Heidi Splete

WASHINGTON — The challenge of paying for vaccinations will become even greater once the human papilloma virus vaccine becomes available in 2007.

At a meeting of the National Vaccine Advisory Committee, representatives from several organizations reported that there is not enough money to go around and that states will have to make tough choices about funding for the HPV vaccine, which is scheduled to become a standard immunization for 11- to 12-year-old girls.

The evidence used by the Advisory Committee on Immunization Practices to make vaccine recommendations includes economic factors as part of the public health perspective, said Dr. Lance Rodewald, director of the immunization services division at the Centers for Disease Control and Prevention.

But the price of a vaccine cannot be a consideration for resolutions made by the Vaccines for Children (VFC) program. The key consideration in a VFC resolution simply is whether the vaccine is recommended for VFC-eligible children, he said.

Consequently, an ACIP recommendation raises the possibility for disparity, with VFC-eligible children receiving a vaccine because it is paid for, and children with private insurance not receiving the same vaccine because it is not paid for.

Neither state-appropriated funds nor funds from Section 317 (a discretionary program within the Public Health Service Act that covers individuals whose insurance doesn't cover vaccines or who are not eligible for VFC funds) has kept up with VFC's need-based funding, Dr. Rodewald said.

What happens when the need outstrips the resources? “The programs are put in a tough spot,” he said. “The states will need to prioritize vaccinations, and we are looking to other groups to help resolve the financing dilemma.”

Dr. Poki Stewart Namkung, president of the National Association of County & City Health Officials shared responses to a survey that solicited their members' concerns about implementing HPV vaccines. Key issues raised by the local health departments included how to vaccinate girls and young women who fall outside the bounds of public assistance given the limitations of the VFC program and Section 317.

States will receive VFC funding, but do not know what other funds to expect, said Claire Hannan, executive director of the Association of Immunization Managers (AIM). AIM members are involved in every aspect of vaccination, including distribution, purchasing, and provider and consumer education.

Uninsured individuals aged 9–18 years will be covered by VFC, and limited coverage for uninsured females aged 9–26 years may be available through Merck & Co.'s vaccine assistance program. Insured individuals are covered in theory, but AIM members are concerned that as new, expensive vaccines are added to the vaccine schedule, more insurance plans will not cover all the vaccines, Ms. Hannan said.

“Programs are making decisions about how to use limited funds, and they are making different decisions,” she said. The result is a patchwork of vaccination coverage.

Possible solutions to the problem of patchwork coverage could include enlisting the help of ob.gyns. and dermatologists, since they treat children and adolescents and could enroll their eligible younger patients in the VFC program, Ms. Hannan said.

No one knows how the financing for HPV vaccines will play out until the vaccine actually is in use, but vaccine financing is dynamic because both the payments and the individual insurance plans change annually, said Dr. Gregory Wallace of the CDC's National Immunization Program. “Difficult decisions have to be made with competing priorities every year.”

WASHINGTON — The challenge of paying for vaccinations will become even greater once the human papilloma virus vaccine becomes available in 2007.

At a meeting of the National Vaccine Advisory Committee, representatives from several organizations reported that there is not enough money to go around and that states will have to make tough choices about funding for the HPV vaccine, which is scheduled to become a standard immunization for 11- to 12-year-old girls.

The evidence used by the Advisory Committee on Immunization Practices to make vaccine recommendations includes economic factors as part of the public health perspective, said Dr. Lance Rodewald, director of the immunization services division at the Centers for Disease Control and Prevention.

But the price of a vaccine cannot be a consideration for resolutions made by the Vaccines for Children (VFC) program. The key consideration in a VFC resolution simply is whether the vaccine is recommended for VFC-eligible children, he said.

Consequently, an ACIP recommendation raises the possibility for disparity, with VFC-eligible children receiving a vaccine because it is paid for, and children with private insurance not receiving the same vaccine because it is not paid for.

Neither state-appropriated funds nor funds from Section 317 (a discretionary program within the Public Health Service Act that covers individuals whose insurance doesn't cover vaccines or who are not eligible for VFC funds) has kept up with VFC's need-based funding, Dr. Rodewald said.

What happens when the need outstrips the resources? “The programs are put in a tough spot,” he said. “The states will need to prioritize vaccinations, and we are looking to other groups to help resolve the financing dilemma.”

Dr. Poki Stewart Namkung, president of the National Association of County & City Health Officials shared responses to a survey that solicited their members' concerns about implementing HPV vaccines. Key issues raised by the local health departments included how to vaccinate girls and young women who fall outside the bounds of public assistance given the limitations of the VFC program and Section 317.

States will receive VFC funding, but do not know what other funds to expect, said Claire Hannan, executive director of the Association of Immunization Managers (AIM). AIM members are involved in every aspect of vaccination, including distribution, purchasing, and provider and consumer education.

Uninsured individuals aged 9–18 years will be covered by VFC, and limited coverage for uninsured females aged 9–26 years may be available through Merck & Co.'s vaccine assistance program. Insured individuals are covered in theory, but AIM members are concerned that as new, expensive vaccines are added to the vaccine schedule, more insurance plans will not cover all the vaccines, Ms. Hannan said.

“Programs are making decisions about how to use limited funds, and they are making different decisions,” she said. The result is a patchwork of vaccination coverage.

Possible solutions to the problem of patchwork coverage could include enlisting the help of ob.gyns. and dermatologists, since they treat children and adolescents and could enroll their eligible younger patients in the VFC program, Ms. Hannan said.

No one knows how the financing for HPV vaccines will play out until the vaccine actually is in use, but vaccine financing is dynamic because both the payments and the individual insurance plans change annually, said Dr. Gregory Wallace of the CDC's National Immunization Program. “Difficult decisions have to be made with competing priorities every year.”

WASHINGTON — The challenge of paying for vaccinations will become even greater once the human papilloma virus vaccine becomes available in 2007.

At a meeting of the National Vaccine Advisory Committee, representatives from several organizations reported that there is not enough money to go around and that states will have to make tough choices about funding for the HPV vaccine, which is scheduled to become a standard immunization for 11- to 12-year-old girls.

The evidence used by the Advisory Committee on Immunization Practices to make vaccine recommendations includes economic factors as part of the public health perspective, said Dr. Lance Rodewald, director of the immunization services division at the Centers for Disease Control and Prevention.

But the price of a vaccine cannot be a consideration for resolutions made by the Vaccines for Children (VFC) program. The key consideration in a VFC resolution simply is whether the vaccine is recommended for VFC-eligible children, he said.

Consequently, an ACIP recommendation raises the possibility for disparity, with VFC-eligible children receiving a vaccine because it is paid for, and children with private insurance not receiving the same vaccine because it is not paid for.

Neither state-appropriated funds nor funds from Section 317 (a discretionary program within the Public Health Service Act that covers individuals whose insurance doesn't cover vaccines or who are not eligible for VFC funds) has kept up with VFC's need-based funding, Dr. Rodewald said.

What happens when the need outstrips the resources? “The programs are put in a tough spot,” he said. “The states will need to prioritize vaccinations, and we are looking to other groups to help resolve the financing dilemma.”

Dr. Poki Stewart Namkung, president of the National Association of County & City Health Officials shared responses to a survey that solicited their members' concerns about implementing HPV vaccines. Key issues raised by the local health departments included how to vaccinate girls and young women who fall outside the bounds of public assistance given the limitations of the VFC program and Section 317.

States will receive VFC funding, but do not know what other funds to expect, said Claire Hannan, executive director of the Association of Immunization Managers (AIM). AIM members are involved in every aspect of vaccination, including distribution, purchasing, and provider and consumer education.

Uninsured individuals aged 9–18 years will be covered by VFC, and limited coverage for uninsured females aged 9–26 years may be available through Merck & Co.'s vaccine assistance program. Insured individuals are covered in theory, but AIM members are concerned that as new, expensive vaccines are added to the vaccine schedule, more insurance plans will not cover all the vaccines, Ms. Hannan said.

“Programs are making decisions about how to use limited funds, and they are making different decisions,” she said. The result is a patchwork of vaccination coverage.

Possible solutions to the problem of patchwork coverage could include enlisting the help of ob.gyns. and dermatologists, since they treat children and adolescents and could enroll their eligible younger patients in the VFC program, Ms. Hannan said.

No one knows how the financing for HPV vaccines will play out until the vaccine actually is in use, but vaccine financing is dynamic because both the payments and the individual insurance plans change annually, said Dr. Gregory Wallace of the CDC's National Immunization Program. “Difficult decisions have to be made with competing priorities every year.”

WASHINGTON – The opportunity to refer patients to a telephone quit line encourages physicians to talk to their patients about quitting smoking, Dr. Stephen Rothemich said at a conference on tobacco control sponsored by the American Cancer Society.

Dr. Rothemich found a statistically significant 14% increase in intensive counseling for patients in practices where their referrals were immediately faxed to smoking quit lines, compared with practices that were not partnered with quit lines, based on preliminary data from more than 1,500 smokers over 7 months' follow-up.

Dr. Rothemich, of Virginia Commonwealth University in Richmond, randomized eight medical practices to immediately refer patients who expressed interest in quitting smoking in the next 30 days to a quit line for follow-up support and guidance. Another eight practices that did not immediately refer patients to quit lines were controls.

The study participants were adults who had just visited a primary care medical practice. When the patients were surveyed after their office visits, significantly more smokers in the intervention practices, compared with the control practices, reported that they had been asked about plans to quit smoking (36% vs. 29%) and were referred to a quit line (22% vs. 9%). Of the 16 practices, 11 focused on family medicine, 2 on internal medicine, and 3 on combined family medicine and internal medicine practice.

The practice size ranged from two to seven providers. These small practices are representative of primary care in much of America, Dr. Rothemich noted. “Our intervention goal was to talk to the practices and figure out how to customize their use of quit lines,” he said. After a basic training session, the practices decided which staff members would work with patients and fax the referral forms to the quit lines.

