Roxanna Guilford-Blake

Major Finding: Healthy adults had immunogenic responses of 84% to influenza A(H1N1), 71% to influenza A(H3N2), and 61% to influenza B when the pneumococcal vaccine and the trivalent influenza vaccine were given together.

Data Source: Randomized, double blind, phase III clinical trials in over 1,000 healthy adults.

Disclosures: The study was funded by Pfizer Inc. Dr. Frenck said he had no other conflict to declare. Several of the coauthors are Pfizer employees.

ATLANTA — In healthy adults, the 13-valent pneumococcal conjugate vaccine can be safely administered at the same time as trivalent inactivated influenza vaccine without compromising immunogenicity, reported Dr. Robert W. Frenck Jr. of Cincinnati Children's Hospital Medical Center and colleagues.

PCV13 is not approved for use in adults, but “likely will be in the not-too-distant future, and this study will help clinicians decide how to administer the vaccine,” Dr. Frenck said.

The findings from randomized, double blind, phase III clinical trials were presented in a poster at the conference, sponsored by the Centers for Disease Control and Prevention.

For the study, 1,116 healthy adults aged 50–59 years were randomized to receive either PCV13 and TIV (PCV13+TIV) followed by placebo 1 month later, or TIV and placebo (TIV+placebo) followed by PCV13 1 month later.

“Noninferiority of PCV13+TIV to TIV+placebo was demonstrated for all virus subtypes,” investigators reported. The PCV13+TIV and TIV+placebo groups each had similar proportions of responders with a fourfold increase in TIV antibody titer (see chart).

Similarly, for the PCV13, investigators reported that the noninferiority criterion was met for all serotypes.

Most adverse events were mild; none was serious. Local reactions occurred in 89% of PCV13+TIV recipients vs. 39% in recipients of TIV+placebo and 85% of those receiving PCV13 alone. Systemic events occurred in 86% of PCV13+TIV recipients, 76% of recipients of TIV+placebo, and 77% of those receiving PCV13 alone.

Vitals

Source Elsevier Global Medical News

Major Finding: Healthy adults had immunogenic responses of 84% to influenza A(H1N1), 71% to influenza A(H3N2), and 61% to influenza B when the pneumococcal vaccine and the trivalent influenza vaccine were given together.

Data Source: Randomized, double blind, phase III clinical trials in over 1,000 healthy adults.

Disclosures: The study was funded by Pfizer Inc. Dr. Frenck said he had no other conflict to declare. Several of the coauthors are Pfizer employees.

ATLANTA — In healthy adults, the 13-valent pneumococcal conjugate vaccine can be safely administered at the same time as trivalent inactivated influenza vaccine without compromising immunogenicity, reported Dr. Robert W. Frenck Jr. of Cincinnati Children's Hospital Medical Center and colleagues.

PCV13 is not approved for use in adults, but “likely will be in the not-too-distant future, and this study will help clinicians decide how to administer the vaccine,” Dr. Frenck said.

The findings from randomized, double blind, phase III clinical trials were presented in a poster at the conference, sponsored by the Centers for Disease Control and Prevention.

For the study, 1,116 healthy adults aged 50–59 years were randomized to receive either PCV13 and TIV (PCV13+TIV) followed by placebo 1 month later, or TIV and placebo (TIV+placebo) followed by PCV13 1 month later.

“Noninferiority of PCV13+TIV to TIV+placebo was demonstrated for all virus subtypes,” investigators reported. The PCV13+TIV and TIV+placebo groups each had similar proportions of responders with a fourfold increase in TIV antibody titer (see chart).

Similarly, for the PCV13, investigators reported that the noninferiority criterion was met for all serotypes.

Most adverse events were mild; none was serious. Local reactions occurred in 89% of PCV13+TIV recipients vs. 39% in recipients of TIV+placebo and 85% of those receiving PCV13 alone. Systemic events occurred in 86% of PCV13+TIV recipients, 76% of recipients of TIV+placebo, and 77% of those receiving PCV13 alone.

Vitals

Source Elsevier Global Medical News

Major Finding: Healthy adults had immunogenic responses of 84% to influenza A(H1N1), 71% to influenza A(H3N2), and 61% to influenza B when the pneumococcal vaccine and the trivalent influenza vaccine were given together.

Data Source: Randomized, double blind, phase III clinical trials in over 1,000 healthy adults.

Disclosures: The study was funded by Pfizer Inc. Dr. Frenck said he had no other conflict to declare. Several of the coauthors are Pfizer employees.

ATLANTA — In healthy adults, the 13-valent pneumococcal conjugate vaccine can be safely administered at the same time as trivalent inactivated influenza vaccine without compromising immunogenicity, reported Dr. Robert W. Frenck Jr. of Cincinnati Children's Hospital Medical Center and colleagues.

PCV13 is not approved for use in adults, but “likely will be in the not-too-distant future, and this study will help clinicians decide how to administer the vaccine,” Dr. Frenck said.

The findings from randomized, double blind, phase III clinical trials were presented in a poster at the conference, sponsored by the Centers for Disease Control and Prevention.

For the study, 1,116 healthy adults aged 50–59 years were randomized to receive either PCV13 and TIV (PCV13+TIV) followed by placebo 1 month later, or TIV and placebo (TIV+placebo) followed by PCV13 1 month later.

“Noninferiority of PCV13+TIV to TIV+placebo was demonstrated for all virus subtypes,” investigators reported. The PCV13+TIV and TIV+placebo groups each had similar proportions of responders with a fourfold increase in TIV antibody titer (see chart).

Similarly, for the PCV13, investigators reported that the noninferiority criterion was met for all serotypes.

Most adverse events were mild; none was serious. Local reactions occurred in 89% of PCV13+TIV recipients vs. 39% in recipients of TIV+placebo and 85% of those receiving PCV13 alone. Systemic events occurred in 86% of PCV13+TIV recipients, 76% of recipients of TIV+placebo, and 77% of those receiving PCV13 alone.

Vitals

Source Elsevier Global Medical News

ATLANTA — Although most parents in a national survey say that they believe the male HPV vaccine is important, only about half said they would have their own sons vaccinated.

Of the 1,178 parents of boys aged 18 years and younger who responded, 90% said they believed the male HPV vaccination was important in general, Dr. Amanda Dempsey of the University of Michigan, Ann Arbor, reported in a poster.

However, only 52% of parents of boys aged 9–17 years indicated that they would have their own son vaccinated in the near future, and only 48% of the parents of boys aged 8 years and younger said they would do so when their son was older.

Parents appeared to be more motivated by the possibility of transmission than by disease protection, even though there is no evidence that the vaccine protects against transmission, Dr. Dempsey noted in an interview. In data not reported on the poster, 100% of parents cited decreased transmission as a reason to get the vaccine—more than those who cited preventing male cancers (93%) or genital warts (91%).

Perceived benefits to vaccination had the largest impact on parental vaccination intention; perceived susceptibility—but not perceived severity—was also a factor.

Parents having less than a high school education were associated with decreased vaccination intention for older, but not younger, boys, Dr. Dempsey and her colleagues reported at the conference sponsored by the Centers for Disease Control and Prevention.

The study was conducted before the vaccine was licensed for males, and that may have had an impact on parental decisions, the researchers noted.

The research is a starting point, she explained; it may help clinicians identify key messages that resonate with parents. Intervention studies are underway to explore ways to tailor effective messages.

Disclosures: Dr. Dempsey serves on an advisory board for Merck.

ATLANTA — Although most parents in a national survey say that they believe the male HPV vaccine is important, only about half said they would have their own sons vaccinated.

Of the 1,178 parents of boys aged 18 years and younger who responded, 90% said they believed the male HPV vaccination was important in general, Dr. Amanda Dempsey of the University of Michigan, Ann Arbor, reported in a poster.

However, only 52% of parents of boys aged 9–17 years indicated that they would have their own son vaccinated in the near future, and only 48% of the parents of boys aged 8 years and younger said they would do so when their son was older.

Parents appeared to be more motivated by the possibility of transmission than by disease protection, even though there is no evidence that the vaccine protects against transmission, Dr. Dempsey noted in an interview. In data not reported on the poster, 100% of parents cited decreased transmission as a reason to get the vaccine—more than those who cited preventing male cancers (93%) or genital warts (91%).

Perceived benefits to vaccination had the largest impact on parental vaccination intention; perceived susceptibility—but not perceived severity—was also a factor.

Parents having less than a high school education were associated with decreased vaccination intention for older, but not younger, boys, Dr. Dempsey and her colleagues reported at the conference sponsored by the Centers for Disease Control and Prevention.

The study was conducted before the vaccine was licensed for males, and that may have had an impact on parental decisions, the researchers noted.

The research is a starting point, she explained; it may help clinicians identify key messages that resonate with parents. Intervention studies are underway to explore ways to tailor effective messages.

Disclosures: Dr. Dempsey serves on an advisory board for Merck.

ATLANTA — Although most parents in a national survey say that they believe the male HPV vaccine is important, only about half said they would have their own sons vaccinated.

Of the 1,178 parents of boys aged 18 years and younger who responded, 90% said they believed the male HPV vaccination was important in general, Dr. Amanda Dempsey of the University of Michigan, Ann Arbor, reported in a poster.

However, only 52% of parents of boys aged 9–17 years indicated that they would have their own son vaccinated in the near future, and only 48% of the parents of boys aged 8 years and younger said they would do so when their son was older.

Parents appeared to be more motivated by the possibility of transmission than by disease protection, even though there is no evidence that the vaccine protects against transmission, Dr. Dempsey noted in an interview. In data not reported on the poster, 100% of parents cited decreased transmission as a reason to get the vaccine—more than those who cited preventing male cancers (93%) or genital warts (91%).

Perceived benefits to vaccination had the largest impact on parental vaccination intention; perceived susceptibility—but not perceived severity—was also a factor.

Parents having less than a high school education were associated with decreased vaccination intention for older, but not younger, boys, Dr. Dempsey and her colleagues reported at the conference sponsored by the Centers for Disease Control and Prevention.

