Heidi Splete

CHICAGO – Adenotonsillectomy improved both sleep and behavior in a pair of studies presented at the Combined Otolaryngology Spring Meetings.

Children with either obstructive sleep apnea syndrome (OSAS) or mild sleep disordered breathing (SDB) demonstrated significantly improved scores on behavior measurements after adenotonsillectomy, compared with presurgery scores, which suggests that symptom severity does not affect improvement, said Dr. Ron B. Mitchell, a pediatric laryngologist at Virginia Commonwealth University in Richmond.

Of 40 children aged 3–18 years, 23 had OSAS and 17 had SDB; demographics were similar between the two groups. The mean apnea-hypopnea index prior to surgery was 25 among the children with OSAS and 3 among those with SDB.

At a follow-up evaluation an average of 3 months after an adenotonsillectomy, children in both the OSAS and SDB groups showed significant improvements, compared with presurgery scores on the Behavior Symptom Index, a global measure of behavior. Differences in postsurgery scores between the two groups were not significant, however.

In addition, scores on the Behavior Assessment System for Children subscales of depression, hyperactivity, atypicality, and somatization were significantly improved after surgery, compared with presurgery scores for children in both groups, and the scores did not differ significantly between the groups.

All children had been measured with polysomnography and had undergone comprehensive behavior assessments prior to surgery. Children with comorbidities were excluded. The study was limited by the absence of a control group, the short follow-up period, and the selection bias inherent in the use of a population at a specialized clinic for sleep problems.

“Without a control group, all we can say is that adenotonsillectomy and improved behavior were associated, not necessarily correlated,” said Dr. Mitchell.

However, the study suggests that SDB is associated with a significant amount of behavioral morbidity regardless of the severity of the condition, and that these problems improve after adenotonsillectomy regardless of whether the child has only mild SDB or OSAS, he said.

In a second study of children with SDB, the 71 for whom follow-up data were available showed significant improvement in both sleep and behavior based on the pediatric sleep questionnaire (PSQ) and the Conners' Parent Rating Scale-Revised (CPRS-RS).

In addition, Dr. Julie Wei and her colleagues at the University of Kansas in Kansas City examined whether children whose scores were worse prior to surgery show greater benefit after surgery.

“We wanted to explore whether the improvements were a function of the baseline scores,” said Dr. Wei.

The prospective study included children aged 3–17 years, with a mean age of 6.5 years, who were evaluated using the PSQ and CPRS-RS.

Six months after the surgery, the average scores on the questionnaires improved significantly, compared with scores prior to surgery, especially among the children with the worst scores. “There was almost a 20-point reduction among the children who were worse to begin with,” Dr. Wei said.

The CPRS-RS evaluated the children's behavior in four categories: opposition, cognitive/inattention, hyperactivity, and the Conners' ADHD index. A score of 60 in any category would place a child at risk for problems in that category, Dr. Wei said. Before surgery, the mean scores in these categories were 59.4, 59.5, 62, and 59.9, respectively; after surgery, the mean scores were 51, 51.2, 52.4, and 50.6, respectively.

The children were clinically evaluated for SDB based on the 22-item pediatric sleep subscale of the 74-item PSQ, rather than polysomnography. The subscale has been shown to accurately predict SDB.

Although polysomnography is the approved measure of SDB, it is not available in all areas, and is used rarely. “Less than 5% of children have polysomnography prior to surgery,” Dr. Wei said.

The PSQ questionnaire can be a useful screening tool to determine candidacy for surgery as an adjunct to a history and physical exam, especially in areas where polysomnography is not available, Dr. Wei said.

The results of this study suggest that treatment of children who are diagnosed clinically using the pediatric sleep subscale show improved behavior and sleep even if their diagnosis is not confirmed by polysomnography, she said. The study was limited by the lack of a control group, the lack of data on behavior at school, and the use of a convenient sample of children with sleep problems. The evidence supported findings from previous research, including a study in which children with ADHD who underwent adenotonsillectomies no longer met ADHD criteria 1 year later (Pediatrics 2006;117:e769–e778).

CHICAGO – Adenotonsillectomy improved both sleep and behavior in a pair of studies presented at the Combined Otolaryngology Spring Meetings.

Children with either obstructive sleep apnea syndrome (OSAS) or mild sleep disordered breathing (SDB) demonstrated significantly improved scores on behavior measurements after adenotonsillectomy, compared with presurgery scores, which suggests that symptom severity does not affect improvement, said Dr. Ron B. Mitchell, a pediatric laryngologist at Virginia Commonwealth University in Richmond.

Of 40 children aged 3–18 years, 23 had OSAS and 17 had SDB; demographics were similar between the two groups. The mean apnea-hypopnea index prior to surgery was 25 among the children with OSAS and 3 among those with SDB.

At a follow-up evaluation an average of 3 months after an adenotonsillectomy, children in both the OSAS and SDB groups showed significant improvements, compared with presurgery scores on the Behavior Symptom Index, a global measure of behavior. Differences in postsurgery scores between the two groups were not significant, however.

In addition, scores on the Behavior Assessment System for Children subscales of depression, hyperactivity, atypicality, and somatization were significantly improved after surgery, compared with presurgery scores for children in both groups, and the scores did not differ significantly between the groups.

All children had been measured with polysomnography and had undergone comprehensive behavior assessments prior to surgery. Children with comorbidities were excluded. The study was limited by the absence of a control group, the short follow-up period, and the selection bias inherent in the use of a population at a specialized clinic for sleep problems.

“Without a control group, all we can say is that adenotonsillectomy and improved behavior were associated, not necessarily correlated,” said Dr. Mitchell.

However, the study suggests that SDB is associated with a significant amount of behavioral morbidity regardless of the severity of the condition, and that these problems improve after adenotonsillectomy regardless of whether the child has only mild SDB or OSAS, he said.

In a second study of children with SDB, the 71 for whom follow-up data were available showed significant improvement in both sleep and behavior based on the pediatric sleep questionnaire (PSQ) and the Conners' Parent Rating Scale-Revised (CPRS-RS).

In addition, Dr. Julie Wei and her colleagues at the University of Kansas in Kansas City examined whether children whose scores were worse prior to surgery show greater benefit after surgery.

“We wanted to explore whether the improvements were a function of the baseline scores,” said Dr. Wei.

The prospective study included children aged 3–17 years, with a mean age of 6.5 years, who were evaluated using the PSQ and CPRS-RS.

Six months after the surgery, the average scores on the questionnaires improved significantly, compared with scores prior to surgery, especially among the children with the worst scores. “There was almost a 20-point reduction among the children who were worse to begin with,” Dr. Wei said.

The CPRS-RS evaluated the children's behavior in four categories: opposition, cognitive/inattention, hyperactivity, and the Conners' ADHD index. A score of 60 in any category would place a child at risk for problems in that category, Dr. Wei said. Before surgery, the mean scores in these categories were 59.4, 59.5, 62, and 59.9, respectively; after surgery, the mean scores were 51, 51.2, 52.4, and 50.6, respectively.

The children were clinically evaluated for SDB based on the 22-item pediatric sleep subscale of the 74-item PSQ, rather than polysomnography. The subscale has been shown to accurately predict SDB.

Although polysomnography is the approved measure of SDB, it is not available in all areas, and is used rarely. “Less than 5% of children have polysomnography prior to surgery,” Dr. Wei said.

The PSQ questionnaire can be a useful screening tool to determine candidacy for surgery as an adjunct to a history and physical exam, especially in areas where polysomnography is not available, Dr. Wei said.

The results of this study suggest that treatment of children who are diagnosed clinically using the pediatric sleep subscale show improved behavior and sleep even if their diagnosis is not confirmed by polysomnography, she said. The study was limited by the lack of a control group, the lack of data on behavior at school, and the use of a convenient sample of children with sleep problems. The evidence supported findings from previous research, including a study in which children with ADHD who underwent adenotonsillectomies no longer met ADHD criteria 1 year later (Pediatrics 2006;117:e769–e778).

CHICAGO – Adenotonsillectomy improved both sleep and behavior in a pair of studies presented at the Combined Otolaryngology Spring Meetings.

Children with either obstructive sleep apnea syndrome (OSAS) or mild sleep disordered breathing (SDB) demonstrated significantly improved scores on behavior measurements after adenotonsillectomy, compared with presurgery scores, which suggests that symptom severity does not affect improvement, said Dr. Ron B. Mitchell, a pediatric laryngologist at Virginia Commonwealth University in Richmond.

Of 40 children aged 3–18 years, 23 had OSAS and 17 had SDB; demographics were similar between the two groups. The mean apnea-hypopnea index prior to surgery was 25 among the children with OSAS and 3 among those with SDB.

At a follow-up evaluation an average of 3 months after an adenotonsillectomy, children in both the OSAS and SDB groups showed significant improvements, compared with presurgery scores on the Behavior Symptom Index, a global measure of behavior. Differences in postsurgery scores between the two groups were not significant, however.

In addition, scores on the Behavior Assessment System for Children subscales of depression, hyperactivity, atypicality, and somatization were significantly improved after surgery, compared with presurgery scores for children in both groups, and the scores did not differ significantly between the groups.

All children had been measured with polysomnography and had undergone comprehensive behavior assessments prior to surgery. Children with comorbidities were excluded. The study was limited by the absence of a control group, the short follow-up period, and the selection bias inherent in the use of a population at a specialized clinic for sleep problems.

“Without a control group, all we can say is that adenotonsillectomy and improved behavior were associated, not necessarily correlated,” said Dr. Mitchell.

