Sharon Worcester

SAN FRANCISCO — Inflammatory bowel disease does not severely alter ovarian reserve but may accelerate loss of primordial follicles in those aged 30 years and older, results from a clinical study showed.

The investigators measured anti-müllerian hormone—which is a reliable hormonal marker for evaluating ovarian reserve independently of the menstrual cycle—in 44 women aged 20–41 years who had IBD and were in clinical remission after infliximab treatment for either Crohn's disease (37 patients) or ulcerative colitis (in 7 patients).

The hormone levels were compared with those of 163 age-matched women undergoing in vitro fertilization who had a normal ovarian response to controlled ovarian stimulation (5–15 oocytes retrieved) and a normal serum anti-müllerian hormone level (greater than 1.5 mcg/L).

The anti-müllerian hormone levels did not differ significantly overall between the IBD and control patients (2.72 vs. 2.12 mcg/L), Dr. Thomas Fréour reported in a poster at the annual meeting of the American Society for Reproductive Medicine.

However, when the women were stratified by age 30 years and older versus age less than 30 years, the anti-müllerian hormone levels were found to differ in the older women, with those aged 30 years and older having lower levels than controls (2 vs. 2.96 mcg/L).

The levels in the younger patients remained comparable in the patients and controls, said Dr. Fréour of the University Hospital Center of Nantes (France).

Inflammatory bowel disease has been shown in previous studies to be associated with female subfertility, mainly through tubal dysfunctions, extensive adhesions, or chirurgical consequences on pelvic function, but alteration of ovarian reserve in those with IBD had not been previously studied, Dr. Fréour noted.

The findings suggest that in reproductive age women 30 years and older who have IBD, a substantially accelerated loss of primordial follicles may occur.

This loss might be attributed to chronic inflammation and/or to IBD treatments, he noted, adding that although the findings need to be confirmed in a larger population, they could be helpful for counseling women with IBD about their future prospects of fertility.

SAN FRANCISCO — Inflammatory bowel disease does not severely alter ovarian reserve but may accelerate loss of primordial follicles in those aged 30 years and older, results from a clinical study showed.

The investigators measured anti-müllerian hormone—which is a reliable hormonal marker for evaluating ovarian reserve independently of the menstrual cycle—in 44 women aged 20–41 years who had IBD and were in clinical remission after infliximab treatment for either Crohn's disease (37 patients) or ulcerative colitis (in 7 patients).

The hormone levels were compared with those of 163 age-matched women undergoing in vitro fertilization who had a normal ovarian response to controlled ovarian stimulation (5–15 oocytes retrieved) and a normal serum anti-müllerian hormone level (greater than 1.5 mcg/L).

The anti-müllerian hormone levels did not differ significantly overall between the IBD and control patients (2.72 vs. 2.12 mcg/L), Dr. Thomas Fréour reported in a poster at the annual meeting of the American Society for Reproductive Medicine.

However, when the women were stratified by age 30 years and older versus age less than 30 years, the anti-müllerian hormone levels were found to differ in the older women, with those aged 30 years and older having lower levels than controls (2 vs. 2.96 mcg/L).

The levels in the younger patients remained comparable in the patients and controls, said Dr. Fréour of the University Hospital Center of Nantes (France).

Inflammatory bowel disease has been shown in previous studies to be associated with female subfertility, mainly through tubal dysfunctions, extensive adhesions, or chirurgical consequences on pelvic function, but alteration of ovarian reserve in those with IBD had not been previously studied, Dr. Fréour noted.

The findings suggest that in reproductive age women 30 years and older who have IBD, a substantially accelerated loss of primordial follicles may occur.

This loss might be attributed to chronic inflammation and/or to IBD treatments, he noted, adding that although the findings need to be confirmed in a larger population, they could be helpful for counseling women with IBD about their future prospects of fertility.

SAN FRANCISCO — Inflammatory bowel disease does not severely alter ovarian reserve but may accelerate loss of primordial follicles in those aged 30 years and older, results from a clinical study showed.

The investigators measured anti-müllerian hormone—which is a reliable hormonal marker for evaluating ovarian reserve independently of the menstrual cycle—in 44 women aged 20–41 years who had IBD and were in clinical remission after infliximab treatment for either Crohn's disease (37 patients) or ulcerative colitis (in 7 patients).

The hormone levels were compared with those of 163 age-matched women undergoing in vitro fertilization who had a normal ovarian response to controlled ovarian stimulation (5–15 oocytes retrieved) and a normal serum anti-müllerian hormone level (greater than 1.5 mcg/L).

The anti-müllerian hormone levels did not differ significantly overall between the IBD and control patients (2.72 vs. 2.12 mcg/L), Dr. Thomas Fréour reported in a poster at the annual meeting of the American Society for Reproductive Medicine.

However, when the women were stratified by age 30 years and older versus age less than 30 years, the anti-müllerian hormone levels were found to differ in the older women, with those aged 30 years and older having lower levels than controls (2 vs. 2.96 mcg/L).

The levels in the younger patients remained comparable in the patients and controls, said Dr. Fréour of the University Hospital Center of Nantes (France).

Inflammatory bowel disease has been shown in previous studies to be associated with female subfertility, mainly through tubal dysfunctions, extensive adhesions, or chirurgical consequences on pelvic function, but alteration of ovarian reserve in those with IBD had not been previously studied, Dr. Fréour noted.

The findings suggest that in reproductive age women 30 years and older who have IBD, a substantially accelerated loss of primordial follicles may occur.

This loss might be attributed to chronic inflammation and/or to IBD treatments, he noted, adding that although the findings need to be confirmed in a larger population, they could be helpful for counseling women with IBD about their future prospects of fertility.

SAN FRANCISCO — Simvastatin improved menstrual regularity in women with polycystic ovary syndrome—and it did so more effectively than either metformin or a combination of both drugs in a randomized study that compared the three treatments.

Furthermore, simvastatin was more effective than the metformin or combination treatment for reducing cardiovascular risk factors, including lipid profile and systemic inflammation, and was at least as effective for improving clinical and biochemical measures of hyperandrogenism, according to data presented at the annual meeting of the American Society for Reproductive Medicine.

Dr. Leszek Pawelczyk of the University of Medical Sciences in Poznan, Poland and his colleagues randomized 60 women with PCOS to receive simvastatin (20 mg/day), metformin (850 mg twice daily), or a combination of the two. Dr. Pawelczyk reported 6-month study data at the meeting.

The prospective study included only nonobese women who were not using oral contraceptives or other hormonal therapies.

The three treatment groups were comparable at baseline with regard to demographic and clinical characteristics; they averaged 2.5 menses every 6 months. The 18 women in the simvastatin group had an 89% increase in the number of menses after 6 months of treatment, compared with a 32% increase in the 19 women in the metformin group, and a 68% increase in the 23 women in the combination group. The differences between the groups were statistically significant.

All groups experienced a significant decrease in body mass index, hirsutism, acne scores, and total and free testosterone levels, but the differences in these measures were not statistically improved in the combination therapy group, compared with the simvastatin and metformin groups. For example, testosterone decreased 27% in the simvastatin group, 19% in the metformin group, and 15% in the combination group. Body mass index decreased 2.2% in the simvastatin group, 4.3% in the metformin group, and 5.8% in the combination group.

Similarly, there was no additive effect of combination therapy on total cholesterol, LDL cholesterol, and C-reactive protein in the combination group.

Improvements in these measures were seen only in the presence of simvastatin, and the improvement was not greater in the combination group.

Given the increasing evidence that statins benefit women with PCOS, they “may be a very good option in these patients,” Dr. Pawelczyk said in response to an audience member's question about whether he would recommend treatment in PCOS patients now, or wait for further study.

He noted, however, that this treatment is not an option in patients who are planning to become pregnant because statins have been associated with birth defects.

SAN FRANCISCO — Simvastatin improved menstrual regularity in women with polycystic ovary syndrome—and it did so more effectively than either metformin or a combination of both drugs in a randomized study that compared the three treatments.

Furthermore, simvastatin was more effective than the metformin or combination treatment for reducing cardiovascular risk factors, including lipid profile and systemic inflammation, and was at least as effective for improving clinical and biochemical measures of hyperandrogenism, according to data presented at the annual meeting of the American Society for Reproductive Medicine.

Dr. Leszek Pawelczyk of the University of Medical Sciences in Poznan, Poland and his colleagues randomized 60 women with PCOS to receive simvastatin (20 mg/day), metformin (850 mg twice daily), or a combination of the two. Dr. Pawelczyk reported 6-month study data at the meeting.

The prospective study included only nonobese women who were not using oral contraceptives or other hormonal therapies.

The three treatment groups were comparable at baseline with regard to demographic and clinical characteristics; they averaged 2.5 menses every 6 months. The 18 women in the simvastatin group had an 89% increase in the number of menses after 6 months of treatment, compared with a 32% increase in the 19 women in the metformin group, and a 68% increase in the 23 women in the combination group. The differences between the groups were statistically significant.

All groups experienced a significant decrease in body mass index, hirsutism, acne scores, and total and free testosterone levels, but the differences in these measures were not statistically improved in the combination therapy group, compared with the simvastatin and metformin groups. For example, testosterone decreased 27% in the simvastatin group, 19% in the metformin group, and 15% in the combination group. Body mass index decreased 2.2% in the simvastatin group, 4.3% in the metformin group, and 5.8% in the combination group.

Similarly, there was no additive effect of combination therapy on total cholesterol, LDL cholesterol, and C-reactive protein in the combination group.

Improvements in these measures were seen only in the presence of simvastatin, and the improvement was not greater in the combination group.

Given the increasing evidence that statins benefit women with PCOS, they “may be a very good option in these patients,” Dr. Pawelczyk said in response to an audience member's question about whether he would recommend treatment in PCOS patients now, or wait for further study.

He noted, however, that this treatment is not an option in patients who are planning to become pregnant because statins have been associated with birth defects.

