Pulmonary Health Hub

Adaptive servo-ventilation is not beneficial and may even be harmful for patients who have predominantly central sleep apnea accompanying heart failure with reduced ejection fraction, Dr. Martin R. Cowie reported at the annual congress of the European Society of Cardiology.

The noninvasive therapy did control central sleep apnea in a large international randomized controlled trial, but nevertheless did not affect the composite end point of death from any cause, lifesaving cardiovascular intervention, or unplanned hospitalization for worsening HF. Moreover, it unexpectedly raised the risk of cardiovascular death by 34%, and significantly increased all-cause mortality as well, said Dr. Cowie of Imperial College London.

Adaptive servo-ventilation delivers servo-controlled inspiratory pressure on top of expiratory positive airway pressure during sleep, to alleviate central sleep apnea. This form of sleep-disordered breathing, which may manifest as Cheyne-Stokes respiration in patients who have HF with reduced ejection fraction, is reported to affect up to 40% of this patient population. Its prevalence rises as the severity of HF increases, and it is an independent risk marker for poor prognosis and death in HF.

A recent trial showed that continuous positive airway pressure (CPAP) did not improve morbidity or mortality in patients who had HF with central sleep apnea, but suggested that a treatment that could reduce the apnea-hypopnea index (AHI) – the number of apnea or hypopnea events per hour of sleep – to below 15 might be effective. Adaptive servo-ventilation can accomplish this, and small studies and meta-analyses have shown that the treatment improves surrogate markers including plasma concentration of brain natriuretic peptide, left ventricular ejection fraction (LVEF), and functional outcomes in heart failure.

Dr. Cowie and his associates conducted the SERVE-HF trial, assessing the effect of adding adaptive servo-ventilation to guideline-based medical therapy on survival and cardiovascular outcomes. He presented the trial results at the meeting, and they were simultaneously published online (N Engl J Med. 2015 Sep 1. doi:10.1056/NEJMoa1506459).

The industry-sponsored study comprised 1,325 patients aged 22 and older treated and followed at 91 medical centers for a median of 31 months (range, 0-80 months). They were randomly assigned to receive medical therapy plus adaptive servo-ventilation delivered through a face mask for at least 5 hours every night (666 intervention subjects) or medical therapy alone (659 control subjects).

Central sleep apnea was well controlled only in the intervention group. At 1 year, their mean AHI was 6.6 events per hour, and the oxygen desaturation index – the number of times per hour that the blood oxygen level dropped by 3 or more percentage points from baseline level – was 8.6.

Yet the primary composite end point was not significantly different between the two study groups: The rate of death from any cause, lifesaving cardiovascular intervention, and unplanned hospitalization for worsening HF was 54.1% with adaptive servo-ventilation and 50.8% without it. The treatment also had no significant effect on a broad spectrum of secondary measures such as symptoms and quality of life. Six-minute walk distance gradually declined in both groups, but that decline was significantly more pronounced in the intervention group, the investigator said.

Even more worrisome was the significant increase in mortality associated with adaptive servo-ventilation. Cardiovascular mortality was 29.9% with the treatment, compared with 24.0% without it, for a hazard ratio of 1.34. All-cause mortality was 34.8% with the treatment and 29.3% without it, for an HR of 1.28.

The reason for this unexpected result is not yet known. One explanation is that central sleep apnea may be a compensatory mechanism with potentially beneficial effects in patients who have HF. Attenuating those effects with adaptive servo-ventilation may then have been detrimental. For example, central sleep apnea, and particularly Cheyne-Stokes breathing, may beneficially activate the respiratory muscles, increase sympathetic nervous system activity, induce hypercapnic acidosis, increase end-expiratory lung volume, and raise intrinsic positive airway pressure.

Another possibility is that applying positive airway pressure with adaptive servo-ventilation may impair cardiac function in at least a portion of patients who have HF by decreasing cardiac output and stroke volume during treatment.

ResMed, maker of the AutoSet adaptive servo-ventilator, sponsored SERVE-HF, which was also supported by the National Institute for Health Research and the National Institutes of Health. Dr. Cowie disclosed ties with Servier, Novartis, Pfizer, St. Jude Medical, Boston Scientific, Respicardia,Medtronic, and Bayer; his associates reported ties to numerous industry sources.

Adaptive servo-ventilation is not beneficial and may even be harmful for patients who have predominantly central sleep apnea accompanying heart failure with reduced ejection fraction, Dr. Martin R. Cowie reported at the annual congress of the European Society of Cardiology.

The noninvasive therapy did control central sleep apnea in a large international randomized controlled trial, but nevertheless did not affect the composite end point of death from any cause, lifesaving cardiovascular intervention, or unplanned hospitalization for worsening HF. Moreover, it unexpectedly raised the risk of cardiovascular death by 34%, and significantly increased all-cause mortality as well, said Dr. Cowie of Imperial College London.

Adaptive servo-ventilation delivers servo-controlled inspiratory pressure on top of expiratory positive airway pressure during sleep, to alleviate central sleep apnea. This form of sleep-disordered breathing, which may manifest as Cheyne-Stokes respiration in patients who have HF with reduced ejection fraction, is reported to affect up to 40% of this patient population. Its prevalence rises as the severity of HF increases, and it is an independent risk marker for poor prognosis and death in HF.

A recent trial showed that continuous positive airway pressure (CPAP) did not improve morbidity or mortality in patients who had HF with central sleep apnea, but suggested that a treatment that could reduce the apnea-hypopnea index (AHI) – the number of apnea or hypopnea events per hour of sleep – to below 15 might be effective. Adaptive servo-ventilation can accomplish this, and small studies and meta-analyses have shown that the treatment improves surrogate markers including plasma concentration of brain natriuretic peptide, left ventricular ejection fraction (LVEF), and functional outcomes in heart failure.

Dr. Cowie and his associates conducted the SERVE-HF trial, assessing the effect of adding adaptive servo-ventilation to guideline-based medical therapy on survival and cardiovascular outcomes. He presented the trial results at the meeting, and they were simultaneously published online (N Engl J Med. 2015 Sep 1. doi:10.1056/NEJMoa1506459).

The industry-sponsored study comprised 1,325 patients aged 22 and older treated and followed at 91 medical centers for a median of 31 months (range, 0-80 months). They were randomly assigned to receive medical therapy plus adaptive servo-ventilation delivered through a face mask for at least 5 hours every night (666 intervention subjects) or medical therapy alone (659 control subjects).

Central sleep apnea was well controlled only in the intervention group. At 1 year, their mean AHI was 6.6 events per hour, and the oxygen desaturation index – the number of times per hour that the blood oxygen level dropped by 3 or more percentage points from baseline level – was 8.6.

Yet the primary composite end point was not significantly different between the two study groups: The rate of death from any cause, lifesaving cardiovascular intervention, and unplanned hospitalization for worsening HF was 54.1% with adaptive servo-ventilation and 50.8% without it. The treatment also had no significant effect on a broad spectrum of secondary measures such as symptoms and quality of life. Six-minute walk distance gradually declined in both groups, but that decline was significantly more pronounced in the intervention group, the investigator said.

Even more worrisome was the significant increase in mortality associated with adaptive servo-ventilation. Cardiovascular mortality was 29.9% with the treatment, compared with 24.0% without it, for a hazard ratio of 1.34. All-cause mortality was 34.8% with the treatment and 29.3% without it, for an HR of 1.28.

The reason for this unexpected result is not yet known. One explanation is that central sleep apnea may be a compensatory mechanism with potentially beneficial effects in patients who have HF. Attenuating those effects with adaptive servo-ventilation may then have been detrimental. For example, central sleep apnea, and particularly Cheyne-Stokes breathing, may beneficially activate the respiratory muscles, increase sympathetic nervous system activity, induce hypercapnic acidosis, increase end-expiratory lung volume, and raise intrinsic positive airway pressure.

Another possibility is that applying positive airway pressure with adaptive servo-ventilation may impair cardiac function in at least a portion of patients who have HF by decreasing cardiac output and stroke volume during treatment.

ResMed, maker of the AutoSet adaptive servo-ventilator, sponsored SERVE-HF, which was also supported by the National Institute for Health Research and the National Institutes of Health. Dr. Cowie disclosed ties with Servier, Novartis, Pfizer, St. Jude Medical, Boston Scientific, Respicardia,Medtronic, and Bayer; his associates reported ties to numerous industry sources.

Adaptive servo-ventilation is not beneficial and may even be harmful for patients who have predominantly central sleep apnea accompanying heart failure with reduced ejection fraction, Dr. Martin R. Cowie reported at the annual congress of the European Society of Cardiology.

The noninvasive therapy did control central sleep apnea in a large international randomized controlled trial, but nevertheless did not affect the composite end point of death from any cause, lifesaving cardiovascular intervention, or unplanned hospitalization for worsening HF. Moreover, it unexpectedly raised the risk of cardiovascular death by 34%, and significantly increased all-cause mortality as well, said Dr. Cowie of Imperial College London.

Adaptive servo-ventilation delivers servo-controlled inspiratory pressure on top of expiratory positive airway pressure during sleep, to alleviate central sleep apnea. This form of sleep-disordered breathing, which may manifest as Cheyne-Stokes respiration in patients who have HF with reduced ejection fraction, is reported to affect up to 40% of this patient population. Its prevalence rises as the severity of HF increases, and it is an independent risk marker for poor prognosis and death in HF.

A recent trial showed that continuous positive airway pressure (CPAP) did not improve morbidity or mortality in patients who had HF with central sleep apnea, but suggested that a treatment that could reduce the apnea-hypopnea index (AHI) – the number of apnea or hypopnea events per hour of sleep – to below 15 might be effective. Adaptive servo-ventilation can accomplish this, and small studies and meta-analyses have shown that the treatment improves surrogate markers including plasma concentration of brain natriuretic peptide, left ventricular ejection fraction (LVEF), and functional outcomes in heart failure.

Dr. Cowie and his associates conducted the SERVE-HF trial, assessing the effect of adding adaptive servo-ventilation to guideline-based medical therapy on survival and cardiovascular outcomes. He presented the trial results at the meeting, and they were simultaneously published online (N Engl J Med. 2015 Sep 1. doi:10.1056/NEJMoa1506459).

