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Exogenous boosting against shingles not as robust as thought
Exposure to children with chickenpox reduces the incidence of shingles in adults 33% over 2 years, and 27% out to 20 years, according to British investigators.
Being exposed to children with illness due to varicella infection acts as an “exogenous booster” in adults who had chickenpox themselves as children, making shingles less likely, they explained in a BMJ article.
Although that’s good news, it’s been reported previously that exposure to children with chickenpox confers complete protection against shingles in adults for years afterward.
The finding matters in the United Kingdom because varicella vaccine is not part of the pediatric immunization schedule. The United States is the only country that mandates two shots as a requirement for children to attend school.
The United Kingdom, however, is reconsidering its policy. In the past, the exogenous booster idea has been one of the arguments used against mandating the vaccine for children; the concern is that preventing chickenpox in children – and subsequent reexposure to herpes zoster in adults – would kick off a costly wave of shingles in adults.
The study results “are themselves unable to justify for or against specific vaccination schedules, but they do suggest that revised mathematical models are required to estimate the impact of varicella vaccination, with the updated assumption that exogenous boosting is incomplete and only reduces the risk of zoster by about 30%,” noted the investigators, led by Harriet Forbes of the London School of Hygiene and Tropical Medicine.
The researchers identified 9,604 adults with a shingles diagnosis during 1997-2018 who at some point lived with a child who had chickenpox. Data came from the U.K. Clinical Practice Research Datalink, a general practice database.
They then looked at the incidence of shingles within 20 years of exposure to the sick child and compared it with the incidence before exposure and after 20 years, by which time the exogenous booster is thought to wear off. It was a self-controlled case series analysis, “a relatively novel epidemiological study design where individuals act as their own controls. Comparisons are made within individuals rather than between individuals as in a cohort or case control study,” Ms. Forbes and colleagues explained.
After adjustment for age, calendar time, and season, they found that in the 2 years after household exposure to a child with varicella, adults were 33% less likely to develop zoster (incidence ratio 0.67, 95% confidence interval 0.62-0.73), and 27% less likely from 10 to 20 years (IR 0.73, CI 0.62-0.87). The boosting effect appeared to be stronger in men.
“Exogenous boosting provides some protection from the risk of herpes zoster, but not complete immunity, as assumed by previous cost effectiveness estimates of varicella immunization,” the researchers said.
More than two-thirds of the adults with shingles were women, which fits with previous reports. Median age of exposure to a child with varicella was 38 years.
Ms. Forbes and colleagues noted that “the study design required patients with zoster to be living with a child with varicella, therefore the study cohort is younger than a general population with zoster. ... However, when we restricted our analysis to adults aged 50 and older at exposure to varicella, a similar pattern of association was observed, with no evidence of effect modification by age. This suggests that although the median age of our study cohort ... was low, the findings can be generalized to older people.”
There was no external funding for the work, and the lead investigator had no relevant financial disclosures. One investigator reported research grants from GSK and Merck, both makers of chickenpox and shingles vaccines.
SOURCE: Forbes H et al. BMJ. 2020 Jan 22;368:l6987.
Exposure to children with chickenpox reduces the incidence of shingles in adults 33% over 2 years, and 27% out to 20 years, according to British investigators.
Being exposed to children with illness due to varicella infection acts as an “exogenous booster” in adults who had chickenpox themselves as children, making shingles less likely, they explained in a BMJ article.
Although that’s good news, it’s been reported previously that exposure to children with chickenpox confers complete protection against shingles in adults for years afterward.
The finding matters in the United Kingdom because varicella vaccine is not part of the pediatric immunization schedule. The United States is the only country that mandates two shots as a requirement for children to attend school.
The United Kingdom, however, is reconsidering its policy. In the past, the exogenous booster idea has been one of the arguments used against mandating the vaccine for children; the concern is that preventing chickenpox in children – and subsequent reexposure to herpes zoster in adults – would kick off a costly wave of shingles in adults.
The study results “are themselves unable to justify for or against specific vaccination schedules, but they do suggest that revised mathematical models are required to estimate the impact of varicella vaccination, with the updated assumption that exogenous boosting is incomplete and only reduces the risk of zoster by about 30%,” noted the investigators, led by Harriet Forbes of the London School of Hygiene and Tropical Medicine.
The researchers identified 9,604 adults with a shingles diagnosis during 1997-2018 who at some point lived with a child who had chickenpox. Data came from the U.K. Clinical Practice Research Datalink, a general practice database.
They then looked at the incidence of shingles within 20 years of exposure to the sick child and compared it with the incidence before exposure and after 20 years, by which time the exogenous booster is thought to wear off. It was a self-controlled case series analysis, “a relatively novel epidemiological study design where individuals act as their own controls. Comparisons are made within individuals rather than between individuals as in a cohort or case control study,” Ms. Forbes and colleagues explained.
After adjustment for age, calendar time, and season, they found that in the 2 years after household exposure to a child with varicella, adults were 33% less likely to develop zoster (incidence ratio 0.67, 95% confidence interval 0.62-0.73), and 27% less likely from 10 to 20 years (IR 0.73, CI 0.62-0.87). The boosting effect appeared to be stronger in men.
“Exogenous boosting provides some protection from the risk of herpes zoster, but not complete immunity, as assumed by previous cost effectiveness estimates of varicella immunization,” the researchers said.
More than two-thirds of the adults with shingles were women, which fits with previous reports. Median age of exposure to a child with varicella was 38 years.
Ms. Forbes and colleagues noted that “the study design required patients with zoster to be living with a child with varicella, therefore the study cohort is younger than a general population with zoster. ... However, when we restricted our analysis to adults aged 50 and older at exposure to varicella, a similar pattern of association was observed, with no evidence of effect modification by age. This suggests that although the median age of our study cohort ... was low, the findings can be generalized to older people.”
There was no external funding for the work, and the lead investigator had no relevant financial disclosures. One investigator reported research grants from GSK and Merck, both makers of chickenpox and shingles vaccines.
SOURCE: Forbes H et al. BMJ. 2020 Jan 22;368:l6987.
Exposure to children with chickenpox reduces the incidence of shingles in adults 33% over 2 years, and 27% out to 20 years, according to British investigators.
Being exposed to children with illness due to varicella infection acts as an “exogenous booster” in adults who had chickenpox themselves as children, making shingles less likely, they explained in a BMJ article.
Although that’s good news, it’s been reported previously that exposure to children with chickenpox confers complete protection against shingles in adults for years afterward.
The finding matters in the United Kingdom because varicella vaccine is not part of the pediatric immunization schedule. The United States is the only country that mandates two shots as a requirement for children to attend school.
The United Kingdom, however, is reconsidering its policy. In the past, the exogenous booster idea has been one of the arguments used against mandating the vaccine for children; the concern is that preventing chickenpox in children – and subsequent reexposure to herpes zoster in adults – would kick off a costly wave of shingles in adults.
The study results “are themselves unable to justify for or against specific vaccination schedules, but they do suggest that revised mathematical models are required to estimate the impact of varicella vaccination, with the updated assumption that exogenous boosting is incomplete and only reduces the risk of zoster by about 30%,” noted the investigators, led by Harriet Forbes of the London School of Hygiene and Tropical Medicine.
The researchers identified 9,604 adults with a shingles diagnosis during 1997-2018 who at some point lived with a child who had chickenpox. Data came from the U.K. Clinical Practice Research Datalink, a general practice database.
They then looked at the incidence of shingles within 20 years of exposure to the sick child and compared it with the incidence before exposure and after 20 years, by which time the exogenous booster is thought to wear off. It was a self-controlled case series analysis, “a relatively novel epidemiological study design where individuals act as their own controls. Comparisons are made within individuals rather than between individuals as in a cohort or case control study,” Ms. Forbes and colleagues explained.
After adjustment for age, calendar time, and season, they found that in the 2 years after household exposure to a child with varicella, adults were 33% less likely to develop zoster (incidence ratio 0.67, 95% confidence interval 0.62-0.73), and 27% less likely from 10 to 20 years (IR 0.73, CI 0.62-0.87). The boosting effect appeared to be stronger in men.
“Exogenous boosting provides some protection from the risk of herpes zoster, but not complete immunity, as assumed by previous cost effectiveness estimates of varicella immunization,” the researchers said.
More than two-thirds of the adults with shingles were women, which fits with previous reports. Median age of exposure to a child with varicella was 38 years.
Ms. Forbes and colleagues noted that “the study design required patients with zoster to be living with a child with varicella, therefore the study cohort is younger than a general population with zoster. ... However, when we restricted our analysis to adults aged 50 and older at exposure to varicella, a similar pattern of association was observed, with no evidence of effect modification by age. This suggests that although the median age of our study cohort ... was low, the findings can be generalized to older people.”
There was no external funding for the work, and the lead investigator had no relevant financial disclosures. One investigator reported research grants from GSK and Merck, both makers of chickenpox and shingles vaccines.
SOURCE: Forbes H et al. BMJ. 2020 Jan 22;368:l6987.
FROM BMJ
Washington state patient is first U.S. case of novel coronavirus
The first case of the novel coronavirus, named 2019-nCoV, in the United States has been diagnosed in a traveler from China who came through Seattle-Tacoma International Airport on Jan 15, the Centers for Disease Control and Prevention announced today at a press briefing.
The outbreak began at a animal and meat market in China and now has spread to at least three other countries, including Thailand, Japan and South Korea. While originally thought to be spreading from animal to person, it appears that limited person-to-person transmission is occurring, although it is currently unknown how easily this virus spreads between people.
More than 300 cases have been reported and six deaths have occurred. Fourteen health care workers have been infected.
