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Bacterial Tracheitis Gains Prominence
Bacterial tracheitis, a relatively uncommon infection, may have outpaced viral croup and epiglottitis as the most common potentially life-threatening upper airway infection in children, based on data from 127 patients treated in a single hospital between 1997 and 2006.
The widespread immunization of children against Haemophilus influenza type b and the use of corticosteroids to treat viral croup have likely contributed to the decline in viral croup and epiglottitis, and the resulting prevalence of cases of bacterial tracheitis, reported Dr. Amelia Hopkins of the University of Colorado School of Medicine, Denver, and her colleagues (Pediatrics 2006;118:1416–21).
Respiratory failures were three times more likely to be caused by bacterial tracheitis than by viral croup and epiglottitis combined, they said. Overall, 35 children were sent to the pediatric ICU: 17 (48%) were diagnosed with bacterial tracheitis, 16 (46%) were diagnosed with viral croup, and 2 (6%) were diagnosed with epiglottitis. Of the 20 children in the PICU who developed respiratory failure, 15 (75%) had bacterial tracheitis, compared with only 3 (15%) who had viral croup and 2 (10%) who had nonclassic epiglottitis.
Of the 18 cases of bacterial tracheitis reviewed, 17 (94%) children were sent to the PICU and 15 (83%) of these needed to be intubated and five had serious complications. By contrast, only 16 (15%) of the 107 cases of viral croup that were reviewed were sent to the PICU, and 3 of these children needed to be intubated, but none experienced serious complications.
Clinical characteristics of bacterial tracheitis included cough and retractions in 17 (94%) patients, stridor in 16 (89%) patients, and hoarseness in 12 (67%) patients.
Child Care Ills Decrease With Time
Children younger than 3 years of age were at increased risk of acute respiratory infections during their first months of attendance at child care facilities, but the risk decreased as they got older and spent more time in child care, according to data from 138,821 hospital admissions among children aged 0–5 years.
The youngest children were at the greatest risk for infection within the first 6 months of child care attendance. At 6 months of age, the incidence rate ratio of hospitalizations for acute respiratory infections was 79% higher among children in child care, compared with children of the same age who were cared for at home. The incidence decreased with age, and at 1 year of age the risk of hospitalization for acute respiratory infections was 44% higher among children in child care compared with children cared for at home.
The results suggest that postponing children's enrollment in child care centers until they reach 1 year of age might reduce the incidence of acute respiratory infections in this age group, wrote Mads Kamper-Jorgensen of the Statens Serum Institut, Copenhagen, and associates (Pediatrics 2006;118:1439–46).
Menactra Protects Despite Error
Persons who mistakenly received the meningococcal conjugate vaccine (Menactra) subcutaneously rather than intramuscularly were nonetheless sufficiently protected, according to a report by the Centers for Disease Control and Prevention.
The CDC received reports that 101 persons aged 11–47 years (median age 17.5 years) in seven states received the new meningococcal vaccine (MCV4) subcutaneously, although it is licensed for intramuscular use only. Of these, 38 agreed to participate in an investigation to show whether revaccination was needed (MMWR 2006;55:1016–7).
Overall, 36 of the 38 investigation participants were protected for each of the four vaccine subgroups (A, C, Y, and W-135), based on a baby rabbit-based serum bactericidal assay (rSBA) in which titers of at least 8 were considered protective. Two patients had titers less than 8, and these involved one serogroup in each patient (one for serogroup C only and one for serogroup W-135 only).
Although the geometric mean titers (GMTs) were significantly lower for the subcutaneous vaccinees, compared with age-matched intramuscular vaccinees from the MCV4 clinical trials for serogroups A, C, and Y, there were no significant differences in GMTs for serogroup W-135.
Based on these findings, the researchers did not recommend revaccination for any of the subcutaneous vaccinees.
MCV4, a tetravalent meningococcal conjugate vaccine, was licensed in January 2005 after demonstrating safety and effectiveness, compared with the meningococcal polysaccharide vaccine (MPSV4) that has been used for 30 years.
By contrast, MPSV4 is licensed for subcutaneous use, not intramuscular use, and this is the most likely reason for the misadministration of MCV4, said health care providers who participated in the investigation.