The industry-sponsored study comprised 1,325 patients aged 22 and older treated and followed at 91 medical centers for a median of 31 months (range, 0-80 months). They were randomly assigned to receive medical therapy plus adaptive servo-ventilation delivered through a face mask for at least 5 hours every night (666 intervention subjects) or medical therapy alone (659 control subjects).

Central sleep apnea was well controlled only in the intervention group. At 1 year, their mean AHI was 6.6 events per hour, and the oxygen desaturation index – the number of times per hour that the blood oxygen level dropped by 3 or more percentage points from baseline level – was 8.6.

Yet the primary composite end point was not significantly different between the two study groups: The rate of death from any cause, lifesaving cardiovascular intervention, and unplanned hospitalization for worsening HF was 54.1% with adaptive servo-ventilation and 50.8% without it. The treatment also had no significant effect on a broad spectrum of secondary measures such as symptoms and quality of life. Six-minute walk distance gradually declined in both groups, but that decline was significantly more pronounced in the intervention group, the investigator said.

Even more worrisome was the significant increase in mortality associated with adaptive servo-ventilation. Cardiovascular mortality was 29.9% with the treatment, compared with 24.0% without it, for a hazard ratio of 1.34. All-cause mortality was 34.8% with the treatment and 29.3% without it, for an HR of 1.28.

The reason for this unexpected result is not yet known. One explanation is that central sleep apnea may be a compensatory mechanism with potentially beneficial effects in patients who have HF. Attenuating those effects with adaptive servo-ventilation may then have been detrimental. For example, central sleep apnea, and particularly Cheyne-Stokes breathing, may beneficially activate the respiratory muscles, increase sympathetic nervous system activity, induce hypercapnic acidosis, increase end-expiratory lung volume, and raise intrinsic positive airway pressure.

Another possibility is that applying positive airway pressure with adaptive servo-ventilation may impair cardiac function in at least a portion of patients who have HF by decreasing cardiac output and stroke volume during treatment.

ResMed, maker of the AutoSet adaptive servo-ventilator, sponsored SERVE-HF, which was also supported by the National Institute for Health Research and the National Institutes of Health. Dr. Cowie disclosed ties with Servier, Novartis, Pfizer, St. Jude Medical, Boston Scientific, Respicardia,Medtronic, and Bayer; his associates reported ties to numerous industry sources.

ATLANTA – Individuals who neglect to get their annual influenza vaccinations will likely experience more-severe symptoms and a longer duration of the illness if they contract the disease, specifically the A/H₃N₂ strain.

In a study of 155 influenza patients between 2009 and 2014, 138 (89%) were positive for influenza A virus, 111 (72%) of whom were vaccinated against influenza.

Deepak Chitnis

“We know that flu vaccines are about 60% effective, but of that remaining 40%, do they still get severe flu? The data from our study say no,” explained Dr. Eugene V. Millar of the Uniformed Services University of the Health Sciences in Bethesda, Md.

Sixty-six (48%) individuals contracted the A/H₃N₂ strain of the influenza virus; of these patients, those who did not get vaccinated reported higher average severity scores for upper respiratory symptoms (7 vs. 3), lower respiratory symptoms (7 vs. 3), systemic symptoms (9.5 vs. 6), and total symptoms (22 vs. 12) than did subjects who did get vaccinated (P less than .01).

“People ask me all the time why I bother getting a flu vaccine if it never works,” Dr. Millar said. “I tell them that if you’re walking around and talking to people, then it did work, even if you feel a little lousy; if you didn’t get that vaccination, you’d be on your back.”

Such disparity in the severity and duration of symptoms was not noted in 69 (50%) of the 155 influenza patients who contracted the A/H₁N₁ strain of the virus, nor in the 3 (2%) subjects who had an “untyped” form of influenza A. However, Dr. Millar cautioned that results regarding H₁N₁ may have been confounded by a couple of factors.

“As we’ve seen with the [H₁N1] pandemic, it was just a pandemic of the sniffles, so it’s very hard to assess symptom severity when the differences are moderate to none,” Dr. Millar explained, adding that the variant strain of H₃N₂ which became prevalent during the 2014-2015 respiratory season proved to be the far more severe disease. Furthermore, patients found with A/H₁N₁ were more likely to be put on antivirals, making it impossible to look at vaccine effect.

In total, 884 patients with influenza-like illness were screened for inclusion in the study, from which the sample of 155 subjects was eventually derived. Median age of the 155 subjects was 30.6 (P = .61), mean body mass index was 27.6 kg/m² (P = .07), males outnumbered females 88 to 67, and 106 subjects were active-duty military at the time they had influenza.

“These are healthy people presenting to outpatient [clinics], it’s very interesting to see if the same thing would hold true for the elderly or people with underlying medical conditions, since those are the people we’re really trying to protect not only from influenza, but its complications, as well, such as secondary bacterial pneumonia.”

Nine subjects (6%) had influenza during the 2009-2010 season, 56 (36%) during the 2010-2011 season, 16 (10%) during the 2011-2012 season, 38 (25%) during the 2012-2013 season, and 36 (23%) during the 2013-2014 season.

This study was supported by the Infectious Disease Clinical Research Program (IDCRP), a Department of Defense program carried out via the Uniformed Services University of the Health Sciences, and the National Institute of Allergy and Infectious Diseases, a division of the National Institutes of Health. Dr. Millar did not report any relevant financial disclosures.

[email protected]

ATLANTA – Individuals who neglect to get their annual influenza vaccinations will likely experience more-severe symptoms and a longer duration of the illness if they contract the disease, specifically the A/H₃N₂ strain.

In a study of 155 influenza patients between 2009 and 2014, 138 (89%) were positive for influenza A virus, 111 (72%) of whom were vaccinated against influenza.

Deepak Chitnis

“We know that flu vaccines are about 60% effective, but of that remaining 40%, do they still get severe flu? The data from our study say no,” explained Dr. Eugene V. Millar of the Uniformed Services University of the Health Sciences in Bethesda, Md.

Sixty-six (48%) individuals contracted the A/H₃N₂ strain of the influenza virus; of these patients, those who did not get vaccinated reported higher average severity scores for upper respiratory symptoms (7 vs. 3), lower respiratory symptoms (7 vs. 3), systemic symptoms (9.5 vs. 6), and total symptoms (22 vs. 12) than did subjects who did get vaccinated (P less than .01).

“People ask me all the time why I bother getting a flu vaccine if it never works,” Dr. Millar said. “I tell them that if you’re walking around and talking to people, then it did work, even if you feel a little lousy; if you didn’t get that vaccination, you’d be on your back.”

Such disparity in the severity and duration of symptoms was not noted in 69 (50%) of the 155 influenza patients who contracted the A/H₁N₁ strain of the virus, nor in the 3 (2%) subjects who had an “untyped” form of influenza A. However, Dr. Millar cautioned that results regarding H₁N₁ may have been confounded by a couple of factors.

“As we’ve seen with the [H₁N1] pandemic, it was just a pandemic of the sniffles, so it’s very hard to assess symptom severity when the differences are moderate to none,” Dr. Millar explained, adding that the variant strain of H₃N₂ which became prevalent during the 2014-2015 respiratory season proved to be the far more severe disease. Furthermore, patients found with A/H₁N₁ were more likely to be put on antivirals, making it impossible to look at vaccine effect.

In total, 884 patients with influenza-like illness were screened for inclusion in the study, from which the sample of 155 subjects was eventually derived. Median age of the 155 subjects was 30.6 (P = .61), mean body mass index was 27.6 kg/m² (P = .07), males outnumbered females 88 to 67, and 106 subjects were active-duty military at the time they had influenza.

“These are healthy people presenting to outpatient [clinics], it’s very interesting to see if the same thing would hold true for the elderly or people with underlying medical conditions, since those are the people we’re really trying to protect not only from influenza, but its complications, as well, such as secondary bacterial pneumonia.”

Nine subjects (6%) had influenza during the 2009-2010 season, 56 (36%) during the 2010-2011 season, 16 (10%) during the 2011-2012 season, 38 (25%) during the 2012-2013 season, and 36 (23%) during the 2013-2014 season.

This study was supported by the Infectious Disease Clinical Research Program (IDCRP), a Department of Defense program carried out via the Uniformed Services University of the Health Sciences, and the National Institute of Allergy and Infectious Diseases, a division of the National Institutes of Health. Dr. Millar did not report any relevant financial disclosures.

[email protected]

ATLANTA – Individuals who neglect to get their annual influenza vaccinations will likely experience more-severe symptoms and a longer duration of the illness if they contract the disease, specifically the A/H₃N₂ strain.

In a study of 155 influenza patients between 2009 and 2014, 138 (89%) were positive for influenza A virus, 111 (72%) of whom were vaccinated against influenza.

Deepak Chitnis

“We know that flu vaccines are about 60% effective, but of that remaining 40%, do they still get severe flu? The data from our study say no,” explained Dr. Eugene V. Millar of the Uniformed Services University of the Health Sciences in Bethesda, Md.

Sixty-six (48%) individuals contracted the A/H₃N₂ strain of the influenza virus; of these patients, those who did not get vaccinated reported higher average severity scores for upper respiratory symptoms (7 vs. 3), lower respiratory symptoms (7 vs. 3), systemic symptoms (9.5 vs. 6), and total symptoms (22 vs. 12) than did subjects who did get vaccinated (P less than .01).

“People ask me all the time why I bother getting a flu vaccine if it never works,” Dr. Millar said. “I tell them that if you’re walking around and talking to people, then it did work, even if you feel a little lousy; if you didn’t get that vaccination, you’d be on your back.”

Such disparity in the severity and duration of symptoms was not noted in 69 (50%) of the 155 influenza patients who contracted the A/H₁N₁ strain of the virus, nor in the 3 (2%) subjects who had an “untyped” form of influenza A. However, Dr. Millar cautioned that results regarding H₁N₁ may have been confounded by a couple of factors.

