Heidi Splete

Bacterial Tracheitis Gains Prominence

Bacterial tracheitis, a relatively uncommon infection, may have outpaced viral croup and epiglottitis as the most common potentially life-threatening upper airway infection in children, based on data from 127 patients treated in a single hospital between 1997 and 2006.

The widespread immunization of children against Haemophilus influenza type b and the use of corticosteroids to treat viral croup have likely contributed to the decline in viral croup and epiglottitis, and the resulting prevalence of cases of bacterial tracheitis, reported Dr. Amelia Hopkins of the University of Colorado School of Medicine, Denver, and her colleagues (Pediatrics 2006;118:1416–21).

Respiratory failures were three times more likely to be caused by bacterial tracheitis than by viral croup and epiglottitis combined, they said. Overall, 35 children were sent to the pediatric ICU: 17 (48%) were diagnosed with bacterial tracheitis, 16 (46%) were diagnosed with viral croup, and 2 (6%) were diagnosed with epiglottitis. Of the 20 children in the PICU who developed respiratory failure, 15 (75%) had bacterial tracheitis, compared with only 3 (15%) who had viral croup and 2 (10%) who had nonclassic epiglottitis.

Of the 18 cases of bacterial tracheitis reviewed, 17 (94%) children were sent to the PICU and 15 (83%) of these needed to be intubated and five had serious complications. By contrast, only 16 (15%) of the 107 cases of viral croup that were reviewed were sent to the PICU, and 3 of these children needed to be intubated, but none experienced serious complications.

Clinical characteristics of bacterial tracheitis included cough and retractions in 17 (94%) patients, stridor in 16 (89%) patients, and hoarseness in 12 (67%) patients.

Child Care Ills Decrease With Time

Children younger than 3 years of age were at increased risk of acute respiratory infections during their first months of attendance at child care facilities, but the risk decreased as they got older and spent more time in child care, according to data from 138,821 hospital admissions among children aged 0–5 years.

The youngest children were at the greatest risk for infection within the first 6 months of child care attendance. At 6 months of age, the incidence rate ratio of hospitalizations for acute respiratory infections was 79% higher among children in child care, compared with children of the same age who were cared for at home. The incidence decreased with age, and at 1 year of age the risk of hospitalization for acute respiratory infections was 44% higher among children in child care compared with children cared for at home.

The results suggest that postponing children's enrollment in child care centers until they reach 1 year of age might reduce the incidence of acute respiratory infections in this age group, wrote Mads Kamper-Jorgensen of the Statens Serum Institut, Copenhagen, and associates (Pediatrics 2006;118:1439–46).

Menactra Protects Despite Error

Persons who mistakenly received the meningococcal conjugate vaccine (Menactra) subcutaneously rather than intramuscularly were nonetheless sufficiently protected, according to a report by the Centers for Disease Control and Prevention.

The CDC received reports that 101 persons aged 11–47 years (median age 17.5 years) in seven states received the new meningococcal vaccine (MCV4) subcutaneously, although it is licensed for intramuscular use only. Of these, 38 agreed to participate in an investigation to show whether revaccination was needed (MMWR 2006;55:1016–7).

Overall, 36 of the 38 investigation participants were protected for each of the four vaccine subgroups (A, C, Y, and W-135), based on a baby rabbit-based serum bactericidal assay (rSBA) in which titers of at least 8 were considered protective. Two patients had titers less than 8, and these involved one serogroup in each patient (one for serogroup C only and one for serogroup W-135 only).

Although the geometric mean titers (GMTs) were significantly lower for the subcutaneous vaccinees, compared with age-matched intramuscular vaccinees from the MCV4 clinical trials for serogroups A, C, and Y, there were no significant differences in GMTs for serogroup W-135.

Based on these findings, the researchers did not recommend revaccination for any of the subcutaneous vaccinees.

MCV4, a tetravalent meningococcal conjugate vaccine, was licensed in January 2005 after demonstrating safety and effectiveness, compared with the meningococcal polysaccharide vaccine (MPSV4) that has been used for 30 years.

By contrast, MPSV4 is licensed for subcutaneous use, not intramuscular use, and this is the most likely reason for the misadministration of MCV4, said health care providers who participated in the investigation.

Bacterial Tracheitis Gains Prominence

Bacterial tracheitis, a relatively uncommon infection, may have outpaced viral croup and epiglottitis as the most common potentially life-threatening upper airway infection in children, based on data from 127 patients treated in a single hospital between 1997 and 2006.

The widespread immunization of children against Haemophilus influenza type b and the use of corticosteroids to treat viral croup have likely contributed to the decline in viral croup and epiglottitis, and the resulting prevalence of cases of bacterial tracheitis, reported Dr. Amelia Hopkins of the University of Colorado School of Medicine, Denver, and her colleagues (Pediatrics 2006;118:1416–21).

Respiratory failures were three times more likely to be caused by bacterial tracheitis than by viral croup and epiglottitis combined, they said. Overall, 35 children were sent to the pediatric ICU: 17 (48%) were diagnosed with bacterial tracheitis, 16 (46%) were diagnosed with viral croup, and 2 (6%) were diagnosed with epiglottitis. Of the 20 children in the PICU who developed respiratory failure, 15 (75%) had bacterial tracheitis, compared with only 3 (15%) who had viral croup and 2 (10%) who had nonclassic epiglottitis.