The study was conducted before the vaccine was licensed for males, and that may have had an impact on parental decisions, the researchers noted.

The research is a starting point, she explained; it may help clinicians identify key messages that resonate with parents. Intervention studies are underway to explore ways to tailor effective messages.

Disclosures: Dr. Dempsey serves on an advisory board for Merck.

SAVANNAH, GA. — Deep brain stimulation may have potential for treating geriatric psychiatric disorders, particularly treatment-resistant depression and obsessive-compulsive disorder.

Deep brain stimulation (DBS), already shown to be an effective therapy for Parkinson's disease and essential tremor, may hold promise for treatment of geriatric psychiatric disorders, Dr. Paul Holtzheimer said in a symposium on neuromodulation therapies.

Research into DBS for treatment-resistant depression (TRD) and obsessive-compulsive disorder (OCD), as well as for other psychiatric disorders, has been advancing, noted Dr. Holtzheimer of the department of psychiatry and behavioral sciences at Emory University, Atlanta. But more studies into efficacy, mechanisms of action, and side-effect profile—and especially long-term effects—are needed.

DBS delivers targeted electrical stimulation into the brain through a device that consists of an electrode connected to an insulated wire, inserted through a small opening in the skull. The wire is run under the skin of the head, neck, and shoulder, connecting the electrode to an implantable pulse generator (a “pacemaker”) implanted near the collarbone.

One advantage of a DBS device is that it can be tuned, Dr. Holtzheimer said. The electrode has four contacts, allowing the stimulation level to be adjusted. Implantation is a relatively safe procedure with a low complication rate (around 10%). The most common complication is infection; stroke is a less common but far more worrisome one, he said.

Research into psychiatric applications is advancing quickly. Thus far, however, studies largely have been limited to a few open-label studies conducted over a few months.

Early research in TRD suggests efficacy and safety for subcallosal cingulate, ventral capsule/ventral striatum (VC/VS), and nucleus accumbens targets. Dr. Holtzheimer called the results so far “reasonably positive.” Multicenter trials are underway for the subcallosal cingulate and VC/VS targets.

The OCD data also suggest reasonable efficacy and safety for the VC/VS, inferior thalamic peduncle, and subthalamic nucleus targets, but not the nucleus accumbens. In 2009, the FDA approved a humanitarian device exemption for the use of DBS to treat OCD (VC/VS target).

All of the progress is encouraging, but the lack of randomized, placebo-controlled data means that long-term safety and efficacy have yet to be established, Dr. Holtzheimer cautioned. Moreover, safety and efficacy have yet to be tested in geriatric populations, and those patients are not part of the ongoing trials.

There's no reason to believe that DBS would be less safe or effective in geriatric populations, observed another member of the neuromodulation panel, Dr. William McDonald, professor of psychiatry and behavioral sciences at Emory University.

Dr. Holtzheimer also pointed out that it may take months of DBS therapy before it becomes effective. It does not replace medications or psychotherapy, but it may enhance other therapeutic approaches, such as cognitive behavioral therapy, he said.

Meanwhile, researchers are starting to look at other psychiatric indications for DBS. For example, research is underway in Toronto to explore its use in dementia, Dr. Holtzheimer said.

Disclosures: Dr. Holtzheimer is a consultant for St. Jude Medical: Neuromodulation, a site of one of the trials for DBS in TRD.

SAVANNAH, GA. — Deep brain stimulation may have potential for treating geriatric psychiatric disorders, particularly treatment-resistant depression and obsessive-compulsive disorder.

Deep brain stimulation (DBS), already shown to be an effective therapy for Parkinson's disease and essential tremor, may hold promise for treatment of geriatric psychiatric disorders, Dr. Paul Holtzheimer said in a symposium on neuromodulation therapies.

Research into DBS for treatment-resistant depression (TRD) and obsessive-compulsive disorder (OCD), as well as for other psychiatric disorders, has been advancing, noted Dr. Holtzheimer of the department of psychiatry and behavioral sciences at Emory University, Atlanta. But more studies into efficacy, mechanisms of action, and side-effect profile—and especially long-term effects—are needed.

DBS delivers targeted electrical stimulation into the brain through a device that consists of an electrode connected to an insulated wire, inserted through a small opening in the skull. The wire is run under the skin of the head, neck, and shoulder, connecting the electrode to an implantable pulse generator (a “pacemaker”) implanted near the collarbone.

One advantage of a DBS device is that it can be tuned, Dr. Holtzheimer said. The electrode has four contacts, allowing the stimulation level to be adjusted. Implantation is a relatively safe procedure with a low complication rate (around 10%). The most common complication is infection; stroke is a less common but far more worrisome one, he said.

Research into psychiatric applications is advancing quickly. Thus far, however, studies largely have been limited to a few open-label studies conducted over a few months.

Early research in TRD suggests efficacy and safety for subcallosal cingulate, ventral capsule/ventral striatum (VC/VS), and nucleus accumbens targets. Dr. Holtzheimer called the results so far “reasonably positive.” Multicenter trials are underway for the subcallosal cingulate and VC/VS targets.

The OCD data also suggest reasonable efficacy and safety for the VC/VS, inferior thalamic peduncle, and subthalamic nucleus targets, but not the nucleus accumbens. In 2009, the FDA approved a humanitarian device exemption for the use of DBS to treat OCD (VC/VS target).

All of the progress is encouraging, but the lack of randomized, placebo-controlled data means that long-term safety and efficacy have yet to be established, Dr. Holtzheimer cautioned. Moreover, safety and efficacy have yet to be tested in geriatric populations, and those patients are not part of the ongoing trials.

There's no reason to believe that DBS would be less safe or effective in geriatric populations, observed another member of the neuromodulation panel, Dr. William McDonald, professor of psychiatry and behavioral sciences at Emory University.

Dr. Holtzheimer also pointed out that it may take months of DBS therapy before it becomes effective. It does not replace medications or psychotherapy, but it may enhance other therapeutic approaches, such as cognitive behavioral therapy, he said.

Meanwhile, researchers are starting to look at other psychiatric indications for DBS. For example, research is underway in Toronto to explore its use in dementia, Dr. Holtzheimer said.

Disclosures: Dr. Holtzheimer is a consultant for St. Jude Medical: Neuromodulation, a site of one of the trials for DBS in TRD.

SAVANNAH, GA. — Deep brain stimulation may have potential for treating geriatric psychiatric disorders, particularly treatment-resistant depression and obsessive-compulsive disorder.

Deep brain stimulation (DBS), already shown to be an effective therapy for Parkinson's disease and essential tremor, may hold promise for treatment of geriatric psychiatric disorders, Dr. Paul Holtzheimer said in a symposium on neuromodulation therapies.

Research into DBS for treatment-resistant depression (TRD) and obsessive-compulsive disorder (OCD), as well as for other psychiatric disorders, has been advancing, noted Dr. Holtzheimer of the department of psychiatry and behavioral sciences at Emory University, Atlanta. But more studies into efficacy, mechanisms of action, and side-effect profile—and especially long-term effects—are needed.

DBS delivers targeted electrical stimulation into the brain through a device that consists of an electrode connected to an insulated wire, inserted through a small opening in the skull. The wire is run under the skin of the head, neck, and shoulder, connecting the electrode to an implantable pulse generator (a “pacemaker”) implanted near the collarbone.

One advantage of a DBS device is that it can be tuned, Dr. Holtzheimer said. The electrode has four contacts, allowing the stimulation level to be adjusted. Implantation is a relatively safe procedure with a low complication rate (around 10%). The most common complication is infection; stroke is a less common but far more worrisome one, he said.

Research into psychiatric applications is advancing quickly. Thus far, however, studies largely have been limited to a few open-label studies conducted over a few months.

Early research in TRD suggests efficacy and safety for subcallosal cingulate, ventral capsule/ventral striatum (VC/VS), and nucleus accumbens targets. Dr. Holtzheimer called the results so far “reasonably positive.” Multicenter trials are underway for the subcallosal cingulate and VC/VS targets.

The OCD data also suggest reasonable efficacy and safety for the VC/VS, inferior thalamic peduncle, and subthalamic nucleus targets, but not the nucleus accumbens. In 2009, the FDA approved a humanitarian device exemption for the use of DBS to treat OCD (VC/VS target).

All of the progress is encouraging, but the lack of randomized, placebo-controlled data means that long-term safety and efficacy have yet to be established, Dr. Holtzheimer cautioned. Moreover, safety and efficacy have yet to be tested in geriatric populations, and those patients are not part of the ongoing trials.

There's no reason to believe that DBS would be less safe or effective in geriatric populations, observed another member of the neuromodulation panel, Dr. William McDonald, professor of psychiatry and behavioral sciences at Emory University.

Dr. Holtzheimer also pointed out that it may take months of DBS therapy before it becomes effective. It does not replace medications or psychotherapy, but it may enhance other therapeutic approaches, such as cognitive behavioral therapy, he said.

Meanwhile, researchers are starting to look at other psychiatric indications for DBS. For example, research is underway in Toronto to explore its use in dementia, Dr. Holtzheimer said.

Disclosures: Dr. Holtzheimer is a consultant for St. Jude Medical: Neuromodulation, a site of one of the trials for DBS in TRD.

ATLANTA — Questions about varicella immunity and human papillomavirus vaccine logistics topped physicians' concerns during a Q&A session with an expert panel at the annual conference sponsored by the Centers for Disease Control and Prevention.

The panelists at the conference included Dr. William Atkinson, Dr. Andrew Kroger, and Donna Weaver, R.N., of the CDC's National Center for Immunization and Respiratory Diseases.

Among the questions were the following:

▸ Does an infant less than 1 year old who develops chickenpox still need the varicella vaccine?

“A few experts will say if you are absolutely sure it was chickenpox … the child would have natural immunity in that circumstance and not need another dose,” Dr. Kroger said.

But it can be difficult to be certain that this is the case.

He advised clinicians to “play it safe” and follow the recommended ages for vaccination.