“As we’ve seen with the [H₁N1] pandemic, it was just a pandemic of the sniffles, so it’s very hard to assess symptom severity when the differences are moderate to none,” Dr. Millar explained, adding that the variant strain of H₃N₂ which became prevalent during the 2014-2015 respiratory season proved to be the far more severe disease. Furthermore, patients found with A/H₁N₁ were more likely to be put on antivirals, making it impossible to look at vaccine effect.

In total, 884 patients with influenza-like illness were screened for inclusion in the study, from which the sample of 155 subjects was eventually derived. Median age of the 155 subjects was 30.6 (P = .61), mean body mass index was 27.6 kg/m² (P = .07), males outnumbered females 88 to 67, and 106 subjects were active-duty military at the time they had influenza.

“These are healthy people presenting to outpatient [clinics], it’s very interesting to see if the same thing would hold true for the elderly or people with underlying medical conditions, since those are the people we’re really trying to protect not only from influenza, but its complications, as well, such as secondary bacterial pneumonia.”

Nine subjects (6%) had influenza during the 2009-2010 season, 56 (36%) during the 2010-2011 season, 16 (10%) during the 2011-2012 season, 38 (25%) during the 2012-2013 season, and 36 (23%) during the 2013-2014 season.

This study was supported by the Infectious Disease Clinical Research Program (IDCRP), a Department of Defense program carried out via the Uniformed Services University of the Health Sciences, and the National Institute of Allergy and Infectious Diseases, a division of the National Institutes of Health. Dr. Millar did not report any relevant financial disclosures.

[email protected]

Alcohol and marijuana use is common in youth with chronic disease, and alcohol use is associated with nonadherence to treatment, according to a new study published in Pediatrics.

Approximately 1 in 4 American youths are living with a chronic medical condition. The most common substance abused by young people is alcohol, which can lead to adverse medication interactions and difficulty with treatment adherence and self-care. As with healthy youth, alcohol abuse may be associated with poor sleep, smoke exposure, and unprotected or unplanned sex. Marijuana use can lead to airway inflammation, treatment nonadherence, and sleep disturbances. Currently, there are no studies that indicate marijuana has therapeutic utility in young people.

© Stockphoto4u/iStockphoto.com

Elissa Weitzman of Harvard Medical School in Boston, and colleagues sought to fill in knowledge gaps on the prevalence of substance use in chronically ill youths, which may lead to development of preventative strategies.

The investigators conducted a cross-sectional web-based assessment of youth aged 9-18 years who were being treated for cystic fibrosis, asthma, arthritis, type 1 diabetes, or inflammatory bowel disease (IBD). The questionnaire assessed alcohol use, behaviors, marijuana use, and health care interactions (Pediatrics 2015. doi: 10.1542/peds.2015-0722).

Of the 532 youths invited to participate in the study, 403 consented to participate; 51.6% were female, and 75.1% where white. The average age of participants was 15.6 years, and overall they were in good mental health.

Alcohol use within the past year was reported in 30.8%, and older age correlated to alcohol use (P less than .001). Binge drinking was reported in 37.7% of respondents who reported alcohol use within the past year, and 10.4% in the total group. Binge drinking was reported more often in older (P less than .001) and white (P less than .01) chronically ill youth. Better mental health scores were associated with binge drinking (P less than .01).

Marijuana use was reported in 17.2% of the study group and 20.6% of the high school–aged group. Furthermore, marijuana use in chronically ill youth was associated with males, older age, lower socioeconomic status (P less than .01), and poorer mental health (P less than .01). Participants with IBD had higher rates of marijuana use than participants with arthritis or asthma. Almost all youth who reported past-year marijuana use also reported past-year alcohol use, the investigators noted.

Knowledge of alcohol’s potential effects with medications and laboratory results was low, with only 53.1% and 37.2% of high school students answering correctly, respectively. Those who answered incorrectly were 8.53 and 4.46 times more likely to drink and binge drink (P less than .001).

Approximately 8.3% and 32% of the high school–aged participants reported skipping or forgetting to take prescription medications within the past 30 days, respectively. Intentional nonadherence was associated with lower mental health scores (P less than .001). High school–aged youth who admitted to alcohol use within the past year were 1.61 times and 1.79 times more likely to skip and forget their medications, respectively.

Ms. Weitzman and her associates noted that the association of better mental health scores with binge drinking may be related to the social aspect, whereas the association of poorer mental health scores with marijuana may be related to its possible use to improve symptoms.

The authors also pointed out that although nonadherence was associated with alcohol use and poorer mental health scores, it also may be related to health-risking behaviors, poor self-regulation, and the feeling of invulnerability associated with adolescent development.

“Alcohol and marijuana use are prevalent among youth with chronic medical conditions, and drinking is associated with treatment nonadherence. Education and screening of medically vulnerable youth are warranted to ameliorate risk,” they concluded.

The authors reported no disclosures, and the study was supported by an NIH grant.

Alcohol and marijuana use is common in youth with chronic disease, and alcohol use is associated with nonadherence to treatment, according to a new study published in Pediatrics.

Approximately 1 in 4 American youths are living with a chronic medical condition. The most common substance abused by young people is alcohol, which can lead to adverse medication interactions and difficulty with treatment adherence and self-care. As with healthy youth, alcohol abuse may be associated with poor sleep, smoke exposure, and unprotected or unplanned sex. Marijuana use can lead to airway inflammation, treatment nonadherence, and sleep disturbances. Currently, there are no studies that indicate marijuana has therapeutic utility in young people.

© Stockphoto4u/iStockphoto.com

Elissa Weitzman of Harvard Medical School in Boston, and colleagues sought to fill in knowledge gaps on the prevalence of substance use in chronically ill youths, which may lead to development of preventative strategies.

The investigators conducted a cross-sectional web-based assessment of youth aged 9-18 years who were being treated for cystic fibrosis, asthma, arthritis, type 1 diabetes, or inflammatory bowel disease (IBD). The questionnaire assessed alcohol use, behaviors, marijuana use, and health care interactions (Pediatrics 2015. doi: 10.1542/peds.2015-0722).

Of the 532 youths invited to participate in the study, 403 consented to participate; 51.6% were female, and 75.1% where white. The average age of participants was 15.6 years, and overall they were in good mental health.

Alcohol use within the past year was reported in 30.8%, and older age correlated to alcohol use (P less than .001). Binge drinking was reported in 37.7% of respondents who reported alcohol use within the past year, and 10.4% in the total group. Binge drinking was reported more often in older (P less than .001) and white (P less than .01) chronically ill youth. Better mental health scores were associated with binge drinking (P less than .01).

Marijuana use was reported in 17.2% of the study group and 20.6% of the high school–aged group. Furthermore, marijuana use in chronically ill youth was associated with males, older age, lower socioeconomic status (P less than .01), and poorer mental health (P less than .01). Participants with IBD had higher rates of marijuana use than participants with arthritis or asthma. Almost all youth who reported past-year marijuana use also reported past-year alcohol use, the investigators noted.

Knowledge of alcohol’s potential effects with medications and laboratory results was low, with only 53.1% and 37.2% of high school students answering correctly, respectively. Those who answered incorrectly were 8.53 and 4.46 times more likely to drink and binge drink (P less than .001).

Approximately 8.3% and 32% of the high school–aged participants reported skipping or forgetting to take prescription medications within the past 30 days, respectively. Intentional nonadherence was associated with lower mental health scores (P less than .001). High school–aged youth who admitted to alcohol use within the past year were 1.61 times and 1.79 times more likely to skip and forget their medications, respectively.

Ms. Weitzman and her associates noted that the association of better mental health scores with binge drinking may be related to the social aspect, whereas the association of poorer mental health scores with marijuana may be related to its possible use to improve symptoms.

The authors also pointed out that although nonadherence was associated with alcohol use and poorer mental health scores, it also may be related to health-risking behaviors, poor self-regulation, and the feeling of invulnerability associated with adolescent development.

“Alcohol and marijuana use are prevalent among youth with chronic medical conditions, and drinking is associated with treatment nonadherence. Education and screening of medically vulnerable youth are warranted to ameliorate risk,” they concluded.

The authors reported no disclosures, and the study was supported by an NIH grant.

Alcohol and marijuana use is common in youth with chronic disease, and alcohol use is associated with nonadherence to treatment, according to a new study published in Pediatrics.

Approximately 1 in 4 American youths are living with a chronic medical condition. The most common substance abused by young people is alcohol, which can lead to adverse medication interactions and difficulty with treatment adherence and self-care. As with healthy youth, alcohol abuse may be associated with poor sleep, smoke exposure, and unprotected or unplanned sex. Marijuana use can lead to airway inflammation, treatment nonadherence, and sleep disturbances. Currently, there are no studies that indicate marijuana has therapeutic utility in young people.

© Stockphoto4u/iStockphoto.com

Elissa Weitzman of Harvard Medical School in Boston, and colleagues sought to fill in knowledge gaps on the prevalence of substance use in chronically ill youths, which may lead to development of preventative strategies.

The investigators conducted a cross-sectional web-based assessment of youth aged 9-18 years who were being treated for cystic fibrosis, asthma, arthritis, type 1 diabetes, or inflammatory bowel disease (IBD). The questionnaire assessed alcohol use, behaviors, marijuana use, and health care interactions (Pediatrics 2015. doi: 10.1542/peds.2015-0722).

Of the 532 youths invited to participate in the study, 403 consented to participate; 51.6% were female, and 75.1% where white. The average age of participants was 15.6 years, and overall they were in good mental health.

Alcohol use within the past year was reported in 30.8%, and older age correlated to alcohol use (P less than .001). Binge drinking was reported in 37.7% of respondents who reported alcohol use within the past year, and 10.4% in the total group. Binge drinking was reported more often in older (P less than .001) and white (P less than .01) chronically ill youth. Better mental health scores were associated with binge drinking (P less than .01).

Marijuana use was reported in 17.2% of the study group and 20.6% of the high school–aged group. Furthermore, marijuana use in chronically ill youth was associated with males, older age, lower socioeconomic status (P less than .01), and poorer mental health (P less than .01). Participants with IBD had higher rates of marijuana use than participants with arthritis or asthma. Almost all youth who reported past-year marijuana use also reported past-year alcohol use, the investigators noted.