Scott Lindquist, MD, MPH, Washington state epidemiologist, said at the briefing that the patient, a man who had been in Wuhan, arrived at Sea-Tac on Jan. 15, 2 days before airport screening had been initiated. He was symptom free at the time of his arrival and probably would not have been identified as infected with 2019-nCoV. The patient had been aware of the public health and news media coverage of 2019-nCoV and, after developing symptoms, contacted his health care provider on Jan. 19. The patient did not fly directly from Wuhan, but Dr. Lindquist said that he has been fully cooperative and has been helpful to authorities in tracing his route and contacts. The man is being treated at Providence Regional Medical Center, Everett, Wash.
The CDC obtained a specimen from the patient immediately and identified the 2019-nCoV within 24 hours.
Screening at airports is part of a multipart strategy to address this type of infection that includes public health information dissemination, patient education, as well as hospital preparation and training exercises. Currently, a strategy referred to as “funneling” is being implemented wherein travelers from China are rerouted and reticketed to one of the five airports conducting screening. At present, JFK in New York, San Francisco International, Los Angeles International, Hartsfield-Jackson Atlanta International Airport, and Chicago O’Hare International Airport are conducting inbound traveler screening.
The CDC is working in close cooperation with the Department of Homeland Security and the Federal Aviation Administration to coordinate travel screenings and reroutings. In addition, the CDC is working with the World Health Organization and the international global health community to share information about this outbreak. The CDC also has staff on site in Wuhan and is communicating with local health authorities. The CDC has activated its Emergency Operations Center to better provide ongoing support to the 2019-nCoV response. Currently, the focus is on tracing contacts and the means of transmission of this virus.
Updates on the outbreak will be posted on the CDC coronavirus website.
CORRECTION: 1/21/2020: The name of the medical center where the 2019-nCoV patient is being treated was corrected.
The first case of the novel coronavirus, named 2019-nCoV, in the United States has been diagnosed in a traveler from China who came through Seattle-Tacoma International Airport on Jan 15, the Centers for Disease Control and Prevention announced today at a press briefing.
The outbreak began at a animal and meat market in China and now has spread to at least three other countries, including Thailand, Japan and South Korea. While originally thought to be spreading from animal to person, it appears that limited person-to-person transmission is occurring, although it is currently unknown how easily this virus spreads between people.
More than 300 cases have been reported and six deaths have occurred. Fourteen health care workers have been infected.
Scott Lindquist, MD, MPH, Washington state epidemiologist, said at the briefing that the patient, a man who had been in Wuhan, arrived at Sea-Tac on Jan. 15, 2 days before airport screening had been initiated. He was symptom free at the time of his arrival and probably would not have been identified as infected with 2019-nCoV. The patient had been aware of the public health and news media coverage of 2019-nCoV and, after developing symptoms, contacted his health care provider on Jan. 19. The patient did not fly directly from Wuhan, but Dr. Lindquist said that he has been fully cooperative and has been helpful to authorities in tracing his route and contacts. The man is being treated at Providence Regional Medical Center, Everett, Wash.
The CDC obtained a specimen from the patient immediately and identified the 2019-nCoV within 24 hours.
Screening at airports is part of a multipart strategy to address this type of infection that includes public health information dissemination, patient education, as well as hospital preparation and training exercises. Currently, a strategy referred to as “funneling” is being implemented wherein travelers from China are rerouted and reticketed to one of the five airports conducting screening. At present, JFK in New York, San Francisco International, Los Angeles International, Hartsfield-Jackson Atlanta International Airport, and Chicago O’Hare International Airport are conducting inbound traveler screening.
The CDC is working in close cooperation with the Department of Homeland Security and the Federal Aviation Administration to coordinate travel screenings and reroutings. In addition, the CDC is working with the World Health Organization and the international global health community to share information about this outbreak. The CDC also has staff on site in Wuhan and is communicating with local health authorities. The CDC has activated its Emergency Operations Center to better provide ongoing support to the 2019-nCoV response. Currently, the focus is on tracing contacts and the means of transmission of this virus.
Updates on the outbreak will be posted on the CDC coronavirus website.
CORRECTION: 1/21/2020: The name of the medical center where the 2019-nCoV patient is being treated was corrected.
The first case of the novel coronavirus, named 2019-nCoV, in the United States has been diagnosed in a traveler from China who came through Seattle-Tacoma International Airport on Jan 15, the Centers for Disease Control and Prevention announced today at a press briefing.
The outbreak began at a animal and meat market in China and now has spread to at least three other countries, including Thailand, Japan and South Korea. While originally thought to be spreading from animal to person, it appears that limited person-to-person transmission is occurring, although it is currently unknown how easily this virus spreads between people.
More than 300 cases have been reported and six deaths have occurred. Fourteen health care workers have been infected.
Scott Lindquist, MD, MPH, Washington state epidemiologist, said at the briefing that the patient, a man who had been in Wuhan, arrived at Sea-Tac on Jan. 15, 2 days before airport screening had been initiated. He was symptom free at the time of his arrival and probably would not have been identified as infected with 2019-nCoV. The patient had been aware of the public health and news media coverage of 2019-nCoV and, after developing symptoms, contacted his health care provider on Jan. 19. The patient did not fly directly from Wuhan, but Dr. Lindquist said that he has been fully cooperative and has been helpful to authorities in tracing his route and contacts. The man is being treated at Providence Regional Medical Center, Everett, Wash.
The CDC obtained a specimen from the patient immediately and identified the 2019-nCoV within 24 hours.
Screening at airports is part of a multipart strategy to address this type of infection that includes public health information dissemination, patient education, as well as hospital preparation and training exercises. Currently, a strategy referred to as “funneling” is being implemented wherein travelers from China are rerouted and reticketed to one of the five airports conducting screening. At present, JFK in New York, San Francisco International, Los Angeles International, Hartsfield-Jackson Atlanta International Airport, and Chicago O’Hare International Airport are conducting inbound traveler screening.
The CDC is working in close cooperation with the Department of Homeland Security and the Federal Aviation Administration to coordinate travel screenings and reroutings. In addition, the CDC is working with the World Health Organization and the international global health community to share information about this outbreak. The CDC also has staff on site in Wuhan and is communicating with local health authorities. The CDC has activated its Emergency Operations Center to better provide ongoing support to the 2019-nCoV response. Currently, the focus is on tracing contacts and the means of transmission of this virus.
Updates on the outbreak will be posted on the CDC coronavirus website.
CORRECTION: 1/21/2020: The name of the medical center where the 2019-nCoV patient is being treated was corrected.
REPORTING FROM CDC
Runaway youth: Knowing the risk factors and care needs
As many as 1 in 20 youth run away from home each year, and you can play a critical role in identifying adolescents at high risk through confidential social histories and discussions, according to a clinical report from the American Academy of Pediatrics.
The academy’s data-rich report, “Runaway Youth: Caring for the Nation’s Largest Segment of Missing Children,” details how unaccompanied youth who run away – either on their own or who are asked to leave home – have high rates of trauma and neglect, mental illness, substance abuse, family dysfunction, and disengagement from school.
Children who identify as lesbian, gay, bisexual, transgender, and questioning or queer (LGBTQ) and youth in protective custody also are at high risk of running away and of becoming homeless – and once away from home, they and other runaways are at high risk for additional trauma, victimization, and violence, including sexual exploitation, according to the report published in Pediatrics.
“There clearly are certain populations at higher risk, and we really need to be aware of and in tune with these risks, and ask about the home and the household in order to try to decrease the risk of these kids getting into dangerous situations,” Thresia B. Gambon, MD, said in an interview. She is coauthor of the report and a pediatrician with the Citrus Health Network in Miami.
Among the AAP’s recommendations for practice is the guidance to conduct a thorough and confidential psychosocial assessment such as the HEEADSSS assessment (home environment, education and employment, eating peer-related activities, drugs, sexuality, suicide/depression, and safety) and to use a validated depression screening tool for adolescents, such as the Patient Health Questionnaire for Adolescents (PHQ-A) and the primary care version of the Beck Depression Inventory (BDI).
Broadly speaking, which involves being aware of trauma and adverse childhood experiences that can affect health,” according to the report. The AAP Trauma Toolbox for Primary Care is mentioned as a resource.
Most surprising to Dr. Gambon in the research and report-writing process were data showing that disengagement from school is a significant risk factor. “This stood out to me,” she said. “If there are school problems [of various types], kids might run away to avoid attending school.”
Tasked with updating the AAP’s 2004 clinical report, “The Pediatrician’s Role in the Prevention of Missing Children,” Dr. Gambon and coauthor, Janna R. Gewirtz O’Brien, MD, decided to look more closely at runaway youth after studying the numbers – some studies estimate that between 5% and 8% of adolescents run away every year. They saw that, “in general, the number of kids who just go missing has actually decreased [with the help of] cell phones,” Dr. Gambon said in an interview.
“The numbers of kids who are actually running away are high,” she said, “and probably we’re underidentifying these in our primary care clinics.”
Because a significant number of runaway youth become homeless, data on the homeless offers a valuable window not only into the health risks of homelessness for teens (substance abuse, pregnancy, STDs,) but also into risk factors for leaving home in the first place, she noted. Research shows, for instance, that about 20%-40% of teenagers who are homeless identify as LGBTQ, compared with 4%-10% of their nonhomeless peers.
When an adolescent at high risk for running away is identified, you should use practice- and community-based resources to address key issues, support psychological and behavioral health needs of the child and family, and ensure safety.
For youth who have run away, you can share information on local resources, as well as the national Runaway Safeline (1-800-RUNAWAY), which provides 24-hour referrals to community resources, including shelter, food banks, social services, and counseling. You also can ask adolescents whether they have sources of support and shelter (safe, supportive adults who might help in a crisis), and discuss safety plans for leaving home that include health care to mitigate risk, such as reliable contraception and access to mental health care.
“The goal with talking about a safety plan isn’t, of course, to encourage a child to run away, but if they feel as if they need to find somewhere else to live or stay, to discuss what resources are available to them to try to keep them as safe as possible when they’re out of their home,” Dr. Gambon said.
