Heidi Splete

ATLANTA — About 80% of Salmonella cases in the United States in 2004 and 2005 were domestically acquired isolated incidents, Dina Hoefer reported in a poster presented at the International Conference on Emerging Infectious Diseases.

In contrast, about 12% of infected patients with known travel status had traveled internationally, and almost 8% of cases were associated with a recognized outbreak, based on data from the Foodborne Diseases Active Surveillance Network (FoodNet).

FoodNet is a program supported by the CDC, the U.S. Department of Agriculture, and the FDA; it seeks to link foodborne illnesses to specific foods and settings based on data from 10 U.S. sites.

Ms. Hoefer, of the New York Department of Health in Albany, and her colleagues reviewed FoodNet surveillance data for 12,159 cases of Salmonella infection from 2004 and 2005. Of the 7,500 patients whose travel status and outbreak associations were known, 878 had traveled internationally within 7 days prior to illness onset, and 583 were known to be part of a documented Salmonella outbreak.

Overall, the isolated domestically acquired cases were significantly more likely to require hospitalization, compared with travel-related cases (relative risk 1.5) or cases associated with outbreaks (RR 1.4). The most common serotypes among all cases were S. enteritidis and S. typhimurium, but S. enteritidis accounted for a significantly higher proportion of travel-related cases, compared with S. typhimurium (35% vs. 9%).

In addition, isolated domestically acquired cases were more likely than outbreak-associated cases but less likely than travel-related cases to have Salmonella isolates in the blood or cerebrospinal fluid.

ATLANTA — About 80% of Salmonella cases in the United States in 2004 and 2005 were domestically acquired isolated incidents, Dina Hoefer reported in a poster presented at the International Conference on Emerging Infectious Diseases.

In contrast, about 12% of infected patients with known travel status had traveled internationally, and almost 8% of cases were associated with a recognized outbreak, based on data from the Foodborne Diseases Active Surveillance Network (FoodNet).

FoodNet is a program supported by the CDC, the U.S. Department of Agriculture, and the FDA; it seeks to link foodborne illnesses to specific foods and settings based on data from 10 U.S. sites.

Ms. Hoefer, of the New York Department of Health in Albany, and her colleagues reviewed FoodNet surveillance data for 12,159 cases of Salmonella infection from 2004 and 2005. Of the 7,500 patients whose travel status and outbreak associations were known, 878 had traveled internationally within 7 days prior to illness onset, and 583 were known to be part of a documented Salmonella outbreak.

Overall, the isolated domestically acquired cases were significantly more likely to require hospitalization, compared with travel-related cases (relative risk 1.5) or cases associated with outbreaks (RR 1.4). The most common serotypes among all cases were S. enteritidis and S. typhimurium, but S. enteritidis accounted for a significantly higher proportion of travel-related cases, compared with S. typhimurium (35% vs. 9%).

In addition, isolated domestically acquired cases were more likely than outbreak-associated cases but less likely than travel-related cases to have Salmonella isolates in the blood or cerebrospinal fluid.

ATLANTA — About 80% of Salmonella cases in the United States in 2004 and 2005 were domestically acquired isolated incidents, Dina Hoefer reported in a poster presented at the International Conference on Emerging Infectious Diseases.

In contrast, about 12% of infected patients with known travel status had traveled internationally, and almost 8% of cases were associated with a recognized outbreak, based on data from the Foodborne Diseases Active Surveillance Network (FoodNet).

FoodNet is a program supported by the CDC, the U.S. Department of Agriculture, and the FDA; it seeks to link foodborne illnesses to specific foods and settings based on data from 10 U.S. sites.

Ms. Hoefer, of the New York Department of Health in Albany, and her colleagues reviewed FoodNet surveillance data for 12,159 cases of Salmonella infection from 2004 and 2005. Of the 7,500 patients whose travel status and outbreak associations were known, 878 had traveled internationally within 7 days prior to illness onset, and 583 were known to be part of a documented Salmonella outbreak.

Overall, the isolated domestically acquired cases were significantly more likely to require hospitalization, compared with travel-related cases (relative risk 1.5) or cases associated with outbreaks (RR 1.4). The most common serotypes among all cases were S. enteritidis and S. typhimurium, but S. enteritidis accounted for a significantly higher proportion of travel-related cases, compared with S. typhimurium (35% vs. 9%).

In addition, isolated domestically acquired cases were more likely than outbreak-associated cases but less likely than travel-related cases to have Salmonella isolates in the blood or cerebrospinal fluid.

ATLANTA — Just when you thought that prepackaged deli meat was safe, a gastroenteritis outbreak among river rafters in Colorado was traced to norovirus in prepackaged chicken and beef, Dr. Ezra J. Barzilay said at the International Conference on Emerging Infectious Diseases.

On Sept. 18, 2005, the National Park Service contacted the Centers for Disease Control and Prevention to report an outbreak of 136 cases of gastroenteritis in 3 weeks among rafters who participated in group trips on the Colorado River, said Dr. Barzilay, an epidemiologist at the CDC.

“Norovirus accounts for about 50% of all foodborne outbreaks in the U.S.,” he noted.

The cases occurred among participants in 12 of 90 trips conducted by 16 rafting companies during the 3-week period.

Most rafting trips last from 2 to 14 days. Perishable food is carried in cold storage containers on each raft. Typical rafts carry six to eight people as well as a guide, and each raft carries a portable excrement storage container known as an “ammo can.”

Dr. Barzilay and his colleagues interviewed rafters who went on trips on which people became ill. An “ill rafter” was defined as a rafter or guide who suffered vomiting or diarrhea while on a rafting trip between Aug. 19 and Sept. 12, 2005. An “ill trip” was defined as a trip with three or more ill rafters. “Cases” were individuals who became ill within the first 48 hours of a trip, and controls were individuals who were not ill within 72 hours of the start of the trip or who were never ill.

“The mean incubation for norovirus is about 33 hours, so we looked at possible exposure to the virus on the launch date of any given trip,” Dr. Barzilay said. A review of 57 cases and 96 controls showed that cases were 7.3 times more likely than controls to have consumed deli meat. Deli meat was served for either lunch or dinner on the first day of each of the trips on which people became ill.

Three of five composite stool samples from the “ammo cans” on trips sponsored by two rafting companies tested positive for norovirus, as did two of four individual stool samples from ill rafters; all positive norovirus samples were of the same genetic sequence.

The rafters came from different geographic locations, and the ill trips did not use the same raft guides or equipment. All ill trips were launched by 5 of 16 rafting companies, and these 5 companies shared three food suppliers. Both chicken and beef from a plant that supplied meats to five rafting companies tested positive for norovirus, despite the fact that the meat was vacuum-packed and frozen at −10° F for 7–28 days before shipping.

While visiting the plant where the contamination was thought to originate, the CDC investigators learned that a food handler had become ill around the time that the deli meat for the rafting companies was processed. “He was most likely still shedding virus when he returned to work, and he cross-contaminated that meat,” Dr. Barzilay said.

“This is the first report of food product contaminated at the point of processing in a government-inspected plant,” he noted.