Knowledge of alcohol’s potential effects with medications and laboratory results was low, with only 53.1% and 37.2% of high school students answering correctly, respectively. Those who answered incorrectly were 8.53 and 4.46 times more likely to drink and binge drink (P less than .001).

Approximately 8.3% and 32% of the high school–aged participants reported skipping or forgetting to take prescription medications within the past 30 days, respectively. Intentional nonadherence was associated with lower mental health scores (P less than .001). High school–aged youth who admitted to alcohol use within the past year were 1.61 times and 1.79 times more likely to skip and forget their medications, respectively.

Ms. Weitzman and her associates noted that the association of better mental health scores with binge drinking may be related to the social aspect, whereas the association of poorer mental health scores with marijuana may be related to its possible use to improve symptoms.

The authors also pointed out that although nonadherence was associated with alcohol use and poorer mental health scores, it also may be related to health-risking behaviors, poor self-regulation, and the feeling of invulnerability associated with adolescent development.

“Alcohol and marijuana use are prevalent among youth with chronic medical conditions, and drinking is associated with treatment nonadherence. Education and screening of medically vulnerable youth are warranted to ameliorate risk,” they concluded.

The authors reported no disclosures, and the study was supported by an NIH grant.

Infants at high risk for peanut allergy should start a peanut-based diet by age 4-11 months, experts from the American Academy of Pediatrics and nine other medical groups advised in the September issue of Pediatrics.*

The consensus communication upends traditional views about preventing childhood peanut allergy and highlights the landmark LEAP study in which high-risk infants fed peanut-based foods had about an 80% lower risk of developing peanut allergy, compared with those fed a peanut-free diet.

©mates/Fotolia.com

“Early intervention will prevent peanut allergy, and the pediatrician’s involvement is absolutely essential to the success of this approach,” said Dr. Hugh Sampson, who contributed to the guidance and is at the Icahn School of Medicine at Mount Sinai, New York. “Without very early evaluation and implementation, we won’t change anything.”

LEAP investigators defined “high risk” for peanut allergy as severe eczema with or without egg allergy, “but many other infants are likely at risk, and thus would benefit from early peanut introduction,” added Dr. David Fleischer, who also contributed to the guidance and is at the University of Colorado at Denver, Aurora. “Many feel that given the potential benefit, all infants, regardless of risk level, should have peanut introduced early into the diet,” he said.

Peanut allergy affects more than 2% of American children and is about twice as prevalent in Western countries as it was a decade ago. It’s not clear why rates have increased, but pediatricians can help stem the rising tide, Dr. Sampson said. “When a pediatrician suspects a ‘high-risk’ baby, he or she needs to explain to parents the risks involved in their baby developing peanut allergy, and the benefits of early evaluation and introduction. Once peanut allergy is established, the vast majority of young children will retain the allergy for life.”

Because “high-risk” children might already be allergic to peanuts, they could benefit from evaluation by an allergist, according to the consensus communication (Pediatrics 2015;136[3]:601-4). Expert consultation might also benefit those who feel reluctant to introduce peanuts for other reasons, Dr. Fleischer said.

Dr. Sampson recommends peanut-based skin prick testing for high-risk infants aged 4-8 months. Patients with a negative result should receive 2 grams of peanut protein three times a week for the next 3 years. Those who are mildly sensitive (wheal diameter less than 4 mm) should undergo a peanut challenge observed by an experienced physician. Infants who do not react can start the peanut-based diet.

The LEAP study randomized 640 high-risk infants to either avoid peanuts or consume at least 6 grams per week of the allergen in foods such as smooth peanut butter mixed with mashed fruit, peanut soup, and ground peanuts in other foods. Five-year-olds in the peanut group had significantly lower rates of peanut allergy, regardless of whether their skin prick test had been positive at baseline (N. Engl. J. Med. 2015;372[9]:803-13). While the consensus communication provides interim guidance, a panel sponsored by the National Institute of Allergy and Infectious Diseases is reviewing food allergy data in preparation for updating its guidelines, Dr. Sampson noted. “Several major questions remain,” he said. “Do we need to give such large amounts of peanut to induce tolerance? Is it necessary to give this amount of peanut for such an extended period? What happens if parents don’t give peanut to their infants on a regular basis, as done in the LEAP trial? Could this put them at higher risk? And will this approach apply to other foods?”

Another key knowledge gap is whether the results from one single-center study can be applied elsewhere, said Dr. Fleischer. “We do not know the effects of early peanut introduction in other risk populations.”

Authors of the consensus communication reported no funding sources or conflicts of interest.

*Correction, 8/31/2015: An earlier version of this article misstated the journal in which the study was published.

Infants at high risk for peanut allergy should start a peanut-based diet by age 4-11 months, experts from the American Academy of Pediatrics and nine other medical groups advised in the September issue of Pediatrics.*

The consensus communication upends traditional views about preventing childhood peanut allergy and highlights the landmark LEAP study in which high-risk infants fed peanut-based foods had about an 80% lower risk of developing peanut allergy, compared with those fed a peanut-free diet.

©mates/Fotolia.com

“Early intervention will prevent peanut allergy, and the pediatrician’s involvement is absolutely essential to the success of this approach,” said Dr. Hugh Sampson, who contributed to the guidance and is at the Icahn School of Medicine at Mount Sinai, New York. “Without very early evaluation and implementation, we won’t change anything.”

LEAP investigators defined “high risk” for peanut allergy as severe eczema with or without egg allergy, “but many other infants are likely at risk, and thus would benefit from early peanut introduction,” added Dr. David Fleischer, who also contributed to the guidance and is at the University of Colorado at Denver, Aurora. “Many feel that given the potential benefit, all infants, regardless of risk level, should have peanut introduced early into the diet,” he said.

Peanut allergy affects more than 2% of American children and is about twice as prevalent in Western countries as it was a decade ago. It’s not clear why rates have increased, but pediatricians can help stem the rising tide, Dr. Sampson said. “When a pediatrician suspects a ‘high-risk’ baby, he or she needs to explain to parents the risks involved in their baby developing peanut allergy, and the benefits of early evaluation and introduction. Once peanut allergy is established, the vast majority of young children will retain the allergy for life.”

Because “high-risk” children might already be allergic to peanuts, they could benefit from evaluation by an allergist, according to the consensus communication (Pediatrics 2015;136[3]:601-4). Expert consultation might also benefit those who feel reluctant to introduce peanuts for other reasons, Dr. Fleischer said.

Dr. Sampson recommends peanut-based skin prick testing for high-risk infants aged 4-8 months. Patients with a negative result should receive 2 grams of peanut protein three times a week for the next 3 years. Those who are mildly sensitive (wheal diameter less than 4 mm) should undergo a peanut challenge observed by an experienced physician. Infants who do not react can start the peanut-based diet.

The LEAP study randomized 640 high-risk infants to either avoid peanuts or consume at least 6 grams per week of the allergen in foods such as smooth peanut butter mixed with mashed fruit, peanut soup, and ground peanuts in other foods. Five-year-olds in the peanut group had significantly lower rates of peanut allergy, regardless of whether their skin prick test had been positive at baseline (N. Engl. J. Med. 2015;372[9]:803-13). While the consensus communication provides interim guidance, a panel sponsored by the National Institute of Allergy and Infectious Diseases is reviewing food allergy data in preparation for updating its guidelines, Dr. Sampson noted. “Several major questions remain,” he said. “Do we need to give such large amounts of peanut to induce tolerance? Is it necessary to give this amount of peanut for such an extended period? What happens if parents don’t give peanut to their infants on a regular basis, as done in the LEAP trial? Could this put them at higher risk? And will this approach apply to other foods?”

Another key knowledge gap is whether the results from one single-center study can be applied elsewhere, said Dr. Fleischer. “We do not know the effects of early peanut introduction in other risk populations.”

Authors of the consensus communication reported no funding sources or conflicts of interest.

*Correction, 8/31/2015: An earlier version of this article misstated the journal in which the study was published.

Infants at high risk for peanut allergy should start a peanut-based diet by age 4-11 months, experts from the American Academy of Pediatrics and nine other medical groups advised in the September issue of Pediatrics.*

The consensus communication upends traditional views about preventing childhood peanut allergy and highlights the landmark LEAP study in which high-risk infants fed peanut-based foods had about an 80% lower risk of developing peanut allergy, compared with those fed a peanut-free diet.

©mates/Fotolia.com

“Early intervention will prevent peanut allergy, and the pediatrician’s involvement is absolutely essential to the success of this approach,” said Dr. Hugh Sampson, who contributed to the guidance and is at the Icahn School of Medicine at Mount Sinai, New York. “Without very early evaluation and implementation, we won’t change anything.”

LEAP investigators defined “high risk” for peanut allergy as severe eczema with or without egg allergy, “but many other infants are likely at risk, and thus would benefit from early peanut introduction,” added Dr. David Fleischer, who also contributed to the guidance and is at the University of Colorado at Denver, Aurora. “Many feel that given the potential benefit, all infants, regardless of risk level, should have peanut introduced early into the diet,” he said.

Peanut allergy affects more than 2% of American children and is about twice as prevalent in Western countries as it was a decade ago. It’s not clear why rates have increased, but pediatricians can help stem the rising tide, Dr. Sampson said. “When a pediatrician suspects a ‘high-risk’ baby, he or she needs to explain to parents the risks involved in their baby developing peanut allergy, and the benefits of early evaluation and introduction. Once peanut allergy is established, the vast majority of young children will retain the allergy for life.”

Because “high-risk” children might already be allergic to peanuts, they could benefit from evaluation by an allergist, according to the consensus communication (Pediatrics 2015;136[3]:601-4). Expert consultation might also benefit those who feel reluctant to introduce peanuts for other reasons, Dr. Fleischer said.

Dr. Sampson recommends peanut-based skin prick testing for high-risk infants aged 4-8 months. Patients with a negative result should receive 2 grams of peanut protein three times a week for the next 3 years. Those who are mildly sensitive (wheal diameter less than 4 mm) should undergo a peanut challenge observed by an experienced physician. Infants who do not react can start the peanut-based diet.

