ADOLESCENT IMMUNIZATION RATES LAG BEHIND

Adolescent immunization rates lag behind those of younger children, according to a new study, “Adolescent Immunizations: Missed Opportunities for Prevention.” Researchers reviewed the health records of nearly 24,000 Massachusetts adolescents between 1997 and 2004. In 2004, the AAP and Centers for Disease Control and Prevention (CDC) recommended that all adolescents be immunized against hepatitis B, measles-mumps-rubella (MMR), tetanus-diphtheria (Td), and varicella (chicken pox). In the study, only 84 percent of the 13-year-old patients were up-to-date on their Td immunizations, 74 percent on MMR, and 67 percent on Hepatitis B. The researchers identified missed opportunities to administer the Td vaccine in 84 percent of the health care visits, including preventive care visits. However, adolescents who regularly attended preventive care visits were more likely to be up-to-date on immunizations. The study authors conclude that physicians and health care providers need to develop more effective strategies to ensure immunization compliance. In 2008, the AAP and CDC expandedtheir immunization recommendations to also include vaccines to prevent meningococcal disease (meningitis), pertussis, and human papillomavirus (HPV). 

PHYSICIAN INFORMATION, ASSURANCES EASE PARENTAL VACCINE CONCERNS

According to a new study, while parents cited different reasons for delaying or not getting a vaccination for their child, physician information and assurances were the top reasons for parents changing their minds. In “Parents With Doubts About Vaccines: Which Vaccines and Reasons Why,” researchers studied results from the 2003-2004 National Immunization Survey of parents who got a vaccination for their child even though they were unsure it was the best thing to do (unsure), delayed a vaccination for their child (delayed) and those who decided not to have their child get a vaccination (refused)  The varicella (chickenpox) vaccine prompted the most concern among parents who refused a vaccination or were unsure about getting a vaccination for their child. Parents most often cited a child’s illness as the reason for delaying vaccine administration. The largest proportion of parents who changed their minds about delaying or not getting a vaccination for their child listed “information or assurances from health care provider” as the main reason. The results indicate a need for physicians and other health care providers to solicit questions about vaccines from parents and share appropriate tailored immunization information.

PEDIATRIC DRUG SAMPLES: CONCERNS OVER DISTRIBUTION, SAFETY

Free, pediatric drug samples are typically distributed to insured children with greater and more frequent access to care and may have significant safety issues, according to a new study. In “Free Drug Samples in the United States: Characteristics of Pediatric Recipients and Safety Concerns,” researchers reviewed data from the 2004 Medical Expenditure Panel Survey on free drug sample distribution to children and adolescents under age 18. The data showed that 10 percent of children who received prescription medication and 4.9 percent of all children received one or more free drug samples in 2004.  Less than one-fifth of sample recipients were uninsured for all or part of 2004, and less than one-third had low family incomes. Better access to health care increased the likelihood of receiving a sample.  Significant safety concerns were identified for four of the top fifteen most frequently distributed samples.  These medications acquired new black box warnings or had significant revisions to existing black box warnings issued after 2004.  Two of the top 15 sample medications were schedule II controlled substances (drugs controlled by the Drug Enforcement Agency due to high potential for abuse).  The authors conclude that free sample distribution does not equalize medication access for children, and that the distribution of free drug samples should be undertaken cautiously, if at all.

CHILD CARE PROVIDER TRAINING REDUCES SIDS DEATHS

Child care providers who received Sudden Infant Death Syndrome (SIDS) prevention training approved by the American Academy of Pediatrics (AAP) were more likely to appropriately place infants to sleep on their backs, a proven SIDS prevention practice. An estimated 20 percent of SIDS deaths occur while a child is in the care of someone other than a parent. In the study, “Reducing the Risk of Sudden Infant Death Syndrome (SIDS) in Child Care and Changing Provider Practices: Lessons Learned from a Demonstration Project,” 1,212 providers in 264 child care programs received SIDS prevention training that specifically focused on placing infants to sleep on their backs, as recommended by the AAP. Following the training, the child care providers reported an increased understanding of the need to place infants to sleep on their back, from 59.7 percent to 87.8 percent. In addition, child care providers placing infants on their back increased from 51 percent to 62.1 percent. The study authors concluded that continued education of parents, expanded training efforts, and statewide mandates are critical to further decreasing the risk of SIDS in child care settings.

