she added.

The PCV7 rates have continued to drop, but the overall rates have flattened in the last few years. An increase in disease caused by non-PCV7 serotypes has contributed to the plateau effect, Dr. Whitney explained. In particular, the incidence of disease caused by serotype 19A has increased consistently since 2002.

Although vaccine-type disease decreased and 19A disease increased, these changes occurred mostly between 2002 and 2006, and the rates in 2006 and 2007 were similar. “It may be that now, 8 years into the vaccine program, we are finally reaching a steady state for some of these changes,” Dr. Whitney observed.

The benefits of PCV7 extend to all ages, she emphasized. “Very few people older than 5 years have received the vaccine, so the herd effect has been important.”

Data from 2007 show some disease in all age groups. But only 7% of 2007 cases were caused by PCV7 serotypes. By contrast, 20% were caused by 19A, and 58% were caused by serotypes that are included in the PCV13 vaccine (1, 3, 5, 6A, 7F, 19A). The PCV13 vaccine data are under review, and the vaccine may be licensed in the United States next year.

“Recommending the 7-valent vaccine to a small part of the population, kids younger than 2 years, has led to substantial community protection,” said Dr. Whitney.

Ideally, the upcoming PCV13 vaccine will have an even greater impact on pneumococcal disease, she said.

Dr. Whitney said she had no conflicts of interest to disclose.

Elsevier Global Medical News

WASHINGTON — The 7-valent pneumococcal conjugate vaccine (PCV7) has prevented about 210,000 cases of invasive pneumococcal disease and 14,000 disease-related deaths in the United States since its introduction 7 years ago, according to data from the Centers for Disease Control and Prevention in Atlanta.

“This far into our program, the effects have been very sustainable,” said Dr. Cynthia Whitney of the Centers for Disease Control and Prevention, adding that overall disease rates dropped after vaccination and have remained stable since 2002.

Dr. Whitney presented data based on a surveillance population of 18.5 million people at the jointly held annual Interscience Conference on Antimicrobial Agents and Chemotherapy and the annual meeting of the Infectious Diseases Society of America.

From 1998 to 2007, she and her colleagues identified cases of laboratory-confirmed invasive pneumococcal disease (IPD) through eight U.S. sites that continuously participated in Active Bacterial Core surveillance, a nationwide program to track vaccination rates and collect isolates.

Children younger than age 5 years were the target age group for disease reduction with PCV7. The disease rates in this age group dropped from 100 cases per 100,000 at a baseline measurement in 1998 to about 25 cases per 100,000 in 2007. For disease caused by PCV7 serotypes (4, 6B, 9V, 14, 18C, 19F, 23F), the rate was less than a single case per 100,000 in 2007, she added.

The PCV7 rates have continued to drop, but the overall rates have flattened in the last few years. An increase in disease caused by non-PCV7 serotypes has contributed to the plateau effect, Dr. Whitney explained. In particular, the incidence of disease caused by serotype 19A has increased consistently since 2002.

Although vaccine-type disease decreased and 19A disease increased, these changes occurred mostly between 2002 and 2006, and the rates in 2006 and 2007 were similar. “It may be that now, 8 years into the vaccine program, we are finally reaching a steady state for some of these changes,” Dr. Whitney observed.

The benefits of PCV7 extend to all ages, she emphasized. “Very few people older than 5 years have received the vaccine, so the herd effect has been important.”

Data from 2007 show some disease in all age groups. But only 7% of 2007 cases were caused by PCV7 serotypes. By contrast, 20% were caused by 19A, and 58% were caused by serotypes that are included in the PCV13 vaccine (1, 3, 5, 6A, 7F, 19A). The PCV13 vaccine data are under review, and the vaccine may be licensed in the United States next year.

“Recommending the 7-valent vaccine to a small part of the population, kids younger than 2 years, has led to substantial community protection,” said Dr. Whitney.