Of the 18 cases of bacterial tracheitis reviewed, 17 (94%) children were sent to the PICU and 15 (83%) of these needed to be intubated and five had serious complications. By contrast, only 16 (15%) of the 107 cases of viral croup that were reviewed were sent to the PICU, and 3 of these children needed to be intubated, but none experienced serious complications.

Clinical characteristics of bacterial tracheitis included cough and retractions in 17 (94%) patients, stridor in 16 (89%) patients, and hoarseness in 12 (67%) patients.

Child Care Ills Decrease With Time

Children younger than 3 years of age were at increased risk of acute respiratory infections during their first months of attendance at child care facilities, but the risk decreased as they got older and spent more time in child care, according to data from 138,821 hospital admissions among children aged 0–5 years.

The youngest children were at the greatest risk for infection within the first 6 months of child care attendance. At 6 months of age, the incidence rate ratio of hospitalizations for acute respiratory infections was 79% higher among children in child care, compared with children of the same age who were cared for at home. The incidence decreased with age, and at 1 year of age the risk of hospitalization for acute respiratory infections was 44% higher among children in child care compared with children cared for at home.

The results suggest that postponing children's enrollment in child care centers until they reach 1 year of age might reduce the incidence of acute respiratory infections in this age group, wrote Mads Kamper-Jorgensen of the Statens Serum Institut, Copenhagen, and associates (Pediatrics 2006;118:1439–46).

Menactra Protects Despite Error

Persons who mistakenly received the meningococcal conjugate vaccine (Menactra) subcutaneously rather than intramuscularly were nonetheless sufficiently protected, according to a report by the Centers for Disease Control and Prevention.

The CDC received reports that 101 persons aged 11–47 years (median age 17.5 years) in seven states received the new meningococcal vaccine (MCV4) subcutaneously, although it is licensed for intramuscular use only. Of these, 38 agreed to participate in an investigation to show whether revaccination was needed (MMWR 2006;55:1016–7).

Overall, 36 of the 38 investigation participants were protected for each of the four vaccine subgroups (A, C, Y, and W-135), based on a baby rabbit-based serum bactericidal assay (rSBA) in which titers of at least 8 were considered protective. Two patients had titers less than 8, and these involved one serogroup in each patient (one for serogroup C only and one for serogroup W-135 only).

Although the geometric mean titers (GMTs) were significantly lower for the subcutaneous vaccinees, compared with age-matched intramuscular vaccinees from the MCV4 clinical trials for serogroups A, C, and Y, there were no significant differences in GMTs for serogroup W-135.

Based on these findings, the researchers did not recommend revaccination for any of the subcutaneous vaccinees.

MCV4, a tetravalent meningococcal conjugate vaccine, was licensed in January 2005 after demonstrating safety and effectiveness, compared with the meningococcal polysaccharide vaccine (MPSV4) that has been used for 30 years.

By contrast, MPSV4 is licensed for subcutaneous use, not intramuscular use, and this is the most likely reason for the misadministration of MCV4, said health care providers who participated in the investigation.

Bacterial Tracheitis Gains Prominence

Bacterial tracheitis, a relatively uncommon infection, may have outpaced viral croup and epiglottitis as the most common potentially life-threatening upper airway infection in children, based on data from 127 patients treated in a single hospital between 1997 and 2006.

The widespread immunization of children against Haemophilus influenza type b and the use of corticosteroids to treat viral croup have likely contributed to the decline in viral croup and epiglottitis, and the resulting prevalence of cases of bacterial tracheitis, reported Dr. Amelia Hopkins of the University of Colorado School of Medicine, Denver, and her colleagues (Pediatrics 2006;118:1416–21).

Respiratory failures were three times more likely to be caused by bacterial tracheitis than by viral croup and epiglottitis combined, they said. Overall, 35 children were sent to the pediatric ICU: 17 (48%) were diagnosed with bacterial tracheitis, 16 (46%) were diagnosed with viral croup, and 2 (6%) were diagnosed with epiglottitis. Of the 20 children in the PICU who developed respiratory failure, 15 (75%) had bacterial tracheitis, compared with only 3 (15%) who had viral croup and 2 (10%) who had nonclassic epiglottitis.

Of the 18 cases of bacterial tracheitis reviewed, 17 (94%) children were sent to the PICU and 15 (83%) of these needed to be intubated and five had serious complications. By contrast, only 16 (15%) of the 107 cases of viral croup that were reviewed were sent to the PICU, and 3 of these children needed to be intubated, but none experienced serious complications.

Clinical characteristics of bacterial tracheitis included cough and retractions in 17 (94%) patients, stridor in 16 (89%) patients, and hoarseness in 12 (67%) patients.

Child Care Ills Decrease With Time

Children younger than 3 years of age were at increased risk of acute respiratory infections during their first months of attendance at child care facilities, but the risk decreased as they got older and spent more time in child care, according to data from 138,821 hospital admissions among children aged 0–5 years.

The youngest children were at the greatest risk for infection within the first 6 months of child care attendance. At 6 months of age, the incidence rate ratio of hospitalizations for acute respiratory infections was 79% higher among children in child care, compared with children of the same age who were cared for at home. The incidence decreased with age, and at 1 year of age the risk of hospitalization for acute respiratory infections was 44% higher among children in child care compared with children cared for at home.