However, the study suggests that SDB is associated with a significant amount of behavioral morbidity regardless of the severity of the condition, and that these problems improve after adenotonsillectomy regardless of whether the child has only mild SDB or OSAS, he said.

In a second study of children with SDB, the 71 for whom follow-up data were available showed significant improvement in both sleep and behavior based on the pediatric sleep questionnaire (PSQ) and the Conners' Parent Rating Scale-Revised (CPRS-RS).

In addition, Dr. Julie Wei and her colleagues at the University of Kansas in Kansas City examined whether children whose scores were worse prior to surgery show greater benefit after surgery.

“We wanted to explore whether the improvements were a function of the baseline scores,” said Dr. Wei.

The prospective study included children aged 3–17 years, with a mean age of 6.5 years, who were evaluated using the PSQ and CPRS-RS.

Six months after the surgery, the average scores on the questionnaires improved significantly, compared with scores prior to surgery, especially among the children with the worst scores. “There was almost a 20-point reduction among the children who were worse to begin with,” Dr. Wei said.

The CPRS-RS evaluated the children's behavior in four categories: opposition, cognitive/inattention, hyperactivity, and the Conners' ADHD index. A score of 60 in any category would place a child at risk for problems in that category, Dr. Wei said. Before surgery, the mean scores in these categories were 59.4, 59.5, 62, and 59.9, respectively; after surgery, the mean scores were 51, 51.2, 52.4, and 50.6, respectively.

The children were clinically evaluated for SDB based on the 22-item pediatric sleep subscale of the 74-item PSQ, rather than polysomnography. The subscale has been shown to accurately predict SDB.

Although polysomnography is the approved measure of SDB, it is not available in all areas, and is used rarely. “Less than 5% of children have polysomnography prior to surgery,” Dr. Wei said.

The PSQ questionnaire can be a useful screening tool to determine candidacy for surgery as an adjunct to a history and physical exam, especially in areas where polysomnography is not available, Dr. Wei said.

The results of this study suggest that treatment of children who are diagnosed clinically using the pediatric sleep subscale show improved behavior and sleep even if their diagnosis is not confirmed by polysomnography, she said. The study was limited by the lack of a control group, the lack of data on behavior at school, and the use of a convenient sample of children with sleep problems. The evidence supported findings from previous research, including a study in which children with ADHD who underwent adenotonsillectomies no longer met ADHD criteria 1 year later (Pediatrics 2006;117:e769–e778).

WASHINGTON — Women who get plenty of vitamin D, especially early in life, are less likely to develop breast cancer than women who get smaller amounts of the vitamin, according to data from two studies presented at the annual meeting of the American Association for Cancer Research.

Julia Knight, Ph.D., of Mount Sinai Hospital in Toronto, and her colleagues conducted a case-control, population-based study of women aged 20–59 years from a Canadian cancer registry and the surrounding community. They identified 971 cases of breast cancer and 1,135 controls and asked the women about lifetime sun exposure and dietary vitamin D.

Logistic regression analyses adjusted for variables including age, ethnicity, age at menarche, age at first pregnancy, duration of breast-feeding, and family history of breast cancer.

Overall, participating in any outdoor work at any point in life resulted in about a 40% reduction in breast cancer risk (odds ratio 0.60). Participation in at least six types of outdoor activities at ages 10–19 years and at least five types of outdoor activities at ages 20–29 years reduced the risk by about 35%. Outdoor activities did not have to involve physical activity, Dr. Knight noted. However, the risk reduction was not as robust in women who reported that they had kept their arms and legs covered outside.

In addition, drinking at least nine glasses of milk per week at ages 20–29 years was significantly associated with reductions in breast cancer risk, as was the regular consumption of cod liver oil for at least 10 years.

“In general, most women drank more milk when they were younger,” Dr. Knight said. Vitamin D exposure during breast development or prior to pregnancy may be particularly important in preventing breast cancer later on, she added.

The evidence for the protective role of vitamin D appeared to weaken with age. By ages 45–54 years, there was some evidence of reduced risk associated with outdoor activity, but it was no longer significant, although the risk was no longer affected by whether the arms and legs were covered.

When asked about the role of vitamin D supplements, Dr. Knight admitted that supplements of any sort complicate the picture. “The problem with supplements is that there tends to be a reduced risk in anyone who takes any kind of vitamin supplements, whether they include vitamin D or not,” she said. People who take supplements tend to have other characteristics of a healthy lifestyle, she said.

“We did ask about sunscreen. We are still analyzing that because it is complicated, since sunblock use has only become common in the last 20 years,” she said.

Increasing the levels of serum vitamin D in the body, regardless of age, may reduce the risk of breast cancer, according to a second study presented at the meeting by Cedric F. Garland, Dr.P.H., of the University of California, San Diego.

Dr. Garland and his associates reviewed data on a total of 1,760 women in two studies. In the first, a serum 25-hydroxyvitamin D (25[OH]D) level of 35 ng/mL was associated with a 20% drop in breast cancer risk (Cancer Epidemiol. Biomarkers Prev. 2005;14:1991–7).

A second study of 179 women with breast cancer and 179 controls showed that as vitamin D levels in the blood increased, the risk of breast cancer decreased. Women with 25-(OH)D levels less than 50 ng/mL were six times more likely to develop breast cancer than those with levels greater than 50 ng/mL (Eur. J. Cancer 2005;41:1164–9).

Dr. Garland chose these two studies because 25 (OH) D has been shown to vary with geography. Death rates from breast cancer could be as much as three times higher in the Northeast, compared with the Southwest, because of reduced vitamin D intake from sunlight, he noted.

Based on these studies, “if we can get women up to 20–22 ng/mL of serum vitamin D, we could expect a 20% reduction in breast cancer risk. We think this is a good aim,” Dr. Garland said. Levels closer to 52 ng/mL—which are common among some women in sunny areas such as California—would be even better, he noted. Some women in the Northeast have vitamin D levels of about 15 ng/mL, and some women have levels so low that they are barely detectable, he added.

A vitamin D intake of 2,000 IU/day has been associated with vitamin D levels of 32 ng/mL. That intake is well above the average consumption of most American women, but below the upper limit of 2,400 IU that is currently recommended by the National Academy of Sciences. But even 1,000 IU/day may produce a vitamin D level of about 22 ng/mL.

“Levels above 2,400 IU are terra incognita,” Dr. Garland said. The lowest level of vitamin D associated with toxicity is 3,800 IU, according to the National Academy of Sciences. Some scientists have proposed daily intakes of 4,000 IU. In any case, supplements and vitamin-fortified foods, such as cereals and grains, will be necessary for most people to maintain optimal levels of vitamin D, he noted.

WASHINGTON — Women who get plenty of vitamin D, especially early in life, are less likely to develop breast cancer than women who get smaller amounts of the vitamin, according to data from two studies presented at the annual meeting of the American Association for Cancer Research.

Julia Knight, Ph.D., of Mount Sinai Hospital in Toronto, and her colleagues conducted a case-control, population-based study of women aged 20–59 years from a Canadian cancer registry and the surrounding community. They identified 971 cases of breast cancer and 1,135 controls and asked the women about lifetime sun exposure and dietary vitamin D.

Logistic regression analyses adjusted for variables including age, ethnicity, age at menarche, age at first pregnancy, duration of breast-feeding, and family history of breast cancer.

Overall, participating in any outdoor work at any point in life resulted in about a 40% reduction in breast cancer risk (odds ratio 0.60). Participation in at least six types of outdoor activities at ages 10–19 years and at least five types of outdoor activities at ages 20–29 years reduced the risk by about 35%. Outdoor activities did not have to involve physical activity, Dr. Knight noted. However, the risk reduction was not as robust in women who reported that they had kept their arms and legs covered outside.

In addition, drinking at least nine glasses of milk per week at ages 20–29 years was significantly associated with reductions in breast cancer risk, as was the regular consumption of cod liver oil for at least 10 years.

“In general, most women drank more milk when they were younger,” Dr. Knight said. Vitamin D exposure during breast development or prior to pregnancy may be particularly important in preventing breast cancer later on, she added.

The evidence for the protective role of vitamin D appeared to weaken with age. By ages 45–54 years, there was some evidence of reduced risk associated with outdoor activity, but it was no longer significant, although the risk was no longer affected by whether the arms and legs were covered.

When asked about the role of vitamin D supplements, Dr. Knight admitted that supplements of any sort complicate the picture. “The problem with supplements is that there tends to be a reduced risk in anyone who takes any kind of vitamin supplements, whether they include vitamin D or not,” she said. People who take supplements tend to have other characteristics of a healthy lifestyle, she said.

“We did ask about sunscreen. We are still analyzing that because it is complicated, since sunblock use has only become common in the last 20 years,” she said.

Increasing the levels of serum vitamin D in the body, regardless of age, may reduce the risk of breast cancer, according to a second study presented at the meeting by Cedric F. Garland, Dr.P.H., of the University of California, San Diego.

Dr. Garland and his associates reviewed data on a total of 1,760 women in two studies. In the first, a serum 25-hydroxyvitamin D (25[OH]D) level of 35 ng/mL was associated with a 20% drop in breast cancer risk (Cancer Epidemiol. Biomarkers Prev. 2005;14:1991–7).

A second study of 179 women with breast cancer and 179 controls showed that as vitamin D levels in the blood increased, the risk of breast cancer decreased. Women with 25-(OH)D levels less than 50 ng/mL were six times more likely to develop breast cancer than those with levels greater than 50 ng/mL (Eur. J. Cancer 2005;41:1164–9).