A lack of office support is one of the most common barriers to intensive counseling for smokers in primary care settings, but quit lines can supply the intensive follow-up counseling that many doctors do not have time for. “It's a win-win situation with great potential to improve public health,” Dr. Rothemich said.

Although the referral rates at the practices using quit lines dropped dramatically–from 235 referrals during the first 3 months to 66 referrals during the second 3 months–the data collection is ongoing and the rates may stabilize, Dr. Rothemich said.

More important than the numbers, though, was the doctors' enthusiasm for the program. “They were disappointed when they were randomized to the control group,” he said.

Telephone quit lines are state based, and residents of all 50 states and the District of Columbia can gain access to them, according to the North American Quitline Consortium, a nonprofit organization that promotes quit lines. When a quit line office receives a faxed referral from a health care provider, the patient receives counseling phone calls, support materials by mail, information about interactive online assistance programs, and referrals to community-based cessation programs.

For more information on telephone quit lines, visit the Centers for Disease Control and Prevention's Web site at www.cdc.gov/tobacco/quitlines.htm

WASHINGTON – The opportunity to refer patients to a telephone quit line encourages physicians to talk to their patients about quitting smoking, Dr. Stephen Rothemich said at a conference on tobacco control sponsored by the American Cancer Society.

Dr. Rothemich found a statistically significant 14% increase in intensive counseling for patients in practices where their referrals were immediately faxed to smoking quit lines, compared with practices that were not partnered with quit lines, based on preliminary data from more than 1,500 smokers over 7 months' follow-up.

Dr. Rothemich, of Virginia Commonwealth University in Richmond, randomized eight medical practices to immediately refer patients who expressed interest in quitting smoking in the next 30 days to a quit line for follow-up support and guidance. Another eight practices that did not immediately refer patients to quit lines were controls.

The study participants were adults who had just visited a primary care medical practice. When the patients were surveyed after their office visits, significantly more smokers in the intervention practices, compared with the control practices, reported that they had been asked about plans to quit smoking (36% vs. 29%) and were referred to a quit line (22% vs. 9%). Of the 16 practices, 11 focused on family medicine, 2 on internal medicine, and 3 on combined family medicine and internal medicine practice.

The practice size ranged from two to seven providers. These small practices are representative of primary care in much of America, Dr. Rothemich noted. “Our intervention goal was to talk to the practices and figure out how to customize their use of quit lines,” he said. After a basic training session, the practices decided which staff members would work with patients and fax the referral forms to the quit lines.

A lack of office support is one of the most common barriers to intensive counseling for smokers in primary care settings, but quit lines can supply the intensive follow-up counseling that many doctors do not have time for. “It's a win-win situation with great potential to improve public health,” Dr. Rothemich said.

Although the referral rates at the practices using quit lines dropped dramatically–from 235 referrals during the first 3 months to 66 referrals during the second 3 months–the data collection is ongoing and the rates may stabilize, Dr. Rothemich said.

More important than the numbers, though, was the doctors' enthusiasm for the program. “They were disappointed when they were randomized to the control group,” he said.

Telephone quit lines are state based, and residents of all 50 states and the District of Columbia can gain access to them, according to the North American Quitline Consortium, a nonprofit organization that promotes quit lines. When a quit line office receives a faxed referral from a health care provider, the patient receives counseling phone calls, support materials by mail, information about interactive online assistance programs, and referrals to community-based cessation programs.

For more information on telephone quit lines, visit the Centers for Disease Control and Prevention's Web site at www.cdc.gov/tobacco/quitlines.htm

WASHINGTON – The opportunity to refer patients to a telephone quit line encourages physicians to talk to their patients about quitting smoking, Dr. Stephen Rothemich said at a conference on tobacco control sponsored by the American Cancer Society.

Dr. Rothemich found a statistically significant 14% increase in intensive counseling for patients in practices where their referrals were immediately faxed to smoking quit lines, compared with practices that were not partnered with quit lines, based on preliminary data from more than 1,500 smokers over 7 months' follow-up.

Dr. Rothemich, of Virginia Commonwealth University in Richmond, randomized eight medical practices to immediately refer patients who expressed interest in quitting smoking in the next 30 days to a quit line for follow-up support and guidance. Another eight practices that did not immediately refer patients to quit lines were controls.

The study participants were adults who had just visited a primary care medical practice. When the patients were surveyed after their office visits, significantly more smokers in the intervention practices, compared with the control practices, reported that they had been asked about plans to quit smoking (36% vs. 29%) and were referred to a quit line (22% vs. 9%). Of the 16 practices, 11 focused on family medicine, 2 on internal medicine, and 3 on combined family medicine and internal medicine practice.

The practice size ranged from two to seven providers. These small practices are representative of primary care in much of America, Dr. Rothemich noted. “Our intervention goal was to talk to the practices and figure out how to customize their use of quit lines,” he said. After a basic training session, the practices decided which staff members would work with patients and fax the referral forms to the quit lines.

A lack of office support is one of the most common barriers to intensive counseling for smokers in primary care settings, but quit lines can supply the intensive follow-up counseling that many doctors do not have time for. “It's a win-win situation with great potential to improve public health,” Dr. Rothemich said.

Although the referral rates at the practices using quit lines dropped dramatically–from 235 referrals during the first 3 months to 66 referrals during the second 3 months–the data collection is ongoing and the rates may stabilize, Dr. Rothemich said.

More important than the numbers, though, was the doctors' enthusiasm for the program. “They were disappointed when they were randomized to the control group,” he said.

Telephone quit lines are state based, and residents of all 50 states and the District of Columbia can gain access to them, according to the North American Quitline Consortium, a nonprofit organization that promotes quit lines. When a quit line office receives a faxed referral from a health care provider, the patient receives counseling phone calls, support materials by mail, information about interactive online assistance programs, and referrals to community-based cessation programs.

For more information on telephone quit lines, visit the Centers for Disease Control and Prevention's Web site at www.cdc.gov/tobacco/quitlines.htm

Tailor Teen Pregnancy Messages

Pregnant adolescents aged 12–17 years are more likely than 18- or 19-year-olds to report that their babies would enhance their relationships with others, and older teens are more likely to identify the challenges of teen motherhood, data collected from 247 girls who sought care at a prenatal clinic show.

Understanding the variations in pregnant girls' attitudes toward pregnancy can help health care providers target interventions, although the differences among age subgroups did not reach statistical significance, reported Cynthia Rosengard, Ph.D., of Rhode Island Hospital in Providence and her colleagues (Pediatrics 2006;118:503–10).

The adolescents completed questionnaires and interviews about the pros and cons of having a baby as a teen. Their mean age was 16.8 years, and data were collected over a 2-year period.

The girls reported stronger connections with others and a sense of responsibility and purpose that might discourage them from other risky behaviors as some advantages of teen pregnancy. Disadvantages included financial concerns, lack of preparedness for motherhood, changing life plans, and missing out on other teenage experiences.

Risky Sex in Black Teens

Black adolescents who report depressive symptoms are nearly four times more likely to report inconsistent condom use than are peers who were not depressed, Dr. Larry K. Brown of Brown University in Providence, R.I., and his colleagues reported.

A majority of 277 of the 415 adolescents (67%) reported using condoms in less than 75% of sexual activities, and 138 (33%) reported using condoms in at least 75% of sexual activities, after the investigators controlled for demographic factors including age, gender, and income (J. Adolesc. Health 2006 [Epub doi:j.jadohealth.2006.01.015]).

Although males reported more condom use than females overall, the 13 males who reported depressive symptoms were significantly less likely to report condom use than were those who were not depressed. The 26 girls who reported depressive symptoms also were less likely to report condom use at follow-up, but the difference was not statistically significant.

People younger than 25 years account for about half of all new HIV infections in the United States each year, and blacks represented about 50% of HIV cases diagnosed in the country in 2003. Interventions for depression could reduce risky sexual behaviors in the high-risk black adolescent population and prevent the development of more severe emotional disorders, the researchers noted.

“Regardless of the lower incidence of depressive symptoms among these youth compared with peers of other races, depressive symptoms had a major impact on HIV and STI risk by quadrupling the odds of inconsistent condom use,” they wrote.

Older adolescents (19–21 years) were less likely to use condoms consistently than those aged 18 years and younger.

Race, Gender Affect Meth Use

Nonmedical use of prescription stimulants and methamphetamine by adolescents aged 12–17 years is significantly associated with use of marijuana and other illegal drugs and also with the use of mental health services, a study of more than 17,000 teenagers shows.

To assess the risk factors for stimulant abuse in adolescents, Mindy A. Herman-Stahl, Ph.D., and her colleagues at RTI International reviewed data on adolescents from the 2002 National Survey of Drug Use and Health (NSDUH), an annual survey of the civilian, noninstitutionalized population aged 12 years and older (J. Adolesc. Health 2006;39:374–80).

Overall, adolescents who reported treatment for mental health problems during the year before the survey were more than one and a half times as likely to report either amphetamine use or nonmedical prescription stimulant use during the past year. Also, marijuana use was more than four times as likely among the methamphetamine users and more than twice as likely among the illicit stimulant users.

After controlling for demographic variables, methamphetamine use was more than twice as likely among girls vs. boys and significantly less likely among non-Hispanic blacks vs. non-Hispanic whites. There were no racial or gender differences linked to nonprescription stimulant use, but significant associations were found with high levels of family conflict and sensation-seeking behavior.

Methamphetamine use was associated with deviant behavior such as selling drugs and binge drinking, which suggests that adolescents who use methamphetamine may be more likely to be exposed to delinquent peers and dangerous environments, the researchers said.

The study was built on a project that received funding from Eli Lilly & Co.

Tailor Teen Pregnancy Messages

Pregnant adolescents aged 12–17 years are more likely than 18- or 19-year-olds to report that their babies would enhance their relationships with others, and older teens are more likely to identify the challenges of teen motherhood, data collected from 247 girls who sought care at a prenatal clinic show.

Understanding the variations in pregnant girls' attitudes toward pregnancy can help health care providers target interventions, although the differences among age subgroups did not reach statistical significance, reported Cynthia Rosengard, Ph.D., of Rhode Island Hospital in Providence and her colleagues (Pediatrics 2006;118:503–10).