The results suggest that postponing children's enrollment in child care centers until they reach 1 year of age might reduce the incidence of acute respiratory infections in this age group, wrote Mads Kamper-Jorgensen of the Statens Serum Institut, Copenhagen, and associates (Pediatrics 2006;118:1439–46).

Menactra Protects Despite Error

Persons who mistakenly received the meningococcal conjugate vaccine (Menactra) subcutaneously rather than intramuscularly were nonetheless sufficiently protected, according to a report by the Centers for Disease Control and Prevention.

The CDC received reports that 101 persons aged 11–47 years (median age 17.5 years) in seven states received the new meningococcal vaccine (MCV4) subcutaneously, although it is licensed for intramuscular use only. Of these, 38 agreed to participate in an investigation to show whether revaccination was needed (MMWR 2006;55:1016–7).

Overall, 36 of the 38 investigation participants were protected for each of the four vaccine subgroups (A, C, Y, and W-135), based on a baby rabbit-based serum bactericidal assay (rSBA) in which titers of at least 8 were considered protective. Two patients had titers less than 8, and these involved one serogroup in each patient (one for serogroup C only and one for serogroup W-135 only).

Although the geometric mean titers (GMTs) were significantly lower for the subcutaneous vaccinees, compared with age-matched intramuscular vaccinees from the MCV4 clinical trials for serogroups A, C, and Y, there were no significant differences in GMTs for serogroup W-135.

Based on these findings, the researchers did not recommend revaccination for any of the subcutaneous vaccinees.

MCV4, a tetravalent meningococcal conjugate vaccine, was licensed in January 2005 after demonstrating safety and effectiveness, compared with the meningococcal polysaccharide vaccine (MPSV4) that has been used for 30 years.

By contrast, MPSV4 is licensed for subcutaneous use, not intramuscular use, and this is the most likely reason for the misadministration of MCV4, said health care providers who participated in the investigation.

WASHINGTON — The challenge of paying for vaccinations has become even greater now that the human papilloma virus vaccine is on the immunization schedule.

At a meeting of the National Vaccine Advisory Committee, representatives from several organizations reported that there isn't 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.

However, the price of a vaccine is not allowed to 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). Ms. Hannan said 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 has become even greater now that the human papilloma virus vaccine is on the immunization schedule.

At a meeting of the National Vaccine Advisory Committee, representatives from several organizations reported that there isn't 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.

However, the price of a vaccine is not allowed to 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). Ms. Hannan said 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 has become even greater now that the human papilloma virus vaccine is on the immunization schedule.

At a meeting of the National Vaccine Advisory Committee, representatives from several organizations reported that there isn't 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.

However, the price of a vaccine is not allowed to 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). Ms. Hannan said 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.”

Children aged 5–8 years who have not previously received a flu vaccine need two doses of trivalent inactivated influenza vaccine, based on antibody response data from 222 children in a prospective, open-label study.

Prior studies have established the need for two doses of flu vaccine for unvaccinated infants and young children, but research in older children has been limited, said Dr. Kathleen M. Neuzil of the University of Washington, Seattle, and her colleagues (J. Infect. Dis. 2006;194:1032–9). Dr. Neuzil has received grant support from Sanofi Pasteur and MedImmune.

Among children who were seronegative at baseline, an additional 50%, 51%, and 31% developed protective responses to A/H1N1, A/H3N2, and B vaccine antigens, respectively, after a second dose of trivalent inactivated influenza vaccine (TIV).

Baseline seropositive children showed a significant increase in antibody titers after one dose, but they showed no significant additional difference in antibody titers after a second dose (see box).

The results remained significant after controlling for baseline serostatus (the strongest predictor of a protective antibody response) as well as age and sex.

Overall, the antibody titers for the B vaccine component were significantly lower than for the A components in both seronegative and seropositive children, but this finding was consistent with data from other vaccine studies, the researchers noted.

Because baseline serostatus is not easily determined and serologic testing before vaccination is not practical, the study confirms the need for two doses of TIV in previously unvaccinated 5− to 8-year-olds, Dr. Kathryn M. Edwards and Dr. Marie R. Griffin of Vanderbilt University in Nashville, Tenn., said in an editorial (J. Infect. Dis. 2006;194:1027–9).

The children received two 0.5-mL shots of TIV 2 weeks apart. Serum samples were taken at baseline, at 4 weeks after the first dose (before the second dose was given), and at 4 weeks after the second dose. The vaccine was well tolerated among all age groups and in both dosage groups, and no significant differences appeared between the dosage groups in the number of children with redness, swelling, fever, or itching after either one or two doses.

Children aged 5–8 years who have not previously received a flu vaccine need two doses of trivalent inactivated influenza vaccine, based on antibody response data from 222 children in a prospective, open-label study.

Prior studies have established the need for two doses of flu vaccine for unvaccinated infants and young children, but research in older children has been limited, said Dr. Kathleen M. Neuzil of the University of Washington, Seattle, and her colleagues (J. Infect. Dis. 2006;194:1032–9). Dr. Neuzil has received grant support from Sanofi Pasteur and MedImmune.

Among children who were seronegative at baseline, an additional 50%, 51%, and 31% developed protective responses to A/H1N1, A/H3N2, and B vaccine antigens, respectively, after a second dose of trivalent inactivated influenza vaccine (TIV).