SAN FRANCISCO — Simvastatin improved menstrual regularity in women with polycystic ovary syndrome—and it did so more effectively than either metformin or a combination of both drugs in a randomized study that compared the three treatments.

Furthermore, simvastatin was more effective than the metformin or combination treatment for reducing cardiovascular risk factors, including lipid profile and systemic inflammation, and was at least as effective for improving clinical and biochemical measures of hyperandrogenism, according to data presented at the annual meeting of the American Society for Reproductive Medicine.

Dr. Leszek Pawelczyk of the University of Medical Sciences in Poznan, Poland and his colleagues randomized 60 women with PCOS to receive simvastatin (20 mg/day), metformin (850 mg twice daily), or a combination of the two. Dr. Pawelczyk reported 6-month study data at the meeting.

The prospective study included only nonobese women who were not using oral contraceptives or other hormonal therapies.

The three treatment groups were comparable at baseline with regard to demographic and clinical characteristics; they averaged 2.5 menses every 6 months. The 18 women in the simvastatin group had an 89% increase in the number of menses after 6 months of treatment, compared with a 32% increase in the 19 women in the metformin group, and a 68% increase in the 23 women in the combination group. The differences between the groups were statistically significant.

All groups experienced a significant decrease in body mass index, hirsutism, acne scores, and total and free testosterone levels, but the differences in these measures were not statistically improved in the combination therapy group, compared with the simvastatin and metformin groups. For example, testosterone decreased 27% in the simvastatin group, 19% in the metformin group, and 15% in the combination group. Body mass index decreased 2.2% in the simvastatin group, 4.3% in the metformin group, and 5.8% in the combination group.

Similarly, there was no additive effect of combination therapy on total cholesterol, LDL cholesterol, and C-reactive protein in the combination group.

Improvements in these measures were seen only in the presence of simvastatin, and the improvement was not greater in the combination group.

Given the increasing evidence that statins benefit women with PCOS, they “may be a very good option in these patients,” Dr. Pawelczyk said in response to an audience member's question about whether he would recommend treatment in PCOS patients now, or wait for further study.

He noted, however, that this treatment is not an option in patients who are planning to become pregnant because statins have been associated with birth defects.

Assisted reproductive technology is associated with an increased risk of certain types of birth defects, according to a report from the Centers for Disease Control and Prevention.

The findings, based on data from the ongoing National Birth Defects Prevention Study—a population-based case-control study of birth defects—indicate that infants conceived using ART are twice as likely to be born with certain types of heart defects and with cleft lip (with or without cleft palate), and are more than four times as likely to have certain gastrointestinal defects, compared with those conceived naturally.

The investigators noted, however, that the underlying biologic mechanism by which ART might affect development remains unclear and that without further study, practical application of the results is limited.

The report, published in Human Reproduction (doi:10.1093/humrep/den387

Those considering ART should be informed of the risks involved, they urged.

The investigators compared outcomes in 281 babies conceived using in vitro fertilization (IVF) or intracytoplasmic sperm injection and 14,095 conceived without ART delivered between October 1997 and December 2003.

After controlling for maternal race and ethnicity, age, smoking, and parity, they found that among singleton births, the use of ART was associated with septal heart defects (adjusted odds ratio, 2.1), cleft lip with or without cleft palate (adjusted OR, 2.4), esophageal atresia (adjusted OR, 4.5), and anorectal atresia (adjusted OR, 3.7). Among multiple births, none of the more than 30 defects studied was significantly associated with ART.

The authors acknowledged that underlying infertility, small numbers, and chance may have played a role in the increased risk of birth defects found in the study.

Indeed, “this study suffers from the same significant deficiencies as many others looking at IVF outcomes,” Dr. Elizabeth Ginsburg, president of the Society for Assisted Reproductive Technology (SART), said in an interview. That is, rather than comparing two similar populations, this study compares babies of infertile women undergoing ART with those of fertile women. As a result, no conclusions can be made about why the incidence of birth defects is higher in those undergoing ART, she explained.

“I don't think the study changes what we have been telling our patients for some time, which is that there may be a higher risk of birth defects or other adverse outcomes in babies born from IVF. Whether these findings are due to the fact that there is something different about couples with infertility who require IVF to conceive or something related to the treatment itself, we don't know,” she said, adding that patients have the right to be informed, regardless.

Assisted reproductive technology is associated with an increased risk of certain types of birth defects, according to a report from the Centers for Disease Control and Prevention.

The findings, based on data from the ongoing National Birth Defects Prevention Study—a population-based case-control study of birth defects—indicate that infants conceived using ART are twice as likely to be born with certain types of heart defects and with cleft lip (with or without cleft palate), and are more than four times as likely to have certain gastrointestinal defects, compared with those conceived naturally.

The investigators noted, however, that the underlying biologic mechanism by which ART might affect development remains unclear and that without further study, practical application of the results is limited.

The report, published in Human Reproduction (doi:10.1093/humrep/den387

Those considering ART should be informed of the risks involved, they urged.

The investigators compared outcomes in 281 babies conceived using in vitro fertilization (IVF) or intracytoplasmic sperm injection and 14,095 conceived without ART delivered between October 1997 and December 2003.

After controlling for maternal race and ethnicity, age, smoking, and parity, they found that among singleton births, the use of ART was associated with septal heart defects (adjusted odds ratio, 2.1), cleft lip with or without cleft palate (adjusted OR, 2.4), esophageal atresia (adjusted OR, 4.5), and anorectal atresia (adjusted OR, 3.7). Among multiple births, none of the more than 30 defects studied was significantly associated with ART.

The authors acknowledged that underlying infertility, small numbers, and chance may have played a role in the increased risk of birth defects found in the study.

Indeed, “this study suffers from the same significant deficiencies as many others looking at IVF outcomes,” Dr. Elizabeth Ginsburg, president of the Society for Assisted Reproductive Technology (SART), said in an interview. That is, rather than comparing two similar populations, this study compares babies of infertile women undergoing ART with those of fertile women. As a result, no conclusions can be made about why the incidence of birth defects is higher in those undergoing ART, she explained.

“I don't think the study changes what we have been telling our patients for some time, which is that there may be a higher risk of birth defects or other adverse outcomes in babies born from IVF. Whether these findings are due to the fact that there is something different about couples with infertility who require IVF to conceive or something related to the treatment itself, we don't know,” she said, adding that patients have the right to be informed, regardless.

Assisted reproductive technology is associated with an increased risk of certain types of birth defects, according to a report from the Centers for Disease Control and Prevention.

The findings, based on data from the ongoing National Birth Defects Prevention Study—a population-based case-control study of birth defects—indicate that infants conceived using ART are twice as likely to be born with certain types of heart defects and with cleft lip (with or without cleft palate), and are more than four times as likely to have certain gastrointestinal defects, compared with those conceived naturally.

The investigators noted, however, that the underlying biologic mechanism by which ART might affect development remains unclear and that without further study, practical application of the results is limited.

The report, published in Human Reproduction (doi:10.1093/humrep/den387

Those considering ART should be informed of the risks involved, they urged.

The investigators compared outcomes in 281 babies conceived using in vitro fertilization (IVF) or intracytoplasmic sperm injection and 14,095 conceived without ART delivered between October 1997 and December 2003.

After controlling for maternal race and ethnicity, age, smoking, and parity, they found that among singleton births, the use of ART was associated with septal heart defects (adjusted odds ratio, 2.1), cleft lip with or without cleft palate (adjusted OR, 2.4), esophageal atresia (adjusted OR, 4.5), and anorectal atresia (adjusted OR, 3.7). Among multiple births, none of the more than 30 defects studied was significantly associated with ART.

The authors acknowledged that underlying infertility, small numbers, and chance may have played a role in the increased risk of birth defects found in the study.

Indeed, “this study suffers from the same significant deficiencies as many others looking at IVF outcomes,” Dr. Elizabeth Ginsburg, president of the Society for Assisted Reproductive Technology (SART), said in an interview. That is, rather than comparing two similar populations, this study compares babies of infertile women undergoing ART with those of fertile women. As a result, no conclusions can be made about why the incidence of birth defects is higher in those undergoing ART, she explained.

“I don't think the study changes what we have been telling our patients for some time, which is that there may be a higher risk of birth defects or other adverse outcomes in babies born from IVF. Whether these findings are due to the fact that there is something different about couples with infertility who require IVF to conceive or something related to the treatment itself, we don't know,” she said, adding that patients have the right to be informed, regardless.

SAN FRANCISCO — Metformin treatment before and during in vitro fertilization does not improve the chance of pregnancy in women with ovaries of polycystic morphology who do not have anovulation or hyperandrogenism, according to a study of 134 women.

Study participants treated with metformin before oocyte collection were no more likely to become pregnant or have a clinical pregnancy than were patients given placebo, Dr. Alex G. Swanton of John Radcliffe Hospital in Oxford, England said at the annual meeting of the American Society for Reproductive Medicine.

In the multicenter study, women with ovaries of polycystic morphology but no other manifestations of polycystic ovary syndrome (PCOS), such as anovulation or hyperandrogenism, were randomized to receive 1.5 g metformin (62 patients) or placebo (62 patients) starting 7 weeks before oocyte retrieval. The women were younger than 39 years and undergoing their first or second cycle of IVF (with or without intracytoplasmic sperm injection). IVF was performed using the long protocol. One 500-mg capsule of metformin was taken every morning for 1 week, increasing to two capsules daily and then three daily until the day of oocyte collection.

Polycystic ovaries were diagnosed by the ultrasound presence of at least 12 follicles measuring 2-9 mm in diameter and/or increased ovarian volume greater than 10 mL in at least one ovary. Severe ovarian hyperstimulation syndrome was defined as the presence of clinical ascites and hemoconcentration requiring hospital admission.

There were no statistically significant differences between the two groups in baseline characteristics.