Ideally, the upcoming PCV13 vaccine will have an even greater impact on pneumococcal disease, she said.

Dr. Whitney said she had no conflicts of interest to disclose.

Elsevier Global Medical News

WASHINGTON — The 7-valent pneumococcal conjugate vaccine (PCV7) has prevented about 210,000 cases of invasive pneumococcal disease and 14,000 disease-related deaths in the United States since its introduction 7 years ago, according to data from the Centers for Disease Control and Prevention in Atlanta.

“This far into our program, the effects have been very sustainable,” said Dr. Cynthia Whitney of the Centers for Disease Control and Prevention, adding that overall disease rates dropped after vaccination and have remained stable since 2002.

Dr. Whitney presented data based on a surveillance population of 18.5 million people at the jointly held annual Interscience Conference on Antimicrobial Agents and Chemotherapy and the annual meeting of the Infectious Diseases Society of America.

From 1998 to 2007, she and her colleagues identified cases of laboratory-confirmed invasive pneumococcal disease (IPD) through eight U.S. sites that continuously participated in Active Bacterial Core surveillance, a nationwide program to track vaccination rates and collect isolates.

Children younger than age 5 years were the target age group for disease reduction with PCV7. The disease rates in this age group dropped from 100 cases per 100,000 at a baseline measurement in 1998 to about 25 cases per 100,000 in 2007. For disease caused by PCV7 serotypes (4, 6B, 9V, 14, 18C, 19F, 23F), the rate was less than a single case per 100,000 in 2007, she added.

The PCV7 rates have continued to drop, but the overall rates have flattened in the last few years. An increase in disease caused by non-PCV7 serotypes has contributed to the plateau effect, Dr. Whitney explained. In particular, the incidence of disease caused by serotype 19A has increased consistently since 2002.

Although vaccine-type disease decreased and 19A disease increased, these changes occurred mostly between 2002 and 2006, and the rates in 2006 and 2007 were similar. “It may be that now, 8 years into the vaccine program, we are finally reaching a steady state for some of these changes,” Dr. Whitney observed.

The benefits of PCV7 extend to all ages, she emphasized. “Very few people older than 5 years have received the vaccine, so the herd effect has been important.”

Data from 2007 show some disease in all age groups. But only 7% of 2007 cases were caused by PCV7 serotypes. By contrast, 20% were caused by 19A, and 58% were caused by serotypes that are included in the PCV13 vaccine (1, 3, 5, 6A, 7F, 19A). The PCV13 vaccine data are under review, and the vaccine may be licensed in the United States next year.

“Recommending the 7-valent vaccine to a small part of the population, kids younger than 2 years, has led to substantial community protection,” said Dr. Whitney.

Ideally, the upcoming PCV13 vaccine will have an even greater impact on pneumococcal disease, she said.

Dr. Whitney said she had no conflicts of interest to disclose.

Elsevier Global Medical News

WASHINGTON — Vaccine site has little impact on the vaccine's effect, but using a 25-mm needle instead of a 16-mm needle may be more effective in administering flu vaccine to older patients, based on results of a study conducted at the Mayo Clinic in Rochester, Minn.

The Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices currently recommends influenza vaccination for all adults older than 50 years, but studies have shown that vaccine efficacy may be reduced in older adults, said Dr. Prikish Tosh, an infectious disease fellow at the Mayo Clinic.

“We wondered whether vaccine site had any effect,” said Dr. Tosh, who presented the study results at the joint annual meeting of the Interscience Conference on Antimicrobial Agents and Chemotherapy and the Infectious Diseases Society of America.

He and his colleagues also examined whether a longer needle would increase penetration into the muscle and affect immunogenicity and reactogenicity in older patients. Flu vaccine manufacturers recommend 25-mm needles, but some single-dose vials are currently packaged with 16-mm needles, Dr. Tosh said.