Baseline seropositive children showed a significant increase in antibody titers after one dose, but they showed no significant additional difference in antibody titers after a second dose (see box).

The results remained significant after controlling for baseline serostatus (the strongest predictor of a protective antibody response) as well as age and sex.

Overall, the antibody titers for the B vaccine component were significantly lower than for the A components in both seronegative and seropositive children, but this finding was consistent with data from other vaccine studies, the researchers noted.

Because baseline serostatus is not easily determined and serologic testing before vaccination is not practical, the study confirms the need for two doses of TIV in previously unvaccinated 5− to 8-year-olds, Dr. Kathryn M. Edwards and Dr. Marie R. Griffin of Vanderbilt University in Nashville, Tenn., said in an editorial (J. Infect. Dis. 2006;194:1027–9).

The children received two 0.5-mL shots of TIV 2 weeks apart. Serum samples were taken at baseline, at 4 weeks after the first dose (before the second dose was given), and at 4 weeks after the second dose. The vaccine was well tolerated among all age groups and in both dosage groups, and no significant differences appeared between the dosage groups in the number of children with redness, swelling, fever, or itching after either one or two doses.

Children aged 5–8 years who have not previously received a flu vaccine need two doses of trivalent inactivated influenza vaccine, based on antibody response data from 222 children in a prospective, open-label study.

Prior studies have established the need for two doses of flu vaccine for unvaccinated infants and young children, but research in older children has been limited, said Dr. Kathleen M. Neuzil of the University of Washington, Seattle, and her colleagues (J. Infect. Dis. 2006;194:1032–9). Dr. Neuzil has received grant support from Sanofi Pasteur and MedImmune.

Among children who were seronegative at baseline, an additional 50%, 51%, and 31% developed protective responses to A/H1N1, A/H3N2, and B vaccine antigens, respectively, after a second dose of trivalent inactivated influenza vaccine (TIV).

Baseline seropositive children showed a significant increase in antibody titers after one dose, but they showed no significant additional difference in antibody titers after a second dose (see box).

The results remained significant after controlling for baseline serostatus (the strongest predictor of a protective antibody response) as well as age and sex.

Overall, the antibody titers for the B vaccine component were significantly lower than for the A components in both seronegative and seropositive children, but this finding was consistent with data from other vaccine studies, the researchers noted.

Because baseline serostatus is not easily determined and serologic testing before vaccination is not practical, the study confirms the need for two doses of TIV in previously unvaccinated 5− to 8-year-olds, Dr. Kathryn M. Edwards and Dr. Marie R. Griffin of Vanderbilt University in Nashville, Tenn., said in an editorial (J. Infect. Dis. 2006;194:1027–9).

The children received two 0.5-mL shots of TIV 2 weeks apart. Serum samples were taken at baseline, at 4 weeks after the first dose (before the second dose was given), and at 4 weeks after the second dose. The vaccine was well tolerated among all age groups and in both dosage groups, and no significant differences appeared between the dosage groups in the number of children with redness, swelling, fever, or itching after either one or two doses.

WASHINGTON — Targeting health care workers, reaching out to grandparents, promoting workplace vaccination, and extending the vaccination season are among the Centers for Disease Control and Prevention's short-term efforts to improve vaccination rates in priority groups and the general public for the 2006–2007 flu season, Dr. Jeanne M. Santoli reported at a meeting of the National Vaccine Advisory Committee.

“We looked at what can we do on short notice to try to promote vaccination this year, and what programs we could piggyback onto,” said Dr. Santoli, who is with the CDC's National Center for Immunization and Respiratory Diseases.

Several teams of health care providers are in the process of implementing plans to increase flu vaccination that were established at the National Influenza Vaccine Summit Meeting earlier this year, Dr. Santoli reported.

The team that focused on increasing flu vaccination among heath care workers has crafted joint letters from the CDC and the American Medical Association to administrators of health care facilities about the importance of vaccinating all employees. The team also designed a full-page ad to appear in the Journal of the American Medical Association.

The pediatric team's activities have included promoting flu vaccination in children aged 6–59 months in response to the current recommendations for vaccination in this age group.

In addition, the team is developing flash cards for primary care providers who are trying to reach 5− to 14-year-olds, many of whom are either high risk themselves or are household contacts of high-risk persons. “We don't always do a good job of reaching the household contacts,” Dr. Santoli noted.

The pediatrics team also initiated a joint effort with the AARP that will encourage grandparents to help make sure that their own grandchildren are vaccinated.

Another team targeted the contacts of high-risk persons and the general public by identifying venues where they could reach many people.

The team developed a joint letter to the colleges that are members of the American College Health Association (ACHA) from both the CDC and the ACHA that stressed the importance of sponsoring vaccination clinics for students.

Other efforts have included hosting a Web-based seminar for employers with information about workplace vaccinations and exploring ways to promote flu vaccination through faith-based organizations.

Another team has addressed the misperception that the flu vaccination season ends in December. Their proposed strategies include presenting an award for a provider or organization that develops an innovative approach to vaccination later in the season, and promoting a “Flu Vaccination Day” in January, when providers and patients aren't thinking about flu vaccines.

At the start of flu season, approximately 100 million doses of flu vaccine were available for distribution, Dr. Santoli said.

