Miriam E. Tucker

PITTSBURGH – Medical costs and use of outpatient medical services are much greater among people with obsessive-compulsive disorder than among those with depression, according to the findings of a study that examined the differences in Florida Medicaid patients over a 9-year period.

The study, funded by Jazz Pharmaceuticals, looked at only those patients with “pure” OCD–that is, OCD uncomplicated by depression, bipolar disorder, or psychosis–and “pure” depression–depression in the absence of OCD, bipolar disorder, or psychosis. The findings suggest that much of the care for patients with OCD occurs in outpatient medical settings, said Cheryl S. Hankin, Ph.D., president and chief scientific officer of BioMedEcon Health, Economics, and Outcomes Research, Moss Beach, Calif.

Anecdotally, such OCD patients have appeared in a variety of medical settings, including primary care, dermatology (patients who compulsively pick at their skin or pull their hair), and in obstetrics (pregnant women who fear contamination or other harm to their unborn children), Dr. Hankin noted.

Of approximately 2.9 million Florida Medicaid enrollees during 1997–2006, 16,055 met the criteria for pure depression and 156 for pure OCD. Of those, 135 of the pure OCD patients were matched to 1,511 pure depression patients for sex, race/ethnicity, medical illness severity (Charlson index), and age/year at initial diagnosis.

During the 2 years after diagnosis of OCD or depression, median overall health care costs were more than three times higher in those with pure OCD ($25,666) than those with pure depression ($7,832). The differences were greater for pure OCD for both overall medical costs ($24,799 vs. $7056) and for overall psychiatric costs ($3390 vs. $943). Total inpatient costs did not differ between the two groups ($8,932 for pure OCD, $5,791 for pure depression). There were no psychiatric inpatient stays in either group, Dr. Hankin noted.

Despite matching for medical illness severity, total outpatient costs ($5,139 vs. $2,687) drove the cost differential, with most of that difference coming from outpatient medical costs ($4,820 vs. $2,525). Outpatient psychiatric costs between pure OCD ($220) and pure depression ($224) did not differ significantly. Total pharmacy costs were also significantly higher for the pure OCD patients ($5,741 vs. $2,548), the difference being driven mainly by psychiatric medication costs ($3,294 vs. $818), while the difference for other medical pharmacy costs did not differ significantly ($1,810 for pure OCD vs. $1,346 for pure depression).

Dr. Hankin and her associates are now investigating whether the pharmaceutical treatment of OCD is appropriate in primary care medical settings. Some data have suggested that 40%–50% of patients are treated inappropriately, either with the wrong drugs, for too short a duration, and/or at too low a dose.

PITTSBURGH – Medical costs and use of outpatient medical services are much greater among people with obsessive-compulsive disorder than among those with depression, according to the findings of a study that examined the differences in Florida Medicaid patients over a 9-year period.

The study, funded by Jazz Pharmaceuticals, looked at only those patients with “pure” OCD–that is, OCD uncomplicated by depression, bipolar disorder, or psychosis–and “pure” depression–depression in the absence of OCD, bipolar disorder, or psychosis. The findings suggest that much of the care for patients with OCD occurs in outpatient medical settings, said Cheryl S. Hankin, Ph.D., president and chief scientific officer of BioMedEcon Health, Economics, and Outcomes Research, Moss Beach, Calif.

Anecdotally, such OCD patients have appeared in a variety of medical settings, including primary care, dermatology (patients who compulsively pick at their skin or pull their hair), and in obstetrics (pregnant women who fear contamination or other harm to their unborn children), Dr. Hankin noted.

Of approximately 2.9 million Florida Medicaid enrollees during 1997–2006, 16,055 met the criteria for pure depression and 156 for pure OCD. Of those, 135 of the pure OCD patients were matched to 1,511 pure depression patients for sex, race/ethnicity, medical illness severity (Charlson index), and age/year at initial diagnosis.

During the 2 years after diagnosis of OCD or depression, median overall health care costs were more than three times higher in those with pure OCD ($25,666) than those with pure depression ($7,832). The differences were greater for pure OCD for both overall medical costs ($24,799 vs. $7056) and for overall psychiatric costs ($3390 vs. $943). Total inpatient costs did not differ between the two groups ($8,932 for pure OCD, $5,791 for pure depression). There were no psychiatric inpatient stays in either group, Dr. Hankin noted.

Despite matching for medical illness severity, total outpatient costs ($5,139 vs. $2,687) drove the cost differential, with most of that difference coming from outpatient medical costs ($4,820 vs. $2,525). Outpatient psychiatric costs between pure OCD ($220) and pure depression ($224) did not differ significantly. Total pharmacy costs were also significantly higher for the pure OCD patients ($5,741 vs. $2,548), the difference being driven mainly by psychiatric medication costs ($3,294 vs. $818), while the difference for other medical pharmacy costs did not differ significantly ($1,810 for pure OCD vs. $1,346 for pure depression).

Dr. Hankin and her associates are now investigating whether the pharmaceutical treatment of OCD is appropriate in primary care medical settings. Some data have suggested that 40%–50% of patients are treated inappropriately, either with the wrong drugs, for too short a duration, and/or at too low a dose.

PITTSBURGH – Medical costs and use of outpatient medical services are much greater among people with obsessive-compulsive disorder than among those with depression, according to the findings of a study that examined the differences in Florida Medicaid patients over a 9-year period.

The study, funded by Jazz Pharmaceuticals, looked at only those patients with “pure” OCD–that is, OCD uncomplicated by depression, bipolar disorder, or psychosis–and “pure” depression–depression in the absence of OCD, bipolar disorder, or psychosis. The findings suggest that much of the care for patients with OCD occurs in outpatient medical settings, said Cheryl S. Hankin, Ph.D., president and chief scientific officer of BioMedEcon Health, Economics, and Outcomes Research, Moss Beach, Calif.

Anecdotally, such OCD patients have appeared in a variety of medical settings, including primary care, dermatology (patients who compulsively pick at their skin or pull their hair), and in obstetrics (pregnant women who fear contamination or other harm to their unborn children), Dr. Hankin noted.

Of approximately 2.9 million Florida Medicaid enrollees during 1997–2006, 16,055 met the criteria for pure depression and 156 for pure OCD. Of those, 135 of the pure OCD patients were matched to 1,511 pure depression patients for sex, race/ethnicity, medical illness severity (Charlson index), and age/year at initial diagnosis.

During the 2 years after diagnosis of OCD or depression, median overall health care costs were more than three times higher in those with pure OCD ($25,666) than those with pure depression ($7,832). The differences were greater for pure OCD for both overall medical costs ($24,799 vs. $7056) and for overall psychiatric costs ($3390 vs. $943). Total inpatient costs did not differ between the two groups ($8,932 for pure OCD, $5,791 for pure depression). There were no psychiatric inpatient stays in either group, Dr. Hankin noted.

Despite matching for medical illness severity, total outpatient costs ($5,139 vs. $2,687) drove the cost differential, with most of that difference coming from outpatient medical costs ($4,820 vs. $2,525). Outpatient psychiatric costs between pure OCD ($220) and pure depression ($224) did not differ significantly. Total pharmacy costs were also significantly higher for the pure OCD patients ($5,741 vs. $2,548), the difference being driven mainly by psychiatric medication costs ($3,294 vs. $818), while the difference for other medical pharmacy costs did not differ significantly ($1,810 for pure OCD vs. $1,346 for pure depression).

Dr. Hankin and her associates are now investigating whether the pharmaceutical treatment of OCD is appropriate in primary care medical settings. Some data have suggested that 40%–50% of patients are treated inappropriately, either with the wrong drugs, for too short a duration, and/or at too low a dose.

WASHINGTON — Direct intra-arterial chemotherapy in children with advanced retinoblastoma preserved the eyes in 14 children and vision in 9 eyes, according to research presented at the annual meeting of the Society for Interventional Radiology.

Without the treatment, all affected eyes would have been destined for enucleation, said Dr. Pierre Gobin, professor of radiology and neurosurgery and director of the Division of Interventional Neuroradiology at New York-Presbyterian Hospital and Cornell University, New York.

A total of 22 children aged 1 month to 10 years (median age 2 years) with advanced retinoblastoma in a total of 23 eyes underwent catheterization of the ophthalmic artery via a femoral artery approach. The children were anesthetized and anticoagulated during the procedure. The chemotherapy agent melphalan was used initially in doses of 3.0–7.5 mg, but later switched to 3.5 mg and infused in combination with topotecan over a 30-minute period. The dose was a function of the eye size, not body surface area, Dr. Gobin noted.

Eleven children had bilateral retinoblastoma, with previous enucleation of the contralateral eye in 5. Eleven had previously received intravenous chemotherapy, and 8 had undergone external beam radiotherapy. Eleven patients were treatment naive. All but one had Reese-Ellsworth stage V; the remaining patient had a stage IB tumor on the macula.

Of the 20 who completed treatment (2 are still being treated), catheterization of the ophthalmic artery was possible in 18. Eleven patients underwent three treatments, 3 had two treatments, and the rest had more treatments (up to six). There were no procedure-related complications in the total of 64 procedures. There were no hospital admissions, infections, transfusions, or other complications commonly seen with intravenous chemotherapy.

Transient skin discoloration occurred in two patients. Retinopathy occurred in four patients, for whom it was determined the dose was too high and therefore was lowered in subsequent patients. An inflammatory reaction during the procedure predicted the development of retinopathy, Dr. Gobin noted.

The tumors were cured in 16 of 18 patients, with 14 able to keep the eye in place and 9 with restored vision. Treatment failed in two cases, including one in which there was tumor growth.

Dr. Gobin disclosed that he had no conflicts of interest.

WASHINGTON — Direct intra-arterial chemotherapy in children with advanced retinoblastoma preserved the eyes in 14 children and vision in 9 eyes, according to research presented at the annual meeting of the Society for Interventional Radiology.

Without the treatment, all affected eyes would have been destined for enucleation, said Dr. Pierre Gobin, professor of radiology and neurosurgery and director of the Division of Interventional Neuroradiology at New York-Presbyterian Hospital and Cornell University, New York.

A total of 22 children aged 1 month to 10 years (median age 2 years) with advanced retinoblastoma in a total of 23 eyes underwent catheterization of the ophthalmic artery via a femoral artery approach. The children were anesthetized and anticoagulated during the procedure. The chemotherapy agent melphalan was used initially in doses of 3.0–7.5 mg, but later switched to 3.5 mg and infused in combination with topotecan over a 30-minute period. The dose was a function of the eye size, not body surface area, Dr. Gobin noted.