Dr. Tosh and colleagues randomized 133 adults aged 50–88 years to receive the trivalent inactivated influenza vaccine in either the deltoid muscle or the deltoid fat pad. The groups were similar in terms of age, gender, weight, and other demographic characteristics. Patients who were immunocompromised or had previously received the vaccine were excluded.

Antibody titers for each of the three strains of influenza in the vaccine were measured at baseline and at 4–6 weeks after vaccination.

The researchers found no significant differences in antibody response rates between the two groups. “The results … were surprising,” Dr. Tosh said. “At baseline, the antibody levels in the two groups were the same. However, after vaccination, we were expecting to see a substantial difference between the two groups. But we didn't see any difference for any of the three vaccine components.”

The researchers found no significant differences in immunogenicity between those who seroconverted and those who did not.

“Injecting in the fat pad did increase reactogenicity,” Dr. Tosh noted. The patients who received deltoid fat pad injections reported significantly more redness and swelling, compared with those who had intramuscular injections (34% and 5%, respectively).

In a subset analysis, 66 patients underwent ultrasound before vaccination to assess fat pad thickness and to determine whether the intramuscular injections succeeded. “Based on the ultrasound, a 25-mm needle would have worked for 97% of the subjects,” Dr. Tosh noted. A 25-mm needle would have penetrated the muscle in all of the men and all but 3% of the women, but a 16-mm needle would have failed to penetrate the muscle in 26% of men and 51% of women, he said.

Dr. Tosh stated that he had no financial conflicts to report.

WASHINGTON — Vaccine site has little impact on the vaccine's effect, but using a 25-mm needle instead of a 16-mm needle may be more effective in administering flu vaccine to older patients, based on results of a study conducted at the Mayo Clinic in Rochester, Minn.

The Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices currently recommends influenza vaccination for all adults older than 50 years, but studies have shown that vaccine efficacy may be reduced in older adults, said Dr. Prikish Tosh, an infectious disease fellow at the Mayo Clinic.

“We wondered whether vaccine site had any effect,” said Dr. Tosh, who presented the study results at the joint annual meeting of the Interscience Conference on Antimicrobial Agents and Chemotherapy and the Infectious Diseases Society of America.

He and his colleagues also examined whether a longer needle would increase penetration into the muscle and affect immunogenicity and reactogenicity in older patients. Flu vaccine manufacturers recommend 25-mm needles, but some single-dose vials are currently packaged with 16-mm needles, Dr. Tosh said.

Dr. Tosh and colleagues randomized 133 adults aged 50–88 years to receive the trivalent inactivated influenza vaccine in either the deltoid muscle or the deltoid fat pad. The groups were similar in terms of age, gender, weight, and other demographic characteristics. Patients who were immunocompromised or had previously received the vaccine were excluded.

Antibody titers for each of the three strains of influenza in the vaccine were measured at baseline and at 4–6 weeks after vaccination.

The researchers found no significant differences in antibody response rates between the two groups. “The results … were surprising,” Dr. Tosh said. “At baseline, the antibody levels in the two groups were the same. However, after vaccination, we were expecting to see a substantial difference between the two groups. But we didn't see any difference for any of the three vaccine components.”

The researchers found no significant differences in immunogenicity between those who seroconverted and those who did not.

“Injecting in the fat pad did increase reactogenicity,” Dr. Tosh noted. The patients who received deltoid fat pad injections reported significantly more redness and swelling, compared with those who had intramuscular injections (34% and 5%, respectively).

In a subset analysis, 66 patients underwent ultrasound before vaccination to assess fat pad thickness and to determine whether the intramuscular injections succeeded. “Based on the ultrasound, a 25-mm needle would have worked for 97% of the subjects,” Dr. Tosh noted. A 25-mm needle would have penetrated the muscle in all of the men and all but 3% of the women, but a 16-mm needle would have failed to penetrate the muscle in 26% of men and 51% of women, he said.