The adolescents completed questionnaires and interviews about the pros and cons of having a baby as a teen. Their mean age was 16.8 years, and data were collected over a 2-year period.

The girls reported stronger connections with others and a sense of responsibility and purpose that might discourage them from other risky behaviors as some advantages of teen pregnancy. Disadvantages included financial concerns, lack of preparedness for motherhood, changing life plans, and missing out on other teenage experiences.

Risky Sex in Black Teens

Black adolescents who report depressive symptoms are nearly four times more likely to report inconsistent condom use than are peers who were not depressed, Dr. Larry K. Brown of Brown University in Providence, R.I., and his colleagues reported.

A majority of 277 of the 415 adolescents (67%) reported using condoms in less than 75% of sexual activities, and 138 (33%) reported using condoms in at least 75% of sexual activities, after the investigators controlled for demographic factors including age, gender, and income (J. Adolesc. Health 2006 [Epub doi:j.jadohealth.2006.01.015]).

Although males reported more condom use than females overall, the 13 males who reported depressive symptoms were significantly less likely to report condom use than were those who were not depressed. The 26 girls who reported depressive symptoms also were less likely to report condom use at follow-up, but the difference was not statistically significant.

People younger than 25 years account for about half of all new HIV infections in the United States each year, and blacks represented about 50% of HIV cases diagnosed in the country in 2003. Interventions for depression could reduce risky sexual behaviors in the high-risk black adolescent population and prevent the development of more severe emotional disorders, the researchers noted.

“Regardless of the lower incidence of depressive symptoms among these youth compared with peers of other races, depressive symptoms had a major impact on HIV and STI risk by quadrupling the odds of inconsistent condom use,” they wrote.

Older adolescents (19–21 years) were less likely to use condoms consistently than those aged 18 years and younger.

Race, Gender Affect Meth Use

Nonmedical use of prescription stimulants and methamphetamine by adolescents aged 12–17 years is significantly associated with use of marijuana and other illegal drugs and also with the use of mental health services, a study of more than 17,000 teenagers shows.

To assess the risk factors for stimulant abuse in adolescents, Mindy A. Herman-Stahl, Ph.D., and her colleagues at RTI International reviewed data on adolescents from the 2002 National Survey of Drug Use and Health (NSDUH), an annual survey of the civilian, noninstitutionalized population aged 12 years and older (J. Adolesc. Health 2006;39:374–80).

Overall, adolescents who reported treatment for mental health problems during the year before the survey were more than one and a half times as likely to report either amphetamine use or nonmedical prescription stimulant use during the past year. Also, marijuana use was more than four times as likely among the methamphetamine users and more than twice as likely among the illicit stimulant users.

After controlling for demographic variables, methamphetamine use was more than twice as likely among girls vs. boys and significantly less likely among non-Hispanic blacks vs. non-Hispanic whites. There were no racial or gender differences linked to nonprescription stimulant use, but significant associations were found with high levels of family conflict and sensation-seeking behavior.

Methamphetamine use was associated with deviant behavior such as selling drugs and binge drinking, which suggests that adolescents who use methamphetamine may be more likely to be exposed to delinquent peers and dangerous environments, the researchers said.

The study was built on a project that received funding from Eli Lilly & Co.

Tailor Teen Pregnancy Messages

Pregnant adolescents aged 12–17 years are more likely than 18- or 19-year-olds to report that their babies would enhance their relationships with others, and older teens are more likely to identify the challenges of teen motherhood, data collected from 247 girls who sought care at a prenatal clinic show.

Understanding the variations in pregnant girls' attitudes toward pregnancy can help health care providers target interventions, although the differences among age subgroups did not reach statistical significance, reported Cynthia Rosengard, Ph.D., of Rhode Island Hospital in Providence and her colleagues (Pediatrics 2006;118:503–10).

The adolescents completed questionnaires and interviews about the pros and cons of having a baby as a teen. Their mean age was 16.8 years, and data were collected over a 2-year period.

The girls reported stronger connections with others and a sense of responsibility and purpose that might discourage them from other risky behaviors as some advantages of teen pregnancy. Disadvantages included financial concerns, lack of preparedness for motherhood, changing life plans, and missing out on other teenage experiences.

Risky Sex in Black Teens

Black adolescents who report depressive symptoms are nearly four times more likely to report inconsistent condom use than are peers who were not depressed, Dr. Larry K. Brown of Brown University in Providence, R.I., and his colleagues reported.

A majority of 277 of the 415 adolescents (67%) reported using condoms in less than 75% of sexual activities, and 138 (33%) reported using condoms in at least 75% of sexual activities, after the investigators controlled for demographic factors including age, gender, and income (J. Adolesc. Health 2006 [Epub doi:j.jadohealth.2006.01.015]).

Although males reported more condom use than females overall, the 13 males who reported depressive symptoms were significantly less likely to report condom use than were those who were not depressed. The 26 girls who reported depressive symptoms also were less likely to report condom use at follow-up, but the difference was not statistically significant.

People younger than 25 years account for about half of all new HIV infections in the United States each year, and blacks represented about 50% of HIV cases diagnosed in the country in 2003. Interventions for depression could reduce risky sexual behaviors in the high-risk black adolescent population and prevent the development of more severe emotional disorders, the researchers noted.

“Regardless of the lower incidence of depressive symptoms among these youth compared with peers of other races, depressive symptoms had a major impact on HIV and STI risk by quadrupling the odds of inconsistent condom use,” they wrote.

Older adolescents (19–21 years) were less likely to use condoms consistently than those aged 18 years and younger.

Race, Gender Affect Meth Use

Nonmedical use of prescription stimulants and methamphetamine by adolescents aged 12–17 years is significantly associated with use of marijuana and other illegal drugs and also with the use of mental health services, a study of more than 17,000 teenagers shows.

To assess the risk factors for stimulant abuse in adolescents, Mindy A. Herman-Stahl, Ph.D., and her colleagues at RTI International reviewed data on adolescents from the 2002 National Survey of Drug Use and Health (NSDUH), an annual survey of the civilian, noninstitutionalized population aged 12 years and older (J. Adolesc. Health 2006;39:374–80).

Overall, adolescents who reported treatment for mental health problems during the year before the survey were more than one and a half times as likely to report either amphetamine use or nonmedical prescription stimulant use during the past year. Also, marijuana use was more than four times as likely among the methamphetamine users and more than twice as likely among the illicit stimulant users.

After controlling for demographic variables, methamphetamine use was more than twice as likely among girls vs. boys and significantly less likely among non-Hispanic blacks vs. non-Hispanic whites. There were no racial or gender differences linked to nonprescription stimulant use, but significant associations were found with high levels of family conflict and sensation-seeking behavior.

Methamphetamine use was associated with deviant behavior such as selling drugs and binge drinking, which suggests that adolescents who use methamphetamine may be more likely to be exposed to delinquent peers and dangerous environments, the researchers said.

The study was built on a project that received funding from Eli Lilly & Co.

WASHINGTON — Serosorting—the selection of sex practices based on a partner's known or perceived HIV status—is becoming more popular among men who have sex with men, Dr. Robert M. Grant said at the Ryan White CARE Act clinical meeting on HIV treatment.

Increased serosorting may reduce the spread of new HIV infections in this population. “This trend suggests that we need to think of sexual risk in a new way,” said Dr. Grant of the University of California, San Francisco.

HIV patients' choices of partners with the same HIV status for high-risk sex may explain a plateau in HIV among men who have sex with men (MSM) in recent years, Dr. Grant said. He cited the 2003 HIV/AIDS Epidemiology Annual Report from the San Francisco Department of Public Health, which showed a tapering off of annual HIV incidence in MSM locally from 4% in 1999 to 2.9% in 2003.

The San Francisco report also noted that receptive unprotected anal intercourse (UAI) among MSM decreased from 1999 to 2003, which suggests that HIV-negative MSM are selectively using condoms or taking other precautions if they know their partners are HIV positive.

“We suspect it is a harm-reduction strategy that is better than not serosorting,” Dr. Grant said.

Results from several studies of MSM in San Francisco presented at the Conference on Retroviruses and Opportunistic Infections earlier this year support an increase in serosorting behavior. A total of 32% of 310 MSM who were randomly surveyed reported no UAI, but 27% reported UAI with partners with the same HIV status. Another 21% reported no anal sex, while 19% reported UAI with partners who had a different HIV status. Data were not available for the remaining 1%.

In addition, the rate of newly diagnosed HIV-positive infections among MSM who were tested in an STD clinic between 2001 and 2005 was 2.6% among HIV-positive patients who reported serosorting, vs. 4.1% among those who reported no serosorting, based on data from more than 6,000 HIV tests.

Serosorting as a risk reduction strategy is probably more effective than not serosorting but less effective than adhering to other safe sex practices such as condom use, Dr. Grant said. Serosorting does not protect against other STDs, he added; additional data from the San Francisco clinic study showed that serosorters had about the same risk of developing STDs as those who were not serosorting (27% vs. 29%).

Although there is nothing wrong with serosorting, Dr. Grant recommends that clinicians continue to promote HIV testing to patients, as well as disclosure of HIV status to prospective sex partners.

Whether serosorting can increase the risk of infection with a second HIV strain (superinfection) remains to be seen. Data on superinfection are limited, but recently infected patients may be the most vulnerable. If there is a risk of superinfection, it may decline over time.

Of the 20 documented cases of HIV superinfection in the medical literature, 90% occurred during the first 3 years of infection, and no evidence of superinfection has been documented among HIV patients with long-term infections, Dr. Grant said.

That doesn't mean superinfection can't occur later on. But the possible risk of superinfection from serosorting should not be overstated, he added, and more research is needed to define the period of possible susceptibility to a second infection.

WASHINGTON — Serosorting—the selection of sex practices based on a partner's known or perceived HIV status—is becoming more popular among men who have sex with men, Dr. Robert M. Grant said at the Ryan White CARE Act clinical meeting on HIV treatment.