Physicians who see patients with foodborne illnesses should consider that food involved in disease outbreaks may have been contaminated at the point of processing, rather than the point of service.

“Although we often think of norovirus contamination occurring at point of service, we suspect that contamination can also occur at point of processing for prepackaged and ready-to-eat foods,” Dr. Barzilay said.

Norovirus is highly resilient, and it can survive on surfaces for extended periods of time, he noted. Food handlers who become ill should stay home from work for 24 hours after their symptoms resolve, he added.

ATLANTA — Just when you thought that prepackaged deli meat was safe, a gastroenteritis outbreak among river rafters in Colorado was traced to norovirus in prepackaged chicken and beef, Dr. Ezra J. Barzilay said at the International Conference on Emerging Infectious Diseases.

On Sept. 18, 2005, the National Park Service contacted the Centers for Disease Control and Prevention to report an outbreak of 136 cases of gastroenteritis in 3 weeks among rafters who participated in group trips on the Colorado River, said Dr. Barzilay, an epidemiologist at the CDC.

“Norovirus accounts for about 50% of all foodborne outbreaks in the U.S.,” he noted.

The cases occurred among participants in 12 of 90 trips conducted by 16 rafting companies during the 3-week period.

Most rafting trips last from 2 to 14 days. Perishable food is carried in cold storage containers on each raft. Typical rafts carry six to eight people as well as a guide, and each raft carries a portable excrement storage container known as an “ammo can.”

Dr. Barzilay and his colleagues interviewed rafters who went on trips on which people became ill. An “ill rafter” was defined as a rafter or guide who suffered vomiting or diarrhea while on a rafting trip between Aug. 19 and Sept. 12, 2005. An “ill trip” was defined as a trip with three or more ill rafters. “Cases” were individuals who became ill within the first 48 hours of a trip, and controls were individuals who were not ill within 72 hours of the start of the trip or who were never ill.

“The mean incubation for norovirus is about 33 hours, so we looked at possible exposure to the virus on the launch date of any given trip,” Dr. Barzilay said. A review of 57 cases and 96 controls showed that cases were 7.3 times more likely than controls to have consumed deli meat. Deli meat was served for either lunch or dinner on the first day of each of the trips on which people became ill.

Three of five composite stool samples from the “ammo cans” on trips sponsored by two rafting companies tested positive for norovirus, as did two of four individual stool samples from ill rafters; all positive norovirus samples were of the same genetic sequence.

The rafters came from different geographic locations, and the ill trips did not use the same raft guides or equipment. All ill trips were launched by 5 of 16 rafting companies, and these 5 companies shared three food suppliers. Both chicken and beef from a plant that supplied meats to five rafting companies tested positive for norovirus, despite the fact that the meat was vacuum-packed and frozen at −10° F for 7–28 days before shipping.

While visiting the plant where the contamination was thought to originate, the CDC investigators learned that a food handler had become ill around the time that the deli meat for the rafting companies was processed. “He was most likely still shedding virus when he returned to work, and he cross-contaminated that meat,” Dr. Barzilay said.

“This is the first report of food product contaminated at the point of processing in a government-inspected plant,” he noted.

Physicians who see patients with foodborne illnesses should consider that food involved in disease outbreaks may have been contaminated at the point of processing, rather than the point of service.

“Although we often think of norovirus contamination occurring at point of service, we suspect that contamination can also occur at point of processing for prepackaged and ready-to-eat foods,” Dr. Barzilay said.

Norovirus is highly resilient, and it can survive on surfaces for extended periods of time, he noted. Food handlers who become ill should stay home from work for 24 hours after their symptoms resolve, he added.

ATLANTA — Just when you thought that prepackaged deli meat was safe, a gastroenteritis outbreak among river rafters in Colorado was traced to norovirus in prepackaged chicken and beef, Dr. Ezra J. Barzilay said at the International Conference on Emerging Infectious Diseases.

On Sept. 18, 2005, the National Park Service contacted the Centers for Disease Control and Prevention to report an outbreak of 136 cases of gastroenteritis in 3 weeks among rafters who participated in group trips on the Colorado River, said Dr. Barzilay, an epidemiologist at the CDC.

“Norovirus accounts for about 50% of all foodborne outbreaks in the U.S.,” he noted.

The cases occurred among participants in 12 of 90 trips conducted by 16 rafting companies during the 3-week period.

Most rafting trips last from 2 to 14 days. Perishable food is carried in cold storage containers on each raft. Typical rafts carry six to eight people as well as a guide, and each raft carries a portable excrement storage container known as an “ammo can.”

Dr. Barzilay and his colleagues interviewed rafters who went on trips on which people became ill. An “ill rafter” was defined as a rafter or guide who suffered vomiting or diarrhea while on a rafting trip between Aug. 19 and Sept. 12, 2005. An “ill trip” was defined as a trip with three or more ill rafters. “Cases” were individuals who became ill within the first 48 hours of a trip, and controls were individuals who were not ill within 72 hours of the start of the trip or who were never ill.

“The mean incubation for norovirus is about 33 hours, so we looked at possible exposure to the virus on the launch date of any given trip,” Dr. Barzilay said. A review of 57 cases and 96 controls showed that cases were 7.3 times more likely than controls to have consumed deli meat. Deli meat was served for either lunch or dinner on the first day of each of the trips on which people became ill.

Three of five composite stool samples from the “ammo cans” on trips sponsored by two rafting companies tested positive for norovirus, as did two of four individual stool samples from ill rafters; all positive norovirus samples were of the same genetic sequence.

The rafters came from different geographic locations, and the ill trips did not use the same raft guides or equipment. All ill trips were launched by 5 of 16 rafting companies, and these 5 companies shared three food suppliers. Both chicken and beef from a plant that supplied meats to five rafting companies tested positive for norovirus, despite the fact that the meat was vacuum-packed and frozen at −10° F for 7–28 days before shipping.

While visiting the plant where the contamination was thought to originate, the CDC investigators learned that a food handler had become ill around the time that the deli meat for the rafting companies was processed. “He was most likely still shedding virus when he returned to work, and he cross-contaminated that meat,” Dr. Barzilay said.

“This is the first report of food product contaminated at the point of processing in a government-inspected plant,” he noted.

Physicians who see patients with foodborne illnesses should consider that food involved in disease outbreaks may have been contaminated at the point of processing, rather than the point of service.

“Although we often think of norovirus contamination occurring at point of service, we suspect that contamination can also occur at point of processing for prepackaged and ready-to-eat foods,” Dr. Barzilay said.

Norovirus is highly resilient, and it can survive on surfaces for extended periods of time, he noted. Food handlers who become ill should stay home from work for 24 hours after their symptoms resolve, he added.

DENVER — Phobic anxiety was significantly associated with both ventricular arrhythmia and mortality in coronary artery disease patients during a median 3-year follow-up, Lana Watkins, Ph.D., said at the annual meeting of the American Psychosomatic Society.