For updates on flu vaccination recommendations and vaccine supplies, visit www.cdc.gov/flu/about/qa/vaxsupply.htm

WASHINGTON — Targeting health care workers, reaching out to grandparents, promoting workplace vaccination, and extending the vaccination season are among the Centers for Disease Control and Prevention's short-term efforts to improve vaccination rates in priority groups and the general public for the 2006–2007 flu season, Dr. Jeanne M. Santoli reported at a meeting of the National Vaccine Advisory Committee.

“We looked at what can we do on short notice to try to promote vaccination this year, and what programs we could piggyback onto,” said Dr. Santoli, who is with the CDC's National Center for Immunization and Respiratory Diseases.

Several teams of health care providers are in the process of implementing plans to increase flu vaccination that were established at the National Influenza Vaccine Summit Meeting earlier this year, Dr. Santoli reported.

The team that focused on increasing flu vaccination among heath care workers has crafted joint letters from the CDC and the American Medical Association to administrators of health care facilities about the importance of vaccinating all employees. The team also designed a full-page ad to appear in the Journal of the American Medical Association.

The pediatric team's activities have included promoting flu vaccination in children aged 6–59 months in response to the current recommendations for vaccination in this age group.

In addition, the team is developing flash cards for primary care providers who are trying to reach 5− to 14-year-olds, many of whom are either high risk themselves or are household contacts of high-risk persons. “We don't always do a good job of reaching the household contacts,” Dr. Santoli noted.

The pediatrics team also initiated a joint effort with the AARP that will encourage grandparents to help make sure that their own grandchildren are vaccinated.

Another team targeted the contacts of high-risk persons and the general public by identifying venues where they could reach many people.

The team developed a joint letter to the colleges that are members of the American College Health Association (ACHA) from both the CDC and the ACHA that stressed the importance of sponsoring vaccination clinics for students.

Other efforts have included hosting a Web-based seminar for employers with information about workplace vaccinations and exploring ways to promote flu vaccination through faith-based organizations.

Another team has addressed the misperception that the flu vaccination season ends in December. Their proposed strategies include presenting an award for a provider or organization that develops an innovative approach to vaccination later in the season, and promoting a “Flu Vaccination Day” in January, when providers and patients aren't thinking about flu vaccines.

At the start of flu season, approximately 100 million doses of flu vaccine were available for distribution, Dr. Santoli said.

For updates on flu vaccination recommendations and vaccine supplies, visit www.cdc.gov/flu/about/qa/vaxsupply.htm

WASHINGTON — Targeting health care workers, reaching out to grandparents, promoting workplace vaccination, and extending the vaccination season are among the Centers for Disease Control and Prevention's short-term efforts to improve vaccination rates in priority groups and the general public for the 2006–2007 flu season, Dr. Jeanne M. Santoli reported at a meeting of the National Vaccine Advisory Committee.

“We looked at what can we do on short notice to try to promote vaccination this year, and what programs we could piggyback onto,” said Dr. Santoli, who is with the CDC's National Center for Immunization and Respiratory Diseases.

Several teams of health care providers are in the process of implementing plans to increase flu vaccination that were established at the National Influenza Vaccine Summit Meeting earlier this year, Dr. Santoli reported.

The team that focused on increasing flu vaccination among heath care workers has crafted joint letters from the CDC and the American Medical Association to administrators of health care facilities about the importance of vaccinating all employees. The team also designed a full-page ad to appear in the Journal of the American Medical Association.

The pediatric team's activities have included promoting flu vaccination in children aged 6–59 months in response to the current recommendations for vaccination in this age group.

In addition, the team is developing flash cards for primary care providers who are trying to reach 5− to 14-year-olds, many of whom are either high risk themselves or are household contacts of high-risk persons. “We don't always do a good job of reaching the household contacts,” Dr. Santoli noted.

The pediatrics team also initiated a joint effort with the AARP that will encourage grandparents to help make sure that their own grandchildren are vaccinated.

Another team targeted the contacts of high-risk persons and the general public by identifying venues where they could reach many people.

The team developed a joint letter to the colleges that are members of the American College Health Association (ACHA) from both the CDC and the ACHA that stressed the importance of sponsoring vaccination clinics for students.

Other efforts have included hosting a Web-based seminar for employers with information about workplace vaccinations and exploring ways to promote flu vaccination through faith-based organizations.

Another team has addressed the misperception that the flu vaccination season ends in December. Their proposed strategies include presenting an award for a provider or organization that develops an innovative approach to vaccination later in the season, and promoting a “Flu Vaccination Day” in January, when providers and patients aren't thinking about flu vaccines.

At the start of flu season, approximately 100 million doses of flu vaccine were available for distribution, Dr. Santoli said.

For updates on flu vaccination recommendations and vaccine supplies, visit www.cdc.gov/flu/about/qa/vaxsupply.htm

Women who have no chance of becoming pregnant, as well as men, no longer need to observe a 23-day lockout period before starting a new prescription of isotretinoin for the treatment of acne, according to a statement from the Food and Drug Administration.

To take advantage of this change, however, patients must repeat the qualification process to confirm that they meet the qualifying criteria to skip the 23-day lockout.

The iPLEDGE program was designed as a risk management plan to prevent, because of its severe teratogenic side effects, the use of isotretinoin by females who are or may become pregnant. The program initiated a universal set of strict criteria to be met before any patients could receive isotretinoin, regardless of their childbearing potential.

According to the original criteria, all female patients who wanted to take isotretinoin had to undergo a pregnancy test, and all patients had to be counseled that two types of contraception are essential while taking isotretinoin.