Eleven children had bilateral retinoblastoma, with previous enucleation of the contralateral eye in 5. Eleven had previously received intravenous chemotherapy, and 8 had undergone external beam radiotherapy. Eleven patients were treatment naive. All but one had Reese-Ellsworth stage V; the remaining patient had a stage IB tumor on the macula.

Of the 20 who completed treatment (2 are still being treated), catheterization of the ophthalmic artery was possible in 18. Eleven patients underwent three treatments, 3 had two treatments, and the rest had more treatments (up to six). There were no procedure-related complications in the total of 64 procedures. There were no hospital admissions, infections, transfusions, or other complications commonly seen with intravenous chemotherapy.

Transient skin discoloration occurred in two patients. Retinopathy occurred in four patients, for whom it was determined the dose was too high and therefore was lowered in subsequent patients. An inflammatory reaction during the procedure predicted the development of retinopathy, Dr. Gobin noted.

The tumors were cured in 16 of 18 patients, with 14 able to keep the eye in place and 9 with restored vision. Treatment failed in two cases, including one in which there was tumor growth.

Dr. Gobin disclosed that he had no conflicts of interest.

WASHINGTON — Direct intra-arterial chemotherapy in children with advanced retinoblastoma preserved the eyes in 14 children and vision in 9 eyes, according to research presented at the annual meeting of the Society for Interventional Radiology.

Without the treatment, all affected eyes would have been destined for enucleation, said Dr. Pierre Gobin, professor of radiology and neurosurgery and director of the Division of Interventional Neuroradiology at New York-Presbyterian Hospital and Cornell University, New York.

A total of 22 children aged 1 month to 10 years (median age 2 years) with advanced retinoblastoma in a total of 23 eyes underwent catheterization of the ophthalmic artery via a femoral artery approach. The children were anesthetized and anticoagulated during the procedure. The chemotherapy agent melphalan was used initially in doses of 3.0–7.5 mg, but later switched to 3.5 mg and infused in combination with topotecan over a 30-minute period. The dose was a function of the eye size, not body surface area, Dr. Gobin noted.

Eleven children had bilateral retinoblastoma, with previous enucleation of the contralateral eye in 5. Eleven had previously received intravenous chemotherapy, and 8 had undergone external beam radiotherapy. Eleven patients were treatment naive. All but one had Reese-Ellsworth stage V; the remaining patient had a stage IB tumor on the macula.

Of the 20 who completed treatment (2 are still being treated), catheterization of the ophthalmic artery was possible in 18. Eleven patients underwent three treatments, 3 had two treatments, and the rest had more treatments (up to six). There were no procedure-related complications in the total of 64 procedures. There were no hospital admissions, infections, transfusions, or other complications commonly seen with intravenous chemotherapy.

Transient skin discoloration occurred in two patients. Retinopathy occurred in four patients, for whom it was determined the dose was too high and therefore was lowered in subsequent patients. An inflammatory reaction during the procedure predicted the development of retinopathy, Dr. Gobin noted.

The tumors were cured in 16 of 18 patients, with 14 able to keep the eye in place and 9 with restored vision. Treatment failed in two cases, including one in which there was tumor growth.

Dr. Gobin disclosed that he had no conflicts of interest.

WASHINGTON — Contrary to common belief, octogenarians can safely undergo diagnostic arteriography and arterial interventions as outpatient procedures.

That was the conclusion of a retrospective comparison of outpatient arterial procedures performed over 36 months (2005–2007) in 91 patients aged 80 years and above (mean 83.8) with those of 260 patients done in adults aged 50–79 years (mean 67.6) during the same time period by Dr. George G. Hartnell.

“Octogenarians seem to tolerate arteriography and arterial interventions as well as younger patients,” Dr. Hartnell, chief of cardiovascular and interventional radiology of Baystate Medical Center, Springfield, Mass., said at the annual meeting of the Society of Interventional Radiology.

The risks of diagnostic arteriography and arterial interventions are believed to increase with age. Some have suggested that patients in their 80s and older who require such procedures should be automatically admitted to the hospital, but it appears likely that in many cases, the procedures aren't offered to the very elderly at all. “Octogenarians may be inappropriately denied treatment because of the perceived high risk,” he said.

Because of that bias, octogenarians often are excluded—deliberately or unconsciously—from clinical trials of these procedures, so there is no database to guide interventionalists. “There should be more use of these procedures in the elderly, but data are lacking,” he remarked.

During the study period, 27% of the octogenarians underwent diagnostic arteriography (10 renal, 14 femoral, and 1 carotids/upper-extremity procedures), as did 43% of the 50–79 year old patients (30 renal, 46 femoral, 31 carotids/UE, and 7 mesenteric procedures).

Angiography/cryoplasty was performed in 19 octogenarians (21%) and 26 of the younger adults (10%). Stenting, with or without angioplasty, was done in 46 (51%) of the octogenarians (9 multivessel) and in 119 (46%) of the 50- to 79-year-olds (34 multivessel).

Patients of all ages were treated the same way, with closure devices used in less than 2% of all the interventions. “The routine or frequent use of closure devices is not necessary,” he commented.

The fact that the proportion of patients who underwent diagnostic arteriography was significantly lower among the 80-plus group (27% vs. 43%) probably reflects the bias: “They just don't get referred,” Dr. Hartnell remarked.

Reported rates of complications in the two age groups were very similar. Total events occurred in 5.5% of the octogenarians and 5.7% of the younger cohort, and major events requiring hospital admission in 2.2% and 2.3%, respectively. Worsening ischemia occurred in one younger patient and none of the older ones. There was one hematoma requiring admission among the octogenarians and two in the 50- to 79-year-olds, while hematomas of greater than 3 cm requiring no action occurred in three of the older group (3.3%) and six (2.3%) of the younger group. Heart failure developed in one younger patient and none of the older ones, and there were no deaths in either group, he reported.

These complication rates fall within the thresholds set by the Society of Interventional Radiology, which include an overall diagnostic arteriography threshold for major complications of no more than 1% (J. Vasc. Interv. Radiol. 2003;14:S283–8). Among the Society's upper limits for complications from percutaneous renal revascularization are 1% for 30-day mortality, 2% for renal artery occlusions and acute renal failure, and 5% for access site hematomas requiring surgery, transfusion, or prolonged hospital stay (J. Vasc. Interv. Radiol. 2003;14:S219–21).

WASHINGTON — Contrary to common belief, octogenarians can safely undergo diagnostic arteriography and arterial interventions as outpatient procedures.

That was the conclusion of a retrospective comparison of outpatient arterial procedures performed over 36 months (2005–2007) in 91 patients aged 80 years and above (mean 83.8) with those of 260 patients done in adults aged 50–79 years (mean 67.6) during the same time period by Dr. George G. Hartnell.

“Octogenarians seem to tolerate arteriography and arterial interventions as well as younger patients,” Dr. Hartnell, chief of cardiovascular and interventional radiology of Baystate Medical Center, Springfield, Mass., said at the annual meeting of the Society of Interventional Radiology.

The risks of diagnostic arteriography and arterial interventions are believed to increase with age. Some have suggested that patients in their 80s and older who require such procedures should be automatically admitted to the hospital, but it appears likely that in many cases, the procedures aren't offered to the very elderly at all. “Octogenarians may be inappropriately denied treatment because of the perceived high risk,” he said.

Because of that bias, octogenarians often are excluded—deliberately or unconsciously—from clinical trials of these procedures, so there is no database to guide interventionalists. “There should be more use of these procedures in the elderly, but data are lacking,” he remarked.

During the study period, 27% of the octogenarians underwent diagnostic arteriography (10 renal, 14 femoral, and 1 carotids/upper-extremity procedures), as did 43% of the 50–79 year old patients (30 renal, 46 femoral, 31 carotids/UE, and 7 mesenteric procedures).

Angiography/cryoplasty was performed in 19 octogenarians (21%) and 26 of the younger adults (10%). Stenting, with or without angioplasty, was done in 46 (51%) of the octogenarians (9 multivessel) and in 119 (46%) of the 50- to 79-year-olds (34 multivessel).

Patients of all ages were treated the same way, with closure devices used in less than 2% of all the interventions. “The routine or frequent use of closure devices is not necessary,” he commented.

The fact that the proportion of patients who underwent diagnostic arteriography was significantly lower among the 80-plus group (27% vs. 43%) probably reflects the bias: “They just don't get referred,” Dr. Hartnell remarked.

Reported rates of complications in the two age groups were very similar. Total events occurred in 5.5% of the octogenarians and 5.7% of the younger cohort, and major events requiring hospital admission in 2.2% and 2.3%, respectively. Worsening ischemia occurred in one younger patient and none of the older ones. There was one hematoma requiring admission among the octogenarians and two in the 50- to 79-year-olds, while hematomas of greater than 3 cm requiring no action occurred in three of the older group (3.3%) and six (2.3%) of the younger group. Heart failure developed in one younger patient and none of the older ones, and there were no deaths in either group, he reported.

These complication rates fall within the thresholds set by the Society of Interventional Radiology, which include an overall diagnostic arteriography threshold for major complications of no more than 1% (J. Vasc. Interv. Radiol. 2003;14:S283–8). Among the Society's upper limits for complications from percutaneous renal revascularization are 1% for 30-day mortality, 2% for renal artery occlusions and acute renal failure, and 5% for access site hematomas requiring surgery, transfusion, or prolonged hospital stay (J. Vasc. Interv. Radiol. 2003;14:S219–21).

WASHINGTON — Contrary to common belief, octogenarians can safely undergo diagnostic arteriography and arterial interventions as outpatient procedures.

That was the conclusion of a retrospective comparison of outpatient arterial procedures performed over 36 months (2005–2007) in 91 patients aged 80 years and above (mean 83.8) with those of 260 patients done in adults aged 50–79 years (mean 67.6) during the same time period by Dr. George G. Hartnell.

“Octogenarians seem to tolerate arteriography and arterial interventions as well as younger patients,” Dr. Hartnell, chief of cardiovascular and interventional radiology of Baystate Medical Center, Springfield, Mass., said at the annual meeting of the Society of Interventional Radiology.