The relationship between sudden cardiac death and phobic anxiety in particular has not been well studied, Dr. Watkins noted. She and her colleagues at Duke University Medical Center in Durham, N.C., evaluated 941 adult patients who were being treated for coronary artery disease. A majority of these patients were white males. About a third of the patients did not have high school diplomas, and smoking and obesity were common among patients in the study.

The highest number of arrhythmias occurred among those with the highest levels of phobic anxiety based on the Crown-Crisp index, which rates eight types of phobias, including fear of heights, crowds, and closed spaces.

Overall, the highest tertile of phobic anxiety scores had twice as many females as males, and a higher level of phobic anxiety was significantly associated with female sex, minority status, increased body mass index, and younger age.

Despite the finding of an association between phobic anxiety and ventricular arrhythmias, no significant relationship was found between phobic anxiety and sudden cardiac death, Dr. Watkins noted.

During a follow-up period, 134 patients died, and 46 of these met the criteria for sudden cardiac death. Sudden cardiac death was defined as death within 72 hours of collapse, in order to account for deaths of patients who lived alone. However, mortality was highest among patients with high levels of phobic anxiety, he said.

The predictability of phobic anxiety for both mortality and an increased risk of ventricular arrhythmias was maintained in a regression analysis after adjustment for other predictors of mortality, including age, gender, education level, and comorbidities.

DENVER — Phobic anxiety was significantly associated with both ventricular arrhythmia and mortality in coronary artery disease patients during a median 3-year follow-up, Lana Watkins, Ph.D., said at the annual meeting of the American Psychosomatic Society.

The relationship between sudden cardiac death and phobic anxiety in particular has not been well studied, Dr. Watkins noted. She and her colleagues at Duke University Medical Center in Durham, N.C., evaluated 941 adult patients who were being treated for coronary artery disease. A majority of these patients were white males. About a third of the patients did not have high school diplomas, and smoking and obesity were common among patients in the study.

The highest number of arrhythmias occurred among those with the highest levels of phobic anxiety based on the Crown-Crisp index, which rates eight types of phobias, including fear of heights, crowds, and closed spaces.

Overall, the highest tertile of phobic anxiety scores had twice as many females as males, and a higher level of phobic anxiety was significantly associated with female sex, minority status, increased body mass index, and younger age.

Despite the finding of an association between phobic anxiety and ventricular arrhythmias, no significant relationship was found between phobic anxiety and sudden cardiac death, Dr. Watkins noted.

During a follow-up period, 134 patients died, and 46 of these met the criteria for sudden cardiac death. Sudden cardiac death was defined as death within 72 hours of collapse, in order to account for deaths of patients who lived alone. However, mortality was highest among patients with high levels of phobic anxiety, he said.

The predictability of phobic anxiety for both mortality and an increased risk of ventricular arrhythmias was maintained in a regression analysis after adjustment for other predictors of mortality, including age, gender, education level, and comorbidities.

DENVER — Phobic anxiety was significantly associated with both ventricular arrhythmia and mortality in coronary artery disease patients during a median 3-year follow-up, Lana Watkins, Ph.D., said at the annual meeting of the American Psychosomatic Society.

The relationship between sudden cardiac death and phobic anxiety in particular has not been well studied, Dr. Watkins noted. She and her colleagues at Duke University Medical Center in Durham, N.C., evaluated 941 adult patients who were being treated for coronary artery disease. A majority of these patients were white males. About a third of the patients did not have high school diplomas, and smoking and obesity were common among patients in the study.

The highest number of arrhythmias occurred among those with the highest levels of phobic anxiety based on the Crown-Crisp index, which rates eight types of phobias, including fear of heights, crowds, and closed spaces.

Overall, the highest tertile of phobic anxiety scores had twice as many females as males, and a higher level of phobic anxiety was significantly associated with female sex, minority status, increased body mass index, and younger age.

Despite the finding of an association between phobic anxiety and ventricular arrhythmias, no significant relationship was found between phobic anxiety and sudden cardiac death, Dr. Watkins noted.

During a follow-up period, 134 patients died, and 46 of these met the criteria for sudden cardiac death. Sudden cardiac death was defined as death within 72 hours of collapse, in order to account for deaths of patients who lived alone. However, mortality was highest among patients with high levels of phobic anxiety, he said.

The predictability of phobic anxiety for both mortality and an increased risk of ventricular arrhythmias was maintained in a regression analysis after adjustment for other predictors of mortality, including age, gender, education level, and comorbidities.

Quetiapine was at least as effective as divalproex in alleviating manic symptoms in adolescents in a randomized, double-blind pilot study, wrote Dr. Melissa P. DelBello and her colleagues at the University of Cincinnati, Ohio.

The 28-day pilot study of 50 adolescents aged 12–18 years was the first known to directly compare an atypical antipsychotic with an antiepileptic in adolescents with mania, the researchers noted (J. Am. Acad. Child Adolesc. Psychiatry 2006;45:305–13). The study was supported by a grant from AstraZeneca Pharmaceuticals, which markets quetiapine (Seroquel), and is one of the many companies from which Dr. DelBello has received research funding.

The adolescents who received quetiapine started with a 100-mg dose on the first day, which was increased to 400 mg by days 4–7, up to a maximum of 600 mg/day. Those who received divalproex started with a 20-mg/kg dose on the first day, which was increased to achieve serum valproic acid levels of 80–120 μg/mL. At the end of the study, the mean doses were 412 mg/day to 422 mg/day in the quetiapine group, and a valproic acid level of 101 μg/mL in the divalproex group.

Overall, patients in both groups showed statistically significant improvements in their scores on the Young Mania Rating Scale at the end of the study. The response was quicker among the quetiapine patients, compared with divalproex patients, and the overall response rate on the Clinical Global Impressions-Bipolar Version-Improvement scale was significantly greater in the quetiapine group than in the divalproex group (72% vs. 40%).

Quetiapine was at least as effective as divalproex in alleviating manic symptoms in adolescents in a randomized, double-blind pilot study, wrote Dr. Melissa P. DelBello and her colleagues at the University of Cincinnati, Ohio.

The 28-day pilot study of 50 adolescents aged 12–18 years was the first known to directly compare an atypical antipsychotic with an antiepileptic in adolescents with mania, the researchers noted (J. Am. Acad. Child Adolesc. Psychiatry 2006;45:305–13). The study was supported by a grant from AstraZeneca Pharmaceuticals, which markets quetiapine (Seroquel), and is one of the many companies from which Dr. DelBello has received research funding.

The adolescents who received quetiapine started with a 100-mg dose on the first day, which was increased to 400 mg by days 4–7, up to a maximum of 600 mg/day. Those who received divalproex started with a 20-mg/kg dose on the first day, which was increased to achieve serum valproic acid levels of 80–120 μg/mL. At the end of the study, the mean doses were 412 mg/day to 422 mg/day in the quetiapine group, and a valproic acid level of 101 μg/mL in the divalproex group.

Overall, patients in both groups showed statistically significant improvements in their scores on the Young Mania Rating Scale at the end of the study. The response was quicker among the quetiapine patients, compared with divalproex patients, and the overall response rate on the Clinical Global Impressions-Bipolar Version-Improvement scale was significantly greater in the quetiapine group than in the divalproex group (72% vs. 40%).