Dr. Garland chose these two studies because 25 (OH) D has been shown to vary with geography. Death rates from breast cancer could be as much as three times higher in the Northeast, compared with the Southwest, because of reduced vitamin D intake from sunlight, he noted.

Based on these studies, “if we can get women up to 20–22 ng/mL of serum vitamin D, we could expect a 20% reduction in breast cancer risk. We think this is a good aim,” Dr. Garland said. Levels closer to 52 ng/mL—which are common among some women in sunny areas such as California—would be even better, he noted. Some women in the Northeast have vitamin D levels of about 15 ng/mL, and some women have levels so low that they are barely detectable, he added.

A vitamin D intake of 2,000 IU/day has been associated with vitamin D levels of 32 ng/mL. That intake is well above the average consumption of most American women, but below the upper limit of 2,400 IU that is currently recommended by the National Academy of Sciences. But even 1,000 IU/day may produce a vitamin D level of about 22 ng/mL.

“Levels above 2,400 IU are terra incognita,” Dr. Garland said. The lowest level of vitamin D associated with toxicity is 3,800 IU, according to the National Academy of Sciences. Some scientists have proposed daily intakes of 4,000 IU. In any case, supplements and vitamin-fortified foods, such as cereals and grains, will be necessary for most people to maintain optimal levels of vitamin D, he noted.

WASHINGTON — Women who get plenty of vitamin D, especially early in life, are less likely to develop breast cancer than women who get smaller amounts of the vitamin, according to data from two studies presented at the annual meeting of the American Association for Cancer Research.

Julia Knight, Ph.D., of Mount Sinai Hospital in Toronto, and her colleagues conducted a case-control, population-based study of women aged 20–59 years from a Canadian cancer registry and the surrounding community. They identified 971 cases of breast cancer and 1,135 controls and asked the women about lifetime sun exposure and dietary vitamin D.

Logistic regression analyses adjusted for variables including age, ethnicity, age at menarche, age at first pregnancy, duration of breast-feeding, and family history of breast cancer.

Overall, participating in any outdoor work at any point in life resulted in about a 40% reduction in breast cancer risk (odds ratio 0.60). Participation in at least six types of outdoor activities at ages 10–19 years and at least five types of outdoor activities at ages 20–29 years reduced the risk by about 35%. Outdoor activities did not have to involve physical activity, Dr. Knight noted. However, the risk reduction was not as robust in women who reported that they had kept their arms and legs covered outside.

In addition, drinking at least nine glasses of milk per week at ages 20–29 years was significantly associated with reductions in breast cancer risk, as was the regular consumption of cod liver oil for at least 10 years.

“In general, most women drank more milk when they were younger,” Dr. Knight said. Vitamin D exposure during breast development or prior to pregnancy may be particularly important in preventing breast cancer later on, she added.

The evidence for the protective role of vitamin D appeared to weaken with age. By ages 45–54 years, there was some evidence of reduced risk associated with outdoor activity, but it was no longer significant, although the risk was no longer affected by whether the arms and legs were covered.

When asked about the role of vitamin D supplements, Dr. Knight admitted that supplements of any sort complicate the picture. “The problem with supplements is that there tends to be a reduced risk in anyone who takes any kind of vitamin supplements, whether they include vitamin D or not,” she said. People who take supplements tend to have other characteristics of a healthy lifestyle, she said.

“We did ask about sunscreen. We are still analyzing that because it is complicated, since sunblock use has only become common in the last 20 years,” she said.

Increasing the levels of serum vitamin D in the body, regardless of age, may reduce the risk of breast cancer, according to a second study presented at the meeting by Cedric F. Garland, Dr.P.H., of the University of California, San Diego.

Dr. Garland and his associates reviewed data on a total of 1,760 women in two studies. In the first, a serum 25-hydroxyvitamin D (25[OH]D) level of 35 ng/mL was associated with a 20% drop in breast cancer risk (Cancer Epidemiol. Biomarkers Prev. 2005;14:1991–7).

A second study of 179 women with breast cancer and 179 controls showed that as vitamin D levels in the blood increased, the risk of breast cancer decreased. Women with 25-(OH)D levels less than 50 ng/mL were six times more likely to develop breast cancer than those with levels greater than 50 ng/mL (Eur. J. Cancer 2005;41:1164–9).

Dr. Garland chose these two studies because 25 (OH) D has been shown to vary with geography. Death rates from breast cancer could be as much as three times higher in the Northeast, compared with the Southwest, because of reduced vitamin D intake from sunlight, he noted.

Based on these studies, “if we can get women up to 20–22 ng/mL of serum vitamin D, we could expect a 20% reduction in breast cancer risk. We think this is a good aim,” Dr. Garland said. Levels closer to 52 ng/mL—which are common among some women in sunny areas such as California—would be even better, he noted. Some women in the Northeast have vitamin D levels of about 15 ng/mL, and some women have levels so low that they are barely detectable, he added.

A vitamin D intake of 2,000 IU/day has been associated with vitamin D levels of 32 ng/mL. That intake is well above the average consumption of most American women, but below the upper limit of 2,400 IU that is currently recommended by the National Academy of Sciences. But even 1,000 IU/day may produce a vitamin D level of about 22 ng/mL.

“Levels above 2,400 IU are terra incognita,” Dr. Garland said. The lowest level of vitamin D associated with toxicity is 3,800 IU, according to the National Academy of Sciences. Some scientists have proposed daily intakes of 4,000 IU. In any case, supplements and vitamin-fortified foods, such as cereals and grains, will be necessary for most people to maintain optimal levels of vitamin D, he noted.

WASHINGTON — Despite a recommendation to prioritize 11- to 12-year-olds, distribution of the meningococcal conjugate vaccine was especially high among 18-year-olds and was evenly distributed among 11- to 17-year-olds during its first year on the market, Dr. Gregory Wallace reported at a meeting of the National Vaccine Advisory Committee.

The rationale for the recommendation was to help establish an adolescent vaccine visit, and was not generated because of an increased disease risk among 11- to 12-year-olds, explained Dr. Wallace, chief of the Vaccine Supply & Assurance Branch at the Centers for Disease Control and Prevention.

The vaccine is also recommended for adolescents entering high school who have not been previously vaccinated, as well as for college freshmen living in dorms.

Demand for the meningococcal conjugate vaccine (MCV4), marketed as Menactra, was high starting in June 2005 after the publication and promotion of the vaccination recommendations by the CDC's Advisory Committee on Immunization Practices, the American Academy of Pediatrics, and the American Academy of Family Physicians.

The demand was initially highest for 18-year-olds, and the peak months were June and July 2005. The high demand then decreased during the fall of 2005, as did patients' and parents' concerns about the vaccine supply.

The overall vaccine distribution rate from March 2005 to March 2006 was approximately 10% for 11- to 17-year-olds, but it approached 16% among 18-year-olds, based on physicians' billing-claims data provided by the vaccine's manufacturer, Sanofi Pasteur USA.

About 4.2 million doses were distributed between March 2005 and March 2006. Although the manufacturer projects that 6 million doses will be available for 2006–2007, the amount currently available for the summer months of 2006 is approximately the same as last year, Dr. Wallace said.

Sanofi Pasteur expects the demand for the vaccine to exceed supply this summer. To handle the anticipated summer rush among 18-year-olds, the CDC and other organizations have recommended that physicians defer the vaccination of 11- to 12-year-olds until further notice from the manufacturer that the shortage has been resolved.

The current supply projections should be sufficient to cover adolescents entering high school, dorm-dwelling college freshmen, and other high-risk groups, including military recruits and travelers to areas where the risk of meningococcal disease is high.

For periodic vaccine supply updates, visit www.cdc.gov/nip/news/shortages/default.htm

WASHINGTON — Despite a recommendation to prioritize 11- to 12-year-olds, distribution of the meningococcal conjugate vaccine was especially high among 18-year-olds and was evenly distributed among 11- to 17-year-olds during its first year on the market, Dr. Gregory Wallace reported at a meeting of the National Vaccine Advisory Committee.

The rationale for the recommendation was to help establish an adolescent vaccine visit, and was not generated because of an increased disease risk among 11- to 12-year-olds, explained Dr. Wallace, chief of the Vaccine Supply & Assurance Branch at the Centers for Disease Control and Prevention.

The vaccine is also recommended for adolescents entering high school who have not been previously vaccinated, as well as for college freshmen living in dorms.

Demand for the meningococcal conjugate vaccine (MCV4), marketed as Menactra, was high starting in June 2005 after the publication and promotion of the vaccination recommendations by the CDC's Advisory Committee on Immunization Practices, the American Academy of Pediatrics, and the American Academy of Family Physicians.

The demand was initially highest for 18-year-olds, and the peak months were June and July 2005. The high demand then decreased during the fall of 2005, as did patients' and parents' concerns about the vaccine supply.

The overall vaccine distribution rate from March 2005 to March 2006 was approximately 10% for 11- to 17-year-olds, but it approached 16% among 18-year-olds, based on physicians' billing-claims data provided by the vaccine's manufacturer, Sanofi Pasteur USA.

About 4.2 million doses were distributed between March 2005 and March 2006. Although the manufacturer projects that 6 million doses will be available for 2006–2007, the amount currently available for the summer months of 2006 is approximately the same as last year, Dr. Wallace said.

Sanofi Pasteur expects the demand for the vaccine to exceed supply this summer. To handle the anticipated summer rush among 18-year-olds, the CDC and other organizations have recommended that physicians defer the vaccination of 11- to 12-year-olds until further notice from the manufacturer that the shortage has been resolved.

