Showing posts with label epidemiology. Show all posts
Showing posts with label epidemiology. Show all posts

Wednesday, March 11, 2015

Measles in the United States: Not Just Imported from Disneyland but from China

By: Lewis First, MD, MS; Editor-in-Chief  

     We have all read by now, and perhaps some have experienced, children with measles in our practices thanks to the recent outbreak that seems to have started at Disneyland.  But taking a family vacation to the theme park is not the only way to spread this virus into our country. 
     Su et al. (doi: 10.1542/peds.2014-1947) remind us this week about the introduction of measles into the US in 2013 via newly-adopted children with cerebral palsy adopted from China who had gone unimmunized in both China prior to adoption and after arrival into this country. The authors explain how this might have happened and what needs to be done to prevent this kind of measles importation from occurring going forward.       
     This article makes for a most fascinating read, especially in light of what we have been experiencing with the surge of this virus in our country, largely in unimmunized children.  Spread the word (rather than the measles) about this article especially to those who see newly arrived internationally adopted children so appropriate vaccinations such as the MMR can be administered as soon as possible to those previously unimmunized.

Related Links

Wednesday, March 4, 2015

Spreading Out the Vaccine Schedule: Do We Do What Some Patients Request?

By: Lewis First, MD, MS; Editor-in-Chief
          With the ongoing measles epidemic, vaccine discussion has again reared up with lots of debate on the merits of giving live vaccines like the MMR, with some parents more concerned about the potential for side effects (rare though they may be) compared to the serious risk of their young child actually getting the disease that can be prevented by the vaccine.  
     One strategy to combat vaccine refusal is to stagger or delay giving live vaccines until a child’s brain has developed past the point where they might be detected with an autism spectrum disorder or other behavioral or developmental abnormality for which vaccines are being inappropriately and inaccurately blamed.  So how many of us are asked to delay routine vaccination until children are older? (despite young children being more susceptible to the infections to which we immunize at a young age)
     Kempe et al. (doi:10.1542/peds.2014-3474) surveyed pediatricians and family physicians to look at the frequency of requests being made to them by families to spread out vaccines for children less than 2 years.  They also report on whether pediatricians and family physicians agree to that request, and what strategies they use to hold the line and not delay the schedule. 
     One of the more shocking statistics revealed in this troubling study is that 93% of health care providers note they experience requests to delay vaccination  with almost a quarter of pediatricians surveyed noting that one out of ten parents makes this request. What is even more thought-provoking is that almost ¾ of those surveyed agreed sometimes or always to spread out the vaccines despite knowing that timely administration is in the best interest of the patients they care for. 
     Take a shot at reading this provocative study and then reflect on whether you can empathize with the pediatricians who responded to this survey—or better yet, share your response to this study or what you do in practice with us by sharing a comment at the bottom of this blog or via an e-letter or posting on our Facebook or Twitter sites.

Friday, January 16, 2015

Examining Lows And Highs Of Meningococcal Disease Statistics

Editorial Board Member Joann Schulte, DO, MPH  
Courtsey of Dawn Huczek @Flickr
     It’s the pictures that I remember when I think of meningococcal disease.   I think of purpura on legs and worse, a couple of infants who developed gangrene on a hand or foot.  Children with such complications are rare in the USA these days, according to new research published this month in Pediatrics.  Meningococcal disease is at historic lows in the United States (0.15 per 100,000 persons), but incidence remains highest among infants less than 1 year of age. 

     MacNeil et al. (doi: 10.1542/peds.2014-2035) used surveillance data for the period 2006-2012 collected by the Active Bacterial Core (ABC) surveillance program, which covers about 13.6% of the US population.  That population included 350,000 infants < 1 year of age. During the study period, an estimated 113 cases occurred annually among the infants with an overall incidence of 2.74 cases per 100,000 infants.  Most of the cases were caused by serotype B (64%).  Serogroup Y caused 16% of the cases and serotype C was implicated in 12% of the cases.  The ABC program is funded by the Centers for Disease Control and Prevention. 

      The authors also indicated that a new vaccine and innovative immunization strategies will be needed before meningococcal disease can be combatted as effectively as Haemophilus influenzae type B (HIB) and pneumococcal disease have been.  Meningococcal vaccines in use in the USA now do not include protection against serogroup B.  The vaccines currently in use provide protection against serogroups C and Y.  Vaccines to prevent serogroup B meningococcal are in clinical trials now, but licensure is likely several years away.  When a meningococcal vaccine is licensed, an innovative strategy will be needed because most meningococcal disease among young infants occurs in the first six months of life.  That’s before the two or three doses of vaccine can be given to induce immunity in a child.  So as in the effort against pertussis, innovative strategies will be needed.  Possibilities include maternal immunization or targeting the adolescent/young adult population where carriage rates are high.