The study was prompted by several factors. “Firstly, polycystic ovaries are very common, affecting about 33% of patients attending fertility clinics,” Dr. Swanton said in an interview. “Secondly, women with polycystic ovaries, who have regular cycles and no symptoms of acne or hirsutism (that is, no features of polycystic ovary syndrome) may have underlying biochemical abnormalities similar to [those of] women with polycystic ovary syndrome. Thirdly, there is good evidence that women with polycystic ovary syndrome undergoing IVF treatment benefit from metformin treatment, as it increases pregnancy rates and decreases ovarian hyperstimulation syndrome rates.”

The study relates to 33% of fertility clinic patients, Dr. Alex G. Swanton noted.

SAN FRANCISCO — Metformin treatment before and during in vitro fertilization does not improve the chance of pregnancy in women with ovaries of polycystic morphology who do not have anovulation or hyperandrogenism, according to a study of 134 women.

Study participants treated with metformin before oocyte collection were no more likely to become pregnant or have a clinical pregnancy than were patients given placebo, Dr. Alex G. Swanton of John Radcliffe Hospital in Oxford, England said at the annual meeting of the American Society for Reproductive Medicine.

In the multicenter study, women with ovaries of polycystic morphology but no other manifestations of polycystic ovary syndrome (PCOS), such as anovulation or hyperandrogenism, were randomized to receive 1.5 g metformin (62 patients) or placebo (62 patients) starting 7 weeks before oocyte retrieval. The women were younger than 39 years and undergoing their first or second cycle of IVF (with or without intracytoplasmic sperm injection). IVF was performed using the long protocol. One 500-mg capsule of metformin was taken every morning for 1 week, increasing to two capsules daily and then three daily until the day of oocyte collection.

Polycystic ovaries were diagnosed by the ultrasound presence of at least 12 follicles measuring 2-9 mm in diameter and/or increased ovarian volume greater than 10 mL in at least one ovary. Severe ovarian hyperstimulation syndrome was defined as the presence of clinical ascites and hemoconcentration requiring hospital admission.

There were no statistically significant differences between the two groups in baseline characteristics.

The study was prompted by several factors. “Firstly, polycystic ovaries are very common, affecting about 33% of patients attending fertility clinics,” Dr. Swanton said in an interview. “Secondly, women with polycystic ovaries, who have regular cycles and no symptoms of acne or hirsutism (that is, no features of polycystic ovary syndrome) may have underlying biochemical abnormalities similar to [those of] women with polycystic ovary syndrome. Thirdly, there is good evidence that women with polycystic ovary syndrome undergoing IVF treatment benefit from metformin treatment, as it increases pregnancy rates and decreases ovarian hyperstimulation syndrome rates.”

The study relates to 33% of fertility clinic patients, Dr. Alex G. Swanton noted.

SAN FRANCISCO — Metformin treatment before and during in vitro fertilization does not improve the chance of pregnancy in women with ovaries of polycystic morphology who do not have anovulation or hyperandrogenism, according to a study of 134 women.

Study participants treated with metformin before oocyte collection were no more likely to become pregnant or have a clinical pregnancy than were patients given placebo, Dr. Alex G. Swanton of John Radcliffe Hospital in Oxford, England said at the annual meeting of the American Society for Reproductive Medicine.

In the multicenter study, women with ovaries of polycystic morphology but no other manifestations of polycystic ovary syndrome (PCOS), such as anovulation or hyperandrogenism, were randomized to receive 1.5 g metformin (62 patients) or placebo (62 patients) starting 7 weeks before oocyte retrieval. The women were younger than 39 years and undergoing their first or second cycle of IVF (with or without intracytoplasmic sperm injection). IVF was performed using the long protocol. One 500-mg capsule of metformin was taken every morning for 1 week, increasing to two capsules daily and then three daily until the day of oocyte collection.

Polycystic ovaries were diagnosed by the ultrasound presence of at least 12 follicles measuring 2-9 mm in diameter and/or increased ovarian volume greater than 10 mL in at least one ovary. Severe ovarian hyperstimulation syndrome was defined as the presence of clinical ascites and hemoconcentration requiring hospital admission.

There were no statistically significant differences between the two groups in baseline characteristics.

The study was prompted by several factors. “Firstly, polycystic ovaries are very common, affecting about 33% of patients attending fertility clinics,” Dr. Swanton said in an interview. “Secondly, women with polycystic ovaries, who have regular cycles and no symptoms of acne or hirsutism (that is, no features of polycystic ovary syndrome) may have underlying biochemical abnormalities similar to [those of] women with polycystic ovary syndrome. Thirdly, there is good evidence that women with polycystic ovary syndrome undergoing IVF treatment benefit from metformin treatment, as it increases pregnancy rates and decreases ovarian hyperstimulation syndrome rates.”

The study relates to 33% of fertility clinic patients, Dr. Alex G. Swanton noted.

Many nursing home residents with dementia are at risk for undiagnosed, underestimated, and undermanaged pain because of their difficulty in communicating, but ongoing study suggests that objective assessment of a resident's health status can identify those with dementia who are in pain but can't report it themselves.

For the study, Christie Teigland, Ph.D., and her team at the New York Association of Homes & Services for the Aging first identified risk factors for pain in more than 500,000 cognitively intact residents of 670 nursing homes throughout New York state by applying logistic regression analysis to Medicare Minimum Data Set (MDS) data on these residents.

In keeping with a 2008 position statement by the American Society of Pain Management Nurses, the researchers assumed that the factors causing pain in these residents also would cause pain in dementia residents

The investigators found that being older and male decreased the likelihood that any person would report pain (odds ratios of 0.72–0.45, depending on the age group, and 0.67, respectively). Higher body mass index emerged as a risk factor for more pain (odds ratio of 1.09–1.29).

Many diseases, conditions, and treatments correlated directly or inversely with pain. For example, arthritis, hip fractures, and asthma were associated with increased likelihood of pain. Infections and skin conditions increased the risk for pain, whereas preventive skin treatments decreased risk. (See box, page 41)

The researchers used the data to apply a predictive risk model to pain reported by cognitively intact residents and estimate undetected or underreported pain in residents with dementia. Dr. Teigland found a difference of 16 percentage points between observed pain in the residents with dementia (19% of residents) and expected pain in that population (35% of residents). Because the researchers adjusted the model for diseases and conditions that can cause pain, the 84% difference indicates the underassessment of pain in residents whose dementia prevents full communication about their pain, Dr. Teigland asserted.

Overall, 42% of residents free of dementia had observed pain, compared with 19% of residents with dementia, a 23-point difference. When the researchers used their model to assess dementia patients' pain, the differences in expected pain rates between cognitively intact residents and dementia residents were much smaller, with rates of 45% versus 35% overall. Thus, after risk adjustment for conditions that cause pain, the expected rates of pain for dementia residents are 84% higher than rates actually reported.

This difference is further confounded by the finding that after risk adjustment, the older the resident, the lower the likelihood of reporting pain. There is disagreement in the literature about why this is the case.

Some studies suggest the threshold for and sensitivity to pain decreases with advancing age, so older residents experience less pain. Other studies state that pain is reported less with age because of attitudes (i.e., old people expect to have pain; or they are afraid of taking the medications).

If the latter is true, the difference between expected and reported pain is even higher than the risk adjusted data show because dementia residents tend to be older on average, said Dr. Teigland. “What is clear from this analysis is that pain is significantly underassessed in residents with dementia as compared to residents without dementia but with similar characteristics and risk factors for pain,” she said.

Dr. Teigland reported the findings at a conference on dementia sponsored by the Alzheimer's Association.

The new model isn't the only way to assess pain in nursing home residents, including those with dementia, she said. In those able to communicate their pain, self-reporting is the most reliable. Numeric rating scales, verbal descriptor scales, pain-thermometer scales, and faces scales can all be useful in assisting residents with self-reports, said Dr. Teigland. Assessments in those with dementia should include a review of potential causes of pain, observation for both verbal and nonverbal pain behaviors, and observation for behavior changes such as acting out or withdrawing. Surrogate reporting, done by nursing home staff, family members, and clergy, is also important, as are analgesic trials to test for response, she said. Pain detection has been shown to improve with the use of a combination of these tools in residents with dementia.

For the study, which was funded by the Alzheimer's Association, dementia residents were defined as those with a diagnosis of dementia or Alzheimer's disease or as those with a cognitive performance score (CPS) of 4–6, indicating moderately severe to very severe cognitive impairment. The CPS is a validated measure of cognitive status and was used because about 10% of nursing home residents with dementia do not have a diagnosis coded on the MDS. About 60% of nursing home residents in the study met these criteria.

Dr. Teigland said the findings have important implications for residents with dementia, who could receive better pain treatment and thus have a better quality of life if more caregivers were to use the new model to assess pain.

For residents with dementia, improved pain assessment and treatment have been shown to be associated with less depression, fewer negative behaviors, and slower functional decline, she said. The result for nursing homes could be more accurate reporting on quality of care measures, including those reported to Nursing Home Compare, the Centers for Medicare and Medicaid (CMS) Web site for the public.

Scores on quality measures can be skewed by the underdiagnosis and undertreatment of pain in dementia residents, Dr. Teigland noted. The findings in the current study reveal that CMS quality measures offer “a highly skewed snapshot of facility pain rates,” she said in an interview.

These hidden problems with quality measures tend to multiply, Dr. Teigland added. Dementia residents are up to 5 times as likely as others to have pain-related outcomes such as agitation and depression, which lead to higher use of antipsychotics in a facility, she explained. Better quality measures would ensure that serious quality of life issues are not missed for the growing dementia population, she said.

The study indicates that these problems can be circumvented by using the wealth of resident information readily available in every nursing home's MDS, Dr. Teigland concluded. Such data on medial conditions and behavioral issues can identify cognitively impaired residents who are suffering from undetected or undertreated pain.