Dr. Tosh stated that he had no financial conflicts to report.

WASHINGTON — Vaccine site has little impact on the vaccine's effect, but using a 25-mm needle instead of a 16-mm needle may be more effective in administering flu vaccine to older patients, based on results of a study conducted at the Mayo Clinic in Rochester, Minn.

The Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices currently recommends influenza vaccination for all adults older than 50 years, but studies have shown that vaccine efficacy may be reduced in older adults, said Dr. Prikish Tosh, an infectious disease fellow at the Mayo Clinic.

“We wondered whether vaccine site had any effect,” said Dr. Tosh, who presented the study results at the joint annual meeting of the Interscience Conference on Antimicrobial Agents and Chemotherapy and the Infectious Diseases Society of America.

He and his colleagues also examined whether a longer needle would increase penetration into the muscle and affect immunogenicity and reactogenicity in older patients. Flu vaccine manufacturers recommend 25-mm needles, but some single-dose vials are currently packaged with 16-mm needles, Dr. Tosh said.

Dr. Tosh and colleagues randomized 133 adults aged 50–88 years to receive the trivalent inactivated influenza vaccine in either the deltoid muscle or the deltoid fat pad. The groups were similar in terms of age, gender, weight, and other demographic characteristics. Patients who were immunocompromised or had previously received the vaccine were excluded.

Antibody titers for each of the three strains of influenza in the vaccine were measured at baseline and at 4–6 weeks after vaccination.

The researchers found no significant differences in antibody response rates between the two groups. “The results … were surprising,” Dr. Tosh said. “At baseline, the antibody levels in the two groups were the same. However, after vaccination, we were expecting to see a substantial difference between the two groups. But we didn't see any difference for any of the three vaccine components.”

The researchers found no significant differences in immunogenicity between those who seroconverted and those who did not.

“Injecting in the fat pad did increase reactogenicity,” Dr. Tosh noted. The patients who received deltoid fat pad injections reported significantly more redness and swelling, compared with those who had intramuscular injections (34% and 5%, respectively).

In a subset analysis, 66 patients underwent ultrasound before vaccination to assess fat pad thickness and to determine whether the intramuscular injections succeeded. “Based on the ultrasound, a 25-mm needle would have worked for 97% of the subjects,” Dr. Tosh noted. A 25-mm needle would have penetrated the muscle in all of the men and all but 3% of the women, but a 16-mm needle would have failed to penetrate the muscle in 26% of men and 51% of women, he said.

Dr. Tosh stated that he had no financial conflicts to report.

A new clinical practice guideline from the Endocrine Society provides strategies for keeping type 2 diabetes and cardiovascular disease at bay in adults with metabolic syndrome.

“This guideline focuses on [those] with the components of the metabolic syndrome who do not yet have diagnosed cardiovascular disease or type 2 diabetes mellitus, and on the steps that can be taken to prevent these two diseases,” the guideline authors said in an introductory statement.

Health care providers are urged to make metabolic risk reduction part of their regular practice by measuring waist circumference, blood pressure, fasting lipid profiles, and fasting glucose as part of every routine clinical visit. (See table.)

If patients approach or fall into the at-risk category for any of these measures, they should be counseled on how to reduce their disease risk with lifestyle management, including a healthy diet, adequate exercise, and weight loss if needed.

The guideline appeared in print in the Journal of Clinical Endocrinology and Metabolism and is now available online at www.endojournals.org

It defines metabolic risk as the risk for CVD and type 2 diabetes based on several elements, including elevated triglycerides, reduced HDL cholesterol, increased plasma glucose levels, hypertension, enlarged waist circumference, a prothrombotic state, and a proinflammatory state.

It also recommends a global risk assessment for signs on cardiovascular and coronary heart disease every 10 years for patients meeting the criteria for metabolic risk. The LDL cholesterol measure should be used to target lipoprotein-lowering therapy if lifestyle modification has been insufficient.