Bacterial Tracheitis Gains Prominence
Bacterial tracheitis, a relatively uncommon infection, may have outpaced viral croup and epiglottitis as the most common potentially life-threatening upper airway infection in children, based on data from 127 patients treated in a single hospital between 1997 and 2006.
The widespread immunization of children against Haemophilus influenza type b and the use of corticosteroids to treat viral croup have likely contributed to the decline in viral croup and epiglottitis, and the resulting prevalence of cases of bacterial tracheitis, reported Dr. Amelia Hopkins of the University of Colorado School of Medicine, Denver, and her colleagues (Pediatrics 2006;118:1416–21).
Respiratory failures were three times more likely to be caused by bacterial tracheitis than by viral croup and epiglottitis combined, they said. Overall, 35 children were sent to the pediatric ICU: 17 (48%) were diagnosed with bacterial tracheitis, 16 (46%) were diagnosed with viral croup, and 2 (6%) were diagnosed with epiglottitis. Of the 20 children in the PICU who developed respiratory failure, 15 (75%) had bacterial tracheitis, compared with only 3 (15%) who had viral croup and 2 (10%) who had nonclassic epiglottitis.
Of the 18 cases of bacterial tracheitis reviewed, 17 (94%) children were sent to the PICU and 15 (83%) of these needed to be intubated and five had serious complications. By contrast, only 16 (15%) of the 107 cases of viral croup that were reviewed were sent to the PICU, and 3 of these children needed to be intubated, but none experienced serious complications.
Clinical characteristics of bacterial tracheitis included cough and retractions in 17 (94%) patients, stridor in 16 (89%) patients, and hoarseness in 12 (67%) patients.
Child Care Ills Decrease With Time
Children younger than 3 years of age were at increased risk of acute respiratory infections during their first months of attendance at child care facilities, but the risk decreased as they got older and spent more time in child care, according to data from 138,821 hospital admissions among children aged 0–5 years.
The youngest children were at the greatest risk for infection within the first 6 months of child care attendance. At 6 months of age, the incidence rate ratio of hospitalizations for acute respiratory infections was 79% higher among children in child care, compared with children of the same age who were cared for at home. The incidence decreased with age, and at 1 year of age the risk of hospitalization for acute respiratory infections was 44% higher among children in child care compared with children cared for at home.
The results suggest that postponing children's enrollment in child care centers until they reach 1 year of age might reduce the incidence of acute respiratory infections in this age group, wrote Mads Kamper-Jorgensen of the Statens Serum Institut, Copenhagen, and associates (Pediatrics 2006;118:1439–46).
Menactra Protects Despite Error
Persons who mistakenly received the meningococcal conjugate vaccine (Menactra) subcutaneously rather than intramuscularly were nonetheless sufficiently protected, according to a report by the Centers for Disease Control and Prevention.
The CDC received reports that 101 persons aged 11–47 years (median age 17.5 years) in seven states received the new meningococcal vaccine (MCV4) subcutaneously, although it is licensed for intramuscular use only. Of these, 38 agreed to participate in an investigation to show whether revaccination was needed (MMWR 2006;55:1016–7).
Overall, 36 of the 38 investigation participants were protected for each of the four vaccine subgroups (A, C, Y, and W-135), based on a baby rabbit-based serum bactericidal assay (rSBA) in which titers of at least 8 were considered protective. Two patients had titers less than 8, and these involved one serogroup in each patient (one for serogroup C only and one for serogroup W-135 only).
Although the geometric mean titers (GMTs) were significantly lower for the subcutaneous vaccinees, compared with age-matched intramuscular vaccinees from the MCV4 clinical trials for serogroups A, C, and Y, there were no significant differences in GMTs for serogroup W-135.
Based on these findings, the researchers did not recommend revaccination for any of the subcutaneous vaccinees.
MCV4, a tetravalent meningococcal conjugate vaccine, was licensed in January 2005 after demonstrating safety and effectiveness, compared with the meningococcal polysaccharide vaccine (MPSV4) that has been used for 30 years.
By contrast, MPSV4 is licensed for subcutaneous use, not intramuscular use, and this is the most likely reason for the misadministration of MCV4, said health care providers who participated in the investigation.
