IDWeek 2014

PHILADELPHIA – A single injection of the investigational 4-antigen SA4Ag vaccine was well tolerated and induced robust antibody responses against Staphylococcusaureus in healthy adults in a phase I/II study.

“The very quick development of antibodies suggest that the vaccine could be used pre-operatively [2-3 weeks] for elective surgeries that are at higher risk of Staph. infection, such as thoracotomy or insertion of rods for scoliosis or spinal fusion,” Dr. Robert W. Frenck Jr. said in an interview at Infectious Diseases Week 2014.

As to the durability of responses, antibody levels for all four antigens in the vaccine rose rapidly and then decayed slowly over the next 12 months, he said. “The results support the continued development of SA4Ag for the prevention of invasive S. aureus disease in at-risk adults, including those undergoing elective surgery.”

There is no licensed vaccine that prevents invasive S. aureus infection, although several multi-antigen vaccines are in development.

SA4Ag vaccine is a second-generation vaccine to Pfizer’s 3-antigen SA3AG candidate vaccine and was granted Fast Track designation by the U.S. Food and Drug Administration in February 2014, according to the manufacturer.

SA4Ag contains capsular polysaccharides serotypes 5 and 8 (CP5 and CP8) individually conjugated to CRM₁₉₇, a recombinant surface protein clumping factor A (rmClfA), with a recombinant manganese transporter protein C known as rP305A. Each component was selected based on the virulence of these antigens in S. aureus infections, Dr. Frenck Jr., professor of pediatrics and interim director of infectious diseases, at Cincinnati (Ohio) Children’s Hospital Medical Center, said.

The study stratified 456 healthy adults by age (18-49 years and 50-64 years) and then randomly assigned them to receive a single injection of placebo or one of three formulations of SA4Ag: fixed doses of 30 μg CP5-CRM₁₉₇, 30 μg CP8-CRM₁₉₇, and 60 μg rmClfA, and either a low- (20 μg), mid- (60 μg), or high- (200 μg) rP305A dose.

The participants average age was 45 years, 57% were female, 73% were white, and 87.5% completed the study through month 12.

Local reactions reported through day 14 were mild or moderate, and systemic events and other adverse events were comparable across all groups, Dr. Frenck Jr. said. No vaccine-related serious adverse events or deaths were reported.

At day 29, all participants vaccinated with SA4Ag achieved the CP5 opsonophagocytic activity (OPA) threshold (≥ 1,000 titers) and 96%–99% met the CP8 OPA threshold (≥ 2,000 titers).

“The percentage of subjects reaching the threshold is equivalent for each one of the vaccine doses, indicating that the rP305A did not affect the immune response to the other components in the vaccine,” Dr. Frenck Jr. said.

Less than 25% of patients given placebo achieved the CP5 or CP8 OPA thresholds.

Immune responses to ClfA were robust by day 15 and did not vary by the dose of rP305A, again suggesting that rP305A does not affect the other three antigens in the vaccine, he observed.

Immune responses to the rP305A antigen were dose dependent, with the percentage of patients with a threshold response increasing step-wise from the low (47%), mid (63.2%), and high (83%) doses.

By day 29, there was a very brisk rise in geometric mean titers for CP5. Responses did not differ by rP305A dose or across age groups, with a similar pattern observed for CP8 and ClfA, Dr. Fenck Jr. said.

Session co-moderator Dr. Walter Orenstein, from Emory University in Atlanta, commented that the rate of decay post-vaccination was promising, particularly compared with that observed with meningococcal vaccines.

The vaccine “program is exciting because it not only relies on just antibody, but it actually looks at functional responses and those functional responses have some correlate with protection against staphylococcal disease,” he said in an interview. High-risk populations, like renal dialysis patients, were not studied and it would be interesting to see how well they would respond. “Previous studies have shown transient benefits for those types of populations.”

[email protected]

PHILADELPHIA – A single injection of the investigational 4-antigen SA4Ag vaccine was well tolerated and induced robust antibody responses against Staphylococcusaureus in healthy adults in a phase I/II study.

“The very quick development of antibodies suggest that the vaccine could be used pre-operatively [2-3 weeks] for elective surgeries that are at higher risk of Staph. infection, such as thoracotomy or insertion of rods for scoliosis or spinal fusion,” Dr. Robert W. Frenck Jr. said in an interview at Infectious Diseases Week 2014.

As to the durability of responses, antibody levels for all four antigens in the vaccine rose rapidly and then decayed slowly over the next 12 months, he said. “The results support the continued development of SA4Ag for the prevention of invasive S. aureus disease in at-risk adults, including those undergoing elective surgery.”

There is no licensed vaccine that prevents invasive S. aureus infection, although several multi-antigen vaccines are in development.

SA4Ag vaccine is a second-generation vaccine to Pfizer’s 3-antigen SA3AG candidate vaccine and was granted Fast Track designation by the U.S. Food and Drug Administration in February 2014, according to the manufacturer.

SA4Ag contains capsular polysaccharides serotypes 5 and 8 (CP5 and CP8) individually conjugated to CRM₁₉₇, a recombinant surface protein clumping factor A (rmClfA), with a recombinant manganese transporter protein C known as rP305A. Each component was selected based on the virulence of these antigens in S. aureus infections, Dr. Frenck Jr., professor of pediatrics and interim director of infectious diseases, at Cincinnati (Ohio) Children’s Hospital Medical Center, said.

The study stratified 456 healthy adults by age (18-49 years and 50-64 years) and then randomly assigned them to receive a single injection of placebo or one of three formulations of SA4Ag: fixed doses of 30 μg CP5-CRM₁₉₇, 30 μg CP8-CRM₁₉₇, and 60 μg rmClfA, and either a low- (20 μg), mid- (60 μg), or high- (200 μg) rP305A dose.

The participants average age was 45 years, 57% were female, 73% were white, and 87.5% completed the study through month 12.

Local reactions reported through day 14 were mild or moderate, and systemic events and other adverse events were comparable across all groups, Dr. Frenck Jr. said. No vaccine-related serious adverse events or deaths were reported.

At day 29, all participants vaccinated with SA4Ag achieved the CP5 opsonophagocytic activity (OPA) threshold (≥ 1,000 titers) and 96%–99% met the CP8 OPA threshold (≥ 2,000 titers).

“The percentage of subjects reaching the threshold is equivalent for each one of the vaccine doses, indicating that the rP305A did not affect the immune response to the other components in the vaccine,” Dr. Frenck Jr. said.

Less than 25% of patients given placebo achieved the CP5 or CP8 OPA thresholds.

Immune responses to ClfA were robust by day 15 and did not vary by the dose of rP305A, again suggesting that rP305A does not affect the other three antigens in the vaccine, he observed.

Immune responses to the rP305A antigen were dose dependent, with the percentage of patients with a threshold response increasing step-wise from the low (47%), mid (63.2%), and high (83%) doses.

By day 29, there was a very brisk rise in geometric mean titers for CP5. Responses did not differ by rP305A dose or across age groups, with a similar pattern observed for CP8 and ClfA, Dr. Fenck Jr. said.

Session co-moderator Dr. Walter Orenstein, from Emory University in Atlanta, commented that the rate of decay post-vaccination was promising, particularly compared with that observed with meningococcal vaccines.

The vaccine “program is exciting because it not only relies on just antibody, but it actually looks at functional responses and those functional responses have some correlate with protection against staphylococcal disease,” he said in an interview. High-risk populations, like renal dialysis patients, were not studied and it would be interesting to see how well they would respond. “Previous studies have shown transient benefits for those types of populations.”

[email protected]

PHILADELPHIA – A single injection of the investigational 4-antigen SA4Ag vaccine was well tolerated and induced robust antibody responses against Staphylococcusaureus in healthy adults in a phase I/II study.

“The very quick development of antibodies suggest that the vaccine could be used pre-operatively [2-3 weeks] for elective surgeries that are at higher risk of Staph. infection, such as thoracotomy or insertion of rods for scoliosis or spinal fusion,” Dr. Robert W. Frenck Jr. said in an interview at Infectious Diseases Week 2014.

As to the durability of responses, antibody levels for all four antigens in the vaccine rose rapidly and then decayed slowly over the next 12 months, he said. “The results support the continued development of SA4Ag for the prevention of invasive S. aureus disease in at-risk adults, including those undergoing elective surgery.”

There is no licensed vaccine that prevents invasive S. aureus infection, although several multi-antigen vaccines are in development.

SA4Ag vaccine is a second-generation vaccine to Pfizer’s 3-antigen SA3AG candidate vaccine and was granted Fast Track designation by the U.S. Food and Drug Administration in February 2014, according to the manufacturer.

SA4Ag contains capsular polysaccharides serotypes 5 and 8 (CP5 and CP8) individually conjugated to CRM₁₉₇, a recombinant surface protein clumping factor A (rmClfA), with a recombinant manganese transporter protein C known as rP305A. Each component was selected based on the virulence of these antigens in S. aureus infections, Dr. Frenck Jr., professor of pediatrics and interim director of infectious diseases, at Cincinnati (Ohio) Children’s Hospital Medical Center, said.

The study stratified 456 healthy adults by age (18-49 years and 50-64 years) and then randomly assigned them to receive a single injection of placebo or one of three formulations of SA4Ag: fixed doses of 30 μg CP5-CRM₁₉₇, 30 μg CP8-CRM₁₉₇, and 60 μg rmClfA, and either a low- (20 μg), mid- (60 μg), or high- (200 μg) rP305A dose.

The participants average age was 45 years, 57% were female, 73% were white, and 87.5% completed the study through month 12.

Local reactions reported through day 14 were mild or moderate, and systemic events and other adverse events were comparable across all groups, Dr. Frenck Jr. said. No vaccine-related serious adverse events or deaths were reported.

At day 29, all participants vaccinated with SA4Ag achieved the CP5 opsonophagocytic activity (OPA) threshold (≥ 1,000 titers) and 96%–99% met the CP8 OPA threshold (≥ 2,000 titers).

“The percentage of subjects reaching the threshold is equivalent for each one of the vaccine doses, indicating that the rP305A did not affect the immune response to the other components in the vaccine,” Dr. Frenck Jr. said.

Less than 25% of patients given placebo achieved the CP5 or CP8 OPA thresholds.

Immune responses to ClfA were robust by day 15 and did not vary by the dose of rP305A, again suggesting that rP305A does not affect the other three antigens in the vaccine, he observed.

Immune responses to the rP305A antigen were dose dependent, with the percentage of patients with a threshold response increasing step-wise from the low (47%), mid (63.2%), and high (83%) doses.

By day 29, there was a very brisk rise in geometric mean titers for CP5. Responses did not differ by rP305A dose or across age groups, with a similar pattern observed for CP8 and ClfA, Dr. Fenck Jr. said.

Session co-moderator Dr. Walter Orenstein, from Emory University in Atlanta, commented that the rate of decay post-vaccination was promising, particularly compared with that observed with meningococcal vaccines.

The vaccine “program is exciting because it not only relies on just antibody, but it actually looks at functional responses and those functional responses have some correlate with protection against staphylococcal disease,” he said in an interview. High-risk populations, like renal dialysis patients, were not studied and it would be interesting to see how well they would respond. “Previous studies have shown transient benefits for those types of populations.”

[email protected]

PHILADELPHIA – Low IgG1/high IgG4 ratios appear to be more common in pregnant women and may be associated with a diminished response to influenza vaccination, according to Dr. Elizabeth P. Schlaudecker.

“Basically, we know that at the maternal-fetal interface, there are lots of cytokine changes going on and lots of immunologic changes going on, but does this immune milieu of pregnancy actually influence systemic response? Obviously we think it does, but does it really affect the pregnant woman’s response to immunization? In turn, does it really influence the magnitude and character of the antibody response to flu vaccine?” Dr. Schlaudecker, of Cincinnati Children’s Hospital Medical Center, said at an annual scientific meeting on infectious diseases.

These questions prompted her research, and the answers are important because pregnant women don’t do well during flu seasons, she said, noting that “this was especially brought to light during the H1N1 pandemic,” when pregnant women had higher rates of hospital admission, more medical encounters with confirmed or suspected influenza, and greater severity of disease during late pregnancy than nonpregnant women and others.

These effects, which also occur during regular flu seasons, are more pronounced during the second and third trimesters, she said.

Because of this, influenza vaccine is recommended universally in pregnancy with the goal of preventing infection in both mothers and infants.

To determine whether the effects of pregnancy that worsen the outcome of influenza infection also suppress the response to flu vaccine, Dr. Schlaudecker and her colleagues reviewed reports about the immunogenicity of influenza vaccine in pregnancy.

Most studies and reports show that vaccinated pregnant women are likely to have seroprotective responses, but few have compared pregnant and nonpregnant women, so she recruited 70 pregnant women and 65 nonpregnant women, aged 18-39 years, and compared sera before and 28 days after influenza immunization during the 2011-2012 and 2012-2013 flu seasons.