A dose of the varicella vaccine won't hurt a child who had chickenpox as an infant, Dr. Kroger said.

▸ Is birth prior to 1980 evidence of varicella immunity?

Dr. Atkinson, a medical epidemiologist, said that for health care workers and pregnant women, being born before 1980 is not considered evidence of varicella immunity.

The CDC's Advisory Committee on Immunization Practices has a document forthcoming on health care workers later this year, he added.

▸ When a private pediatric clinic sees teens who have begun their human papillomavirus (HPV) vaccine series elsewhere, can the series be finished with a vaccine different from the one with which they started the series?

Both the quadrivalent HPV vaccine Gardasil and the bivalent HPV vaccine Cervarix protect against HPV serotypes 16 and 18, but only Gardasil protects against HPV-6 and −11 as well.

Ideally, said Ms. Weaver, you should use the same HPV vaccine you started with.

If you have to switch, you need to make it clear that there's no protection for HPV-6 and −11 if you're not using Gardasil.

“It's preferred that you complete the series with the same vaccine if you can,” Ms. Weaver commented.

▸ Would the male HPV vaccine help protect females?

“The hope is certainly there, but … we don't know at this point,” said Ms. Weaver.

“That would be a very tough study to do,” Dr. Atkinson observed.

“What kind of study would you design … to be able to show that transmission was less frequent from—or to—a vaccinated person compared to an unvaccinated person?”

Generally, immune people don't transmit and don't get infected, he reminded the audience, “so it's reasonable to hope … that it will interfere with transmission.”

Disclosures: None was reported.

ATLANTA — Questions about varicella immunity and human papillomavirus vaccine logistics topped physicians' concerns during a Q&A session with an expert panel at the annual conference sponsored by the Centers for Disease Control and Prevention.

The panelists at the conference included Dr. William Atkinson, Dr. Andrew Kroger, and Donna Weaver, R.N., of the CDC's National Center for Immunization and Respiratory Diseases.

Among the questions were the following:

▸ Does an infant less than 1 year old who develops chickenpox still need the varicella vaccine?

“A few experts will say if you are absolutely sure it was chickenpox … the child would have natural immunity in that circumstance and not need another dose,” Dr. Kroger said.

But it can be difficult to be certain that this is the case.

He advised clinicians to “play it safe” and follow the recommended ages for vaccination.

A dose of the varicella vaccine won't hurt a child who had chickenpox as an infant, Dr. Kroger said.

▸ Is birth prior to 1980 evidence of varicella immunity?

Dr. Atkinson, a medical epidemiologist, said that for health care workers and pregnant women, being born before 1980 is not considered evidence of varicella immunity.

The CDC's Advisory Committee on Immunization Practices has a document forthcoming on health care workers later this year, he added.

▸ When a private pediatric clinic sees teens who have begun their human papillomavirus (HPV) vaccine series elsewhere, can the series be finished with a vaccine different from the one with which they started the series?

Both the quadrivalent HPV vaccine Gardasil and the bivalent HPV vaccine Cervarix protect against HPV serotypes 16 and 18, but only Gardasil protects against HPV-6 and −11 as well.

Ideally, said Ms. Weaver, you should use the same HPV vaccine you started with.

If you have to switch, you need to make it clear that there's no protection for HPV-6 and −11 if you're not using Gardasil.

“It's preferred that you complete the series with the same vaccine if you can,” Ms. Weaver commented.

▸ Would the male HPV vaccine help protect females?

“The hope is certainly there, but … we don't know at this point,” said Ms. Weaver.

“That would be a very tough study to do,” Dr. Atkinson observed.

“What kind of study would you design … to be able to show that transmission was less frequent from—or to—a vaccinated person compared to an unvaccinated person?”

Generally, immune people don't transmit and don't get infected, he reminded the audience, “so it's reasonable to hope … that it will interfere with transmission.”

Disclosures: None was reported.

ATLANTA — Questions about varicella immunity and human papillomavirus vaccine logistics topped physicians' concerns during a Q&A session with an expert panel at the annual conference sponsored by the Centers for Disease Control and Prevention.

The panelists at the conference included Dr. William Atkinson, Dr. Andrew Kroger, and Donna Weaver, R.N., of the CDC's National Center for Immunization and Respiratory Diseases.

Among the questions were the following:

▸ Does an infant less than 1 year old who develops chickenpox still need the varicella vaccine?

“A few experts will say if you are absolutely sure it was chickenpox … the child would have natural immunity in that circumstance and not need another dose,” Dr. Kroger said.

But it can be difficult to be certain that this is the case.

He advised clinicians to “play it safe” and follow the recommended ages for vaccination.

A dose of the varicella vaccine won't hurt a child who had chickenpox as an infant, Dr. Kroger said.

▸ Is birth prior to 1980 evidence of varicella immunity?

Dr. Atkinson, a medical epidemiologist, said that for health care workers and pregnant women, being born before 1980 is not considered evidence of varicella immunity.

The CDC's Advisory Committee on Immunization Practices has a document forthcoming on health care workers later this year, he added.

▸ When a private pediatric clinic sees teens who have begun their human papillomavirus (HPV) vaccine series elsewhere, can the series be finished with a vaccine different from the one with which they started the series?

Both the quadrivalent HPV vaccine Gardasil and the bivalent HPV vaccine Cervarix protect against HPV serotypes 16 and 18, but only Gardasil protects against HPV-6 and −11 as well.

Ideally, said Ms. Weaver, you should use the same HPV vaccine you started with.

If you have to switch, you need to make it clear that there's no protection for HPV-6 and −11 if you're not using Gardasil.

“It's preferred that you complete the series with the same vaccine if you can,” Ms. Weaver commented.

▸ Would the male HPV vaccine help protect females?

“The hope is certainly there, but … we don't know at this point,” said Ms. Weaver.

“That would be a very tough study to do,” Dr. Atkinson observed.

“What kind of study would you design … to be able to show that transmission was less frequent from—or to—a vaccinated person compared to an unvaccinated person?”

Generally, immune people don't transmit and don't get infected, he reminded the audience, “so it's reasonable to hope … that it will interfere with transmission.”

Disclosures: None was reported.

Major Finding: The odds ratio of having acute asthma episodes for the vaccinated group was 0.78, when the instrumental variables method was used.

Data Source: A retrospective cohort of 138,935 children and adults with persistent asthma drawn from the MarketScan Commercial Claims and Encounters database, 22% of whom received the seasonal flu vaccine.

Disclosures: Dr. Saha said the findings do not represent the official position of the CDC. He reported no conflicts of interest.

ATLANTA — Individuals with persistent asthma who received the seasonal influenza vaccination appeared to have fewer episodes of acute asthma than did those who were not vaccinated, according to Shubhayu Saha, Ph.D., of the Centers for Disease Control and Prevention's National Center for Environmental Health.

The findings corroborate current guidelines that recommend the vaccine for patients with persistent asthma, Dr. Saha said in a poster presentation at the conference sponsored by the CDC.

A retrospective cohort of children and adults who met the HEDIS (Healthcare Effectiveness Data and Information Set) definition of persistent asthma was drawn from the MarketScan Commercial Claims and Encounters database, Dr. Saha commented.

Those with chronic obstructive pulmonary disease, cystic fibrosis, and emphysema were excluded from the study.

Of 138,935 individuals in the cohort, 22% received the vaccine in the 2006-2007 flu season (August 2006 to March 2007).

Bivariate comparisons indicated that acute asthma episodes requiring an emergency department visit and/or hospitalization during the follow-up period were more frequent in those who received the vaccine (4.9%) than in those who did not (4.0%), Dr Saha and his investigators reported.

However, those in the treatment group also were younger, had higher Charlson comorbidity scores, used more controller medications, and had more acute asthma episodes in the past.

To control for potential confounding where asthma patients with poorer prognoses also were more likely to get the influenza vaccine, the investigators used instrumental variable and propensity score matching methods to obtain unbiased estimates of the effect of vaccine on acute asthma episodes, Dr. Saha explained.

Each approach yielded similar and statistically significant results'results that were contrary to those of the bivariate comparisons.

Controlling for age, sex, region, health plan, comorbidity, and past asthma exacerbation, the instrumental variables method indicated the odds ratio of having acute asthma episodes for the vaccinated group was 0.78.

When the propensity score matching methods were used with four different matching algorithms, the vaccinated group consistently had an odds ratio of 0.7 for experiencing acute asthma episodes, the investigators reported.

“Estimates from both instrumental variable regression and propensity score matching show [the] significant protective effect of the influenza vaccination in reducing acute asthma episodes among individuals with persistent asthma in a population with employer-based health insurance,” Dr. Saha said.

The researchers involved in this study acknowledged several limitations.

The data did not include factors such as ethnicity and income.

Moreover, the claims data did not capture vaccines received outside of the health plan—for instance, at a retail clinic or school.

Because the research was limited to an employer-based population, the findings cannot be readily generalized to other populations, Dr. Saha and his associates said.

Major Finding: The odds ratio of having acute asthma episodes for the vaccinated group was 0.78, when the instrumental variables method was used.

Data Source: A retrospective cohort of 138,935 children and adults with persistent asthma drawn from the MarketScan Commercial Claims and Encounters database, 22% of whom received the seasonal flu vaccine.

Disclosures: Dr. Saha said the findings do not represent the official position of the CDC. He reported no conflicts of interest.

ATLANTA — Individuals with persistent asthma who received the seasonal influenza vaccination appeared to have fewer episodes of acute asthma than did those who were not vaccinated, according to Shubhayu Saha, Ph.D., of the Centers for Disease Control and Prevention's National Center for Environmental Health.

The findings corroborate current guidelines that recommend the vaccine for patients with persistent asthma, Dr. Saha said in a poster presentation at the conference sponsored by the CDC.

A retrospective cohort of children and adults who met the HEDIS (Healthcare Effectiveness Data and Information Set) definition of persistent asthma was drawn from the MarketScan Commercial Claims and Encounters database, Dr. Saha commented.

Those with chronic obstructive pulmonary disease, cystic fibrosis, and emphysema were excluded from the study.