The LEAP study randomized 640 high-risk infants to either avoid peanuts or consume at least 6 grams per week of the allergen in foods such as smooth peanut butter mixed with mashed fruit, peanut soup, and ground peanuts in other foods. Five-year-olds in the peanut group had significantly lower rates of peanut allergy, regardless of whether their skin prick test had been positive at baseline (N. Engl. J. Med. 2015;372[9]:803-13). While the consensus communication provides interim guidance, a panel sponsored by the National Institute of Allergy and Infectious Diseases is reviewing food allergy data in preparation for updating its guidelines, Dr. Sampson noted. “Several major questions remain,” he said. “Do we need to give such large amounts of peanut to induce tolerance? Is it necessary to give this amount of peanut for such an extended period? What happens if parents don’t give peanut to their infants on a regular basis, as done in the LEAP trial? Could this put them at higher risk? And will this approach apply to other foods?”

Another key knowledge gap is whether the results from one single-center study can be applied elsewhere, said Dr. Fleischer. “We do not know the effects of early peanut introduction in other risk populations.”

Authors of the consensus communication reported no funding sources or conflicts of interest.

*Correction, 8/31/2015: An earlier version of this article misstated the journal in which the study was published.

LONDON – U.S. patients hospitalized for heart failure and treated with antibiotics during their hospital stay had an increased rate both for developing Clostridium difficile infection and dying from it, based on nationwide data collected from nearly six million patients.

“Heart failure was an independent risk factor” in multivariate analyses that controlled for demographic factors as well as for several comorbidities of heart failure, Dr. Petra Mamic said in a video interview at the annual congress of the European Society of Cardiology.

She and her associates used data collected by the National Inpatient Sample during 2012 in more than 5.8 million U.S. hospitalized patients who received antibiotic treatment for a urinary tract infection, pneumonia, or sepsis. They compared the rate of subsequent infection with C. difficile in the roughly 1.4 million of these patients who had heart failure and the nearly 4.5 million without heart failure. In a multivariate analysis heart failure patients were 13% more likely to develop C. difficile infection compared with patients without heart failure. In a second multivariate analysis that focused just on patients with heart failure those who had become infected by C. difficile were 81% more likely to die in hospital compared with heart failure patients without this type of infection.

“Heart failure patients are frequently hospitalized and have a lot of bacterial infections, and so receive treatment with a lot of antibiotics,” said Dr. Mamic, an internal medicine physician at Stanford (Calif.) University. “What is important is that C. difficile infection is preventable. Our ultimate goal is to prevent C. difficile in these patients who have such high morbidity and mortality,”

Dr. Mamic had no disclosures.

[email protected]

On Twitter @mitchelzoler

LONDON – U.S. patients hospitalized for heart failure and treated with antibiotics during their hospital stay had an increased rate both for developing Clostridium difficile infection and dying from it, based on nationwide data collected from nearly six million patients.

“Heart failure was an independent risk factor” in multivariate analyses that controlled for demographic factors as well as for several comorbidities of heart failure, Dr. Petra Mamic said in a video interview at the annual congress of the European Society of Cardiology.

She and her associates used data collected by the National Inpatient Sample during 2012 in more than 5.8 million U.S. hospitalized patients who received antibiotic treatment for a urinary tract infection, pneumonia, or sepsis. They compared the rate of subsequent infection with C. difficile in the roughly 1.4 million of these patients who had heart failure and the nearly 4.5 million without heart failure. In a multivariate analysis heart failure patients were 13% more likely to develop C. difficile infection compared with patients without heart failure. In a second multivariate analysis that focused just on patients with heart failure those who had become infected by C. difficile were 81% more likely to die in hospital compared with heart failure patients without this type of infection.

“Heart failure patients are frequently hospitalized and have a lot of bacterial infections, and so receive treatment with a lot of antibiotics,” said Dr. Mamic, an internal medicine physician at Stanford (Calif.) University. “What is important is that C. difficile infection is preventable. Our ultimate goal is to prevent C. difficile in these patients who have such high morbidity and mortality,”

Dr. Mamic had no disclosures.

[email protected]

On Twitter @mitchelzoler

LONDON – U.S. patients hospitalized for heart failure and treated with antibiotics during their hospital stay had an increased rate both for developing Clostridium difficile infection and dying from it, based on nationwide data collected from nearly six million patients.

“Heart failure was an independent risk factor” in multivariate analyses that controlled for demographic factors as well as for several comorbidities of heart failure, Dr. Petra Mamic said in a video interview at the annual congress of the European Society of Cardiology.

She and her associates used data collected by the National Inpatient Sample during 2012 in more than 5.8 million U.S. hospitalized patients who received antibiotic treatment for a urinary tract infection, pneumonia, or sepsis. They compared the rate of subsequent infection with C. difficile in the roughly 1.4 million of these patients who had heart failure and the nearly 4.5 million without heart failure. In a multivariate analysis heart failure patients were 13% more likely to develop C. difficile infection compared with patients without heart failure. In a second multivariate analysis that focused just on patients with heart failure those who had become infected by C. difficile were 81% more likely to die in hospital compared with heart failure patients without this type of infection.

“Heart failure patients are frequently hospitalized and have a lot of bacterial infections, and so receive treatment with a lot of antibiotics,” said Dr. Mamic, an internal medicine physician at Stanford (Calif.) University. “What is important is that C. difficile infection is preventable. Our ultimate goal is to prevent C. difficile in these patients who have such high morbidity and mortality,”

Dr. Mamic had no disclosures.

[email protected]

On Twitter @mitchelzoler

A new study will expose adults to respiratory syncytial virus (RSV), so researchers can understand how it develops, with the goal of developing better RSV antivirals and vaccines in the future, according to a National Institutes of Health press release.

©Dr. Craig Lyerla / CDC

While RSV causes cold-like symptoms and is not much of an issue for adults, the disease can cause much more severe symptoms in very young children, in anyone with a weakened immune system, and in the elderly. Around 55,000 children are hospitalized for RSV annually, mostly infants younger than 6 months. In addition, RSV causes about 14,000 deaths per year in people older than 65, according to the NIH.

The study, conducted by the NIH’s National Institute of Allergy and Infectious Diseases, will involve up to 60 adults – men and nonpregnant women – aged 18-50 years. They will be given two droplets containing a laboratory-developed strain of RSV, called RSV A2, commonly used in medical research, and they will be closely monitored for up to 2 weeks in isolation.

“We do not anticipate that the healthy, carefully screened adult volunteers in this study will become severely sick from the RSV challenge virus because, in general, healthy adults are repeatedly exposed to RSV in their lives and either remain asymptomatic or develop a mild to moderate cold,” said Dr. Lesia K. Dropulic of NIAID’s Laboratory of Infectious Diseases.

[email protected]

A new study will expose adults to respiratory syncytial virus (RSV), so researchers can understand how it develops, with the goal of developing better RSV antivirals and vaccines in the future, according to a National Institutes of Health press release.

©Dr. Craig Lyerla / CDC

While RSV causes cold-like symptoms and is not much of an issue for adults, the disease can cause much more severe symptoms in very young children, in anyone with a weakened immune system, and in the elderly. Around 55,000 children are hospitalized for RSV annually, mostly infants younger than 6 months. In addition, RSV causes about 14,000 deaths per year in people older than 65, according to the NIH.

The study, conducted by the NIH’s National Institute of Allergy and Infectious Diseases, will involve up to 60 adults – men and nonpregnant women – aged 18-50 years. They will be given two droplets containing a laboratory-developed strain of RSV, called RSV A2, commonly used in medical research, and they will be closely monitored for up to 2 weeks in isolation.

“We do not anticipate that the healthy, carefully screened adult volunteers in this study will become severely sick from the RSV challenge virus because, in general, healthy adults are repeatedly exposed to RSV in their lives and either remain asymptomatic or develop a mild to moderate cold,” said Dr. Lesia K. Dropulic of NIAID’s Laboratory of Infectious Diseases.

[email protected]

A new study will expose adults to respiratory syncytial virus (RSV), so researchers can understand how it develops, with the goal of developing better RSV antivirals and vaccines in the future, according to a National Institutes of Health press release.

©Dr. Craig Lyerla / CDC

While RSV causes cold-like symptoms and is not much of an issue for adults, the disease can cause much more severe symptoms in very young children, in anyone with a weakened immune system, and in the elderly. Around 55,000 children are hospitalized for RSV annually, mostly infants younger than 6 months. In addition, RSV causes about 14,000 deaths per year in people older than 65, according to the NIH.

The study, conducted by the NIH’s National Institute of Allergy and Infectious Diseases, will involve up to 60 adults – men and nonpregnant women – aged 18-50 years. They will be given two droplets containing a laboratory-developed strain of RSV, called RSV A2, commonly used in medical research, and they will be closely monitored for up to 2 weeks in isolation.

“We do not anticipate that the healthy, carefully screened adult volunteers in this study will become severely sick from the RSV challenge virus because, in general, healthy adults are repeatedly exposed to RSV in their lives and either remain asymptomatic or develop a mild to moderate cold,” said Dr. Lesia K. Dropulic of NIAID’s Laboratory of Infectious Diseases.

[email protected]

ATLANTA – Influenza vaccine effectiveness during the 2010-2011 through 2013-2014 flu seasons was moderate for up to 6 months post vaccination – about the duration of the average flu season, according to surveillance data.

Vaccine effectiveness in 1,720 non–active duty U.S. Department of Defense beneficiaries ranged from 40% to 69% across the flu seasons, and after adjusting for age group, calendar season, and flu season, significant and fairly consistent protection was provided for up to 180 days, Dr. Jennifer M. Radin and her colleagues at the Naval Health Research Center, San Diego, reported in a poster at the International Conference on Emerging Infectious Diseases.

lisafx/istockphoto.com

The adjusted vaccine effectiveness was 61% during the first 2 weeks after vaccination, 62% from days 15 through 90, and 60% during days 91 through 180. After that, the effectiveness dropped to –11%, the investigators said.