Hemagglutination inhibition (HAI), as expected, was reduced during pregnancy. The pregnant women, who were in either their second or third trimester, had significantly lower HAI titers for anti-influenza H3N2 (154.55 vs. 242.51), and the differences approached significance for both H1N1 (129.96 vs. 181.84) and B antigens (24.91 v. 35.20). She reported these findings at the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

“So I took this information and realized that women may have a decreased antibody response when they are pregnant, and hypothesized that during this time of pregnancy, there are cytokines associated with this maternal-fetal interface that suppress the IgG1 and IgG3 response and promote an IgG4 response to influenza vaccination, particularly during the second and third trimesters, when production of these cytokines should be highest,” she said.

This matters, because the four subclasses of IgG have functional differences. The effector functions of the IgG subclasses are usually opsonization and complement activation, and activation of inflammatory cells through Fc-gamma receptors. IgG1 and IgG3 are more effective than IgG2 or IgG4 in binding stimulatory Fc-gamma receptors and activating complement, she explained.

“IgG4 is also functionally monovalent, so it doesn’t aggregate antigens very well, and it makes it less protective against viruses,” she said, explaining that in normal, nonpregnant women, IgG1 and IgG3 are the predominant responders to viral infection, and they are most likely to be involved in flu virus protection.

“So the question is, although we know [down-regulation of IgG1 and IgG3, and up-regulation of IgG4,] is taking place around the placenta, are these cytokine effects actually circulating systemically enough to affect the flu vaccine?” she asked.

In the study participants, there was a general trend for most pregnant women to have responses that had high IgG4s and low IgG1s, which is not protective, and for nonpregnant women to have high IgG1s and low IgG4s.

The difference between the groups in this regard was not statistically significant, but there were significantly more pregnant women than nonpregnant women with high IgG4 and low IgG1 (10% vs. 0%), and there were significantly fewer pregnant women than nonpregnant women with low IgG4 and high IgG1 (3% vs. 15%), she said.

Both anti-H1N1 HAI and IgG1 titers were significantly lower in pregnant vs. nonpregnant women, but for anti-H1N1 IgG4 titers, the levels were much higher in pregnant vs. nonpregnant women, she said.

“These correlated with each other, suggesting that when you have a high HAI titer, you have a high IgG1 response, which goes along with IgG1 being the predominant IgG isotype and the one most associated with protecting against viral disease,” she said.

“A subset of these women had this very high IgG4 and low IgG1 response, and this suggests a Th2/Treg influence. This unique isotype profile was not found in any nonpregnant women,” she said, adding that very few pregnant women in their second or third trimester make the high IgG1/low IgG4 that should provide a good response to flu vaccine.

Although Dr. Schlaudecker acknowledged that 80%-90% of the pregnant women in the study had protective HAI titers after immunization, she said the findings have important implications.

“I’m concerned that these low IgG1/high IgG4 ratios seen in pregnant women might actually be giving poor protection against flu infection, which brings us back to the pediatric patients. If pregnant women are not protected well, we are not protecting the babies as well. This suggests that we might need to reconsider approaches to timing of flu vaccine or actually the particular vaccines that we give to pregnant women, and it also shows that pregnancy likely effects systemic responses to things like flu vaccine and other vaccines,” she said.

Dr. Schlaudecker reported having no disclosures.

PHILADELPHIA – Low IgG1/high IgG4 ratios appear to be more common in pregnant women and may be associated with a diminished response to influenza vaccination, according to Dr. Elizabeth P. Schlaudecker.

“Basically, we know that at the maternal-fetal interface, there are lots of cytokine changes going on and lots of immunologic changes going on, but does this immune milieu of pregnancy actually influence systemic response? Obviously we think it does, but does it really affect the pregnant woman’s response to immunization? In turn, does it really influence the magnitude and character of the antibody response to flu vaccine?” Dr. Schlaudecker, of Cincinnati Children’s Hospital Medical Center, said at an annual scientific meeting on infectious diseases.

These questions prompted her research, and the answers are important because pregnant women don’t do well during flu seasons, she said, noting that “this was especially brought to light during the H1N1 pandemic,” when pregnant women had higher rates of hospital admission, more medical encounters with confirmed or suspected influenza, and greater severity of disease during late pregnancy than nonpregnant women and others.

These effects, which also occur during regular flu seasons, are more pronounced during the second and third trimesters, she said.

Because of this, influenza vaccine is recommended universally in pregnancy with the goal of preventing infection in both mothers and infants.

To determine whether the effects of pregnancy that worsen the outcome of influenza infection also suppress the response to flu vaccine, Dr. Schlaudecker and her colleagues reviewed reports about the immunogenicity of influenza vaccine in pregnancy.

Most studies and reports show that vaccinated pregnant women are likely to have seroprotective responses, but few have compared pregnant and nonpregnant women, so she recruited 70 pregnant women and 65 nonpregnant women, aged 18-39 years, and compared sera before and 28 days after influenza immunization during the 2011-2012 and 2012-2013 flu seasons.

Hemagglutination inhibition (HAI), as expected, was reduced during pregnancy. The pregnant women, who were in either their second or third trimester, had significantly lower HAI titers for anti-influenza H3N2 (154.55 vs. 242.51), and the differences approached significance for both H1N1 (129.96 vs. 181.84) and B antigens (24.91 v. 35.20). She reported these findings at the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

“So I took this information and realized that women may have a decreased antibody response when they are pregnant, and hypothesized that during this time of pregnancy, there are cytokines associated with this maternal-fetal interface that suppress the IgG1 and IgG3 response and promote an IgG4 response to influenza vaccination, particularly during the second and third trimesters, when production of these cytokines should be highest,” she said.

This matters, because the four subclasses of IgG have functional differences. The effector functions of the IgG subclasses are usually opsonization and complement activation, and activation of inflammatory cells through Fc-gamma receptors. IgG1 and IgG3 are more effective than IgG2 or IgG4 in binding stimulatory Fc-gamma receptors and activating complement, she explained.

“IgG4 is also functionally monovalent, so it doesn’t aggregate antigens very well, and it makes it less protective against viruses,” she said, explaining that in normal, nonpregnant women, IgG1 and IgG3 are the predominant responders to viral infection, and they are most likely to be involved in flu virus protection.

“So the question is, although we know [down-regulation of IgG1 and IgG3, and up-regulation of IgG4,] is taking place around the placenta, are these cytokine effects actually circulating systemically enough to affect the flu vaccine?” she asked.

In the study participants, there was a general trend for most pregnant women to have responses that had high IgG4s and low IgG1s, which is not protective, and for nonpregnant women to have high IgG1s and low IgG4s.

The difference between the groups in this regard was not statistically significant, but there were significantly more pregnant women than nonpregnant women with high IgG4 and low IgG1 (10% vs. 0%), and there were significantly fewer pregnant women than nonpregnant women with low IgG4 and high IgG1 (3% vs. 15%), she said.

Both anti-H1N1 HAI and IgG1 titers were significantly lower in pregnant vs. nonpregnant women, but for anti-H1N1 IgG4 titers, the levels were much higher in pregnant vs. nonpregnant women, she said.

“These correlated with each other, suggesting that when you have a high HAI titer, you have a high IgG1 response, which goes along with IgG1 being the predominant IgG isotype and the one most associated with protecting against viral disease,” she said.

“A subset of these women had this very high IgG4 and low IgG1 response, and this suggests a Th2/Treg influence. This unique isotype profile was not found in any nonpregnant women,” she said, adding that very few pregnant women in their second or third trimester make the high IgG1/low IgG4 that should provide a good response to flu vaccine.

Although Dr. Schlaudecker acknowledged that 80%-90% of the pregnant women in the study had protective HAI titers after immunization, she said the findings have important implications.

“I’m concerned that these low IgG1/high IgG4 ratios seen in pregnant women might actually be giving poor protection against flu infection, which brings us back to the pediatric patients. If pregnant women are not protected well, we are not protecting the babies as well. This suggests that we might need to reconsider approaches to timing of flu vaccine or actually the particular vaccines that we give to pregnant women, and it also shows that pregnancy likely effects systemic responses to things like flu vaccine and other vaccines,” she said.

Dr. Schlaudecker reported having no disclosures.

PHILADELPHIA – Low IgG1/high IgG4 ratios appear to be more common in pregnant women and may be associated with a diminished response to influenza vaccination, according to Dr. Elizabeth P. Schlaudecker.

“Basically, we know that at the maternal-fetal interface, there are lots of cytokine changes going on and lots of immunologic changes going on, but does this immune milieu of pregnancy actually influence systemic response? Obviously we think it does, but does it really affect the pregnant woman’s response to immunization? In turn, does it really influence the magnitude and character of the antibody response to flu vaccine?” Dr. Schlaudecker, of Cincinnati Children’s Hospital Medical Center, said at an annual scientific meeting on infectious diseases.

These questions prompted her research, and the answers are important because pregnant women don’t do well during flu seasons, she said, noting that “this was especially brought to light during the H1N1 pandemic,” when pregnant women had higher rates of hospital admission, more medical encounters with confirmed or suspected influenza, and greater severity of disease during late pregnancy than nonpregnant women and others.

These effects, which also occur during regular flu seasons, are more pronounced during the second and third trimesters, she said.

Because of this, influenza vaccine is recommended universally in pregnancy with the goal of preventing infection in both mothers and infants.

To determine whether the effects of pregnancy that worsen the outcome of influenza infection also suppress the response to flu vaccine, Dr. Schlaudecker and her colleagues reviewed reports about the immunogenicity of influenza vaccine in pregnancy.

Most studies and reports show that vaccinated pregnant women are likely to have seroprotective responses, but few have compared pregnant and nonpregnant women, so she recruited 70 pregnant women and 65 nonpregnant women, aged 18-39 years, and compared sera before and 28 days after influenza immunization during the 2011-2012 and 2012-2013 flu seasons.

Hemagglutination inhibition (HAI), as expected, was reduced during pregnancy. The pregnant women, who were in either their second or third trimester, had significantly lower HAI titers for anti-influenza H3N2 (154.55 vs. 242.51), and the differences approached significance for both H1N1 (129.96 vs. 181.84) and B antigens (24.91 v. 35.20). She reported these findings at the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

“So I took this information and realized that women may have a decreased antibody response when they are pregnant, and hypothesized that during this time of pregnancy, there are cytokines associated with this maternal-fetal interface that suppress the IgG1 and IgG3 response and promote an IgG4 response to influenza vaccination, particularly during the second and third trimesters, when production of these cytokines should be highest,” she said.

This matters, because the four subclasses of IgG have functional differences. The effector functions of the IgG subclasses are usually opsonization and complement activation, and activation of inflammatory cells through Fc-gamma receptors. IgG1 and IgG3 are more effective than IgG2 or IgG4 in binding stimulatory Fc-gamma receptors and activating complement, she explained.

“IgG4 is also functionally monovalent, so it doesn’t aggregate antigens very well, and it makes it less protective against viruses,” she said, explaining that in normal, nonpregnant women, IgG1 and IgG3 are the predominant responders to viral infection, and they are most likely to be involved in flu virus protection.

“So the question is, although we know [down-regulation of IgG1 and IgG3, and up-regulation of IgG4,] is taking place around the placenta, are these cytokine effects actually circulating systemically enough to affect the flu vaccine?” she asked.

In the study participants, there was a general trend for most pregnant women to have responses that had high IgG4s and low IgG1s, which is not protective, and for nonpregnant women to have high IgG1s and low IgG4s.

The difference between the groups in this regard was not statistically significant, but there were significantly more pregnant women than nonpregnant women with high IgG4 and low IgG1 (10% vs. 0%), and there were significantly fewer pregnant women than nonpregnant women with low IgG4 and high IgG1 (3% vs. 15%), she said.

Both anti-H1N1 HAI and IgG1 titers were significantly lower in pregnant vs. nonpregnant women, but for anti-H1N1 IgG4 titers, the levels were much higher in pregnant vs. nonpregnant women, she said.

“These correlated with each other, suggesting that when you have a high HAI titer, you have a high IgG1 response, which goes along with IgG1 being the predominant IgG isotype and the one most associated with protecting against viral disease,” she said.

“A subset of these women had this very high IgG4 and low IgG1 response, and this suggests a Th2/Treg influence. This unique isotype profile was not found in any nonpregnant women,” she said, adding that very few pregnant women in their second or third trimester make the high IgG1/low IgG4 that should provide a good response to flu vaccine.

Although Dr. Schlaudecker acknowledged that 80%-90% of the pregnant women in the study had protective HAI titers after immunization, she said the findings have important implications.