Of 138,935 individuals in the cohort, 22% received the vaccine in the 2006-2007 flu season (August 2006 to March 2007).

Bivariate comparisons indicated that acute asthma episodes requiring an emergency department visit and/or hospitalization during the follow-up period were more frequent in those who received the vaccine (4.9%) than in those who did not (4.0%), Dr Saha and his investigators reported.

However, those in the treatment group also were younger, had higher Charlson comorbidity scores, used more controller medications, and had more acute asthma episodes in the past.

To control for potential confounding where asthma patients with poorer prognoses also were more likely to get the influenza vaccine, the investigators used instrumental variable and propensity score matching methods to obtain unbiased estimates of the effect of vaccine on acute asthma episodes, Dr. Saha explained.

Each approach yielded similar and statistically significant results'results that were contrary to those of the bivariate comparisons.

Controlling for age, sex, region, health plan, comorbidity, and past asthma exacerbation, the instrumental variables method indicated the odds ratio of having acute asthma episodes for the vaccinated group was 0.78.

When the propensity score matching methods were used with four different matching algorithms, the vaccinated group consistently had an odds ratio of 0.7 for experiencing acute asthma episodes, the investigators reported.

“Estimates from both instrumental variable regression and propensity score matching show [the] significant protective effect of the influenza vaccination in reducing acute asthma episodes among individuals with persistent asthma in a population with employer-based health insurance,” Dr. Saha said.

The researchers involved in this study acknowledged several limitations.

The data did not include factors such as ethnicity and income.

Moreover, the claims data did not capture vaccines received outside of the health plan—for instance, at a retail clinic or school.

Because the research was limited to an employer-based population, the findings cannot be readily generalized to other populations, Dr. Saha and his associates said.

Major Finding: The odds ratio of having acute asthma episodes for the vaccinated group was 0.78, when the instrumental variables method was used.

Data Source: A retrospective cohort of 138,935 children and adults with persistent asthma drawn from the MarketScan Commercial Claims and Encounters database, 22% of whom received the seasonal flu vaccine.

Disclosures: Dr. Saha said the findings do not represent the official position of the CDC. He reported no conflicts of interest.

ATLANTA — Individuals with persistent asthma who received the seasonal influenza vaccination appeared to have fewer episodes of acute asthma than did those who were not vaccinated, according to Shubhayu Saha, Ph.D., of the Centers for Disease Control and Prevention's National Center for Environmental Health.

The findings corroborate current guidelines that recommend the vaccine for patients with persistent asthma, Dr. Saha said in a poster presentation at the conference sponsored by the CDC.

A retrospective cohort of children and adults who met the HEDIS (Healthcare Effectiveness Data and Information Set) definition of persistent asthma was drawn from the MarketScan Commercial Claims and Encounters database, Dr. Saha commented.

Those with chronic obstructive pulmonary disease, cystic fibrosis, and emphysema were excluded from the study.

Of 138,935 individuals in the cohort, 22% received the vaccine in the 2006-2007 flu season (August 2006 to March 2007).

Bivariate comparisons indicated that acute asthma episodes requiring an emergency department visit and/or hospitalization during the follow-up period were more frequent in those who received the vaccine (4.9%) than in those who did not (4.0%), Dr Saha and his investigators reported.

However, those in the treatment group also were younger, had higher Charlson comorbidity scores, used more controller medications, and had more acute asthma episodes in the past.

To control for potential confounding where asthma patients with poorer prognoses also were more likely to get the influenza vaccine, the investigators used instrumental variable and propensity score matching methods to obtain unbiased estimates of the effect of vaccine on acute asthma episodes, Dr. Saha explained.

Each approach yielded similar and statistically significant results'results that were contrary to those of the bivariate comparisons.

Controlling for age, sex, region, health plan, comorbidity, and past asthma exacerbation, the instrumental variables method indicated the odds ratio of having acute asthma episodes for the vaccinated group was 0.78.

When the propensity score matching methods were used with four different matching algorithms, the vaccinated group consistently had an odds ratio of 0.7 for experiencing acute asthma episodes, the investigators reported.

“Estimates from both instrumental variable regression and propensity score matching show [the] significant protective effect of the influenza vaccination in reducing acute asthma episodes among individuals with persistent asthma in a population with employer-based health insurance,” Dr. Saha said.

The researchers involved in this study acknowledged several limitations.

The data did not include factors such as ethnicity and income.

Moreover, the claims data did not capture vaccines received outside of the health plan—for instance, at a retail clinic or school.

Because the research was limited to an employer-based population, the findings cannot be readily generalized to other populations, Dr. Saha and his associates said.

SAVANNAH, GA. – Little research exists on inappropriate sexual behavior in patients with dementia. The behaviors, while distressing and disruptive, are poorly defined, and data on the neurobiology, prevalence, assessment, and treatment are lacking.

An estimated 7%-25% of patients with dementia exhibit such behavior, Dr. Alicia A. Romeo reported. Males are far more likely than females to engage in inappropriate sexual behavior, but the types of behaviors do not vary by sex.

Few studies have looked at prevalence rates for sexually inappropriate behaviors in dementia, and discussion among symposium members and the audience indicated that such behaviors often go unreported, noted Dr. Romeo, a psychiatrist in the Geropsychiatry Program at the Boston VA Healthcare System and an instructor at Harvard Medical School, Boston.

The few data that do exist suggest that nonpharmacologic and pharmacologic treatments can work. Behavioral modification can be “very effective,” she said. For example, ensuring adequate social activity is crucial. Adjustment of social cues given to these patients makes a significant difference. For instance, when nursing assistants wear white coats, it signals they are medical professionals.

Nonpharmacologic therapy also can involve supportive psychotherapy for the family and caregivers, and additional staff training–including a “suitable” sex education program. With no Food and Drug Administration–approved medication for treatment for such behaviors, what little research there is addresses off-label use. And with no double-blind placebo-controlled trials, researchers can only look at case reports to identify possible medical therapies.

Medications found to be useful in the treatment of inappropriate sexual behaviors in patients with dementia include anticonvulsants; antidementia agents; antidepressants such as trazodone; cimetidine, a histamine H₂ receptor antagonist; and pindolol, a beta-blocker, she reported.

Three case reports suggest that antipsychotics might be an option, but she advised against using them, citing the side effects. (The FDA issued an advisory and black box warning in 2005 about the risk of atypical antipsychotics in elderly patients with dementia. Three years later, the agency revised labeling for conventional antipsychotics with wording stating that “elderly patients with dementia-related psychosis who are treated with antipsychotic drugs have an increased risk of death [“All Antipsychotics Get Warnings About Elderly,” July 2008, p. 9].) Clinicians should first consult with the family and document everything.

Use medications only when other methods fail, and use them in combination with other treatments, she advised. The choice of treatments depends upon the urgency of the situation, the types of behaviors manifested, and the patient's underlying medical conditions.

Dr. Romeo offered an algorithm to help make treatment decisions. It was developed by the session's chair, Dr. Rajesh R. Tampi of Yale University, New Haven, Conn., who has coauthored articles on the subject (J. Geriatr. Psychiatry Neurol. 2005;18:155–62 and Am. J. Alzheimers Dis. Other Demen. 2008;234:344–54).

Four brain systems have been implicated in the neurobiology, Dr. Romeo said. The frontal system dysfunction typically involves disinhibition. Temporo-limbic system and hypothalamic disorders are associated with hypersexual behavior. Striatum dysfunction is associated with obsession.

Future research should focus on effective treatments as well as early detection and prevention, she said. But defining what constitutes inappropriate behavior can be tricky, and ethical issues can arise over what's appropriate and inappropriate.

Improved interaction between the clinician and caregivers, including nurses, will help in early detection and treatment of these behaviors,” Dr. Tampi said in an interview. Neither Dr. Romeo nor Dr. Tampi reported any conflicts.

SAVANNAH, GA. – Little research exists on inappropriate sexual behavior in patients with dementia. The behaviors, while distressing and disruptive, are poorly defined, and data on the neurobiology, prevalence, assessment, and treatment are lacking.

An estimated 7%-25% of patients with dementia exhibit such behavior, Dr. Alicia A. Romeo reported. Males are far more likely than females to engage in inappropriate sexual behavior, but the types of behaviors do not vary by sex.

Few studies have looked at prevalence rates for sexually inappropriate behaviors in dementia, and discussion among symposium members and the audience indicated that such behaviors often go unreported, noted Dr. Romeo, a psychiatrist in the Geropsychiatry Program at the Boston VA Healthcare System and an instructor at Harvard Medical School, Boston.

The few data that do exist suggest that nonpharmacologic and pharmacologic treatments can work. Behavioral modification can be “very effective,” she said. For example, ensuring adequate social activity is crucial. Adjustment of social cues given to these patients makes a significant difference. For instance, when nursing assistants wear white coats, it signals they are medical professionals.

Nonpharmacologic therapy also can involve supportive psychotherapy for the family and caregivers, and additional staff training–including a “suitable” sex education program. With no Food and Drug Administration–approved medication for treatment for such behaviors, what little research there is addresses off-label use. And with no double-blind placebo-controlled trials, researchers can only look at case reports to identify possible medical therapies.

Medications found to be useful in the treatment of inappropriate sexual behaviors in patients with dementia include anticonvulsants; antidementia agents; antidepressants such as trazodone; cimetidine, a histamine H₂ receptor antagonist; and pindolol, a beta-blocker, she reported.

Three case reports suggest that antipsychotics might be an option, but she advised against using them, citing the side effects. (The FDA issued an advisory and black box warning in 2005 about the risk of atypical antipsychotics in elderly patients with dementia. Three years later, the agency revised labeling for conventional antipsychotics with wording stating that “elderly patients with dementia-related psychosis who are treated with antipsychotic drugs have an increased risk of death [“All Antipsychotics Get Warnings About Elderly,” July 2008, p. 9].) Clinicians should first consult with the family and document everything.