The risks of diagnostic arteriography and arterial interventions are believed to increase with age. Some have suggested that patients in their 80s and older who require such procedures should be automatically admitted to the hospital, but it appears likely that in many cases, the procedures aren't offered to the very elderly at all. “Octogenarians may be inappropriately denied treatment because of the perceived high risk,” he said.

Because of that bias, octogenarians often are excluded—deliberately or unconsciously—from clinical trials of these procedures, so there is no database to guide interventionalists. “There should be more use of these procedures in the elderly, but data are lacking,” he remarked.

During the study period, 27% of the octogenarians underwent diagnostic arteriography (10 renal, 14 femoral, and 1 carotids/upper-extremity procedures), as did 43% of the 50–79 year old patients (30 renal, 46 femoral, 31 carotids/UE, and 7 mesenteric procedures).

Angiography/cryoplasty was performed in 19 octogenarians (21%) and 26 of the younger adults (10%). Stenting, with or without angioplasty, was done in 46 (51%) of the octogenarians (9 multivessel) and in 119 (46%) of the 50- to 79-year-olds (34 multivessel).

Patients of all ages were treated the same way, with closure devices used in less than 2% of all the interventions. “The routine or frequent use of closure devices is not necessary,” he commented.

The fact that the proportion of patients who underwent diagnostic arteriography was significantly lower among the 80-plus group (27% vs. 43%) probably reflects the bias: “They just don't get referred,” Dr. Hartnell remarked.

Reported rates of complications in the two age groups were very similar. Total events occurred in 5.5% of the octogenarians and 5.7% of the younger cohort, and major events requiring hospital admission in 2.2% and 2.3%, respectively. Worsening ischemia occurred in one younger patient and none of the older ones. There was one hematoma requiring admission among the octogenarians and two in the 50- to 79-year-olds, while hematomas of greater than 3 cm requiring no action occurred in three of the older group (3.3%) and six (2.3%) of the younger group. Heart failure developed in one younger patient and none of the older ones, and there were no deaths in either group, he reported.

These complication rates fall within the thresholds set by the Society of Interventional Radiology, which include an overall diagnostic arteriography threshold for major complications of no more than 1% (J. Vasc. Interv. Radiol. 2003;14:S283–8). Among the Society's upper limits for complications from percutaneous renal revascularization are 1% for 30-day mortality, 2% for renal artery occlusions and acute renal failure, and 5% for access site hematomas requiring surgery, transfusion, or prolonged hospital stay (J. Vasc. Interv. Radiol. 2003;14:S219–21).

ATLANTA — Supplies of human rabies biologicals for pre- or postexposure prophylaxis in the United States are “manageable, but are expected to be less than ideal” over the next few years, Charles E. Rupprecht, V.M.D., said at the winter meeting of the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention.

Since the meeting, ACIP has formed an ad hoc working group to address the problem. The group is discussing strategies for maximizing current supplies and devising algorithms for how to prioritize the vaccine and immune globulin in the event of an actual shortage, CDC spokeswoman Abbigail Tumpey said in an interview.

The CDC also is working on public education messages about when rabies vaccination is necessary and when it isn't, noted Dr. Rupprecht, chief of the CDC's rabies program, in his presentation at the meeting.

There are two human rabies vaccines and two rabies immunoglobulins (IGs) on the U.S. market. The vaccines are Sanofi-Pasteur Inc.'s human diploid cell vaccine Imovax and Novartis AG's purified chick embryo cell RabAvert. The IG products are Sanofi-Pasteur's IG Imogam Rabies-HT and Talecris Biotherapeutics' HyperRAB S/D.

Novartis' supply is limited and is being distributed for postexposure prophylaxis only. Phil Hosbach, vice president of immunization policy and government relations at Sanofi-Pasteur US, said the company has stepped in to fill the gap as much as possible, but can only supply a limited portion of the U.S. rabies vaccine market.

The overall supply of IG is limited because of human plasma shortages.

ATLANTA — Supplies of human rabies biologicals for pre- or postexposure prophylaxis in the United States are “manageable, but are expected to be less than ideal” over the next few years, Charles E. Rupprecht, V.M.D., said at the winter meeting of the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention.

Since the meeting, ACIP has formed an ad hoc working group to address the problem. The group is discussing strategies for maximizing current supplies and devising algorithms for how to prioritize the vaccine and immune globulin in the event of an actual shortage, CDC spokeswoman Abbigail Tumpey said in an interview.

The CDC also is working on public education messages about when rabies vaccination is necessary and when it isn't, noted Dr. Rupprecht, chief of the CDC's rabies program, in his presentation at the meeting.

There are two human rabies vaccines and two rabies immunoglobulins (IGs) on the U.S. market. The vaccines are Sanofi-Pasteur Inc.'s human diploid cell vaccine Imovax and Novartis AG's purified chick embryo cell RabAvert. The IG products are Sanofi-Pasteur's IG Imogam Rabies-HT and Talecris Biotherapeutics' HyperRAB S/D.

Novartis' supply is limited and is being distributed for postexposure prophylaxis only. Phil Hosbach, vice president of immunization policy and government relations at Sanofi-Pasteur US, said the company has stepped in to fill the gap as much as possible, but can only supply a limited portion of the U.S. rabies vaccine market.

The overall supply of IG is limited because of human plasma shortages.

ATLANTA — Supplies of human rabies biologicals for pre- or postexposure prophylaxis in the United States are “manageable, but are expected to be less than ideal” over the next few years, Charles E. Rupprecht, V.M.D., said at the winter meeting of the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention.

Since the meeting, ACIP has formed an ad hoc working group to address the problem. The group is discussing strategies for maximizing current supplies and devising algorithms for how to prioritize the vaccine and immune globulin in the event of an actual shortage, CDC spokeswoman Abbigail Tumpey said in an interview.

The CDC also is working on public education messages about when rabies vaccination is necessary and when it isn't, noted Dr. Rupprecht, chief of the CDC's rabies program, in his presentation at the meeting.

There are two human rabies vaccines and two rabies immunoglobulins (IGs) on the U.S. market. The vaccines are Sanofi-Pasteur Inc.'s human diploid cell vaccine Imovax and Novartis AG's purified chick embryo cell RabAvert. The IG products are Sanofi-Pasteur's IG Imogam Rabies-HT and Talecris Biotherapeutics' HyperRAB S/D.

Novartis' supply is limited and is being distributed for postexposure prophylaxis only. Phil Hosbach, vice president of immunization policy and government relations at Sanofi-Pasteur US, said the company has stepped in to fill the gap as much as possible, but can only supply a limited portion of the U.S. rabies vaccine market.

The overall supply of IG is limited because of human plasma shortages.

Attempts to translate hemoglobin A_1c into mean blood glucose via a mathematical formula are likely to introduce substantial error, according to data from an analysis of continuous glucose monitoring data in 47 children with type 1 diabetes.

A recent multinational trial identified a formula for converting HbA_1c to mean blood glucose, based on continuous glucose monitoring (CGM) data from 643 diabetic and nondiabetic subjects. Pending the final results of that study, the American Diabetes Association, the European Association for the Study of Diabetes, the International Federation of Clinical Chemistry and Laboratory Medicine, and the International Diabetes Federation have called for laboratories to report that mean glucose value in addition to the HbA_1c itself (Diabetes Care 2007;30:2399–400).

However, new data from the Diabetes Research in Children Network (DirectNet) Study Group suggest that although HbA_1c does clearly reflect mean glucose, there is substantial variability in individual mean glucose concentrations for a given HbA_1c value. Moreover, the strong relationship between HbA_1c and the risk for diabetic complications may reflect not only mean blood glucose but also a patient's propensity to glycosylate other structural proteins, said Dr. H. Peter Chase of the University of Colorado, Denver, and colleagues (Diabetes Care 2008;31:381–5).

The 47 patients, aged 4–18 years, included 28 pump users and 19 who took multiple daily injections using glargine as their basal insulin. They wore Abbott Laboratory's FreeStyle Navigator continuous glucose monitor for an average of 115 hr/wk. The slope of mean glucose over the previous 3 months was 18 mg/dL per 1.0% HbA_1c, with considerable variation in glucose concentrations for any given HbA_1c. This relationship was similar between the pump users and those taking injections, and at both 3-month and 6-month visits.

“For any given A_1c level, mean sensor glucose levels differed by up to 50 mg/dL or more, making the conversion of A_1c into mean glucose equivalents as suggested by a recent American Diabetes Association consensus statement tenuous at best,” the study group commented.

Two measures of a patient's rate of glycation—a simple ratio of mean glucose to HbA_1c and a derived “glycation index”—remained relatively constant over the 6 months of the study, suggesting that individuals glycate proteins at different rates and the tendency to be a fast or slow “glycator” persists over time.

After controlling for mean glucose over the previous 3 months, HbA_1c was not significantly associated with measures of glucose lability, thus refuting findings in other studies that high glucose values contribute disproportionately to the HbA_1c value. “We found no evidence to contradict the simple hypothesis that A_1c directly reflects the integral of glucose level over time,” they said.

The group cautioned that because children and adolescents may have higher glycemic variability than do adults, the findings may not be directly applicable to adult patients.

Funding for the study was provided by the National Institutes of Health; Abbott Diabetes Care provided the continuous glucose monitors and test strips.

Attempts to translate hemoglobin A_1c into mean blood glucose via a mathematical formula are likely to introduce substantial error, according to data from an analysis of continuous glucose monitoring data in 47 children with type 1 diabetes.

A recent multinational trial identified a formula for converting HbA_1c to mean blood glucose, based on continuous glucose monitoring (CGM) data from 643 diabetic and nondiabetic subjects. Pending the final results of that study, the American Diabetes Association, the European Association for the Study of Diabetes, the International Federation of Clinical Chemistry and Laboratory Medicine, and the International Diabetes Federation have called for laboratories to report that mean glucose value in addition to the HbA_1c itself (Diabetes Care 2007;30:2399–400).

However, new data from the Diabetes Research in Children Network (DirectNet) Study Group suggest that although HbA_1c does clearly reflect mean glucose, there is substantial variability in individual mean glucose concentrations for a given HbA_1c value. Moreover, the strong relationship between HbA_1c and the risk for diabetic complications may reflect not only mean blood glucose but also a patient's propensity to glycosylate other structural proteins, said Dr. H. Peter Chase of the University of Colorado, Denver, and colleagues (Diabetes Care 2008;31:381–5).