The current supply projections should be sufficient to cover adolescents entering high school, dorm-dwelling college freshmen, and other high-risk groups, including military recruits and travelers to areas where the risk of meningococcal disease is high.

For periodic vaccine supply updates, visit www.cdc.gov/nip/news/shortages/default.htm

WASHINGTON — Despite a recommendation to prioritize 11- to 12-year-olds, distribution of the meningococcal conjugate vaccine was especially high among 18-year-olds and was evenly distributed among 11- to 17-year-olds during its first year on the market, Dr. Gregory Wallace reported at a meeting of the National Vaccine Advisory Committee.

The rationale for the recommendation was to help establish an adolescent vaccine visit, and was not generated because of an increased disease risk among 11- to 12-year-olds, explained Dr. Wallace, chief of the Vaccine Supply & Assurance Branch at the Centers for Disease Control and Prevention.

The vaccine is also recommended for adolescents entering high school who have not been previously vaccinated, as well as for college freshmen living in dorms.

Demand for the meningococcal conjugate vaccine (MCV4), marketed as Menactra, was high starting in June 2005 after the publication and promotion of the vaccination recommendations by the CDC's Advisory Committee on Immunization Practices, the American Academy of Pediatrics, and the American Academy of Family Physicians.

The demand was initially highest for 18-year-olds, and the peak months were June and July 2005. The high demand then decreased during the fall of 2005, as did patients' and parents' concerns about the vaccine supply.

The overall vaccine distribution rate from March 2005 to March 2006 was approximately 10% for 11- to 17-year-olds, but it approached 16% among 18-year-olds, based on physicians' billing-claims data provided by the vaccine's manufacturer, Sanofi Pasteur USA.

About 4.2 million doses were distributed between March 2005 and March 2006. Although the manufacturer projects that 6 million doses will be available for 2006–2007, the amount currently available for the summer months of 2006 is approximately the same as last year, Dr. Wallace said.

Sanofi Pasteur expects the demand for the vaccine to exceed supply this summer. To handle the anticipated summer rush among 18-year-olds, the CDC and other organizations have recommended that physicians defer the vaccination of 11- to 12-year-olds until further notice from the manufacturer that the shortage has been resolved.

The current supply projections should be sufficient to cover adolescents entering high school, dorm-dwelling college freshmen, and other high-risk groups, including military recruits and travelers to areas where the risk of meningococcal disease is high.

For periodic vaccine supply updates, visit www.cdc.gov/nip/news/shortages/default.htm

WASHINGTON — Despite a recommendation to prioritize 11- to 12-year-olds, distribution of the meningococcal conjugate vaccine was especially high among 18-year-olds and was evenly distributed among 11- to 17-year-olds during its first year on the market, Dr. Gregory Wallace reported at a meeting of the National Vaccine Advisory Committee.

The rationale for the recommendation was to help establish an adolescent vaccine visit, and was not generated because of an increased disease risk among 11- to 12-year-olds, explained Dr. Wallace, chief of the Vaccine Supply & Assurance Branch at the Centers for Disease Control and Prevention.

The vaccine is also recommended for adolescents entering high school who have not been previously vaccinated, as well as for college freshmen living in dorms.

Demand for the meningococcal conjugate vaccine (MCV4), marketed as Menactra, was high starting in June 2005 after the publication and promotion of the vaccination recommendations by the CDC's Advisory Committee on Immunization Practices, the American Academy of Pediatrics, and the American Academy of Family Physicians.

The demand was initially highest for 18-year-olds, and the peak months were June and July 2005. The high demand then decreased during the fall of 2005, as did patients' and parents' concerns about the vaccine supply.

The overall vaccine distribution rate from March 2005 to March 2006 was approximately 10% for 11- to 17-year-olds, but it approached 16% among 18-year-olds, based on physicians' billing-claims data provided by the vaccine's manufacturer, Sanofi Pasteur USA.

About 4.2 million doses were distributed between March 2005 and March 2006. The manufacturer projects that 6 million doses will be available for 2006–2007, but the amount currently available for the summer months of 2006 is about the same as last year, and Sanofi Pasteur expects the demand for the vaccine to exceed supply this summer.

To handle the anticipated summer rush among 18-year-olds, the CDC and other organizations have recommended that physicians defer the vaccination of 11- to 12-year-olds until further notice from the manufacturer that the shortage has been resolved. The current supply projections should be sufficient to cover adolescents entering high school, dorm-dwelling college freshmen, and other high-risk groups, including military recruits and travelers to areas where the risk of meningococcal disease is high. For periodic vaccine supply updates, visit www.cdc.gov/nip/news/shortages/default.htm

WASHINGTON — Despite a recommendation to prioritize 11- to 12-year-olds, distribution of the meningococcal conjugate vaccine was especially high among 18-year-olds and was evenly distributed among 11- to 17-year-olds during its first year on the market, Dr. Gregory Wallace reported at a meeting of the National Vaccine Advisory Committee.

The rationale for the recommendation was to help establish an adolescent vaccine visit, and was not generated because of an increased disease risk among 11- to 12-year-olds, explained Dr. Wallace, chief of the Vaccine Supply & Assurance Branch at the Centers for Disease Control and Prevention.

The vaccine is also recommended for adolescents entering high school who have not been previously vaccinated, as well as for college freshmen living in dorms.

Demand for the meningococcal conjugate vaccine (MCV4), marketed as Menactra, was high starting in June 2005 after the publication and promotion of the vaccination recommendations by the CDC's Advisory Committee on Immunization Practices, the American Academy of Pediatrics, and the American Academy of Family Physicians.

The demand was initially highest for 18-year-olds, and the peak months were June and July 2005. The high demand then decreased during the fall of 2005, as did patients' and parents' concerns about the vaccine supply.

The overall vaccine distribution rate from March 2005 to March 2006 was approximately 10% for 11- to 17-year-olds, but it approached 16% among 18-year-olds, based on physicians' billing-claims data provided by the vaccine's manufacturer, Sanofi Pasteur USA.

About 4.2 million doses were distributed between March 2005 and March 2006. The manufacturer projects that 6 million doses will be available for 2006–2007, but the amount currently available for the summer months of 2006 is about the same as last year, and Sanofi Pasteur expects the demand for the vaccine to exceed supply this summer.

To handle the anticipated summer rush among 18-year-olds, the CDC and other organizations have recommended that physicians defer the vaccination of 11- to 12-year-olds until further notice from the manufacturer that the shortage has been resolved. The current supply projections should be sufficient to cover adolescents entering high school, dorm-dwelling college freshmen, and other high-risk groups, including military recruits and travelers to areas where the risk of meningococcal disease is high. For periodic vaccine supply updates, visit www.cdc.gov/nip/news/shortages/default.htm

WASHINGTON — Despite a recommendation to prioritize 11- to 12-year-olds, distribution of the meningococcal conjugate vaccine was especially high among 18-year-olds and was evenly distributed among 11- to 17-year-olds during its first year on the market, Dr. Gregory Wallace reported at a meeting of the National Vaccine Advisory Committee.

The rationale for the recommendation was to help establish an adolescent vaccine visit, and was not generated because of an increased disease risk among 11- to 12-year-olds, explained Dr. Wallace, chief of the Vaccine Supply & Assurance Branch at the Centers for Disease Control and Prevention.

The vaccine is also recommended for adolescents entering high school who have not been previously vaccinated, as well as for college freshmen living in dorms.

Demand for the meningococcal conjugate vaccine (MCV4), marketed as Menactra, was high starting in June 2005 after the publication and promotion of the vaccination recommendations by the CDC's Advisory Committee on Immunization Practices, the American Academy of Pediatrics, and the American Academy of Family Physicians.

The demand was initially highest for 18-year-olds, and the peak months were June and July 2005. The high demand then decreased during the fall of 2005, as did patients' and parents' concerns about the vaccine supply.

The overall vaccine distribution rate from March 2005 to March 2006 was approximately 10% for 11- to 17-year-olds, but it approached 16% among 18-year-olds, based on physicians' billing-claims data provided by the vaccine's manufacturer, Sanofi Pasteur USA.

About 4.2 million doses were distributed between March 2005 and March 2006. The manufacturer projects that 6 million doses will be available for 2006–2007, but the amount currently available for the summer months of 2006 is about the same as last year, and Sanofi Pasteur expects the demand for the vaccine to exceed supply this summer.

To handle the anticipated summer rush among 18-year-olds, the CDC and other organizations have recommended that physicians defer the vaccination of 11- to 12-year-olds until further notice from the manufacturer that the shortage has been resolved. The current supply projections should be sufficient to cover adolescents entering high school, dorm-dwelling college freshmen, and other high-risk groups, including military recruits and travelers to areas where the risk of meningococcal disease is high. For periodic vaccine supply updates, visit www.cdc.gov/nip/news/shortages/default.htm

WASHINGTON — Postmenopausal women who consumed higher amounts of the types of flavonoids found in tea and strawberries showed a decreased risk of breast cancer, according to data presented at the annual meeting of the American Association for Cancer Research.

Breast cancer risk was significantly reduced among postmenopausal women in the highest quintile of dietary flavonol intake compared with the lowest quintile, reported Brian Fink of the University of North Carolina, Chapel Hill, who analyzed data on 1,508 women who had breast cancer and 1,556 controls in the Long Island Women's Health Study. However, no reductions in breast cancer risk were observed among premenopausal women, he noted.