Use medications only when other methods fail, and use them in combination with other treatments, she advised. The choice of treatments depends upon the urgency of the situation, the types of behaviors manifested, and the patient's underlying medical conditions.

Dr. Romeo offered an algorithm to help make treatment decisions. It was developed by the session's chair, Dr. Rajesh R. Tampi of Yale University, New Haven, Conn., who has coauthored articles on the subject (J. Geriatr. Psychiatry Neurol. 2005;18:155–62 and Am. J. Alzheimers Dis. Other Demen. 2008;234:344–54).

Four brain systems have been implicated in the neurobiology, Dr. Romeo said. The frontal system dysfunction typically involves disinhibition. Temporo-limbic system and hypothalamic disorders are associated with hypersexual behavior. Striatum dysfunction is associated with obsession.

Future research should focus on effective treatments as well as early detection and prevention, she said. But defining what constitutes inappropriate behavior can be tricky, and ethical issues can arise over what's appropriate and inappropriate.

Improved interaction between the clinician and caregivers, including nurses, will help in early detection and treatment of these behaviors,” Dr. Tampi said in an interview. Neither Dr. Romeo nor Dr. Tampi reported any conflicts.

SAVANNAH, GA. – Little research exists on inappropriate sexual behavior in patients with dementia. The behaviors, while distressing and disruptive, are poorly defined, and data on the neurobiology, prevalence, assessment, and treatment are lacking.

An estimated 7%-25% of patients with dementia exhibit such behavior, Dr. Alicia A. Romeo reported. Males are far more likely than females to engage in inappropriate sexual behavior, but the types of behaviors do not vary by sex.

Few studies have looked at prevalence rates for sexually inappropriate behaviors in dementia, and discussion among symposium members and the audience indicated that such behaviors often go unreported, noted Dr. Romeo, a psychiatrist in the Geropsychiatry Program at the Boston VA Healthcare System and an instructor at Harvard Medical School, Boston.

The few data that do exist suggest that nonpharmacologic and pharmacologic treatments can work. Behavioral modification can be “very effective,” she said. For example, ensuring adequate social activity is crucial. Adjustment of social cues given to these patients makes a significant difference. For instance, when nursing assistants wear white coats, it signals they are medical professionals.

Nonpharmacologic therapy also can involve supportive psychotherapy for the family and caregivers, and additional staff training–including a “suitable” sex education program. With no Food and Drug Administration–approved medication for treatment for such behaviors, what little research there is addresses off-label use. And with no double-blind placebo-controlled trials, researchers can only look at case reports to identify possible medical therapies.

Medications found to be useful in the treatment of inappropriate sexual behaviors in patients with dementia include anticonvulsants; antidementia agents; antidepressants such as trazodone; cimetidine, a histamine H₂ receptor antagonist; and pindolol, a beta-blocker, she reported.

Three case reports suggest that antipsychotics might be an option, but she advised against using them, citing the side effects. (The FDA issued an advisory and black box warning in 2005 about the risk of atypical antipsychotics in elderly patients with dementia. Three years later, the agency revised labeling for conventional antipsychotics with wording stating that “elderly patients with dementia-related psychosis who are treated with antipsychotic drugs have an increased risk of death [“All Antipsychotics Get Warnings About Elderly,” July 2008, p. 9].) Clinicians should first consult with the family and document everything.

Use medications only when other methods fail, and use them in combination with other treatments, she advised. The choice of treatments depends upon the urgency of the situation, the types of behaviors manifested, and the patient's underlying medical conditions.

Dr. Romeo offered an algorithm to help make treatment decisions. It was developed by the session's chair, Dr. Rajesh R. Tampi of Yale University, New Haven, Conn., who has coauthored articles on the subject (J. Geriatr. Psychiatry Neurol. 2005;18:155–62 and Am. J. Alzheimers Dis. Other Demen. 2008;234:344–54).

Four brain systems have been implicated in the neurobiology, Dr. Romeo said. The frontal system dysfunction typically involves disinhibition. Temporo-limbic system and hypothalamic disorders are associated with hypersexual behavior. Striatum dysfunction is associated with obsession.

Future research should focus on effective treatments as well as early detection and prevention, she said. But defining what constitutes inappropriate behavior can be tricky, and ethical issues can arise over what's appropriate and inappropriate.

Improved interaction between the clinician and caregivers, including nurses, will help in early detection and treatment of these behaviors,” Dr. Tampi said in an interview. Neither Dr. Romeo nor Dr. Tampi reported any conflicts.

SAVANNAH, GA. — Poor sleep quality might be a modifiable risk for depression; moreover, many biomarkers associated with depression also are associated with poor sleep.

Poor sleep quality before interferon-alpha treatment appeared to predict which subjects would develop depressive symptoms, Dr. Francis E. Lotrich of the University of Pittsburgh reported during a symposium on geriatric depression.

The findings, which might have broader implications for geriatric depression, come from ongoing National Institute of Mental Health–funded research into interferon-induced depression.

Interferon-alpha therapy can induce major depression in about 25% of people within a few months of starting treatment, he said. Researchers prospectively followed a cohort of nondepressed hepatitis C patients about to receive interferon-alpha. Subjects were drawn from several overlapping studies and cohorts, Dr. Lotrich said in an interview; so far, researchers have followed over 100 patients.

Pretreatment with selective serotonin reuptake inhibitors (SSRIs) might help prevent depression in some, but is not universally effective. Initial data suggest that those having elevated symptoms of depression might be the subset of people who benefit from using an SSRI to prevent interferon-induced depression.

Preliminary findings suggest that genetic polymorphisms in the serotonin transporter—and possibly in interaction with other genetic polymorphisms in other serotonin genes—can help predict the risk of major depressive disorder (MDD) in younger adults.

In older adults (for this presentation, aged 50 years and older), genetic polymorphisms in growth factor genes (such as BDNF) might help predict who is more at risk for major depressive disorder, he said. In addition, among older adults, elevations in other inflammatory cytokines, such as interleukin-6, might help predict who is at greater risk for MDD.

What emerged across all age groups is that poor sleep quality can predict who is at risk for MDD. Poor sleep quality before interferon-alpha treatment appeared to predict depression. Moreover, many of the genes and blood-based biomarkers that predict depression are associated with poor sleep as well. “Poor sleep explained everything,” Dr. Lotrich said.

He cautions, however, that whether addressing poor sleep quality can prevent interferon-induced depression—or, for that matter, other types of depression—remains to be determined. “We can treat sleep,” Dr. Lotrich said. “Can we treat depression by treating sleep?

Disclosures: Dr. Lotrich's research has been funded by the NIMH.

'We can treat sleep. Can we treat depression by treating sleep?'

Source DR. LOTRICH

Genes and biomarkers that predict depression also are tied to poor sleep.

Source ©Li Kim Goh/iStockphoto.com

SAVANNAH, GA. — Poor sleep quality might be a modifiable risk for depression; moreover, many biomarkers associated with depression also are associated with poor sleep.

Poor sleep quality before interferon-alpha treatment appeared to predict which subjects would develop depressive symptoms, Dr. Francis E. Lotrich of the University of Pittsburgh reported during a symposium on geriatric depression.

The findings, which might have broader implications for geriatric depression, come from ongoing National Institute of Mental Health–funded research into interferon-induced depression.

Interferon-alpha therapy can induce major depression in about 25% of people within a few months of starting treatment, he said. Researchers prospectively followed a cohort of nondepressed hepatitis C patients about to receive interferon-alpha. Subjects were drawn from several overlapping studies and cohorts, Dr. Lotrich said in an interview; so far, researchers have followed over 100 patients.

Pretreatment with selective serotonin reuptake inhibitors (SSRIs) might help prevent depression in some, but is not universally effective. Initial data suggest that those having elevated symptoms of depression might be the subset of people who benefit from using an SSRI to prevent interferon-induced depression.

Preliminary findings suggest that genetic polymorphisms in the serotonin transporter—and possibly in interaction with other genetic polymorphisms in other serotonin genes—can help predict the risk of major depressive disorder (MDD) in younger adults.

In older adults (for this presentation, aged 50 years and older), genetic polymorphisms in growth factor genes (such as BDNF) might help predict who is more at risk for major depressive disorder, he said. In addition, among older adults, elevations in other inflammatory cytokines, such as interleukin-6, might help predict who is at greater risk for MDD.

What emerged across all age groups is that poor sleep quality can predict who is at risk for MDD. Poor sleep quality before interferon-alpha treatment appeared to predict depression. Moreover, many of the genes and blood-based biomarkers that predict depression are associated with poor sleep as well. “Poor sleep explained everything,” Dr. Lotrich said.

He cautions, however, that whether addressing poor sleep quality can prevent interferon-induced depression—or, for that matter, other types of depression—remains to be determined. “We can treat sleep,” Dr. Lotrich said. “Can we treat depression by treating sleep?

Disclosures: Dr. Lotrich's research has been funded by the NIMH.

'We can treat sleep. Can we treat depression by treating sleep?'

Source DR. LOTRICH

Genes and biomarkers that predict depression also are tied to poor sleep.

Source ©Li Kim Goh/iStockphoto.com

SAVANNAH, GA. — Poor sleep quality might be a modifiable risk for depression; moreover, many biomarkers associated with depression also are associated with poor sleep.

Poor sleep quality before interferon-alpha treatment appeared to predict which subjects would develop depressive symptoms, Dr. Francis E. Lotrich of the University of Pittsburgh reported during a symposium on geriatric depression.

The findings, which might have broader implications for geriatric depression, come from ongoing National Institute of Mental Health–funded research into interferon-induced depression.

Interferon-alpha therapy can induce major depression in about 25% of people within a few months of starting treatment, he said. Researchers prospectively followed a cohort of nondepressed hepatitis C patients about to receive interferon-alpha. Subjects were drawn from several overlapping studies and cohorts, Dr. Lotrich said in an interview; so far, researchers have followed over 100 patients.

Pretreatment with selective serotonin reuptake inhibitors (SSRIs) might help prevent depression in some, but is not universally effective. Initial data suggest that those having elevated symptoms of depression might be the subset of people who benefit from using an SSRI to prevent interferon-induced depression.