Dr. Gambon speaks partly from experience. She works routinely with youth who have run away from foster care homes, youth who have been trafficked, and other runaways. “I always try to talk with them about safety. I try not to put them down for their decisions but to work with them to make better decisions,” she said. “I work closely with a psychologist because a big part of this is getting them to have self-worth. They often feel as if no one cares, and some just want to be heard and to be able to talk about their situations.”
The AAP report notes that, of more than 70,000 contacts made to Runaway Safeline in 2017, 31% were about youth who were contemplating running away, 16% were about youth who had run away, 5% were about youth asked to leave home or prevented from returning, and 9% concerned youth experiencing homelessness. About three-quarters of the calls came from the youth themselves.
Dr. Gambon and Dr. Gewirtz O’Brien, of the department of pediatrics at the University of Minnesota in Minneapolis, worked with the AAP Committee on Psychosocial Aspects of Child and Family Health and the AAP Council on Community Pediatrics in producing the report. There was no external funding for this report and the authors said they had no conflicts of interest.
SOURCE: Gambon TB et al. Pediatrics. 2020 Jan 21. doi: 10.1542/peds.2019-3752.
As many as 1 in 20 youth run away from home each year, and you can play a critical role in identifying adolescents at high risk through confidential social histories and discussions, according to a clinical report from the American Academy of Pediatrics.
The academy’s data-rich report, “Runaway Youth: Caring for the Nation’s Largest Segment of Missing Children,” details how unaccompanied youth who run away – either on their own or who are asked to leave home – have high rates of trauma and neglect, mental illness, substance abuse, family dysfunction, and disengagement from school.
Children who identify as lesbian, gay, bisexual, transgender, and questioning or queer (LGBTQ) and youth in protective custody also are at high risk of running away and of becoming homeless – and once away from home, they and other runaways are at high risk for additional trauma, victimization, and violence, including sexual exploitation, according to the report published in Pediatrics.
“There clearly are certain populations at higher risk, and we really need to be aware of and in tune with these risks, and ask about the home and the household in order to try to decrease the risk of these kids getting into dangerous situations,” Thresia B. Gambon, MD, said in an interview. She is coauthor of the report and a pediatrician with the Citrus Health Network in Miami.
Among the AAP’s recommendations for practice is the guidance to conduct a thorough and confidential psychosocial assessment such as the HEEADSSS assessment (home environment, education and employment, eating peer-related activities, drugs, sexuality, suicide/depression, and safety) and to use a validated depression screening tool for adolescents, such as the Patient Health Questionnaire for Adolescents (PHQ-A) and the primary care version of the Beck Depression Inventory (BDI).
Broadly speaking, which involves being aware of trauma and adverse childhood experiences that can affect health,” according to the report. The AAP Trauma Toolbox for Primary Care is mentioned as a resource.
Most surprising to Dr. Gambon in the research and report-writing process were data showing that disengagement from school is a significant risk factor. “This stood out to me,” she said. “If there are school problems [of various types], kids might run away to avoid attending school.”
Tasked with updating the AAP’s 2004 clinical report, “The Pediatrician’s Role in the Prevention of Missing Children,” Dr. Gambon and coauthor, Janna R. Gewirtz O’Brien, MD, decided to look more closely at runaway youth after studying the numbers – some studies estimate that between 5% and 8% of adolescents run away every year. They saw that, “in general, the number of kids who just go missing has actually decreased [with the help of] cell phones,” Dr. Gambon said in an interview.
“The numbers of kids who are actually running away are high,” she said, “and probably we’re underidentifying these in our primary care clinics.”
Because a significant number of runaway youth become homeless, data on the homeless offers a valuable window not only into the health risks of homelessness for teens (substance abuse, pregnancy, STDs,) but also into risk factors for leaving home in the first place, she noted. Research shows, for instance, that about 20%-40% of teenagers who are homeless identify as LGBTQ, compared with 4%-10% of their nonhomeless peers.
When an adolescent at high risk for running away is identified, you should use practice- and community-based resources to address key issues, support psychological and behavioral health needs of the child and family, and ensure safety.
For youth who have run away, you can share information on local resources, as well as the national Runaway Safeline (1-800-RUNAWAY), which provides 24-hour referrals to community resources, including shelter, food banks, social services, and counseling. You also can ask adolescents whether they have sources of support and shelter (safe, supportive adults who might help in a crisis), and discuss safety plans for leaving home that include health care to mitigate risk, such as reliable contraception and access to mental health care.
“The goal with talking about a safety plan isn’t, of course, to encourage a child to run away, but if they feel as if they need to find somewhere else to live or stay, to discuss what resources are available to them to try to keep them as safe as possible when they’re out of their home,” Dr. Gambon said.
Dr. Gambon speaks partly from experience. She works routinely with youth who have run away from foster care homes, youth who have been trafficked, and other runaways. “I always try to talk with them about safety. I try not to put them down for their decisions but to work with them to make better decisions,” she said. “I work closely with a psychologist because a big part of this is getting them to have self-worth. They often feel as if no one cares, and some just want to be heard and to be able to talk about their situations.”
The AAP report notes that, of more than 70,000 contacts made to Runaway Safeline in 2017, 31% were about youth who were contemplating running away, 16% were about youth who had run away, 5% were about youth asked to leave home or prevented from returning, and 9% concerned youth experiencing homelessness. About three-quarters of the calls came from the youth themselves.
Dr. Gambon and Dr. Gewirtz O’Brien, of the department of pediatrics at the University of Minnesota in Minneapolis, worked with the AAP Committee on Psychosocial Aspects of Child and Family Health and the AAP Council on Community Pediatrics in producing the report. There was no external funding for this report and the authors said they had no conflicts of interest.
SOURCE: Gambon TB et al. Pediatrics. 2020 Jan 21. doi: 10.1542/peds.2019-3752.
As many as 1 in 20 youth run away from home each year, and you can play a critical role in identifying adolescents at high risk through confidential social histories and discussions, according to a clinical report from the American Academy of Pediatrics.
The academy’s data-rich report, “Runaway Youth: Caring for the Nation’s Largest Segment of Missing Children,” details how unaccompanied youth who run away – either on their own or who are asked to leave home – have high rates of trauma and neglect, mental illness, substance abuse, family dysfunction, and disengagement from school.
Children who identify as lesbian, gay, bisexual, transgender, and questioning or queer (LGBTQ) and youth in protective custody also are at high risk of running away and of becoming homeless – and once away from home, they and other runaways are at high risk for additional trauma, victimization, and violence, including sexual exploitation, according to the report published in Pediatrics.
“There clearly are certain populations at higher risk, and we really need to be aware of and in tune with these risks, and ask about the home and the household in order to try to decrease the risk of these kids getting into dangerous situations,” Thresia B. Gambon, MD, said in an interview. She is coauthor of the report and a pediatrician with the Citrus Health Network in Miami.
Among the AAP’s recommendations for practice is the guidance to conduct a thorough and confidential psychosocial assessment such as the HEEADSSS assessment (home environment, education and employment, eating peer-related activities, drugs, sexuality, suicide/depression, and safety) and to use a validated depression screening tool for adolescents, such as the Patient Health Questionnaire for Adolescents (PHQ-A) and the primary care version of the Beck Depression Inventory (BDI).
Broadly speaking, which involves being aware of trauma and adverse childhood experiences that can affect health,” according to the report. The AAP Trauma Toolbox for Primary Care is mentioned as a resource.
Most surprising to Dr. Gambon in the research and report-writing process were data showing that disengagement from school is a significant risk factor. “This stood out to me,” she said. “If there are school problems [of various types], kids might run away to avoid attending school.”
Tasked with updating the AAP’s 2004 clinical report, “The Pediatrician’s Role in the Prevention of Missing Children,” Dr. Gambon and coauthor, Janna R. Gewirtz O’Brien, MD, decided to look more closely at runaway youth after studying the numbers – some studies estimate that between 5% and 8% of adolescents run away every year. They saw that, “in general, the number of kids who just go missing has actually decreased [with the help of] cell phones,” Dr. Gambon said in an interview.
“The numbers of kids who are actually running away are high,” she said, “and probably we’re underidentifying these in our primary care clinics.”
Because a significant number of runaway youth become homeless, data on the homeless offers a valuable window not only into the health risks of homelessness for teens (substance abuse, pregnancy, STDs,) but also into risk factors for leaving home in the first place, she noted. Research shows, for instance, that about 20%-40% of teenagers who are homeless identify as LGBTQ, compared with 4%-10% of their nonhomeless peers.
When an adolescent at high risk for running away is identified, you should use practice- and community-based resources to address key issues, support psychological and behavioral health needs of the child and family, and ensure safety.
For youth who have run away, you can share information on local resources, as well as the national Runaway Safeline (1-800-RUNAWAY), which provides 24-hour referrals to community resources, including shelter, food banks, social services, and counseling. You also can ask adolescents whether they have sources of support and shelter (safe, supportive adults who might help in a crisis), and discuss safety plans for leaving home that include health care to mitigate risk, such as reliable contraception and access to mental health care.
“The goal with talking about a safety plan isn’t, of course, to encourage a child to run away, but if they feel as if they need to find somewhere else to live or stay, to discuss what resources are available to them to try to keep them as safe as possible when they’re out of their home,” Dr. Gambon said.
Dr. Gambon speaks partly from experience. She works routinely with youth who have run away from foster care homes, youth who have been trafficked, and other runaways. “I always try to talk with them about safety. I try not to put them down for their decisions but to work with them to make better decisions,” she said. “I work closely with a psychologist because a big part of this is getting them to have self-worth. They often feel as if no one cares, and some just want to be heard and to be able to talk about their situations.”
The AAP report notes that, of more than 70,000 contacts made to Runaway Safeline in 2017, 31% were about youth who were contemplating running away, 16% were about youth who had run away, 5% were about youth asked to leave home or prevented from returning, and 9% concerned youth experiencing homelessness. About three-quarters of the calls came from the youth themselves.