Quetiapine was at least as effective as divalproex in alleviating manic symptoms in adolescents in a randomized, double-blind pilot study, wrote Dr. Melissa P. DelBello and her colleagues at the University of Cincinnati, Ohio.

The 28-day pilot study of 50 adolescents aged 12–18 years was the first known to directly compare an atypical antipsychotic with an antiepileptic in adolescents with mania, the researchers noted (J. Am. Acad. Child Adolesc. Psychiatry 2006;45:305–13). The study was supported by a grant from AstraZeneca Pharmaceuticals, which markets quetiapine (Seroquel), and is one of the many companies from which Dr. DelBello has received research funding.

The adolescents who received quetiapine started with a 100-mg dose on the first day, which was increased to 400 mg by days 4–7, up to a maximum of 600 mg/day. Those who received divalproex started with a 20-mg/kg dose on the first day, which was increased to achieve serum valproic acid levels of 80–120 μg/mL. At the end of the study, the mean doses were 412 mg/day to 422 mg/day in the quetiapine group, and a valproic acid level of 101 μg/mL in the divalproex group.

Overall, patients in both groups showed statistically significant improvements in their scores on the Young Mania Rating Scale at the end of the study. The response was quicker among the quetiapine patients, compared with divalproex patients, and the overall response rate on the Clinical Global Impressions-Bipolar Version-Improvement scale was significantly greater in the quetiapine group than in the divalproex group (72% vs. 40%).

More than 25% of children and adolescents with obsessive-compulsive disorder had comorbid attention-deficit hyperactivity disorder in a consecutive study of 94 patients, reported Dr. Gabriele Masi and her associates at the Scientific Institute of Child Neurology and Psychiatry in Calambrone, Pisa (Italy).

Overall, 88% of the 24 comorbid patients were male, and the average age of onset of obsessive-compulsive disorder (OCD) was slightly higher among patients with comorbid attention-deficit hyperactivity disorder (ADHD). Several disruptive behavior disorders—oppositional defiant disorder, bipolar disorder, and tic disorder—were significantly more common among comorbid patients.

The 3-year study included 65 males and 29 females aged 8–18 years. All of the patients were undergoing treatment for OCD with selective serotonin reuptake inhibitors, such as fluoxetine and sertraline (Zoloft), but none was being treated for ADHD with psychostimulants (Compr. Psychiatry 2006;47:42–7).

In patients with comorbid ADHD, functional baseline impairment was higher, and improvement in symptoms after 6 months of follow-up was lower. Patients with co-occurring OCD-ADHD were more frequently male (88% vs. 62%). In addition, patients with OCD and ADHD had higher rates of comorbid disorders, such as various anxiety disorders.

There were no significant differences between patients with and without comorbid ADHD with regard to OCD behaviors involving ordering, aggression, contamination, and hoarding.

The study results suggest a need for ADHD screening in all children and adolescents with OCD, the investigators wrote.

More than 25% of children and adolescents with obsessive-compulsive disorder had comorbid attention-deficit hyperactivity disorder in a consecutive study of 94 patients, reported Dr. Gabriele Masi and her associates at the Scientific Institute of Child Neurology and Psychiatry in Calambrone, Pisa (Italy).

Overall, 88% of the 24 comorbid patients were male, and the average age of onset of obsessive-compulsive disorder (OCD) was slightly higher among patients with comorbid attention-deficit hyperactivity disorder (ADHD). Several disruptive behavior disorders—oppositional defiant disorder, bipolar disorder, and tic disorder—were significantly more common among comorbid patients.

The 3-year study included 65 males and 29 females aged 8–18 years. All of the patients were undergoing treatment for OCD with selective serotonin reuptake inhibitors, such as fluoxetine and sertraline (Zoloft), but none was being treated for ADHD with psychostimulants (Compr. Psychiatry 2006;47:42–7).

In patients with comorbid ADHD, functional baseline impairment was higher, and improvement in symptoms after 6 months of follow-up was lower. Patients with co-occurring OCD-ADHD were more frequently male (88% vs. 62%). In addition, patients with OCD and ADHD had higher rates of comorbid disorders, such as various anxiety disorders.

There were no significant differences between patients with and without comorbid ADHD with regard to OCD behaviors involving ordering, aggression, contamination, and hoarding.

The study results suggest a need for ADHD screening in all children and adolescents with OCD, the investigators wrote.

More than 25% of children and adolescents with obsessive-compulsive disorder had comorbid attention-deficit hyperactivity disorder in a consecutive study of 94 patients, reported Dr. Gabriele Masi and her associates at the Scientific Institute of Child Neurology and Psychiatry in Calambrone, Pisa (Italy).

Overall, 88% of the 24 comorbid patients were male, and the average age of onset of obsessive-compulsive disorder (OCD) was slightly higher among patients with comorbid attention-deficit hyperactivity disorder (ADHD). Several disruptive behavior disorders—oppositional defiant disorder, bipolar disorder, and tic disorder—were significantly more common among comorbid patients.

The 3-year study included 65 males and 29 females aged 8–18 years. All of the patients were undergoing treatment for OCD with selective serotonin reuptake inhibitors, such as fluoxetine and sertraline (Zoloft), but none was being treated for ADHD with psychostimulants (Compr. Psychiatry 2006;47:42–7).

In patients with comorbid ADHD, functional baseline impairment was higher, and improvement in symptoms after 6 months of follow-up was lower. Patients with co-occurring OCD-ADHD were more frequently male (88% vs. 62%). In addition, patients with OCD and ADHD had higher rates of comorbid disorders, such as various anxiety disorders.

There were no significant differences between patients with and without comorbid ADHD with regard to OCD behaviors involving ordering, aggression, contamination, and hoarding.

The study results suggest a need for ADHD screening in all children and adolescents with OCD, the investigators wrote.

The adult formula of the tetanus and diphtheria toxoids and acellular pertussis vaccine (Tdap) can be given to children and adolescents starting at 18 months after a children's formula tetanus and diphtheria vaccine, said Dr. Scott A. Halperin of Dalhousie University, Halifax, Nova Scotia, and his colleagues.

Prior recommendations for a 10-year waiting period between doses of the tetanus and diphtheria toxoid-containing vaccine for infants and young children (TD) or the vaccine for older children and adults (Td) had been based on effectiveness rather than a lack of safety information, the investigators noted.

Concerns about the timing of vaccinations and adverse events prompted an open-label clinical trial including 7,156 children in grades 3–12 who received Tdap at time intervals ranging from 18 months to 9 years after their previous vaccinations with TD, Td, or diphtheria-tetanus-acellular pertussis (DTaP).

Tdap was generally well tolerated regardless of the time elapsed since the previous vaccination. Data on fever, injection site erythema, swelling, and pain were solicited for 14 days after immunization, and unsolicited adverse events were recorded for 28 days (Pediatr. Infect. Dis. J. 2006;25:195–200).