The New York Association of Homes & Services for the Aging, a nonprofit association, has incorporated Dr. Teigland's model into a Web-based informatics software tool, EQUIP for Quality. The decision-support tool includes other MDS-based predictive risk assessment models. It is available to nursing homes nationwide and is already being used by more than 400 facilities in 22 states. More information is available at www.equipforquality.com

Predicting PainIn the Elderly

Dr. Christie Teigland noted that men and older residents are less likely to report pain; obese individuals and those with arthritis are more likely to experience pain. Fractures increase the risk of pain by 100%.

Numerous risk factors related to incontinence are related to pain. For example, residents on bladder training were more than 50% more likely to have pain, and those with a scheduled toileting plan were less likely to have pain. Surgical wounds increased the likelihood of pain by more than 100%.

Dr. Teigland's study assessed the following risk factors for their association with pain in residents without dementia in New York nursing homes. For each factor, the odds ratio indicates the likelihood that a patient has pain.

Many nursing home residents with dementia are at risk for undiagnosed, underestimated, and undermanaged pain because of their difficulty in communicating, but ongoing study suggests that objective assessment of a resident's health status can identify those with dementia who are in pain but can't report it themselves.

For the study, Christie Teigland, Ph.D., and her team at the New York Association of Homes & Services for the Aging first identified risk factors for pain in more than 500,000 cognitively intact residents of 670 nursing homes throughout New York state by applying logistic regression analysis to Medicare Minimum Data Set (MDS) data on these residents.

In keeping with a 2008 position statement by the American Society of Pain Management Nurses, the researchers assumed that the factors causing pain in these residents also would cause pain in dementia residents

The investigators found that being older and male decreased the likelihood that any person would report pain (odds ratios of 0.72–0.45, depending on the age group, and 0.67, respectively). Higher body mass index emerged as a risk factor for more pain (odds ratio of 1.09–1.29).

Many diseases, conditions, and treatments correlated directly or inversely with pain. For example, arthritis, hip fractures, and asthma were associated with increased likelihood of pain. Infections and skin conditions increased the risk for pain, whereas preventive skin treatments decreased risk. (See box, page 41)

The researchers used the data to apply a predictive risk model to pain reported by cognitively intact residents and estimate undetected or underreported pain in residents with dementia. Dr. Teigland found a difference of 16 percentage points between observed pain in the residents with dementia (19% of residents) and expected pain in that population (35% of residents). Because the researchers adjusted the model for diseases and conditions that can cause pain, the 84% difference indicates the underassessment of pain in residents whose dementia prevents full communication about their pain, Dr. Teigland asserted.

Overall, 42% of residents free of dementia had observed pain, compared with 19% of residents with dementia, a 23-point difference. When the researchers used their model to assess dementia patients' pain, the differences in expected pain rates between cognitively intact residents and dementia residents were much smaller, with rates of 45% versus 35% overall. Thus, after risk adjustment for conditions that cause pain, the expected rates of pain for dementia residents are 84% higher than rates actually reported.

This difference is further confounded by the finding that after risk adjustment, the older the resident, the lower the likelihood of reporting pain. There is disagreement in the literature about why this is the case.

Some studies suggest the threshold for and sensitivity to pain decreases with advancing age, so older residents experience less pain. Other studies state that pain is reported less with age because of attitudes (i.e., old people expect to have pain; or they are afraid of taking the medications).

If the latter is true, the difference between expected and reported pain is even higher than the risk adjusted data show because dementia residents tend to be older on average, said Dr. Teigland. “What is clear from this analysis is that pain is significantly underassessed in residents with dementia as compared to residents without dementia but with similar characteristics and risk factors for pain,” she said.

Dr. Teigland reported the findings at a conference on dementia sponsored by the Alzheimer's Association.

The new model isn't the only way to assess pain in nursing home residents, including those with dementia, she said. In those able to communicate their pain, self-reporting is the most reliable. Numeric rating scales, verbal descriptor scales, pain-thermometer scales, and faces scales can all be useful in assisting residents with self-reports, said Dr. Teigland. Assessments in those with dementia should include a review of potential causes of pain, observation for both verbal and nonverbal pain behaviors, and observation for behavior changes such as acting out or withdrawing. Surrogate reporting, done by nursing home staff, family members, and clergy, is also important, as are analgesic trials to test for response, she said. Pain detection has been shown to improve with the use of a combination of these tools in residents with dementia.

For the study, which was funded by the Alzheimer's Association, dementia residents were defined as those with a diagnosis of dementia or Alzheimer's disease or as those with a cognitive performance score (CPS) of 4–6, indicating moderately severe to very severe cognitive impairment. The CPS is a validated measure of cognitive status and was used because about 10% of nursing home residents with dementia do not have a diagnosis coded on the MDS. About 60% of nursing home residents in the study met these criteria.

Dr. Teigland said the findings have important implications for residents with dementia, who could receive better pain treatment and thus have a better quality of life if more caregivers were to use the new model to assess pain.

For residents with dementia, improved pain assessment and treatment have been shown to be associated with less depression, fewer negative behaviors, and slower functional decline, she said. The result for nursing homes could be more accurate reporting on quality of care measures, including those reported to Nursing Home Compare, the Centers for Medicare and Medicaid (CMS) Web site for the public.

Scores on quality measures can be skewed by the underdiagnosis and undertreatment of pain in dementia residents, Dr. Teigland noted. The findings in the current study reveal that CMS quality measures offer “a highly skewed snapshot of facility pain rates,” she said in an interview.

These hidden problems with quality measures tend to multiply, Dr. Teigland added. Dementia residents are up to 5 times as likely as others to have pain-related outcomes such as agitation and depression, which lead to higher use of antipsychotics in a facility, she explained. Better quality measures would ensure that serious quality of life issues are not missed for the growing dementia population, she said.

The study indicates that these problems can be circumvented by using the wealth of resident information readily available in every nursing home's MDS, Dr. Teigland concluded. Such data on medial conditions and behavioral issues can identify cognitively impaired residents who are suffering from undetected or undertreated pain.

The New York Association of Homes & Services for the Aging, a nonprofit association, has incorporated Dr. Teigland's model into a Web-based informatics software tool, EQUIP for Quality. The decision-support tool includes other MDS-based predictive risk assessment models. It is available to nursing homes nationwide and is already being used by more than 400 facilities in 22 states. More information is available at www.equipforquality.com

Predicting PainIn the Elderly

Dr. Christie Teigland noted that men and older residents are less likely to report pain; obese individuals and those with arthritis are more likely to experience pain. Fractures increase the risk of pain by 100%.

Numerous risk factors related to incontinence are related to pain. For example, residents on bladder training were more than 50% more likely to have pain, and those with a scheduled toileting plan were less likely to have pain. Surgical wounds increased the likelihood of pain by more than 100%.

Dr. Teigland's study assessed the following risk factors for their association with pain in residents without dementia in New York nursing homes. For each factor, the odds ratio indicates the likelihood that a patient has pain.

Many nursing home residents with dementia are at risk for undiagnosed, underestimated, and undermanaged pain because of their difficulty in communicating, but ongoing study suggests that objective assessment of a resident's health status can identify those with dementia who are in pain but can't report it themselves.

For the study, Christie Teigland, Ph.D., and her team at the New York Association of Homes & Services for the Aging first identified risk factors for pain in more than 500,000 cognitively intact residents of 670 nursing homes throughout New York state by applying logistic regression analysis to Medicare Minimum Data Set (MDS) data on these residents.

In keeping with a 2008 position statement by the American Society of Pain Management Nurses, the researchers assumed that the factors causing pain in these residents also would cause pain in dementia residents

The investigators found that being older and male decreased the likelihood that any person would report pain (odds ratios of 0.72–0.45, depending on the age group, and 0.67, respectively). Higher body mass index emerged as a risk factor for more pain (odds ratio of 1.09–1.29).

Many diseases, conditions, and treatments correlated directly or inversely with pain. For example, arthritis, hip fractures, and asthma were associated with increased likelihood of pain. Infections and skin conditions increased the risk for pain, whereas preventive skin treatments decreased risk. (See box, page 41)

The researchers used the data to apply a predictive risk model to pain reported by cognitively intact residents and estimate undetected or underreported pain in residents with dementia. Dr. Teigland found a difference of 16 percentage points between observed pain in the residents with dementia (19% of residents) and expected pain in that population (35% of residents). Because the researchers adjusted the model for diseases and conditions that can cause pain, the 84% difference indicates the underassessment of pain in residents whose dementia prevents full communication about their pain, Dr. Teigland asserted.

Overall, 42% of residents free of dementia had observed pain, compared with 19% of residents with dementia, a 23-point difference. When the researchers used their model to assess dementia patients' pain, the differences in expected pain rates between cognitively intact residents and dementia residents were much smaller, with rates of 45% versus 35% overall. Thus, after risk adjustment for conditions that cause pain, the expected rates of pain for dementia residents are 84% higher than rates actually reported.

This difference is further confounded by the finding that after risk adjustment, the older the resident, the lower the likelihood of reporting pain. There is disagreement in the literature about why this is the case.

Some studies suggest the threshold for and sensitivity to pain decreases with advancing age, so older residents experience less pain. Other studies state that pain is reported less with age because of attitudes (i.e., old people expect to have pain; or they are afraid of taking the medications).

If the latter is true, the difference between expected and reported pain is even higher than the risk adjusted data show because dementia residents tend to be older on average, said Dr. Teigland. “What is clear from this analysis is that pain is significantly underassessed in residents with dementia as compared to residents without dementia but with similar characteristics and risk factors for pain,” she said.

Dr. Teigland reported the findings at a conference on dementia sponsored by the Alzheimer's Association.