Vaccine effectiveness in this study was assessed using outpatient febrile respiratory illness surveillance among a convenience sample of individuals of all ages, 75% of whom were under age 25 years, who presented with fever, cough, or sore throat at outpatient facilities in California and Illinois. Case patients were those who tested polymerase chain reaction–positive for influenza; those who were PCR negative for influenza served as controls.

“Previous studies have found that protection from contracting influenza declines over time following influenza vaccination due to decreasing antibody levels. However, we found ... moderate, sustained protection up to 6 months post vaccination,” Dr. Radin said in a press statement, explaining that at this level of effectiveness, vaccination reduces the risk of a doctor’s visit by 50%-70%.

The findings suggest that vaccine administration close to the start of flu season is associated with slightly increased vaccine effectiveness, but the start of flu season varies each year, thus optimal timing is hard to predict.

“Consequently, early flu vaccination may still offer the best overall protection,” Dr. Radin and her colleagues wrote.

The finding of a dramatic drop in effectiveness after 6 months also underscores the importance of yearly vaccination, they noted.

The investigators reported having no disclosures.

[email protected]

ATLANTA – Influenza vaccine effectiveness during the 2010-2011 through 2013-2014 flu seasons was moderate for up to 6 months post vaccination – about the duration of the average flu season, according to surveillance data.

Vaccine effectiveness in 1,720 non–active duty U.S. Department of Defense beneficiaries ranged from 40% to 69% across the flu seasons, and after adjusting for age group, calendar season, and flu season, significant and fairly consistent protection was provided for up to 180 days, Dr. Jennifer M. Radin and her colleagues at the Naval Health Research Center, San Diego, reported in a poster at the International Conference on Emerging Infectious Diseases.

lisafx/istockphoto.com

The adjusted vaccine effectiveness was 61% during the first 2 weeks after vaccination, 62% from days 15 through 90, and 60% during days 91 through 180. After that, the effectiveness dropped to –11%, the investigators said.

Vaccine effectiveness in this study was assessed using outpatient febrile respiratory illness surveillance among a convenience sample of individuals of all ages, 75% of whom were under age 25 years, who presented with fever, cough, or sore throat at outpatient facilities in California and Illinois. Case patients were those who tested polymerase chain reaction–positive for influenza; those who were PCR negative for influenza served as controls.

“Previous studies have found that protection from contracting influenza declines over time following influenza vaccination due to decreasing antibody levels. However, we found ... moderate, sustained protection up to 6 months post vaccination,” Dr. Radin said in a press statement, explaining that at this level of effectiveness, vaccination reduces the risk of a doctor’s visit by 50%-70%.

The findings suggest that vaccine administration close to the start of flu season is associated with slightly increased vaccine effectiveness, but the start of flu season varies each year, thus optimal timing is hard to predict.

“Consequently, early flu vaccination may still offer the best overall protection,” Dr. Radin and her colleagues wrote.

The finding of a dramatic drop in effectiveness after 6 months also underscores the importance of yearly vaccination, they noted.

The investigators reported having no disclosures.

[email protected]

ATLANTA – Influenza vaccine effectiveness during the 2010-2011 through 2013-2014 flu seasons was moderate for up to 6 months post vaccination – about the duration of the average flu season, according to surveillance data.

Vaccine effectiveness in 1,720 non–active duty U.S. Department of Defense beneficiaries ranged from 40% to 69% across the flu seasons, and after adjusting for age group, calendar season, and flu season, significant and fairly consistent protection was provided for up to 180 days, Dr. Jennifer M. Radin and her colleagues at the Naval Health Research Center, San Diego, reported in a poster at the International Conference on Emerging Infectious Diseases.

lisafx/istockphoto.com

The adjusted vaccine effectiveness was 61% during the first 2 weeks after vaccination, 62% from days 15 through 90, and 60% during days 91 through 180. After that, the effectiveness dropped to –11%, the investigators said.

Vaccine effectiveness in this study was assessed using outpatient febrile respiratory illness surveillance among a convenience sample of individuals of all ages, 75% of whom were under age 25 years, who presented with fever, cough, or sore throat at outpatient facilities in California and Illinois. Case patients were those who tested polymerase chain reaction–positive for influenza; those who were PCR negative for influenza served as controls.

“Previous studies have found that protection from contracting influenza declines over time following influenza vaccination due to decreasing antibody levels. However, we found ... moderate, sustained protection up to 6 months post vaccination,” Dr. Radin said in a press statement, explaining that at this level of effectiveness, vaccination reduces the risk of a doctor’s visit by 50%-70%.

The findings suggest that vaccine administration close to the start of flu season is associated with slightly increased vaccine effectiveness, but the start of flu season varies each year, thus optimal timing is hard to predict.

“Consequently, early flu vaccination may still offer the best overall protection,” Dr. Radin and her colleagues wrote.

The finding of a dramatic drop in effectiveness after 6 months also underscores the importance of yearly vaccination, they noted.

The investigators reported having no disclosures.

[email protected]

ATLANTA – Implementing surveillance programs at area hospitals is an effective tool for health care providers and public health officials to identify severe acute respiratory illness (SARI) and enterovirus specifically early.

“We do surveillance for respiratory illness [at] three sentinel sites that participate in the Minneapolis-St. Paul metro area,” explained Hannah Friedlander, an epidemiologist with the Minnesota Department of Health in St. Paul, who presented the study. “[But] our surveillance didn’t actually actively look for enterovirus, it looked for rhinovirus, which is known to cross-react with enterovirus on PCRs [polymerase chain reactions],” she said at the International Conference on Emerging Infectious Diseases

To remedy that, the surveillance program – which involves the participation of one pediatric hospital, one hospital serving both children and adults, and one primarily serving adults – added testing for enterovirus to PCRs of all SARI specimens collected from Sept. 1 through Oct. 31, 2014. In total, 363 SARI specimens were collected over that time frame, of which 100 (28%) were found to be pan-EV positive and underwent further evaluation for EV-D68. Ultimately, 64 of the EV-positive specimens were found to be EV-D68 strains.

The vast majority of cases identified as being caused by the EV-D68 strain (73%) were collected between Sept. 6 and Sept. 20.

This indicates that starting surveillance of SARI cases when enteroviruses traditionally become more frequent could allow for faster determination of which strain is most prevalent and what the optimal treatment should be.

“It’s hard to say if this was surprising because we hadn’t previously been looking for enterovirus, so we don’t have another year to compare [these] data to,” Ms. Friedlander explained. “But I think it’s surprising that we saw as much of [enterovirus] as we did.”

Most cases of EV-D68 (64, or 36%) were in patients between the ages of 5 and 11 years, with a median age of 6 years. A total of 52 (81%) EV-D68 cases presented with shortness of breath, and 31 cases (48%) presented with wheezing or cough. Hospital stays of 4 days or fewer occurred in 73% of cases, with a median stay length of 3 days; 33% of EV-D68 patients required admittance to the ICU, and 13% of EV-D68 patients were placed on a mechanical ventilator at some point during treatment.

“This fall is our third year doing this type of surveillance, so at the time the data for this [were] collected, we only had 1 year of surveillance under our belt,” explained Ms. Friedlander. “We now look prospectively for enterovirus, not EV-D68 specifically, so it’ll be interesting to see as the years go on if this was an outlier year.”

Ms. Friedlander and her coinvestigators say they hope that further SARI surveillance will shed more light on the trends of viral pathogens and the impact that these have on hospitalization rates. They implore hospital systems to not only have surveillance programs in place, but also for them to have the flexibility to include additional testing should the need for it arise. That flexibility, Ms. Friedlander said, is what proved crucial in the early identification of EV-D68 in her own study population.

This study was funded by the Council of State and Territorial Epidemiologists, and the Centers for the Disease Control and Prevention. Ms. Friedlander did not report any relevant financial disclosures.

[email protected]

ATLANTA – Implementing surveillance programs at area hospitals is an effective tool for health care providers and public health officials to identify severe acute respiratory illness (SARI) and enterovirus specifically early.

“We do surveillance for respiratory illness [at] three sentinel sites that participate in the Minneapolis-St. Paul metro area,” explained Hannah Friedlander, an epidemiologist with the Minnesota Department of Health in St. Paul, who presented the study. “[But] our surveillance didn’t actually actively look for enterovirus, it looked for rhinovirus, which is known to cross-react with enterovirus on PCRs [polymerase chain reactions],” she said at the International Conference on Emerging Infectious Diseases

To remedy that, the surveillance program – which involves the participation of one pediatric hospital, one hospital serving both children and adults, and one primarily serving adults – added testing for enterovirus to PCRs of all SARI specimens collected from Sept. 1 through Oct. 31, 2014. In total, 363 SARI specimens were collected over that time frame, of which 100 (28%) were found to be pan-EV positive and underwent further evaluation for EV-D68. Ultimately, 64 of the EV-positive specimens were found to be EV-D68 strains.

The vast majority of cases identified as being caused by the EV-D68 strain (73%) were collected between Sept. 6 and Sept. 20.

This indicates that starting surveillance of SARI cases when enteroviruses traditionally become more frequent could allow for faster determination of which strain is most prevalent and what the optimal treatment should be.

“It’s hard to say if this was surprising because we hadn’t previously been looking for enterovirus, so we don’t have another year to compare [these] data to,” Ms. Friedlander explained. “But I think it’s surprising that we saw as much of [enterovirus] as we did.”

Most cases of EV-D68 (64, or 36%) were in patients between the ages of 5 and 11 years, with a median age of 6 years. A total of 52 (81%) EV-D68 cases presented with shortness of breath, and 31 cases (48%) presented with wheezing or cough. Hospital stays of 4 days or fewer occurred in 73% of cases, with a median stay length of 3 days; 33% of EV-D68 patients required admittance to the ICU, and 13% of EV-D68 patients were placed on a mechanical ventilator at some point during treatment.

“This fall is our third year doing this type of surveillance, so at the time the data for this [were] collected, we only had 1 year of surveillance under our belt,” explained Ms. Friedlander. “We now look prospectively for enterovirus, not EV-D68 specifically, so it’ll be interesting to see as the years go on if this was an outlier year.”