Dr. Gambon and Dr. Gewirtz O’Brien, of the department of pediatrics at the University of Minnesota in Minneapolis, worked with the AAP Committee on Psychosocial Aspects of Child and Family Health and the AAP Council on Community Pediatrics in producing the report. There was no external funding for this report and the authors said they had no conflicts of interest.
SOURCE: Gambon TB et al. Pediatrics. 2020 Jan 21. doi: 10.1542/peds.2019-3752.
FROM PEDIATRICS
A quick guide to PrEP: Steps to take & insurance coverage changes to watch for
References
- Centers for Disease Control and Prevention. Estimated HIV incidence and prevalence in the United States, 2010–2016. HIV Surveillance Supplemental Report. 2019;24. http://www.cdc.gov/hiv/library/reports/hiv-surveillance.html. Published February 2019. Accessed January 17, 2020.
- US Public Health Service. Preexposure prophylaxis for the prevention of HIV infection in the United States—2017 update: a clinical practice guideline. CDC Web Site. https://www.cdc.gov/hiv/pdf/risk/prep/cdc-hiv-prep-guidelines-2017.pdf. Published March 2018. Accessed January 17, 2020.
- US Preventive Services Task Force. Final recommendation statement: prevention of human immunodeficiency virus (HIV) infection: preexposure prophylaxis. https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/prevention-of-human-immunodeficiency-virus-hiv-infection-pre-exposure-prophylaxis. Published June 2019. Accessed January 17, 2020.
- Campos-Outcalt D. A look at new guidelines for HIV treatment and prevention. J Fam Pract. 2018;67:768-772.
References
- Centers for Disease Control and Prevention. Estimated HIV incidence and prevalence in the United States, 2010–2016. HIV Surveillance Supplemental Report. 2019;24. http://www.cdc.gov/hiv/library/reports/hiv-surveillance.html. Published February 2019. Accessed January 17, 2020.
- US Public Health Service. Preexposure prophylaxis for the prevention of HIV infection in the United States—2017 update: a clinical practice guideline. CDC Web Site. https://www.cdc.gov/hiv/pdf/risk/prep/cdc-hiv-prep-guidelines-2017.pdf. Published March 2018. Accessed January 17, 2020.
- US Preventive Services Task Force. Final recommendation statement: prevention of human immunodeficiency virus (HIV) infection: preexposure prophylaxis. https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/prevention-of-human-immunodeficiency-virus-hiv-infection-pre-exposure-prophylaxis. Published June 2019. Accessed January 17, 2020.
- Campos-Outcalt D. A look at new guidelines for HIV treatment and prevention. J Fam Pract. 2018;67:768-772.
References
- Centers for Disease Control and Prevention. Estimated HIV incidence and prevalence in the United States, 2010–2016. HIV Surveillance Supplemental Report. 2019;24. http://www.cdc.gov/hiv/library/reports/hiv-surveillance.html. Published February 2019. Accessed January 17, 2020.
- US Public Health Service. Preexposure prophylaxis for the prevention of HIV infection in the United States—2017 update: a clinical practice guideline. CDC Web Site. https://www.cdc.gov/hiv/pdf/risk/prep/cdc-hiv-prep-guidelines-2017.pdf. Published March 2018. Accessed January 17, 2020.
- US Preventive Services Task Force. Final recommendation statement: prevention of human immunodeficiency virus (HIV) infection: preexposure prophylaxis. https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/prevention-of-human-immunodeficiency-virus-hiv-infection-pre-exposure-prophylaxis. Published June 2019. Accessed January 17, 2020.
- Campos-Outcalt D. A look at new guidelines for HIV treatment and prevention. J Fam Pract. 2018;67:768-772.
Nontuberculous mycobacterial lung disease cases on the rise across U.S.
To assess the NTM lung disease burden on a national level, Kevin L. Winthrop, MD, of Oregon Health & Science University, Portland, and associates analyzed patient data from a U.S. managed care claims database between 2008 and 2015. Their findings were published in the Annals of the American Thoracic Society.
A case of NTM lung disease was defined as a patient with at least two medical claims with the disease’s diagnostic codes – 031.0 and A31.0 – that were at least 30 days apart. Of the 74,984,596 beneficiaries in the database, 9,476 met the case definition for NTM lung disease; 69% (n = 6,530) were women.
From 2008 to 2015, the annual incidence of NTM lung disease increased from 3.13 (95% confidence interval, 2.88-3.40) to 4.73 (95% CI, 4.43-5.05) per 100,000 person-years, with the average rate of yearly change being +5.2% (95% CI, 4.0%-6.4%; P less than .01).The annual prevalence increased from 6.78 (95% CI, 6.45-7.14) to 11.70 (95% CI, 11.26-12.16) per 100,000 persons, with the average rate of yearly change being +7.5% (95% CI, 6.7-8.2%; P less than .01).
The majority of NTM lung disease in the United States is caused by Mycobacterium avium complex (17), although other species such as M. abscessus, M. kansasii, M. xenopi, and others contribute to this disease burden.
“It’s a classic chicken-or-egg scenario,” said Sachin Gupta, MD, a pulmonologist in San Francisco, in regard to the rising numbers. “Increased awareness of NTM lung disease is, in part, why we’re seeing prevalence and incidence go up. And yet the disease itself may also be growing in clusters and pockets, as the data show, in various places across the nation.
“The worrisome aspect here,” he added, “is that future studies will likely show that, as incidence is increasing, mortality is increasing as well. That speaks to the challenges with these bugs: Very hard to diagnose, very hard to treat.”
The authors acknowledged their study’s limitations, including the lack of microbiologic or radiographic confirmation of the NTM infection and the inherent shortcomings of claims data–based studies overall. They did note a previous report, however, that “claims-based case identification has a high positive predictive value of approximately 82% for NTM lung disease.”
The study was funded by Insmed; the Intramural Research Programs of the National Institute of Allergy and Infectious Diseases; and the National Heart, Lung, and Blood Institute. The authors reported no conflicts of interest.
SOURCE: Winthrop KL et al. Ann Am Thorac Soc. 2019 Dec 13. doi: 10.1513/AnnalsATS.201804-236OC.
To assess the NTM lung disease burden on a national level, Kevin L. Winthrop, MD, of Oregon Health & Science University, Portland, and associates analyzed patient data from a U.S. managed care claims database between 2008 and 2015. Their findings were published in the Annals of the American Thoracic Society.
A case of NTM lung disease was defined as a patient with at least two medical claims with the disease’s diagnostic codes – 031.0 and A31.0 – that were at least 30 days apart. Of the 74,984,596 beneficiaries in the database, 9,476 met the case definition for NTM lung disease; 69% (n = 6,530) were women.
From 2008 to 2015, the annual incidence of NTM lung disease increased from 3.13 (95% confidence interval, 2.88-3.40) to 4.73 (95% CI, 4.43-5.05) per 100,000 person-years, with the average rate of yearly change being +5.2% (95% CI, 4.0%-6.4%; P less than .01).The annual prevalence increased from 6.78 (95% CI, 6.45-7.14) to 11.70 (95% CI, 11.26-12.16) per 100,000 persons, with the average rate of yearly change being +7.5% (95% CI, 6.7-8.2%; P less than .01).
The majority of NTM lung disease in the United States is caused by Mycobacterium avium complex (17), although other species such as M. abscessus, M. kansasii, M. xenopi, and others contribute to this disease burden.
“It’s a classic chicken-or-egg scenario,” said Sachin Gupta, MD, a pulmonologist in San Francisco, in regard to the rising numbers. “Increased awareness of NTM lung disease is, in part, why we’re seeing prevalence and incidence go up. And yet the disease itself may also be growing in clusters and pockets, as the data show, in various places across the nation.
“The worrisome aspect here,” he added, “is that future studies will likely show that, as incidence is increasing, mortality is increasing as well. That speaks to the challenges with these bugs: Very hard to diagnose, very hard to treat.”
The authors acknowledged their study’s limitations, including the lack of microbiologic or radiographic confirmation of the NTM infection and the inherent shortcomings of claims data–based studies overall. They did note a previous report, however, that “claims-based case identification has a high positive predictive value of approximately 82% for NTM lung disease.”
The study was funded by Insmed; the Intramural Research Programs of the National Institute of Allergy and Infectious Diseases; and the National Heart, Lung, and Blood Institute. The authors reported no conflicts of interest.
SOURCE: Winthrop KL et al. Ann Am Thorac Soc. 2019 Dec 13. doi: 10.1513/AnnalsATS.201804-236OC.
To assess the NTM lung disease burden on a national level, Kevin L. Winthrop, MD, of Oregon Health & Science University, Portland, and associates analyzed patient data from a U.S. managed care claims database between 2008 and 2015. Their findings were published in the Annals of the American Thoracic Society.
A case of NTM lung disease was defined as a patient with at least two medical claims with the disease’s diagnostic codes – 031.0 and A31.0 – that were at least 30 days apart. Of the 74,984,596 beneficiaries in the database, 9,476 met the case definition for NTM lung disease; 69% (n = 6,530) were women.
From 2008 to 2015, the annual incidence of NTM lung disease increased from 3.13 (95% confidence interval, 2.88-3.40) to 4.73 (95% CI, 4.43-5.05) per 100,000 person-years, with the average rate of yearly change being +5.2% (95% CI, 4.0%-6.4%; P less than .01).The annual prevalence increased from 6.78 (95% CI, 6.45-7.14) to 11.70 (95% CI, 11.26-12.16) per 100,000 persons, with the average rate of yearly change being +7.5% (95% CI, 6.7-8.2%; P less than .01).
The majority of NTM lung disease in the United States is caused by Mycobacterium avium complex (17), although other species such as M. abscessus, M. kansasii, M. xenopi, and others contribute to this disease burden.
“It’s a classic chicken-or-egg scenario,” said Sachin Gupta, MD, a pulmonologist in San Francisco, in regard to the rising numbers. “Increased awareness of NTM lung disease is, in part, why we’re seeing prevalence and incidence go up. And yet the disease itself may also be growing in clusters and pockets, as the data show, in various places across the nation.