“I’m concerned that these low IgG1/high IgG4 ratios seen in pregnant women might actually be giving poor protection against flu infection, which brings us back to the pediatric patients. If pregnant women are not protected well, we are not protecting the babies as well. This suggests that we might need to reconsider approaches to timing of flu vaccine or actually the particular vaccines that we give to pregnant women, and it also shows that pregnancy likely effects systemic responses to things like flu vaccine and other vaccines,” she said.

Dr. Schlaudecker reported having no disclosures.

PHILADELPHIA– The swath cut by the Ebola virus in West Africa needs to be understood by Westerners in the context of the health care infrastructure available in West Africa, according to Dr. Robert Fowler, who worked as a consulting physician with the World Health Organization and health ministries in West Africa.

The health care infrastructure in West Africa is inadequate to support implementation of infection prevention and control and triage, including even the most basic standard precautions, such as access to soap and water, alcohol-based hand rubs, and sharps disposal boxes, safe needle handling, and rational use of personal protective equipment.

During a special session on the Ebola virus at the recent Infectious Diseases Week 2014, Dr. Fowler described infected patients lying outdoors because of a lack of beds, soiled personal protective equipment piled up where dogs and chickens could run through them, and a room where an Ebola patient hemorrhaged to death after being left untended for days.

Couple this with a limited ability to monitor patients or provide lifesaving rehydration therapy, and one begins to see how health systems in the United States, Canada, and Western Europe are far better prepared to handle the crisis than were their West African counterparts, according to Dr. Fowler of the department of critical care medicine, University of Toronto.

In a video interview, Dr. Fowler discussed the fears surrounding Ebola in the United States and Canada, and highlighted the realities of those countries’ capabilities to combat the outbreak.

Dr. Fowler reported no financial disclosures.

[email protected]

PHILADELPHIA– The swath cut by the Ebola virus in West Africa needs to be understood by Westerners in the context of the health care infrastructure available in West Africa, according to Dr. Robert Fowler, who worked as a consulting physician with the World Health Organization and health ministries in West Africa.

The health care infrastructure in West Africa is inadequate to support implementation of infection prevention and control and triage, including even the most basic standard precautions, such as access to soap and water, alcohol-based hand rubs, and sharps disposal boxes, safe needle handling, and rational use of personal protective equipment.

During a special session on the Ebola virus at the recent Infectious Diseases Week 2014, Dr. Fowler described infected patients lying outdoors because of a lack of beds, soiled personal protective equipment piled up where dogs and chickens could run through them, and a room where an Ebola patient hemorrhaged to death after being left untended for days.

Couple this with a limited ability to monitor patients or provide lifesaving rehydration therapy, and one begins to see how health systems in the United States, Canada, and Western Europe are far better prepared to handle the crisis than were their West African counterparts, according to Dr. Fowler of the department of critical care medicine, University of Toronto.

In a video interview, Dr. Fowler discussed the fears surrounding Ebola in the United States and Canada, and highlighted the realities of those countries’ capabilities to combat the outbreak.

Dr. Fowler reported no financial disclosures.

[email protected]

PHILADELPHIA– The swath cut by the Ebola virus in West Africa needs to be understood by Westerners in the context of the health care infrastructure available in West Africa, according to Dr. Robert Fowler, who worked as a consulting physician with the World Health Organization and health ministries in West Africa.

The health care infrastructure in West Africa is inadequate to support implementation of infection prevention and control and triage, including even the most basic standard precautions, such as access to soap and water, alcohol-based hand rubs, and sharps disposal boxes, safe needle handling, and rational use of personal protective equipment.

During a special session on the Ebola virus at the recent Infectious Diseases Week 2014, Dr. Fowler described infected patients lying outdoors because of a lack of beds, soiled personal protective equipment piled up where dogs and chickens could run through them, and a room where an Ebola patient hemorrhaged to death after being left untended for days.

Couple this with a limited ability to monitor patients or provide lifesaving rehydration therapy, and one begins to see how health systems in the United States, Canada, and Western Europe are far better prepared to handle the crisis than were their West African counterparts, according to Dr. Fowler of the department of critical care medicine, University of Toronto.

In a video interview, Dr. Fowler discussed the fears surrounding Ebola in the United States and Canada, and highlighted the realities of those countries’ capabilities to combat the outbreak.

Dr. Fowler reported no financial disclosures.

[email protected]

PHILADELPHIA – Community associated Clostridium difficile infections continue to increase, rising most rapidly in children, a new study shows.

Age-related changes in C. difficile infection (CDI) also are being paralleled by age-dependent changes in the use of antibiotics, proton pump inhibitors (PPIs), and histamine type 2 receptor (H2) blockers, study author Dr. Howard Faden reported at an annual scientific meeting on infectious diseases.

Children aged 1-18 years had the highest use of antibiotics at 35.39%. This was followed closely by those younger than 1 year of age at 34.01%, who also had the highest use of H2 blockers at 4.30%.

“While children less than 1 year old may or may not develop community-associated C. difficile, their high rate of use of antibiotics and H2 blockers may be associated with higher rates of CD colonization. This could result in the spread of CD in the community,” said Dr. Faden, professor and chief of infectious diseases at the State University of New York at Buffalo.

Dr. Faden and his colleagues used New York State Medicaid data for an annual population of approximately 5 million recipients to calculate outpatient CDI and medication use from 2005 through 2012. Because CD is not considered a pathogen in the first year of life, infants younger than 1 year were included in drug use calculations, but not considered in the overall CDI analysis.

Over the study period, the overall annual incidence of community-acquired CDI increased significantly from 0.13% to 0.32% (P < .01), Dr. Faden said.

The highest incidence was among adults 65 years and older, increasing from 0.28% in 2005 to a peak of 0.54% in 2011, before declining slightly to 0.51% in 2012.

The incidence also increased in adults aged 19-64 years (0.10% -0.29%), but there was a “tremendous rise” in the diagnosis of community acquired CDI in children aged 1-18 years (0.01%-0.05%), Dr. Faden said.

“Granted, it’s much less than the adults, but the rise is much greater,” he remarked.

The differences between years were statistically significant for all age groups (P < .01).

For the total population, the annual use of antibiotics was 25%-35%, surpassing the use of prescribed PPIs at 7% and H2 blockers at 2.5%. “What’s startling to me is that roughly one in three patients in New York have had an antibiotic prescription in the preceding year,” Dr. Faden said in an interview. “When you consider that PPIs and H2 blockers are readily sold over the counter and our analysis accounts for only those that are prescribed, these are clearly underestimates.”

Notably, the use of two or three drug classes was significantly more common in CDI-positive than CDI-negative patients, regardless of age. The same relationship was not seen for one or no drug use.

Mayo Clinic in Minnesota also recently reported that the overall incidence of community-acquired CDI is increasing and that community-acquired CDI patients are significantly younger (median age 50 years) than those with hospital-acquired infections.

The study authors question, however, whether novel risk factors may be playing a role in acquisition, noting that 22% of all patients contracting CDI in the community had no prior antibiotic exposure, and 78% had no exposure to gastric acid suppression drugs (Am. J. Gastroenterol. 2012;107:89-95).

One of the novel risk factors may be having infants younger than 1 year in the household, Dr. Faden said in an interview. The frequent, but unsupported use of PPIs and H2 blockers in this age group further increases colonization, which can be easily transmitted through diaper changes. A study supports this theory, finding that patients with CDI and no or low-level outpatient health care exposure were significantly more likely to be exposed to infants younger than 1 year (JAMA Intern. Med. 2013;173:1359-67).

IDWeek 2014 is the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

Dr. Faden reported having no financial disclosures.

PHILADELPHIA – Community associated Clostridium difficile infections continue to increase, rising most rapidly in children, a new study shows.

Age-related changes in C. difficile infection (CDI) also are being paralleled by age-dependent changes in the use of antibiotics, proton pump inhibitors (PPIs), and histamine type 2 receptor (H2) blockers, study author Dr. Howard Faden reported at an annual scientific meeting on infectious diseases.

Children aged 1-18 years had the highest use of antibiotics at 35.39%. This was followed closely by those younger than 1 year of age at 34.01%, who also had the highest use of H2 blockers at 4.30%.

“While children less than 1 year old may or may not develop community-associated C. difficile, their high rate of use of antibiotics and H2 blockers may be associated with higher rates of CD colonization. This could result in the spread of CD in the community,” said Dr. Faden, professor and chief of infectious diseases at the State University of New York at Buffalo.

Dr. Faden and his colleagues used New York State Medicaid data for an annual population of approximately 5 million recipients to calculate outpatient CDI and medication use from 2005 through 2012. Because CD is not considered a pathogen in the first year of life, infants younger than 1 year were included in drug use calculations, but not considered in the overall CDI analysis.

Over the study period, the overall annual incidence of community-acquired CDI increased significantly from 0.13% to 0.32% (P < .01), Dr. Faden said.

The highest incidence was among adults 65 years and older, increasing from 0.28% in 2005 to a peak of 0.54% in 2011, before declining slightly to 0.51% in 2012.

The incidence also increased in adults aged 19-64 years (0.10% -0.29%), but there was a “tremendous rise” in the diagnosis of community acquired CDI in children aged 1-18 years (0.01%-0.05%), Dr. Faden said.

“Granted, it’s much less than the adults, but the rise is much greater,” he remarked.

The differences between years were statistically significant for all age groups (P < .01).

For the total population, the annual use of antibiotics was 25%-35%, surpassing the use of prescribed PPIs at 7% and H2 blockers at 2.5%. “What’s startling to me is that roughly one in three patients in New York have had an antibiotic prescription in the preceding year,” Dr. Faden said in an interview. “When you consider that PPIs and H2 blockers are readily sold over the counter and our analysis accounts for only those that are prescribed, these are clearly underestimates.”

Notably, the use of two or three drug classes was significantly more common in CDI-positive than CDI-negative patients, regardless of age. The same relationship was not seen for one or no drug use.

Mayo Clinic in Minnesota also recently reported that the overall incidence of community-acquired CDI is increasing and that community-acquired CDI patients are significantly younger (median age 50 years) than those with hospital-acquired infections.

The study authors question, however, whether novel risk factors may be playing a role in acquisition, noting that 22% of all patients contracting CDI in the community had no prior antibiotic exposure, and 78% had no exposure to gastric acid suppression drugs (Am. J. Gastroenterol. 2012;107:89-95).

One of the novel risk factors may be having infants younger than 1 year in the household, Dr. Faden said in an interview. The frequent, but unsupported use of PPIs and H2 blockers in this age group further increases colonization, which can be easily transmitted through diaper changes. A study supports this theory, finding that patients with CDI and no or low-level outpatient health care exposure were significantly more likely to be exposed to infants younger than 1 year (JAMA Intern. Med. 2013;173:1359-67).

IDWeek 2014 is the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

Dr. Faden reported having no financial disclosures.

PHILADELPHIA – Community associated Clostridium difficile infections continue to increase, rising most rapidly in children, a new study shows.

Age-related changes in C. difficile infection (CDI) also are being paralleled by age-dependent changes in the use of antibiotics, proton pump inhibitors (PPIs), and histamine type 2 receptor (H2) blockers, study author Dr. Howard Faden reported at an annual scientific meeting on infectious diseases.

Children aged 1-18 years had the highest use of antibiotics at 35.39%. This was followed closely by those younger than 1 year of age at 34.01%, who also had the highest use of H2 blockers at 4.30%.

“While children less than 1 year old may or may not develop community-associated C. difficile, their high rate of use of antibiotics and H2 blockers may be associated with higher rates of CD colonization. This could result in the spread of CD in the community,” said Dr. Faden, professor and chief of infectious diseases at the State University of New York at Buffalo.

Dr. Faden and his colleagues used New York State Medicaid data for an annual population of approximately 5 million recipients to calculate outpatient CDI and medication use from 2005 through 2012. Because CD is not considered a pathogen in the first year of life, infants younger than 1 year were included in drug use calculations, but not considered in the overall CDI analysis.

Over the study period, the overall annual incidence of community-acquired CDI increased significantly from 0.13% to 0.32% (P < .01), Dr. Faden said.

The highest incidence was among adults 65 years and older, increasing from 0.28% in 2005 to a peak of 0.54% in 2011, before declining slightly to 0.51% in 2012.

The incidence also increased in adults aged 19-64 years (0.10% -0.29%), but there was a “tremendous rise” in the diagnosis of community acquired CDI in children aged 1-18 years (0.01%-0.05%), Dr. Faden said.

“Granted, it’s much less than the adults, but the rise is much greater,” he remarked.

The differences between years were statistically significant for all age groups (P < .01).

For the total population, the annual use of antibiotics was 25%-35%, surpassing the use of prescribed PPIs at 7% and H2 blockers at 2.5%. “What’s startling to me is that roughly one in three patients in New York have had an antibiotic prescription in the preceding year,” Dr. Faden said in an interview. “When you consider that PPIs and H2 blockers are readily sold over the counter and our analysis accounts for only those that are prescribed, these are clearly underestimates.”