The 47 patients, aged 4–18 years, included 28 pump users and 19 who took multiple daily injections using glargine as their basal insulin. They wore Abbott Laboratory's FreeStyle Navigator continuous glucose monitor for an average of 115 hr/wk. The slope of mean glucose over the previous 3 months was 18 mg/dL per 1.0% HbA_1c, with considerable variation in glucose concentrations for any given HbA_1c. This relationship was similar between the pump users and those taking injections, and at both 3-month and 6-month visits.

“For any given A_1c level, mean sensor glucose levels differed by up to 50 mg/dL or more, making the conversion of A_1c into mean glucose equivalents as suggested by a recent American Diabetes Association consensus statement tenuous at best,” the study group commented.

Two measures of a patient's rate of glycation—a simple ratio of mean glucose to HbA_1c and a derived “glycation index”—remained relatively constant over the 6 months of the study, suggesting that individuals glycate proteins at different rates and the tendency to be a fast or slow “glycator” persists over time.

After controlling for mean glucose over the previous 3 months, HbA_1c was not significantly associated with measures of glucose lability, thus refuting findings in other studies that high glucose values contribute disproportionately to the HbA_1c value. “We found no evidence to contradict the simple hypothesis that A_1c directly reflects the integral of glucose level over time,” they said.

The group cautioned that because children and adolescents may have higher glycemic variability than do adults, the findings may not be directly applicable to adult patients.

Funding for the study was provided by the National Institutes of Health; Abbott Diabetes Care provided the continuous glucose monitors and test strips.

Attempts to translate hemoglobin A_1c into mean blood glucose via a mathematical formula are likely to introduce substantial error, according to data from an analysis of continuous glucose monitoring data in 47 children with type 1 diabetes.

A recent multinational trial identified a formula for converting HbA_1c to mean blood glucose, based on continuous glucose monitoring (CGM) data from 643 diabetic and nondiabetic subjects. Pending the final results of that study, the American Diabetes Association, the European Association for the Study of Diabetes, the International Federation of Clinical Chemistry and Laboratory Medicine, and the International Diabetes Federation have called for laboratories to report that mean glucose value in addition to the HbA_1c itself (Diabetes Care 2007;30:2399–400).

However, new data from the Diabetes Research in Children Network (DirectNet) Study Group suggest that although HbA_1c does clearly reflect mean glucose, there is substantial variability in individual mean glucose concentrations for a given HbA_1c value. Moreover, the strong relationship between HbA_1c and the risk for diabetic complications may reflect not only mean blood glucose but also a patient's propensity to glycosylate other structural proteins, said Dr. H. Peter Chase of the University of Colorado, Denver, and colleagues (Diabetes Care 2008;31:381–5).

The 47 patients, aged 4–18 years, included 28 pump users and 19 who took multiple daily injections using glargine as their basal insulin. They wore Abbott Laboratory's FreeStyle Navigator continuous glucose monitor for an average of 115 hr/wk. The slope of mean glucose over the previous 3 months was 18 mg/dL per 1.0% HbA_1c, with considerable variation in glucose concentrations for any given HbA_1c. This relationship was similar between the pump users and those taking injections, and at both 3-month and 6-month visits.

“For any given A_1c level, mean sensor glucose levels differed by up to 50 mg/dL or more, making the conversion of A_1c into mean glucose equivalents as suggested by a recent American Diabetes Association consensus statement tenuous at best,” the study group commented.

Two measures of a patient's rate of glycation—a simple ratio of mean glucose to HbA_1c and a derived “glycation index”—remained relatively constant over the 6 months of the study, suggesting that individuals glycate proteins at different rates and the tendency to be a fast or slow “glycator” persists over time.

After controlling for mean glucose over the previous 3 months, HbA_1c was not significantly associated with measures of glucose lability, thus refuting findings in other studies that high glucose values contribute disproportionately to the HbA_1c value. “We found no evidence to contradict the simple hypothesis that A_1c directly reflects the integral of glucose level over time,” they said.

The group cautioned that because children and adolescents may have higher glycemic variability than do adults, the findings may not be directly applicable to adult patients.

Funding for the study was provided by the National Institutes of Health; Abbott Diabetes Care provided the continuous glucose monitors and test strips.

Men with erectile dysfunction should be screened for thyroid disease before any ED-specific treatment is prescribed, researchers concluded based on a study of men treated at a thyroid clinic.

Among men with ED in whom thyroid dysfunction is identified and treated, specific ED treatment with selective phosphodiesterase-5 (PDE-5) inhibitors should be postponed for at least 6 months after euthyroidism is achieved because the thyroid problem may have been principally responsible for the ED, said Dr. Gerasimos E. Krassas of Panagia General Hospital, Thessaloniki, Greece, and his associates.

The study included 71 men (mean age 51 years) who presented to a thyroid clinic, 27 of whom had clinical hyperthyroidism (18 with Graves' disease, 9 toxic nodular or multinodular goiter) and 44 with clinical hypothyroidism (thyroid-stimulating hormone greater than 10 mU/L), including 37 with positive thyroid antibodies, they reported online in the Journal of Clinical Endocrinology and Metabolism (doi:10.1210/jc.2007-2259).

None of the patients were on thyroid medication prior to the study. Patients with diabetes, cardiovascular, or urological diseases were excluded, as were those with abnormal levels of total testosterone or sex hormone binding globulin. A similar number of age-matched normal men were recruited as controls.

All of the subjects filled out the validated Sexual Health Inventory for Males (SHIM), a five-item questionnaire that assesses a man's ability to attain and then maintain an erection. Scores of 21 or less, indicating some degree of ED, were found in 79% of the men with thyroid dysfunction (19 were hyperthyroid and 37 were hypothyroid), compared with 34% of the controls, a significant difference.

Among the men with any degree of ED, 38% of those with thyroid dysfunction had SHIM scores of 10 or less, indicative of severe ED, compared with 25% of the controls. Of the 21 patients with severe ED, 8 were hyperthyroid and 13 hypothyroid.

There was no difference in SHIM scores between hyperthyroid and hypothyroid patients. In the patients with hypothyroidism, SHIM scored correlated positively with free thyroxine (FT4) levels and negatively with thyroid-stimulating hormone (TSH) levels. In contrast, SHIM scores did not correlate with either FT4 or TSH levels in patients with hyperthyroidism, Dr. Krassas and his associates reported.

Scores on the SHIM improved significantly at 1 year after treatment of the thyroid dysfunction: Only 20 of the patients—7 with hyperthyroid and 13 hypothyroid—still had SHIM scores of 21 or less, and of those, only 7 had severe ED (SHIM less than 10), proportions similar to those among the controls.

In addition, no difference was found between hypothyroid patients having positive thyroid antibodies and those with negative antibodies, nor between patients with Graves' disease and those with nodular or multinodular toxic goiter, they said.

Men with erectile dysfunction should be screened for thyroid disease before any ED-specific treatment is prescribed, researchers concluded based on a study of men treated at a thyroid clinic.

Among men with ED in whom thyroid dysfunction is identified and treated, specific ED treatment with selective phosphodiesterase-5 (PDE-5) inhibitors should be postponed for at least 6 months after euthyroidism is achieved because the thyroid problem may have been principally responsible for the ED, said Dr. Gerasimos E. Krassas of Panagia General Hospital, Thessaloniki, Greece, and his associates.

The study included 71 men (mean age 51 years) who presented to a thyroid clinic, 27 of whom had clinical hyperthyroidism (18 with Graves' disease, 9 toxic nodular or multinodular goiter) and 44 with clinical hypothyroidism (thyroid-stimulating hormone greater than 10 mU/L), including 37 with positive thyroid antibodies, they reported online in the Journal of Clinical Endocrinology and Metabolism (doi:10.1210/jc.2007-2259).

None of the patients were on thyroid medication prior to the study. Patients with diabetes, cardiovascular, or urological diseases were excluded, as were those with abnormal levels of total testosterone or sex hormone binding globulin. A similar number of age-matched normal men were recruited as controls.

All of the subjects filled out the validated Sexual Health Inventory for Males (SHIM), a five-item questionnaire that assesses a man's ability to attain and then maintain an erection. Scores of 21 or less, indicating some degree of ED, were found in 79% of the men with thyroid dysfunction (19 were hyperthyroid and 37 were hypothyroid), compared with 34% of the controls, a significant difference.

Among the men with any degree of ED, 38% of those with thyroid dysfunction had SHIM scores of 10 or less, indicative of severe ED, compared with 25% of the controls. Of the 21 patients with severe ED, 8 were hyperthyroid and 13 hypothyroid.

There was no difference in SHIM scores between hyperthyroid and hypothyroid patients. In the patients with hypothyroidism, SHIM scored correlated positively with free thyroxine (FT4) levels and negatively with thyroid-stimulating hormone (TSH) levels. In contrast, SHIM scores did not correlate with either FT4 or TSH levels in patients with hyperthyroidism, Dr. Krassas and his associates reported.

Scores on the SHIM improved significantly at 1 year after treatment of the thyroid dysfunction: Only 20 of the patients—7 with hyperthyroid and 13 hypothyroid—still had SHIM scores of 21 or less, and of those, only 7 had severe ED (SHIM less than 10), proportions similar to those among the controls.

In addition, no difference was found between hypothyroid patients having positive thyroid antibodies and those with negative antibodies, nor between patients with Graves' disease and those with nodular or multinodular toxic goiter, they said.

Men with erectile dysfunction should be screened for thyroid disease before any ED-specific treatment is prescribed, researchers concluded based on a study of men treated at a thyroid clinic.

Among men with ED in whom thyroid dysfunction is identified and treated, specific ED treatment with selective phosphodiesterase-5 (PDE-5) inhibitors should be postponed for at least 6 months after euthyroidism is achieved because the thyroid problem may have been principally responsible for the ED, said Dr. Gerasimos E. Krassas of Panagia General Hospital, Thessaloniki, Greece, and his associates.

The study included 71 men (mean age 51 years) who presented to a thyroid clinic, 27 of whom had clinical hyperthyroidism (18 with Graves' disease, 9 toxic nodular or multinodular goiter) and 44 with clinical hypothyroidism (thyroid-stimulating hormone greater than 10 mU/L), including 37 with positive thyroid antibodies, they reported online in the Journal of Clinical Endocrinology and Metabolism (doi:10.1210/jc.2007-2259).