Preliminary findings suggest that genetic polymorphisms in the serotonin transporter—and possibly in interaction with other genetic polymorphisms in other serotonin genes—can help predict the risk of major depressive disorder (MDD) in younger adults.

In older adults (for this presentation, aged 50 years and older), genetic polymorphisms in growth factor genes (such as BDNF) might help predict who is more at risk for major depressive disorder, he said. In addition, among older adults, elevations in other inflammatory cytokines, such as interleukin-6, might help predict who is at greater risk for MDD.

What emerged across all age groups is that poor sleep quality can predict who is at risk for MDD. Poor sleep quality before interferon-alpha treatment appeared to predict depression. Moreover, many of the genes and blood-based biomarkers that predict depression are associated with poor sleep as well. “Poor sleep explained everything,” Dr. Lotrich said.

He cautions, however, that whether addressing poor sleep quality can prevent interferon-induced depression—or, for that matter, other types of depression—remains to be determined. “We can treat sleep,” Dr. Lotrich said. “Can we treat depression by treating sleep?

Disclosures: Dr. Lotrich's research has been funded by the NIMH.

'We can treat sleep. Can we treat depression by treating sleep?'

Source DR. LOTRICH

Genes and biomarkers that predict depression also are tied to poor sleep.

Source ©Li Kim Goh/iStockphoto.com

SAVANNAH, GA. — Older Mexican American and white non-Hispanic men are undertreated for depression, possibly because they talk about the depression experience differently from the way in which women do, preliminary findings from the Men's Health and Aging Study show.

MeHAS examines depression in Mexican American and white non-Hispanic men aged 60 years and older in primary care. It explores how those men experience depression and considers the factors that impede or facilitate care.

The cross-sectional, mixed-method study, when complete, will comprise 96 Mexican American and white non-Hispanic subjects with recent depression. It also will include 48 of their primary care physicians, said principal investigator Dr. Ladson Hinton of the University of California, Davis, and his colleagues when they presented preliminary findings.

Previous research has established that depression is more prevalent in women, but men are less likely to seek treatment. “Women are more likely to be treated for depression; men are more likely to kill themselves,” Dr. Hinton said.

Older age and its attendant comorbidities can make identification of depression more challenging, he noted.

The preliminary findings drew on screening data from more than 190 men, 74 of whom were eligible for the study. Results from analyses of the first 36 qualitative interviews with eligible men also were presented. The study sample was drawn from a public hospital outpatient clinic and a university outpatient clinic. Future participants will be drawn from other settings.

All of the candidates undergo a brief screening. Eligible participants complete a quantitative interview, then undergo a qualitative interview that includes discussions about childhood, occupational history, migration, family, the experience of depression, health, views of aging, family and social responses to depression, suicide, formal care, and help-seeking attitudes.

Dr. Jrgen Untzer of the University of Washington, Seattle, and the University of California, Los Angeles, reviewed the data from the initial two-stage screening.

Nearly half (48%) of the eligible participants had suicidal thoughts in the previous year; 23% reported such thoughts in the previous month. A third (33%) reported the loss of a loved one in the previous year.

Of the eligible participants, 72% rated their health as fair or poor. Nearly three-quarters (74%) received prescriptions for pain. In contrast, 46% received a prescription for depression; 15% received counseling or psychotherapy.

“We're confirming earlier research about particularly low rates of treatment among older men from ethic minority groups,” he reported. Mexican Americans, especially those who primarily speak Spanish, have the lowest rates of treatment.

Judith C. Barker, Ph.D., of the University of California, San Francisco, discussed the extended interviews vis-à-vis notions of male roles and masculinity.

Of the 74 men who were eligible for the study, 52 have participated in the qualitative interview. Dr. Barker presented on the first 36 interviews that have been transcribed and analyzed.

What emerges is a picture of men whose sense of manhood is tied into being productive; depression appears to be communicated in the language of lost productivity.

These men perceived loss of productivity as a threat to identity—especially in terms of masculinity and male roles. The interviewees did not want to be a burden. She noted that the issue has come up in research related to other chronic conditions, but not to the same extent as when older men talk about depression.

She quoted one of the interviewees: “A man's got to take care of the responsibilities, no matter what they are. You know what I mean? He can't be a burden on anybody. I started right away [after my marriage] taking care of me and my wife.”

In the interviews, the men don't use “red flag” words, such as “blue” or “sad,” Dr. Barker reported. They talk about productivity. She cites an interview in which a 60-year-old white non-Hispanic male said: “I never used to, but lately I have to ask for help sometimes. Physically, there's things you can't do. I used to do everything by myself. … It don't make me feel bad, but I don't like it. … You're not supposed to do that. You are supposed to do it on your own.”

Because older men talk about depression differently from the way women do, clinicians might be less adept at recognizing depression—and its expressions—in them, she said. “Health care professionals need to expand their repertoires for detecting depression.”

They should encourage older men to report and discuss changes in work, health, and family contexts and “assess the reported emotional impact of these changes for possible depression,” Dr. Barker said. “Overall, the degree of distress wrought by these losses that the men were talking about was expressed similarly for both groups of men.”

Dr. Barker did identify some differences. Mexican American men linked these losses with impacts on the family more than white non-Hispanic men did. “Mexican men's concerns about the family versus [white non-Hispanic] men's more individualized issues are definitely consistent with a large and diverse literature on these population groups,” she said.

Lack of productivity was linked to an inability to provide for or take care of family members. White non-Hispanic men, however, were more likely to directly link it to physical disability that affected them as individuals.

Ester Carolina Apesoa-Varano, Ph.D., of the University of California, Davis, addressed family issues that emerged from the interviews.

Families play a dual role, both facilitating and serving as barriers to the treatment of depression. Drawing from the participants' accounts, she observed men often perceive a lack of support for their depression.

“Families tend to normalize depression as a part of aging,” she said. That can inhibit care seeking. They also can stigmatize depression, making men less willing to disclose their feelings and less likely to seek formal care, she added.

Conversely, families facilitate care by being involved in daily support and helping the men cope, and by being engaged in illness management such as helping with driving and medications.

Finally, they are often present during the office visits. Generally, having family present during a medical visit is considered a “good thing,” but their presence in clinical encounters “is a trickier situation,” she said, because although it can sometimes facilitate care, it can also be a hindrance. Again, issues of masculinity come into play. Men talk about not wanting to be a burden, so the family's presence might inhibit full disclosure of their feelings and experiences.

Clinicians should actively elicit information about the family and then decide how best to include them. If appropriate, they should provide opportunities for the family to participate in treatment. But this might not always be appropriate. Providers need to tailor their treatment and approach based on what they know of the family's role, she said.

More research is needed to understand the role of the family, Dr. Apesoa-Varano said.

Disclosures: None of the presenters disclosed any conflicts. MeHAS is funded by the National Institute for Mental Health.

SAVANNAH, GA. — Older Mexican American and white non-Hispanic men are undertreated for depression, possibly because they talk about the depression experience differently from the way in which women do, preliminary findings from the Men's Health and Aging Study show.

MeHAS examines depression in Mexican American and white non-Hispanic men aged 60 years and older in primary care. It explores how those men experience depression and considers the factors that impede or facilitate care.

The cross-sectional, mixed-method study, when complete, will comprise 96 Mexican American and white non-Hispanic subjects with recent depression. It also will include 48 of their primary care physicians, said principal investigator Dr. Ladson Hinton of the University of California, Davis, and his colleagues when they presented preliminary findings.

Previous research has established that depression is more prevalent in women, but men are less likely to seek treatment. “Women are more likely to be treated for depression; men are more likely to kill themselves,” Dr. Hinton said.

Older age and its attendant comorbidities can make identification of depression more challenging, he noted.

The preliminary findings drew on screening data from more than 190 men, 74 of whom were eligible for the study. Results from analyses of the first 36 qualitative interviews with eligible men also were presented. The study sample was drawn from a public hospital outpatient clinic and a university outpatient clinic. Future participants will be drawn from other settings.

All of the candidates undergo a brief screening. Eligible participants complete a quantitative interview, then undergo a qualitative interview that includes discussions about childhood, occupational history, migration, family, the experience of depression, health, views of aging, family and social responses to depression, suicide, formal care, and help-seeking attitudes.

Dr. Jrgen Untzer of the University of Washington, Seattle, and the University of California, Los Angeles, reviewed the data from the initial two-stage screening.

Nearly half (48%) of the eligible participants had suicidal thoughts in the previous year; 23% reported such thoughts in the previous month. A third (33%) reported the loss of a loved one in the previous year.

Of the eligible participants, 72% rated their health as fair or poor. Nearly three-quarters (74%) received prescriptions for pain. In contrast, 46% received a prescription for depression; 15% received counseling or psychotherapy.

“We're confirming earlier research about particularly low rates of treatment among older men from ethic minority groups,” he reported. Mexican Americans, especially those who primarily speak Spanish, have the lowest rates of treatment.

Judith C. Barker, Ph.D., of the University of California, San Francisco, discussed the extended interviews vis-à-vis notions of male roles and masculinity.

Of the 74 men who were eligible for the study, 52 have participated in the qualitative interview. Dr. Barker presented on the first 36 interviews that have been transcribed and analyzed.

What emerges is a picture of men whose sense of manhood is tied into being productive; depression appears to be communicated in the language of lost productivity.

These men perceived loss of productivity as a threat to identity—especially in terms of masculinity and male roles. The interviewees did not want to be a burden. She noted that the issue has come up in research related to other chronic conditions, but not to the same extent as when older men talk about depression.

She quoted one of the interviewees: “A man's got to take care of the responsibilities, no matter what they are. You know what I mean? He can't be a burden on anybody. I started right away [after my marriage] taking care of me and my wife.”

In the interviews, the men don't use “red flag” words, such as “blue” or “sad,” Dr. Barker reported. They talk about productivity. She cites an interview in which a 60-year-old white non-Hispanic male said: “I never used to, but lately I have to ask for help sometimes. Physically, there's things you can't do. I used to do everything by myself. … It don't make me feel bad, but I don't like it. … You're not supposed to do that. You are supposed to do it on your own.”