EDITOR’S NOTE: A related commentary, “Recurrence of Sudden Infant Death Syndrome,” argues that statistics commonly published in Great Britain estimating the likely recurrence of SIDS in a family at 1 in 200, is too high. In most instances, once the first SIDS death in a family is thoroughly investigated, and no familial propensity is found for disease, homicide or major SIDS risk factors, the family should be advised that the likelihood of having another child succumb to SIDS is actually very remote.

MICROWAVE LIQUIDS POSE BURN RISKS FOR YOUNG CHILDREN

Hot microwaved liquids pose a significant burn threat to children as young as 18-months-old, according to a new study. In “Preventing Unintentional Scald Burns: Moving Beyond Tap Water,” researchers reviewed medical records of children ages 4 and younger who were admitted to the University of Chicago Burn Center between Jan. 1, 2002, and Dec. 31, 2004. Of the 118 unintentional burn injuries, 14 were tap water scalds, and 94 were due to hot cooking or drinking liquids, including 26 related to microwave use. Specifically, nine children (8.7 percent) between the ages of 18 months and 4 were scalded after opening a microwave oven and removing a hot substance themselves, and 17 (16.3 percent) were burned while an older child, ages 7 to 14, was cooking, carrying a scalding substance, or supervising a younger child. As burn injuries are extremely painful and can cause scarring and physical limitations, the study authors recommendprevention strategies and messages that address a broader range of liquid safety hazards, including microwave dangers. In addition, the study authors recommend changes in microwave design to prevent child entry.

INFLUENZA CO-INFECTIONS RISE IN PEDIATRIC PATIENTS

While child death from influenza is rare, related co-infections such as Staphylococcus aureus have increased dramatically over the past three flu seasons. In the study, “Influenza-Associated Pediatric Mortality in the United States: Increase of Staphylococcus aureus Coinfection,” researchers reviewed Centers for Disease Control (CDC) demographic, clinical and laboratory data on influenza-associated pediatric deaths during the three flu seasons between the fall of 2004 and the spring of 2007. During each flu season, the number of influenza-S. aureus co-infections increased – 2 percent, 6 percent and 30 percent, respectively. Children with Influenza-S. aureus co-infection were significantly more likely to be older and have pneumonia than children with influenza alone. The study authors recommend additional studies to evaluate risk factors for influenza co-infection, and the role of influenza vaccine in preventing infection and death.

FEDERAL STUDY PROVIDES COMPREHENSIVE OVERVIEW OF U.S. INFANT FEEDING PRACTICES

A new, comprehensive federal study provides an overview of infant feeding and care practices in the U.S., including breastfeeding patterns, influences and adherence to recommendations; sleeping patterns; and food-related health problems, such as allergies. In “Infant Feeding and Care Practices in the United States: Results From the Infant Feeding Practices Study II,” the Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC), reviewed surveys submitted by more than 2,000 women prenatally and throughout the first year of their child’s life. Since the first study was completed in 1992- 1993, significant changes have occurred in the products, policies, information and education related to infant feeding and sleep practices. Among the study findings were that one-fourth of mothers do not place their child on their backs to sleep, as recommended by the American Academy of Pediatrics, and 34 percent regularly co-slept with their infants. In addition, only 8 percent of mothers experienced six “baby-friendly” hospital practices that encourage and assist mothers with breastfeeding. The more of these practices experienced, the greater the likelihood that mothers would breastfeed for six weeks or longer. Pertaining to food practices, nearly all mothers who fed their infants formula used an iron-fortified product, and more than 20 percent of infants had a food-related health problem, including 6 percent with allergies. The study authors hope that these comprehensive findings will result in more practice-specific research and more effective health strategies.