Notably, the use of two or three drug classes was significantly more common in CDI-positive than CDI-negative patients, regardless of age. The same relationship was not seen for one or no drug use.

Mayo Clinic in Minnesota also recently reported that the overall incidence of community-acquired CDI is increasing and that community-acquired CDI patients are significantly younger (median age 50 years) than those with hospital-acquired infections.

The study authors question, however, whether novel risk factors may be playing a role in acquisition, noting that 22% of all patients contracting CDI in the community had no prior antibiotic exposure, and 78% had no exposure to gastric acid suppression drugs (Am. J. Gastroenterol. 2012;107:89-95).

One of the novel risk factors may be having infants younger than 1 year in the household, Dr. Faden said in an interview. The frequent, but unsupported use of PPIs and H2 blockers in this age group further increases colonization, which can be easily transmitted through diaper changes. A study supports this theory, finding that patients with CDI and no or low-level outpatient health care exposure were significantly more likely to be exposed to infants younger than 1 year (JAMA Intern. Med. 2013;173:1359-67).

IDWeek 2014 is the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

Dr. Faden reported having no financial disclosures.

PHILADELPHIA – Community associated Clostridium difficile infections continue to increase, rising most rapidly in children, a new study shows.

Age-related changes in C. difficile infection (CDI) also are being paralleled by age-dependent changes in the use of antibiotics, proton pump inhibitors (PPIs), and histamine type 2 receptor (H2) blockers, study author Dr. Howard Faden reported at an annual scientific meeting on infectious diseases.

Patrice Wendling/Frontline Medical News

Children aged 1-18 years had the highest use of antibiotics at 35.39%. This was followed closely by those younger than 1 year of age at 34.01%, who also had the highest use of H2 blockers at 4.30%.

“While children less than 1 year old may or may not develop community-associated C. difficile, their high rate of use of antibiotics and H2 blockers may be associated with higher rates of CD colonization. This could result in the spread of CD in the community,” said Dr. Faden, professor and chief of infectious diseases at the State University of New York at Buffalo.

Dr. Faden and his colleagues used New York State Medicaid data for an annual population of approximately 5 million recipients to calculate outpatient CDI and medication use from 2005 through 2012. Because CD is not considered a pathogen in the first year of life, infants younger than 1 year were included in drug use calculations, but not considered in the overall CDI analysis.

Over the study period, the overall annual incidence of community-acquired CDI increased significantly from 0.13% to 0.32% (P < .01), Dr. Faden said.

The highest incidence was among adults 65 years and older, increasing from 0.28% in 2005 to a peak of 0.54% in 2011, before declining slightly to 0.51% in 2012.

The incidence also increased in adults aged 19-64 years (0.10% -0.29%), but there was a “tremendous rise” in the diagnosis of community acquired CDI in children aged 1-18 years (0.01%-0.05%), Dr. Faden said.

“Granted, it’s much less than the adults, but the rise is much greater,” he remarked.

The differences between years were statistically significant for all age groups (P < .01).

For the total population, the annual use of antibiotics was 25%-35%, surpassing the use of prescribed PPIs at 7% and H2 blockers at 2.5%. “What’s startling to me is that roughly one in three patients in New York have had an antibiotic prescription in the preceding year,” Dr. Faden said in an interview. “When you consider that PPIs and H2 blockers are readily sold over the counter and our analysis accounts for only those that are prescribed, these are clearly underestimates.”

Notably, the use of two or three drug classes was significantly more common in CDI-positive than CDI-negative patients, regardless of age. The same relationship was not seen for one or no drug use.

Mayo Clinic in Minnesota also recently reported that the overall incidence of community-acquired CDI is increasing and that community-acquired CDI patients are significantly younger (median age 50 years) than those with hospital-acquired infections.

The study authors question, however, whether novel risk factors may be playing a role in acquisition, noting that 22% of all patients contracting CDI in the community had no prior antibiotic exposure, and 78% had no exposure to gastric acid suppression drugs (Am. J. Gastroenterol. 2012;107:89-95).

One of the novel risk factors may be having infants younger than 1 year in the household, Dr. Faden said in an interview. The frequent, but unsupported use of PPIs and H2 blockers in this age group further increases colonization, which can be easily transmitted through diaper changes. A study supports this theory, finding that patients with CDI and no or low-level outpatient health care exposure were significantly more likely to be exposed to infants younger than 1 year (JAMA Intern. Med. 2013;173:1359-67).

IDWeek 2014 is the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

Dr. Faden reported having no financial disclosures.

[email protected]

PHILADELPHIA – Community associated Clostridium difficile infections continue to increase, rising most rapidly in children, a new study shows.

Age-related changes in C. difficile infection (CDI) also are being paralleled by age-dependent changes in the use of antibiotics, proton pump inhibitors (PPIs), and histamine type 2 receptor (H2) blockers, study author Dr. Howard Faden reported at an annual scientific meeting on infectious diseases.

Patrice Wendling/Frontline Medical News

Children aged 1-18 years had the highest use of antibiotics at 35.39%. This was followed closely by those younger than 1 year of age at 34.01%, who also had the highest use of H2 blockers at 4.30%.

“While children less than 1 year old may or may not develop community-associated C. difficile, their high rate of use of antibiotics and H2 blockers may be associated with higher rates of CD colonization. This could result in the spread of CD in the community,” said Dr. Faden, professor and chief of infectious diseases at the State University of New York at Buffalo.

Dr. Faden and his colleagues used New York State Medicaid data for an annual population of approximately 5 million recipients to calculate outpatient CDI and medication use from 2005 through 2012. Because CD is not considered a pathogen in the first year of life, infants younger than 1 year were included in drug use calculations, but not considered in the overall CDI analysis.

Over the study period, the overall annual incidence of community-acquired CDI increased significantly from 0.13% to 0.32% (P < .01), Dr. Faden said.

The highest incidence was among adults 65 years and older, increasing from 0.28% in 2005 to a peak of 0.54% in 2011, before declining slightly to 0.51% in 2012.

The incidence also increased in adults aged 19-64 years (0.10% -0.29%), but there was a “tremendous rise” in the diagnosis of community acquired CDI in children aged 1-18 years (0.01%-0.05%), Dr. Faden said.

“Granted, it’s much less than the adults, but the rise is much greater,” he remarked.

The differences between years were statistically significant for all age groups (P < .01).

For the total population, the annual use of antibiotics was 25%-35%, surpassing the use of prescribed PPIs at 7% and H2 blockers at 2.5%. “What’s startling to me is that roughly one in three patients in New York have had an antibiotic prescription in the preceding year,” Dr. Faden said in an interview. “When you consider that PPIs and H2 blockers are readily sold over the counter and our analysis accounts for only those that are prescribed, these are clearly underestimates.”

Notably, the use of two or three drug classes was significantly more common in CDI-positive than CDI-negative patients, regardless of age. The same relationship was not seen for one or no drug use.

Mayo Clinic in Minnesota also recently reported that the overall incidence of community-acquired CDI is increasing and that community-acquired CDI patients are significantly younger (median age 50 years) than those with hospital-acquired infections.

The study authors question, however, whether novel risk factors may be playing a role in acquisition, noting that 22% of all patients contracting CDI in the community had no prior antibiotic exposure, and 78% had no exposure to gastric acid suppression drugs (Am. J. Gastroenterol. 2012;107:89-95).

One of the novel risk factors may be having infants younger than 1 year in the household, Dr. Faden said in an interview. The frequent, but unsupported use of PPIs and H2 blockers in this age group further increases colonization, which can be easily transmitted through diaper changes. A study supports this theory, finding that patients with CDI and no or low-level outpatient health care exposure were significantly more likely to be exposed to infants younger than 1 year (JAMA Intern. Med. 2013;173:1359-67).

IDWeek 2014 is the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

Dr. Faden reported having no financial disclosures.

[email protected]

PHILADELPHIA – Community associated Clostridium difficile infections continue to increase, rising most rapidly in children, a new study shows.

Age-related changes in C. difficile infection (CDI) also are being paralleled by age-dependent changes in the use of antibiotics, proton pump inhibitors (PPIs), and histamine type 2 receptor (H2) blockers, study author Dr. Howard Faden reported at an annual scientific meeting on infectious diseases.

Patrice Wendling/Frontline Medical News

Children aged 1-18 years had the highest use of antibiotics at 35.39%. This was followed closely by those younger than 1 year of age at 34.01%, who also had the highest use of H2 blockers at 4.30%.

“While children less than 1 year old may or may not develop community-associated C. difficile, their high rate of use of antibiotics and H2 blockers may be associated with higher rates of CD colonization. This could result in the spread of CD in the community,” said Dr. Faden, professor and chief of infectious diseases at the State University of New York at Buffalo.

Dr. Faden and his colleagues used New York State Medicaid data for an annual population of approximately 5 million recipients to calculate outpatient CDI and medication use from 2005 through 2012. Because CD is not considered a pathogen in the first year of life, infants younger than 1 year were included in drug use calculations, but not considered in the overall CDI analysis.

Over the study period, the overall annual incidence of community-acquired CDI increased significantly from 0.13% to 0.32% (P < .01), Dr. Faden said.

The highest incidence was among adults 65 years and older, increasing from 0.28% in 2005 to a peak of 0.54% in 2011, before declining slightly to 0.51% in 2012.

The incidence also increased in adults aged 19-64 years (0.10% -0.29%), but there was a “tremendous rise” in the diagnosis of community acquired CDI in children aged 1-18 years (0.01%-0.05%), Dr. Faden said.

“Granted, it’s much less than the adults, but the rise is much greater,” he remarked.

The differences between years were statistically significant for all age groups (P < .01).

For the total population, the annual use of antibiotics was 25%-35%, surpassing the use of prescribed PPIs at 7% and H2 blockers at 2.5%. “What’s startling to me is that roughly one in three patients in New York have had an antibiotic prescription in the preceding year,” Dr. Faden said in an interview. “When you consider that PPIs and H2 blockers are readily sold over the counter and our analysis accounts for only those that are prescribed, these are clearly underestimates.”

Notably, the use of two or three drug classes was significantly more common in CDI-positive than CDI-negative patients, regardless of age. The same relationship was not seen for one or no drug use.

Mayo Clinic in Minnesota also recently reported that the overall incidence of community-acquired CDI is increasing and that community-acquired CDI patients are significantly younger (median age 50 years) than those with hospital-acquired infections.

The study authors question, however, whether novel risk factors may be playing a role in acquisition, noting that 22% of all patients contracting CDI in the community had no prior antibiotic exposure, and 78% had no exposure to gastric acid suppression drugs (Am. J. Gastroenterol. 2012;107:89-95).

One of the novel risk factors may be having infants younger than 1 year in the household, Dr. Faden said in an interview. The frequent, but unsupported use of PPIs and H2 blockers in this age group further increases colonization, which can be easily transmitted through diaper changes. A study supports this theory, finding that patients with CDI and no or low-level outpatient health care exposure were significantly more likely to be exposed to infants younger than 1 year (JAMA Intern. Med. 2013;173:1359-67).

IDWeek 2014 is the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

Dr. Faden reported having no financial disclosures.

[email protected]

PHILADELPHIA – Invasive pneumococcal infections declined by 42% in 2011, compared with 2007-2009, the years after the introduction of the 13-valent pneumococcal conjugate vaccine, according to an analysis of data from eight U.S. children’s hospitals.

Infections continued to decline – by 48% overall – 2-3 years after full implementation of the vaccine. Declines were seen in the rates of bacteremia, pneumonia, and mastoiditis, but the rates of pneumococcal meningitis in the latter years remained unchanged, with an increasing proportion of cases occurring among children with invasive disease.

© Micah Young / istockphoto.com

The most common 13-valent pneumococcal conjugate vaccine (PCV13) serotypes causing invasive pneumococcal infections in 2011 were 19A and 7F. The declines in invasive infections in 2012 and 2013 were mainly because of declines in serotype 19A and 7F isolates, which decreased by 58% and 54%, respectively, but serotype 3 isolates remained at pre-PCV13 levels, Dr. Sheldon L. Kaplan of Baylor College of Medicine and Texas Children’s Hospital, in Houston, reported at an annual scientific meeting on infectious diseases.

“We had 29 children with invasive pneumococcal disease caused by a PCV13 serotype [in 2012-2013]. All but one were a 19A or serotype 3,” he said at thecombined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

Nine children with serotype 19A isolates, and 4 with serotype 3 isolates had received at least two doses of PCV13 prior to developing infections. In 2013, 3 of 12 children with 19A isolates had received four PCV13 doses prior to developing serotype 19A infections.