Ms. Friedlander and her coinvestigators say they hope that further SARI surveillance will shed more light on the trends of viral pathogens and the impact that these have on hospitalization rates. They implore hospital systems to not only have surveillance programs in place, but also for them to have the flexibility to include additional testing should the need for it arise. That flexibility, Ms. Friedlander said, is what proved crucial in the early identification of EV-D68 in her own study population.

This study was funded by the Council of State and Territorial Epidemiologists, and the Centers for the Disease Control and Prevention. Ms. Friedlander did not report any relevant financial disclosures.

[email protected]

ATLANTA – Implementing surveillance programs at area hospitals is an effective tool for health care providers and public health officials to identify severe acute respiratory illness (SARI) and enterovirus specifically early.

“We do surveillance for respiratory illness [at] three sentinel sites that participate in the Minneapolis-St. Paul metro area,” explained Hannah Friedlander, an epidemiologist with the Minnesota Department of Health in St. Paul, who presented the study. “[But] our surveillance didn’t actually actively look for enterovirus, it looked for rhinovirus, which is known to cross-react with enterovirus on PCRs [polymerase chain reactions],” she said at the International Conference on Emerging Infectious Diseases

To remedy that, the surveillance program – which involves the participation of one pediatric hospital, one hospital serving both children and adults, and one primarily serving adults – added testing for enterovirus to PCRs of all SARI specimens collected from Sept. 1 through Oct. 31, 2014. In total, 363 SARI specimens were collected over that time frame, of which 100 (28%) were found to be pan-EV positive and underwent further evaluation for EV-D68. Ultimately, 64 of the EV-positive specimens were found to be EV-D68 strains.

The vast majority of cases identified as being caused by the EV-D68 strain (73%) were collected between Sept. 6 and Sept. 20.

This indicates that starting surveillance of SARI cases when enteroviruses traditionally become more frequent could allow for faster determination of which strain is most prevalent and what the optimal treatment should be.

“It’s hard to say if this was surprising because we hadn’t previously been looking for enterovirus, so we don’t have another year to compare [these] data to,” Ms. Friedlander explained. “But I think it’s surprising that we saw as much of [enterovirus] as we did.”

Most cases of EV-D68 (64, or 36%) were in patients between the ages of 5 and 11 years, with a median age of 6 years. A total of 52 (81%) EV-D68 cases presented with shortness of breath, and 31 cases (48%) presented with wheezing or cough. Hospital stays of 4 days or fewer occurred in 73% of cases, with a median stay length of 3 days; 33% of EV-D68 patients required admittance to the ICU, and 13% of EV-D68 patients were placed on a mechanical ventilator at some point during treatment.

“This fall is our third year doing this type of surveillance, so at the time the data for this [were] collected, we only had 1 year of surveillance under our belt,” explained Ms. Friedlander. “We now look prospectively for enterovirus, not EV-D68 specifically, so it’ll be interesting to see as the years go on if this was an outlier year.”

Ms. Friedlander and her coinvestigators say they hope that further SARI surveillance will shed more light on the trends of viral pathogens and the impact that these have on hospitalization rates. They implore hospital systems to not only have surveillance programs in place, but also for them to have the flexibility to include additional testing should the need for it arise. That flexibility, Ms. Friedlander said, is what proved crucial in the early identification of EV-D68 in her own study population.

This study was funded by the Council of State and Territorial Epidemiologists, and the Centers for the Disease Control and Prevention. Ms. Friedlander did not report any relevant financial disclosures.

[email protected]

First-line combination therapy with ambrisentan and tadalafil cut the rate of clinical events in pulmonary arterial hypertension (PAH) by half, compared with monotherapy using either drug, in an international phase 3-4 clinical trial reported online Aug. 27 in the New England Journal of Medicine.

Ambrisentan, a selective endothelin-A-receptor antagonist, and tadalafil, a phosphodiesterase type 5 inhibitor, target different intracellular pathways known to have dysfunctional signaling in PAH, so researchers expected them to have an additive effect when combined. The study findings support the rationale of targeting multiple affected pathways early in the course of PAH, rather than following the traditional approach of sequentially adding newer agents to established background therapy, said Dr. Nazzareno Galie of the department of experimental, diagnostic, and specialty medicine, University of Bologna (Italy), and his associates.

The 4-year, industry-sponsored trial involved 500 adults treated at 120 medical centers in 14 countries for PAH with World Health Organization functional class II or III symptoms. It included patients whose disorder was idiopathic; hereditary; or associated with connective tissue disease, drugs or toxins, stable HIV infection, or repaired congenital heart defects.

The mean age of participants was 54.4 years, and 78% were women. The mean pulmonary artery pressure was 48.7 mm Hg, and mean 6-minute walk distance was 353 m at baseline. A total of 253 patients were randomly assigned to receive oral, once-daily combination therapy, 126 to receive ambrisentan plus placebo, and 121 to receive tadalafil plus placebo. They were assessed at monthly intervals during the 24-week treatment period and were allowed to continue therapy indefinitely. The mean duration of use of the study medication was 517 days. Patients were followed up a final time 1 month after taking their last dose of study medication.

The primary efficacy endpoint was the first event of clinical failure, which was a composite of death, hospitalization for worsening PAH, disease progression, or unsatisfactory long-term treatment response. Only 18% of the combination-therapy group reached this endpoint, compared with 34% of the ambrisentan group, 28% of the tadalafil group, and 31% of the pooled-monotherapy group. The hazard ratios for the primary endpoint were 0.50 for the combination therapy versus pooled monotherapy, 0.48 for combination therapy versus ambrisentan alone, and 0.53 for combination therapy versus tadalafil alone.

This treatment benefit was mainly driven by one component of the combined endpoint: The rate of hospitalization for worsening PAH was three times higher with the two monotherapies (12%) than with combination therapy (4%). Improvement in the secondary endpoints of change in N-terminal pro–brain natriuretic peptide level, the percentage of participants with a satisfactory treatment response, and change in 6-minute walk distance all significantly favored the combination therapy, Dr. Galie and his associates said (N Engl J Med. 2015 Aug 27. doi: 10.1056/NEJMoa1413687).It is important to note, however, that “despite improvements in a variety of factors with combination therapy, we found no significant difference in WHO functional class among the study groups at week 24,” they wrote.

The combination of ambrisentan and tadalafil produced more adverse effects than either monotherapy, but the rate of discontinuation of a study drug and the rate of serious adverse events were similar across the three study groups. The most frequent adverse effects were peripheral edema, headache, nasal congestion, and anemia.

The AMBITION study was funded by Gilead Sciences and GlaxoSmithKline, which designed the trial, collected and analyzed the data, and wrote the report in conjunction with the authors. Gilead Sciences, GlaxoSmithKline, and Eli Lilly provided the study drugs. Dr. Galie reported receiving grants and personal fees from GlaxoSmithKline, Actelion, Bayer, and Pfizer; his associates reported ties to numerous industry sources.

First-line combination therapy with ambrisentan and tadalafil cut the rate of clinical events in pulmonary arterial hypertension (PAH) by half, compared with monotherapy using either drug, in an international phase 3-4 clinical trial reported online Aug. 27 in the New England Journal of Medicine.

Ambrisentan, a selective endothelin-A-receptor antagonist, and tadalafil, a phosphodiesterase type 5 inhibitor, target different intracellular pathways known to have dysfunctional signaling in PAH, so researchers expected them to have an additive effect when combined. The study findings support the rationale of targeting multiple affected pathways early in the course of PAH, rather than following the traditional approach of sequentially adding newer agents to established background therapy, said Dr. Nazzareno Galie of the department of experimental, diagnostic, and specialty medicine, University of Bologna (Italy), and his associates.

The 4-year, industry-sponsored trial involved 500 adults treated at 120 medical centers in 14 countries for PAH with World Health Organization functional class II or III symptoms. It included patients whose disorder was idiopathic; hereditary; or associated with connective tissue disease, drugs or toxins, stable HIV infection, or repaired congenital heart defects.

The mean age of participants was 54.4 years, and 78% were women. The mean pulmonary artery pressure was 48.7 mm Hg, and mean 6-minute walk distance was 353 m at baseline. A total of 253 patients were randomly assigned to receive oral, once-daily combination therapy, 126 to receive ambrisentan plus placebo, and 121 to receive tadalafil plus placebo. They were assessed at monthly intervals during the 24-week treatment period and were allowed to continue therapy indefinitely. The mean duration of use of the study medication was 517 days. Patients were followed up a final time 1 month after taking their last dose of study medication.

The primary efficacy endpoint was the first event of clinical failure, which was a composite of death, hospitalization for worsening PAH, disease progression, or unsatisfactory long-term treatment response. Only 18% of the combination-therapy group reached this endpoint, compared with 34% of the ambrisentan group, 28% of the tadalafil group, and 31% of the pooled-monotherapy group. The hazard ratios for the primary endpoint were 0.50 for the combination therapy versus pooled monotherapy, 0.48 for combination therapy versus ambrisentan alone, and 0.53 for combination therapy versus tadalafil alone.

This treatment benefit was mainly driven by one component of the combined endpoint: The rate of hospitalization for worsening PAH was three times higher with the two monotherapies (12%) than with combination therapy (4%). Improvement in the secondary endpoints of change in N-terminal pro–brain natriuretic peptide level, the percentage of participants with a satisfactory treatment response, and change in 6-minute walk distance all significantly favored the combination therapy, Dr. Galie and his associates said (N Engl J Med. 2015 Aug 27. doi: 10.1056/NEJMoa1413687).It is important to note, however, that “despite improvements in a variety of factors with combination therapy, we found no significant difference in WHO functional class among the study groups at week 24,” they wrote.

The combination of ambrisentan and tadalafil produced more adverse effects than either monotherapy, but the rate of discontinuation of a study drug and the rate of serious adverse events were similar across the three study groups. The most frequent adverse effects were peripheral edema, headache, nasal congestion, and anemia.

The AMBITION study was funded by Gilead Sciences and GlaxoSmithKline, which designed the trial, collected and analyzed the data, and wrote the report in conjunction with the authors. Gilead Sciences, GlaxoSmithKline, and Eli Lilly provided the study drugs. Dr. Galie reported receiving grants and personal fees from GlaxoSmithKline, Actelion, Bayer, and Pfizer; his associates reported ties to numerous industry sources.