Increased serosorting may reduce the spread of new HIV infections in this population. “This trend suggests that we need to think of sexual risk in a new way,” said Dr. Grant of the University of California, San Francisco.

HIV patients' choices of partners with the same HIV status for high-risk sex may explain a plateau in HIV among men who have sex with men (MSM) in recent years, Dr. Grant said. He cited the 2003 HIV/AIDS Epidemiology Annual Report from the San Francisco Department of Public Health, which showed a tapering off of annual HIV incidence in MSM locally from 4% in 1999 to 2.9% in 2003.

The San Francisco report also noted that receptive unprotected anal intercourse (UAI) among MSM decreased from 1999 to 2003, which suggests that HIV-negative MSM are selectively using condoms or taking other precautions if they know their partners are HIV positive.

“We suspect it is a harm-reduction strategy that is better than not serosorting,” Dr. Grant said.

Results from several studies of MSM in San Francisco presented at the Conference on Retroviruses and Opportunistic Infections earlier this year support an increase in serosorting behavior. A total of 32% of 310 MSM who were randomly surveyed reported no UAI, but 27% reported UAI with partners with the same HIV status. Another 21% reported no anal sex, while 19% reported UAI with partners who had a different HIV status. Data were not available for the remaining 1%.

In addition, the rate of newly diagnosed HIV-positive infections among MSM who were tested in an STD clinic between 2001 and 2005 was 2.6% among HIV-positive patients who reported serosorting, vs. 4.1% among those who reported no serosorting, based on data from more than 6,000 HIV tests.

Serosorting as a risk reduction strategy is probably more effective than not serosorting but less effective than adhering to other safe sex practices such as condom use, Dr. Grant said. Serosorting does not protect against other STDs, he added; additional data from the San Francisco clinic study showed that serosorters had about the same risk of developing STDs as those who were not serosorting (27% vs. 29%).

Although there is nothing wrong with serosorting, Dr. Grant recommends that clinicians continue to promote HIV testing to patients, as well as disclosure of HIV status to prospective sex partners.

Whether serosorting can increase the risk of infection with a second HIV strain (superinfection) remains to be seen. Data on superinfection are limited, but recently infected patients may be the most vulnerable. If there is a risk of superinfection, it may decline over time.

Of the 20 documented cases of HIV superinfection in the medical literature, 90% occurred during the first 3 years of infection, and no evidence of superinfection has been documented among HIV patients with long-term infections, Dr. Grant said.

That doesn't mean superinfection can't occur later on. But the possible risk of superinfection from serosorting should not be overstated, he added, and more research is needed to define the period of possible susceptibility to a second infection.

WASHINGTON — Serosorting—the selection of sex practices based on a partner's known or perceived HIV status—is becoming more popular among men who have sex with men, Dr. Robert M. Grant said at the Ryan White CARE Act clinical meeting on HIV treatment.

Increased serosorting may reduce the spread of new HIV infections in this population. “This trend suggests that we need to think of sexual risk in a new way,” said Dr. Grant of the University of California, San Francisco.

HIV patients' choices of partners with the same HIV status for high-risk sex may explain a plateau in HIV among men who have sex with men (MSM) in recent years, Dr. Grant said. He cited the 2003 HIV/AIDS Epidemiology Annual Report from the San Francisco Department of Public Health, which showed a tapering off of annual HIV incidence in MSM locally from 4% in 1999 to 2.9% in 2003.

The San Francisco report also noted that receptive unprotected anal intercourse (UAI) among MSM decreased from 1999 to 2003, which suggests that HIV-negative MSM are selectively using condoms or taking other precautions if they know their partners are HIV positive.

“We suspect it is a harm-reduction strategy that is better than not serosorting,” Dr. Grant said.

Results from several studies of MSM in San Francisco presented at the Conference on Retroviruses and Opportunistic Infections earlier this year support an increase in serosorting behavior. A total of 32% of 310 MSM who were randomly surveyed reported no UAI, but 27% reported UAI with partners with the same HIV status. Another 21% reported no anal sex, while 19% reported UAI with partners who had a different HIV status. Data were not available for the remaining 1%.

In addition, the rate of newly diagnosed HIV-positive infections among MSM who were tested in an STD clinic between 2001 and 2005 was 2.6% among HIV-positive patients who reported serosorting, vs. 4.1% among those who reported no serosorting, based on data from more than 6,000 HIV tests.

Serosorting as a risk reduction strategy is probably more effective than not serosorting but less effective than adhering to other safe sex practices such as condom use, Dr. Grant said. Serosorting does not protect against other STDs, he added; additional data from the San Francisco clinic study showed that serosorters had about the same risk of developing STDs as those who were not serosorting (27% vs. 29%).

Although there is nothing wrong with serosorting, Dr. Grant recommends that clinicians continue to promote HIV testing to patients, as well as disclosure of HIV status to prospective sex partners.

Whether serosorting can increase the risk of infection with a second HIV strain (superinfection) remains to be seen. Data on superinfection are limited, but recently infected patients may be the most vulnerable. If there is a risk of superinfection, it may decline over time.

Of the 20 documented cases of HIV superinfection in the medical literature, 90% occurred during the first 3 years of infection, and no evidence of superinfection has been documented among HIV patients with long-term infections, Dr. Grant said.

That doesn't mean superinfection can't occur later on. But the possible risk of superinfection from serosorting should not be overstated, he added, and more research is needed to define the period of possible susceptibility to a second infection.

Pregnant adolescents aged 12–17 years are more likely than 18- or 19-year-olds to report that their babies would enhance their relationships with others, and older teens are more likely to identify the challenges of teen motherhood, data collected from 247 girls who sought care at a prenatal clinic show.

Understanding the variations in pregnant girls' attitudes toward pregnancy can help health care providers target interventions, although the differences among age and cultural subgroups did not reach statistical significance, reported Cynthia Rosengard, Ph.D., of Rhode Island Hospital in Providence and her colleagues (Pediatrics 2006;118:503–10).

The adolescents completed questionnaires and interviews about the pros and cons of having a baby as a teen. Their mean age was 16.8 years, and data were collected over a 2-year period.

The girls reported stronger connections with others and a sense of responsibility and purpose that might discourage them from other risky behaviors as some advantages of teen pregnancy. Disadvantages included financial concerns, lack of preparedness for motherhood, changing life plans, and missing out on other teenage experiences.

Disadvantages outweighed advantages overall, but several subgroup trends emerged.

For example, 64 of 117 (55%) Hispanic teens said having a baby would enhance their connections with others, vs. 62 of 130 (48%) non-Hispanic teens. But most Hispanic and non-Hispanic teens (84% and 75%, respectively) identified changes in life plans as a significant disadvantage to pregnancy.

Additionally, 26 of 58 girls with intended pregnancies (45%) associated the pregnancy with positive changes, vs. 61 of 189 (32%) of girls whose pregnancies were unintended.

Pregnant adolescents aged 12–17 years are more likely than 18- or 19-year-olds to report that their babies would enhance their relationships with others, and older teens are more likely to identify the challenges of teen motherhood, data collected from 247 girls who sought care at a prenatal clinic show.

Understanding the variations in pregnant girls' attitudes toward pregnancy can help health care providers target interventions, although the differences among age and cultural subgroups did not reach statistical significance, reported Cynthia Rosengard, Ph.D., of Rhode Island Hospital in Providence and her colleagues (Pediatrics 2006;118:503–10).

The adolescents completed questionnaires and interviews about the pros and cons of having a baby as a teen. Their mean age was 16.8 years, and data were collected over a 2-year period.

The girls reported stronger connections with others and a sense of responsibility and purpose that might discourage them from other risky behaviors as some advantages of teen pregnancy. Disadvantages included financial concerns, lack of preparedness for motherhood, changing life plans, and missing out on other teenage experiences.

Disadvantages outweighed advantages overall, but several subgroup trends emerged.

For example, 64 of 117 (55%) Hispanic teens said having a baby would enhance their connections with others, vs. 62 of 130 (48%) non-Hispanic teens. But most Hispanic and non-Hispanic teens (84% and 75%, respectively) identified changes in life plans as a significant disadvantage to pregnancy.

Additionally, 26 of 58 girls with intended pregnancies (45%) associated the pregnancy with positive changes, vs. 61 of 189 (32%) of girls whose pregnancies were unintended.

Pregnant adolescents aged 12–17 years are more likely than 18- or 19-year-olds to report that their babies would enhance their relationships with others, and older teens are more likely to identify the challenges of teen motherhood, data collected from 247 girls who sought care at a prenatal clinic show.

Understanding the variations in pregnant girls' attitudes toward pregnancy can help health care providers target interventions, although the differences among age and cultural subgroups did not reach statistical significance, reported Cynthia Rosengard, Ph.D., of Rhode Island Hospital in Providence and her colleagues (Pediatrics 2006;118:503–10).

The adolescents completed questionnaires and interviews about the pros and cons of having a baby as a teen. Their mean age was 16.8 years, and data were collected over a 2-year period.

The girls reported stronger connections with others and a sense of responsibility and purpose that might discourage them from other risky behaviors as some advantages of teen pregnancy. Disadvantages included financial concerns, lack of preparedness for motherhood, changing life plans, and missing out on other teenage experiences.

Disadvantages outweighed advantages overall, but several subgroup trends emerged.

For example, 64 of 117 (55%) Hispanic teens said having a baby would enhance their connections with others, vs. 62 of 130 (48%) non-Hispanic teens. But most Hispanic and non-Hispanic teens (84% and 75%, respectively) identified changes in life plans as a significant disadvantage to pregnancy.

Additionally, 26 of 58 girls with intended pregnancies (45%) associated the pregnancy with positive changes, vs. 61 of 189 (32%) of girls whose pregnancies were unintended.

Less than 12% of 312 pediatricians experienced or expected a notable decrease in revenue from using Pediarix, the combined vaccine from GlaxoSmithKline, based on a nationwide survey.