The population-based study included women aged 20–98 years in Nassau and Suffolk counties on Long Island in New York, and was conducted between Aug. 1, 1996, and July 31, 1997. The women answered questions about their reproductive histories, environment, occupations, and lifestyles, including dietary intake, during the past year.

When the flavonoids were broken down into specific types, the significant reduction in breast cancer risk applied to flavones, flavan-3-ols, and lignans only; it did not apply to flavanones, isoflavones, or anthocyanadins. Tea provided the main source of beneficial flavonoids in the women's diets, but strawberries and apples were among the other often-consumed sources.

In another study presented at the meeting, women who consumed kaempferol, a flavonoid found in tea, broccoli, and kale, had a reduced risk for ovarian cancer, said Margaret Gates, a doctoral candidate at Harvard University.

Ms. Gates and her colleagues reviewed data on 66,384 women from the Nurses' Health Study who completed baseline food frequency questionnaires in 1984, and again in 1990, 1994, and 1998. The study group included 344 cases of ovarian cancer diagnosed between 1984 and 2002.

Although overall flavonoid intake was not significantly associated with a reduction in risk for ovarian cancer, consumption of kaempferol was associated with a significant (38%) reduction in risk, Ms. Gates said.

Possible inverse associations with ovarian cancer risk were observed for two other flavonoids, myricetin and quercetin, but the results for these flavonoids were not conclusive.

No other known prospective analyses of the protective effects of flavonoids against ovarian cancer have been published, but if additional studies confirm these findings, dietary flavonoids could provide a target for disease prevention, Ms. Gates noted.

WASHINGTON — Postmenopausal women who consumed higher amounts of the types of flavonoids found in tea and strawberries showed a decreased risk of breast cancer, according to data presented at the annual meeting of the American Association for Cancer Research.

Breast cancer risk was significantly reduced among postmenopausal women in the highest quintile of dietary flavonol intake compared with the lowest quintile, reported Brian Fink of the University of North Carolina, Chapel Hill, who analyzed data on 1,508 women who had breast cancer and 1,556 controls in the Long Island Women's Health Study. However, no reductions in breast cancer risk were observed among premenopausal women, he noted.

The population-based study included women aged 20–98 years in Nassau and Suffolk counties on Long Island in New York, and was conducted between Aug. 1, 1996, and July 31, 1997. The women answered questions about their reproductive histories, environment, occupations, and lifestyles, including dietary intake, during the past year.

When the flavonoids were broken down into specific types, the significant reduction in breast cancer risk applied to flavones, flavan-3-ols, and lignans only; it did not apply to flavanones, isoflavones, or anthocyanadins. Tea provided the main source of beneficial flavonoids in the women's diets, but strawberries and apples were among the other often-consumed sources.

In another study presented at the meeting, women who consumed kaempferol, a flavonoid found in tea, broccoli, and kale, had a reduced risk for ovarian cancer, said Margaret Gates, a doctoral candidate at Harvard University.

Ms. Gates and her colleagues reviewed data on 66,384 women from the Nurses' Health Study who completed baseline food frequency questionnaires in 1984, and again in 1990, 1994, and 1998. The study group included 344 cases of ovarian cancer diagnosed between 1984 and 2002.

Although overall flavonoid intake was not significantly associated with a reduction in risk for ovarian cancer, consumption of kaempferol was associated with a significant (38%) reduction in risk, Ms. Gates said.

Possible inverse associations with ovarian cancer risk were observed for two other flavonoids, myricetin and quercetin, but the results for these flavonoids were not conclusive.

No other known prospective analyses of the protective effects of flavonoids against ovarian cancer have been published, but if additional studies confirm these findings, dietary flavonoids could provide a target for disease prevention, Ms. Gates noted.

WASHINGTON — Postmenopausal women who consumed higher amounts of the types of flavonoids found in tea and strawberries showed a decreased risk of breast cancer, according to data presented at the annual meeting of the American Association for Cancer Research.

Breast cancer risk was significantly reduced among postmenopausal women in the highest quintile of dietary flavonol intake compared with the lowest quintile, reported Brian Fink of the University of North Carolina, Chapel Hill, who analyzed data on 1,508 women who had breast cancer and 1,556 controls in the Long Island Women's Health Study. However, no reductions in breast cancer risk were observed among premenopausal women, he noted.

The population-based study included women aged 20–98 years in Nassau and Suffolk counties on Long Island in New York, and was conducted between Aug. 1, 1996, and July 31, 1997. The women answered questions about their reproductive histories, environment, occupations, and lifestyles, including dietary intake, during the past year.

When the flavonoids were broken down into specific types, the significant reduction in breast cancer risk applied to flavones, flavan-3-ols, and lignans only; it did not apply to flavanones, isoflavones, or anthocyanadins. Tea provided the main source of beneficial flavonoids in the women's diets, but strawberries and apples were among the other often-consumed sources.

In another study presented at the meeting, women who consumed kaempferol, a flavonoid found in tea, broccoli, and kale, had a reduced risk for ovarian cancer, said Margaret Gates, a doctoral candidate at Harvard University.

Ms. Gates and her colleagues reviewed data on 66,384 women from the Nurses' Health Study who completed baseline food frequency questionnaires in 1984, and again in 1990, 1994, and 1998. The study group included 344 cases of ovarian cancer diagnosed between 1984 and 2002.

Although overall flavonoid intake was not significantly associated with a reduction in risk for ovarian cancer, consumption of kaempferol was associated with a significant (38%) reduction in risk, Ms. Gates said.

Possible inverse associations with ovarian cancer risk were observed for two other flavonoids, myricetin and quercetin, but the results for these flavonoids were not conclusive.

No other known prospective analyses of the protective effects of flavonoids against ovarian cancer have been published, but if additional studies confirm these findings, dietary flavonoids could provide a target for disease prevention, Ms. Gates noted.

ATLANTA — Child care providers surveyed in 2004 were significantly less likely to exclude a sick child who had not received antibiotics, compared with child care providers surveyed in 2001, Shelly Feaver reported in a poster presented at the International Conference on Emerging Infectious Diseases.

Of 1,409 Minnesota child care center teachers surveyed in 2004 and 421 surveyed in 2001, the 2004 teachers were significantly less likely to exclude a child with a fever, a runny nose without mucus, or a chest cold who had not received antibiotics. In addition, the teachers surveyed in 2004 were significantly more likely than those surveyed in 2001 to believe that physicians should not prescribe antibiotics for children with fevers, middle ear infections, runny noses with green or yellow mucus, conjunctivitis with pus, and conjunctivitis with watery discharge.

Ms. Feaver and her colleagues at the Minnesota Department of Health in St. Paul developed an educational intervention program based on the results of the 2001 surveys. The program included a child care provider curriculum with education slides, and viral excuse pads. The Minnesota Department of Human Services Child Care Licensing Division approved the curriculum for continuing education credit for licensed child care providers prior to the second survey in 2004, but there were no significant differences in the 2004 survey responses between teachers who reported completing the curriculum and those who had not completed the curriculum.

In addition, messages about judicious antibiotic use were distributed to child care health consultants and were posted on the Web site of the Minnesota Antibiotic Research Collaborative during the study period.

ATLANTA — Child care providers surveyed in 2004 were significantly less likely to exclude a sick child who had not received antibiotics, compared with child care providers surveyed in 2001, Shelly Feaver reported in a poster presented at the International Conference on Emerging Infectious Diseases.

Of 1,409 Minnesota child care center teachers surveyed in 2004 and 421 surveyed in 2001, the 2004 teachers were significantly less likely to exclude a child with a fever, a runny nose without mucus, or a chest cold who had not received antibiotics. In addition, the teachers surveyed in 2004 were significantly more likely than those surveyed in 2001 to believe that physicians should not prescribe antibiotics for children with fevers, middle ear infections, runny noses with green or yellow mucus, conjunctivitis with pus, and conjunctivitis with watery discharge.

Ms. Feaver and her colleagues at the Minnesota Department of Health in St. Paul developed an educational intervention program based on the results of the 2001 surveys. The program included a child care provider curriculum with education slides, and viral excuse pads. The Minnesota Department of Human Services Child Care Licensing Division approved the curriculum for continuing education credit for licensed child care providers prior to the second survey in 2004, but there were no significant differences in the 2004 survey responses between teachers who reported completing the curriculum and those who had not completed the curriculum.

In addition, messages about judicious antibiotic use were distributed to child care health consultants and were posted on the Web site of the Minnesota Antibiotic Research Collaborative during the study period.

ATLANTA — Child care providers surveyed in 2004 were significantly less likely to exclude a sick child who had not received antibiotics, compared with child care providers surveyed in 2001, Shelly Feaver reported in a poster presented at the International Conference on Emerging Infectious Diseases.

Of 1,409 Minnesota child care center teachers surveyed in 2004 and 421 surveyed in 2001, the 2004 teachers were significantly less likely to exclude a child with a fever, a runny nose without mucus, or a chest cold who had not received antibiotics. In addition, the teachers surveyed in 2004 were significantly more likely than those surveyed in 2001 to believe that physicians should not prescribe antibiotics for children with fevers, middle ear infections, runny noses with green or yellow mucus, conjunctivitis with pus, and conjunctivitis with watery discharge.

Ms. Feaver and her colleagues at the Minnesota Department of Health in St. Paul developed an educational intervention program based on the results of the 2001 surveys. The program included a child care provider curriculum with education slides, and viral excuse pads. The Minnesota Department of Human Services Child Care Licensing Division approved the curriculum for continuing education credit for licensed child care providers prior to the second survey in 2004, but there were no significant differences in the 2004 survey responses between teachers who reported completing the curriculum and those who had not completed the curriculum.