First-line combination therapy with ambrisentan and tadalafil cut the rate of clinical events in pulmonary arterial hypertension (PAH) by half, compared with monotherapy using either drug, in an international phase 3-4 clinical trial reported online Aug. 27 in the New England Journal of Medicine.

Ambrisentan, a selective endothelin-A-receptor antagonist, and tadalafil, a phosphodiesterase type 5 inhibitor, target different intracellular pathways known to have dysfunctional signaling in PAH, so researchers expected them to have an additive effect when combined. The study findings support the rationale of targeting multiple affected pathways early in the course of PAH, rather than following the traditional approach of sequentially adding newer agents to established background therapy, said Dr. Nazzareno Galie of the department of experimental, diagnostic, and specialty medicine, University of Bologna (Italy), and his associates.

The 4-year, industry-sponsored trial involved 500 adults treated at 120 medical centers in 14 countries for PAH with World Health Organization functional class II or III symptoms. It included patients whose disorder was idiopathic; hereditary; or associated with connective tissue disease, drugs or toxins, stable HIV infection, or repaired congenital heart defects.

The mean age of participants was 54.4 years, and 78% were women. The mean pulmonary artery pressure was 48.7 mm Hg, and mean 6-minute walk distance was 353 m at baseline. A total of 253 patients were randomly assigned to receive oral, once-daily combination therapy, 126 to receive ambrisentan plus placebo, and 121 to receive tadalafil plus placebo. They were assessed at monthly intervals during the 24-week treatment period and were allowed to continue therapy indefinitely. The mean duration of use of the study medication was 517 days. Patients were followed up a final time 1 month after taking their last dose of study medication.

The primary efficacy endpoint was the first event of clinical failure, which was a composite of death, hospitalization for worsening PAH, disease progression, or unsatisfactory long-term treatment response. Only 18% of the combination-therapy group reached this endpoint, compared with 34% of the ambrisentan group, 28% of the tadalafil group, and 31% of the pooled-monotherapy group. The hazard ratios for the primary endpoint were 0.50 for the combination therapy versus pooled monotherapy, 0.48 for combination therapy versus ambrisentan alone, and 0.53 for combination therapy versus tadalafil alone.

This treatment benefit was mainly driven by one component of the combined endpoint: The rate of hospitalization for worsening PAH was three times higher with the two monotherapies (12%) than with combination therapy (4%). Improvement in the secondary endpoints of change in N-terminal pro–brain natriuretic peptide level, the percentage of participants with a satisfactory treatment response, and change in 6-minute walk distance all significantly favored the combination therapy, Dr. Galie and his associates said (N Engl J Med. 2015 Aug 27. doi: 10.1056/NEJMoa1413687).It is important to note, however, that “despite improvements in a variety of factors with combination therapy, we found no significant difference in WHO functional class among the study groups at week 24,” they wrote.

The combination of ambrisentan and tadalafil produced more adverse effects than either monotherapy, but the rate of discontinuation of a study drug and the rate of serious adverse events were similar across the three study groups. The most frequent adverse effects were peripheral edema, headache, nasal congestion, and anemia.

The AMBITION study was funded by Gilead Sciences and GlaxoSmithKline, which designed the trial, collected and analyzed the data, and wrote the report in conjunction with the authors. Gilead Sciences, GlaxoSmithKline, and Eli Lilly provided the study drugs. Dr. Galie reported receiving grants and personal fees from GlaxoSmithKline, Actelion, Bayer, and Pfizer; his associates reported ties to numerous industry sources.

ATLANTA – Clothing worn by caregivers and visitors may be an important vehicle for the transmission of respiratory syncytial virus in the neonatal intensive care unit setting, according to findings from a prospective study conducted in an Australian hospital.

In an effort to identify potential sources of RSV transmission and to facilitate development of infection control strategies, the investigators swabbed all health personnel, every third neonate and their visitors, and any child clinically suspected of having an RSV infection. They detected RSV in one of 81 nasal specimens collected from 55 neonates and in 4% of 80 visitors’ clothing swabs, Nusrat Homaira, Ph.D., of the University of New South Wales, Sydney, and her colleagues reported in a poster at the International Conference on Emerging Infectious Diseases.

RSV also was detected in 1% of nose swabs from the visitors and in 1% of nose swabs from 84 health care workers.

No RSV was detected on the clothing of health care workers or on the hands of visitors or health care workers, which may be explained by the presence of alcohol-based hand rub at the point of care and by prevalent hand hygiene practices within the neonatal intensive care unit (NICU), the investigators noted.

The investigators also collected environmental swabs and detected RSV on 9% of high-touch areas, including bed rails; chairs; bed surfaces; countertops; and nurse’s and doctor’s station tables, computers, and chairs.

Samples were collected once each week for 8 weeks during May and June of 2014.

RSV is a major cause of morbidity in very young children, and premature infants have a 10-fold increase in the risk of acquiring RSV infection. Hospital-acquired cases are an important cause of prolonged hospitalization, Dr. Homaira and her associates noted.

The findings suggest that personal clothing may be one of the modes of virus transmission, they said.

“Though the detection rate is low, personal clothing of caregivers/visitors do get contaminated with RSV,” Dr. Homaira said in a written statement, noting that caregivers and visitors are not required to change clothing when they walk into the NICU.

“There is a need for further research to evaluate how long the virus remains infectious on personal clothing, which will have policy implications in terms of need for use of separate gowns by the visitors while they are in the NICU,” Dr. Homaira added, concluding that frequent cleaning of high-touch areas and periodic screening of visitors for RSV as they enter the NICU during seasonal epidemics also may help limit disease transmission.

The investigators reported having no disclosures.

[email protected]

ATLANTA – Clothing worn by caregivers and visitors may be an important vehicle for the transmission of respiratory syncytial virus in the neonatal intensive care unit setting, according to findings from a prospective study conducted in an Australian hospital.

In an effort to identify potential sources of RSV transmission and to facilitate development of infection control strategies, the investigators swabbed all health personnel, every third neonate and their visitors, and any child clinically suspected of having an RSV infection. They detected RSV in one of 81 nasal specimens collected from 55 neonates and in 4% of 80 visitors’ clothing swabs, Nusrat Homaira, Ph.D., of the University of New South Wales, Sydney, and her colleagues reported in a poster at the International Conference on Emerging Infectious Diseases.

RSV also was detected in 1% of nose swabs from the visitors and in 1% of nose swabs from 84 health care workers.

No RSV was detected on the clothing of health care workers or on the hands of visitors or health care workers, which may be explained by the presence of alcohol-based hand rub at the point of care and by prevalent hand hygiene practices within the neonatal intensive care unit (NICU), the investigators noted.

The investigators also collected environmental swabs and detected RSV on 9% of high-touch areas, including bed rails; chairs; bed surfaces; countertops; and nurse’s and doctor’s station tables, computers, and chairs.

Samples were collected once each week for 8 weeks during May and June of 2014.

RSV is a major cause of morbidity in very young children, and premature infants have a 10-fold increase in the risk of acquiring RSV infection. Hospital-acquired cases are an important cause of prolonged hospitalization, Dr. Homaira and her associates noted.

The findings suggest that personal clothing may be one of the modes of virus transmission, they said.

“Though the detection rate is low, personal clothing of caregivers/visitors do get contaminated with RSV,” Dr. Homaira said in a written statement, noting that caregivers and visitors are not required to change clothing when they walk into the NICU.

“There is a need for further research to evaluate how long the virus remains infectious on personal clothing, which will have policy implications in terms of need for use of separate gowns by the visitors while they are in the NICU,” Dr. Homaira added, concluding that frequent cleaning of high-touch areas and periodic screening of visitors for RSV as they enter the NICU during seasonal epidemics also may help limit disease transmission.

The investigators reported having no disclosures.

[email protected]

ATLANTA – Clothing worn by caregivers and visitors may be an important vehicle for the transmission of respiratory syncytial virus in the neonatal intensive care unit setting, according to findings from a prospective study conducted in an Australian hospital.

In an effort to identify potential sources of RSV transmission and to facilitate development of infection control strategies, the investigators swabbed all health personnel, every third neonate and their visitors, and any child clinically suspected of having an RSV infection. They detected RSV in one of 81 nasal specimens collected from 55 neonates and in 4% of 80 visitors’ clothing swabs, Nusrat Homaira, Ph.D., of the University of New South Wales, Sydney, and her colleagues reported in a poster at the International Conference on Emerging Infectious Diseases.

RSV also was detected in 1% of nose swabs from the visitors and in 1% of nose swabs from 84 health care workers.

No RSV was detected on the clothing of health care workers or on the hands of visitors or health care workers, which may be explained by the presence of alcohol-based hand rub at the point of care and by prevalent hand hygiene practices within the neonatal intensive care unit (NICU), the investigators noted.

The investigators also collected environmental swabs and detected RSV on 9% of high-touch areas, including bed rails; chairs; bed surfaces; countertops; and nurse’s and doctor’s station tables, computers, and chairs.

Samples were collected once each week for 8 weeks during May and June of 2014.

RSV is a major cause of morbidity in very young children, and premature infants have a 10-fold increase in the risk of acquiring RSV infection. Hospital-acquired cases are an important cause of prolonged hospitalization, Dr. Homaira and her associates noted.

The findings suggest that personal clothing may be one of the modes of virus transmission, they said.

“Though the detection rate is low, personal clothing of caregivers/visitors do get contaminated with RSV,” Dr. Homaira said in a written statement, noting that caregivers and visitors are not required to change clothing when they walk into the NICU.

“There is a need for further research to evaluate how long the virus remains infectious on personal clothing, which will have policy implications in terms of need for use of separate gowns by the visitors while they are in the NICU,” Dr. Homaira added, concluding that frequent cleaning of high-touch areas and periodic screening of visitors for RSV as they enter the NICU during seasonal epidemics also may help limit disease transmission.

The investigators reported having no disclosures.

[email protected]