Only three serotype 1-, 7-, and 19F-related invasive infections occurred during the study period, and no serotype 5–related infections occurred.

In 2012-2013, non-PCV13 serotypes – mainly 33F and 22F – accounted for 71% of isolates, Dr. Kaplan said.

Of note, 45% of children at the eight hospitals that are part of the U.S. Pediatric Multicenter Pneumococcal Surveillance Study Group – which has been conducting pneumococcal surveillance since 1993 – had an underlying condition during 2011-2013, compared with 37% in 2007-2009. The difference was statistically significant, Dr. Kaplan said, noting that malignancies were the most common type of underlying condition, followed by central nervous system disorders, genetic disorder, cardiovascular disorders, and renal disorders.

Non-PCV13 serotypes accounted for 78% of isolates from children with underlying conditions, he said.

Mortality was 0.8% (5 of 626) in 2007-2009, and 3.7% (13 of 352) in 2011-2013. Of the 13 children who died in 2011-2013, 10 had a non-PCV13 serotype, and 9 had an underlying condition, Dr. Kaplan said.

Almost all (99%) of non–central nervous system infections in 2011-2013 were susceptible to penicillin and ceftriaxone.

“Continued surveillance is warranted, especially to monitor non-PCV13 serotypes associated with invasive pneumococcal disease,” he said.

As for pneumococcal meningitis, rates decreased significantly after the introduction of PCV7, but the proportion among children with invasive pneumococcal disease increased by 67% over time, accounting for 12% of cases during 2007-2009, compared with 20% of cases during 2011-2013, according to Dr. Liset Olarte, also of Baylor College of Medicine and Texas Children’s Hospital.

The proportion decreased by 21% among children younger than 24 months, but increased significantly in those aged 24 to 59 months, she noted.

Clinical data showed that in 2007-2009, 19A, 7F, and 3 were the most common serotypes associated with pneumococcal meningitis in the eight hospitals in the surveillance study group. In 2011-13, 19A remained the most common serotype, followed by non-PCV13 serotypes 35B and 22F. Overall, non-PCV13 serotypes causing pneumococcal meningitis increased in both number of cases (24 to 49) and proportion of cases (46% to 73%) after PCV13 introduction.

“In our study, only the change in serotype 7F was statistically significant,” said Dr. Olarte.

The proportion of isolates that were non-susceptible to penicillin did not change significantly from 2007-2009 to 2011-2013 (26% and 25%, respectively), but the proportion nonsusceptible to ceftriaxone, and thus requiring vancomycin for treatment, decreased significantly – by 77% – from 13% to 3%.

All of the isolates with a ceftriaxone minimum inhibitory concentration of 1 mcg/mL or greater and penicillin minimum inhibitory concentration of 2 mcg/mL or greater were serotype 19A, Dr. Olarte said.

Mortality did not change significantly during the study period, but there was a marked, significant increase in hemiparesis cases, from 1% to 12%, after introduction of PCV13. However, this increase was not associated with any particular serotype.

Additionally, subdural empyema on neuroimaging increased from 1% to 16%, but was not associated with any particular serotype and was not associated with the cases of hemiparesis.

Overall, 52% of survivors had some sort of neurologic sequelae at the time of discharge, but there were no differences in terms of specific sequelae between the two groups.

The rates of morbidity and mortality for pneumococcal meningitis remain substantial and have not changed significantly since introduction of PCV13, Dr. Olarte said.

However, if the number of cephalosporin nonsusceptible pneumococci isolated from children with meningitis continues to decrease, modification of empiric antibiotic selection for suspected bacterial meningitis might be considered in the future, therefore ongoing surveillance is warranted, she said.

The studies were partially supported by Pfizer. The authors reported having no other disclosures.

PHILADELPHIA – Invasive pneumococcal infections declined by 42% in 2011, compared with 2007-2009, the years after the introduction of the 13-valent pneumococcal conjugate vaccine, according to an analysis of data from eight U.S. children’s hospitals.

Infections continued to decline – by 48% overall – 2-3 years after full implementation of the vaccine. Declines were seen in the rates of bacteremia, pneumonia, and mastoiditis, but the rates of pneumococcal meningitis in the latter years remained unchanged, with an increasing proportion of cases occurring among children with invasive disease.

© Micah Young / istockphoto.com

The most common 13-valent pneumococcal conjugate vaccine (PCV13) serotypes causing invasive pneumococcal infections in 2011 were 19A and 7F. The declines in invasive infections in 2012 and 2013 were mainly because of declines in serotype 19A and 7F isolates, which decreased by 58% and 54%, respectively, but serotype 3 isolates remained at pre-PCV13 levels, Dr. Sheldon L. Kaplan of Baylor College of Medicine and Texas Children’s Hospital, in Houston, reported at an annual scientific meeting on infectious diseases.

“We had 29 children with invasive pneumococcal disease caused by a PCV13 serotype [in 2012-2013]. All but one were a 19A or serotype 3,” he said at thecombined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

Nine children with serotype 19A isolates, and 4 with serotype 3 isolates had received at least two doses of PCV13 prior to developing infections. In 2013, 3 of 12 children with 19A isolates had received four PCV13 doses prior to developing serotype 19A infections.

Only three serotype 1-, 7-, and 19F-related invasive infections occurred during the study period, and no serotype 5–related infections occurred.

In 2012-2013, non-PCV13 serotypes – mainly 33F and 22F – accounted for 71% of isolates, Dr. Kaplan said.

Of note, 45% of children at the eight hospitals that are part of the U.S. Pediatric Multicenter Pneumococcal Surveillance Study Group – which has been conducting pneumococcal surveillance since 1993 – had an underlying condition during 2011-2013, compared with 37% in 2007-2009. The difference was statistically significant, Dr. Kaplan said, noting that malignancies were the most common type of underlying condition, followed by central nervous system disorders, genetic disorder, cardiovascular disorders, and renal disorders.

Non-PCV13 serotypes accounted for 78% of isolates from children with underlying conditions, he said.

Mortality was 0.8% (5 of 626) in 2007-2009, and 3.7% (13 of 352) in 2011-2013. Of the 13 children who died in 2011-2013, 10 had a non-PCV13 serotype, and 9 had an underlying condition, Dr. Kaplan said.

Almost all (99%) of non–central nervous system infections in 2011-2013 were susceptible to penicillin and ceftriaxone.

“Continued surveillance is warranted, especially to monitor non-PCV13 serotypes associated with invasive pneumococcal disease,” he said.

As for pneumococcal meningitis, rates decreased significantly after the introduction of PCV7, but the proportion among children with invasive pneumococcal disease increased by 67% over time, accounting for 12% of cases during 2007-2009, compared with 20% of cases during 2011-2013, according to Dr. Liset Olarte, also of Baylor College of Medicine and Texas Children’s Hospital.

The proportion decreased by 21% among children younger than 24 months, but increased significantly in those aged 24 to 59 months, she noted.

Clinical data showed that in 2007-2009, 19A, 7F, and 3 were the most common serotypes associated with pneumococcal meningitis in the eight hospitals in the surveillance study group. In 2011-13, 19A remained the most common serotype, followed by non-PCV13 serotypes 35B and 22F. Overall, non-PCV13 serotypes causing pneumococcal meningitis increased in both number of cases (24 to 49) and proportion of cases (46% to 73%) after PCV13 introduction.

“In our study, only the change in serotype 7F was statistically significant,” said Dr. Olarte.

The proportion of isolates that were non-susceptible to penicillin did not change significantly from 2007-2009 to 2011-2013 (26% and 25%, respectively), but the proportion nonsusceptible to ceftriaxone, and thus requiring vancomycin for treatment, decreased significantly – by 77% – from 13% to 3%.

All of the isolates with a ceftriaxone minimum inhibitory concentration of 1 mcg/mL or greater and penicillin minimum inhibitory concentration of 2 mcg/mL or greater were serotype 19A, Dr. Olarte said.

Mortality did not change significantly during the study period, but there was a marked, significant increase in hemiparesis cases, from 1% to 12%, after introduction of PCV13. However, this increase was not associated with any particular serotype.

Additionally, subdural empyema on neuroimaging increased from 1% to 16%, but was not associated with any particular serotype and was not associated with the cases of hemiparesis.

Overall, 52% of survivors had some sort of neurologic sequelae at the time of discharge, but there were no differences in terms of specific sequelae between the two groups.

The rates of morbidity and mortality for pneumococcal meningitis remain substantial and have not changed significantly since introduction of PCV13, Dr. Olarte said.

However, if the number of cephalosporin nonsusceptible pneumococci isolated from children with meningitis continues to decrease, modification of empiric antibiotic selection for suspected bacterial meningitis might be considered in the future, therefore ongoing surveillance is warranted, she said.

The studies were partially supported by Pfizer. The authors reported having no other disclosures.

PHILADELPHIA – Invasive pneumococcal infections declined by 42% in 2011, compared with 2007-2009, the years after the introduction of the 13-valent pneumococcal conjugate vaccine, according to an analysis of data from eight U.S. children’s hospitals.

Infections continued to decline – by 48% overall – 2-3 years after full implementation of the vaccine. Declines were seen in the rates of bacteremia, pneumonia, and mastoiditis, but the rates of pneumococcal meningitis in the latter years remained unchanged, with an increasing proportion of cases occurring among children with invasive disease.

© Micah Young / istockphoto.com

The most common 13-valent pneumococcal conjugate vaccine (PCV13) serotypes causing invasive pneumococcal infections in 2011 were 19A and 7F. The declines in invasive infections in 2012 and 2013 were mainly because of declines in serotype 19A and 7F isolates, which decreased by 58% and 54%, respectively, but serotype 3 isolates remained at pre-PCV13 levels, Dr. Sheldon L. Kaplan of Baylor College of Medicine and Texas Children’s Hospital, in Houston, reported at an annual scientific meeting on infectious diseases.

“We had 29 children with invasive pneumococcal disease caused by a PCV13 serotype [in 2012-2013]. All but one were a 19A or serotype 3,” he said at thecombined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

Nine children with serotype 19A isolates, and 4 with serotype 3 isolates had received at least two doses of PCV13 prior to developing infections. In 2013, 3 of 12 children with 19A isolates had received four PCV13 doses prior to developing serotype 19A infections.

Only three serotype 1-, 7-, and 19F-related invasive infections occurred during the study period, and no serotype 5–related infections occurred.

In 2012-2013, non-PCV13 serotypes – mainly 33F and 22F – accounted for 71% of isolates, Dr. Kaplan said.

Of note, 45% of children at the eight hospitals that are part of the U.S. Pediatric Multicenter Pneumococcal Surveillance Study Group – which has been conducting pneumococcal surveillance since 1993 – had an underlying condition during 2011-2013, compared with 37% in 2007-2009. The difference was statistically significant, Dr. Kaplan said, noting that malignancies were the most common type of underlying condition, followed by central nervous system disorders, genetic disorder, cardiovascular disorders, and renal disorders.

Non-PCV13 serotypes accounted for 78% of isolates from children with underlying conditions, he said.

Mortality was 0.8% (5 of 626) in 2007-2009, and 3.7% (13 of 352) in 2011-2013. Of the 13 children who died in 2011-2013, 10 had a non-PCV13 serotype, and 9 had an underlying condition, Dr. Kaplan said.

Almost all (99%) of non–central nervous system infections in 2011-2013 were susceptible to penicillin and ceftriaxone.

“Continued surveillance is warranted, especially to monitor non-PCV13 serotypes associated with invasive pneumococcal disease,” he said.

As for pneumococcal meningitis, rates decreased significantly after the introduction of PCV7, but the proportion among children with invasive pneumococcal disease increased by 67% over time, accounting for 12% of cases during 2007-2009, compared with 20% of cases during 2011-2013, according to Dr. Liset Olarte, also of Baylor College of Medicine and Texas Children’s Hospital.

The proportion decreased by 21% among children younger than 24 months, but increased significantly in those aged 24 to 59 months, she noted.

Clinical data showed that in 2007-2009, 19A, 7F, and 3 were the most common serotypes associated with pneumococcal meningitis in the eight hospitals in the surveillance study group. In 2011-13, 19A remained the most common serotype, followed by non-PCV13 serotypes 35B and 22F. Overall, non-PCV13 serotypes causing pneumococcal meningitis increased in both number of cases (24 to 49) and proportion of cases (46% to 73%) after PCV13 introduction.

“In our study, only the change in serotype 7F was statistically significant,” said Dr. Olarte.

The proportion of isolates that were non-susceptible to penicillin did not change significantly from 2007-2009 to 2011-2013 (26% and 25%, respectively), but the proportion nonsusceptible to ceftriaxone, and thus requiring vancomycin for treatment, decreased significantly – by 77% – from 13% to 3%.