In addition, messages about judicious antibiotic use were distributed to child care health consultants and were posted on the Web site of the Minnesota Antibiotic Research Collaborative during the study period.

Amoxicillin and Acute Otitis Media

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

If therapy is necessary, high-dose amoxicillin may be appropriate for unvaccinated children or for those who have received fewer than three doses of the vaccine (Pediatrics 2006;117:1087–94).

An increase in vaccination with at least three doses of heptavalent pneumococcal conjugate vaccine (PCV7) from 0% to 54% in a St. Louis community from 2001 to 2004 appeared to reduce the prevalence of Streptococcus pneumoniae isolates that were not susceptible to penicillin (NSSP), whereas the prevalence of S. pneumoniae not susceptible to amoxicillin (NSSP-A) remained low.

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

The prevalence of NSSP was significantly reduced in children with any diagnosis who had received at least three doses of PCV7, compared with those who had fewer or no doses (8% vs. 20%), and no NSSP-A isolates were found among the study children who had received at least three doses of the PCV7 vaccine.

In addition, vaccination with at least three doses of PCV7 was protective for all child care attendees, but vaccination with at least one dose was not protective.

Antibiotics End K. kingae Outbreak

An outbreak of three Kingella kingae infections at a day care center was contained using prophylactic antibiotics, reported Dr. Pablo Yagupsky of Ben-Gurion University of the Negev in Beer-Sheva, Israel, and his colleagues.

The findings confirm the susceptibility of day care populations to invasive disease. K. kingae has a particularly high carriage rate among very young children, who frequently put their hands or other objects into their mouths and spread the organisms through saliva, the investigators noted (Pediatr. Infect. Dis. J. 2006;25:526–32).

The outbreak occurred during a period of 15 days (starting on March 10, 2005), when three children aged 8–12 months who attended the same day care center showed signs of bone infection, and osteomyelitis was confirmed. All three children were hospitalized and treated, and all three recovered uneventfully. K. kingae was confirmed in one patient and suspected in the other two.

Surveillance cultures taken from several day care centers before the administration of prophylactic antibiotics yielded K. kingae isolates in 4 of 11 attendees at the index facility and 5 of 12 and 1 of 15 attendees at neighboring facilities. The confirmed K. kingae isolate was the same strain as other isolates from the same day care center, but different from strains found at neighboring facilities.

All children aged 6–30 months who lived in the community started an antibiotic regimen of 20 mg/kg oral rifampin twice daily for 2 days, followed by 80 mg/kg amoxicillin twice daily for 4 days. The carrier rate was significantly reduced from 11 children (28%) to 2 children (5%) among the 40 children who completed the course of antibiotic therapy.

Dexamethasone Eases Pharyngitis

Children with streptococcal pharyngitis who were treated with dexamethasone as an add-on therapy showed significant improvement in general condition and activity levels after about 1 day, compared with 2 days for those who were treated with a placebo in a pilot study.

In addition, children who received three daily doses of dexamethasone showed significant improvement in their sore throat symptoms, whereas those who received one daily dose did not show such improvement, reported Dr. Mary-Lynn Niland and her colleagues at Ohio State University, Columbus.

Steroids have been shown to mitigate throat pain in adults with pharyngitis, and the researchers sought to assess the effects of extended dosage on symptoms in children (Pediatr. Infect. Dis. J. 2006;25:477–81).

A total of 90 children aged 4–21 years with group A beta hemolytic streptococcal pharyngitis were randomized to receive one oral daily dose of 0.6 mg/kg dexamethasone (maximum dose 10 mg), three oral daily doses of 0.6 mg/kg dexamethasone (maximum dose 10 mg), or a placebo in addition to an oral or intramuscular antibiotic.

The children were assessed by a combination of telephone interviews and symptom diaries.

Amoxicillin and Acute Otitis Media

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

If therapy is necessary, high-dose amoxicillin may be appropriate for unvaccinated children or for those who have received fewer than three doses of the vaccine (Pediatrics 2006;117:1087–94).

An increase in vaccination with at least three doses of heptavalent pneumococcal conjugate vaccine (PCV7) from 0% to 54% in a St. Louis community from 2001 to 2004 appeared to reduce the prevalence of Streptococcus pneumoniae isolates that were not susceptible to penicillin (NSSP), whereas the prevalence of S. pneumoniae not susceptible to amoxicillin (NSSP-A) remained low.

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

The prevalence of NSSP was significantly reduced in children with any diagnosis who had received at least three doses of PCV7, compared with those who had fewer or no doses (8% vs. 20%), and no NSSP-A isolates were found among the study children who had received at least three doses of the PCV7 vaccine.

In addition, vaccination with at least three doses of PCV7 was protective for all child care attendees, but vaccination with at least one dose was not protective.

Antibiotics End K. kingae Outbreak

An outbreak of three Kingella kingae infections at a day care center was contained using prophylactic antibiotics, reported Dr. Pablo Yagupsky of Ben-Gurion University of the Negev in Beer-Sheva, Israel, and his colleagues.

The findings confirm the susceptibility of day care populations to invasive disease. K. kingae has a particularly high carriage rate among very young children, who frequently put their hands or other objects into their mouths and spread the organisms through saliva, the investigators noted (Pediatr. Infect. Dis. J. 2006;25:526–32).

The outbreak occurred during a period of 15 days (starting on March 10, 2005), when three children aged 8–12 months who attended the same day care center showed signs of bone infection, and osteomyelitis was confirmed. All three children were hospitalized and treated, and all three recovered uneventfully. K. kingae was confirmed in one patient and suspected in the other two.

Surveillance cultures taken from several day care centers before the administration of prophylactic antibiotics yielded K. kingae isolates in 4 of 11 attendees at the index facility and 5 of 12 and 1 of 15 attendees at neighboring facilities. The confirmed K. kingae isolate was the same strain as other isolates from the same day care center, but different from strains found at neighboring facilities.

All children aged 6–30 months who lived in the community started an antibiotic regimen of 20 mg/kg oral rifampin twice daily for 2 days, followed by 80 mg/kg amoxicillin twice daily for 4 days. The carrier rate was significantly reduced from 11 children (28%) to 2 children (5%) among the 40 children who completed the course of antibiotic therapy.

Dexamethasone Eases Pharyngitis

Children with streptococcal pharyngitis who were treated with dexamethasone as an add-on therapy showed significant improvement in general condition and activity levels after about 1 day, compared with 2 days for those who were treated with a placebo in a pilot study.

In addition, children who received three daily doses of dexamethasone showed significant improvement in their sore throat symptoms, whereas those who received one daily dose did not show such improvement, reported Dr. Mary-Lynn Niland and her colleagues at Ohio State University, Columbus.

Steroids have been shown to mitigate throat pain in adults with pharyngitis, and the researchers sought to assess the effects of extended dosage on symptoms in children (Pediatr. Infect. Dis. J. 2006;25:477–81).

A total of 90 children aged 4–21 years with group A beta hemolytic streptococcal pharyngitis were randomized to receive one oral daily dose of 0.6 mg/kg dexamethasone (maximum dose 10 mg), three oral daily doses of 0.6 mg/kg dexamethasone (maximum dose 10 mg), or a placebo in addition to an oral or intramuscular antibiotic.

The children were assessed by a combination of telephone interviews and symptom diaries.

Amoxicillin and Acute Otitis Media

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

If therapy is necessary, high-dose amoxicillin may be appropriate for unvaccinated children or for those who have received fewer than three doses of the vaccine (Pediatrics 2006;117:1087–94).

An increase in vaccination with at least three doses of heptavalent pneumococcal conjugate vaccine (PCV7) from 0% to 54% in a St. Louis community from 2001 to 2004 appeared to reduce the prevalence of Streptococcus pneumoniae isolates that were not susceptible to penicillin (NSSP), whereas the prevalence of S. pneumoniae not susceptible to amoxicillin (NSSP-A) remained low.

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

The prevalence of NSSP was significantly reduced in children with any diagnosis who had received at least three doses of PCV7, compared with those who had fewer or no doses (8% vs. 20%), and no NSSP-A isolates were found among the study children who had received at least three doses of the PCV7 vaccine.

In addition, vaccination with at least three doses of PCV7 was protective for all child care attendees, but vaccination with at least one dose was not protective.

Antibiotics End K. kingae Outbreak

An outbreak of three Kingella kingae infections at a day care center was contained using prophylactic antibiotics, reported Dr. Pablo Yagupsky of Ben-Gurion University of the Negev in Beer-Sheva, Israel, and his colleagues.

The findings confirm the susceptibility of day care populations to invasive disease. K. kingae has a particularly high carriage rate among very young children, who frequently put their hands or other objects into their mouths and spread the organisms through saliva, the investigators noted (Pediatr. Infect. Dis. J. 2006;25:526–32).

The outbreak occurred during a period of 15 days (starting on March 10, 2005), when three children aged 8–12 months who attended the same day care center showed signs of bone infection, and osteomyelitis was confirmed. All three children were hospitalized and treated, and all three recovered uneventfully. K. kingae was confirmed in one patient and suspected in the other two.

Surveillance cultures taken from several day care centers before the administration of prophylactic antibiotics yielded K. kingae isolates in 4 of 11 attendees at the index facility and 5 of 12 and 1 of 15 attendees at neighboring facilities. The confirmed K. kingae isolate was the same strain as other isolates from the same day care center, but different from strains found at neighboring facilities.