Patients meeting criteria for prediabetes based on measurements from a routine visit should be screened for diabetes at 1- to 2-year intervals using a fasting plasma glucose test or a 2-hour oral glucose tolerance test.

The society suggests that physicians screen for metabolic risk factors using the American Heart Association/National Heart, Lung, and Blood Institute definition at each clinical visit. “The finding of three or more components especially should alert the clinician to a patient at metabolic risk,” the guideline states.

The guideline should not be considered inclusive or exclusive of other approaches to care, the authors noted.

Dr. James L. Rosenzweig of Boston University, chair of the task force that developed the guidelines, stated that he had no financial conflicts to disclose. Other members of the task force had no financial interests to disclose, but they have served on speakers bureaus for multiple pharmaceutical companies including Novartis, Pfizer Inc., Merck & Co., and GlaxoSmithKline.

Elsevier Global Medical News

A new clinical practice guideline from the Endocrine Society provides strategies for keeping type 2 diabetes and cardiovascular disease at bay in adults with metabolic syndrome.

“This guideline focuses on [those] with the components of the metabolic syndrome who do not yet have diagnosed cardiovascular disease or type 2 diabetes mellitus, and on the steps that can be taken to prevent these two diseases,” the guideline authors said in an introductory statement.

Health care providers are urged to make metabolic risk reduction part of their regular practice by measuring waist circumference, blood pressure, fasting lipid profiles, and fasting glucose as part of every routine clinical visit. (See table.)

If patients approach or fall into the at-risk category for any of these measures, they should be counseled on how to reduce their disease risk with lifestyle management, including a healthy diet, adequate exercise, and weight loss if needed.

The guideline appeared in print in the Journal of Clinical Endocrinology and Metabolism and is now available online at www.endojournals.org

It defines metabolic risk as the risk for CVD and type 2 diabetes based on several elements, including elevated triglycerides, reduced HDL cholesterol, increased plasma glucose levels, hypertension, enlarged waist circumference, a prothrombotic state, and a proinflammatory state.

It also recommends a global risk assessment for signs on cardiovascular and coronary heart disease every 10 years for patients meeting the criteria for metabolic risk. The LDL cholesterol measure should be used to target lipoprotein-lowering therapy if lifestyle modification has been insufficient.

Patients meeting criteria for prediabetes based on measurements from a routine visit should be screened for diabetes at 1- to 2-year intervals using a fasting plasma glucose test or a 2-hour oral glucose tolerance test.

The society suggests that physicians screen for metabolic risk factors using the American Heart Association/National Heart, Lung, and Blood Institute definition at each clinical visit. “The finding of three or more components especially should alert the clinician to a patient at metabolic risk,” the guideline states.

The guideline should not be considered inclusive or exclusive of other approaches to care, the authors noted.

Dr. James L. Rosenzweig of Boston University, chair of the task force that developed the guidelines, stated that he had no financial conflicts to disclose. Other members of the task force had no financial interests to disclose, but they have served on speakers bureaus for multiple pharmaceutical companies including Novartis, Pfizer Inc., Merck & Co., and GlaxoSmithKline.

Elsevier Global Medical News

A new clinical practice guideline from the Endocrine Society provides strategies for keeping type 2 diabetes and cardiovascular disease at bay in adults with metabolic syndrome.

“This guideline focuses on [those] with the components of the metabolic syndrome who do not yet have diagnosed cardiovascular disease or type 2 diabetes mellitus, and on the steps that can be taken to prevent these two diseases,” the guideline authors said in an introductory statement.

Health care providers are urged to make metabolic risk reduction part of their regular practice by measuring waist circumference, blood pressure, fasting lipid profiles, and fasting glucose as part of every routine clinical visit. (See table.)

If patients approach or fall into the at-risk category for any of these measures, they should be counseled on how to reduce their disease risk with lifestyle management, including a healthy diet, adequate exercise, and weight loss if needed.