Once these criteria were met, patients had 7 days to fill a prescription. If they didn't fill it within that time, they would have to wait for 23 days, a time frame designed to accommodate another pregnancy test for women who could become pregnant. This process was to be repeated for each refill, which increased the administrative workload for clinicians and put pressure on patients.

Since then, clinicians' frustration with the iPLEDGE criteria has led to efforts by the American Academy of Dermatology and other organizations to convince the FDA and drug manufacturers that iPLEDGE needed revision.

For more information about the changes to the iPLEDGE program, visit the Web site at www.ipledgeprogram.com

Women who have no chance of becoming pregnant, as well as men, no longer need to observe a 23-day lockout period before starting a new prescription of isotretinoin for the treatment of acne, according to a statement from the Food and Drug Administration.

To take advantage of this change, however, patients must repeat the qualification process to confirm that they meet the qualifying criteria to skip the 23-day lockout.

The iPLEDGE program was designed as a risk management plan to prevent, because of its severe teratogenic side effects, the use of isotretinoin by females who are or may become pregnant. The program initiated a universal set of strict criteria to be met before any patients could receive isotretinoin, regardless of their childbearing potential.

According to the original criteria, all female patients who wanted to take isotretinoin had to undergo a pregnancy test, and all patients had to be counseled that two types of contraception are essential while taking isotretinoin.

Once these criteria were met, patients had 7 days to fill a prescription. If they didn't fill it within that time, they would have to wait for 23 days, a time frame designed to accommodate another pregnancy test for women who could become pregnant. This process was to be repeated for each refill, which increased the administrative workload for clinicians and put pressure on patients.

Since then, clinicians' frustration with the iPLEDGE criteria has led to efforts by the American Academy of Dermatology and other organizations to convince the FDA and drug manufacturers that iPLEDGE needed revision.

For more information about the changes to the iPLEDGE program, visit the Web site at www.ipledgeprogram.com

Women who have no chance of becoming pregnant, as well as men, no longer need to observe a 23-day lockout period before starting a new prescription of isotretinoin for the treatment of acne, according to a statement from the Food and Drug Administration.

To take advantage of this change, however, patients must repeat the qualification process to confirm that they meet the qualifying criteria to skip the 23-day lockout.

The iPLEDGE program was designed as a risk management plan to prevent, because of its severe teratogenic side effects, the use of isotretinoin by females who are or may become pregnant. The program initiated a universal set of strict criteria to be met before any patients could receive isotretinoin, regardless of their childbearing potential.

According to the original criteria, all female patients who wanted to take isotretinoin had to undergo a pregnancy test, and all patients had to be counseled that two types of contraception are essential while taking isotretinoin.

Once these criteria were met, patients had 7 days to fill a prescription. If they didn't fill it within that time, they would have to wait for 23 days, a time frame designed to accommodate another pregnancy test for women who could become pregnant. This process was to be repeated for each refill, which increased the administrative workload for clinicians and put pressure on patients.

Since then, clinicians' frustration with the iPLEDGE criteria has led to efforts by the American Academy of Dermatology and other organizations to convince the FDA and drug manufacturers that iPLEDGE needed revision.

For more information about the changes to the iPLEDGE program, visit the Web site at www.ipledgeprogram.com

WASHINGTON — Protect HIV-infected patients from additional illness by vaccinating them against influenza, hepatitis A and B, pneumococcal disease, and tetanus-diphtheria, Dr. David H. Spach advised at the Ryan White CARE Act meeting on HIV treatment.

As flu season begins, “vaccinate everyone for flu regardless of their CD4 count or viral load,” said Dr. Spach, of the University of Washington, Seattle. He presented a roundup of immunization recommendations for HIV patients:

▸ Influenza. Adults with AIDS are at significantly greater risk for influenza, compared with healthy adults, and even compared with healthy persons older than 65 years, according to data from a 3-year study of deaths from influenza or pneumonia (Arch. Intern. Med. 2001;161:441–6). Studies have shown that the flu vaccine is most effective for patients with CD4 counts greater than 100 cells/mm

Vaccinate HIV patients annually with the trivalent vaccine regardless of their CD4 count, but remember that the live vaccine is contraindicated for these patients, he said. Data from the Centers for Disease Control and Prevention from 1976–2006 confirm that peak flu activity occurs in the 4-month period from December through March, which reinforces the current recommendations to give HIV patients the flu vaccine at a regular visit just prior to the start of flu season.

▸ Hepatitis B. Clinicians may encounter HIV patients who received one or two doses of the hepatitis B vaccine and then disappeared for years.

But if an HIV patient has missed a dose, “it's fine to pick up where you left off,” Dr. Spach said. Long intervals between the first and second doses of hepatitis B vaccine appear to have little effect on immunogenicity in HIV patients, and the third dose is more like a booster dose, he said. The CDC's Advisory Committee on Immunization Practices recommends a standard 20-mcg dose at baseline, with subsequent doses at 1 month and 6 months.