“The worrisome aspect here,” he added, “is that future studies will likely show that, as incidence is increasing, mortality is increasing as well. That speaks to the challenges with these bugs: Very hard to diagnose, very hard to treat.”
The authors acknowledged their study’s limitations, including the lack of microbiologic or radiographic confirmation of the NTM infection and the inherent shortcomings of claims data–based studies overall. They did note a previous report, however, that “claims-based case identification has a high positive predictive value of approximately 82% for NTM lung disease.”
The study was funded by Insmed; the Intramural Research Programs of the National Institute of Allergy and Infectious Diseases; and the National Heart, Lung, and Blood Institute. The authors reported no conflicts of interest.
SOURCE: Winthrop KL et al. Ann Am Thorac Soc. 2019 Dec 13. doi: 10.1513/AnnalsATS.201804-236OC.
FROM ANNALS OF THE AMERICAN THORACIC SOCIETY
Travelers to three U.S. airports to be screened for novel coronavirus
according to an announcement from the Centers for Disease Control and Prevention.
Starting today, Jan. 17, 2020, people traveling from Wuhan to New York (JFK), San Francisco (SFO), and Los Angeles (LAX) airports will be screened for symptoms associated with 2019-nCoV, which include fever, cough, and difficulty breathing.
“Based on the information that CDC has today, we believe the current risk for this virus to the general public is low,” Nancy Messonnier, MD, director of the National Center for Immunization and Respiratory Diseases, said during a CDC telebriefing.
To date, 45 cases of 2019-nCoV have been reported in Wuhan, according to the CDC. The Wuhan Municipal Health Commission said 15 patients have been cured and discharged, 5 severe cases are still being treated, and 2 patients have died. Both deaths occurred in older patients, one of whom was aged 69 years and one aged 61 years. One of the patients was known to have underlying health conditions.
Three cases of 2019-nCoV have been confirmed outside of Wuhan, one in Japan and two in Thailand. All three were travelers from Wuhan.
The virus is believed to have originated at Wuhan South China Seafood City, a market that sold seafood, chickens, bats, cats, marmots, and other wild animals. (The market has since been closed and disinfected.) The origin suggests animal-to-human transmission of 2019-nCoV, but it appears that human-to-human transmission can occur as well.
“While most of these infections seem to be happening from animals to people, there is some indication that limited person-to-person spread is happening,” Dr. Messonnier said.
Because of this potential risk, the CDC is working with the Department of Homeland Security’s Customs and Border Protection to screen travelers from Wuhan to the United States. The CDC is deploying about 100 additional staff to JFK, SFO, and LAX, where direct flights (JFK and SFO) or connecting flights (LAX) from Wuhan land.
The CDC could not confirm if exit screening is planned for people traveling abroad from Wuhan.
At the U.S. airports, travelers from Wuhan will be given a questionnaire asking about symptoms of 2019-nCoV (fever, cough, and difficulty breathing). People who exhibit symptoms will be assessed and questioned further. If they are believed to have 2019-nCoV, they will be sent to designated hospitals, where they will be examined, and samples will be collected.
Samples from patients with suspected 2019-nCoV will be sent to the CDC for analysis. Chinese health authorities made the full genome of 2019-nCoV publicly available, which will allow the CDC to confirm any cases that may arise in the United States. The CDC is currently working on a test to detect 2019-nCoV, which can be distributed to state health departments.
Earlier this month, the CDC issued a Level 1 Travel Health Notice for travelers to Wuhan and a Health Alert on 2019-nCoV. The latest information on 2019-nCoV can be found on the CDC’s Novel Coronavirus 2019 webpage.
according to an announcement from the Centers for Disease Control and Prevention.
Starting today, Jan. 17, 2020, people traveling from Wuhan to New York (JFK), San Francisco (SFO), and Los Angeles (LAX) airports will be screened for symptoms associated with 2019-nCoV, which include fever, cough, and difficulty breathing.
“Based on the information that CDC has today, we believe the current risk for this virus to the general public is low,” Nancy Messonnier, MD, director of the National Center for Immunization and Respiratory Diseases, said during a CDC telebriefing.
To date, 45 cases of 2019-nCoV have been reported in Wuhan, according to the CDC. The Wuhan Municipal Health Commission said 15 patients have been cured and discharged, 5 severe cases are still being treated, and 2 patients have died. Both deaths occurred in older patients, one of whom was aged 69 years and one aged 61 years. One of the patients was known to have underlying health conditions.
Three cases of 2019-nCoV have been confirmed outside of Wuhan, one in Japan and two in Thailand. All three were travelers from Wuhan.
The virus is believed to have originated at Wuhan South China Seafood City, a market that sold seafood, chickens, bats, cats, marmots, and other wild animals. (The market has since been closed and disinfected.) The origin suggests animal-to-human transmission of 2019-nCoV, but it appears that human-to-human transmission can occur as well.
“While most of these infections seem to be happening from animals to people, there is some indication that limited person-to-person spread is happening,” Dr. Messonnier said.
Because of this potential risk, the CDC is working with the Department of Homeland Security’s Customs and Border Protection to screen travelers from Wuhan to the United States. The CDC is deploying about 100 additional staff to JFK, SFO, and LAX, where direct flights (JFK and SFO) or connecting flights (LAX) from Wuhan land.
The CDC could not confirm if exit screening is planned for people traveling abroad from Wuhan.
At the U.S. airports, travelers from Wuhan will be given a questionnaire asking about symptoms of 2019-nCoV (fever, cough, and difficulty breathing). People who exhibit symptoms will be assessed and questioned further. If they are believed to have 2019-nCoV, they will be sent to designated hospitals, where they will be examined, and samples will be collected.
Samples from patients with suspected 2019-nCoV will be sent to the CDC for analysis. Chinese health authorities made the full genome of 2019-nCoV publicly available, which will allow the CDC to confirm any cases that may arise in the United States. The CDC is currently working on a test to detect 2019-nCoV, which can be distributed to state health departments.
Earlier this month, the CDC issued a Level 1 Travel Health Notice for travelers to Wuhan and a Health Alert on 2019-nCoV. The latest information on 2019-nCoV can be found on the CDC’s Novel Coronavirus 2019 webpage.
according to an announcement from the Centers for Disease Control and Prevention.
Starting today, Jan. 17, 2020, people traveling from Wuhan to New York (JFK), San Francisco (SFO), and Los Angeles (LAX) airports will be screened for symptoms associated with 2019-nCoV, which include fever, cough, and difficulty breathing.
“Based on the information that CDC has today, we believe the current risk for this virus to the general public is low,” Nancy Messonnier, MD, director of the National Center for Immunization and Respiratory Diseases, said during a CDC telebriefing.
To date, 45 cases of 2019-nCoV have been reported in Wuhan, according to the CDC. The Wuhan Municipal Health Commission said 15 patients have been cured and discharged, 5 severe cases are still being treated, and 2 patients have died. Both deaths occurred in older patients, one of whom was aged 69 years and one aged 61 years. One of the patients was known to have underlying health conditions.
Three cases of 2019-nCoV have been confirmed outside of Wuhan, one in Japan and two in Thailand. All three were travelers from Wuhan.
The virus is believed to have originated at Wuhan South China Seafood City, a market that sold seafood, chickens, bats, cats, marmots, and other wild animals. (The market has since been closed and disinfected.) The origin suggests animal-to-human transmission of 2019-nCoV, but it appears that human-to-human transmission can occur as well.
“While most of these infections seem to be happening from animals to people, there is some indication that limited person-to-person spread is happening,” Dr. Messonnier said.
Because of this potential risk, the CDC is working with the Department of Homeland Security’s Customs and Border Protection to screen travelers from Wuhan to the United States. The CDC is deploying about 100 additional staff to JFK, SFO, and LAX, where direct flights (JFK and SFO) or connecting flights (LAX) from Wuhan land.
The CDC could not confirm if exit screening is planned for people traveling abroad from Wuhan.
At the U.S. airports, travelers from Wuhan will be given a questionnaire asking about symptoms of 2019-nCoV (fever, cough, and difficulty breathing). People who exhibit symptoms will be assessed and questioned further. If they are believed to have 2019-nCoV, they will be sent to designated hospitals, where they will be examined, and samples will be collected.
Samples from patients with suspected 2019-nCoV will be sent to the CDC for analysis. Chinese health authorities made the full genome of 2019-nCoV publicly available, which will allow the CDC to confirm any cases that may arise in the United States. The CDC is currently working on a test to detect 2019-nCoV, which can be distributed to state health departments.
Earlier this month, the CDC issued a Level 1 Travel Health Notice for travelers to Wuhan and a Health Alert on 2019-nCoV. The latest information on 2019-nCoV can be found on the CDC’s Novel Coronavirus 2019 webpage.
Flu activity declines for second straight week
Flu activity dropped nationally for a second consecutive week, but the changing predominance in type from influenza B to A suggests that “it is too early to know whether the season has peaked,” the Centers for Disease Control and Prevention said Jan. 17.
Patients with influenza-like illness (ILI) dropped from 5.7% to 4.7% of all visits to outpatient providers for the week ending Jan. 11, and the proportion of respiratory specimens positive for influenza decreased from 23.6% the week before to 22.9%, the CDC’s influenza division reported.
Despite that overall drop in positive specimens, however, “the percent positive for influenza A viruses increased and some regions are seeing increases in the proportion of influenza A(H1N1)pdm09 viruses compared to other influenza viruses,” the influenza division noted.
Outpatient activity on the state level also was down for the week. There were 23 jurisdictions – 21 states, New York City, and Puerto Rico – at level 10 on the CDC’s 1-10 scale of ILI activity for the week ending Jan. 11, compared with 33 the previous week, data from the CDC’s Outpatient Influenza-like Illness Surveillance Network show.