About 11% of the practices reported a moderate decrease in revenue and less than 1% reported a significant decrease, said Dr. Gary L. Freed and his colleagues at the University of Michigan in Ann Arbor (Pediatrics 2006;118:251–7). The researchers had no financial relationships related to the study.

Pediarix, which includes diphtheria, tetanus, acellular pertussis, hepatitis B, and inactivated polio vaccines, was licensed by the Food and Drug Administration in December 2002 and accounted for more than 30% of all diphtheria, tetanus, acellular pertussis vaccine administered in the United States by the end of 2003. The researchers conducted the survey to determine factors that influenced Pediarix use.

Overall, 123 pediatricians (39%) reported purchasing Pediarix for in-office use. Another 18% were considering a Pediarix purchase, and 40% were not considering a purchase. The remaining 3% said they did not know, or left the question blank.

Fewer administration fees and a decreased profit from the Pediarix vaccine itself were the most common reasons for decreased revenue (69% and 51%, respectively), and 74 practices had raised or planned to raise fees to recoup their losses. Some practices simply charged more for the vaccine—23% of practices charged payers more for the vaccine, while 12% charged patients more for it. In addition, 16% of practices charged payers higher administration fees, 9% charged patients higher administration fees, 7% charged payers more for office visits, and 3% charged patients more for office visits.

Despite the increased costs in some practices, combination vaccines were generally popular with patients and providers because they reduced the number of injections given to a child at a single visit.

Overall, 51% of the 241 pediatricians who reported factors that influenced their vaccine purchase decisions said that parent and provider interest in decreasing the number of injections was a factor.

“The study nicely depicts the multiple factors involved in making that decision [about combined vaccine use], and different physicians and parents will weigh the factors differently,” said Dr. Edgar K. Marcuse, a professor of pediatrics at the University of Washington, Seattle, and a member of the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices.

The combination vaccines can decrease missed opportunities and missed vaccine coverage, which is something of importance to all pediatricians, he added.

The financial impact of combined vaccine use is likely to vary by region and by payer contracts. Some state and private insurance programs limit the number of administrative fees that physicians can charge, which may reduce the impact of combination vaccine use on total practice revenue.

For some, “given the circumstances of their practice and the socioeconomic status of their patients, the price is not off-putting; for others price may be the key driver,” Dr. Marcuse said.

“Parents and physicians will look at the factors identified in the study, and those who are enthusiastic about this particular combination and who value the decreased injections will use it, while those who are hesitant may look at the increased cost and refrain for now,” he said.

But some practices are reluctant to maintain two supplies of vaccine and two standards of care: one for those covered by state-funded vaccine programs and one for those funded by private purchasers.

The practices surveyed were less likely to purchase Pediarix when they did not order it through the federal Vaccines for Children program, which highlights the reluctance of most physicians to use one vaccine for certain patients and not for others, the researchers noted.

Less than 12% of 312 pediatricians experienced or expected a notable decrease in revenue from using Pediarix, the combined vaccine from GlaxoSmithKline, based on a nationwide survey.

About 11% of the practices reported a moderate decrease in revenue and less than 1% reported a significant decrease, said Dr. Gary L. Freed and his colleagues at the University of Michigan in Ann Arbor (Pediatrics 2006;118:251–7). The researchers had no financial relationships related to the study.

Pediarix, which includes diphtheria, tetanus, acellular pertussis, hepatitis B, and inactivated polio vaccines, was licensed by the Food and Drug Administration in December 2002 and accounted for more than 30% of all diphtheria, tetanus, acellular pertussis vaccine administered in the United States by the end of 2003. The researchers conducted the survey to determine factors that influenced Pediarix use.

Overall, 123 pediatricians (39%) reported purchasing Pediarix for in-office use. Another 18% were considering a Pediarix purchase, and 40% were not considering a purchase. The remaining 3% said they did not know, or left the question blank.

Fewer administration fees and a decreased profit from the Pediarix vaccine itself were the most common reasons for decreased revenue (69% and 51%, respectively), and 74 practices had raised or planned to raise fees to recoup their losses. Some practices simply charged more for the vaccine—23% of practices charged payers more for the vaccine, while 12% charged patients more for it. In addition, 16% of practices charged payers higher administration fees, 9% charged patients higher administration fees, 7% charged payers more for office visits, and 3% charged patients more for office visits.

Despite the increased costs in some practices, combination vaccines were generally popular with patients and providers because they reduced the number of injections given to a child at a single visit.

Overall, 51% of the 241 pediatricians who reported factors that influenced their vaccine purchase decisions said that parent and provider interest in decreasing the number of injections was a factor.

“The study nicely depicts the multiple factors involved in making that decision [about combined vaccine use], and different physicians and parents will weigh the factors differently,” said Dr. Edgar K. Marcuse, a professor of pediatrics at the University of Washington, Seattle, and a member of the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices.

The combination vaccines can decrease missed opportunities and missed vaccine coverage, which is something of importance to all pediatricians, he added.

The financial impact of combined vaccine use is likely to vary by region and by payer contracts. Some state and private insurance programs limit the number of administrative fees that physicians can charge, which may reduce the impact of combination vaccine use on total practice revenue.

For some, “given the circumstances of their practice and the socioeconomic status of their patients, the price is not off-putting; for others price may be the key driver,” Dr. Marcuse said.

“Parents and physicians will look at the factors identified in the study, and those who are enthusiastic about this particular combination and who value the decreased injections will use it, while those who are hesitant may look at the increased cost and refrain for now,” he said.

But some practices are reluctant to maintain two supplies of vaccine and two standards of care: one for those covered by state-funded vaccine programs and one for those funded by private purchasers.

The practices surveyed were less likely to purchase Pediarix when they did not order it through the federal Vaccines for Children program, which highlights the reluctance of most physicians to use one vaccine for certain patients and not for others, the researchers noted.

Less than 12% of 312 pediatricians experienced or expected a notable decrease in revenue from using Pediarix, the combined vaccine from GlaxoSmithKline, based on a nationwide survey.

About 11% of the practices reported a moderate decrease in revenue and less than 1% reported a significant decrease, said Dr. Gary L. Freed and his colleagues at the University of Michigan in Ann Arbor (Pediatrics 2006;118:251–7). The researchers had no financial relationships related to the study.

Pediarix, which includes diphtheria, tetanus, acellular pertussis, hepatitis B, and inactivated polio vaccines, was licensed by the Food and Drug Administration in December 2002 and accounted for more than 30% of all diphtheria, tetanus, acellular pertussis vaccine administered in the United States by the end of 2003. The researchers conducted the survey to determine factors that influenced Pediarix use.

Overall, 123 pediatricians (39%) reported purchasing Pediarix for in-office use. Another 18% were considering a Pediarix purchase, and 40% were not considering a purchase. The remaining 3% said they did not know, or left the question blank.

Fewer administration fees and a decreased profit from the Pediarix vaccine itself were the most common reasons for decreased revenue (69% and 51%, respectively), and 74 practices had raised or planned to raise fees to recoup their losses. Some practices simply charged more for the vaccine—23% of practices charged payers more for the vaccine, while 12% charged patients more for it. In addition, 16% of practices charged payers higher administration fees, 9% charged patients higher administration fees, 7% charged payers more for office visits, and 3% charged patients more for office visits.

Despite the increased costs in some practices, combination vaccines were generally popular with patients and providers because they reduced the number of injections given to a child at a single visit.

Overall, 51% of the 241 pediatricians who reported factors that influenced their vaccine purchase decisions said that parent and provider interest in decreasing the number of injections was a factor.

“The study nicely depicts the multiple factors involved in making that decision [about combined vaccine use], and different physicians and parents will weigh the factors differently,” said Dr. Edgar K. Marcuse, a professor of pediatrics at the University of Washington, Seattle, and a member of the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices.

The combination vaccines can decrease missed opportunities and missed vaccine coverage, which is something of importance to all pediatricians, he added.

The financial impact of combined vaccine use is likely to vary by region and by payer contracts. Some state and private insurance programs limit the number of administrative fees that physicians can charge, which may reduce the impact of combination vaccine use on total practice revenue.

For some, “given the circumstances of their practice and the socioeconomic status of their patients, the price is not off-putting; for others price may be the key driver,” Dr. Marcuse said.

“Parents and physicians will look at the factors identified in the study, and those who are enthusiastic about this particular combination and who value the decreased injections will use it, while those who are hesitant may look at the increased cost and refrain for now,” he said.

But some practices are reluctant to maintain two supplies of vaccine and two standards of care: one for those covered by state-funded vaccine programs and one for those funded by private purchasers.

The practices surveyed were less likely to purchase Pediarix when they did not order it through the federal Vaccines for Children program, which highlights the reluctance of most physicians to use one vaccine for certain patients and not for others, the researchers noted.

A standard daily dose of 40–45 mg/kg per day amoxicillin is an appropriate first-line antibiotic for children with acute otitis media who have received at least three doses of the heptavalent pneumococcal conjugate vaccine, if treatment is needed, reported Dr. Jane Garbutt and her colleagues at Washington University, St. Louis.

The investigators reviewed data from 327 children younger than 7 years old with new diagnoses of acute otitis media, otitis media with effusion, acute sinusitis, streptococcal pharyngitis, nonspecific upper respiratory tract infections, or a cough illness during the 4-year period (Pediatrics 2006;117:1087–94).

The prevalence of Streptococcus pneumoniae isolates that were not susceptible to penicillin (NSSP) was significantly reduced in children with any diagnosis who had received at least three doses of heptavalent pneumococcal conjugate vaccine (PCV7), compared with those who had fewer or no doses (8% vs. 20%), and no NSSP-A isolates were found among the study children who had received at least three doses of the PCV7 vaccine. In addition, vaccination with at least three doses of PCV7 was protective for all child care attendees, but vaccination with at least one dose was not protective.

A standard daily dose of 40–45 mg/kg per day amoxicillin is an appropriate first-line antibiotic for children with acute otitis media who have received at least three doses of the heptavalent pneumococcal conjugate vaccine, if treatment is needed, reported Dr. Jane Garbutt and her colleagues at Washington University, St. Louis.