None of the patients were on thyroid medication prior to the study. Patients with diabetes, cardiovascular, or urological diseases were excluded, as were those with abnormal levels of total testosterone or sex hormone binding globulin. A similar number of age-matched normal men were recruited as controls.

All of the subjects filled out the validated Sexual Health Inventory for Males (SHIM), a five-item questionnaire that assesses a man's ability to attain and then maintain an erection. Scores of 21 or less, indicating some degree of ED, were found in 79% of the men with thyroid dysfunction (19 were hyperthyroid and 37 were hypothyroid), compared with 34% of the controls, a significant difference.

Among the men with any degree of ED, 38% of those with thyroid dysfunction had SHIM scores of 10 or less, indicative of severe ED, compared with 25% of the controls. Of the 21 patients with severe ED, 8 were hyperthyroid and 13 hypothyroid.

There was no difference in SHIM scores between hyperthyroid and hypothyroid patients. In the patients with hypothyroidism, SHIM scored correlated positively with free thyroxine (FT4) levels and negatively with thyroid-stimulating hormone (TSH) levels. In contrast, SHIM scores did not correlate with either FT4 or TSH levels in patients with hyperthyroidism, Dr. Krassas and his associates reported.

Scores on the SHIM improved significantly at 1 year after treatment of the thyroid dysfunction: Only 20 of the patients—7 with hyperthyroid and 13 hypothyroid—still had SHIM scores of 21 or less, and of those, only 7 had severe ED (SHIM less than 10), proportions similar to those among the controls.

In addition, no difference was found between hypothyroid patients having positive thyroid antibodies and those with negative antibodies, nor between patients with Graves' disease and those with nodular or multinodular toxic goiter, they said.

WASHINGTON — Financial assistance is available to patients struggling with costs of the new—and extremely expensive—targeted therapies for renal cell carcinoma as well as other advanced cancers, Mr. James Goetz said at the annual Community Oncology Conference.

As far as the patient is concerned, the approved agents sunitinib (Sutent), sorafenib (Nexavar), and temsirolimus (Torisel) are all in the same cost ballpark, with each resulting in a bill of about $135,000 for a 6-month regimen at St. Luke's Hospital and Health Network in Bethlehem, Pa., where Mr. Goetz is the network administrator of the Oncology Service Line.

"We're seeing more and more patients on Medicare without secondary insurance, those who are underinsured, and who have no insurance. … The onus of these expensive drugs is on the patient," he said.

But there are places to turn for help, according to Mr. Goetz. First, all the manufacturers offer patient assistance programs, accessible on their Web sites (www.sutent.comwww.nexavar.comwww.torisel.com

Nonprofit organizations can help fill in the gaps. A highly recommended resource is the Patient Advocate Foundation (PAF; www.patientadvocate.org

The foundation employs professional case managers and attorneys to assist patients with a wide range of access-to-care issues, including pre-authorization, insurance appeals, and assistance with expedited applications for Social Security disability, Medicare, Medicaid, SCHIPs, and other programs. It also provides assistance with job retention, debt crisis, housing, transportation to medical treatment, and child care. In addition, it offers a "Co-Pay Relief" program for those who are already insured, and an assistance program geared specifically to patients with colorectal cancer. "The PAF is a great resource that we give to many of our patients," Mr. Goetz said.

Other potentially helpful nonprofit patient assistance organizations listed by Mr. Goetz include the following:

▸ Patient Access Network Foundation (www.patientaccessnetwork.org

▸ Healthwell Foundation (www.healthwellfoundation.org

▸ Cancer Care (www.cancercare.org

Mr. Goetz declared no financial interest in any of the relevant manufacturers. SKIN & ALLERGY NEWS and Community Oncology are both published by Elsevier.

WASHINGTON — Financial assistance is available to patients struggling with costs of the new—and extremely expensive—targeted therapies for renal cell carcinoma as well as other advanced cancers, Mr. James Goetz said at the annual Community Oncology Conference.

As far as the patient is concerned, the approved agents sunitinib (Sutent), sorafenib (Nexavar), and temsirolimus (Torisel) are all in the same cost ballpark, with each resulting in a bill of about $135,000 for a 6-month regimen at St. Luke's Hospital and Health Network in Bethlehem, Pa., where Mr. Goetz is the network administrator of the Oncology Service Line.

"We're seeing more and more patients on Medicare without secondary insurance, those who are underinsured, and who have no insurance. … The onus of these expensive drugs is on the patient," he said.

But there are places to turn for help, according to Mr. Goetz. First, all the manufacturers offer patient assistance programs, accessible on their Web sites (www.sutent.comwww.nexavar.comwww.torisel.com

Nonprofit organizations can help fill in the gaps. A highly recommended resource is the Patient Advocate Foundation (PAF; www.patientadvocate.org

The foundation employs professional case managers and attorneys to assist patients with a wide range of access-to-care issues, including pre-authorization, insurance appeals, and assistance with expedited applications for Social Security disability, Medicare, Medicaid, SCHIPs, and other programs. It also provides assistance with job retention, debt crisis, housing, transportation to medical treatment, and child care. In addition, it offers a "Co-Pay Relief" program for those who are already insured, and an assistance program geared specifically to patients with colorectal cancer. "The PAF is a great resource that we give to many of our patients," Mr. Goetz said.

Other potentially helpful nonprofit patient assistance organizations listed by Mr. Goetz include the following:

▸ Patient Access Network Foundation (www.patientaccessnetwork.org

▸ Healthwell Foundation (www.healthwellfoundation.org

▸ Cancer Care (www.cancercare.org

Mr. Goetz declared no financial interest in any of the relevant manufacturers. SKIN & ALLERGY NEWS and Community Oncology are both published by Elsevier.

WASHINGTON — Financial assistance is available to patients struggling with costs of the new—and extremely expensive—targeted therapies for renal cell carcinoma as well as other advanced cancers, Mr. James Goetz said at the annual Community Oncology Conference.

As far as the patient is concerned, the approved agents sunitinib (Sutent), sorafenib (Nexavar), and temsirolimus (Torisel) are all in the same cost ballpark, with each resulting in a bill of about $135,000 for a 6-month regimen at St. Luke's Hospital and Health Network in Bethlehem, Pa., where Mr. Goetz is the network administrator of the Oncology Service Line.

"We're seeing more and more patients on Medicare without secondary insurance, those who are underinsured, and who have no insurance. … The onus of these expensive drugs is on the patient," he said.

But there are places to turn for help, according to Mr. Goetz. First, all the manufacturers offer patient assistance programs, accessible on their Web sites (www.sutent.comwww.nexavar.comwww.torisel.com

Nonprofit organizations can help fill in the gaps. A highly recommended resource is the Patient Advocate Foundation (PAF; www.patientadvocate.org

The foundation employs professional case managers and attorneys to assist patients with a wide range of access-to-care issues, including pre-authorization, insurance appeals, and assistance with expedited applications for Social Security disability, Medicare, Medicaid, SCHIPs, and other programs. It also provides assistance with job retention, debt crisis, housing, transportation to medical treatment, and child care. In addition, it offers a "Co-Pay Relief" program for those who are already insured, and an assistance program geared specifically to patients with colorectal cancer. "The PAF is a great resource that we give to many of our patients," Mr. Goetz said.

Other potentially helpful nonprofit patient assistance organizations listed by Mr. Goetz include the following:

▸ Patient Access Network Foundation (www.patientaccessnetwork.org

▸ Healthwell Foundation (www.healthwellfoundation.org

▸ Cancer Care (www.cancercare.org

Mr. Goetz declared no financial interest in any of the relevant manufacturers. SKIN & ALLERGY NEWS and Community Oncology are both published by Elsevier.

ATLANTA — Full immunization against influenza is about 75% effective in preventing hospitalizations in 6- to 23-month-old children, Dr. David Shay said at the winter meeting of the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention.

The ACIP's recommendation for annual influenza immunization for all children aged 6–23 months beginning in the 2004–2005 influenza season was based on the burden of disease in that age group and the fact that hospitalization rates among this age group were similar to those among the elderly, for whom annual flu vaccination was already recommended. However, no previous study has assessed the effectiveness of the trivalent inactivated vaccine (TIV) in preventing laboratory-confirmed hospitalizations in this age group, said Dr. Shay of the CDC's National Center for Immunization and Respiratory Diseases, Influenza Division.

Now, a multistate case-control study conducted during the 2005–2006 and 2006–2007 flu seasons has confirmed that TIV indeed prevents influenza-related hospitalizations in 6- to 23-month-olds, but only if they receive “full” immunization. “Partial immunization was less effective, and not significantly protective, based on two seasons of data. It is critical to ensure that children aged 6–23 months are fully immunized if we seek to prevent influenza-associated hospitalizations among children,” Dr. Shay commented.

The data were analyzed using the 2007 definition of “full” immunization, which is more stringent than it had been during the study period: The child must have received two doses during the current season if they had never previously received TIV or if they had received only one dose in the previous season. A child who received just one dose in the current season would be considered “fully” immunized if he or she received two doses in a single prior season or had one dose in two or more prior seasons.

The study population comprised 93 of a total 191 eligible 6- to 23-month-old children who were hospitalized with laboratory-confirmed influenza (85% type A, 12% B, and 3% unknown), identified at eight U.S. state health department surveillance sites, and 334 age-matched controls. Cases and controls also were well matched by gender (56% of cases and 52% of controls were male) and by race (72% and 80% were white, respectively).

During the 2005–2006 season, only 9% of cases were fully immunized, compared with 20% of controls. Sixty-seven percent of cases were not immunized, compared with 55% of controls, while about a quarter of both groups was partially immunized. In 2006–2007, only 13% of cases had been immunized, compared with 32% of controls, while 65% of cases were not immunized vs. 38% of controls. Again, the rates of partial immunization were similar, 23% among cases and 30% among controls. (Cumulative percentages might exceed 100% because of rounding.)

Overall effectiveness of TIV in preventing hospitalization was 74% for full immunization, compared with just 39% for partial immunization. Adjustment for high-risk conditions, very low birth weight, and insurance status did not significantly change the result for full immunization (76%), but it dropped the effectiveness of partial immunization to just 27%, Dr. Shay reported.