      Maybe someday those pictures of meningococcal disease complications that I remember will be a historical artifact.  But before that, some clever work is going to have to be done by public health physicians and infectious disease specialists.

         Related Links:

Wednesday, August 27, 2014

Effect of a Pertussis Epidemic on Vaccination Status: Coughing Up Some Interesting Findings

By: Lewis First, MD, MS; Editor-in-Chief 
Photo by  Sandy Chase via Flickr

From late 2011 throughout 2012, a pertussis epidemic occurred in Washington State. One would think that an epidemic would result in an uptick in infants being up-to-date on their pertussis vaccinations, but think again—at least after you read the study by Wolf et al. (doi: 10.1542/peds.2013-3637) we are early releasing this week.

If an epidemic doesn't prompt parents to insure their infants are vaccinated, just what will? Drs. Jessica Atwell and Daniel Salmon (doi: 10.1542/peds.2014-1883) reflect on the implications of this study in a topical commentary that accompanies this study.

We welcome your thoughts on this study and commentary and on what you are doing to improve your own vaccination rates in your practice, since an epidemic does not appear to be a significant change agent. Share your comments with us via a response to this blog, an eLetter or on Facebook or Twitter.

Related Reading: 

Monday, June 9, 2014

Years after Implementing Rotavirus and Varicella Vaccines: Wow—What a Difference an Immunization Can Make!

By: Lewis First, MD, MS

With the implementation of varicella vaccine in 1995 and with the return of rotavirus vaccine in 2007, investigators have been tracking the epidemiology of subsequent cases of these infections both pre- and post-vaccine in two studies being early released this week in our journal.

Photo by ntm-a_cstc-a via Flickr
The first by Leshem et al. (doi: 10.1542/peds.2013-3849) takes a look at reductions in diarrhea-associated use of healthcare post-rotavirus vaccine implementation using a retrospective cohort of children less than 5 years of age based on claims data of commercially insured young patients. The results in terms of decreased rates of hospitalizations for rotavirus are dramatic—even in those not vaccinated after the implementation of vaccine.

Not to be outdone were the results from a study by Baxter et al. (doi: 10.1542/ peds.2013-4251) who reviewed five cross-sectional studies (one pre-vaccine in 1994-95) and four post-vaccine over the next 15 years in northern California again looking at reductions in hospitalizations using telephone survey data inquiring about varicella history in more than 8,000 children and teens between 5- and 19-years-old. Across all age groups, the reduction in varicella cases is remarkable—approximately 90-95 percent, including a reduction in varicella susceptible children and in hospitalization rates.

If you ever need good evidence that vaccination makes a difference in reducing morbidity in children, these two studies inject just what the doctor ordered when it comes to convincing your patients about the importance of administering these two vaccines. Take your best shot and read both these studies to learn more.

Related Reading:

Wednesday, March 5, 2014

Vaccine Messaging: What Strategy Do You Think Works?

Photo by Amanda Mills via the
US Centers for Disease Control and Prevention
When a family is apprehensive to the point of refusing to have their child vaccinated, what strategy do you turn to in order to try to convince them otherwise?

Do you refute the data that vaccines are associated with autism? Do you share information about how dangerous the real diseases that an unimmunized child might contract might be? Do you show pictures of children with these diseases or anecdotally discuss a patient who had an unfortunate outcome due to not being vaccinated?

All of these seem like reasonable strategies—but needle caps off to Nyhan et al. (doi: 10.1542/peds.2013-2365) who randomized more than 1,700 parents of children and teenagers to receive one of these strategies and then asked parents about their intent to vaccinate a future child both before and after receiving the particular strategic message. Did any of the strategies make a difference? To get the point of what type of vaccine messaging works or doesn’t work, roll up your sleeves and read this interesting but troubling study.

Do any of these strategies studied in this article work for you? Do you have other ways to convince families to vaccinate their children? We’d love it if you shared your thoughts on this topic by responding to our blog or posting a comment via Facebook, Twitter or even writing us an eLetter in response to this study.

Related Reading:

Monday, September 23, 2013

Have MRSA on Us! A Five Year Trend Analysis

We are well aware of the prevalence of invasive methicillin-resistant Staphylococcus aureus (MRSA) in some of our sickest patients, but is this organism increasing or decreasing in incidence? Iwamoto et al. (doi: 10.1542/peds.2013-1112) opted to look at population-based surveillance cases of MRSA from 2005-2010 in this country, further subdivided by age and race.  Almost 900 cases were identified by the authors over the time period studied with more than one-third in infants. The authors found that the majority were community-associated, with hospital-onset and healthcare-associated community-onset cases not far behind. As to concerning trends—the authors report several, including an increasing incidence in younger infants, as well as in black children.

What might be causing the increased trending in these groups along with other epidemiologic findings makes for interesting reading. You and your staff who may represent the healthcare-associated spread of this organism should make this article a must-read.