The guideline appeared in print in the Journal of Clinical Endocrinology and Metabolism and is now available online at www.endojournals.org

It defines metabolic risk as the risk for CVD and type 2 diabetes based on several elements, including elevated triglycerides, reduced HDL cholesterol, increased plasma glucose levels, hypertension, enlarged waist circumference, a prothrombotic state, and a proinflammatory state.

It also recommends a global risk assessment for signs on cardiovascular and coronary heart disease every 10 years for patients meeting the criteria for metabolic risk. The LDL cholesterol measure should be used to target lipoprotein-lowering therapy if lifestyle modification has been insufficient.

Patients meeting criteria for prediabetes based on measurements from a routine visit should be screened for diabetes at 1- to 2-year intervals using a fasting plasma glucose test or a 2-hour oral glucose tolerance test.

The society suggests that physicians screen for metabolic risk factors using the American Heart Association/National Heart, Lung, and Blood Institute definition at each clinical visit. “The finding of three or more components especially should alert the clinician to a patient at metabolic risk,” the guideline states.

The guideline should not be considered inclusive or exclusive of other approaches to care, the authors noted.

Dr. James L. Rosenzweig of Boston University, chair of the task force that developed the guidelines, stated that he had no financial conflicts to disclose. Other members of the task force had no financial interests to disclose, but they have served on speakers bureaus for multiple pharmaceutical companies including Novartis, Pfizer Inc., Merck & Co., and GlaxoSmithKline.

Elsevier Global Medical News

WASHINGTON—Perinatal outcomes were slightly, but not significantly, better in renal transplant recipients who were immunosuppressed with cyclosporine, compared with those given azathioprine, according to findings from a study involving 59 pregnant women at a single research center.

“There are no described rates of maternal mortality for women with renal transplants,” noted Dr. Vicenç Cararach, who presented study results at the annual meeting of the International Society of Obstetric Medicine.

Dr. Cararach and colleagues at the University of Barcelona compared 27 patients who were treated with azathioprine and prednisone (1973–1991) and 32 patients who were treated with cyclosporine and prednisone (1992–2007).

Overall, 3 patients (11%) in the azathioprine group and 2 patients (6%) in the cyclosporine group delivered at less than 32 weeks' gestation. An average of 13 infants in each group had birth weights below 2500 grams.

There were no maternal deaths in either group, and the three reported perinatal deaths all occurred in the azathioprine group.

More cases of premature rupture of membranes occurred in the azathioprine group, while more cases of preeclampsia and intrauterine growth restriction were found in the cyclosporine group.

Although these differences were not significant because of the limited number of cases, “it does not mean that they were not clinically important,” Dr. Cararach noted.

Creatinine levels during pregnancy were similar between the two groups, he said. However, 3 years after pregnancy, creatinine levels were higher in the cyclosporine group, which raises some concerns about renal function with long-term cyclosporine use, Dr. Cararach added.

The results support those from previous studies demonstrating that perinatal outcomes are generally positive among renal transplant recipients, he said.

However, the elevated risk of premature birth remains a concern. And there are long-term risks for hypertension and infection that deserve further study, he noted.

Dr. Cararach stated that he had no financial conflicts of interest.

WASHINGTON—Perinatal outcomes were slightly, but not significantly, better in renal transplant recipients who were immunosuppressed with cyclosporine, compared with those given azathioprine, according to findings from a study involving 59 pregnant women at a single research center.

“There are no described rates of maternal mortality for women with renal transplants,” noted Dr. Vicenç Cararach, who presented study results at the annual meeting of the International Society of Obstetric Medicine.

Dr. Cararach and colleagues at the University of Barcelona compared 27 patients who were treated with azathioprine and prednisone (1973–1991) and 32 patients who were treated with cyclosporine and prednisone (1992–2007).