After Dr. Shay's presentation, ACIP member Dr. Carol J. Baker urged meeting participants to inform their constituencies of the importance of giving two doses in the 6- to 23-month age group, even if it means vaccinating late into the season. “We have created a culture of stopping vaccination in late November, early December. … That mentality must change,” said Dr. Baker, professor of pediatrics, molecular virology, and microbiology at Baylor College of Medicine, Houston.

ATLANTA — Full immunization against influenza is about 75% effective in preventing hospitalizations in 6- to 23-month-old children, Dr. David Shay said at the winter meeting of the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention.

The ACIP's recommendation for annual influenza immunization for all children aged 6–23 months beginning in the 2004–2005 influenza season was based on the burden of disease in that age group and the fact that hospitalization rates among this age group were similar to those among the elderly, for whom annual flu vaccination was already recommended. However, no previous study has assessed the effectiveness of the trivalent inactivated vaccine (TIV) in preventing laboratory-confirmed hospitalizations in this age group, said Dr. Shay of the CDC's National Center for Immunization and Respiratory Diseases, Influenza Division.

Now, a multistate case-control study conducted during the 2005–2006 and 2006–2007 flu seasons has confirmed that TIV indeed prevents influenza-related hospitalizations in 6- to 23-month-olds, but only if they receive “full” immunization. “Partial immunization was less effective, and not significantly protective, based on two seasons of data. It is critical to ensure that children aged 6–23 months are fully immunized if we seek to prevent influenza-associated hospitalizations among children,” Dr. Shay commented.

The data were analyzed using the 2007 definition of “full” immunization, which is more stringent than it had been during the study period: The child must have received two doses during the current season if they had never previously received TIV or if they had received only one dose in the previous season. A child who received just one dose in the current season would be considered “fully” immunized if he or she received two doses in a single prior season or had one dose in two or more prior seasons.

The study population comprised 93 of a total 191 eligible 6- to 23-month-old children who were hospitalized with laboratory-confirmed influenza (85% type A, 12% B, and 3% unknown), identified at eight U.S. state health department surveillance sites, and 334 age-matched controls. Cases and controls also were well matched by gender (56% of cases and 52% of controls were male) and by race (72% and 80% were white, respectively).

During the 2005–2006 season, only 9% of cases were fully immunized, compared with 20% of controls. Sixty-seven percent of cases were not immunized, compared with 55% of controls, while about a quarter of both groups was partially immunized. In 2006–2007, only 13% of cases had been immunized, compared with 32% of controls, while 65% of cases were not immunized vs. 38% of controls. Again, the rates of partial immunization were similar, 23% among cases and 30% among controls. (Cumulative percentages might exceed 100% because of rounding.)

Overall effectiveness of TIV in preventing hospitalization was 74% for full immunization, compared with just 39% for partial immunization. Adjustment for high-risk conditions, very low birth weight, and insurance status did not significantly change the result for full immunization (76%), but it dropped the effectiveness of partial immunization to just 27%, Dr. Shay reported.

After Dr. Shay's presentation, ACIP member Dr. Carol J. Baker urged meeting participants to inform their constituencies of the importance of giving two doses in the 6- to 23-month age group, even if it means vaccinating late into the season. “We have created a culture of stopping vaccination in late November, early December. … That mentality must change,” said Dr. Baker, professor of pediatrics, molecular virology, and microbiology at Baylor College of Medicine, Houston.

ATLANTA — Full immunization against influenza is about 75% effective in preventing hospitalizations in 6- to 23-month-old children, Dr. David Shay said at the winter meeting of the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention.

The ACIP's recommendation for annual influenza immunization for all children aged 6–23 months beginning in the 2004–2005 influenza season was based on the burden of disease in that age group and the fact that hospitalization rates among this age group were similar to those among the elderly, for whom annual flu vaccination was already recommended. However, no previous study has assessed the effectiveness of the trivalent inactivated vaccine (TIV) in preventing laboratory-confirmed hospitalizations in this age group, said Dr. Shay of the CDC's National Center for Immunization and Respiratory Diseases, Influenza Division.

Now, a multistate case-control study conducted during the 2005–2006 and 2006–2007 flu seasons has confirmed that TIV indeed prevents influenza-related hospitalizations in 6- to 23-month-olds, but only if they receive “full” immunization. “Partial immunization was less effective, and not significantly protective, based on two seasons of data. It is critical to ensure that children aged 6–23 months are fully immunized if we seek to prevent influenza-associated hospitalizations among children,” Dr. Shay commented.

The data were analyzed using the 2007 definition of “full” immunization, which is more stringent than it had been during the study period: The child must have received two doses during the current season if they had never previously received TIV or if they had received only one dose in the previous season. A child who received just one dose in the current season would be considered “fully” immunized if he or she received two doses in a single prior season or had one dose in two or more prior seasons.

The study population comprised 93 of a total 191 eligible 6- to 23-month-old children who were hospitalized with laboratory-confirmed influenza (85% type A, 12% B, and 3% unknown), identified at eight U.S. state health department surveillance sites, and 334 age-matched controls. Cases and controls also were well matched by gender (56% of cases and 52% of controls were male) and by race (72% and 80% were white, respectively).

During the 2005–2006 season, only 9% of cases were fully immunized, compared with 20% of controls. Sixty-seven percent of cases were not immunized, compared with 55% of controls, while about a quarter of both groups was partially immunized. In 2006–2007, only 13% of cases had been immunized, compared with 32% of controls, while 65% of cases were not immunized vs. 38% of controls. Again, the rates of partial immunization were similar, 23% among cases and 30% among controls. (Cumulative percentages might exceed 100% because of rounding.)

Overall effectiveness of TIV in preventing hospitalization was 74% for full immunization, compared with just 39% for partial immunization. Adjustment for high-risk conditions, very low birth weight, and insurance status did not significantly change the result for full immunization (76%), but it dropped the effectiveness of partial immunization to just 27%, Dr. Shay reported.

After Dr. Shay's presentation, ACIP member Dr. Carol J. Baker urged meeting participants to inform their constituencies of the importance of giving two doses in the 6- to 23-month age group, even if it means vaccinating late into the season. “We have created a culture of stopping vaccination in late November, early December. … That mentality must change,” said Dr. Baker, professor of pediatrics, molecular virology, and microbiology at Baylor College of Medicine, Houston.

WASHINGTON — Collaboration between oncologists and primary care physicians can ensure seamless care for cancer patients, according to a hematologist and a family practice physician who gave a joint presentation at the annual Community Oncology Conference.

Routine use of printed forms can facilitate exchange of important information, Dr. Leslie R. Laufman and Dr. Mary Beth Hall advised, outlining a blueprint for cooperation.

They counseled, however, that even when forms are used, there will be times when one provider or the other needs to pick up the phone and initiate discussion of a patient's medical treatment and/or psychosocial issues.

Communication between a cancer patient's oncologist and primary care physician is critical, but in many cases it isn't carried out effectively, said Dr. Laufman of Ohio State University, Columbus, who is also in private practice in oncology in Columbus, and Dr. Hall, a family physician in private practice in Newark, Ohio.

Many aspects of the “division of labor” were described as straightforward:

▸ The oncologist handles the cancer status definition, the cancer treatment plan, urgent care during treatment, the unique side effects of the chemotherapy agents, and possibly entering patients into clinical trials.

▸ The primary care physician provides ongoing medical care for noncancer health issues, helps manage psychosocial issues that either predate or accompany the cancer diagnosis, helps with family-related issues, and possibly plays a role in palliative care.

The primary care physician needs to receive timely information from the oncologist regarding the patient's initial consultation, including diagnosis, prognosis, treatment plan and objectives, likely toxicities or cancer-related problems, and plans for home care. “We are very anxious to hear how the patient is going to do,” Dr. Hall said.

Access to educational materials—such as newsletters or links to Internet sites—would be very helpful, as would the oncologist's direct telephone number, she added. “I promise we won't abuse it. It just comes in handy to have it right there in the patient's chart so that we can do a rapid phone consult. … And it works both ways. The oncologist needs our phone number too.”

Any hospitalization plans, as well as the patient's advance directive status, should be provided to the primary care physician. It is important to spell out ahead of time which physician will manage the patient in the hospital or whether the two will collaborate.

Some aspects of a cancer patient's care might present a conflict or be overlooked unless they are anticipated and addressed. Among these are the management of pain, depression, or insomnia that develops in response to the cancer or its treatment, hospitalization for acute toxicities, long-term follow-up, and screening for new primary cancers.

“Who tells the patient about needing a colonoscopy if they have breast cancer? One may assume the other is doing that,” Dr. Hall noted as an example.

Both physicians should ask patients whether they are taking any type of alternative treatments that could interact with their prescribed agents, and should inform the other physician if they are. St. John's wort is a common one that some patients take for depression but that can also cause bleeding.

“Patients don't always tell you. You have to ask them,” she said.

Much of the communication between the two physicians can be accomplished through printed forms.

A recommended template for such letters was developed by Dr. Ted C. Braun and his associates at the Tom Baker Cancer Centre, a large tertiary referral center in Calgary, Alta. (Can. Family Physician 2003;49:884).

Dr. Laufman discussed a single-page (front and back) “precertification” form that she uses both as an in-house communication tool within her three-oncologist practice and also with the patient's primary care physician.

The form includes items to be circled and lines to be filled in for treatment goals and options, patient status, and comorbidities, along with documentation of what the patient has been taught and of consent to treatment.

The physician fills out his or her part of the form, signs off, and then forwards it to the nurses who do the same when they conduct patient teaching. It then goes to the billing department to ensure likely coverage for treatment before it is sent to the pharmacy technician for drug dispensing.

Formal chemotherapy orders are listed for the entire duration of therapy, with information about doses, schedule, lab parameters, and premedications, along with a formal amendment procedure for any changes. The patient also signs it. The whole form also serves as a legal document, Dr. Laufman said.

A version of the form is then sent, along with a cover letter, to the primary care physician. “This is one of the things that makes our practice work very, very well,” she said.

Although forms can go a long way in facilitating communication between providers, there will be urgent situations that require a phone call. These include a suicidal patient, a hospital admission, or when the oncologist starts a diabetic patient on steroids or changes the steroid dosage.

An atypical symptom that might represent a reaction to a nononcology drug also should signal the oncologist to pick up the phone, Dr. Laufman said.