Indicators of ILI severity have not risen to high levels. “The percentage of deaths attributed to pneumonia and influenza increased from 6.0% to 6.9% but remains below the epidemic threshold” of 7.0% for the week, and the hospitalization rate remains at a fairly typical level for this time of year, the influenza division said.
For the week ending Jan. 11, 7 new ILI-related pediatric deaths were reported, which brings the total to 39 for the 2019-2020 season. Children aged 0-4 years are the second-most likely age group to be hospitalized with the flu (34.4/100,000 population) after adults aged 65 years and older, who have a cumulative rate of 47.6/100,000 for the season, the CDC reported.
Flu activity dropped nationally for a second consecutive week, but the changing predominance in type from influenza B to A suggests that “it is too early to know whether the season has peaked,” the Centers for Disease Control and Prevention said Jan. 17.
Patients with influenza-like illness (ILI) dropped from 5.7% to 4.7% of all visits to outpatient providers for the week ending Jan. 11, and the proportion of respiratory specimens positive for influenza decreased from 23.6% the week before to 22.9%, the CDC’s influenza division reported.
Despite that overall drop in positive specimens, however, “the percent positive for influenza A viruses increased and some regions are seeing increases in the proportion of influenza A(H1N1)pdm09 viruses compared to other influenza viruses,” the influenza division noted.
Outpatient activity on the state level also was down for the week. There were 23 jurisdictions – 21 states, New York City, and Puerto Rico – at level 10 on the CDC’s 1-10 scale of ILI activity for the week ending Jan. 11, compared with 33 the previous week, data from the CDC’s Outpatient Influenza-like Illness Surveillance Network show.
Indicators of ILI severity have not risen to high levels. “The percentage of deaths attributed to pneumonia and influenza increased from 6.0% to 6.9% but remains below the epidemic threshold” of 7.0% for the week, and the hospitalization rate remains at a fairly typical level for this time of year, the influenza division said.
For the week ending Jan. 11, 7 new ILI-related pediatric deaths were reported, which brings the total to 39 for the 2019-2020 season. Children aged 0-4 years are the second-most likely age group to be hospitalized with the flu (34.4/100,000 population) after adults aged 65 years and older, who have a cumulative rate of 47.6/100,000 for the season, the CDC reported.
Flu activity dropped nationally for a second consecutive week, but the changing predominance in type from influenza B to A suggests that “it is too early to know whether the season has peaked,” the Centers for Disease Control and Prevention said Jan. 17.
Patients with influenza-like illness (ILI) dropped from 5.7% to 4.7% of all visits to outpatient providers for the week ending Jan. 11, and the proportion of respiratory specimens positive for influenza decreased from 23.6% the week before to 22.9%, the CDC’s influenza division reported.
Despite that overall drop in positive specimens, however, “the percent positive for influenza A viruses increased and some regions are seeing increases in the proportion of influenza A(H1N1)pdm09 viruses compared to other influenza viruses,” the influenza division noted.
Outpatient activity on the state level also was down for the week. There were 23 jurisdictions – 21 states, New York City, and Puerto Rico – at level 10 on the CDC’s 1-10 scale of ILI activity for the week ending Jan. 11, compared with 33 the previous week, data from the CDC’s Outpatient Influenza-like Illness Surveillance Network show.
Indicators of ILI severity have not risen to high levels. “The percentage of deaths attributed to pneumonia and influenza increased from 6.0% to 6.9% but remains below the epidemic threshold” of 7.0% for the week, and the hospitalization rate remains at a fairly typical level for this time of year, the influenza division said.
For the week ending Jan. 11, 7 new ILI-related pediatric deaths were reported, which brings the total to 39 for the 2019-2020 season. Children aged 0-4 years are the second-most likely age group to be hospitalized with the flu (34.4/100,000 population) after adults aged 65 years and older, who have a cumulative rate of 47.6/100,000 for the season, the CDC reported.
Children with resistant UTIs unexpectedly may respond to discordant antibiotics
Children with urinary tract infections (UTIs) may improve clinically, and pyuria may resolve, during empiric treatment with an antibiotic that turns out to be discordant, according a retrospective study in Pediatrics.
“The low rate of care escalation and high rate of clinical improvement while on discordant antibiotics suggests that, for most patients, it would be reasonable to continue current empiric antibiotic practices until urine culture sensitivities return,” said first author Marie E. Wang, MD, a pediatric hospitalist at Stanford (Calif.) University, and colleagues.
The researchers examined the initial clinical response and escalation of care for 316 children with UTIs who received therapy to which the infecting isolate was not susceptible. The study included patients who had infections that were resistant to third-generation cephalosporins – that is, urinalysis found that the infections were not susceptible to ceftriaxone or cefotaxime in vitro. Before the resistant organisms were identified, however, the patients were started on discordant antibiotics.
Escalation of care was uncommon
The patients had a median age of 2.4 years, and 78% were girls. Approximately 90% were started on a cephalosporin, and about 65% received a first-generation cephalosporin. Patients presented during 2012-2017 to one of five children’s hospitals or to a large managed care organization with 10 hospitals in the United States. The investigators defined care escalation as a visit to the emergency department, hospitalization, or transfer to the ICU.
In all, seven patients (2%) had escalation of care on discordant antibiotics. Four children visited an emergency department without hospitalization, and three children were hospitalized because of persistent symptoms.
Among 230 cases for which the researchers had data about clinical response at a median follow-up of 3 days, 84% “had overall clinical improvement while on discordant antibiotics,” the authors said.
For 22 children who had repeat urine testing while on discordant antibiotics, 53% had resolution of pyuria, and 32% had improvement of pyuria, whereas 16% did not have improvement. Of the three patients without improvement, one had no change, and two had worsening.
Of 17 patients who had a repeat urine culture on discordant therapy, 65% had a negative repeat culture, and 18% grew the same pathogen with a decreased colony count. Two patients had a colony count that remained unchanged, and one patient had an increased colony count.
Small studies outside the United States have reported similar results, the researchers noted. Spontaneous resolution of UTIs or antibiotics reaching a sufficient concentration in the urine and renal parenchyma to achieve a clinical response are possible explanations for the findings, they wrote.
“Few children required escalation of care and most experienced initial clinical improvement,” noted Dr. Wang and colleagues. “Furthermore, in the small group of children that underwent repeat urine testing while on discordant therapy, most had resolution or improvement in pyuria and sterilization of their urine cultures. Our findings suggest that Additionally, given that these patients initially received what would generally be considered inadequate treatment, our findings may provide some insight into the natural history of UTIs and/or trigger further investigation into the relationship between in vitro urine culture susceptibilities and in vivo clinical response to treatment.”
‘Caution is needed’
The study “highlights an intriguing observation about children with UTIs unexpectedly responding to discordant antibiotic therapy,” Tej K. Mattoo, MD, and Basim I. Asmar, MD, wrote in an accompanying commentary.(doi: 10.1542/peds.2019-3512). Dr. Mattoo and Dr. Asmar, a pediatric nephrologist and a specialist in pediatric infectious diseases, respectively, at Wayne State University and affiliated with Children’s Hospital of Michigan, both in Detroit.
In an inpatient setting, it may be easy for physicians to reassess patients “once urine culture results reveal resistance to the treating antibiotic,” they noted. In an ambulatory setting, however, “it is likely that some patients will receive a full course of an antibiotic that does not have in vitro activity against the urinary pathogen.”
Physicians have a responsibility to use antibiotics judiciously, they said. Widely accepted principles include avoiding repeated courses of antibiotics, diagnosing UTIs appropriately, and not treating asymptomatic bacteriuria.
The study had no external funding. The authors had no relevant financial disclosures.
SOURCE: Wang ME et al. Pediatrics. 2020 Jan 17. doi: 10.1542/peds.2019-1608.
This article was updated 2/4/2020.
Children with urinary tract infections (UTIs) may improve clinically, and pyuria may resolve, during empiric treatment with an antibiotic that turns out to be discordant, according a retrospective study in Pediatrics.
“The low rate of care escalation and high rate of clinical improvement while on discordant antibiotics suggests that, for most patients, it would be reasonable to continue current empiric antibiotic practices until urine culture sensitivities return,” said first author Marie E. Wang, MD, a pediatric hospitalist at Stanford (Calif.) University, and colleagues.
The researchers examined the initial clinical response and escalation of care for 316 children with UTIs who received therapy to which the infecting isolate was not susceptible. The study included patients who had infections that were resistant to third-generation cephalosporins – that is, urinalysis found that the infections were not susceptible to ceftriaxone or cefotaxime in vitro. Before the resistant organisms were identified, however, the patients were started on discordant antibiotics.
Escalation of care was uncommon
The patients had a median age of 2.4 years, and 78% were girls. Approximately 90% were started on a cephalosporin, and about 65% received a first-generation cephalosporin. Patients presented during 2012-2017 to one of five children’s hospitals or to a large managed care organization with 10 hospitals in the United States. The investigators defined care escalation as a visit to the emergency department, hospitalization, or transfer to the ICU.
In all, seven patients (2%) had escalation of care on discordant antibiotics. Four children visited an emergency department without hospitalization, and three children were hospitalized because of persistent symptoms.
Among 230 cases for which the researchers had data about clinical response at a median follow-up of 3 days, 84% “had overall clinical improvement while on discordant antibiotics,” the authors said.
For 22 children who had repeat urine testing while on discordant antibiotics, 53% had resolution of pyuria, and 32% had improvement of pyuria, whereas 16% did not have improvement. Of the three patients without improvement, one had no change, and two had worsening.
Of 17 patients who had a repeat urine culture on discordant therapy, 65% had a negative repeat culture, and 18% grew the same pathogen with a decreased colony count. Two patients had a colony count that remained unchanged, and one patient had an increased colony count.
Small studies outside the United States have reported similar results, the researchers noted. Spontaneous resolution of UTIs or antibiotics reaching a sufficient concentration in the urine and renal parenchyma to achieve a clinical response are possible explanations for the findings, they wrote.