Overall, 3 patients (11%) in the azathioprine group and 2 patients (6%) in the cyclosporine group delivered at less than 32 weeks' gestation. An average of 13 infants in each group had birth weights below 2500 grams.

There were no maternal deaths in either group, and the three reported perinatal deaths all occurred in the azathioprine group.

More cases of premature rupture of membranes occurred in the azathioprine group, while more cases of preeclampsia and intrauterine growth restriction were found in the cyclosporine group.

Although these differences were not significant because of the limited number of cases, “it does not mean that they were not clinically important,” Dr. Cararach noted.

Creatinine levels during pregnancy were similar between the two groups, he said. However, 3 years after pregnancy, creatinine levels were higher in the cyclosporine group, which raises some concerns about renal function with long-term cyclosporine use, Dr. Cararach added.

The results support those from previous studies demonstrating that perinatal outcomes are generally positive among renal transplant recipients, he said.

However, the elevated risk of premature birth remains a concern. And there are long-term risks for hypertension and infection that deserve further study, he noted.

Dr. Cararach stated that he had no financial conflicts of interest.

WASHINGTON—Perinatal outcomes were slightly, but not significantly, better in renal transplant recipients who were immunosuppressed with cyclosporine, compared with those given azathioprine, according to findings from a study involving 59 pregnant women at a single research center.

“There are no described rates of maternal mortality for women with renal transplants,” noted Dr. Vicenç Cararach, who presented study results at the annual meeting of the International Society of Obstetric Medicine.

Dr. Cararach and colleagues at the University of Barcelona compared 27 patients who were treated with azathioprine and prednisone (1973–1991) and 32 patients who were treated with cyclosporine and prednisone (1992–2007).

Overall, 3 patients (11%) in the azathioprine group and 2 patients (6%) in the cyclosporine group delivered at less than 32 weeks' gestation. An average of 13 infants in each group had birth weights below 2500 grams.

There were no maternal deaths in either group, and the three reported perinatal deaths all occurred in the azathioprine group.

More cases of premature rupture of membranes occurred in the azathioprine group, while more cases of preeclampsia and intrauterine growth restriction were found in the cyclosporine group.

Although these differences were not significant because of the limited number of cases, “it does not mean that they were not clinically important,” Dr. Cararach noted.

Creatinine levels during pregnancy were similar between the two groups, he said. However, 3 years after pregnancy, creatinine levels were higher in the cyclosporine group, which raises some concerns about renal function with long-term cyclosporine use, Dr. Cararach added.

The results support those from previous studies demonstrating that perinatal outcomes are generally positive among renal transplant recipients, he said.

However, the elevated risk of premature birth remains a concern. And there are long-term risks for hypertension and infection that deserve further study, he noted.

Dr. Cararach stated that he had no financial conflicts of interest.

WASHINGTON—A maternal history of preeclampsia may identify adults who are at increased risk for stroke: Adults whose mothers had severe preeclampsia were almost twice as likely to have strokes as were adults whose mothers did not have preeclampsia, based on data from more than 6,000 singleton pregnancies in Finland.

This study is one of the first to examine the long-term health risks of the offspring of women who had preeclampsia, Dr. Eero Kajantie said at the annual congress of the International Society for the Study of Hypertension in Pregnancy. “We know surprisingly little about which pregnancy conditions are associated with increased risk for coronary heart disease and stroke” among offspring.

Previous studies have shown that these women are at increased risk for coronary heart disease and stroke later in life. Also, their children are prone to high blood pressure during childhood, said Dr. Kajantie of the National Public Health Institute in Helsinki. Dr. Kajantie and his colleagues based their conclusion on a review of data from 6,410 members of the Helsinki Birth Cohort, who were born as singletons between 1934 and 1944.