WASHINGTON — Collaboration between oncologists and primary care physicians can ensure seamless care for cancer patients, according to a hematologist and a family practice physician who gave a joint presentation at the annual Community Oncology Conference.

Routine use of printed forms can facilitate exchange of important information, Dr. Leslie R. Laufman and Dr. Mary Beth Hall advised, outlining a blueprint for cooperation.

They counseled, however, that even when forms are used, there will be times when one provider or the other needs to pick up the phone and initiate discussion of a patient's medical treatment and/or psychosocial issues.

Communication between a cancer patient's oncologist and primary care physician is critical, but in many cases it isn't carried out effectively, said Dr. Laufman of Ohio State University, Columbus, who is also in private practice in oncology in Columbus, and Dr. Hall, a family physician in private practice in Newark, Ohio.

Many aspects of the “division of labor” were described as straightforward:

▸ The oncologist handles the cancer status definition, the cancer treatment plan, urgent care during treatment, the unique side effects of the chemotherapy agents, and possibly entering patients into clinical trials.

▸ The primary care physician provides ongoing medical care for noncancer health issues, helps manage psychosocial issues that either predate or accompany the cancer diagnosis, helps with family-related issues, and possibly plays a role in palliative care.

The primary care physician needs to receive timely information from the oncologist regarding the patient's initial consultation, including diagnosis, prognosis, treatment plan and objectives, likely toxicities or cancer-related problems, and plans for home care. “We are very anxious to hear how the patient is going to do,” Dr. Hall said.

Access to educational materials—such as newsletters or links to Internet sites—would be very helpful, as would the oncologist's direct telephone number, she added. “I promise we won't abuse it. It just comes in handy to have it right there in the patient's chart so that we can do a rapid phone consult. … And it works both ways. The oncologist needs our phone number too.”

Any hospitalization plans, as well as the patient's advance directive status, should be provided to the primary care physician. It is important to spell out ahead of time which physician will manage the patient in the hospital or whether the two will collaborate.

Some aspects of a cancer patient's care might present a conflict or be overlooked unless they are anticipated and addressed. Among these are the management of pain, depression, or insomnia that develops in response to the cancer or its treatment, hospitalization for acute toxicities, long-term follow-up, and screening for new primary cancers.

“Who tells the patient about needing a colonoscopy if they have breast cancer? One may assume the other is doing that,” Dr. Hall noted as an example.

Both physicians should ask patients whether they are taking any type of alternative treatments that could interact with their prescribed agents, and should inform the other physician if they are. St. John's wort is a common one that some patients take for depression but that can also cause bleeding.

“Patients don't always tell you. You have to ask them,” she said.

Much of the communication between the two physicians can be accomplished through printed forms.

A recommended template for such letters was developed by Dr. Ted C. Braun and his associates at the Tom Baker Cancer Centre, a large tertiary referral center in Calgary, Alta. (Can. Family Physician 2003;49:884).

Dr. Laufman discussed a single-page (front and back) “precertification” form that she uses both as an in-house communication tool within her three-oncologist practice and also with the patient's primary care physician.

The form includes items to be circled and lines to be filled in for treatment goals and options, patient status, and comorbidities, along with documentation of what the patient has been taught and of consent to treatment.

The physician fills out his or her part of the form, signs off, and then forwards it to the nurses who do the same when they conduct patient teaching. It then goes to the billing department to ensure likely coverage for treatment before it is sent to the pharmacy technician for drug dispensing.

Formal chemotherapy orders are listed for the entire duration of therapy, with information about doses, schedule, lab parameters, and premedications, along with a formal amendment procedure for any changes. The patient also signs it. The whole form also serves as a legal document, Dr. Laufman said.

A version of the form is then sent, along with a cover letter, to the primary care physician. “This is one of the things that makes our practice work very, very well,” she said.

Although forms can go a long way in facilitating communication between providers, there will be urgent situations that require a phone call. These include a suicidal patient, a hospital admission, or when the oncologist starts a diabetic patient on steroids or changes the steroid dosage.

An atypical symptom that might represent a reaction to a nononcology drug also should signal the oncologist to pick up the phone, Dr. Laufman said.

WASHINGTON — Collaboration between oncologists and primary care physicians can ensure seamless care for cancer patients, according to a hematologist and a family practice physician who gave a joint presentation at the annual Community Oncology Conference.

Routine use of printed forms can facilitate exchange of important information, Dr. Leslie R. Laufman and Dr. Mary Beth Hall advised, outlining a blueprint for cooperation.

They counseled, however, that even when forms are used, there will be times when one provider or the other needs to pick up the phone and initiate discussion of a patient's medical treatment and/or psychosocial issues.

Communication between a cancer patient's oncologist and primary care physician is critical, but in many cases it isn't carried out effectively, said Dr. Laufman of Ohio State University, Columbus, who is also in private practice in oncology in Columbus, and Dr. Hall, a family physician in private practice in Newark, Ohio.

Many aspects of the “division of labor” were described as straightforward:

▸ The oncologist handles the cancer status definition, the cancer treatment plan, urgent care during treatment, the unique side effects of the chemotherapy agents, and possibly entering patients into clinical trials.

▸ The primary care physician provides ongoing medical care for noncancer health issues, helps manage psychosocial issues that either predate or accompany the cancer diagnosis, helps with family-related issues, and possibly plays a role in palliative care.

The primary care physician needs to receive timely information from the oncologist regarding the patient's initial consultation, including diagnosis, prognosis, treatment plan and objectives, likely toxicities or cancer-related problems, and plans for home care. “We are very anxious to hear how the patient is going to do,” Dr. Hall said.

Access to educational materials—such as newsletters or links to Internet sites—would be very helpful, as would the oncologist's direct telephone number, she added. “I promise we won't abuse it. It just comes in handy to have it right there in the patient's chart so that we can do a rapid phone consult. … And it works both ways. The oncologist needs our phone number too.”

Any hospitalization plans, as well as the patient's advance directive status, should be provided to the primary care physician. It is important to spell out ahead of time which physician will manage the patient in the hospital or whether the two will collaborate.

Some aspects of a cancer patient's care might present a conflict or be overlooked unless they are anticipated and addressed. Among these are the management of pain, depression, or insomnia that develops in response to the cancer or its treatment, hospitalization for acute toxicities, long-term follow-up, and screening for new primary cancers.

“Who tells the patient about needing a colonoscopy if they have breast cancer? One may assume the other is doing that,” Dr. Hall noted as an example.

Both physicians should ask patients whether they are taking any type of alternative treatments that could interact with their prescribed agents, and should inform the other physician if they are. St. John's wort is a common one that some patients take for depression but that can also cause bleeding.

“Patients don't always tell you. You have to ask them,” she said.

Much of the communication between the two physicians can be accomplished through printed forms.

A recommended template for such letters was developed by Dr. Ted C. Braun and his associates at the Tom Baker Cancer Centre, a large tertiary referral center in Calgary, Alta. (Can. Family Physician 2003;49:884).

Dr. Laufman discussed a single-page (front and back) “precertification” form that she uses both as an in-house communication tool within her three-oncologist practice and also with the patient's primary care physician.

The form includes items to be circled and lines to be filled in for treatment goals and options, patient status, and comorbidities, along with documentation of what the patient has been taught and of consent to treatment.

The physician fills out his or her part of the form, signs off, and then forwards it to the nurses who do the same when they conduct patient teaching. It then goes to the billing department to ensure likely coverage for treatment before it is sent to the pharmacy technician for drug dispensing.

Formal chemotherapy orders are listed for the entire duration of therapy, with information about doses, schedule, lab parameters, and premedications, along with a formal amendment procedure for any changes. The patient also signs it. The whole form also serves as a legal document, Dr. Laufman said.

A version of the form is then sent, along with a cover letter, to the primary care physician. “This is one of the things that makes our practice work very, very well,” she said.

Although forms can go a long way in facilitating communication between providers, there will be urgent situations that require a phone call. These include a suicidal patient, a hospital admission, or when the oncologist starts a diabetic patient on steroids or changes the steroid dosage.

An atypical symptom that might represent a reaction to a nononcology drug also should signal the oncologist to pick up the phone, Dr. Laufman said.

ATLANTA — Pediatricians have embraced the current rotavirus vaccine to a much greater extent than have family physicians, Shannon Stokley said at the winter meeting of the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention.

Merck & Co.'s live, oral pentavalent vaccine RotaTeq is currently the only rotavirus vaccine available on the U.S. market. (See related story above.)

To assess the rates of adoption and attitudes toward the Rotateq vaccine among physicians who treat children, in October 2007 the CDC sent surveys by mail and e-mail to a nationwide sample of 2,500 members of the American Academy of Pediatrics and 3,500 members of the American Academy of Family Physicians. After exclusion of those who don't see infants under 6 months of age, the final sample of responders comprised 359 pediatricians and 264 family physicians. Responders did not differ from nonresponders with respect to sociodemographic factors, region of the country, or practice setting or location, said Ms. Stokley of the CDC's National Center for Immunization and Respiratory Diseases.

Pediatricians were far more likely to administer the rotavirus vaccine, with 86% versus 45% of family physicians saying they “routinely” give it. Three percent of pediatricians said they offer it but not routinely, versus 14% of family physicians, while just 11% of pediatricians do not offer the vaccine, compared with 42% of family physicians.

Similarly, 70% of pediatricians “strongly” recommend the vaccine to their patients, compared with just 22% of family physicians, while 18% and 33%, respectively, said they recommend the vaccine but not strongly. Ten percent of pediatricians versus 37% of family physicians inform patients about the rotavirus vaccine without recommending it.

Seventeen percent of pediatricians and 44% of family physicians agreed with the statement “The rotavirus vaccine is not necessary for my patients,” while 88% of pediatricians and 64% of family physicians agreed that “Rotavirus vaccine should be routinely recommended for all eligible infants.”

Knowledge about the vaccine also differed between the two specialties. A total of 69% of pediatricians vs. 30% of family physicians knew the age by which the first dose of rotavirus vaccine should be administered (12 weeks), while 62% and 32%, respectively, knew the age by which all three doses should be administered (32 weeks).

Both specialties cited as barriers to vaccination the failure of some insurance companies to cover the vaccine (19% of pediatricians, 22% of family physicians), the “up-front” costs to purchase the vaccine (17% and 22%, respectively), and lack of adequate reimbursements (15% vs. 18%). However, concern about the safety of rotavirus vaccine was far less common among pediatricians than among family physicians (9% vs. 25%), as was concern about addition of another vaccine to the schedule (5% vs. 22%), Ms. Stokley reported.