All of the isolates with a ceftriaxone minimum inhibitory concentration of 1 mcg/mL or greater and penicillin minimum inhibitory concentration of 2 mcg/mL or greater were serotype 19A, Dr. Olarte said.

Mortality did not change significantly during the study period, but there was a marked, significant increase in hemiparesis cases, from 1% to 12%, after introduction of PCV13. However, this increase was not associated with any particular serotype.

Additionally, subdural empyema on neuroimaging increased from 1% to 16%, but was not associated with any particular serotype and was not associated with the cases of hemiparesis.

Overall, 52% of survivors had some sort of neurologic sequelae at the time of discharge, but there were no differences in terms of specific sequelae between the two groups.

The rates of morbidity and mortality for pneumococcal meningitis remain substantial and have not changed significantly since introduction of PCV13, Dr. Olarte said.

However, if the number of cephalosporin nonsusceptible pneumococci isolated from children with meningitis continues to decrease, modification of empiric antibiotic selection for suspected bacterial meningitis might be considered in the future, therefore ongoing surveillance is warranted, she said.

The studies were partially supported by Pfizer. The authors reported having no other disclosures.

PHILADELPHIA– Infectious diseases played a primary role in 16% of pediatric hospitalizations between 1997 and 2009, and remain a leading cause of pediatric hospitalizations and health care expenditures, but the proportion of hospitalizations associated with an infectious disease declined by 18% during the study period, according to an analysis of the Kids’ Inpatient Database.

©pixelcarpenter/Fotolia.com

Periods of decline were temporally associated with the introduction of pneumococcal and rotavirus vaccines, Chris Stockmann of the University of Utah Health Sciences Center, Salt Lake City, reported at an annual scientific meeting on infectious diseases.

Infectious diseases were second only to newborn deliveries as a cause of pediatric hospitalizations during the study period, Mr. Stockmann said at the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

The burden was highest among children under age 5 years, who accounted for about 75% of all infectious disease hospitalizations; those under age 3 months accounted for 15%.

Eight diagnoses accounted for more than 80% of the hospitalizations. The most common were pneumonia and bronchiolitis, followed by urinary tract infections, other upper respiratory tract infections, intestinal infections, other viral infections, sepsis, and meningitis. Respiratory infections accounted for about two-thirds of all hospitalizations, he said.

Pneumonia was the leading cause of hospitalizations across all age groups. The second leading cause was bronchiolitis in those under age 5 years, and UTI in those aged 5 years and older.

“A smattering of other conditions, including intestinal infections, viral infections, and meningitis, also make an appearance in the top 4,” he said.

Over time, pneumonia, bronchiolitis, and other upper respiratory tract infections decreased by 15% to 30%, and the intestinal infection rate was nearly halved.

The decrease in pneumonia hospitalizations coincided with the introduction of the 7-valent pneumococcal conjugate vaccine in 2000, and the introduction of the rotavirus vaccine in 2007. The introduction of these vaccines also was associated with a reduction in intestinal infection hospitalizations, he said.

During the study period, the overall charge for all infectious disease hospitalizations was $4.3 billion per year nationally. At the patient level, the mean charge was just under $15,000, and the mean length of stay was just over 3 days, Mr. Stockmann said.

Total hospital charges were driven by pneumonia and bronchiolitis, but at the individual patient level, sepsis and meningitis were the most expensive conditions, he noted.

The data for this analysis were derived from the National Inpatient Survey’s Kids’ Inpatient Database (KID), owned and operated by the Agency for Healthcare Research and Quality, and maintained by the Healthcare Cost and Utilization Project. Currently, 3,500 hospitals in 44 states contribute data to KID, which is released every 3 years; data for this study were available for 1997, 2000, 2003, 2006, and 2009 and were weighted with a complex survey design to more than 36 million discharges nationwide.

The findings underscore the need for additional efforts to reduce the burden of pediatric respiratory tract infections, Mr. Stockmann said. “We would posit that respiratory viral vaccines may play a key role in that,” he said.

Mr. Stockmann reported having no disclosures.

PHILADELPHIA– Infectious diseases played a primary role in 16% of pediatric hospitalizations between 1997 and 2009, and remain a leading cause of pediatric hospitalizations and health care expenditures, but the proportion of hospitalizations associated with an infectious disease declined by 18% during the study period, according to an analysis of the Kids’ Inpatient Database.

©pixelcarpenter/Fotolia.com

Periods of decline were temporally associated with the introduction of pneumococcal and rotavirus vaccines, Chris Stockmann of the University of Utah Health Sciences Center, Salt Lake City, reported at an annual scientific meeting on infectious diseases.

Infectious diseases were second only to newborn deliveries as a cause of pediatric hospitalizations during the study period, Mr. Stockmann said at the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

The burden was highest among children under age 5 years, who accounted for about 75% of all infectious disease hospitalizations; those under age 3 months accounted for 15%.

Eight diagnoses accounted for more than 80% of the hospitalizations. The most common were pneumonia and bronchiolitis, followed by urinary tract infections, other upper respiratory tract infections, intestinal infections, other viral infections, sepsis, and meningitis. Respiratory infections accounted for about two-thirds of all hospitalizations, he said.

Pneumonia was the leading cause of hospitalizations across all age groups. The second leading cause was bronchiolitis in those under age 5 years, and UTI in those aged 5 years and older.

“A smattering of other conditions, including intestinal infections, viral infections, and meningitis, also make an appearance in the top 4,” he said.

Over time, pneumonia, bronchiolitis, and other upper respiratory tract infections decreased by 15% to 30%, and the intestinal infection rate was nearly halved.

The decrease in pneumonia hospitalizations coincided with the introduction of the 7-valent pneumococcal conjugate vaccine in 2000, and the introduction of the rotavirus vaccine in 2007. The introduction of these vaccines also was associated with a reduction in intestinal infection hospitalizations, he said.

During the study period, the overall charge for all infectious disease hospitalizations was $4.3 billion per year nationally. At the patient level, the mean charge was just under $15,000, and the mean length of stay was just over 3 days, Mr. Stockmann said.

Total hospital charges were driven by pneumonia and bronchiolitis, but at the individual patient level, sepsis and meningitis were the most expensive conditions, he noted.

The data for this analysis were derived from the National Inpatient Survey’s Kids’ Inpatient Database (KID), owned and operated by the Agency for Healthcare Research and Quality, and maintained by the Healthcare Cost and Utilization Project. Currently, 3,500 hospitals in 44 states contribute data to KID, which is released every 3 years; data for this study were available for 1997, 2000, 2003, 2006, and 2009 and were weighted with a complex survey design to more than 36 million discharges nationwide.

The findings underscore the need for additional efforts to reduce the burden of pediatric respiratory tract infections, Mr. Stockmann said. “We would posit that respiratory viral vaccines may play a key role in that,” he said.

Mr. Stockmann reported having no disclosures.

PHILADELPHIA– Infectious diseases played a primary role in 16% of pediatric hospitalizations between 1997 and 2009, and remain a leading cause of pediatric hospitalizations and health care expenditures, but the proportion of hospitalizations associated with an infectious disease declined by 18% during the study period, according to an analysis of the Kids’ Inpatient Database.

©pixelcarpenter/Fotolia.com

Periods of decline were temporally associated with the introduction of pneumococcal and rotavirus vaccines, Chris Stockmann of the University of Utah Health Sciences Center, Salt Lake City, reported at an annual scientific meeting on infectious diseases.

Infectious diseases were second only to newborn deliveries as a cause of pediatric hospitalizations during the study period, Mr. Stockmann said at the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

The burden was highest among children under age 5 years, who accounted for about 75% of all infectious disease hospitalizations; those under age 3 months accounted for 15%.

Eight diagnoses accounted for more than 80% of the hospitalizations. The most common were pneumonia and bronchiolitis, followed by urinary tract infections, other upper respiratory tract infections, intestinal infections, other viral infections, sepsis, and meningitis. Respiratory infections accounted for about two-thirds of all hospitalizations, he said.

Pneumonia was the leading cause of hospitalizations across all age groups. The second leading cause was bronchiolitis in those under age 5 years, and UTI in those aged 5 years and older.

“A smattering of other conditions, including intestinal infections, viral infections, and meningitis, also make an appearance in the top 4,” he said.

Over time, pneumonia, bronchiolitis, and other upper respiratory tract infections decreased by 15% to 30%, and the intestinal infection rate was nearly halved.

The decrease in pneumonia hospitalizations coincided with the introduction of the 7-valent pneumococcal conjugate vaccine in 2000, and the introduction of the rotavirus vaccine in 2007. The introduction of these vaccines also was associated with a reduction in intestinal infection hospitalizations, he said.

During the study period, the overall charge for all infectious disease hospitalizations was $4.3 billion per year nationally. At the patient level, the mean charge was just under $15,000, and the mean length of stay was just over 3 days, Mr. Stockmann said.

Total hospital charges were driven by pneumonia and bronchiolitis, but at the individual patient level, sepsis and meningitis were the most expensive conditions, he noted.

The data for this analysis were derived from the National Inpatient Survey’s Kids’ Inpatient Database (KID), owned and operated by the Agency for Healthcare Research and Quality, and maintained by the Healthcare Cost and Utilization Project. Currently, 3,500 hospitals in 44 states contribute data to KID, which is released every 3 years; data for this study were available for 1997, 2000, 2003, 2006, and 2009 and were weighted with a complex survey design to more than 36 million discharges nationwide.

The findings underscore the need for additional efforts to reduce the burden of pediatric respiratory tract infections, Mr. Stockmann said. “We would posit that respiratory viral vaccines may play a key role in that,” he said.

Mr. Stockmann reported having no disclosures.

PHILADELPHIA– A “routine recommendation” approach was the most effective but least used strategy for promoting same-day human papillomavirus vaccination in adolescent boys and girls, according to an industry-funded study of more than 150 well-visit interactions.

Of 204 well visits with 20 pediatricians, 167 (82%) involved discussion of adolescent vaccination, and 152 (75%) specifically mentioned HPV vaccination.

Vaccine recommendation approaches used in the recorded visits were categorized into three styles: “routine recommendation,” which was used in 11% of visits, yielding a 94% same-day vaccination rate; “brief mention,” which was used in 17% of visits, yielding a 27% same-day vaccination rate; and “detailed discussion,” which was used in 72% of visits, yielding a 38% same-day vaccination rate, Dr. Liana R. Clark reported at an annual scientific meeting on infectious diseases.

More specifically, the routine recommendation approach was used during 15% of visits with 32 girls aged 11-12 years, 7% of visits with 42 boys aged 11-12 years, and 10% of visits with 78 boys aged 13-18 years, yielding same-day vaccination rates of 80%, 100%, and 100%, respectively.

The brief intervention approach was used in 19%, 29%, and 13% of the visits, yielding same-day vaccination rates of 17%, 8%, and 20%, respectively. And the detailed discussion approach was used in 66%, 64%, and 77% of the visits, yielding same-day vaccination rates of 19%, 33%, and 47%, respectively, Dr. Clark of Merck Vaccines, West Point, Pa., said at the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

The visits recorded for this study took place between January 2013 and June 2013, and involved girls aged 11-12 years and boys aged 11-18 years. Physician participants were members of a panel for a dialogue research company. While the physicians knew their interactions were being recorded, they were not aware that HPV vaccination approach was being evaluated.

The vaccination recommendation–style categories were based on an analysis of the visit recordings. The “routine recommendation” style involved a matter-of-fact recommendation made the same way recommendations for other adolescent vaccines were made. The “brief mention” style involved mention of the vaccine without a recommendation or direction. And the “detailed discussion” style involved a discussion with a parent in greater detail than was provided for other adolescent vaccines.

The findings of this study – the first qualitative project to assess how physicians discuss and recommend HPV vaccination to patients and caregivers – are important, because HPV vaccination rates in the United States remain relatively low, Dr. Clark explained.

Of note, physicians report significant parental barriers to acceptance of routine HPV vaccine recommendations, but parents report a high likelihood of accepting the recommendations of the provider, she added.

Evaluation of the dialogue between physicians and patients in this study suggests that physician recommendations to patients are not consistent with vaccination recommendations from the Centers for Disease Control and Prevention Advisory Committee on Immunization Practices, Dr. Clark said, and many physicians are uncomfortable discussing HPV vaccination.

In addition, some physicians recommended vaccination at age 14-15 years and/or tied vaccination recommendations to sexual activity, rather than recommending vaccination at age 11-12 years. Many physicians also left the decision up to the caregiver and failed to make a strong recommendation, Dr. Clark said. Furthermore, many physicians told patients and parents that vaccination did not need to happen that day, allowing for a missed vaccination opportunity.

Though limited by the small pediatrician sample size and the fact that the participating physicians were part of a paid panel and thus may not be representative of the broader pediatric community, the findings suggest that pediatricians may benefit from training to improve their HPV vaccination recommendations, Dr. Clark said.