The new model isn't the only way to assess pain in nursing home residents, including those with dementia, she said. In those able to communicate their pain, self-reporting is the most reliable. Numeric rating scales, verbal descriptor scales, pain-thermometer scales, and faces scales can all be useful in assisting residents with self-reports, said Dr. Teigland. Assessments in those with dementia should include a review of potential causes of pain, observation for both verbal and nonverbal pain behaviors, and observation for behavior changes such as acting out or withdrawing. Surrogate reporting, done by nursing home staff, family members, and clergy, is also important, as are analgesic trials to test for response, she said. Pain detection has been shown to improve with the use of a combination of these tools in residents with dementia.

For the study, which was funded by the Alzheimer's Association, dementia residents were defined as those with a diagnosis of dementia or Alzheimer's disease or as those with a cognitive performance score (CPS) of 4–6, indicating moderately severe to very severe cognitive impairment. The CPS is a validated measure of cognitive status and was used because about 10% of nursing home residents with dementia do not have a diagnosis coded on the MDS. About 60% of nursing home residents in the study met these criteria.

Dr. Teigland said the findings have important implications for residents with dementia, who could receive better pain treatment and thus have a better quality of life if more caregivers were to use the new model to assess pain.

For residents with dementia, improved pain assessment and treatment have been shown to be associated with less depression, fewer negative behaviors, and slower functional decline, she said. The result for nursing homes could be more accurate reporting on quality of care measures, including those reported to Nursing Home Compare, the Centers for Medicare and Medicaid (CMS) Web site for the public.

Scores on quality measures can be skewed by the underdiagnosis and undertreatment of pain in dementia residents, Dr. Teigland noted. The findings in the current study reveal that CMS quality measures offer “a highly skewed snapshot of facility pain rates,” she said in an interview.

These hidden problems with quality measures tend to multiply, Dr. Teigland added. Dementia residents are up to 5 times as likely as others to have pain-related outcomes such as agitation and depression, which lead to higher use of antipsychotics in a facility, she explained. Better quality measures would ensure that serious quality of life issues are not missed for the growing dementia population, she said.

The study indicates that these problems can be circumvented by using the wealth of resident information readily available in every nursing home's MDS, Dr. Teigland concluded. Such data on medial conditions and behavioral issues can identify cognitively impaired residents who are suffering from undetected or undertreated pain.

The New York Association of Homes & Services for the Aging, a nonprofit association, has incorporated Dr. Teigland's model into a Web-based informatics software tool, EQUIP for Quality. The decision-support tool includes other MDS-based predictive risk assessment models. It is available to nursing homes nationwide and is already being used by more than 400 facilities in 22 states. More information is available at www.equipforquality.com

Predicting PainIn the Elderly

Dr. Christie Teigland noted that men and older residents are less likely to report pain; obese individuals and those with arthritis are more likely to experience pain. Fractures increase the risk of pain by 100%.

Numerous risk factors related to incontinence are related to pain. For example, residents on bladder training were more than 50% more likely to have pain, and those with a scheduled toileting plan were less likely to have pain. Surgical wounds increased the likelihood of pain by more than 100%.

Dr. Teigland's study assessed the following risk factors for their association with pain in residents without dementia in New York nursing homes. For each factor, the odds ratio indicates the likelihood that a patient has pain.

ATLANTA — Despite new data suggesting that current Centers for Disease Control and Prevention recommendations regarding needle length for intramuscular vaccine injections might be flawed, the CDC's Advisory Committee on Immunization Practices favors maintaining the current recommendations.

The new data published this year by Dr. William Lippert and associates suggest that the currently recommended needle lengths increase risk of overpenetration and striking of bone and periosteum (Pediatrics 2008;122:e556–63). In some cases, the CDC recommendations are nearly twice what the study authors recommended, based on their review of 250 diagnostic MRI and CT scans. For example, in boys weighing 140 kg or less and in girls weighing 115 kg or less, the authors recommended a 5/8-inch needle length, while the current CDC recommendations call for a 1-inch needle length in these groups, according to Dr. Andrew Kroger of the CDC and ACIP's General Recommendations Working Group, which proposed the revision at ACIP's fall meeting.

Most working group members favored changing the general recommendations to “partially adopt” the new data by adding footnotes that incorporate the new data, Dr. Kroger said.

A proposed footnote states that “some experts recommend a needle shorter than 1 inch (25 mm) for children/adolescents 3 years through 18 years who weigh less than 140 kg (males) or less than 115 kg (females).”

However, several ACIP members argued against any change, saying that in years of practice they have not seen the types of complications noted in the study and arguing that the proposed change complicates matters for health care providers.

“Overall, I think that any change is unworkable,” said Dr. Michael S. Marcy of the UCLA Center for Vaccine Research in Torrance, Calif.

The Lippert study is “interesting, but perhaps irrelevant,” Dr. Marcy said, noting that a recommendation for shorter needle length for some children might outweigh any benefits—especially given the fact that an increasing number of pediatric patients are overweight or obese, which could lead to increased risk of subcutaneous vs. intramuscular injection with use of shorter needles.

The committee asked the working group to maintain the current recommendations in the updated general recommendations report the group is currently drafting. The first half of the revised report was presented at the meeting.

The last report, adopted in 2006, includes a grid calling for the use of a 5/8-inch needle in newborns injected at the anterolateral thigh, a 1-inch needle in those aged 1–12 months injected at the anterolateral thigh, a 1- to 1 1/4-inch needle in those aged 1–2 years injected at the anterolateral thigh or a 5/8- to 1-inch needle in those injected at the deltoid muscle of the arm, and a 5/8- to 1-inch needle in those aged 3–18 years injected at the deltoid muscle of the arm or a 1- to 1 1/4-inch needle in those injected at the anterolateral thigh.

Although the grid does not emphasize injection technique, the text of the recommendation in the report does address technique, Dr. Kroger noted.

The second half of the revised draft of the General Recommendations report, which addresses immunization issues relevant to all vaccines and which addresses topics ad hoc that cannot be attributed to a single vaccine, will be presented to ACIP in February 2009. The revised report is scheduled for publication in December 2009.

ATLANTA — Despite new data suggesting that current Centers for Disease Control and Prevention recommendations regarding needle length for intramuscular vaccine injections might be flawed, the CDC's Advisory Committee on Immunization Practices favors maintaining the current recommendations.

The new data published this year by Dr. William Lippert and associates suggest that the currently recommended needle lengths increase risk of overpenetration and striking of bone and periosteum (Pediatrics 2008;122:e556–63). In some cases, the CDC recommendations are nearly twice what the study authors recommended, based on their review of 250 diagnostic MRI and CT scans. For example, in boys weighing 140 kg or less and in girls weighing 115 kg or less, the authors recommended a 5/8-inch needle length, while the current CDC recommendations call for a 1-inch needle length in these groups, according to Dr. Andrew Kroger of the CDC and ACIP's General Recommendations Working Group, which proposed the revision at ACIP's fall meeting.

Most working group members favored changing the general recommendations to “partially adopt” the new data by adding footnotes that incorporate the new data, Dr. Kroger said.

A proposed footnote states that “some experts recommend a needle shorter than 1 inch (25 mm) for children/adolescents 3 years through 18 years who weigh less than 140 kg (males) or less than 115 kg (females).”

However, several ACIP members argued against any change, saying that in years of practice they have not seen the types of complications noted in the study and arguing that the proposed change complicates matters for health care providers.

“Overall, I think that any change is unworkable,” said Dr. Michael S. Marcy of the UCLA Center for Vaccine Research in Torrance, Calif.

The Lippert study is “interesting, but perhaps irrelevant,” Dr. Marcy said, noting that a recommendation for shorter needle length for some children might outweigh any benefits—especially given the fact that an increasing number of pediatric patients are overweight or obese, which could lead to increased risk of subcutaneous vs. intramuscular injection with use of shorter needles.

The committee asked the working group to maintain the current recommendations in the updated general recommendations report the group is currently drafting. The first half of the revised report was presented at the meeting.

The last report, adopted in 2006, includes a grid calling for the use of a 5/8-inch needle in newborns injected at the anterolateral thigh, a 1-inch needle in those aged 1–12 months injected at the anterolateral thigh, a 1- to 1 1/4-inch needle in those aged 1–2 years injected at the anterolateral thigh or a 5/8- to 1-inch needle in those injected at the deltoid muscle of the arm, and a 5/8- to 1-inch needle in those aged 3–18 years injected at the deltoid muscle of the arm or a 1- to 1 1/4-inch needle in those injected at the anterolateral thigh.

Although the grid does not emphasize injection technique, the text of the recommendation in the report does address technique, Dr. Kroger noted.

The second half of the revised draft of the General Recommendations report, which addresses immunization issues relevant to all vaccines and which addresses topics ad hoc that cannot be attributed to a single vaccine, will be presented to ACIP in February 2009. The revised report is scheduled for publication in December 2009.

ATLANTA — Despite new data suggesting that current Centers for Disease Control and Prevention recommendations regarding needle length for intramuscular vaccine injections might be flawed, the CDC's Advisory Committee on Immunization Practices favors maintaining the current recommendations.

The new data published this year by Dr. William Lippert and associates suggest that the currently recommended needle lengths increase risk of overpenetration and striking of bone and periosteum (Pediatrics 2008;122:e556–63). In some cases, the CDC recommendations are nearly twice what the study authors recommended, based on their review of 250 diagnostic MRI and CT scans. For example, in boys weighing 140 kg or less and in girls weighing 115 kg or less, the authors recommended a 5/8-inch needle length, while the current CDC recommendations call for a 1-inch needle length in these groups, according to Dr. Andrew Kroger of the CDC and ACIP's General Recommendations Working Group, which proposed the revision at ACIP's fall meeting.

Most working group members favored changing the general recommendations to “partially adopt” the new data by adding footnotes that incorporate the new data, Dr. Kroger said.

A proposed footnote states that “some experts recommend a needle shorter than 1 inch (25 mm) for children/adolescents 3 years through 18 years who weigh less than 140 kg (males) or less than 115 kg (females).”

However, several ACIP members argued against any change, saying that in years of practice they have not seen the types of complications noted in the study and arguing that the proposed change complicates matters for health care providers.