Overall, more than 80% of the children in each time interval reported injection site pain, but this was not significantly different from pain reports in children who were vaccinated 10 years after a previous immunization. Injection site erythema was slightly increased among children whose previous vaccine had been DTaP, but not among those whose previous vaccine had been Td. The four reported serious adverse events included one case each of asthma, bronchospasm, syncope, and juvenile onset diabetes mellitus, but none of these were attributed to Tdap.

The adult formula of the tetanus and diphtheria toxoids and acellular pertussis vaccine (Tdap) can be given to children and adolescents starting at 18 months after a children's formula tetanus and diphtheria vaccine, said Dr. Scott A. Halperin of Dalhousie University, Halifax, Nova Scotia, and his colleagues.

Prior recommendations for a 10-year waiting period between doses of the tetanus and diphtheria toxoid-containing vaccine for infants and young children (TD) or the vaccine for older children and adults (Td) had been based on effectiveness rather than a lack of safety information, the investigators noted.

Concerns about the timing of vaccinations and adverse events prompted an open-label clinical trial including 7,156 children in grades 3–12 who received Tdap at time intervals ranging from 18 months to 9 years after their previous vaccinations with TD, Td, or diphtheria-tetanus-acellular pertussis (DTaP).

Tdap was generally well tolerated regardless of the time elapsed since the previous vaccination. Data on fever, injection site erythema, swelling, and pain were solicited for 14 days after immunization, and unsolicited adverse events were recorded for 28 days (Pediatr. Infect. Dis. J. 2006;25:195–200).

Overall, more than 80% of the children in each time interval reported injection site pain, but this was not significantly different from pain reports in children who were vaccinated 10 years after a previous immunization. Injection site erythema was slightly increased among children whose previous vaccine had been DTaP, but not among those whose previous vaccine had been Td. The four reported serious adverse events included one case each of asthma, bronchospasm, syncope, and juvenile onset diabetes mellitus, but none of these were attributed to Tdap.

The adult formula of the tetanus and diphtheria toxoids and acellular pertussis vaccine (Tdap) can be given to children and adolescents starting at 18 months after a children's formula tetanus and diphtheria vaccine, said Dr. Scott A. Halperin of Dalhousie University, Halifax, Nova Scotia, and his colleagues.

Prior recommendations for a 10-year waiting period between doses of the tetanus and diphtheria toxoid-containing vaccine for infants and young children (TD) or the vaccine for older children and adults (Td) had been based on effectiveness rather than a lack of safety information, the investigators noted.

Concerns about the timing of vaccinations and adverse events prompted an open-label clinical trial including 7,156 children in grades 3–12 who received Tdap at time intervals ranging from 18 months to 9 years after their previous vaccinations with TD, Td, or diphtheria-tetanus-acellular pertussis (DTaP).

Tdap was generally well tolerated regardless of the time elapsed since the previous vaccination. Data on fever, injection site erythema, swelling, and pain were solicited for 14 days after immunization, and unsolicited adverse events were recorded for 28 days (Pediatr. Infect. Dis. J. 2006;25:195–200).

Overall, more than 80% of the children in each time interval reported injection site pain, but this was not significantly different from pain reports in children who were vaccinated 10 years after a previous immunization. Injection site erythema was slightly increased among children whose previous vaccine had been DTaP, but not among those whose previous vaccine had been Td. The four reported serious adverse events included one case each of asthma, bronchospasm, syncope, and juvenile onset diabetes mellitus, but none of these were attributed to Tdap.

DENVER — Increased risk of coronary heart disease is significantly associated with stronger symptoms of depression in diabetic adults, Susan M. Barry-Bianchi, Ph.D., reported in a poster presented at the annual meeting of the American Psychosomatic Society.

Dr. Barry-Bianchi, of the Behavioural Cardiology Research Unit at the University Health Network in Toronto, and her colleagues recruited 353 patients for the study from an ongoing investigation, the Community Outreach and Health Risk Reduction Trial. The average patient age was 56 years.

The average score on the Beck Depression Inventory (BDI) was 11.1 among the 184 patients at high risk for coronary heart disease (CHD), compared with 8.8 among the 169 patients at low risk for CHD, Dr. Barry-Bianchi wrote. The 10-year absolute risk for CHD was nearly 22% for high-risk patients and 9% for the low-risk patients. CHD risk for each patient was determined using the Framingham index.

Given the significant difference in the depression levels based on the risk for developing heart disease, depression and CHD risk should be evaluated jointly, when investigating morbidity and mortality in diabetic patients, the investigators suggested. Additionally, treatment of CHD risk factors in diabetic patients may correspond with a reduction in depressive symptoms and improved overall health.

In addition, the results supported previous findings of increased depression among women and patients with low levels of emotional support. Women demonstrated a significantly higher average BDI score, compared with men (11.4 vs. 8.4). Patients with low reported levels of emotional support demonstrated a significantly higher average BDI score, compared with those who reported more support (12 vs. 8).

DENVER — Increased risk of coronary heart disease is significantly associated with stronger symptoms of depression in diabetic adults, Susan M. Barry-Bianchi, Ph.D., reported in a poster presented at the annual meeting of the American Psychosomatic Society.

Dr. Barry-Bianchi, of the Behavioural Cardiology Research Unit at the University Health Network in Toronto, and her colleagues recruited 353 patients for the study from an ongoing investigation, the Community Outreach and Health Risk Reduction Trial. The average patient age was 56 years.

The average score on the Beck Depression Inventory (BDI) was 11.1 among the 184 patients at high risk for coronary heart disease (CHD), compared with 8.8 among the 169 patients at low risk for CHD, Dr. Barry-Bianchi wrote. The 10-year absolute risk for CHD was nearly 22% for high-risk patients and 9% for the low-risk patients. CHD risk for each patient was determined using the Framingham index.

Given the significant difference in the depression levels based on the risk for developing heart disease, depression and CHD risk should be evaluated jointly, when investigating morbidity and mortality in diabetic patients, the investigators suggested. Additionally, treatment of CHD risk factors in diabetic patients may correspond with a reduction in depressive symptoms and improved overall health.

In addition, the results supported previous findings of increased depression among women and patients with low levels of emotional support. Women demonstrated a significantly higher average BDI score, compared with men (11.4 vs. 8.4). Patients with low reported levels of emotional support demonstrated a significantly higher average BDI score, compared with those who reported more support (12 vs. 8).

DENVER — Increased risk of coronary heart disease is significantly associated with stronger symptoms of depression in diabetic adults, Susan M. Barry-Bianchi, Ph.D., reported in a poster presented at the annual meeting of the American Psychosomatic Society.

Dr. Barry-Bianchi, of the Behavioural Cardiology Research Unit at the University Health Network in Toronto, and her colleagues recruited 353 patients for the study from an ongoing investigation, the Community Outreach and Health Risk Reduction Trial. The average patient age was 56 years.

The average score on the Beck Depression Inventory (BDI) was 11.1 among the 184 patients at high risk for coronary heart disease (CHD), compared with 8.8 among the 169 patients at low risk for CHD, Dr. Barry-Bianchi wrote. The 10-year absolute risk for CHD was nearly 22% for high-risk patients and 9% for the low-risk patients. CHD risk for each patient was determined using the Framingham index.

