Tag Archives: children

Have You Had Your Pertussis Vaccine?

As the North Pacific Pediatric Society’s annual meeting got underway recently, organizers invited Dr. Maxine Hayes of the Washington State Department of Health to the podium to deliver a special – and urgent – message.

Dr. Maxine Hayes (Sherry Boschert/IMNG Medical Media)

Her plea to pediatricians: Make sure that you, all of your staff, and your patients have been immunized against pertussis. Not only was the Society meeting during National Infant Immunization Week, but Washington State had just recorded its 1,000th case of pertussis in 2012, with 61% of cases in school-age children, she reported.

“It’s the worst we’ve seen in six decades,” Dr. Hayes said. “If infections continue at this rate, we’ll have more than 3,000 cases by the end of the year.”

Washington State had 1,008 reported cases of pertussis by April 21, 2012 – nearly 10 times more than the 110 cases reported during the same period in 2011, according to the U.S. Centers for Disease Control and Prevention. There are more pertussis cases in the state already for 2012 than there were in all of 2011 (965 cases) or all of 2010 (608 cases).

The Washington epidemic follows on the heals of a 2010 outbreak of 9,143 cases in California – the most in 63 years – that killed at least 10 infants.

My colleagues at IMNG Medical Media have been following the story, with multiple reports. The California epidemic probably was due to the waning immunity of the tetanus-diphtheria-acellular pertussis (Tdap) vaccine. Tdap vaccine is recommended for all health care workers.

And it’s not just for kids, health care workers, and medical office staff. If you’re a physician who treats adults, you should know that older adults need the Tdap vaccine too. Even pregnant women should be vaccinated.

When Dr. Michael E. Pichichero randomly asked 10 pediatricians if they’d had the Tdap vaccine, 8 of them said no, with some pretty weak excuses, if you ask me.

“I know that there are people in this room who have not had their Tdaps,” Dr. Hayes said with an accusing smile. “I also know that in busy practices, you have people in and out every day that have not had their Tdap. I’m calling on you to really get on it.” Make sure that your emergency rooms have Tdap in stock, too, she added.

“And if you’re not in Washington, don’t be smug about this, because you could be next,” Dr. Hayes said. Her public health colleagues in Oregon State are taking this so seriously that they’re planning to open pertussis booster clinics, she noted.

–Sherry Boschert (@sherryboschert on Twitter)

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Filed under Family Medicine, IMNG, Infectious Diseases, Pediatrics, Pulmonary Diseases and Sleep Medicine, Uncategorized

Finding Answers on Food Allergies

Tackling the tough questions parents sometimes have about   food allergies is not easy for pediatric dermatologists, in part because there is so little consensus in the literature. Now a large review of the literature offers some guidance.

“Food allergies in general are challenging and can lead to difficult conversations with parents,” Dr. Robert Sidbury said. Part of the problem for Dr. Sidbury and other pediatric dermatologists is “the complicated association [between] atopic dermatitis and food allergy.”

Many parents, for example, are convinced their child’s atopic dermatitis (also commonly called eczema) is caused by a food allergy, no matter what you tell them, said Dr. Sidbury, Chief of the Division of Dermatology, Department of Pediatrics at Seattle Children’s Hospital.

Concerned parents will have a lot of questions. Because not everything about food allergy is straightforward, doctors sometime struggle with the answers. Physicians now can cite the findings of a systematic review published in JAMA earlier this year  for more concrete answers, Dr. Sidbury said at a seminar on women’s and pediatric dermatology sponsored by the Skin Disease Education Foundation (SDEF).

Patients and parents may ask how many people have  food allergies. It is at least 1% to 2% but no more than 10% of the population, according to this systematic review of 70 published studies. The researchers also stated it is unclear if the number of food allergies is increasing or not over time.  

There are few rigorous data to support use of an elimination diet, even though they are widely used for diagnosis of food allergies. 

In addition, they found no significant difference between two other diagnostic strategies: skin prick tests and food-specific IgE antibody tests.

There is still a need for more research. A lack of standard definition or diagnostic criteria is one of the main challenges to overcome before additional consensus can be reached on food allergy prevalence, diagnosis, management, and prevention.

Dr. Sidbury had no relevant disclosures. I am a reporter for Skin & Allergy News, which is owned by Elsevier. The SDEF is also an Elsevier company.

–Damian McNamara

@MedReporter on Twitter

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Filed under Allergy and Immunology, Dermatology, Family Medicine, IMNG, Internal Medicine, Pediatrics, Primary care, The Mole, Uncategorized

Explosion of PPI Use in Young Children

Members of the FDA’s Pediatric Advisory Committee were surprised by the exponential increase in proton pump inhibitor (PPI) prescriptions dispensed for young children over the past few years, after hearing an FDA presentation on pediatric adverse event reports for PPIs at a meeting last month. But what really struck them was news that infants under age 1 had the steepest increase of all.   

Photo courtesy bbaunach at Creative Commons (flickr)

In her presentation, Dr. Amy Taylor, a medical officer on the pediatric and maternal health staff in the FDA’s Office of New Drugs, presented outpatient prescription data obtained from Vector One for PPIs in children and adolescents between 2002 and 2009.  It showed that for children from birth through age 17, the number of prescriptions increased from 875,000 in 2002 to 2.6 million  in 2009–a threefold increase.  The number of patients prescribed PPIs in this age group increased in the same proportion, from 332,000 in 2002 to 885,000 in 2009. 