All children aged 6–30 months who lived in the community started an antibiotic regimen of 20 mg/kg oral rifampin twice daily for 2 days, followed by 80 mg/kg amoxicillin twice daily for 4 days. The carrier rate was significantly reduced from 11 children (28%) to 2 children (5%) among the 40 children who completed the course of antibiotic therapy.

Dexamethasone Eases Pharyngitis

Children with streptococcal pharyngitis who were treated with dexamethasone as an add-on therapy showed significant improvement in general condition and activity levels after about 1 day, compared with 2 days for those who were treated with a placebo in a pilot study.

In addition, children who received three daily doses of dexamethasone showed significant improvement in their sore throat symptoms, whereas those who received one daily dose did not show such improvement, reported Dr. Mary-Lynn Niland and her colleagues at Ohio State University, Columbus.

Steroids have been shown to mitigate throat pain in adults with pharyngitis, and the researchers sought to assess the effects of extended dosage on symptoms in children (Pediatr. Infect. Dis. J. 2006;25:477–81).

A total of 90 children aged 4–21 years with group A beta hemolytic streptococcal pharyngitis were randomized to receive one oral daily dose of 0.6 mg/kg dexamethasone (maximum dose 10 mg), three oral daily doses of 0.6 mg/kg dexamethasone (maximum dose 10 mg), or a placebo in addition to an oral or intramuscular antibiotic.

The children were assessed by a combination of telephone interviews and symptom diaries.

There were fewer influenza-associated deaths among U.S. children during last year's season, reported the Centers for Disease Control and Prevention.

During last year's flu season (from Oct. 2, 2005, to June 3, 2006), 35 deaths were reported among children aged less than 18 years, which were linked to laboratory-confirmed influenza infections from 13 states.

A total of 153 laboratory-confirmed influenza-associated deaths in children were reported during the 2003–2004 influenza season (N. Engl. J. Med. 2005;353:2559–67).

Of the 31 children for whom the type of virus was known this season, 23 were infected with the influenza A virus and 8 were infected with the influenza B virus. A total of 11 deaths (31.4%) occurred in children aged 6–23 months, 4 (11.4%) in children younger than 6 months of age, 4 (11.4%) in children aged 2–4 years, and 16 (45.7%) in children aged 5–17 years.

Pediatric hospitalizations with lab-confirmed influenza infections were monitored in two networks.

The pediatric hospitalization rates from last year's flu season showed an overall rate of 1.21/10,000 children aged 0–17 years, based on preliminary data from the Emerging Infections Program. When broken down into younger and older age groups, the rates were 2.76/10,000 among children aged 0–5 years and 0.38/10,000 among those aged 5–17 years.

Furthermore, the laboratory-confirmed influenza-associated hospitalization rate was 5.4/10,000 children for children aged 0–4 years, based on preliminary data from the New Vaccine Surveillance Network.

The formulation for the 2006–2007 influenza vaccine calls for A (H3N2) and B strains that differ from last year's version, based on analyses of recently isolated flu viruses, epidemiologic data, and postvaccination serologic studies in humans.

Vaccine manufacturers should include the A/New Caledonia/20/99-like (H1N1), A/Wisconsin/67/2005-like (H3N2), and B/Malaysia/2506/2004-like viruses in formulations of the 2006–2007 influenza vaccine, according to recommendations from the Food and Drug Administration's Vaccines and Related Biological Products Advisory Committee (MMWR 2006;55:648–53).

There were fewer influenza-associated deaths among U.S. children during last year's season, reported the Centers for Disease Control and Prevention.

During last year's flu season (from Oct. 2, 2005, to June 3, 2006), 35 deaths were reported among children aged less than 18 years, which were linked to laboratory-confirmed influenza infections from 13 states.

A total of 153 laboratory-confirmed influenza-associated deaths in children were reported during the 2003–2004 influenza season (N. Engl. J. Med. 2005;353:2559–67).

Of the 31 children for whom the type of virus was known this season, 23 were infected with the influenza A virus and 8 were infected with the influenza B virus. A total of 11 deaths (31.4%) occurred in children aged 6–23 months, 4 (11.4%) in children younger than 6 months of age, 4 (11.4%) in children aged 2–4 years, and 16 (45.7%) in children aged 5–17 years.

Pediatric hospitalizations with lab-confirmed influenza infections were monitored in two networks.

The pediatric hospitalization rates from last year's flu season showed an overall rate of 1.21/10,000 children aged 0–17 years, based on preliminary data from the Emerging Infections Program. When broken down into younger and older age groups, the rates were 2.76/10,000 among children aged 0–5 years and 0.38/10,000 among those aged 5–17 years.

Furthermore, the laboratory-confirmed influenza-associated hospitalization rate was 5.4/10,000 children for children aged 0–4 years, based on preliminary data from the New Vaccine Surveillance Network.

The formulation for the 2006–2007 influenza vaccine calls for A (H3N2) and B strains that differ from last year's version, based on analyses of recently isolated flu viruses, epidemiologic data, and postvaccination serologic studies in humans.

Vaccine manufacturers should include the A/New Caledonia/20/99-like (H1N1), A/Wisconsin/67/2005-like (H3N2), and B/Malaysia/2506/2004-like viruses in formulations of the 2006–2007 influenza vaccine, according to recommendations from the Food and Drug Administration's Vaccines and Related Biological Products Advisory Committee (MMWR 2006;55:648–53).

There were fewer influenza-associated deaths among U.S. children during last year's season, reported the Centers for Disease Control and Prevention.

During last year's flu season (from Oct. 2, 2005, to June 3, 2006), 35 deaths were reported among children aged less than 18 years, which were linked to laboratory-confirmed influenza infections from 13 states.

A total of 153 laboratory-confirmed influenza-associated deaths in children were reported during the 2003–2004 influenza season (N. Engl. J. Med. 2005;353:2559–67).

Of the 31 children for whom the type of virus was known this season, 23 were infected with the influenza A virus and 8 were infected with the influenza B virus. A total of 11 deaths (31.4%) occurred in children aged 6–23 months, 4 (11.4%) in children younger than 6 months of age, 4 (11.4%) in children aged 2–4 years, and 16 (45.7%) in children aged 5–17 years.

Pediatric hospitalizations with lab-confirmed influenza infections were monitored in two networks.

The pediatric hospitalization rates from last year's flu season showed an overall rate of 1.21/10,000 children aged 0–17 years, based on preliminary data from the Emerging Infections Program. When broken down into younger and older age groups, the rates were 2.76/10,000 among children aged 0–5 years and 0.38/10,000 among those aged 5–17 years.

Furthermore, the laboratory-confirmed influenza-associated hospitalization rate was 5.4/10,000 children for children aged 0–4 years, based on preliminary data from the New Vaccine Surveillance Network.

The formulation for the 2006–2007 influenza vaccine calls for A (H3N2) and B strains that differ from last year's version, based on analyses of recently isolated flu viruses, epidemiologic data, and postvaccination serologic studies in humans.

Vaccine manufacturers should include the A/New Caledonia/20/99-like (H1N1), A/Wisconsin/67/2005-like (H3N2), and B/Malaysia/2506/2004-like viruses in formulations of the 2006–2007 influenza vaccine, according to recommendations from the Food and Drug Administration's Vaccines and Related Biological Products Advisory Committee (MMWR 2006;55:648–53).

WASHINGTON — Despite a recommendation to prioritize 11- to 12-year-olds, distribution of the meningococcal conjugate vaccine was especially high among 18-year-olds and was evenly distributed among 11- to 17-year-olds during its first year on the market, Dr. Gregory Wallace reported at a meeting of the National Vaccine Advisory Committee.

The rationale for the recommendation was to help establish an adolescent vaccine visit, and was not generated because of an increased disease risk among 11- to 12-year-olds, explained Dr. Wallace, chief of the Vaccine Supply and Assurance Branch at the Centers for Disease Control and Prevention.

The vaccine is also recommended for adolescents entering high school who have not been previously vaccinated, as well as for college freshmen living in dorms.

Demand for the meningococcal conjugate vaccine (MCV4), marketed as Menactra, was high starting in June 2005 after the publication and promotion of the vaccination recommendations by the CDC's Advisory Committee on Immunization Practices, the American Academy of Pediatrics, and the American Academy of Family Physicians.

The demand was initially highest for 18-year-olds, and the peak months were June and July 2005. The high demand then decreased during the fall of 2005, as did patients' and parents' concerns about the vaccine supply.

The overall vaccine distribution rate from March 2005 to March 2006 was approximately 10% for 11- to 17-year-olds, but nearly 16% among 18-year-olds, based on physicians' billing-claims data provided by the vaccine's manufacturer, Sanofi Pasteur USA.

About 4.2 million doses were distributed between March 2005 and March 2006. Although the manufacturer projects that 6 million doses will be available for 2006–2007, the amount currently available for the summer months of 2006 is approximately the same as last year, Dr. Wallace said.

Sanofi Pasteur expects the demand for the vaccine to exceed supply this summer. To handle the anticipated summer rush among 18-year-olds, the CDC and other organizations have recommended that physicians defer the vaccination of 11- to 12-year-olds until further notice from the manufacturer that the shortage has been resolved. The current supply projections should be sufficient to cover adolescents entering high school, dorm-dwelling college freshmen, and other high-risk groups, including military recruits and travelers to areas where the risk of meningococcal disease is high. For periodic vaccine supply updates, visit www.cdc.gov/nip/news/shortages/default.htm

WASHINGTON — Despite a recommendation to prioritize 11- to 12-year-olds, distribution of the meningococcal conjugate vaccine was especially high among 18-year-olds and was evenly distributed among 11- to 17-year-olds during its first year on the market, Dr. Gregory Wallace reported at a meeting of the National Vaccine Advisory Committee.