A total of 292 of the pediatricians and 109 of the family physicians said that they were familiar with a postmarketing surveillance report published on March 16, 2007, in which neither the passive Vaccine Adverse Events Reporting System nor the active Vaccine Safety Datalink identified an increased risk for intussusception following receipt of RotaTeq (MMWR 2007;56:218–22).

Of those respondents, 91% of the pediatricians versus 62% of the family physicians agreed that the number of intussusception cases reported does not exceed the number expected by chance, 8% versus 24% were uncertain about that, and 1% versus 11% said that the number of cases does exceed the number expected by chance. The report caused 3% of the pediatricians and 11% of the family physicians to stop giving the rotavirus vaccine, while it did not alter practice for 88% and 79%, respectively. Seven percent of pediatricians and 6% of family physicians said they continued to give it and told all their patients about the report.

Seventy-nine percent of pediatricians and 63% of family physicians felt that the message regarding intussusception was communicated clearly, while about a third of each group felt that the findings should not have been publicized because they raised concern unnecessarily.

In the discussion that followed Ms. Stokley's presentation, AAFP coliaison Dr. Jonathan Temte of the University of Wisconsin, Madison, said that family physicians “have a long tradition of a little bit of skepticism” about recommendations because of their broad scope of practice and that, moreover, he has noticed a certain degree of “vaccine fatigue” among family physicians because of the rapid increase in new vaccines and new recommendations over the last few years. “I think that has to be kept in mind so we don't lose what has been a very strong ally over the last few years for immunization practice,” Dr. Temte added.

Dr. Doug Campos-Outcalt, the other AAFP coliaison, said that the lack of adequate reimbursement for vaccine administration is a major issue among family physicians. “They lose money on each vaccine … to the point of diminishing returns. I think we've got to address this issue.”

ATLANTA — Pediatricians have embraced the current rotavirus vaccine to a much greater extent than have family physicians, Shannon Stokley said at the winter meeting of the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention.

Merck & Co.'s live, oral pentavalent vaccine RotaTeq is currently the only rotavirus vaccine available on the U.S. market. (See related story above.)

To assess the rates of adoption and attitudes toward the Rotateq vaccine among physicians who treat children, in October 2007 the CDC sent surveys by mail and e-mail to a nationwide sample of 2,500 members of the American Academy of Pediatrics and 3,500 members of the American Academy of Family Physicians. After exclusion of those who don't see infants under 6 months of age, the final sample of responders comprised 359 pediatricians and 264 family physicians. Responders did not differ from nonresponders with respect to sociodemographic factors, region of the country, or practice setting or location, said Ms. Stokley of the CDC's National Center for Immunization and Respiratory Diseases.

Pediatricians were far more likely to administer the rotavirus vaccine, with 86% versus 45% of family physicians saying they “routinely” give it. Three percent of pediatricians said they offer it but not routinely, versus 14% of family physicians, while just 11% of pediatricians do not offer the vaccine, compared with 42% of family physicians.

Similarly, 70% of pediatricians “strongly” recommend the vaccine to their patients, compared with just 22% of family physicians, while 18% and 33%, respectively, said they recommend the vaccine but not strongly. Ten percent of pediatricians versus 37% of family physicians inform patients about the rotavirus vaccine without recommending it.

Seventeen percent of pediatricians and 44% of family physicians agreed with the statement “The rotavirus vaccine is not necessary for my patients,” while 88% of pediatricians and 64% of family physicians agreed that “Rotavirus vaccine should be routinely recommended for all eligible infants.”

Knowledge about the vaccine also differed between the two specialties. A total of 69% of pediatricians vs. 30% of family physicians knew the age by which the first dose of rotavirus vaccine should be administered (12 weeks), while 62% and 32%, respectively, knew the age by which all three doses should be administered (32 weeks).

Both specialties cited as barriers to vaccination the failure of some insurance companies to cover the vaccine (19% of pediatricians, 22% of family physicians), the “up-front” costs to purchase the vaccine (17% and 22%, respectively), and lack of adequate reimbursements (15% vs. 18%). However, concern about the safety of rotavirus vaccine was far less common among pediatricians than among family physicians (9% vs. 25%), as was concern about addition of another vaccine to the schedule (5% vs. 22%), Ms. Stokley reported.

A total of 292 of the pediatricians and 109 of the family physicians said that they were familiar with a postmarketing surveillance report published on March 16, 2007, in which neither the passive Vaccine Adverse Events Reporting System nor the active Vaccine Safety Datalink identified an increased risk for intussusception following receipt of RotaTeq (MMWR 2007;56:218–22).

Of those respondents, 91% of the pediatricians versus 62% of the family physicians agreed that the number of intussusception cases reported does not exceed the number expected by chance, 8% versus 24% were uncertain about that, and 1% versus 11% said that the number of cases does exceed the number expected by chance. The report caused 3% of the pediatricians and 11% of the family physicians to stop giving the rotavirus vaccine, while it did not alter practice for 88% and 79%, respectively. Seven percent of pediatricians and 6% of family physicians said they continued to give it and told all their patients about the report.

Seventy-nine percent of pediatricians and 63% of family physicians felt that the message regarding intussusception was communicated clearly, while about a third of each group felt that the findings should not have been publicized because they raised concern unnecessarily.

In the discussion that followed Ms. Stokley's presentation, AAFP coliaison Dr. Jonathan Temte of the University of Wisconsin, Madison, said that family physicians “have a long tradition of a little bit of skepticism” about recommendations because of their broad scope of practice and that, moreover, he has noticed a certain degree of “vaccine fatigue” among family physicians because of the rapid increase in new vaccines and new recommendations over the last few years. “I think that has to be kept in mind so we don't lose what has been a very strong ally over the last few years for immunization practice,” Dr. Temte added.

Dr. Doug Campos-Outcalt, the other AAFP coliaison, said that the lack of adequate reimbursement for vaccine administration is a major issue among family physicians. “They lose money on each vaccine … to the point of diminishing returns. I think we've got to address this issue.”

ATLANTA — Pediatricians have embraced the current rotavirus vaccine to a much greater extent than have family physicians, Shannon Stokley said at the winter meeting of the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention.

Merck & Co.'s live, oral pentavalent vaccine RotaTeq is currently the only rotavirus vaccine available on the U.S. market. (See related story above.)

To assess the rates of adoption and attitudes toward the Rotateq vaccine among physicians who treat children, in October 2007 the CDC sent surveys by mail and e-mail to a nationwide sample of 2,500 members of the American Academy of Pediatrics and 3,500 members of the American Academy of Family Physicians. After exclusion of those who don't see infants under 6 months of age, the final sample of responders comprised 359 pediatricians and 264 family physicians. Responders did not differ from nonresponders with respect to sociodemographic factors, region of the country, or practice setting or location, said Ms. Stokley of the CDC's National Center for Immunization and Respiratory Diseases.

Pediatricians were far more likely to administer the rotavirus vaccine, with 86% versus 45% of family physicians saying they “routinely” give it. Three percent of pediatricians said they offer it but not routinely, versus 14% of family physicians, while just 11% of pediatricians do not offer the vaccine, compared with 42% of family physicians.

Similarly, 70% of pediatricians “strongly” recommend the vaccine to their patients, compared with just 22% of family physicians, while 18% and 33%, respectively, said they recommend the vaccine but not strongly. Ten percent of pediatricians versus 37% of family physicians inform patients about the rotavirus vaccine without recommending it.

Seventeen percent of pediatricians and 44% of family physicians agreed with the statement “The rotavirus vaccine is not necessary for my patients,” while 88% of pediatricians and 64% of family physicians agreed that “Rotavirus vaccine should be routinely recommended for all eligible infants.”

Knowledge about the vaccine also differed between the two specialties. A total of 69% of pediatricians vs. 30% of family physicians knew the age by which the first dose of rotavirus vaccine should be administered (12 weeks), while 62% and 32%, respectively, knew the age by which all three doses should be administered (32 weeks).

Both specialties cited as barriers to vaccination the failure of some insurance companies to cover the vaccine (19% of pediatricians, 22% of family physicians), the “up-front” costs to purchase the vaccine (17% and 22%, respectively), and lack of adequate reimbursements (15% vs. 18%). However, concern about the safety of rotavirus vaccine was far less common among pediatricians than among family physicians (9% vs. 25%), as was concern about addition of another vaccine to the schedule (5% vs. 22%), Ms. Stokley reported.

A total of 292 of the pediatricians and 109 of the family physicians said that they were familiar with a postmarketing surveillance report published on March 16, 2007, in which neither the passive Vaccine Adverse Events Reporting System nor the active Vaccine Safety Datalink identified an increased risk for intussusception following receipt of RotaTeq (MMWR 2007;56:218–22).

Of those respondents, 91% of the pediatricians versus 62% of the family physicians agreed that the number of intussusception cases reported does not exceed the number expected by chance, 8% versus 24% were uncertain about that, and 1% versus 11% said that the number of cases does exceed the number expected by chance. The report caused 3% of the pediatricians and 11% of the family physicians to stop giving the rotavirus vaccine, while it did not alter practice for 88% and 79%, respectively. Seven percent of pediatricians and 6% of family physicians said they continued to give it and told all their patients about the report.

Seventy-nine percent of pediatricians and 63% of family physicians felt that the message regarding intussusception was communicated clearly, while about a third of each group felt that the findings should not have been publicized because they raised concern unnecessarily.

In the discussion that followed Ms. Stokley's presentation, AAFP coliaison Dr. Jonathan Temte of the University of Wisconsin, Madison, said that family physicians “have a long tradition of a little bit of skepticism” about recommendations because of their broad scope of practice and that, moreover, he has noticed a certain degree of “vaccine fatigue” among family physicians because of the rapid increase in new vaccines and new recommendations over the last few years. “I think that has to be kept in mind so we don't lose what has been a very strong ally over the last few years for immunization practice,” Dr. Temte added.

Dr. Doug Campos-Outcalt, the other AAFP coliaison, said that the lack of adequate reimbursement for vaccine administration is a major issue among family physicians. “They lose money on each vaccine … to the point of diminishing returns. I think we've got to address this issue.”