Dr. Clark is an employee of Merck Vaccines.

PHILADELPHIA– A “routine recommendation” approach was the most effective but least used strategy for promoting same-day human papillomavirus vaccination in adolescent boys and girls, according to an industry-funded study of more than 150 well-visit interactions.

Of 204 well visits with 20 pediatricians, 167 (82%) involved discussion of adolescent vaccination, and 152 (75%) specifically mentioned HPV vaccination.

Vaccine recommendation approaches used in the recorded visits were categorized into three styles: “routine recommendation,” which was used in 11% of visits, yielding a 94% same-day vaccination rate; “brief mention,” which was used in 17% of visits, yielding a 27% same-day vaccination rate; and “detailed discussion,” which was used in 72% of visits, yielding a 38% same-day vaccination rate, Dr. Liana R. Clark reported at an annual scientific meeting on infectious diseases.

More specifically, the routine recommendation approach was used during 15% of visits with 32 girls aged 11-12 years, 7% of visits with 42 boys aged 11-12 years, and 10% of visits with 78 boys aged 13-18 years, yielding same-day vaccination rates of 80%, 100%, and 100%, respectively.

The brief intervention approach was used in 19%, 29%, and 13% of the visits, yielding same-day vaccination rates of 17%, 8%, and 20%, respectively. And the detailed discussion approach was used in 66%, 64%, and 77% of the visits, yielding same-day vaccination rates of 19%, 33%, and 47%, respectively, Dr. Clark of Merck Vaccines, West Point, Pa., said at the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

The visits recorded for this study took place between January 2013 and June 2013, and involved girls aged 11-12 years and boys aged 11-18 years. Physician participants were members of a panel for a dialogue research company. While the physicians knew their interactions were being recorded, they were not aware that HPV vaccination approach was being evaluated.

The vaccination recommendation–style categories were based on an analysis of the visit recordings. The “routine recommendation” style involved a matter-of-fact recommendation made the same way recommendations for other adolescent vaccines were made. The “brief mention” style involved mention of the vaccine without a recommendation or direction. And the “detailed discussion” style involved a discussion with a parent in greater detail than was provided for other adolescent vaccines.

The findings of this study – the first qualitative project to assess how physicians discuss and recommend HPV vaccination to patients and caregivers – are important, because HPV vaccination rates in the United States remain relatively low, Dr. Clark explained.

Of note, physicians report significant parental barriers to acceptance of routine HPV vaccine recommendations, but parents report a high likelihood of accepting the recommendations of the provider, she added.

Evaluation of the dialogue between physicians and patients in this study suggests that physician recommendations to patients are not consistent with vaccination recommendations from the Centers for Disease Control and Prevention Advisory Committee on Immunization Practices, Dr. Clark said, and many physicians are uncomfortable discussing HPV vaccination.

In addition, some physicians recommended vaccination at age 14-15 years and/or tied vaccination recommendations to sexual activity, rather than recommending vaccination at age 11-12 years. Many physicians also left the decision up to the caregiver and failed to make a strong recommendation, Dr. Clark said. Furthermore, many physicians told patients and parents that vaccination did not need to happen that day, allowing for a missed vaccination opportunity.

Though limited by the small pediatrician sample size and the fact that the participating physicians were part of a paid panel and thus may not be representative of the broader pediatric community, the findings suggest that pediatricians may benefit from training to improve their HPV vaccination recommendations, Dr. Clark said.

Dr. Clark is an employee of Merck Vaccines.

PHILADELPHIA– A “routine recommendation” approach was the most effective but least used strategy for promoting same-day human papillomavirus vaccination in adolescent boys and girls, according to an industry-funded study of more than 150 well-visit interactions.

Of 204 well visits with 20 pediatricians, 167 (82%) involved discussion of adolescent vaccination, and 152 (75%) specifically mentioned HPV vaccination.

Vaccine recommendation approaches used in the recorded visits were categorized into three styles: “routine recommendation,” which was used in 11% of visits, yielding a 94% same-day vaccination rate; “brief mention,” which was used in 17% of visits, yielding a 27% same-day vaccination rate; and “detailed discussion,” which was used in 72% of visits, yielding a 38% same-day vaccination rate, Dr. Liana R. Clark reported at an annual scientific meeting on infectious diseases.

More specifically, the routine recommendation approach was used during 15% of visits with 32 girls aged 11-12 years, 7% of visits with 42 boys aged 11-12 years, and 10% of visits with 78 boys aged 13-18 years, yielding same-day vaccination rates of 80%, 100%, and 100%, respectively.

The brief intervention approach was used in 19%, 29%, and 13% of the visits, yielding same-day vaccination rates of 17%, 8%, and 20%, respectively. And the detailed discussion approach was used in 66%, 64%, and 77% of the visits, yielding same-day vaccination rates of 19%, 33%, and 47%, respectively, Dr. Clark of Merck Vaccines, West Point, Pa., said at the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

The visits recorded for this study took place between January 2013 and June 2013, and involved girls aged 11-12 years and boys aged 11-18 years. Physician participants were members of a panel for a dialogue research company. While the physicians knew their interactions were being recorded, they were not aware that HPV vaccination approach was being evaluated.

The vaccination recommendation–style categories were based on an analysis of the visit recordings. The “routine recommendation” style involved a matter-of-fact recommendation made the same way recommendations for other adolescent vaccines were made. The “brief mention” style involved mention of the vaccine without a recommendation or direction. And the “detailed discussion” style involved a discussion with a parent in greater detail than was provided for other adolescent vaccines.

The findings of this study – the first qualitative project to assess how physicians discuss and recommend HPV vaccination to patients and caregivers – are important, because HPV vaccination rates in the United States remain relatively low, Dr. Clark explained.

Of note, physicians report significant parental barriers to acceptance of routine HPV vaccine recommendations, but parents report a high likelihood of accepting the recommendations of the provider, she added.

Evaluation of the dialogue between physicians and patients in this study suggests that physician recommendations to patients are not consistent with vaccination recommendations from the Centers for Disease Control and Prevention Advisory Committee on Immunization Practices, Dr. Clark said, and many physicians are uncomfortable discussing HPV vaccination.

In addition, some physicians recommended vaccination at age 14-15 years and/or tied vaccination recommendations to sexual activity, rather than recommending vaccination at age 11-12 years. Many physicians also left the decision up to the caregiver and failed to make a strong recommendation, Dr. Clark said. Furthermore, many physicians told patients and parents that vaccination did not need to happen that day, allowing for a missed vaccination opportunity.

Though limited by the small pediatrician sample size and the fact that the participating physicians were part of a paid panel and thus may not be representative of the broader pediatric community, the findings suggest that pediatricians may benefit from training to improve their HPV vaccination recommendations, Dr. Clark said.

Dr. Clark is an employee of Merck Vaccines.

PHILADELPHIA – Every recurrence of Clostridium difficile was associated with a hospital admission in 1 in 4 cases and a complication in 1 in 15 cases, according to a retrospective Canadian cohort study.

“We do have therapeutic options targeted specifically at recurrence, namely fecal transplant, fidaxomicin, and monoclonal antibodies,” study author Dr. Caroline Sheitoyan-Pesant said at Infectious Diseases Week 2014. “But the problem with these approaches is they are either laborious, costly, or unavailable, which is why we felt the need to clarify the burden of multiple recurrences in order to use those options more wisely in the future.”

Dr. Sheitoyan-Pesant and her colleagues at the University of Sherbrooke used a positive cytotoxin and/or ICD-9 CM/ICD-10 code to identified 1,527 episodes of C. difficile infection (CDI) among 1,442 adults living in 1998-2013 in the Sherbrooke area of Quebec, Canada.

Recurrence was defined as the reappearance of diarrhea leading to treatment between 14 to 60 days following the previous episode, with or without microbiologic or endoscopic supportive evidence.

Initial CDI was community acquired in 45% of cases, and 63% of patients were aged at least 65 years. 

Among 1,418 patients who did not die within 14 days of diagnosis, 25% (354) had a first recurrence, Dr Sheitoyan-Pesant said.

Subsequent recurrence rates were 38.3% (128 of 334) for the second recurrence, 29% (35 of 121) for the third, and 27.3% (9 of 33) for the fourth, with numbers quite small for the fifth (62.5%; 5 of 8), and sixth 25% (1 of 4) recurrences.

“Recurrence rates are probably more stable over time than what we used to think before and probably between 25% and 38%,” she said.

When examined by year of diagnosis, the risk of having a first recurrence was 12% during 1998-2002. After the emergence of the North American pulsed-field gel electrophoresis type 1 (NAP1) strain, however, first recurrence rates jumped to 32% in 2003-2005, 20% in 2006-2009, and 31% in 2010-2013.

The NAP1 strain has been shown to be a predictor of severe disease, severe outcome, and death in CDI (Clin. Infect. Dis. 2014;58:1394-400).

The initial CDI episode was severe in 47% of the 1,527 episodes, driven mostly by elevated white blood cell counts. The severity rate went down with each recurrence, which was not the case for complicated episodes, as those rates were stable over time, Dr. Sheitoyan-Pesant said.

The 30-day mortality rate was also stable over time, at 11% for the initial CDI episode and 7%-8% for recurrences.

The study was supported by Cubist as part of an investigator-initiated research study. Dr. Sheitoyan-Pesant reported having no financial disclosures.

[email protected]

PHILADELPHIA – Every recurrence of Clostridium difficile was associated with a hospital admission in 1 in 4 cases and a complication in 1 in 15 cases, according to a retrospective Canadian cohort study.

“We do have therapeutic options targeted specifically at recurrence, namely fecal transplant, fidaxomicin, and monoclonal antibodies,” study author Dr. Caroline Sheitoyan-Pesant said at Infectious Diseases Week 2014. “But the problem with these approaches is they are either laborious, costly, or unavailable, which is why we felt the need to clarify the burden of multiple recurrences in order to use those options more wisely in the future.”

Dr. Sheitoyan-Pesant and her colleagues at the University of Sherbrooke used a positive cytotoxin and/or ICD-9 CM/ICD-10 code to identified 1,527 episodes of C. difficile infection (CDI) among 1,442 adults living in 1998-2013 in the Sherbrooke area of Quebec, Canada.

Recurrence was defined as the reappearance of diarrhea leading to treatment between 14 to 60 days following the previous episode, with or without microbiologic or endoscopic supportive evidence.

Initial CDI was community acquired in 45% of cases, and 63% of patients were aged at least 65 years. 

Among 1,418 patients who did not die within 14 days of diagnosis, 25% (354) had a first recurrence, Dr Sheitoyan-Pesant said.

Subsequent recurrence rates were 38.3% (128 of 334) for the second recurrence, 29% (35 of 121) for the third, and 27.3% (9 of 33) for the fourth, with numbers quite small for the fifth (62.5%; 5 of 8), and sixth 25% (1 of 4) recurrences.

“Recurrence rates are probably more stable over time than what we used to think before and probably between 25% and 38%,” she said.

When examined by year of diagnosis, the risk of having a first recurrence was 12% during 1998-2002. After the emergence of the North American pulsed-field gel electrophoresis type 1 (NAP1) strain, however, first recurrence rates jumped to 32% in 2003-2005, 20% in 2006-2009, and 31% in 2010-2013.

The NAP1 strain has been shown to be a predictor of severe disease, severe outcome, and death in CDI (Clin. Infect. Dis. 2014;58:1394-400).

The initial CDI episode was severe in 47% of the 1,527 episodes, driven mostly by elevated white blood cell counts. The severity rate went down with each recurrence, which was not the case for complicated episodes, as those rates were stable over time, Dr. Sheitoyan-Pesant said.

The 30-day mortality rate was also stable over time, at 11% for the initial CDI episode and 7%-8% for recurrences.

The study was supported by Cubist as part of an investigator-initiated research study. Dr. Sheitoyan-Pesant reported having no financial disclosures.

[email protected]

PHILADELPHIA – Every recurrence of Clostridium difficile was associated with a hospital admission in 1 in 4 cases and a complication in 1 in 15 cases, according to a retrospective Canadian cohort study.

“We do have therapeutic options targeted specifically at recurrence, namely fecal transplant, fidaxomicin, and monoclonal antibodies,” study author Dr. Caroline Sheitoyan-Pesant said at Infectious Diseases Week 2014. “But the problem with these approaches is they are either laborious, costly, or unavailable, which is why we felt the need to clarify the burden of multiple recurrences in order to use those options more wisely in the future.”

Dr. Sheitoyan-Pesant and her colleagues at the University of Sherbrooke used a positive cytotoxin and/or ICD-9 CM/ICD-10 code to identified 1,527 episodes of C. difficile infection (CDI) among 1,442 adults living in 1998-2013 in the Sherbrooke area of Quebec, Canada.