The investigators reviewed data from 327 children younger than 7 years old with new diagnoses of acute otitis media, otitis media with effusion, acute sinusitis, streptococcal pharyngitis, nonspecific upper respiratory tract infections, or a cough illness during the 4-year period (Pediatrics 2006;117:1087–94).

The prevalence of Streptococcus pneumoniae isolates that were not susceptible to penicillin (NSSP) was significantly reduced in children with any diagnosis who had received at least three doses of heptavalent pneumococcal conjugate vaccine (PCV7), compared with those who had fewer or no doses (8% vs. 20%), and no NSSP-A isolates were found among the study children who had received at least three doses of the PCV7 vaccine. In addition, vaccination with at least three doses of PCV7 was protective for all child care attendees, but vaccination with at least one dose was not protective.

A standard daily dose of 40–45 mg/kg per day amoxicillin is an appropriate first-line antibiotic for children with acute otitis media who have received at least three doses of the heptavalent pneumococcal conjugate vaccine, if treatment is needed, reported Dr. Jane Garbutt and her colleagues at Washington University, St. Louis.

The investigators reviewed data from 327 children younger than 7 years old with new diagnoses of acute otitis media, otitis media with effusion, acute sinusitis, streptococcal pharyngitis, nonspecific upper respiratory tract infections, or a cough illness during the 4-year period (Pediatrics 2006;117:1087–94).

The prevalence of Streptococcus pneumoniae isolates that were not susceptible to penicillin (NSSP) was significantly reduced in children with any diagnosis who had received at least three doses of heptavalent pneumococcal conjugate vaccine (PCV7), compared with those who had fewer or no doses (8% vs. 20%), and no NSSP-A isolates were found among the study children who had received at least three doses of the PCV7 vaccine. In addition, vaccination with at least three doses of PCV7 was protective for all child care attendees, but vaccination with at least one dose was not protective.

WASHINGTON — Clinicians should be proactive in checking their HIV patients for herpes and syphilis because of the risk of coinfection, Dr. Connie Celum said at the Ryan White CARE Act meeting on HIV treatment.

“If you don't look for STDs in HIV patients, you won't find them,” said Dr. Celum of the University of Washington, Seattle.

Individuals with STDs are two to five times more likely than those without STDs to become infected with HIV if they are exposed through sexual contact, according to data from the Centers for Disease Control and Prevention.

Comorbid STDs often go undetected in HIV patients, but an HIV-infected person who is coinfected with an STD is more likely to transmit HIV than an HIV-infected person without a comorbid STD.

Genital herpes is the most common sexually-transmitted infection among HIV-positive persons, Dr. Celum said. Previous studies have shown that the herpes virus (HSV-2) increases one's risk of acquiring HIV and increases HIV RNA levels in plasma and in the genital tract; the presence of herpes also makes a person more likely to transmit HIV.

Conversely, the presence of HIV can reactivate herpes that has been dormant. HIV also increases the frequency of HSV-2 shedding in persons with herpes and increases the risk of acquiring and transmitting the herpes virus. A recent study by Dr. Celum and her colleagues at the University of Washington found that 50 HIV-positive men with herpes were 2.7 times more likely to shed the herpes virus orally, compared with 59 HIV-negative men with herpes (J. Infect. Dis. 2006;194:420–7).

A key question is, if you suppress herpes, can you reduce the likelihood of HIV infection? Suppression of herpes may be a strategy that buys more time for researchers who continue to work on other HIV treatments and interventions, Dr. Celum said.

Data from a proof-of-concept study including 140 women coinfected with HIV and herpes showed that treating herpes with valacyclovir significantly reduced HIV levels in plasma and the genital tract. The results were presented at the Conference on Retroviruses and Opportunistic Infections earlier this year, but useful clinical data are still 1–2 years away, she said.

Most herpes patients shed the virus in the genital tract. Although highly active antiretroviral treatment (HAART) may reduce symptoms of herpes, it does not reduce subclinical herpes shedding. Even if suppressing herpes infections with HAART can suppress the viral load in HIV patients, it remains to be seen whether treating herpes also reduces the likelihood of HIV infection.

Clinicians should also be vigilant in evaluating their HIV patients for syphilis because the annual incidence of syphilis is rising, especially among men who have sex with men, Dr. Celum explained.

The reasons for the resurgence of syphilis remain unclear, but some epidemiologic data suggest that improved therapy for HIV and improved survival and well-being among HIV patients may be driving the increase in cases, particularly among men who have sex with men. Most clinicians have limited experience in diagnosing syphilis, and they may not know it when they see it. Syphilis is a great imitator; the appearance of rashes and other signs of secondary syphilis vary from person to person.

Syphilis rashes may be widespread or subtle. The rashes are not usually itchy or vesicular, but they may include papules, macules, pustules, or ring- or lens-shaped lesions. A syphilis rash appears on the palms and soles in 60% of cases, not 100% of cases, so look elsewhere on the body for signs of infection after checking the palms and soles, Dr. Celum said. These symptoms usually appear after the chancres of primary syphilis have resolved.

Syphilis manifestations are especially easy to miss in HIV-positive patients on HAART because these patients often develop rashes that resemble syphilis as a side effect of the medication.

Consequently, Dr. Celum recommends maintaining a high level of suspicion for syphilis in HIV-positive patients because of the increased risk of HIV transmission. She suggests treating for syphilis in possible as well as definite cases, and re-examining the patients clinically and serologically every 6 months.

The most current treatment guidelines for syphilis and other STDs are available on the Centers for Disease Control and Prevention Web site at www.cdc.gov/std

WASHINGTON — Clinicians should be proactive in checking their HIV patients for herpes and syphilis because of the risk of coinfection, Dr. Connie Celum said at the Ryan White CARE Act meeting on HIV treatment.

“If you don't look for STDs in HIV patients, you won't find them,” said Dr. Celum of the University of Washington, Seattle.

Individuals with STDs are two to five times more likely than those without STDs to become infected with HIV if they are exposed through sexual contact, according to data from the Centers for Disease Control and Prevention.

Comorbid STDs often go undetected in HIV patients, but an HIV-infected person who is coinfected with an STD is more likely to transmit HIV than an HIV-infected person without a comorbid STD.

Genital herpes is the most common sexually-transmitted infection among HIV-positive persons, Dr. Celum said. Previous studies have shown that the herpes virus (HSV-2) increases one's risk of acquiring HIV and increases HIV RNA levels in plasma and in the genital tract; the presence of herpes also makes a person more likely to transmit HIV.

Conversely, the presence of HIV can reactivate herpes that has been dormant. HIV also increases the frequency of HSV-2 shedding in persons with herpes and increases the risk of acquiring and transmitting the herpes virus. A recent study by Dr. Celum and her colleagues at the University of Washington found that 50 HIV-positive men with herpes were 2.7 times more likely to shed the herpes virus orally, compared with 59 HIV-negative men with herpes (J. Infect. Dis. 2006;194:420–7).

A key question is, if you suppress herpes, can you reduce the likelihood of HIV infection? Suppression of herpes may be a strategy that buys more time for researchers who continue to work on other HIV treatments and interventions, Dr. Celum said.

Data from a proof-of-concept study including 140 women coinfected with HIV and herpes showed that treating herpes with valacyclovir significantly reduced HIV levels in plasma and the genital tract. The results were presented at the Conference on Retroviruses and Opportunistic Infections earlier this year, but useful clinical data are still 1–2 years away, she said.

Most herpes patients shed the virus in the genital tract. Although highly active antiretroviral treatment (HAART) may reduce symptoms of herpes, it does not reduce subclinical herpes shedding. Even if suppressing herpes infections with HAART can suppress the viral load in HIV patients, it remains to be seen whether treating herpes also reduces the likelihood of HIV infection.

Clinicians should also be vigilant in evaluating their HIV patients for syphilis because the annual incidence of syphilis is rising, especially among men who have sex with men, Dr. Celum explained.

The reasons for the resurgence of syphilis remain unclear, but some epidemiologic data suggest that improved therapy for HIV and improved survival and well-being among HIV patients may be driving the increase in cases, particularly among men who have sex with men. Most clinicians have limited experience in diagnosing syphilis, and they may not know it when they see it. Syphilis is a great imitator; the appearance of rashes and other signs of secondary syphilis vary from person to person.

Syphilis rashes may be widespread or subtle. The rashes are not usually itchy or vesicular, but they may include papules, macules, pustules, or ring- or lens-shaped lesions. A syphilis rash appears on the palms and soles in 60% of cases, not 100% of cases, so look elsewhere on the body for signs of infection after checking the palms and soles, Dr. Celum said. These symptoms usually appear after the chancres of primary syphilis have resolved.

Syphilis manifestations are especially easy to miss in HIV-positive patients on HAART because these patients often develop rashes that resemble syphilis as a side effect of the medication.

Consequently, Dr. Celum recommends maintaining a high level of suspicion for syphilis in HIV-positive patients because of the increased risk of HIV transmission. She suggests treating for syphilis in possible as well as definite cases, and re-examining the patients clinically and serologically every 6 months.

The most current treatment guidelines for syphilis and other STDs are available on the Centers for Disease Control and Prevention Web site at www.cdc.gov/std

WASHINGTON — Clinicians should be proactive in checking their HIV patients for herpes and syphilis because of the risk of coinfection, Dr. Connie Celum said at the Ryan White CARE Act meeting on HIV treatment.

“If you don't look for STDs in HIV patients, you won't find them,” said Dr. Celum of the University of Washington, Seattle.

Individuals with STDs are two to five times more likely than those without STDs to become infected with HIV if they are exposed through sexual contact, according to data from the Centers for Disease Control and Prevention.

Comorbid STDs often go undetected in HIV patients, but an HIV-infected person who is coinfected with an STD is more likely to transmit HIV than an HIV-infected person without a comorbid STD.