Consider a double dose of hepatitis B vaccine in HIV patients who do not respond to the initial three-dose series, Dr. Spach said. Patients with CD4 counts greater than 500 cells/mm

▸ Hepatitis A. Data from a study of 133 HIV-infected adults showed that response rates to hepatitis A vaccine are significantly greater in HIV patients with CD4 counts of at least 200 cells/mm

“Those with CD4 counts under 200 really did not respond well at 7 and 9 months post vaccination,” Dr. Spach said. Vaccine response rates at 7 and 9 months were 11% and 9%, respectively, compared with 53% and 69% among patients with CD4 counts of 200–500 cells/mm

Based on these and other data, hepatitis A is not an optimal vaccine for patients with low CD4 counts. If a patient is set to start antiviral therapy, consider postponing hepatitis A vaccination to see whether the CD4 count increases.

▸ Pneumococcal disease. The rate of invasive pneumococcal disease in HIV-infected patients has decreased as a result of the widespread use of the seven-valent conjugate pneumococcal vaccine given to young children, Dr. Spach said.

Data from 2006 show a 20% decrease in invasive pneumococcal disease among HIV-infected adults since the childhood conjugate vaccine became widely used, with a 60% reduction in the incidence of illness from serotypes that were contained in the vaccine and a slight increase in strains that were not contained in the vaccine (Ann. Intern. Med. 2006;144:1–9). These findings parallel other studies in adults not infected with HIV who have shown a strong herd immunity. “This childhood vaccine probably has had a greater effect on preventing pneumococcal disease in HIV patients than our giving the standard adult polysaccharide vaccine.”

No published data show that the 7-valent vaccine is better than the standard vaccine for HIV-infected adults, and current recommendations still call for a single dose of the 23-valent polysaccharide pneumococcal vaccine followed by another dose 5 years later. “But if you have a patient with children or who interacts with children, encourage those kids to get immunized with the conjugate vaccine,” he said.

▸ Tetanus. The new Tdap vaccine (approved in June 2005) is not a live vaccine, so it's safe for HIV patients. Tdap is not Food and Drug Administration-approved for HIV patients specifically, but it is not contraindicated for them, and it will protect them from pertussis, diphtheria, and tetanus. New recommendations for non-HIV-infected adults call for replacing the next booster dose of Td (tetanus-diphtheria toxoids) with the Tdap vaccine, which should be given routinely to patients whose last Td vaccination was more than 10 years ago.

For the latest immunization information, visit the CDC's National Immunization Program Web site, www.cdc.gov/nip

WASHINGTON — Protect HIV-infected patients from additional illness by vaccinating them against influenza, hepatitis A and B, pneumococcal disease, and tetanus-diphtheria, Dr. David H. Spach advised at the Ryan White CARE Act meeting on HIV treatment.

As flu season begins, “vaccinate everyone for flu regardless of their CD4 count or viral load,” said Dr. Spach, of the University of Washington, Seattle. He presented a roundup of immunization recommendations for HIV patients:

▸ Influenza. Adults with AIDS are at significantly greater risk for influenza, compared with healthy adults, and even compared with healthy persons older than 65 years, according to data from a 3-year study of deaths from influenza or pneumonia (Arch. Intern. Med. 2001;161:441–6). Studies have shown that the flu vaccine is most effective for patients with CD4 counts greater than 100 cells/mm

Vaccinate HIV patients annually with the trivalent vaccine regardless of their CD4 count, but remember that the live vaccine is contraindicated for these patients, he said. Data from the Centers for Disease Control and Prevention from 1976–2006 confirm that peak flu activity occurs in the 4-month period from December through March, which reinforces the current recommendations to give HIV patients the flu vaccine at a regular visit just prior to the start of flu season.

▸ Hepatitis B. Clinicians may encounter HIV patients who received one or two doses of the hepatitis B vaccine and then disappeared for years.

But if an HIV patient has missed a dose, “it's fine to pick up where you left off,” Dr. Spach said. Long intervals between the first and second doses of hepatitis B vaccine appear to have little effect on immunogenicity in HIV patients, and the third dose is more like a booster dose, he said. The CDC's Advisory Committee on Immunization Practices recommends a standard 20-mcg dose at baseline, with subsequent doses at 1 month and 6 months.

Consider a double dose of hepatitis B vaccine in HIV patients who do not respond to the initial three-dose series, Dr. Spach said. Patients with CD4 counts greater than 500 cells/mm

▸ Hepatitis A. Data from a study of 133 HIV-infected adults showed that response rates to hepatitis A vaccine are significantly greater in HIV patients with CD4 counts of at least 200 cells/mm

“Those with CD4 counts under 200 really did not respond well at 7 and 9 months post vaccination,” Dr. Spach said. Vaccine response rates at 7 and 9 months were 11% and 9%, respectively, compared with 53% and 69% among patients with CD4 counts of 200–500 cells/mm

Based on these and other data, hepatitis A is not an optimal vaccine for patients with low CD4 counts. If a patient is set to start antiviral therapy, consider postponing hepatitis A vaccination to see whether the CD4 count increases.

▸ Pneumococcal disease. The rate of invasive pneumococcal disease in HIV-infected patients has decreased as a result of the widespread use of the seven-valent conjugate pneumococcal vaccine given to young children, Dr. Spach said.

Data from 2006 show a 20% decrease in invasive pneumococcal disease among HIV-infected adults since the childhood conjugate vaccine became widely used, with a 60% reduction in the incidence of illness from serotypes that were contained in the vaccine and a slight increase in strains that were not contained in the vaccine (Ann. Intern. Med. 2006;144:1–9). These findings parallel other studies in adults not infected with HIV who have shown a strong herd immunity. “This childhood vaccine probably has had a greater effect on preventing pneumococcal disease in HIV patients than our giving the standard adult polysaccharide vaccine.”