“Few children required escalation of care and most experienced initial clinical improvement,” noted Dr. Wang and colleagues. “Furthermore, in the small group of children that underwent repeat urine testing while on discordant therapy, most had resolution or improvement in pyuria and sterilization of their urine cultures. Our findings suggest that Additionally, given that these patients initially received what would generally be considered inadequate treatment, our findings may provide some insight into the natural history of UTIs and/or trigger further investigation into the relationship between in vitro urine culture susceptibilities and in vivo clinical response to treatment.”
‘Caution is needed’
The study “highlights an intriguing observation about children with UTIs unexpectedly responding to discordant antibiotic therapy,” Tej K. Mattoo, MD, and Basim I. Asmar, MD, wrote in an accompanying commentary.(doi: 10.1542/peds.2019-3512). Dr. Mattoo and Dr. Asmar, a pediatric nephrologist and a specialist in pediatric infectious diseases, respectively, at Wayne State University and affiliated with Children’s Hospital of Michigan, both in Detroit.
In an inpatient setting, it may be easy for physicians to reassess patients “once urine culture results reveal resistance to the treating antibiotic,” they noted. In an ambulatory setting, however, “it is likely that some patients will receive a full course of an antibiotic that does not have in vitro activity against the urinary pathogen.”
Physicians have a responsibility to use antibiotics judiciously, they said. Widely accepted principles include avoiding repeated courses of antibiotics, diagnosing UTIs appropriately, and not treating asymptomatic bacteriuria.
The study had no external funding. The authors had no relevant financial disclosures.
SOURCE: Wang ME et al. Pediatrics. 2020 Jan 17. doi: 10.1542/peds.2019-1608.
This article was updated 2/4/2020.
Children with urinary tract infections (UTIs) may improve clinically, and pyuria may resolve, during empiric treatment with an antibiotic that turns out to be discordant, according a retrospective study in Pediatrics.
“The low rate of care escalation and high rate of clinical improvement while on discordant antibiotics suggests that, for most patients, it would be reasonable to continue current empiric antibiotic practices until urine culture sensitivities return,” said first author Marie E. Wang, MD, a pediatric hospitalist at Stanford (Calif.) University, and colleagues.
The researchers examined the initial clinical response and escalation of care for 316 children with UTIs who received therapy to which the infecting isolate was not susceptible. The study included patients who had infections that were resistant to third-generation cephalosporins – that is, urinalysis found that the infections were not susceptible to ceftriaxone or cefotaxime in vitro. Before the resistant organisms were identified, however, the patients were started on discordant antibiotics.
Escalation of care was uncommon
The patients had a median age of 2.4 years, and 78% were girls. Approximately 90% were started on a cephalosporin, and about 65% received a first-generation cephalosporin. Patients presented during 2012-2017 to one of five children’s hospitals or to a large managed care organization with 10 hospitals in the United States. The investigators defined care escalation as a visit to the emergency department, hospitalization, or transfer to the ICU.
In all, seven patients (2%) had escalation of care on discordant antibiotics. Four children visited an emergency department without hospitalization, and three children were hospitalized because of persistent symptoms.
Among 230 cases for which the researchers had data about clinical response at a median follow-up of 3 days, 84% “had overall clinical improvement while on discordant antibiotics,” the authors said.
For 22 children who had repeat urine testing while on discordant antibiotics, 53% had resolution of pyuria, and 32% had improvement of pyuria, whereas 16% did not have improvement. Of the three patients without improvement, one had no change, and two had worsening.
Of 17 patients who had a repeat urine culture on discordant therapy, 65% had a negative repeat culture, and 18% grew the same pathogen with a decreased colony count. Two patients had a colony count that remained unchanged, and one patient had an increased colony count.
Small studies outside the United States have reported similar results, the researchers noted. Spontaneous resolution of UTIs or antibiotics reaching a sufficient concentration in the urine and renal parenchyma to achieve a clinical response are possible explanations for the findings, they wrote.
“Few children required escalation of care and most experienced initial clinical improvement,” noted Dr. Wang and colleagues. “Furthermore, in the small group of children that underwent repeat urine testing while on discordant therapy, most had resolution or improvement in pyuria and sterilization of their urine cultures. Our findings suggest that Additionally, given that these patients initially received what would generally be considered inadequate treatment, our findings may provide some insight into the natural history of UTIs and/or trigger further investigation into the relationship between in vitro urine culture susceptibilities and in vivo clinical response to treatment.”
‘Caution is needed’
The study “highlights an intriguing observation about children with UTIs unexpectedly responding to discordant antibiotic therapy,” Tej K. Mattoo, MD, and Basim I. Asmar, MD, wrote in an accompanying commentary.(doi: 10.1542/peds.2019-3512). Dr. Mattoo and Dr. Asmar, a pediatric nephrologist and a specialist in pediatric infectious diseases, respectively, at Wayne State University and affiliated with Children’s Hospital of Michigan, both in Detroit.
In an inpatient setting, it may be easy for physicians to reassess patients “once urine culture results reveal resistance to the treating antibiotic,” they noted. In an ambulatory setting, however, “it is likely that some patients will receive a full course of an antibiotic that does not have in vitro activity against the urinary pathogen.”
Physicians have a responsibility to use antibiotics judiciously, they said. Widely accepted principles include avoiding repeated courses of antibiotics, diagnosing UTIs appropriately, and not treating asymptomatic bacteriuria.
The study had no external funding. The authors had no relevant financial disclosures.
SOURCE: Wang ME et al. Pediatrics. 2020 Jan 17. doi: 10.1542/peds.2019-1608.
This article was updated 2/4/2020.
FROM PEDIATRICS
Two new cases of coronavirus pneumonia in Thailand, Japan
Health authorities in Wuhan, Hubei Province, China, identified the novel coronavirus, 2019-nCoV, responsible for the outbreak of a mysterious pneumonia that resulted in hospitalization of more than 40 patients and one death, according to the Centers for Disease Control and Prevention in a statement on the CDC website.
On Jan. 13, the Thailand’s Ministry of Public Health reported the first imported case of lab-confirmed 2019-nCoV from Wuhan. The Centers for Disease Control and Prevention stated: “The traveler with febrile illness was detected on the same day by thermal surveillance at Suvarnabhumi Airport, Thailand, and was hospitalized the same day. After temperature check and initial assessment, she was transferred to the hospital for further investigations and treatment.”
Samples from this patient tested positive for coronaviruses by reverse transcriptase-polymerase chain reaction. The genomic sequencing analysis was performed by Emerging Infectious Diseases Health Science Center, the Thai Red Cross Society, and the Thai National Institute of Health. The patient is reported to be in stable condition.
The New York Times has reported a case of 2019-nCoV in Japan in a traveler returning from Wuhan. That patient is reported to have recovered and been discharged.
Chinese health authorities transmitted the full genome of “2019 novel coronavirus,” or “2019-nCoV,” to GenBank, the genetic sequence database managed by the National Institutes of Health, and in the Global Initiative on Sharing All Influenza Data portal.
Coronaviruses are a large family of viruses. Most known human coronaviruses only cause mild respiratory disease, such as the common cold. But several coronaviruses have emerged to infect people and cause severe disease, such as has been seen with severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). The cases in the Wuhan pneumonia outbreak have tested negative for both SARS and MERS.
The outbreak in Wuhan appears to be contained. The World Health Organization reported that the Wuhan health authorities identified and followed 763 close contacts, including health care workers. No additional cases of infection with the novel coronavirus have been identified. The cluster of cases is linked to the Wuhan South China Seafood City market where – in addition to seafood – chickens, bats, marmots, and other animals were sold. That market has been closed since Jan. 1, 2020, for cleaning and disinfection.
The WHO is monitoring the situation closely and is in close contact with Chinese health authorities.
The CDC has issued a Level 1 travel alert and recommended that travelers to Wuhan, a city of over 19 million people, avoid animal and meat markets, avoid contact with sick people, and wash hands often with soap and water. Travelers who have been in Wuhan recently and who experience respiratory symptoms should notify the local health department immediately.
In addition, the CDC recommends that, for symptomatic patients with a history of travel to Wuhan, caution should be exercised in the health care setting. “Ask such patients to don a surgical mask as soon as they are identified. Conduct their evaluation in a private room with the door closed. Personnel entering the room to evaluate the patient should use contact precautions and wear an N95 disposable facepiece respirator. For patients admitted for inpatient care, implement contact and airborne isolation precautions, in addition to standard precautions, until further information becomes available. For additional infection control guidance see: www.cdc.gov/infectioncontrol/guidelines/isolation/index.html.”
Health authorities in Wuhan, Hubei Province, China, identified the novel coronavirus, 2019-nCoV, responsible for the outbreak of a mysterious pneumonia that resulted in hospitalization of more than 40 patients and one death, according to the Centers for Disease Control and Prevention in a statement on the CDC website.
On Jan. 13, the Thailand’s Ministry of Public Health reported the first imported case of lab-confirmed 2019-nCoV from Wuhan. The Centers for Disease Control and Prevention stated: “The traveler with febrile illness was detected on the same day by thermal surveillance at Suvarnabhumi Airport, Thailand, and was hospitalized the same day. After temperature check and initial assessment, she was transferred to the hospital for further investigations and treatment.”
Samples from this patient tested positive for coronaviruses by reverse transcriptase-polymerase chain reaction. The genomic sequencing analysis was performed by Emerging Infectious Diseases Health Science Center, the Thai Red Cross Society, and the Thai National Institute of Health. The patient is reported to be in stable condition.
The New York Times has reported a case of 2019-nCoV in Japan in a traveler returning from Wuhan. That patient is reported to have recovered and been discharged.
Chinese health authorities transmitted the full genome of “2019 novel coronavirus,” or “2019-nCoV,” to GenBank, the genetic sequence database managed by the National Institutes of Health, and in the Global Initiative on Sharing All Influenza Data portal.