Given the significant difference in the depression levels based on the risk for developing heart disease, depression and CHD risk should be evaluated jointly, when investigating morbidity and mortality in diabetic patients, the investigators suggested. Additionally, treatment of CHD risk factors in diabetic patients may correspond with a reduction in depressive symptoms and improved overall health.

In addition, the results supported previous findings of increased depression among women and patients with low levels of emotional support. Women demonstrated a significantly higher average BDI score, compared with men (11.4 vs. 8.4). Patients with low reported levels of emotional support demonstrated a significantly higher average BDI score, compared with those who reported more support (12 vs. 8).

DENVER — End-stage liver disease was associated with significant deficits in memory, abstract thought, sustained attention, and executive function in a study of 104 adult patients, Tina Meyer, Ph.D., reported in a poster presented at the annual meeting of the American Psychosomatic Society.

“We want to enlighten the surgeons and primary care doctors that cognitive decline can indicate serious liver problems,” Dr. Meyer said in an interview.

She and her colleagues in the Transplant Institute at the Henry Ford Health System in Detroit enrolled liver disease patients who met medical and psychosocial criteria for a transplant. About half (51%) were male, 74% were white, and the average age was 54 years. The patients' average score on the mean model for end-stage liver disease (MELD) was 11.3.

The participants completed a cognitive assessment including the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), which estimates brain function in five different domains: immediate memory, delayed memory, visuospatial abilities, language, and attention.

Overall, scores on the RBANS were below average on the subtests of immediate memory, visuospatial abilities, and attention. After the investigators controlled for education levels, higher MELD scores were significantly associated with lower scores on the immediate memory and delayed memory subtests of RBANS, as well as with lower scores on the Mini-Mental State Exam, the Shipley Institute of Living Scale, and the Trail-Making Test, parts A and B.

DENVER — End-stage liver disease was associated with significant deficits in memory, abstract thought, sustained attention, and executive function in a study of 104 adult patients, Tina Meyer, Ph.D., reported in a poster presented at the annual meeting of the American Psychosomatic Society.

“We want to enlighten the surgeons and primary care doctors that cognitive decline can indicate serious liver problems,” Dr. Meyer said in an interview.

She and her colleagues in the Transplant Institute at the Henry Ford Health System in Detroit enrolled liver disease patients who met medical and psychosocial criteria for a transplant. About half (51%) were male, 74% were white, and the average age was 54 years. The patients' average score on the mean model for end-stage liver disease (MELD) was 11.3.

The participants completed a cognitive assessment including the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), which estimates brain function in five different domains: immediate memory, delayed memory, visuospatial abilities, language, and attention.

Overall, scores on the RBANS were below average on the subtests of immediate memory, visuospatial abilities, and attention. After the investigators controlled for education levels, higher MELD scores were significantly associated with lower scores on the immediate memory and delayed memory subtests of RBANS, as well as with lower scores on the Mini-Mental State Exam, the Shipley Institute of Living Scale, and the Trail-Making Test, parts A and B.

DENVER — End-stage liver disease was associated with significant deficits in memory, abstract thought, sustained attention, and executive function in a study of 104 adult patients, Tina Meyer, Ph.D., reported in a poster presented at the annual meeting of the American Psychosomatic Society.

“We want to enlighten the surgeons and primary care doctors that cognitive decline can indicate serious liver problems,” Dr. Meyer said in an interview.

She and her colleagues in the Transplant Institute at the Henry Ford Health System in Detroit enrolled liver disease patients who met medical and psychosocial criteria for a transplant. About half (51%) were male, 74% were white, and the average age was 54 years. The patients' average score on the mean model for end-stage liver disease (MELD) was 11.3.

The participants completed a cognitive assessment including the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), which estimates brain function in five different domains: immediate memory, delayed memory, visuospatial abilities, language, and attention.

Overall, scores on the RBANS were below average on the subtests of immediate memory, visuospatial abilities, and attention. After the investigators controlled for education levels, higher MELD scores were significantly associated with lower scores on the immediate memory and delayed memory subtests of RBANS, as well as with lower scores on the Mini-Mental State Exam, the Shipley Institute of Living Scale, and the Trail-Making Test, parts A and B.

DENVER — Age and low hostility are independent predictors of poor blood pressure in women over a 10-year period, suggesting a link between certain personality traits and disease development, Jocelyne Leclerc reported in a poster presented at the annual meeting of the American Psychosomatic Society.

Ms. Leclerc and her colleagues at the University of British Columbia, Vancouver, compared the results of ambulatory blood pressure monitoring and personality questionnaires of 112 healthy adults at baseline and after 10 years. The study group included 54 men and 63 women; the average age was 40 years at baseline. Average blood pressure monitoring was done on predetermined days when the patients did not expect significant stressful events. Overall, blood pressure and personality traits were stable over the 10 years. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were significantly correlated with depression at baseline. Baseline hostility predicted increased DBP 10 years later; baseline SBP predicted hostility later.

Gender and family history may moderate the impact of personality on blood pressure, they said (Pers. Individ. Diff. 2006;40:1313–21). Increased age and low hostility significantly predicted SBP in women, while high levels of self-deception were the only significant predictors of SBP and DBP over time in men. The observation of low hostility in women predicting high BP suggests a need to consider “possibly differential adaptiveness of the same personality features of women and men.” In those with a family history of high blood pressure, age and high levels of self-deception were significant SBP predictors, and self-deception was the lone significant DBP predictor. In those without a family history of high blood pressure, only age was a significant SBP predictor. No variables were significant DBP predictors.

DENVER — Age and low hostility are independent predictors of poor blood pressure in women over a 10-year period, suggesting a link between certain personality traits and disease development, Jocelyne Leclerc reported in a poster presented at the annual meeting of the American Psychosomatic Society.

Ms. Leclerc and her colleagues at the University of British Columbia, Vancouver, compared the results of ambulatory blood pressure monitoring and personality questionnaires of 112 healthy adults at baseline and after 10 years. The study group included 54 men and 63 women; the average age was 40 years at baseline. Average blood pressure monitoring was done on predetermined days when the patients did not expect significant stressful events. Overall, blood pressure and personality traits were stable over the 10 years. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were significantly correlated with depression at baseline. Baseline hostility predicted increased DBP 10 years later; baseline SBP predicted hostility later.

Gender and family history may moderate the impact of personality on blood pressure, they said (Pers. Individ. Diff. 2006;40:1313–21). Increased age and low hostility significantly predicted SBP in women, while high levels of self-deception were the only significant predictors of SBP and DBP over time in men. The observation of low hostility in women predicting high BP suggests a need to consider “possibly differential adaptiveness of the same personality features of women and men.” In those with a family history of high blood pressure, age and high levels of self-deception were significant SBP predictors, and self-deception was the lone significant DBP predictor. In those without a family history of high blood pressure, only age was a significant SBP predictor. No variables were significant DBP predictors.