No published data show that the 7-valent vaccine is better than the standard vaccine for HIV-infected adults, and current recommendations still call for a single dose of the 23-valent polysaccharide pneumococcal vaccine followed by another dose 5 years later. “But if you have a patient with children or who interacts with children, encourage those kids to get immunized with the conjugate vaccine,” he said.

▸ Tetanus. The new Tdap vaccine (approved in June 2005) is not a live vaccine, so it's safe for HIV patients. Tdap is not Food and Drug Administration-approved for HIV patients specifically, but it is not contraindicated for them, and it will protect them from pertussis, diphtheria, and tetanus. New recommendations for non-HIV-infected adults call for replacing the next booster dose of Td (tetanus-diphtheria toxoids) with the Tdap vaccine, which should be given routinely to patients whose last Td vaccination was more than 10 years ago.

For the latest immunization information, visit the CDC's National Immunization Program Web site, www.cdc.gov/nip

WASHINGTON — Protect HIV-infected patients from additional illness by vaccinating them against influenza, hepatitis A and B, pneumococcal disease, and tetanus-diphtheria, Dr. David H. Spach advised at the Ryan White CARE Act meeting on HIV treatment.

As flu season begins, “vaccinate everyone for flu regardless of their CD4 count or viral load,” said Dr. Spach, of the University of Washington, Seattle. He presented a roundup of immunization recommendations for HIV patients:

▸ Influenza. Adults with AIDS are at significantly greater risk for influenza, compared with healthy adults, and even compared with healthy persons older than 65 years, according to data from a 3-year study of deaths from influenza or pneumonia (Arch. Intern. Med. 2001;161:441–6). Studies have shown that the flu vaccine is most effective for patients with CD4 counts greater than 100 cells/mm

Vaccinate HIV patients annually with the trivalent vaccine regardless of their CD4 count, but remember that the live vaccine is contraindicated for these patients, he said. Data from the Centers for Disease Control and Prevention from 1976–2006 confirm that peak flu activity occurs in the 4-month period from December through March, which reinforces the current recommendations to give HIV patients the flu vaccine at a regular visit just prior to the start of flu season.

▸ Hepatitis B. Clinicians may encounter HIV patients who received one or two doses of the hepatitis B vaccine and then disappeared for years.

But if an HIV patient has missed a dose, “it's fine to pick up where you left off,” Dr. Spach said. Long intervals between the first and second doses of hepatitis B vaccine appear to have little effect on immunogenicity in HIV patients, and the third dose is more like a booster dose, he said. The CDC's Advisory Committee on Immunization Practices recommends a standard 20-mcg dose at baseline, with subsequent doses at 1 month and 6 months.

Consider a double dose of hepatitis B vaccine in HIV patients who do not respond to the initial three-dose series, Dr. Spach said. Patients with CD4 counts greater than 500 cells/mm

▸ Hepatitis A. Data from a study of 133 HIV-infected adults showed that response rates to hepatitis A vaccine are significantly greater in HIV patients with CD4 counts of at least 200 cells/mm

“Those with CD4 counts under 200 really did not respond well at 7 and 9 months post vaccination,” Dr. Spach said. Vaccine response rates at 7 and 9 months were 11% and 9%, respectively, compared with 53% and 69% among patients with CD4 counts of 200–500 cells/mm

Based on these and other data, hepatitis A is not an optimal vaccine for patients with low CD4 counts. If a patient is set to start antiviral therapy, consider postponing hepatitis A vaccination to see whether the CD4 count increases.

▸ Pneumococcal disease. The rate of invasive pneumococcal disease in HIV-infected patients has decreased as a result of the widespread use of the seven-valent conjugate pneumococcal vaccine given to young children, Dr. Spach said.

Data from 2006 show a 20% decrease in invasive pneumococcal disease among HIV-infected adults since the childhood conjugate vaccine became widely used, with a 60% reduction in the incidence of illness from serotypes that were contained in the vaccine and a slight increase in strains that were not contained in the vaccine (Ann. Intern. Med. 2006;144:1–9). These findings parallel other studies in adults not infected with HIV who have shown a strong herd immunity. “This childhood vaccine probably has had a greater effect on preventing pneumococcal disease in HIV patients than our giving the standard adult polysaccharide vaccine.”

No published data show that the 7-valent vaccine is better than the standard vaccine for HIV-infected adults, and current recommendations still call for a single dose of the 23-valent polysaccharide pneumococcal vaccine followed by another dose 5 years later. “But if you have a patient with children or who interacts with children, encourage those kids to get immunized with the conjugate vaccine,” he said.

▸ Tetanus. The new Tdap vaccine (approved in June 2005) is not a live vaccine, so it's safe for HIV patients. Tdap is not Food and Drug Administration-approved for HIV patients specifically, but it is not contraindicated for them, and it will protect them from pertussis, diphtheria, and tetanus. New recommendations for non-HIV-infected adults call for replacing the next booster dose of Td (tetanus-diphtheria toxoids) with the Tdap vaccine, which should be given routinely to patients whose last Td vaccination was more than 10 years ago.

For the latest immunization information, visit the CDC's National Immunization Program Web site, www.cdc.gov/nip

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.