Recurrence was defined as the reappearance of diarrhea leading to treatment between 14 to 60 days following the previous episode, with or without microbiologic or endoscopic supportive evidence.

Initial CDI was community acquired in 45% of cases, and 63% of patients were aged at least 65 years. 

Among 1,418 patients who did not die within 14 days of diagnosis, 25% (354) had a first recurrence, Dr Sheitoyan-Pesant said.

Subsequent recurrence rates were 38.3% (128 of 334) for the second recurrence, 29% (35 of 121) for the third, and 27.3% (9 of 33) for the fourth, with numbers quite small for the fifth (62.5%; 5 of 8), and sixth 25% (1 of 4) recurrences.

“Recurrence rates are probably more stable over time than what we used to think before and probably between 25% and 38%,” she said.

When examined by year of diagnosis, the risk of having a first recurrence was 12% during 1998-2002. After the emergence of the North American pulsed-field gel electrophoresis type 1 (NAP1) strain, however, first recurrence rates jumped to 32% in 2003-2005, 20% in 2006-2009, and 31% in 2010-2013.

The NAP1 strain has been shown to be a predictor of severe disease, severe outcome, and death in CDI (Clin. Infect. Dis. 2014;58:1394-400).

The initial CDI episode was severe in 47% of the 1,527 episodes, driven mostly by elevated white blood cell counts. The severity rate went down with each recurrence, which was not the case for complicated episodes, as those rates were stable over time, Dr. Sheitoyan-Pesant said.

The 30-day mortality rate was also stable over time, at 11% for the initial CDI episode and 7%-8% for recurrences.

The study was supported by Cubist as part of an investigator-initiated research study. Dr. Sheitoyan-Pesant reported having no financial disclosures.

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PHILADELPHIA – College athletes who play contact sports are more likely than are those who play noncontact sports to carry methicillin-resistant Staphylococcus aureus, putting them at higher risk for infection and for infecting others, according to findings from a 2-year observational study.

During the course of the study, MRSA colonization ranged from 8% to 31% in 224 students who played contact sports, including football, basketball, soccer, and lacrosse, compared with 0% to 23% in 153 students who participated in noncontact or limited-contact sports, including baseball, cross country, and golf. MRSA colonization in the general population ranges from 5% to 10%, Natalia Jimenez-Truque, Ph.D., of Vanderbilt University Medical Center, Nashville, Tenn., reported at an annual scientific meeting on infectious diseases.

©Fred Hall/iStockphoto.com

Overall, contact sports athletes in this study had more than twice the risk of being colonized with MRSA (odds ratio 2.3), and tended to carry S. aureus for longer period of time (OR 3.0 for intermittent carriage, 2.39 for persistent carriage), compared with noncontact sports athletes. Also, contact sports athletes who were not carriers at baseline acquired S. aureus more quickly (hazard ratio 1.6), Dr. Jimenez-Truque said during a press conference at the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

The findings have implications for advising young athletes about the importance of good hygiene practices, including covering any open wounds, washing hands frequently, showering as soon as possible after all practices and games, laundering gym clothes, bags, and towels promptly, and not sharing razors and other personal hygiene items, she said.

Athletes are known to have a higher risk of infection with S. aureus than the general population, but most studies have not assessed staphylococcal carriage or compared risk in contact and noncontact sports participants, Dr. Jimenez-Truque said. The lack of available information about the natural history of carriage across sports limits strategies for preventing infection in athletes, she noted.

For the current study – the first to observe both male and female college athletes who were not part of a MRSA outbreak – Dr. Jimenez-Truque and her colleagues followed varsity collegiate athletes from August 2008 to April 2010. Nasal and oropharyngeal swabs were collected at enrollment and monthly thereafter.

The increased rates of MRSA carriage and acquisition in contact sports athletes in this study may be associated with increased likelihood of having cuts, scrapes, turf burns, and skin-to-skin contact with other athletes, further underscoring the need for good hygiene, she said.

MRSA is a leading cause of both invasive and skin and soft tissue infections. Athletes are commonly affected, and up to 70% of those who develop infection require hospitalization and intravenous antibiotic treatment.

However, despite the “really significant number” of contact sports athletes who carry MRSA, the number who become infected is small, Dr. Jimenez-Truque said.

“What that tells us, we think, is that colonization with specific strains of staph in specific people at specific times is needed for infections to occur, and therefore for outbreaks to occur. When we put it in that sort of framework, we begin to realize that we need to understand the epidemiology of specific strains of S. aureus, we need to understand the periods of time when athletes are at highest risk – that’s probably when they’re newly acquiring strains that they’ve never seen before – and we need to take into account things that we can do that may be unrelated to staph, but may affect their risk for infection,” said lead author C. Buddy Creech, also of Vanderbilt University Medical Center.

For example, during the course of the current study, a cluster of infections “perfectly coincided” with the development of pandemic H1N1 influenza in a number of athletes, Dr. Creech said, adding that even though the two conditions are unrelated, this relationship between S. aureus and influenza shouldn’t be diminished.

“So even though it’s unrelated, all of the things we do to protect collegiate and professional athletes, like influenza vaccination and general health maintenance ... go a long way, and may have widespread implications,” said Dr. Creech.

He noted however, that although strategies of covering compromised skin and wounds are important for preventing the spread of disease, they are comparable to “putting our finger in the dike while we wait for other preventive strategies like vaccination or other more powerful strategies.”

Dr. Creech and Dr. Jimenez-Truque reported having no disclosures.

PHILADELPHIA – College athletes who play contact sports are more likely than are those who play noncontact sports to carry methicillin-resistant Staphylococcus aureus, putting them at higher risk for infection and for infecting others, according to findings from a 2-year observational study.

During the course of the study, MRSA colonization ranged from 8% to 31% in 224 students who played contact sports, including football, basketball, soccer, and lacrosse, compared with 0% to 23% in 153 students who participated in noncontact or limited-contact sports, including baseball, cross country, and golf. MRSA colonization in the general population ranges from 5% to 10%, Natalia Jimenez-Truque, Ph.D., of Vanderbilt University Medical Center, Nashville, Tenn., reported at an annual scientific meeting on infectious diseases.

©Fred Hall/iStockphoto.com

Overall, contact sports athletes in this study had more than twice the risk of being colonized with MRSA (odds ratio 2.3), and tended to carry S. aureus for longer period of time (OR 3.0 for intermittent carriage, 2.39 for persistent carriage), compared with noncontact sports athletes. Also, contact sports athletes who were not carriers at baseline acquired S. aureus more quickly (hazard ratio 1.6), Dr. Jimenez-Truque said during a press conference at the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

The findings have implications for advising young athletes about the importance of good hygiene practices, including covering any open wounds, washing hands frequently, showering as soon as possible after all practices and games, laundering gym clothes, bags, and towels promptly, and not sharing razors and other personal hygiene items, she said.

Athletes are known to have a higher risk of infection with S. aureus than the general population, but most studies have not assessed staphylococcal carriage or compared risk in contact and noncontact sports participants, Dr. Jimenez-Truque said. The lack of available information about the natural history of carriage across sports limits strategies for preventing infection in athletes, she noted.

For the current study – the first to observe both male and female college athletes who were not part of a MRSA outbreak – Dr. Jimenez-Truque and her colleagues followed varsity collegiate athletes from August 2008 to April 2010. Nasal and oropharyngeal swabs were collected at enrollment and monthly thereafter.

The increased rates of MRSA carriage and acquisition in contact sports athletes in this study may be associated with increased likelihood of having cuts, scrapes, turf burns, and skin-to-skin contact with other athletes, further underscoring the need for good hygiene, she said.

MRSA is a leading cause of both invasive and skin and soft tissue infections. Athletes are commonly affected, and up to 70% of those who develop infection require hospitalization and intravenous antibiotic treatment.

However, despite the “really significant number” of contact sports athletes who carry MRSA, the number who become infected is small, Dr. Jimenez-Truque said.

“What that tells us, we think, is that colonization with specific strains of staph in specific people at specific times is needed for infections to occur, and therefore for outbreaks to occur. When we put it in that sort of framework, we begin to realize that we need to understand the epidemiology of specific strains of S. aureus, we need to understand the periods of time when athletes are at highest risk – that’s probably when they’re newly acquiring strains that they’ve never seen before – and we need to take into account things that we can do that may be unrelated to staph, but may affect their risk for infection,” said lead author C. Buddy Creech, also of Vanderbilt University Medical Center.

For example, during the course of the current study, a cluster of infections “perfectly coincided” with the development of pandemic H1N1 influenza in a number of athletes, Dr. Creech said, adding that even though the two conditions are unrelated, this relationship between S. aureus and influenza shouldn’t be diminished.

“So even though it’s unrelated, all of the things we do to protect collegiate and professional athletes, like influenza vaccination and general health maintenance ... go a long way, and may have widespread implications,” said Dr. Creech.

He noted however, that although strategies of covering compromised skin and wounds are important for preventing the spread of disease, they are comparable to “putting our finger in the dike while we wait for other preventive strategies like vaccination or other more powerful strategies.”

Dr. Creech and Dr. Jimenez-Truque reported having no disclosures.

PHILADELPHIA – College athletes who play contact sports are more likely than are those who play noncontact sports to carry methicillin-resistant Staphylococcus aureus, putting them at higher risk for infection and for infecting others, according to findings from a 2-year observational study.

During the course of the study, MRSA colonization ranged from 8% to 31% in 224 students who played contact sports, including football, basketball, soccer, and lacrosse, compared with 0% to 23% in 153 students who participated in noncontact or limited-contact sports, including baseball, cross country, and golf. MRSA colonization in the general population ranges from 5% to 10%, Natalia Jimenez-Truque, Ph.D., of Vanderbilt University Medical Center, Nashville, Tenn., reported at an annual scientific meeting on infectious diseases.

©Fred Hall/iStockphoto.com

Overall, contact sports athletes in this study had more than twice the risk of being colonized with MRSA (odds ratio 2.3), and tended to carry S. aureus for longer period of time (OR 3.0 for intermittent carriage, 2.39 for persistent carriage), compared with noncontact sports athletes. Also, contact sports athletes who were not carriers at baseline acquired S. aureus more quickly (hazard ratio 1.6), Dr. Jimenez-Truque said during a press conference at the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

The findings have implications for advising young athletes about the importance of good hygiene practices, including covering any open wounds, washing hands frequently, showering as soon as possible after all practices and games, laundering gym clothes, bags, and towels promptly, and not sharing razors and other personal hygiene items, she said.

Athletes are known to have a higher risk of infection with S. aureus than the general population, but most studies have not assessed staphylococcal carriage or compared risk in contact and noncontact sports participants, Dr. Jimenez-Truque said. The lack of available information about the natural history of carriage across sports limits strategies for preventing infection in athletes, she noted.

For the current study – the first to observe both male and female college athletes who were not part of a MRSA outbreak – Dr. Jimenez-Truque and her colleagues followed varsity collegiate athletes from August 2008 to April 2010. Nasal and oropharyngeal swabs were collected at enrollment and monthly thereafter.

The increased rates of MRSA carriage and acquisition in contact sports athletes in this study may be associated with increased likelihood of having cuts, scrapes, turf burns, and skin-to-skin contact with other athletes, further underscoring the need for good hygiene, she said.

MRSA is a leading cause of both invasive and skin and soft tissue infections. Athletes are commonly affected, and up to 70% of those who develop infection require hospitalization and intravenous antibiotic treatment.

However, despite the “really significant number” of contact sports athletes who carry MRSA, the number who become infected is small, Dr. Jimenez-Truque said.

“What that tells us, we think, is that colonization with specific strains of staph in specific people at specific times is needed for infections to occur, and therefore for outbreaks to occur. When we put it in that sort of framework, we begin to realize that we need to understand the epidemiology of specific strains of S. aureus, we need to understand the periods of time when athletes are at highest risk – that’s probably when they’re newly acquiring strains that they’ve never seen before – and we need to take into account things that we can do that may be unrelated to staph, but may affect their risk for infection,” said lead author C. Buddy Creech, also of Vanderbilt University Medical Center.

For example, during the course of the current study, a cluster of infections “perfectly coincided” with the development of pandemic H1N1 influenza in a number of athletes, Dr. Creech said, adding that even though the two conditions are unrelated, this relationship between S. aureus and influenza shouldn’t be diminished.

“So even though it’s unrelated, all of the things we do to protect collegiate and professional athletes, like influenza vaccination and general health maintenance ... go a long way, and may have widespread implications,” said Dr. Creech.

He noted however, that although strategies of covering compromised skin and wounds are important for preventing the spread of disease, they are comparable to “putting our finger in the dike while we wait for other preventive strategies like vaccination or other more powerful strategies.”

Dr. Creech and Dr. Jimenez-Truque reported having no disclosures.