Because older men talk about depression differently from the way women do, clinicians might be less adept at recognizing depression—and its expressions—in them, she said. “Health care professionals need to expand their repertoires for detecting depression.”

They should encourage older men to report and discuss changes in work, health, and family contexts and “assess the reported emotional impact of these changes for possible depression,” Dr. Barker said. “Overall, the degree of distress wrought by these losses that the men were talking about was expressed similarly for both groups of men.”

Dr. Barker did identify some differences. Mexican American men linked these losses with impacts on the family more than white non-Hispanic men did. “Mexican men's concerns about the family versus [white non-Hispanic] men's more individualized issues are definitely consistent with a large and diverse literature on these population groups,” she said.

Lack of productivity was linked to an inability to provide for or take care of family members. White non-Hispanic men, however, were more likely to directly link it to physical disability that affected them as individuals.

Ester Carolina Apesoa-Varano, Ph.D., of the University of California, Davis, addressed family issues that emerged from the interviews.

Families play a dual role, both facilitating and serving as barriers to the treatment of depression. Drawing from the participants' accounts, she observed men often perceive a lack of support for their depression.

“Families tend to normalize depression as a part of aging,” she said. That can inhibit care seeking. They also can stigmatize depression, making men less willing to disclose their feelings and less likely to seek formal care, she added.

Conversely, families facilitate care by being involved in daily support and helping the men cope, and by being engaged in illness management such as helping with driving and medications.

Finally, they are often present during the office visits. Generally, having family present during a medical visit is considered a “good thing,” but their presence in clinical encounters “is a trickier situation,” she said, because although it can sometimes facilitate care, it can also be a hindrance. Again, issues of masculinity come into play. Men talk about not wanting to be a burden, so the family's presence might inhibit full disclosure of their feelings and experiences.

Clinicians should actively elicit information about the family and then decide how best to include them. If appropriate, they should provide opportunities for the family to participate in treatment. But this might not always be appropriate. Providers need to tailor their treatment and approach based on what they know of the family's role, she said.

More research is needed to understand the role of the family, Dr. Apesoa-Varano said.

Disclosures: None of the presenters disclosed any conflicts. MeHAS is funded by the National Institute for Mental Health.

SAVANNAH, GA. — Older Mexican American and white non-Hispanic men are undertreated for depression, possibly because they talk about the depression experience differently from the way in which women do, preliminary findings from the Men's Health and Aging Study show.

MeHAS examines depression in Mexican American and white non-Hispanic men aged 60 years and older in primary care. It explores how those men experience depression and considers the factors that impede or facilitate care.

The cross-sectional, mixed-method study, when complete, will comprise 96 Mexican American and white non-Hispanic subjects with recent depression. It also will include 48 of their primary care physicians, said principal investigator Dr. Ladson Hinton of the University of California, Davis, and his colleagues when they presented preliminary findings.

Previous research has established that depression is more prevalent in women, but men are less likely to seek treatment. “Women are more likely to be treated for depression; men are more likely to kill themselves,” Dr. Hinton said.

Older age and its attendant comorbidities can make identification of depression more challenging, he noted.

The preliminary findings drew on screening data from more than 190 men, 74 of whom were eligible for the study. Results from analyses of the first 36 qualitative interviews with eligible men also were presented. The study sample was drawn from a public hospital outpatient clinic and a university outpatient clinic. Future participants will be drawn from other settings.

All of the candidates undergo a brief screening. Eligible participants complete a quantitative interview, then undergo a qualitative interview that includes discussions about childhood, occupational history, migration, family, the experience of depression, health, views of aging, family and social responses to depression, suicide, formal care, and help-seeking attitudes.

Dr. Jrgen Untzer of the University of Washington, Seattle, and the University of California, Los Angeles, reviewed the data from the initial two-stage screening.

Nearly half (48%) of the eligible participants had suicidal thoughts in the previous year; 23% reported such thoughts in the previous month. A third (33%) reported the loss of a loved one in the previous year.

Of the eligible participants, 72% rated their health as fair or poor. Nearly three-quarters (74%) received prescriptions for pain. In contrast, 46% received a prescription for depression; 15% received counseling or psychotherapy.

“We're confirming earlier research about particularly low rates of treatment among older men from ethic minority groups,” he reported. Mexican Americans, especially those who primarily speak Spanish, have the lowest rates of treatment.

Judith C. Barker, Ph.D., of the University of California, San Francisco, discussed the extended interviews vis-à-vis notions of male roles and masculinity.

Of the 74 men who were eligible for the study, 52 have participated in the qualitative interview. Dr. Barker presented on the first 36 interviews that have been transcribed and analyzed.

What emerges is a picture of men whose sense of manhood is tied into being productive; depression appears to be communicated in the language of lost productivity.

These men perceived loss of productivity as a threat to identity—especially in terms of masculinity and male roles. The interviewees did not want to be a burden. She noted that the issue has come up in research related to other chronic conditions, but not to the same extent as when older men talk about depression.

She quoted one of the interviewees: “A man's got to take care of the responsibilities, no matter what they are. You know what I mean? He can't be a burden on anybody. I started right away [after my marriage] taking care of me and my wife.”

In the interviews, the men don't use “red flag” words, such as “blue” or “sad,” Dr. Barker reported. They talk about productivity. She cites an interview in which a 60-year-old white non-Hispanic male said: “I never used to, but lately I have to ask for help sometimes. Physically, there's things you can't do. I used to do everything by myself. … It don't make me feel bad, but I don't like it. … You're not supposed to do that. You are supposed to do it on your own.”

Because older men talk about depression differently from the way women do, clinicians might be less adept at recognizing depression—and its expressions—in them, she said. “Health care professionals need to expand their repertoires for detecting depression.”

They should encourage older men to report and discuss changes in work, health, and family contexts and “assess the reported emotional impact of these changes for possible depression,” Dr. Barker said. “Overall, the degree of distress wrought by these losses that the men were talking about was expressed similarly for both groups of men.”

Dr. Barker did identify some differences. Mexican American men linked these losses with impacts on the family more than white non-Hispanic men did. “Mexican men's concerns about the family versus [white non-Hispanic] men's more individualized issues are definitely consistent with a large and diverse literature on these population groups,” she said.

Lack of productivity was linked to an inability to provide for or take care of family members. White non-Hispanic men, however, were more likely to directly link it to physical disability that affected them as individuals.

Ester Carolina Apesoa-Varano, Ph.D., of the University of California, Davis, addressed family issues that emerged from the interviews.

Families play a dual role, both facilitating and serving as barriers to the treatment of depression. Drawing from the participants' accounts, she observed men often perceive a lack of support for their depression.

“Families tend to normalize depression as a part of aging,” she said. That can inhibit care seeking. They also can stigmatize depression, making men less willing to disclose their feelings and less likely to seek formal care, she added.

Conversely, families facilitate care by being involved in daily support and helping the men cope, and by being engaged in illness management such as helping with driving and medications.

Finally, they are often present during the office visits. Generally, having family present during a medical visit is considered a “good thing,” but their presence in clinical encounters “is a trickier situation,” she said, because although it can sometimes facilitate care, it can also be a hindrance. Again, issues of masculinity come into play. Men talk about not wanting to be a burden, so the family's presence might inhibit full disclosure of their feelings and experiences.

Clinicians should actively elicit information about the family and then decide how best to include them. If appropriate, they should provide opportunities for the family to participate in treatment. But this might not always be appropriate. Providers need to tailor their treatment and approach based on what they know of the family's role, she said.

More research is needed to understand the role of the family, Dr. Apesoa-Varano said.

Disclosures: None of the presenters disclosed any conflicts. MeHAS is funded by the National Institute for Mental Health.

ATLANTA - Although most parents in a national survey said that they believe the male HPV vaccine is important, only about half said they would have their own sons vaccinated.

Of the 1,178 parents of boys aged 18 years and younger who responded, 90% said they believed the male HPV vaccination was important in general, Dr. Amanda Dempsey of the University of Michigan, Ann Arbor, reported in a poster at the National Immunization Conference sponsored by the Centers for Disease Control and Prevention.

However, only 52% of parents of boys aged 9-17 years indicated that they would have their own son vaccinated in the near future, and only 48% of the parents of boys aged 8 years and younger said they would do so when their son was older.

Parents appeared to be more motivated by the possibility of transmission rather than disease protection, even though there's no evidence the vaccine protects against transmission, Dr. Dempsey noted in an interview. In data not reported on the poster, 100% of parents cited decreased transmission as a reason to get the vaccine - more than those who cited preventing male cancers (93%) or genital warts (91%).

Perceived benefits to vaccination had the largest impact on parental vaccination intention; perceived susceptibility - but not perceived severity - was also a factor. Parents having less than a high school education were associated with decreased vaccination intention for older, but not younger, boys, she and her colleagues reported.

The study was conducted before the vaccine was licensed for males, and that may have had an impact on parental decisions, Dr. Dempsey and her associates noted.

The research is a starting point, she explained; it may help clinicians identify key messages that resonate with parents. Intervention studies are underway to explore ways to tailor effective messages.

Dr. Dempsey serves on an advisory board for Merck and Co.

ATLANTA - Although most parents in a national survey said that they believe the male HPV vaccine is important, only about half said they would have their own sons vaccinated.

Of the 1,178 parents of boys aged 18 years and younger who responded, 90% said they believed the male HPV vaccination was important in general, Dr. Amanda Dempsey of the University of Michigan, Ann Arbor, reported in a poster at the National Immunization Conference sponsored by the Centers for Disease Control and Prevention.

However, only 52% of parents of boys aged 9-17 years indicated that they would have their own son vaccinated in the near future, and only 48% of the parents of boys aged 8 years and younger said they would do so when their son was older.