“Overall, I think that any change is unworkable,” said Dr. Michael S. Marcy of the UCLA Center for Vaccine Research in Torrance, Calif.

The Lippert study is “interesting, but perhaps irrelevant,” Dr. Marcy said, noting that a recommendation for shorter needle length for some children might outweigh any benefits—especially given the fact that an increasing number of pediatric patients are overweight or obese, which could lead to increased risk of subcutaneous vs. intramuscular injection with use of shorter needles.

The committee asked the working group to maintain the current recommendations in the updated general recommendations report the group is currently drafting. The first half of the revised report was presented at the meeting.

The last report, adopted in 2006, includes a grid calling for the use of a 5/8-inch needle in newborns injected at the anterolateral thigh, a 1-inch needle in those aged 1–12 months injected at the anterolateral thigh, a 1- to 1 1/4-inch needle in those aged 1–2 years injected at the anterolateral thigh or a 5/8- to 1-inch needle in those injected at the deltoid muscle of the arm, and a 5/8- to 1-inch needle in those aged 3–18 years injected at the deltoid muscle of the arm or a 1- to 1 1/4-inch needle in those injected at the anterolateral thigh.

Although the grid does not emphasize injection technique, the text of the recommendation in the report does address technique, Dr. Kroger noted.

The second half of the revised draft of the General Recommendations report, which addresses immunization issues relevant to all vaccines and which addresses topics ad hoc that cannot be attributed to a single vaccine, will be presented to ACIP in February 2009. The revised report is scheduled for publication in December 2009.

ATLANTA — Hospital-based data from New York and Texas underscore the importance of rotavirus vaccination for reducing disease burden and related hospitalization rates and costs.

The findings were reported at the fall meeting of the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices. Data from 11 sentinel hospitals in New York indicate that in children aged 1 month to 3 years, there was a 56% reduction in hospital admissions for diarrhea, and an 85% reduction in hospital admissions for rotavirus in 2008, compared with 2003–2005—a change that coincides with increasing rotavirus vaccination coverage. Total charges for diarrhea and rotavirus-associated hospitalizations decreased by $22 million and $12 million, respectively, in 2008, compared with 2005–2007, Dr. Hwa-Gan Chang of the New York State Department of Health reported.

He noted that significant reductions in rotavirus-related hospitalizations also were seen in New York among nonimmunized older age groups, which suggests possible herd immunity following the introduction of the oral three-dose pentavalent rotavirus vaccine RotaTeq (Merck & Co.), which was licensed in February 2006.

A project at Texas Children's Hospital in Houston, which was funded by a CDC grant, showed that in children aged 15 days through 23 months, vaccine effectiveness was 85%–89% in both case patients (including 400 children who presented to the hospital emergency department with acute gastroenteritis) and controls (including 115 rotavirus-negative acute gastroenteritis patients, 228 concurrently enrolled patients with acute respiratory infection symptoms). The effectiveness rates, based on findings from February to June 2008, were comparable with prelicensure estimates, Dr. Julie A. Boom, director of infant and childhood immunizations at the Center for Vaccine Awareness and Research of Texas Children's Hospital, reported.

ATLANTA — Hospital-based data from New York and Texas underscore the importance of rotavirus vaccination for reducing disease burden and related hospitalization rates and costs.

The findings were reported at the fall meeting of the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices. Data from 11 sentinel hospitals in New York indicate that in children aged 1 month to 3 years, there was a 56% reduction in hospital admissions for diarrhea, and an 85% reduction in hospital admissions for rotavirus in 2008, compared with 2003–2005—a change that coincides with increasing rotavirus vaccination coverage. Total charges for diarrhea and rotavirus-associated hospitalizations decreased by $22 million and $12 million, respectively, in 2008, compared with 2005–2007, Dr. Hwa-Gan Chang of the New York State Department of Health reported.

He noted that significant reductions in rotavirus-related hospitalizations also were seen in New York among nonimmunized older age groups, which suggests possible herd immunity following the introduction of the oral three-dose pentavalent rotavirus vaccine RotaTeq (Merck & Co.), which was licensed in February 2006.

A project at Texas Children's Hospital in Houston, which was funded by a CDC grant, showed that in children aged 15 days through 23 months, vaccine effectiveness was 85%–89% in both case patients (including 400 children who presented to the hospital emergency department with acute gastroenteritis) and controls (including 115 rotavirus-negative acute gastroenteritis patients, 228 concurrently enrolled patients with acute respiratory infection symptoms). The effectiveness rates, based on findings from February to June 2008, were comparable with prelicensure estimates, Dr. Julie A. Boom, director of infant and childhood immunizations at the Center for Vaccine Awareness and Research of Texas Children's Hospital, reported.

ATLANTA — Hospital-based data from New York and Texas underscore the importance of rotavirus vaccination for reducing disease burden and related hospitalization rates and costs.

The findings were reported at the fall meeting of the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices. Data from 11 sentinel hospitals in New York indicate that in children aged 1 month to 3 years, there was a 56% reduction in hospital admissions for diarrhea, and an 85% reduction in hospital admissions for rotavirus in 2008, compared with 2003–2005—a change that coincides with increasing rotavirus vaccination coverage. Total charges for diarrhea and rotavirus-associated hospitalizations decreased by $22 million and $12 million, respectively, in 2008, compared with 2005–2007, Dr. Hwa-Gan Chang of the New York State Department of Health reported.

He noted that significant reductions in rotavirus-related hospitalizations also were seen in New York among nonimmunized older age groups, which suggests possible herd immunity following the introduction of the oral three-dose pentavalent rotavirus vaccine RotaTeq (Merck & Co.), which was licensed in February 2006.

A project at Texas Children's Hospital in Houston, which was funded by a CDC grant, showed that in children aged 15 days through 23 months, vaccine effectiveness was 85%–89% in both case patients (including 400 children who presented to the hospital emergency department with acute gastroenteritis) and controls (including 115 rotavirus-negative acute gastroenteritis patients, 228 concurrently enrolled patients with acute respiratory infection symptoms). The effectiveness rates, based on findings from February to June 2008, were comparable with prelicensure estimates, Dr. Julie A. Boom, director of infant and childhood immunizations at the Center for Vaccine Awareness and Research of Texas Children's Hospital, reported.

ATLANTA — Family physicians and pediatricians are knowledgeable about several key aspects of human papillomavirus epidemiology and have largely adopted use of the HPV vaccine in their practices, but some important knowledge gaps about the disease and vaccine remain, results of a survey suggest.

Findings from a national HPV vaccination practices survey of 331 family physicians and 349 pediatricians, which was conducted 18 months after licensure of the HPV vaccine Gardasil, indicate that both groups understand that most genital HPV infections are asymptomatic (86% and 85%, respectively, responded correctly on a related survey item), and that almost all cervical cancers are caused by HPV (95% and 85%, respectively, responded correctly).

However, only 58% of family physicians and 43% of pediatricians correctly answered “false” to an item stating that genital warts are caused by the same HPV types as cervical cancer.

The findings, reported at the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices fall meeting by Dr. Matthew F. Daley, also show that 88% of family physicians, and 98% of pediatricians who responded are administering HPV vaccine to female patients.

When surveyed about whether parents feel vaccination might encourage earlier or riskier sexual behavior, 49% of family physicians and 42% of pediatricians said they strongly agree or somewhat agree that parents have such concerns, but only 6% and 4%, respectively, had such concerns themselves.

As for which patient populations are targeted for vaccination, physicians (82% of family physicians and 89% of pediatricians) said they more strongly recommend vaccination for 13- to 15-year-olds than for 11- to 12-year-olds (49% and 56%, respectively), said Dr. Daley of the department of pediatrics at the University of Colorado at Denver.

After adjustment for respondents' specialty and region of the country, factors found to be associated with not strongly recommending vaccination in 11- to 12-year-olds were considering it necessary to discuss sexuality before recommending vaccination (odds ratio, 1.6); reporting that parents of 11- to 12-year-olds have been more likely to refuse vaccination than parents of 16- to 18-year-olds (odds ratio, 4.0); and believing that the time it takes to discuss HPV vaccination is definitely or somewhat of a barrier (odds ratio, 1.9).

Parents' refusal to have a child vaccinated and deferral of vaccination were also addressed in the survey. Parents are more likely to defer than to refuse vaccination, the results suggested. Also, refusal is most common for 11- to 12-year-olds, with about 25% of parents reportedly refusing vaccination in that age group, he noted (see box).

The most common reported reasons for refusal or deferral were the “newness” of the vaccine, patient age, lack of sexual activity on the patient's part, and lack of insurance coverage/inability to pay. Factors reported as definitely or somewhat of a barrier to vaccination included lack of insurance coverage, lack of adequate reimbursement, and up-front costs for purchase of vaccine.

Elsevier Global Medical News

ATLANTA — Family physicians and pediatricians are knowledgeable about several key aspects of human papillomavirus epidemiology and have largely adopted use of the HPV vaccine in their practices, but some important knowledge gaps about the disease and vaccine remain, results of a survey suggest.

Findings from a national HPV vaccination practices survey of 331 family physicians and 349 pediatricians, which was conducted 18 months after licensure of the HPV vaccine Gardasil, indicate that both groups understand that most genital HPV infections are asymptomatic (86% and 85%, respectively, responded correctly on a related survey item), and that almost all cervical cancers are caused by HPV (95% and 85%, respectively, responded correctly).

However, only 58% of family physicians and 43% of pediatricians correctly answered “false” to an item stating that genital warts are caused by the same HPV types as cervical cancer.

The findings, reported at the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices fall meeting by Dr. Matthew F. Daley, also show that 88% of family physicians, and 98% of pediatricians who responded are administering HPV vaccine to female patients.

When surveyed about whether parents feel vaccination might encourage earlier or riskier sexual behavior, 49% of family physicians and 42% of pediatricians said they strongly agree or somewhat agree that parents have such concerns, but only 6% and 4%, respectively, had such concerns themselves.