Genital herpes is the most common sexually-transmitted infection among HIV-positive persons, Dr. Celum said. Previous studies have shown that the herpes virus (HSV-2) increases one's risk of acquiring HIV and increases HIV RNA levels in plasma and in the genital tract; the presence of herpes also makes a person more likely to transmit HIV.

Conversely, the presence of HIV can reactivate herpes that has been dormant. HIV also increases the frequency of HSV-2 shedding in persons with herpes and increases the risk of acquiring and transmitting the herpes virus. A recent study by Dr. Celum and her colleagues at the University of Washington found that 50 HIV-positive men with herpes were 2.7 times more likely to shed the herpes virus orally, compared with 59 HIV-negative men with herpes (J. Infect. Dis. 2006;194:420–7).

A key question is, if you suppress herpes, can you reduce the likelihood of HIV infection? Suppression of herpes may be a strategy that buys more time for researchers who continue to work on other HIV treatments and interventions, Dr. Celum said.

Data from a proof-of-concept study including 140 women coinfected with HIV and herpes showed that treating herpes with valacyclovir significantly reduced HIV levels in plasma and the genital tract. The results were presented at the Conference on Retroviruses and Opportunistic Infections earlier this year, but useful clinical data are still 1–2 years away, she said.

Most herpes patients shed the virus in the genital tract. Although highly active antiretroviral treatment (HAART) may reduce symptoms of herpes, it does not reduce subclinical herpes shedding. Even if suppressing herpes infections with HAART can suppress the viral load in HIV patients, it remains to be seen whether treating herpes also reduces the likelihood of HIV infection.

Clinicians should also be vigilant in evaluating their HIV patients for syphilis because the annual incidence of syphilis is rising, especially among men who have sex with men, Dr. Celum explained.

The reasons for the resurgence of syphilis remain unclear, but some epidemiologic data suggest that improved therapy for HIV and improved survival and well-being among HIV patients may be driving the increase in cases, particularly among men who have sex with men. Most clinicians have limited experience in diagnosing syphilis, and they may not know it when they see it. Syphilis is a great imitator; the appearance of rashes and other signs of secondary syphilis vary from person to person.

Syphilis rashes may be widespread or subtle. The rashes are not usually itchy or vesicular, but they may include papules, macules, pustules, or ring- or lens-shaped lesions. A syphilis rash appears on the palms and soles in 60% of cases, not 100% of cases, so look elsewhere on the body for signs of infection after checking the palms and soles, Dr. Celum said. These symptoms usually appear after the chancres of primary syphilis have resolved.

Syphilis manifestations are especially easy to miss in HIV-positive patients on HAART because these patients often develop rashes that resemble syphilis as a side effect of the medication.

Consequently, Dr. Celum recommends maintaining a high level of suspicion for syphilis in HIV-positive patients because of the increased risk of HIV transmission. She suggests treating for syphilis in possible as well as definite cases, and re-examining the patients clinically and serologically every 6 months.

The most current treatment guidelines for syphilis and other STDs are available on the Centers for Disease Control and Prevention Web site at www.cdc.gov/std

WASHINGTON — Teen vaccine educational material must be quick, accurate, understandable, and relevant, said Dr. Sharon Humiston at a meeting of the National Vaccine Advisory Committee.

The bottom line is that no single information source will hit everyone in a target audience, and some sources will hit unexpected targets, said Dr. Humiston, a pediatrician at the University of Rochester (N.Y.).

Dr. Humiston presented data to NVAC on behalf of the subcommittee on Communications and Public Engagement, and she cited results from a survey of 150 adolescents conducted by Parents of Kids with Infectious Diseases, a national nonprofit group. The goal of the survey was to determine where and how teens get their health information, and the data can be used to develop educational strategies for adolescent vaccination.

Surprisingly, some adolescents surveyed said that they actually read the one-page vaccine information statements available in many physicians' offices. “Most parents don't look at those information sheets,” Dr. Humiston noted. The survey results included responses from 150 adolescents, 53% of whom were male.

Half of the adolescents said that they had talked with parents about immunizations within the past year and that parents had initiated the conversation in 70% of the cases. In addition, 70 of 150 (47%) reported having talked with a health professional about immunizations.

Although 91% of the respondents said that they had ever been immunized, only 16% believed that they knew all their necessary immunizations.

The adolescents were asked to choose all sources from which they remembered receiving any health information.

A doctor's office was the most popular resource, chosen by of 80% of the respondents, followed by school (78%) and home (75%). In addition, 57% reported receiving health information from the Internet at home.

For the complete survey results, visit www.pkids.org/pdf/pkidstvireport.pdf

WASHINGTON — Teen vaccine educational material must be quick, accurate, understandable, and relevant, said Dr. Sharon Humiston at a meeting of the National Vaccine Advisory Committee.

The bottom line is that no single information source will hit everyone in a target audience, and some sources will hit unexpected targets, said Dr. Humiston, a pediatrician at the University of Rochester (N.Y.).

Dr. Humiston presented data to NVAC on behalf of the subcommittee on Communications and Public Engagement, and she cited results from a survey of 150 adolescents conducted by Parents of Kids with Infectious Diseases, a national nonprofit group. The goal of the survey was to determine where and how teens get their health information, and the data can be used to develop educational strategies for adolescent vaccination.

Surprisingly, some adolescents surveyed said that they actually read the one-page vaccine information statements available in many physicians' offices. “Most parents don't look at those information sheets,” Dr. Humiston noted. The survey results included responses from 150 adolescents, 53% of whom were male.

Half of the adolescents said that they had talked with parents about immunizations within the past year and that parents had initiated the conversation in 70% of the cases. In addition, 70 of 150 (47%) reported having talked with a health professional about immunizations.

Although 91% of the respondents said that they had ever been immunized, only 16% believed that they knew all their necessary immunizations.

The adolescents were asked to choose all sources from which they remembered receiving any health information.

A doctor's office was the most popular resource, chosen by of 80% of the respondents, followed by school (78%) and home (75%). In addition, 57% reported receiving health information from the Internet at home.

For the complete survey results, visit www.pkids.org/pdf/pkidstvireport.pdf

WASHINGTON — Teen vaccine educational material must be quick, accurate, understandable, and relevant, said Dr. Sharon Humiston at a meeting of the National Vaccine Advisory Committee.

The bottom line is that no single information source will hit everyone in a target audience, and some sources will hit unexpected targets, said Dr. Humiston, a pediatrician at the University of Rochester (N.Y.).

Dr. Humiston presented data to NVAC on behalf of the subcommittee on Communications and Public Engagement, and she cited results from a survey of 150 adolescents conducted by Parents of Kids with Infectious Diseases, a national nonprofit group. The goal of the survey was to determine where and how teens get their health information, and the data can be used to develop educational strategies for adolescent vaccination.

Surprisingly, some adolescents surveyed said that they actually read the one-page vaccine information statements available in many physicians' offices. “Most parents don't look at those information sheets,” Dr. Humiston noted. The survey results included responses from 150 adolescents, 53% of whom were male.

Half of the adolescents said that they had talked with parents about immunizations within the past year and that parents had initiated the conversation in 70% of the cases. In addition, 70 of 150 (47%) reported having talked with a health professional about immunizations.

Although 91% of the respondents said that they had ever been immunized, only 16% believed that they knew all their necessary immunizations.

The adolescents were asked to choose all sources from which they remembered receiving any health information.

A doctor's office was the most popular resource, chosen by of 80% of the respondents, followed by school (78%) and home (75%). In addition, 57% reported receiving health information from the Internet at home.

For the complete survey results, visit www.pkids.org/pdf/pkidstvireport.pdf

Amoxicillin and GAS Pharyngitis

Amoxicillin given once daily to treat group A streptococcal pharyngitis was no less effective than a twice-daily dose, based on data from 652 children seen in a private pediatric practice during a 2-year period.

Although once-daily penicillin has less effectiveness against group A streptococcal (GAS) pharyngitis than twice-daily dosing, the researchers proposed that amoxicillin, with its longer serum half-life, might be just as effective in one daily dose as in two daily doses, which could improve adherence in some cases.

Dr. Herbert W. Clegg, a pediatrician in group practice in Charlotte, N.C., and his colleagues recruited children aged 3–18 years with signs and symptoms of GAS pharyngitis. The children were randomized to a once-daily dose of either 750 or 1,000 mg or a twice-daily dose of 375 or 500 mg, depending on the child's weight. The treatment duration was 10 days for both groups, and patient demographics and compliance with therapy were similar in both groups.

The researchers assessed bacteriologic failure rates based on pharyngeal swabs taken at 14–21 days (visit 2) and 28–35 days (visit 3) after the start of treatment (Pediatr. Infect. Dis. J. 2006;25:761–7).

Not all children returned for visits 2 and 3 for various reasons, but the bacteriologic failure rate was 33% for both groups in an intent-to-treat analysis that included all patients, the researchers noted. The rates between the groups were not significantly different on further analysis.

Failure rates at visit 2 were 20% (59 of 294) in the once-daily group vs. 16% (46 of 296) in the twice-daily group. Failure rates at visit 3 were 3% (6 of 216) in the once-daily group vs. 7% (16 of 225) in the twice-daily group.

Pertussis Booster May Be Needed

Children may need a booster dose of the acellular pertussis vaccine between the ages of 5 and 7 years to ensure protection from illness, according to data from a 7-year population-based study.

A total of 1,293 cases of culture-confirmed pertussis were seen in Swedish children born in 1996 or later during the period from October 1997 to September 2004—after the introduction and widespread use of an acellular pertussis vaccine in Sweden, reported Lennart Gustafsson, Ph.D., of the Swedish Institute for Infectious Disease Control in Solna, and his colleagues (Pediatrics 2006;118:978–84).

Overall, 516 cases of pertussis occurred in unvaccinated children (225 per 100,000 person-years in children aged 2 months and younger). But the reported incidence of pertussis dropped significantly after the second and third doses of vaccine. The incidence was 31 per 100,000 person-years between dose two and dose three, and 8 per 100,000 person-years in fully vaccinated children within a year of the third dose (children aged 2 years and younger).