Parents appeared to be more motivated by the possibility of transmission rather than disease protection, even though there's no evidence the vaccine protects against transmission, Dr. Dempsey noted in an interview. In data not reported on the poster, 100% of parents cited decreased transmission as a reason to get the vaccine - more than those who cited preventing male cancers (93%) or genital warts (91%).

Perceived benefits to vaccination had the largest impact on parental vaccination intention; perceived susceptibility - but not perceived severity - was also a factor. Parents having less than a high school education were associated with decreased vaccination intention for older, but not younger, boys, she and her colleagues reported.

The study was conducted before the vaccine was licensed for males, and that may have had an impact on parental decisions, Dr. Dempsey and her associates noted.

The research is a starting point, she explained; it may help clinicians identify key messages that resonate with parents. Intervention studies are underway to explore ways to tailor effective messages.

Dr. Dempsey serves on an advisory board for Merck and Co.

ATLANTA - Although most parents in a national survey said that they believe the male HPV vaccine is important, only about half said they would have their own sons vaccinated.

Of the 1,178 parents of boys aged 18 years and younger who responded, 90% said they believed the male HPV vaccination was important in general, Dr. Amanda Dempsey of the University of Michigan, Ann Arbor, reported in a poster at the National Immunization Conference sponsored by the Centers for Disease Control and Prevention.

However, only 52% of parents of boys aged 9-17 years indicated that they would have their own son vaccinated in the near future, and only 48% of the parents of boys aged 8 years and younger said they would do so when their son was older.

Parents appeared to be more motivated by the possibility of transmission rather than disease protection, even though there's no evidence the vaccine protects against transmission, Dr. Dempsey noted in an interview. In data not reported on the poster, 100% of parents cited decreased transmission as a reason to get the vaccine - more than those who cited preventing male cancers (93%) or genital warts (91%).

Perceived benefits to vaccination had the largest impact on parental vaccination intention; perceived susceptibility - but not perceived severity - was also a factor. Parents having less than a high school education were associated with decreased vaccination intention for older, but not younger, boys, she and her colleagues reported.

The study was conducted before the vaccine was licensed for males, and that may have had an impact on parental decisions, Dr. Dempsey and her associates noted.

The research is a starting point, she explained; it may help clinicians identify key messages that resonate with parents. Intervention studies are underway to explore ways to tailor effective messages.

Dr. Dempsey serves on an advisory board for Merck and Co.

Major Finding: The pooled efficacy of LAIV against influenza-associated AOM was 91.4% versus placebo and 62.7% versus TIV.

Data Source: A meta-analysis of five randomized, double-blind, placebo-controlled trials in 7,062 children aged 24–83 months involving LAIV, and two randomized, double-blind, TIV-controlled trials in 5,775 children aged 24–71 months comparing LAIV and TIV.

Disclosures: MedImmune Inc. sponsored the research, and two of the coauthors are MedImmune employees. Dr. Block said he receives support from several pharmaceutical companies, including MedImmune.

ATLANTA — The live attenuated influenza vaccine appears to significantly reduce influenza-associated acute otitis media in children aged 24–83 months, according to a meta-analysis by Dr. Stan L. Block Jr.

The reduction was significant compared with placebo and trivalent inactivated influenza vaccine (TIV), said Dr. Block of the University of Kentucky in Lexington and his colleagues in a poster at the National Immunization Conference sponsored by the Centers for Disease Control and Prevention.

This was true when all cases of influenza were considered, but the reduction was no longer statistically significant for TIV when only children with confirmed influenza were considered.

Investigators pooled data about the incidence of influenza-associated acute otitis media (AOM) in five randomized, double-blind, placebo-controlled trials in children aged 24–83 months (live attenuated influenza vaccine [LAIV], n = 4,278; placebo, n = 2,784) and two randomized, double-blind, TIV-controlled trials in children aged 24–71 months (LAIV, n = 2,872; TIV, n = 2,903).

Influenza was detected by viral culture; all strains were included. AOM was diagnosed clinically. The subjects included healthy children, those with frequent respiratory infections, and those in day care.

The pooled efficacy of LAIV against influenza-associated AOM was 91.4% (0.3% vs. 3.0%) for placebo and 62.7% (0.4% vs. 1.0%) for TIV, the researchers reported.

When only those children with confirmed influenza were considered, AOM was diagnosed in 7.6% of the 145 LAIV recipients and in 17.6% of the 473 placebo recipients, for a 56.8% relative reduction in AOM cases.

In the TIV-controlled studies, AOM was diagnosed in 9.4% of the 117 LAIV recipients and in 11.6% of the of 251 TIV recipients. The relative reduction of 18.6% was not statistically significant.

In an interview, Dr. Seth L. Toback, director of medical affairs at MedImmune and one of the coinvestigators, speculated that the protective effect of LAIV could be related to mucosal protection or cell-mediated immunity—the same reason it protects against the flu, but he stressed that this research does not address that issue.

The reduction was significant compared with placebo and trivalent inactivated influenza vaccine.

Source DR. BLOCK

Major Finding: The pooled efficacy of LAIV against influenza-associated AOM was 91.4% versus placebo and 62.7% versus TIV.

Data Source: A meta-analysis of five randomized, double-blind, placebo-controlled trials in 7,062 children aged 24–83 months involving LAIV, and two randomized, double-blind, TIV-controlled trials in 5,775 children aged 24–71 months comparing LAIV and TIV.

Disclosures: MedImmune Inc. sponsored the research, and two of the coauthors are MedImmune employees. Dr. Block said he receives support from several pharmaceutical companies, including MedImmune.

ATLANTA — The live attenuated influenza vaccine appears to significantly reduce influenza-associated acute otitis media in children aged 24–83 months, according to a meta-analysis by Dr. Stan L. Block Jr.

The reduction was significant compared with placebo and trivalent inactivated influenza vaccine (TIV), said Dr. Block of the University of Kentucky in Lexington and his colleagues in a poster at the National Immunization Conference sponsored by the Centers for Disease Control and Prevention.

This was true when all cases of influenza were considered, but the reduction was no longer statistically significant for TIV when only children with confirmed influenza were considered.

Investigators pooled data about the incidence of influenza-associated acute otitis media (AOM) in five randomized, double-blind, placebo-controlled trials in children aged 24–83 months (live attenuated influenza vaccine [LAIV], n = 4,278; placebo, n = 2,784) and two randomized, double-blind, TIV-controlled trials in children aged 24–71 months (LAIV, n = 2,872; TIV, n = 2,903).

Influenza was detected by viral culture; all strains were included. AOM was diagnosed clinically. The subjects included healthy children, those with frequent respiratory infections, and those in day care.

The pooled efficacy of LAIV against influenza-associated AOM was 91.4% (0.3% vs. 3.0%) for placebo and 62.7% (0.4% vs. 1.0%) for TIV, the researchers reported.

When only those children with confirmed influenza were considered, AOM was diagnosed in 7.6% of the 145 LAIV recipients and in 17.6% of the 473 placebo recipients, for a 56.8% relative reduction in AOM cases.

In the TIV-controlled studies, AOM was diagnosed in 9.4% of the 117 LAIV recipients and in 11.6% of the of 251 TIV recipients. The relative reduction of 18.6% was not statistically significant.

In an interview, Dr. Seth L. Toback, director of medical affairs at MedImmune and one of the coinvestigators, speculated that the protective effect of LAIV could be related to mucosal protection or cell-mediated immunity—the same reason it protects against the flu, but he stressed that this research does not address that issue.

The reduction was significant compared with placebo and trivalent inactivated influenza vaccine.

Source DR. BLOCK

Major Finding: The pooled efficacy of LAIV against influenza-associated AOM was 91.4% versus placebo and 62.7% versus TIV.

Data Source: A meta-analysis of five randomized, double-blind, placebo-controlled trials in 7,062 children aged 24–83 months involving LAIV, and two randomized, double-blind, TIV-controlled trials in 5,775 children aged 24–71 months comparing LAIV and TIV.

Disclosures: MedImmune Inc. sponsored the research, and two of the coauthors are MedImmune employees. Dr. Block said he receives support from several pharmaceutical companies, including MedImmune.

ATLANTA — The live attenuated influenza vaccine appears to significantly reduce influenza-associated acute otitis media in children aged 24–83 months, according to a meta-analysis by Dr. Stan L. Block Jr.

The reduction was significant compared with placebo and trivalent inactivated influenza vaccine (TIV), said Dr. Block of the University of Kentucky in Lexington and his colleagues in a poster at the National Immunization Conference sponsored by the Centers for Disease Control and Prevention.

This was true when all cases of influenza were considered, but the reduction was no longer statistically significant for TIV when only children with confirmed influenza were considered.

Investigators pooled data about the incidence of influenza-associated acute otitis media (AOM) in five randomized, double-blind, placebo-controlled trials in children aged 24–83 months (live attenuated influenza vaccine [LAIV], n = 4,278; placebo, n = 2,784) and two randomized, double-blind, TIV-controlled trials in children aged 24–71 months (LAIV, n = 2,872; TIV, n = 2,903).

Influenza was detected by viral culture; all strains were included. AOM was diagnosed clinically. The subjects included healthy children, those with frequent respiratory infections, and those in day care.

The pooled efficacy of LAIV against influenza-associated AOM was 91.4% (0.3% vs. 3.0%) for placebo and 62.7% (0.4% vs. 1.0%) for TIV, the researchers reported.

When only those children with confirmed influenza were considered, AOM was diagnosed in 7.6% of the 145 LAIV recipients and in 17.6% of the 473 placebo recipients, for a 56.8% relative reduction in AOM cases.

In the TIV-controlled studies, AOM was diagnosed in 9.4% of the 117 LAIV recipients and in 11.6% of the of 251 TIV recipients. The relative reduction of 18.6% was not statistically significant.

In an interview, Dr. Seth L. Toback, director of medical affairs at MedImmune and one of the coinvestigators, speculated that the protective effect of LAIV could be related to mucosal protection or cell-mediated immunity—the same reason it protects against the flu, but he stressed that this research does not address that issue.

The reduction was significant compared with placebo and trivalent inactivated influenza vaccine.

Source DR. BLOCK