The rationale for the recommendation was to help establish an adolescent vaccine visit, and was not generated because of an increased disease risk among 11- to 12-year-olds, explained Dr. Wallace, chief of the Vaccine Supply and Assurance Branch at the Centers for Disease Control and Prevention.

The vaccine is also recommended for adolescents entering high school who have not been previously vaccinated, as well as for college freshmen living in dorms.

Demand for the meningococcal conjugate vaccine (MCV4), marketed as Menactra, was high starting in June 2005 after the publication and promotion of the vaccination recommendations by the CDC's Advisory Committee on Immunization Practices, the American Academy of Pediatrics, and the American Academy of Family Physicians.

The demand was initially highest for 18-year-olds, and the peak months were June and July 2005. The high demand then decreased during the fall of 2005, as did patients' and parents' concerns about the vaccine supply.

The overall vaccine distribution rate from March 2005 to March 2006 was approximately 10% for 11- to 17-year-olds, but nearly 16% among 18-year-olds, based on physicians' billing-claims data provided by the vaccine's manufacturer, Sanofi Pasteur USA.

About 4.2 million doses were distributed between March 2005 and March 2006. Although the manufacturer projects that 6 million doses will be available for 2006–2007, the amount currently available for the summer months of 2006 is approximately the same as last year, Dr. Wallace said.

Sanofi Pasteur expects the demand for the vaccine to exceed supply this summer. To handle the anticipated summer rush among 18-year-olds, the CDC and other organizations have recommended that physicians defer the vaccination of 11- to 12-year-olds until further notice from the manufacturer that the shortage has been resolved. The current supply projections should be sufficient to cover adolescents entering high school, dorm-dwelling college freshmen, and other high-risk groups, including military recruits and travelers to areas where the risk of meningococcal disease is high. For periodic vaccine supply updates, visit www.cdc.gov/nip/news/shortages/default.htm

WASHINGTON — Despite a recommendation to prioritize 11- to 12-year-olds, distribution of the meningococcal conjugate vaccine was especially high among 18-year-olds and was evenly distributed among 11- to 17-year-olds during its first year on the market, Dr. Gregory Wallace reported at a meeting of the National Vaccine Advisory Committee.

The rationale for the recommendation was to help establish an adolescent vaccine visit, and was not generated because of an increased disease risk among 11- to 12-year-olds, explained Dr. Wallace, chief of the Vaccine Supply and Assurance Branch at the Centers for Disease Control and Prevention.

The vaccine is also recommended for adolescents entering high school who have not been previously vaccinated, as well as for college freshmen living in dorms.

Demand for the meningococcal conjugate vaccine (MCV4), marketed as Menactra, was high starting in June 2005 after the publication and promotion of the vaccination recommendations by the CDC's Advisory Committee on Immunization Practices, the American Academy of Pediatrics, and the American Academy of Family Physicians.

The demand was initially highest for 18-year-olds, and the peak months were June and July 2005. The high demand then decreased during the fall of 2005, as did patients' and parents' concerns about the vaccine supply.

The overall vaccine distribution rate from March 2005 to March 2006 was approximately 10% for 11- to 17-year-olds, but nearly 16% among 18-year-olds, based on physicians' billing-claims data provided by the vaccine's manufacturer, Sanofi Pasteur USA.

About 4.2 million doses were distributed between March 2005 and March 2006. Although the manufacturer projects that 6 million doses will be available for 2006–2007, the amount currently available for the summer months of 2006 is approximately the same as last year, Dr. Wallace said.

Sanofi Pasteur expects the demand for the vaccine to exceed supply this summer. To handle the anticipated summer rush among 18-year-olds, the CDC and other organizations have recommended that physicians defer the vaccination of 11- to 12-year-olds until further notice from the manufacturer that the shortage has been resolved. The current supply projections should be sufficient to cover adolescents entering high school, dorm-dwelling college freshmen, and other high-risk groups, including military recruits and travelers to areas where the risk of meningococcal disease is high. For periodic vaccine supply updates, visit www.cdc.gov/nip/news/shortages/default.htm

DENVER – Depression that occurred in adults after acute myocardial infarction decreased in severity during the first 6 months after the cardiac event, but then stabilized over the next several years, Kenneth E. Freedland, Ph.D., reported in a poster presented at the annual meeting of the American Psychosomatic Society.

Dr. Freedland, a member of the psychiatry department at Washington University, St. Louis, and his colleagues reviewed data on 1,086 adults who were randomized to the usual care arm of the Enhancing Recovery in Coronary Heart Disease (ENRICHD) study, a multicenter trial sponsored by the National Institutes of Health that was designed to evaluate depression interventions in MI patients.

The patients' mean age was 43 years, 44% were female, and 35% were minorities. In addition, 55% were high school graduates, 19% were college graduates, and 26% had less than a high school education. About 60% of the patients had a history of major depression before the MI.

The patients completed a Beck Depression Inventory (BDI) at the start of the study, and again at 6-month intervals for an average follow-up period of 26 months. The average baseline BDI score was 15.3; baseline BDI scores were lowest among older patients, non-Hispanic white patients, and patients without a history of major depression, and highest among women and patients who were taking antidepressants.

Antidepressant use was associated with worse depression in the overall ENRICHD study, so its impact in this analysis must be interpreted with caution, the investigators noted.

Overall, the severity of depression decreased during the first 6 months after the MI, but depression scores then stabilized during the follow-up period, which lasted as long as 4 years for some patients. The average decrease in BDI score was −0.85 during months 0–6, compared with −0.07 during months 6–54.

Female gender, minority status, younger age, and lower levels of education were significantly associated with higher levels of depression immediately after MI, but younger female patients showed the fastest improvements in depressive symptoms over time. Additional analysis is needed to determine patterns among these subgroups, the researchers noted.

DENVER – Depression that occurred in adults after acute myocardial infarction decreased in severity during the first 6 months after the cardiac event, but then stabilized over the next several years, Kenneth E. Freedland, Ph.D., reported in a poster presented at the annual meeting of the American Psychosomatic Society.

Dr. Freedland, a member of the psychiatry department at Washington University, St. Louis, and his colleagues reviewed data on 1,086 adults who were randomized to the usual care arm of the Enhancing Recovery in Coronary Heart Disease (ENRICHD) study, a multicenter trial sponsored by the National Institutes of Health that was designed to evaluate depression interventions in MI patients.

The patients' mean age was 43 years, 44% were female, and 35% were minorities. In addition, 55% were high school graduates, 19% were college graduates, and 26% had less than a high school education. About 60% of the patients had a history of major depression before the MI.

The patients completed a Beck Depression Inventory (BDI) at the start of the study, and again at 6-month intervals for an average follow-up period of 26 months. The average baseline BDI score was 15.3; baseline BDI scores were lowest among older patients, non-Hispanic white patients, and patients without a history of major depression, and highest among women and patients who were taking antidepressants.

Antidepressant use was associated with worse depression in the overall ENRICHD study, so its impact in this analysis must be interpreted with caution, the investigators noted.

Overall, the severity of depression decreased during the first 6 months after the MI, but depression scores then stabilized during the follow-up period, which lasted as long as 4 years for some patients. The average decrease in BDI score was −0.85 during months 0–6, compared with −0.07 during months 6–54.

Female gender, minority status, younger age, and lower levels of education were significantly associated with higher levels of depression immediately after MI, but younger female patients showed the fastest improvements in depressive symptoms over time. Additional analysis is needed to determine patterns among these subgroups, the researchers noted.

DENVER – Depression that occurred in adults after acute myocardial infarction decreased in severity during the first 6 months after the cardiac event, but then stabilized over the next several years, Kenneth E. Freedland, Ph.D., reported in a poster presented at the annual meeting of the American Psychosomatic Society.

Dr. Freedland, a member of the psychiatry department at Washington University, St. Louis, and his colleagues reviewed data on 1,086 adults who were randomized to the usual care arm of the Enhancing Recovery in Coronary Heart Disease (ENRICHD) study, a multicenter trial sponsored by the National Institutes of Health that was designed to evaluate depression interventions in MI patients.

The patients' mean age was 43 years, 44% were female, and 35% were minorities. In addition, 55% were high school graduates, 19% were college graduates, and 26% had less than a high school education. About 60% of the patients had a history of major depression before the MI.

The patients completed a Beck Depression Inventory (BDI) at the start of the study, and again at 6-month intervals for an average follow-up period of 26 months. The average baseline BDI score was 15.3; baseline BDI scores were lowest among older patients, non-Hispanic white patients, and patients without a history of major depression, and highest among women and patients who were taking antidepressants.

Antidepressant use was associated with worse depression in the overall ENRICHD study, so its impact in this analysis must be interpreted with caution, the investigators noted.

Overall, the severity of depression decreased during the first 6 months after the MI, but depression scores then stabilized during the follow-up period, which lasted as long as 4 years for some patients. The average decrease in BDI score was −0.85 during months 0–6, compared with −0.07 during months 6–54.

Female gender, minority status, younger age, and lower levels of education were significantly associated with higher levels of depression immediately after MI, but younger female patients showed the fastest improvements in depressive symptoms over time. Additional analysis is needed to determine patterns among these subgroups, the researchers noted.