Overall, 284 pregnancies (4.4%) were complicated by preeclampsia and 1,592 (24.8%) met criteria for hypertension without proteinuria. Among the children of these pregnancies, 464 (7.2%) had a diagnosis of coronary heart disease and 272 (4.2%) had a diagnosis of stroke. Diagnoses of CHD and stroke were collected from national hospital discharge records and death registries. The risk of stroke was almost twice as likely in the 164 adults whose mothers had severe preeclampsia (hazard ratio, 1.7), after the researchers controlled for sex, low birth weight, and gestational age.

The researchers also found that hypertension was a significant predictor of stroke, but was not a significant predictor of CHD.

Dr. Kajantie stated that he had no financial conflicts to disclose.

WASHINGTON—A maternal history of preeclampsia may identify adults who are at increased risk for stroke: Adults whose mothers had severe preeclampsia were almost twice as likely to have strokes as were adults whose mothers did not have preeclampsia, based on data from more than 6,000 singleton pregnancies in Finland.

This study is one of the first to examine the long-term health risks of the offspring of women who had preeclampsia, Dr. Eero Kajantie said at the annual congress of the International Society for the Study of Hypertension in Pregnancy. “We know surprisingly little about which pregnancy conditions are associated with increased risk for coronary heart disease and stroke” among offspring.

Previous studies have shown that these women are at increased risk for coronary heart disease and stroke later in life. Also, their children are prone to high blood pressure during childhood, said Dr. Kajantie of the National Public Health Institute in Helsinki. Dr. Kajantie and his colleagues based their conclusion on a review of data from 6,410 members of the Helsinki Birth Cohort, who were born as singletons between 1934 and 1944.

Overall, 284 pregnancies (4.4%) were complicated by preeclampsia and 1,592 (24.8%) met criteria for hypertension without proteinuria. Among the children of these pregnancies, 464 (7.2%) had a diagnosis of coronary heart disease and 272 (4.2%) had a diagnosis of stroke. Diagnoses of CHD and stroke were collected from national hospital discharge records and death registries. The risk of stroke was almost twice as likely in the 164 adults whose mothers had severe preeclampsia (hazard ratio, 1.7), after the researchers controlled for sex, low birth weight, and gestational age.

The researchers also found that hypertension was a significant predictor of stroke, but was not a significant predictor of CHD.

Dr. Kajantie stated that he had no financial conflicts to disclose.

WASHINGTON—A maternal history of preeclampsia may identify adults who are at increased risk for stroke: Adults whose mothers had severe preeclampsia were almost twice as likely to have strokes as were adults whose mothers did not have preeclampsia, based on data from more than 6,000 singleton pregnancies in Finland.

This study is one of the first to examine the long-term health risks of the offspring of women who had preeclampsia, Dr. Eero Kajantie said at the annual congress of the International Society for the Study of Hypertension in Pregnancy. “We know surprisingly little about which pregnancy conditions are associated with increased risk for coronary heart disease and stroke” among offspring.

Previous studies have shown that these women are at increased risk for coronary heart disease and stroke later in life. Also, their children are prone to high blood pressure during childhood, said Dr. Kajantie of the National Public Health Institute in Helsinki. Dr. Kajantie and his colleagues based their conclusion on a review of data from 6,410 members of the Helsinki Birth Cohort, who were born as singletons between 1934 and 1944.

Overall, 284 pregnancies (4.4%) were complicated by preeclampsia and 1,592 (24.8%) met criteria for hypertension without proteinuria. Among the children of these pregnancies, 464 (7.2%) had a diagnosis of coronary heart disease and 272 (4.2%) had a diagnosis of stroke. Diagnoses of CHD and stroke were collected from national hospital discharge records and death registries. The risk of stroke was almost twice as likely in the 164 adults whose mothers had severe preeclampsia (hazard ratio, 1.7), after the researchers controlled for sex, low birth weight, and gestational age.

The researchers also found that hypertension was a significant predictor of stroke, but was not a significant predictor of CHD.

Dr. Kajantie stated that he had no financial conflicts to disclose.