Bacterial Tracheitis Gains Prominence
Bacterial tracheitis, a relatively uncommon infection, may have outpaced viral croup and epiglottitis as the most common potentially life-threatening upper airway infection in children, based on data from 127 patients treated in a single hospital between 1997 and 2006.
The widespread immunization of children against Haemophilus influenza type b and the use of corticosteroids to treat viral croup have likely contributed to the decline in viral croup and epiglottitis, and the resulting prevalence of cases of bacterial tracheitis, reported Dr. Amelia Hopkins of the University of Colorado School of Medicine, Denver, and her colleagues (Pediatrics 2006;118:1416–21).
Respiratory failures were three times more likely to be caused by bacterial tracheitis than by viral croup and epiglottitis combined, they said. Overall, 35 children were sent to the pediatric ICU: 17 (48%) were diagnosed with bacterial tracheitis, 16 (46%) were diagnosed with viral croup, and 2 (6%) were diagnosed with epiglottitis. Of the 20 children in the PICU who developed respiratory failure, 15 (75%) had bacterial tracheitis, compared with only 3 (15%) who had viral croup and 2 (10%) who had nonclassic epiglottitis.
Of the 18 cases of bacterial tracheitis reviewed, 17 (94%) children were sent to the PICU and 15 (83%) of these needed to be intubated and five had serious complications. By contrast, only 16 (15%) of the 107 cases of viral croup that were reviewed were sent to the PICU, and 3 of these children needed to be intubated, but none experienced serious complications.
Clinical characteristics of bacterial tracheitis included cough and retractions in 17 (94%) patients, stridor in 16 (89%) patients, and hoarseness in 12 (67%) patients.
Child Care Ills Decrease With Time
Children younger than 3 years of age were at increased risk of acute respiratory infections during their first months of attendance at child care facilities, but the risk decreased as they got older and spent more time in child care, according to data from 138,821 hospital admissions among children aged 0–5 years.
The youngest children were at the greatest risk for infection within the first 6 months of child care attendance. At 6 months of age, the incidence rate ratio of hospitalizations for acute respiratory infections was 79% higher among children in child care, compared with children of the same age who were cared for at home. The incidence decreased with age, and at 1 year of age the risk of hospitalization for acute respiratory infections was 44% higher among children in child care compared with children cared for at home.
The results suggest that postponing children's enrollment in child care centers until they reach 1 year of age might reduce the incidence of acute respiratory infections in this age group, wrote Mads Kamper-Jorgensen of the Statens Serum Institut, Copenhagen, and associates (Pediatrics 2006;118:1439–46).
Menactra Protects Despite Error
Persons who mistakenly received the meningococcal conjugate vaccine (Menactra) subcutaneously rather than intramuscularly were nonetheless sufficiently protected, according to a report by the Centers for Disease Control and Prevention.
The CDC received reports that 101 persons aged 11–47 years (median age 17.5 years) in seven states received the new meningococcal vaccine (MCV4) subcutaneously, although it is licensed for intramuscular use only. Of these, 38 agreed to participate in an investigation to show whether revaccination was needed (MMWR 2006;55:1016–7).
Overall, 36 of the 38 investigation participants were protected for each of the four vaccine subgroups (A, C, Y, and W-135), based on a baby rabbit-based serum bactericidal assay (rSBA) in which titers of at least 8 were considered protective. Two patients had titers less than 8, and these involved one serogroup in each patient (one for serogroup C only and one for serogroup W-135 only).
Although the geometric mean titers (GMTs) were significantly lower for the subcutaneous vaccinees, compared with age-matched intramuscular vaccinees from the MCV4 clinical trials for serogroups A, C, and Y, there were no significant differences in GMTs for serogroup W-135.
Based on these findings, the researchers did not recommend revaccination for any of the subcutaneous vaccinees.
MCV4, a tetravalent meningococcal conjugate vaccine, was licensed in January 2005 after demonstrating safety and effectiveness, compared with the meningococcal polysaccharide vaccine (MPSV4) that has been used for 30 years.
By contrast, MPSV4 is licensed for subcutaneous use, not intramuscular use, and this is the most likely reason for the misadministration of MCV4, said health care providers who participated in the investigation.