Coronaviruses are a large family of viruses. Most known human coronaviruses only cause mild respiratory disease, such as the common cold. But several coronaviruses have emerged to infect people and cause severe disease, such as has been seen with severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). The cases in the Wuhan pneumonia outbreak have tested negative for both SARS and MERS.
The outbreak in Wuhan appears to be contained. The World Health Organization reported that the Wuhan health authorities identified and followed 763 close contacts, including health care workers. No additional cases of infection with the novel coronavirus have been identified. The cluster of cases is linked to the Wuhan South China Seafood City market where – in addition to seafood – chickens, bats, marmots, and other animals were sold. That market has been closed since Jan. 1, 2020, for cleaning and disinfection.
The WHO is monitoring the situation closely and is in close contact with Chinese health authorities.
The CDC has issued a Level 1 travel alert and recommended that travelers to Wuhan, a city of over 19 million people, avoid animal and meat markets, avoid contact with sick people, and wash hands often with soap and water. Travelers who have been in Wuhan recently and who experience respiratory symptoms should notify the local health department immediately.
In addition, the CDC recommends that, for symptomatic patients with a history of travel to Wuhan, caution should be exercised in the health care setting. “Ask such patients to don a surgical mask as soon as they are identified. Conduct their evaluation in a private room with the door closed. Personnel entering the room to evaluate the patient should use contact precautions and wear an N95 disposable facepiece respirator. For patients admitted for inpatient care, implement contact and airborne isolation precautions, in addition to standard precautions, until further information becomes available. For additional infection control guidance see: www.cdc.gov/infectioncontrol/guidelines/isolation/index.html.”
Health authorities in Wuhan, Hubei Province, China, identified the novel coronavirus, 2019-nCoV, responsible for the outbreak of a mysterious pneumonia that resulted in hospitalization of more than 40 patients and one death, according to the Centers for Disease Control and Prevention in a statement on the CDC website.
On Jan. 13, the Thailand’s Ministry of Public Health reported the first imported case of lab-confirmed 2019-nCoV from Wuhan. The Centers for Disease Control and Prevention stated: “The traveler with febrile illness was detected on the same day by thermal surveillance at Suvarnabhumi Airport, Thailand, and was hospitalized the same day. After temperature check and initial assessment, she was transferred to the hospital for further investigations and treatment.”
Samples from this patient tested positive for coronaviruses by reverse transcriptase-polymerase chain reaction. The genomic sequencing analysis was performed by Emerging Infectious Diseases Health Science Center, the Thai Red Cross Society, and the Thai National Institute of Health. The patient is reported to be in stable condition.
The New York Times has reported a case of 2019-nCoV in Japan in a traveler returning from Wuhan. That patient is reported to have recovered and been discharged.
Chinese health authorities transmitted the full genome of “2019 novel coronavirus,” or “2019-nCoV,” to GenBank, the genetic sequence database managed by the National Institutes of Health, and in the Global Initiative on Sharing All Influenza Data portal.
Coronaviruses are a large family of viruses. Most known human coronaviruses only cause mild respiratory disease, such as the common cold. But several coronaviruses have emerged to infect people and cause severe disease, such as has been seen with severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). The cases in the Wuhan pneumonia outbreak have tested negative for both SARS and MERS.
The outbreak in Wuhan appears to be contained. The World Health Organization reported that the Wuhan health authorities identified and followed 763 close contacts, including health care workers. No additional cases of infection with the novel coronavirus have been identified. The cluster of cases is linked to the Wuhan South China Seafood City market where – in addition to seafood – chickens, bats, marmots, and other animals were sold. That market has been closed since Jan. 1, 2020, for cleaning and disinfection.
The WHO is monitoring the situation closely and is in close contact with Chinese health authorities.
The CDC has issued a Level 1 travel alert and recommended that travelers to Wuhan, a city of over 19 million people, avoid animal and meat markets, avoid contact with sick people, and wash hands often with soap and water. Travelers who have been in Wuhan recently and who experience respiratory symptoms should notify the local health department immediately.
In addition, the CDC recommends that, for symptomatic patients with a history of travel to Wuhan, caution should be exercised in the health care setting. “Ask such patients to don a surgical mask as soon as they are identified. Conduct their evaluation in a private room with the door closed. Personnel entering the room to evaluate the patient should use contact precautions and wear an N95 disposable facepiece respirator. For patients admitted for inpatient care, implement contact and airborne isolation precautions, in addition to standard precautions, until further information becomes available. For additional infection control guidance see: www.cdc.gov/infectioncontrol/guidelines/isolation/index.html.”
Drop in flu activity may not signal seasonal peak
A key indicator of flu activity dropped but remains high, but measures of severity have not yet shown any unusual increases, according to the Centers for Disease Control and Prevention.
Patients with influenza-like illness (ILI) made up an estimated 5.8% of the visits to outpatient providers during the week ending Jan. 4, and that’s a decline from 7.0% for the last full week of 2019, the CDC’s influenza division reported.
That 7.0% outpatient ILI visit rate was the highest seen in December since 2003, but “hospitalization rates and percent of deaths due to pneumonia and influenza remain low,” the influenza division said in its weekly report.
Influenza B/Victoria and influenza A(H1N1)pdm09 viruses have been the predominant strains so far this season, and they “are more likely to affect children and younger adults than the elderly. Because the majority of hospitalizations and deaths occur among people age 65 and older, with fewer illnesses among that group, we expect, on a population level, to see less impact in flu-related hospitalizations and deaths,” the CDC said.
Last year, there was a similar drop in the outpatient ILI rate in early January after visits rose through December. The rate then increased for another 5 weeks before peaking at 5.0% in February. A similar pattern also occurred during the 2016-2017 and 2015-2016 seasons, CDC data show.
The nationwide ILI hospitalization rate, which is cumulative through the season, was up to 14.6 per 100,000 population for the week ending Jan. 4, the CDC said. Here are the corresponding rates for each of the last five seasons:
- 11.6 (2018-2019).
- 30.5 (2017-2018).
- 12.2 (2016-2017).
- 1.8 (2015-2016).
- 38.3 (2014-2015).
There were five new ILI-related pediatric deaths reported for the week ending Jan. 4, two of which occurred the week before. The total is now up to 32 for the 2019-2020 season, the CDC said in the weekly report. Last season, there were 21 pediatric deaths through the first January report, compared with 42 during the 2017-2018 season and 13 in 2016-2017.
A key indicator of flu activity dropped but remains high, but measures of severity have not yet shown any unusual increases, according to the Centers for Disease Control and Prevention.
Patients with influenza-like illness (ILI) made up an estimated 5.8% of the visits to outpatient providers during the week ending Jan. 4, and that’s a decline from 7.0% for the last full week of 2019, the CDC’s influenza division reported.
That 7.0% outpatient ILI visit rate was the highest seen in December since 2003, but “hospitalization rates and percent of deaths due to pneumonia and influenza remain low,” the influenza division said in its weekly report.
Influenza B/Victoria and influenza A(H1N1)pdm09 viruses have been the predominant strains so far this season, and they “are more likely to affect children and younger adults than the elderly. Because the majority of hospitalizations and deaths occur among people age 65 and older, with fewer illnesses among that group, we expect, on a population level, to see less impact in flu-related hospitalizations and deaths,” the CDC said.
Last year, there was a similar drop in the outpatient ILI rate in early January after visits rose through December. The rate then increased for another 5 weeks before peaking at 5.0% in February. A similar pattern also occurred during the 2016-2017 and 2015-2016 seasons, CDC data show.
The nationwide ILI hospitalization rate, which is cumulative through the season, was up to 14.6 per 100,000 population for the week ending Jan. 4, the CDC said. Here are the corresponding rates for each of the last five seasons:
- 11.6 (2018-2019).
- 30.5 (2017-2018).
- 12.2 (2016-2017).
- 1.8 (2015-2016).
- 38.3 (2014-2015).
There were five new ILI-related pediatric deaths reported for the week ending Jan. 4, two of which occurred the week before. The total is now up to 32 for the 2019-2020 season, the CDC said in the weekly report. Last season, there were 21 pediatric deaths through the first January report, compared with 42 during the 2017-2018 season and 13 in 2016-2017.
A key indicator of flu activity dropped but remains high, but measures of severity have not yet shown any unusual increases, according to the Centers for Disease Control and Prevention.
Patients with influenza-like illness (ILI) made up an estimated 5.8% of the visits to outpatient providers during the week ending Jan. 4, and that’s a decline from 7.0% for the last full week of 2019, the CDC’s influenza division reported.
That 7.0% outpatient ILI visit rate was the highest seen in December since 2003, but “hospitalization rates and percent of deaths due to pneumonia and influenza remain low,” the influenza division said in its weekly report.
Influenza B/Victoria and influenza A(H1N1)pdm09 viruses have been the predominant strains so far this season, and they “are more likely to affect children and younger adults than the elderly. Because the majority of hospitalizations and deaths occur among people age 65 and older, with fewer illnesses among that group, we expect, on a population level, to see less impact in flu-related hospitalizations and deaths,” the CDC said.
Last year, there was a similar drop in the outpatient ILI rate in early January after visits rose through December. The rate then increased for another 5 weeks before peaking at 5.0% in February. A similar pattern also occurred during the 2016-2017 and 2015-2016 seasons, CDC data show.
The nationwide ILI hospitalization rate, which is cumulative through the season, was up to 14.6 per 100,000 population for the week ending Jan. 4, the CDC said. Here are the corresponding rates for each of the last five seasons:
- 11.6 (2018-2019).
- 30.5 (2017-2018).
- 12.2 (2016-2017).
- 1.8 (2015-2016).
- 38.3 (2014-2015).
There were five new ILI-related pediatric deaths reported for the week ending Jan. 4, two of which occurred the week before. The total is now up to 32 for the 2019-2020 season, the CDC said in the weekly report. Last season, there were 21 pediatric deaths through the first January report, compared with 42 during the 2017-2018 season and 13 in 2016-2017.