DENVER — Age and low hostility are independent predictors of poor blood pressure in women over a 10-year period, suggesting a link between certain personality traits and disease development, Jocelyne Leclerc reported in a poster presented at the annual meeting of the American Psychosomatic Society.

Ms. Leclerc and her colleagues at the University of British Columbia, Vancouver, compared the results of ambulatory blood pressure monitoring and personality questionnaires of 112 healthy adults at baseline and after 10 years. The study group included 54 men and 63 women; the average age was 40 years at baseline. Average blood pressure monitoring was done on predetermined days when the patients did not expect significant stressful events. Overall, blood pressure and personality traits were stable over the 10 years. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were significantly correlated with depression at baseline. Baseline hostility predicted increased DBP 10 years later; baseline SBP predicted hostility later.

Gender and family history may moderate the impact of personality on blood pressure, they said (Pers. Individ. Diff. 2006;40:1313–21). Increased age and low hostility significantly predicted SBP in women, while high levels of self-deception were the only significant predictors of SBP and DBP over time in men. The observation of low hostility in women predicting high BP suggests a need to consider “possibly differential adaptiveness of the same personality features of women and men.” In those with a family history of high blood pressure, age and high levels of self-deception were significant SBP predictors, and self-deception was the lone significant DBP predictor. In those without a family history of high blood pressure, only age was a significant SBP predictor. No variables were significant DBP predictors.

Vesicoureteral Reflux and UTIs

Mild to moderate vesicoureteral reflux did not increase the incidence of urinary tract infections, recurrent pyelonephritis, or renal scarring in children with acute pyelonephritis, reported Dr. Eduardo H. Garin of the University of South Florida, Tampa, and his colleagues.

In addition, urinary antibiotic prophylaxis showed no effect on the prevention of either the recurrence of infection or the development of renal scars (Pediatrics 2006;117:626–32).

A total of 218 children aged 3 months to 18 years were monitored for 1 year. Children who were randomized to antibiotics received a once-daily dose of either 1–2 mg/kg of trimethoprim or 5–10 mg/kg sulfamethoxazole or 1.5 mg/kg nitrofurantoin. The overall incidence of urinary tract infections (UTIs) after pyelonephritis was 20.1%. Among children who did not receive antibiotic prophylaxis, the incidence of UTIs was not significantly different between those with and without vesicoureteral reflux (VUR; 22.4% vs. 23.3%). Similarly, among children who did receive antibiotic prophylaxis, the incidence of UTIs was not significantly different between children with and without VUR (23.6% vs. 8.8%).

Only 12 of the 218 patients (5.5%) had recurrence of pyelonephritis. Although more recurrences occurred in patients with VUR than without it (8 vs. 4), there was no significant evidence that reflux increased the odds of recurrence.

In addition, only 13 patients developed renal scars during the follow-up period—7 with VUR and 6 without VUR—there was no significant evidence that VUR increased the risk for scarring. The rates of scarring were similar in the prophylaxis and control groups.

Adult Tdap Called Safe for Children

The adult formula of the tetanus and diphtheria toxoids and acellular pertussis vaccine (Tdap) can be given to children and adolescents starting at 18 months after a children's formula tetanus and diphtheria vaccine, said Dr. Scott A. Halperin of Dalhousie University, Halifax, Nova Scotia, and his colleagues.

Prior recommendations for a 10-year waiting period between doses of the tetanus and diphtheria toxoid-containing vaccine for infants and young children (TD) or the vaccine for older children and adults (Td) had been based on effectiveness rather than a lack of safety information, the investigators noted.

Concerns about the relationship between the timing of vaccinations and adverse events prompted an open-label clinical trial including 7,156 children in grades 3–12 who received Tdap at time intervals ranging from 18 months to 9 years after their previous vaccinations with TD, Td, or diphtheria-tetanus-acellular pertussis (DTaP).

Tdap was generally well tolerated regardless of the time elapsed since the previous vaccination. Data on fever, injection site erythema, swelling, and pain were solicited for 14 days after immunization, and unsolicited adverse events were recorded for 28 days (Pediatr. Infect. Dis. J. 2006;25:195–200). Overall, more than 80% of the children in each time interval reported injection site pain, but this was not significantly different from pain reports in children who were vaccinated 10 years after a previous immunization. Injection site erythema was slightly increased among children whose previous vaccine had been DTaP, but not among those whose previous vaccine had been Td.

DTaP Reactions Defeat OTC Drugs

Neither acetaminophen nor ibuprofen had a significant preventive effect against localized reactions to the fifth dose of the diphtheria-tetanus -acellular pertussis vaccine based on data from 372 children aged 4–6 years.

Dr. Lisa A. Jackson of the University of Washington, Seattle, and her colleagues conducted a randomized, blinded controlled trial within a larger safety study of the Tripedia DTaP vaccine. Dr. Jackson has served on the speakers' bureau for Sanofi Pasteur, which manufactures the vaccine and provided a research grant for the study (Pediatrics 2006;117:620–5).

The children were assigned to receive their first dose of 15 mg/kg of acetaminophen, with a maximum dose of 450 mg; 10 mg/kg of ibuprofen, with a maximum dose of 300 mg; or a placebo 2 hours before their scheduled vaccinations. The second and third doses were given at 6-hour intervals after vaccination, although an interval of up to 12 hours between consecutive doses was allowed. Overall, 90% of parents reported giving their child all three doses, and 70% reported giving all doses on schedule.

Overall, local reactions with an area of redness at least 2.5 cm in size occurred in 43% of the children. In addition, 49% reported some pain in the vaccinated limb and 23% reported some itching in the vaccinated limb during the 2 days after vaccination.

Vesicoureteral Reflux and UTIs

Mild to moderate vesicoureteral reflux did not increase the incidence of urinary tract infections, recurrent pyelonephritis, or renal scarring in children with acute pyelonephritis, reported Dr. Eduardo H. Garin of the University of South Florida, Tampa, and his colleagues.

In addition, urinary antibiotic prophylaxis showed no effect on the prevention of either the recurrence of infection or the development of renal scars (Pediatrics 2006;117:626–32).

A total of 218 children aged 3 months to 18 years were monitored for 1 year. Children who were randomized to antibiotics received a once-daily dose of either 1–2 mg/kg of trimethoprim or 5–10 mg/kg sulfamethoxazole or 1.5 mg/kg nitrofurantoin. The overall incidence of urinary tract infections (UTIs) after pyelonephritis was 20.1%. Among children who did not receive antibiotic prophylaxis, the incidence of UTIs was not significantly different between those with and without vesicoureteral reflux (VUR; 22.4% vs. 23.3%). Similarly, among children who did receive antibiotic prophylaxis, the incidence of UTIs was not significantly different between children with and without VUR (23.6% vs. 8.8%).

Only 12 of the 218 patients (5.5%) had recurrence of pyelonephritis. Although more recurrences occurred in patients with VUR than without it (8 vs. 4), there was no significant evidence that reflux increased the odds of recurrence.