As for which patient populations are targeted for vaccination, physicians (82% of family physicians and 89% of pediatricians) said they more strongly recommend vaccination for 13- to 15-year-olds than for 11- to 12-year-olds (49% and 56%, respectively), said Dr. Daley of the department of pediatrics at the University of Colorado at Denver.

After adjustment for respondents' specialty and region of the country, factors found to be associated with not strongly recommending vaccination in 11- to 12-year-olds were considering it necessary to discuss sexuality before recommending vaccination (odds ratio, 1.6); reporting that parents of 11- to 12-year-olds have been more likely to refuse vaccination than parents of 16- to 18-year-olds (odds ratio, 4.0); and believing that the time it takes to discuss HPV vaccination is definitely or somewhat of a barrier (odds ratio, 1.9).

Parents' refusal to have a child vaccinated and deferral of vaccination were also addressed in the survey. Parents are more likely to defer than to refuse vaccination, the results suggested. Also, refusal is most common for 11- to 12-year-olds, with about 25% of parents reportedly refusing vaccination in that age group, he noted (see box).

The most common reported reasons for refusal or deferral were the “newness” of the vaccine, patient age, lack of sexual activity on the patient's part, and lack of insurance coverage/inability to pay. Factors reported as definitely or somewhat of a barrier to vaccination included lack of insurance coverage, lack of adequate reimbursement, and up-front costs for purchase of vaccine.

Elsevier Global Medical News

ATLANTA — Family physicians and pediatricians are knowledgeable about several key aspects of human papillomavirus epidemiology and have largely adopted use of the HPV vaccine in their practices, but some important knowledge gaps about the disease and vaccine remain, results of a survey suggest.

Findings from a national HPV vaccination practices survey of 331 family physicians and 349 pediatricians, which was conducted 18 months after licensure of the HPV vaccine Gardasil, indicate that both groups understand that most genital HPV infections are asymptomatic (86% and 85%, respectively, responded correctly on a related survey item), and that almost all cervical cancers are caused by HPV (95% and 85%, respectively, responded correctly).

However, only 58% of family physicians and 43% of pediatricians correctly answered “false” to an item stating that genital warts are caused by the same HPV types as cervical cancer.

The findings, reported at the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices fall meeting by Dr. Matthew F. Daley, also show that 88% of family physicians, and 98% of pediatricians who responded are administering HPV vaccine to female patients.

When surveyed about whether parents feel vaccination might encourage earlier or riskier sexual behavior, 49% of family physicians and 42% of pediatricians said they strongly agree or somewhat agree that parents have such concerns, but only 6% and 4%, respectively, had such concerns themselves.

As for which patient populations are targeted for vaccination, physicians (82% of family physicians and 89% of pediatricians) said they more strongly recommend vaccination for 13- to 15-year-olds than for 11- to 12-year-olds (49% and 56%, respectively), said Dr. Daley of the department of pediatrics at the University of Colorado at Denver.

After adjustment for respondents' specialty and region of the country, factors found to be associated with not strongly recommending vaccination in 11- to 12-year-olds were considering it necessary to discuss sexuality before recommending vaccination (odds ratio, 1.6); reporting that parents of 11- to 12-year-olds have been more likely to refuse vaccination than parents of 16- to 18-year-olds (odds ratio, 4.0); and believing that the time it takes to discuss HPV vaccination is definitely or somewhat of a barrier (odds ratio, 1.9).

Parents' refusal to have a child vaccinated and deferral of vaccination were also addressed in the survey. Parents are more likely to defer than to refuse vaccination, the results suggested. Also, refusal is most common for 11- to 12-year-olds, with about 25% of parents reportedly refusing vaccination in that age group, he noted (see box).

The most common reported reasons for refusal or deferral were the “newness” of the vaccine, patient age, lack of sexual activity on the patient's part, and lack of insurance coverage/inability to pay. Factors reported as definitely or somewhat of a barrier to vaccination included lack of insurance coverage, lack of adequate reimbursement, and up-front costs for purchase of vaccine.

Elsevier Global Medical News

Free drug samples not only do little to equalize medication access in the pediatric population, but they also may pose safety concerns in young patients, results of a recent study show.

The practice of providing free drug samples to children in nonurgent situations should be carefully reconsidered–and perhaps abandoned, the investigators concluded (Pediatrics 2008;122;736-42).

Study author Sarah L. Cutrona of Harvard Medical School, Boston, and her colleagues said the findings show that free drug samples tend to go to children with the best health care–rather than those with the greatest financial need.

The findings were based on nationally representative longitudinal survey data from 10,295 U.S. residents under age 18 years from the Agency for Healthcare Research and Quality 2004 Medical Expenditure Panel Survey, the researchers reported.

About 5% of the children in the survey received at least one free drug sample in 2004, and 10% of the children who received a prescription medication received a free drug sample that year. On multivariate analyses, routine health care access, defined for the study as three or more provider visits in 2004, was found to be associated with the receipt of free samples, but insurance status and family income was not found to play a role in determining which children received samples.

That is, poor children, defined as those from families with incomes less than 200% of the federal poverty level, were no more likely to receive free samples than those from families with incomes of 400% of the poverty level or greater (3.8% vs. 5.9%; odds ratio 0.78), and those who were uninsured for part or all of the year were no more likely to receive samples than those who were insured for the entire year, (4.5% vs. 5.1%; OR 1.05).

In addition, Hispanic and nonwhite children were much less likely to receive free samples, compared with non-Hispanic white children (2.4% and 3.5%, respectively, vs. 6.2%; OR 0.51 and 0.72, respectively). Factors indicative of health care access also were associated with free sample receipt. For example, among those who received more free samples, those who had more visits to medical or dental providers (OR of 1.77 for two vs. one visit, and OR of 3.25 for three or more vs. one visit), those who used office-based primary care vs. those with no usual site of care (OR of 1.52), and those who received more medications in 2004 were more likely to receive free samples (OR 1.06 for incremental increase of one drug).

The high prevalence of drug sample use among pediatric patients also is of concern because the 15 most frequently distributed sample drugs in 2004 included two schedule II controlled medications (Strattera and Adderall). In addition, these two drugs, along with two others (Elidel and Advair) required a new or revised black box warning between 2004 and 2007.

The study–the first to look at free drug sample practices in the pediatric population–is an interesting and helpful study that draws attention to the widespread practice, Dr. David Fassler, clinical professor of psychiatry at the University of Vermont, Burlington, said in an interview.

“The authors raise legitimate questions about the potential safety of current practices with respect to free samples. In particular, they report that controlled substances and treatments not generally considered 'first line' were included in the list of medications most commonly distributed as free samples. “Of particular concern, they also note that a significant number of very young children (under 2 years of age) received samples of medications which are specifically contraindicated for this age group,” Dr. Fassler said.

However, based on the methodology employed, the study raises more questions than it answers, he said.

“For example, did the kids actually take the medication received as a free sample? Did the families subsequently receive a prescription for ongoing treatment? Does the availability of free samples influence a physician's overall prescription pattern? The authors have opened an interesting avenue of inquiry. I expect these and other questions will be addressed in subsequent studies,” he added.

The authors stated they had no financial relationships relevant to this study.

Dr. Fassler said he had no conflicts of interest with respect to this issue.

Free drug samples not only do little to equalize medication access in the pediatric population, but they also may pose safety concerns in young patients, results of a recent study show.

The practice of providing free drug samples to children in nonurgent situations should be carefully reconsidered–and perhaps abandoned, the investigators concluded (Pediatrics 2008;122;736-42).

Study author Sarah L. Cutrona of Harvard Medical School, Boston, and her colleagues said the findings show that free drug samples tend to go to children with the best health care–rather than those with the greatest financial need.

The findings were based on nationally representative longitudinal survey data from 10,295 U.S. residents under age 18 years from the Agency for Healthcare Research and Quality 2004 Medical Expenditure Panel Survey, the researchers reported.

About 5% of the children in the survey received at least one free drug sample in 2004, and 10% of the children who received a prescription medication received a free drug sample that year. On multivariate analyses, routine health care access, defined for the study as three or more provider visits in 2004, was found to be associated with the receipt of free samples, but insurance status and family income was not found to play a role in determining which children received samples.

That is, poor children, defined as those from families with incomes less than 200% of the federal poverty level, were no more likely to receive free samples than those from families with incomes of 400% of the poverty level or greater (3.8% vs. 5.9%; odds ratio 0.78), and those who were uninsured for part or all of the year were no more likely to receive samples than those who were insured for the entire year, (4.5% vs. 5.1%; OR 1.05).

In addition, Hispanic and nonwhite children were much less likely to receive free samples, compared with non-Hispanic white children (2.4% and 3.5%, respectively, vs. 6.2%; OR 0.51 and 0.72, respectively). Factors indicative of health care access also were associated with free sample receipt. For example, among those who received more free samples, those who had more visits to medical or dental providers (OR of 1.77 for two vs. one visit, and OR of 3.25 for three or more vs. one visit), those who used office-based primary care vs. those with no usual site of care (OR of 1.52), and those who received more medications in 2004 were more likely to receive free samples (OR 1.06 for incremental increase of one drug).

The high prevalence of drug sample use among pediatric patients also is of concern because the 15 most frequently distributed sample drugs in 2004 included two schedule II controlled medications (Strattera and Adderall). In addition, these two drugs, along with two others (Elidel and Advair) required a new or revised black box warning between 2004 and 2007.

The study–the first to look at free drug sample practices in the pediatric population–is an interesting and helpful study that draws attention to the widespread practice, Dr. David Fassler, clinical professor of psychiatry at the University of Vermont, Burlington, said in an interview.

“The authors raise legitimate questions about the potential safety of current practices with respect to free samples. In particular, they report that controlled substances and treatments not generally considered 'first line' were included in the list of medications most commonly distributed as free samples. “Of particular concern, they also note that a significant number of very young children (under 2 years of age) received samples of medications which are specifically contraindicated for this age group,” Dr. Fassler said.