The incidence at 6 years among vaccinated children who had received at least two doses was similar to the incidence shortly after the second dose at ages 5–12 months (32 per 100,000 person-years vs. 31 per 100,000 person-years). But the incidence had increased to 48 per 100,000 person-years in children aged 7–8 years, which suggests a waning of vaccine protection after 6–7 years, the researchers said.

Infant Flu Vaccination Rates Are Low

Only 7.4% and 17.5% of children aged 6–23 months received at least one dose of the influenza vaccine during 2002–2003 and 2003–2004, respectively, based on a representative sample of 13,881 children from the 2003 and 2004 National Immunization Surveys.

The 2002–2003 and 2003–2004 seasons were the first two flu seasons in which vaccination was encouraged, but not formally recommended, for children aged 6–23 months, and more work is needed to ensure at least two doses for previously unvaccinated children in this age group, said Tammy A. Santibanez, Ph.D., and her colleagues at the Centers for Disease Control and Prevention in Atlanta.

Of the children who received at least one dose of flu vaccine, about 40% and 52% went on to be fully vaccinated during the 2002–2003 and 2003–2004 seasons, respectively. Overall, 4.4% and 8.4% of children aged 6–23 months were fully vaccinated during these two seasons.

“Receipt of two doses for previously unvaccinated children is paramount, because receipt of only one dose may provide little to no protection,” the researchers said.

Vaccination rates were significantly lower among children living below the poverty level, non-Hispanic black children, and children with less-educated mothers (Pediatrics 2006;118:1167–75). Receipt of at least one vaccination was significantly associated with white or Asian race, younger age at the start of flu season, and vaccine receipt at a private practice or a hospital, after controlling for multiple demographic variables.

Amoxicillin and GAS Pharyngitis

Amoxicillin given once daily to treat group A streptococcal pharyngitis was no less effective than a twice-daily dose, based on data from 652 children seen in a private pediatric practice during a 2-year period.

Although once-daily penicillin has less effectiveness against group A streptococcal (GAS) pharyngitis than twice-daily dosing, the researchers proposed that amoxicillin, with its longer serum half-life, might be just as effective in one daily dose as in two daily doses, which could improve adherence in some cases.

Dr. Herbert W. Clegg, a pediatrician in group practice in Charlotte, N.C., and his colleagues recruited children aged 3–18 years with signs and symptoms of GAS pharyngitis. The children were randomized to a once-daily dose of either 750 or 1,000 mg or a twice-daily dose of 375 or 500 mg, depending on the child's weight. The treatment duration was 10 days for both groups, and patient demographics and compliance with therapy were similar in both groups.

The researchers assessed bacteriologic failure rates based on pharyngeal swabs taken at 14–21 days (visit 2) and 28–35 days (visit 3) after the start of treatment (Pediatr. Infect. Dis. J. 2006;25:761–7).

Not all children returned for visits 2 and 3 for various reasons, but the bacteriologic failure rate was 33% for both groups in an intent-to-treat analysis that included all patients, the researchers noted. The rates between the groups were not significantly different on further analysis.

Failure rates at visit 2 were 20% (59 of 294) in the once-daily group vs. 16% (46 of 296) in the twice-daily group. Failure rates at visit 3 were 3% (6 of 216) in the once-daily group vs. 7% (16 of 225) in the twice-daily group.

Pertussis Booster May Be Needed

Children may need a booster dose of the acellular pertussis vaccine between the ages of 5 and 7 years to ensure protection from illness, according to data from a 7-year population-based study.

A total of 1,293 cases of culture-confirmed pertussis were seen in Swedish children born in 1996 or later during the period from October 1997 to September 2004—after the introduction and widespread use of an acellular pertussis vaccine in Sweden, reported Lennart Gustafsson, Ph.D., of the Swedish Institute for Infectious Disease Control in Solna, and his colleagues (Pediatrics 2006;118:978–84).

Overall, 516 cases of pertussis occurred in unvaccinated children (225 per 100,000 person-years in children aged 2 months and younger). But the reported incidence of pertussis dropped significantly after the second and third doses of vaccine. The incidence was 31 per 100,000 person-years between dose two and dose three, and 8 per 100,000 person-years in fully vaccinated children within a year of the third dose (children aged 2 years and younger).

The incidence at 6 years among vaccinated children who had received at least two doses was similar to the incidence shortly after the second dose at ages 5–12 months (32 per 100,000 person-years vs. 31 per 100,000 person-years). But the incidence had increased to 48 per 100,000 person-years in children aged 7–8 years, which suggests a waning of vaccine protection after 6–7 years, the researchers said.

Infant Flu Vaccination Rates Are Low

Only 7.4% and 17.5% of children aged 6–23 months received at least one dose of the influenza vaccine during 2002–2003 and 2003–2004, respectively, based on a representative sample of 13,881 children from the 2003 and 2004 National Immunization Surveys.

The 2002–2003 and 2003–2004 seasons were the first two flu seasons in which vaccination was encouraged, but not formally recommended, for children aged 6–23 months, and more work is needed to ensure at least two doses for previously unvaccinated children in this age group, said Tammy A. Santibanez, Ph.D., and her colleagues at the Centers for Disease Control and Prevention in Atlanta.

Of the children who received at least one dose of flu vaccine, about 40% and 52% went on to be fully vaccinated during the 2002–2003 and 2003–2004 seasons, respectively. Overall, 4.4% and 8.4% of children aged 6–23 months were fully vaccinated during these two seasons.

“Receipt of two doses for previously unvaccinated children is paramount, because receipt of only one dose may provide little to no protection,” the researchers said.

Vaccination rates were significantly lower among children living below the poverty level, non-Hispanic black children, and children with less-educated mothers (Pediatrics 2006;118:1167–75). Receipt of at least one vaccination was significantly associated with white or Asian race, younger age at the start of flu season, and vaccine receipt at a private practice or a hospital, after controlling for multiple demographic variables.

Amoxicillin and GAS Pharyngitis

Amoxicillin given once daily to treat group A streptococcal pharyngitis was no less effective than a twice-daily dose, based on data from 652 children seen in a private pediatric practice during a 2-year period.

Although once-daily penicillin has less effectiveness against group A streptococcal (GAS) pharyngitis than twice-daily dosing, the researchers proposed that amoxicillin, with its longer serum half-life, might be just as effective in one daily dose as in two daily doses, which could improve adherence in some cases.

Dr. Herbert W. Clegg, a pediatrician in group practice in Charlotte, N.C., and his colleagues recruited children aged 3–18 years with signs and symptoms of GAS pharyngitis. The children were randomized to a once-daily dose of either 750 or 1,000 mg or a twice-daily dose of 375 or 500 mg, depending on the child's weight. The treatment duration was 10 days for both groups, and patient demographics and compliance with therapy were similar in both groups.

The researchers assessed bacteriologic failure rates based on pharyngeal swabs taken at 14–21 days (visit 2) and 28–35 days (visit 3) after the start of treatment (Pediatr. Infect. Dis. J. 2006;25:761–7).

Not all children returned for visits 2 and 3 for various reasons, but the bacteriologic failure rate was 33% for both groups in an intent-to-treat analysis that included all patients, the researchers noted. The rates between the groups were not significantly different on further analysis.

Failure rates at visit 2 were 20% (59 of 294) in the once-daily group vs. 16% (46 of 296) in the twice-daily group. Failure rates at visit 3 were 3% (6 of 216) in the once-daily group vs. 7% (16 of 225) in the twice-daily group.

Pertussis Booster May Be Needed

Children may need a booster dose of the acellular pertussis vaccine between the ages of 5 and 7 years to ensure protection from illness, according to data from a 7-year population-based study.

A total of 1,293 cases of culture-confirmed pertussis were seen in Swedish children born in 1996 or later during the period from October 1997 to September 2004—after the introduction and widespread use of an acellular pertussis vaccine in Sweden, reported Lennart Gustafsson, Ph.D., of the Swedish Institute for Infectious Disease Control in Solna, and his colleagues (Pediatrics 2006;118:978–84).

Overall, 516 cases of pertussis occurred in unvaccinated children (225 per 100,000 person-years in children aged 2 months and younger). But the reported incidence of pertussis dropped significantly after the second and third doses of vaccine. The incidence was 31 per 100,000 person-years between dose two and dose three, and 8 per 100,000 person-years in fully vaccinated children within a year of the third dose (children aged 2 years and younger).

The incidence at 6 years among vaccinated children who had received at least two doses was similar to the incidence shortly after the second dose at ages 5–12 months (32 per 100,000 person-years vs. 31 per 100,000 person-years). But the incidence had increased to 48 per 100,000 person-years in children aged 7–8 years, which suggests a waning of vaccine protection after 6–7 years, the researchers said.

Infant Flu Vaccination Rates Are Low

Only 7.4% and 17.5% of children aged 6–23 months received at least one dose of the influenza vaccine during 2002–2003 and 2003–2004, respectively, based on a representative sample of 13,881 children from the 2003 and 2004 National Immunization Surveys.

The 2002–2003 and 2003–2004 seasons were the first two flu seasons in which vaccination was encouraged, but not formally recommended, for children aged 6–23 months, and more work is needed to ensure at least two doses for previously unvaccinated children in this age group, said Tammy A. Santibanez, Ph.D., and her colleagues at the Centers for Disease Control and Prevention in Atlanta.

Of the children who received at least one dose of flu vaccine, about 40% and 52% went on to be fully vaccinated during the 2002–2003 and 2003–2004 seasons, respectively. Overall, 4.4% and 8.4% of children aged 6–23 months were fully vaccinated during these two seasons.

“Receipt of two doses for previously unvaccinated children is paramount, because receipt of only one dose may provide little to no protection,” the researchers said.

Vaccination rates were significantly lower among children living below the poverty level, non-Hispanic black children, and children with less-educated mothers (Pediatrics 2006;118:1167–75). Receipt of at least one vaccination was significantly associated with white or Asian race, younger age at the start of flu season, and vaccine receipt at a private practice or a hospital, after controlling for multiple demographic variables.