In addition, only 13 patients developed renal scars during the follow-up period—7 with VUR and 6 without VUR—there was no significant evidence that VUR increased the risk for scarring. The rates of scarring were similar in the prophylaxis and control groups.

Adult Tdap Called Safe for Children

The adult formula of the tetanus and diphtheria toxoids and acellular pertussis vaccine (Tdap) can be given to children and adolescents starting at 18 months after a children's formula tetanus and diphtheria vaccine, said Dr. Scott A. Halperin of Dalhousie University, Halifax, Nova Scotia, and his colleagues.

Prior recommendations for a 10-year waiting period between doses of the tetanus and diphtheria toxoid-containing vaccine for infants and young children (TD) or the vaccine for older children and adults (Td) had been based on effectiveness rather than a lack of safety information, the investigators noted.

Concerns about the relationship between the timing of vaccinations and adverse events prompted an open-label clinical trial including 7,156 children in grades 3–12 who received Tdap at time intervals ranging from 18 months to 9 years after their previous vaccinations with TD, Td, or diphtheria-tetanus-acellular pertussis (DTaP).

Tdap was generally well tolerated regardless of the time elapsed since the previous vaccination. Data on fever, injection site erythema, swelling, and pain were solicited for 14 days after immunization, and unsolicited adverse events were recorded for 28 days (Pediatr. Infect. Dis. J. 2006;25:195–200). Overall, more than 80% of the children in each time interval reported injection site pain, but this was not significantly different from pain reports in children who were vaccinated 10 years after a previous immunization. Injection site erythema was slightly increased among children whose previous vaccine had been DTaP, but not among those whose previous vaccine had been Td.

DTaP Reactions Defeat OTC Drugs

Neither acetaminophen nor ibuprofen had a significant preventive effect against localized reactions to the fifth dose of the diphtheria-tetanus -acellular pertussis vaccine based on data from 372 children aged 4–6 years.

Dr. Lisa A. Jackson of the University of Washington, Seattle, and her colleagues conducted a randomized, blinded controlled trial within a larger safety study of the Tripedia DTaP vaccine. Dr. Jackson has served on the speakers' bureau for Sanofi Pasteur, which manufactures the vaccine and provided a research grant for the study (Pediatrics 2006;117:620–5).

The children were assigned to receive their first dose of 15 mg/kg of acetaminophen, with a maximum dose of 450 mg; 10 mg/kg of ibuprofen, with a maximum dose of 300 mg; or a placebo 2 hours before their scheduled vaccinations. The second and third doses were given at 6-hour intervals after vaccination, although an interval of up to 12 hours between consecutive doses was allowed. Overall, 90% of parents reported giving their child all three doses, and 70% reported giving all doses on schedule.

Overall, local reactions with an area of redness at least 2.5 cm in size occurred in 43% of the children. In addition, 49% reported some pain in the vaccinated limb and 23% reported some itching in the vaccinated limb during the 2 days after vaccination.

Vesicoureteral Reflux and UTIs

Mild to moderate vesicoureteral reflux did not increase the incidence of urinary tract infections, recurrent pyelonephritis, or renal scarring in children with acute pyelonephritis, reported Dr. Eduardo H. Garin of the University of South Florida, Tampa, and his colleagues.

In addition, urinary antibiotic prophylaxis showed no effect on the prevention of either the recurrence of infection or the development of renal scars (Pediatrics 2006;117:626–32).

A total of 218 children aged 3 months to 18 years were monitored for 1 year. Children who were randomized to antibiotics received a once-daily dose of either 1–2 mg/kg of trimethoprim or 5–10 mg/kg sulfamethoxazole or 1.5 mg/kg nitrofurantoin. The overall incidence of urinary tract infections (UTIs) after pyelonephritis was 20.1%. Among children who did not receive antibiotic prophylaxis, the incidence of UTIs was not significantly different between those with and without vesicoureteral reflux (VUR; 22.4% vs. 23.3%). Similarly, among children who did receive antibiotic prophylaxis, the incidence of UTIs was not significantly different between children with and without VUR (23.6% vs. 8.8%).

Only 12 of the 218 patients (5.5%) had recurrence of pyelonephritis. Although more recurrences occurred in patients with VUR than without it (8 vs. 4), there was no significant evidence that reflux increased the odds of recurrence.

In addition, only 13 patients developed renal scars during the follow-up period—7 with VUR and 6 without VUR—there was no significant evidence that VUR increased the risk for scarring. The rates of scarring were similar in the prophylaxis and control groups.

Adult Tdap Called Safe for Children

The adult formula of the tetanus and diphtheria toxoids and acellular pertussis vaccine (Tdap) can be given to children and adolescents starting at 18 months after a children's formula tetanus and diphtheria vaccine, said Dr. Scott A. Halperin of Dalhousie University, Halifax, Nova Scotia, and his colleagues.

Prior recommendations for a 10-year waiting period between doses of the tetanus and diphtheria toxoid-containing vaccine for infants and young children (TD) or the vaccine for older children and adults (Td) had been based on effectiveness rather than a lack of safety information, the investigators noted.

Concerns about the relationship between the timing of vaccinations and adverse events prompted an open-label clinical trial including 7,156 children in grades 3–12 who received Tdap at time intervals ranging from 18 months to 9 years after their previous vaccinations with TD, Td, or diphtheria-tetanus-acellular pertussis (DTaP).

Tdap was generally well tolerated regardless of the time elapsed since the previous vaccination. Data on fever, injection site erythema, swelling, and pain were solicited for 14 days after immunization, and unsolicited adverse events were recorded for 28 days (Pediatr. Infect. Dis. J. 2006;25:195–200). Overall, more than 80% of the children in each time interval reported injection site pain, but this was not significantly different from pain reports in children who were vaccinated 10 years after a previous immunization. Injection site erythema was slightly increased among children whose previous vaccine had been DTaP, but not among those whose previous vaccine had been Td.

DTaP Reactions Defeat OTC Drugs

Neither acetaminophen nor ibuprofen had a significant preventive effect against localized reactions to the fifth dose of the diphtheria-tetanus -acellular pertussis vaccine based on data from 372 children aged 4–6 years.

Dr. Lisa A. Jackson of the University of Washington, Seattle, and her colleagues conducted a randomized, blinded controlled trial within a larger safety study of the Tripedia DTaP vaccine. Dr. Jackson has served on the speakers' bureau for Sanofi Pasteur, which manufactures the vaccine and provided a research grant for the study (Pediatrics 2006;117:620–5).

The children were assigned to receive their first dose of 15 mg/kg of acetaminophen, with a maximum dose of 450 mg; 10 mg/kg of ibuprofen, with a maximum dose of 300 mg; or a placebo 2 hours before their scheduled vaccinations. The second and third doses were given at 6-hour intervals after vaccination, although an interval of up to 12 hours between consecutive doses was allowed. Overall, 90% of parents reported giving their child all three doses, and 70% reported giving all doses on schedule.

Overall, local reactions with an area of redness at least 2.5 cm in size occurred in 43% of the children. In addition, 49% reported some pain in the vaccinated limb and 23% reported some itching in the vaccinated limb during the 2 days after vaccination.