However, based on the methodology employed, the study raises more questions than it answers, he said.

“For example, did the kids actually take the medication received as a free sample? Did the families subsequently receive a prescription for ongoing treatment? Does the availability of free samples influence a physician's overall prescription pattern? The authors have opened an interesting avenue of inquiry. I expect these and other questions will be addressed in subsequent studies,” he added.

The authors stated they had no financial relationships relevant to this study.

Dr. Fassler said he had no conflicts of interest with respect to this issue.

Free drug samples not only do little to equalize medication access in the pediatric population, but they also may pose safety concerns in young patients, results of a recent study show.

The practice of providing free drug samples to children in nonurgent situations should be carefully reconsidered–and perhaps abandoned, the investigators concluded (Pediatrics 2008;122;736-42).

Study author Sarah L. Cutrona of Harvard Medical School, Boston, and her colleagues said the findings show that free drug samples tend to go to children with the best health care–rather than those with the greatest financial need.

The findings were based on nationally representative longitudinal survey data from 10,295 U.S. residents under age 18 years from the Agency for Healthcare Research and Quality 2004 Medical Expenditure Panel Survey, the researchers reported.

About 5% of the children in the survey received at least one free drug sample in 2004, and 10% of the children who received a prescription medication received a free drug sample that year. On multivariate analyses, routine health care access, defined for the study as three or more provider visits in 2004, was found to be associated with the receipt of free samples, but insurance status and family income was not found to play a role in determining which children received samples.

That is, poor children, defined as those from families with incomes less than 200% of the federal poverty level, were no more likely to receive free samples than those from families with incomes of 400% of the poverty level or greater (3.8% vs. 5.9%; odds ratio 0.78), and those who were uninsured for part or all of the year were no more likely to receive samples than those who were insured for the entire year, (4.5% vs. 5.1%; OR 1.05).

In addition, Hispanic and nonwhite children were much less likely to receive free samples, compared with non-Hispanic white children (2.4% and 3.5%, respectively, vs. 6.2%; OR 0.51 and 0.72, respectively). Factors indicative of health care access also were associated with free sample receipt. For example, among those who received more free samples, those who had more visits to medical or dental providers (OR of 1.77 for two vs. one visit, and OR of 3.25 for three or more vs. one visit), those who used office-based primary care vs. those with no usual site of care (OR of 1.52), and those who received more medications in 2004 were more likely to receive free samples (OR 1.06 for incremental increase of one drug).

The high prevalence of drug sample use among pediatric patients also is of concern because the 15 most frequently distributed sample drugs in 2004 included two schedule II controlled medications (Strattera and Adderall). In addition, these two drugs, along with two others (Elidel and Advair) required a new or revised black box warning between 2004 and 2007.

The study–the first to look at free drug sample practices in the pediatric population–is an interesting and helpful study that draws attention to the widespread practice, Dr. David Fassler, clinical professor of psychiatry at the University of Vermont, Burlington, said in an interview.

“The authors raise legitimate questions about the potential safety of current practices with respect to free samples. In particular, they report that controlled substances and treatments not generally considered 'first line' were included in the list of medications most commonly distributed as free samples. “Of particular concern, they also note that a significant number of very young children (under 2 years of age) received samples of medications which are specifically contraindicated for this age group,” Dr. Fassler said.

However, based on the methodology employed, the study raises more questions than it answers, he said.

“For example, did the kids actually take the medication received as a free sample? Did the families subsequently receive a prescription for ongoing treatment? Does the availability of free samples influence a physician's overall prescription pattern? The authors have opened an interesting avenue of inquiry. I expect these and other questions will be addressed in subsequent studies,” he added.

The authors stated they had no financial relationships relevant to this study.

Dr. Fassler said he had no conflicts of interest with respect to this issue.

ATLANTA — Influenza vaccination rates remain low among children aged 6–23 months, despite a recommendation made 3 years ago by the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices that children younger than age 2 years be vaccinated.

The latest data show complete coverage of only about 21% in this age group, Dr. Anthony Fiore of the CDC reported at the committee's fall meeting. “We still have a long way to go,” he said.

The findings are from the 2007 National Immunization Survey and are based on the 2006–2007 influenza season (MMWR 2008;57:1039-43). Data emerging from the 2007–2008 season appear similar to those from 2006–2007, Dr. Fiore noted.

Because children younger than age 2 years are at the greatest risk for influenza-related hospitalizations, ACIP in 2002 encouraged vaccination of this population, and in 2004 strengthened their stand by recommending vaccination.

According to the MMWR report, 32% of children aged 6–23 months received one or more doses of vaccine during the 2006–2007 flu season, and only 21% were fully vaccinated. Two doses given 4 weeks apart are recommended in children younger than age 9 years who are being vaccinated for the first time.

And there was substantial variability in vaccination coverage among states, according to the survey results. For example, in Mississippi, only about 9% of children were fully vaccinated, whereas in Rhode Island, nearly 48% were vaccinated. In most states, there was no significant increase in the percentage of children who were fully vaccinated, compared with the previous flu season.

“The findings underscore the need to increase interest in and access to influenza vaccination for more children in the United States. Further study is needed to identify knowledge deficits or logistical barriers that might contribute to continued low influenza vaccination coverage among young children,” the article states.

The authors also stated in an editorial note that health care providers can help improve vaccination coverage among young children by routinely informing parents about the “burden of influenza illness among young children and about the benefits and safety of preventing influenza with vaccination.”

They noted that proven strategies for reducing missed opportunities for vaccination include having standing orders to offer vaccine to all patients throughout the flu season, holding vaccination-only clinics, and using reminder/recall systems.

With coverage at 21%, “we still have a long way to go,” to vaccinate children aged 6–23 months, said Dr. Anthony Fiore. ©Parker Clayton Smith

ATLANTA — Influenza vaccination rates remain low among children aged 6–23 months, despite a recommendation made 3 years ago by the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices that children younger than age 2 years be vaccinated.

The latest data show complete coverage of only about 21% in this age group, Dr. Anthony Fiore of the CDC reported at the committee's fall meeting. “We still have a long way to go,” he said.

The findings are from the 2007 National Immunization Survey and are based on the 2006–2007 influenza season (MMWR 2008;57:1039-43). Data emerging from the 2007–2008 season appear similar to those from 2006–2007, Dr. Fiore noted.

Because children younger than age 2 years are at the greatest risk for influenza-related hospitalizations, ACIP in 2002 encouraged vaccination of this population, and in 2004 strengthened their stand by recommending vaccination.

According to the MMWR report, 32% of children aged 6–23 months received one or more doses of vaccine during the 2006–2007 flu season, and only 21% were fully vaccinated. Two doses given 4 weeks apart are recommended in children younger than age 9 years who are being vaccinated for the first time.

And there was substantial variability in vaccination coverage among states, according to the survey results. For example, in Mississippi, only about 9% of children were fully vaccinated, whereas in Rhode Island, nearly 48% were vaccinated. In most states, there was no significant increase in the percentage of children who were fully vaccinated, compared with the previous flu season.

“The findings underscore the need to increase interest in and access to influenza vaccination for more children in the United States. Further study is needed to identify knowledge deficits or logistical barriers that might contribute to continued low influenza vaccination coverage among young children,” the article states.

The authors also stated in an editorial note that health care providers can help improve vaccination coverage among young children by routinely informing parents about the “burden of influenza illness among young children and about the benefits and safety of preventing influenza with vaccination.”

They noted that proven strategies for reducing missed opportunities for vaccination include having standing orders to offer vaccine to all patients throughout the flu season, holding vaccination-only clinics, and using reminder/recall systems.

With coverage at 21%, “we still have a long way to go,” to vaccinate children aged 6–23 months, said Dr. Anthony Fiore. ©Parker Clayton Smith

ATLANTA — Influenza vaccination rates remain low among children aged 6–23 months, despite a recommendation made 3 years ago by the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices that children younger than age 2 years be vaccinated.

The latest data show complete coverage of only about 21% in this age group, Dr. Anthony Fiore of the CDC reported at the committee's fall meeting. “We still have a long way to go,” he said.

The findings are from the 2007 National Immunization Survey and are based on the 2006–2007 influenza season (MMWR 2008;57:1039-43). Data emerging from the 2007–2008 season appear similar to those from 2006–2007, Dr. Fiore noted.

Because children younger than age 2 years are at the greatest risk for influenza-related hospitalizations, ACIP in 2002 encouraged vaccination of this population, and in 2004 strengthened their stand by recommending vaccination.

According to the MMWR report, 32% of children aged 6–23 months received one or more doses of vaccine during the 2006–2007 flu season, and only 21% were fully vaccinated. Two doses given 4 weeks apart are recommended in children younger than age 9 years who are being vaccinated for the first time.

And there was substantial variability in vaccination coverage among states, according to the survey results. For example, in Mississippi, only about 9% of children were fully vaccinated, whereas in Rhode Island, nearly 48% were vaccinated. In most states, there was no significant increase in the percentage of children who were fully vaccinated, compared with the previous flu season.

“The findings underscore the need to increase interest in and access to influenza vaccination for more children in the United States. Further study is needed to identify knowledge deficits or logistical barriers that might contribute to continued low influenza vaccination coverage among young children,” the article states.

The authors also stated in an editorial note that health care providers can help improve vaccination coverage among young children by routinely informing parents about the “burden of influenza illness among young children and about the benefits and safety of preventing influenza with vaccination.”

They noted that proven strategies for reducing missed opportunities for vaccination include having standing orders to offer vaccine to all patients throughout the flu season, holding vaccination-only clinics, and using reminder/recall systems.

With coverage at 21%, “we still have a long way to go,” to vaccinate children aged 6–23 months, said Dr. Anthony Fiore. ©Parker Clayton Smith