Now here are the really striking numbers: In children under age 1, PPI prescriptions grew from 37,000 to 403,000 in the same period–an 11-fold increase. The number of patients in this age group prescribed a PPI increased from 18,000 to 145,000, an 8-fold increase. 

But none of the PPIs approved in the United States are approved for use in children younger than 1 year. (Esomeprazole, lansoprazole, and omeprazole are approved for gastroesophageal reflux disease [GERD], erosive esophagitis, and/or maintenance of healing of erosive esophagitis in children ages 1 and older; rabeprazole is approved for GERD in ages 12-17 years.)  

Pediatric use of PPIs and the effectiveness of these drugs in pediatric populations is a topic that the FDA is looking at more closely. During the discussion, Dr. Joyce Korvick, deputy director for safety in the FDA’s division of gastroenterology products, informed the panel that the agency is planning an advisory panel meeting on clinical trials on the effficacy of PPIs in pediatric patients in November. Dr. Dianne Murphy, director of the FDA’s Office of Pediatric Therapeutics,  remarked that when she saw the prescription use data, “I just about fell out of my chair,”  and said that one of the reasons the meeting is planned is “we’re learning how much we don’t know” about the use of PPIs in pediatrics. 

 They both indicated that questions raised by panelists during the discussion-which included how efficacy in older children is extrapolated to those under age 1, the differences in reflux disease across age groups, and the use of PPIs in premature babies–will be addressed at that meeting. 

The meeting will probably be a joint meeting of the Pediatric Advisory Committee  and the Gastrointestinal Drugs Advisory Committee 

–Elizabeth Mechcatie (twitter: @elizmech)

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Filed under Drug And Device Safety, Family Medicine, Gastroenterology, Hospital and Critical Care Medicine, IMNG, Pediatrics, Practice Trends, Primary care

Falls: The Humpty Dumpty Hypothesis

Image via Flickr user aturkus by Creative Common License

From the International Conference of Pediatric Psychological Trauma in Infants & Young Children in Los Angeles

Humpty Dumpty sat on a wall,

Humpty Dumpty had a great fall,

All the King’s horses and all the King’s men,

Couldn’t put Humpty together again.

Serious falls are among the most common injuries to children, representing 52% of injuries in infants and 43% of injuries in children aged 1-4, according to recent figures from the Centers for Disease Control and Prevention. Fortunately, most children who fall can be physically put together much better than hapless Humpty Dumpty, but new findings from Duke University suggest that their psychological sequelae may be harder to heal.

Dr. Helen Link Egger of the Center for Developmental Epidemiology in the Department of Psychiatry and Behavioral Sciences reported that preschool children (ages 2-5) who suffer any injury serious enough to require medical attention were 2.7 times more likely to meet criteria for separation anxiety disorder, based on findings of a longitudinal study of 666 children.

Those who suffered a fall were also 5.8 times more likely to meet criteria for depression.

“Now that’s a big odds ratio,” she said, explaining that the data translated into nearly 1 in 5 children who had fallen.

In well over half — 58%, the fall occurred prior to any depressive symptom.

The powerful link to depression was not seen in children who had endured other traumas, such as serious illnesses or injuries that required hospitalization. 

The chicken-and-egg question, which Dr. Egger said requires urgent research, is whether the falls themselves or the circumstances leading to the falls are most salient with regard to associations with depression.

“Are these children with depressed mothers? Children living in a household where no one is looking out for them?”

Even if it takes all of the King’s horses and all of the King’s men, it’s something we need to find out. 

—Betsy Bates
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Filed under Emergency Medicine, Family Medicine, IMNG, Pediatrics, Primary care, Psychiatry, Uncategorized

New Obesity Recommendations Face Uphill Battle

Courtesy of Flickr user ktheory

There is now enough evidence to recommend screening for overweight and obesity in children aged 6 years and older and enough evidence backing the efficacy of behavioral interventions of at least moderate intensity, according to the U.S. Preventive Services Task Force. (See story.)

Will this recommendation pack a big enough punch to kick-start a movement toward more screening and greater acceptance and awareness of the efficacy of behavioral interventions? It looks like it will be an uphill battle, if a new survey of members of the American Academy of Pediatrics gives a true indication.

The survey of 677 primary care clinicians in active practice revealed that only 52% assess BMI percentile for children older than 2 years and only 23% said they believe that there are good treatment strategies for overweight. Less than half said they are able to make referrals to interventional programs.

It also was notable that clinicians who are familiar with American Academy of Pediatrics guidelines on obesity screening and treatment were more likely to use BMI percentiles in their care and more likely to feel prepared to counsel patients.

Dr. Ned Calonge, the chair of the USPSTF, recognized that many clinicians won’t be able to offer referrals to weight management centers, but he said with greater recognition of the value of screening and the efficacy of treatment, greater availability of referral services and insurance coverage will hopefully follow. That will be key because 69% of providers in the survey said that insurance does not cover weight management programs, and only 15% reported that they can bill for overweight counseling and treatment separate from well-child visits.

Jeff Evans (@jeffaevans on Twitter)

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Filed under Endocrinology, Diabetes, and Metabolism, Family Medicine, Pediatrics, Primary care, Uncategorized