Alicia Ault

As many as one-fourth of patients in primary care settings could be engaging in hazardous or harmful drinking, and discerning that through careful screening–especially in trauma cases–can lead to better care and more accurate flagging of those who abuse alcohol.

According to a study published online, 17.6 million adults abuse alcohol or are alcohol dependent, and 85,000 deaths may be attributable to alcohol each year.

“With brief interventions, primary care clinicians can help 40% of them (compared with 20% in control groups) reduce their drinking to safe levels,” according to Andrea Canagasaby and Dr. Daniel C. Vinson of the department of family and community medicine at the University of Missouri-Columbia (Alcohol Alcohol. 2005;40:208–13).

Physicians in emergency departments or family practice settings generally ask two screening questions: How often do you drink, and on those days, how much do you drink on average? But these have been shown to be somewhat inaccurate for identifying alcohol-use disorder, Dr. Vinson said in an interview with this newspaper. It's hard for people to say how much they drink on average when they might consume two drinks each weeknight but a six-pack on the weekend, he said. So physicians might miss some people who abuse alcohol by asking only about frequency and quantity.

Dr. Vinson, who is a professor in the department of family and community medicine and lead author of the study, found that asking, “When was the last time you had more than five drinks in 1 day [or four for a woman]?” flagged people who should be further queried.

The study comprised interviews with 1,537 patients presenting to the ED for an acute injury, 1,151 who came to the ED due to illness, and 1,112 persons randomly phoned in the community to serve as controls.

They were first asked about tobacco use, and then about number of drinks consumed in a day. A yes to four or five drinks in the past 3 months was considered a positive screen. Those patients were then asked to review, day-by-day, their drinking behavior during the previous 28 days, and to answer questions about the quantity and frequency of alcohol use from the Diagnostic Interview Schedule (DIS).

Hazardous drinking was defined as drinking more than four drinks in 1 day or more than 14 in a week for men, and more than three in a day or seven in a week for women, according to National Institute on Alcohol Abuse and Alcoholism criteria.

The investigators calculated results by estimating the area under the receiver operating characteristic (ROC) curve with 95% confidence intervals. The area under the ROC curve is commonly used as a summary measure of diagnostic accuracy. They compared the ability to identify hazardous drinking or alcohol-use disorders for the three approaches: the single question developed by Dr. Vinson, the quantity-frequency responses to the DIS questions, and a question solely about average quantity consumed.

The ROC area for the quantity-frequency questions was slightly higher than for the single question devised by Dr. Vinson, which in turn was higher than the quantity question alone.

But, Dr. Vinson told this newspaper, physicians in busy EDs or primary care practice settings might not always have the time to go through the quantity-frequency questions, and these questions may not be sensitive enough to detect an alcohol-use disorder. A threshold of three or more drinks per occasion has a sensitivity of 77%, but that declines when a threshold of four or more drinks is used. And the scores can be confusing: A quantity-frequency score of 6 could be derived from six drinks less than once a month, three drinks 1–3 days a month, or two drinks once or twice a week.

The single question could be used as a quicker, more efficient screen, although any of the approaches would be better than nothing, he said. One-third of all ED injuries are caused by people who have harmed themselves while drinking, and 10% of people seen in EDs have been harmed by others who were drinking, Dr. Vinson said in the interview.

Identification can lead to treatment and intervention, which inevitably are cost effective, he said. “We can reduce that person's risks for being reinjured just by talking to that person.”

Dr. Vinson's study was funded by the National Institute on Alcohol Abuse and Alcoholism.

As many as one-fourth of patients in primary care settings could be engaging in hazardous or harmful drinking, and discerning that through careful screening–especially in trauma cases–can lead to better care and more accurate flagging of those who abuse alcohol.

According to a study published online, 17.6 million adults abuse alcohol or are alcohol dependent, and 85,000 deaths may be attributable to alcohol each year.

“With brief interventions, primary care clinicians can help 40% of them (compared with 20% in control groups) reduce their drinking to safe levels,” according to Andrea Canagasaby and Dr. Daniel C. Vinson of the department of family and community medicine at the University of Missouri-Columbia (Alcohol Alcohol. 2005;40:208–13).

Physicians in emergency departments or family practice settings generally ask two screening questions: How often do you drink, and on those days, how much do you drink on average? But these have been shown to be somewhat inaccurate for identifying alcohol-use disorder, Dr. Vinson said in an interview with this newspaper. It's hard for people to say how much they drink on average when they might consume two drinks each weeknight but a six-pack on the weekend, he said. So physicians might miss some people who abuse alcohol by asking only about frequency and quantity.

Dr. Vinson, who is a professor in the department of family and community medicine and lead author of the study, found that asking, “When was the last time you had more than five drinks in 1 day [or four for a woman]?” flagged people who should be further queried.

The study comprised interviews with 1,537 patients presenting to the ED for an acute injury, 1,151 who came to the ED due to illness, and 1,112 persons randomly phoned in the community to serve as controls.

They were first asked about tobacco use, and then about number of drinks consumed in a day. A yes to four or five drinks in the past 3 months was considered a positive screen. Those patients were then asked to review, day-by-day, their drinking behavior during the previous 28 days, and to answer questions about the quantity and frequency of alcohol use from the Diagnostic Interview Schedule (DIS).

Hazardous drinking was defined as drinking more than four drinks in 1 day or more than 14 in a week for men, and more than three in a day or seven in a week for women, according to National Institute on Alcohol Abuse and Alcoholism criteria.

The investigators calculated results by estimating the area under the receiver operating characteristic (ROC) curve with 95% confidence intervals. The area under the ROC curve is commonly used as a summary measure of diagnostic accuracy. They compared the ability to identify hazardous drinking or alcohol-use disorders for the three approaches: the single question developed by Dr. Vinson, the quantity-frequency responses to the DIS questions, and a question solely about average quantity consumed.

The ROC area for the quantity-frequency questions was slightly higher than for the single question devised by Dr. Vinson, which in turn was higher than the quantity question alone.

But, Dr. Vinson told this newspaper, physicians in busy EDs or primary care practice settings might not always have the time to go through the quantity-frequency questions, and these questions may not be sensitive enough to detect an alcohol-use disorder. A threshold of three or more drinks per occasion has a sensitivity of 77%, but that declines when a threshold of four or more drinks is used. And the scores can be confusing: A quantity-frequency score of 6 could be derived from six drinks less than once a month, three drinks 1–3 days a month, or two drinks once or twice a week.

The single question could be used as a quicker, more efficient screen, although any of the approaches would be better than nothing, he said. One-third of all ED injuries are caused by people who have harmed themselves while drinking, and 10% of people seen in EDs have been harmed by others who were drinking, Dr. Vinson said in the interview.

Identification can lead to treatment and intervention, which inevitably are cost effective, he said. “We can reduce that person's risks for being reinjured just by talking to that person.”

Dr. Vinson's study was funded by the National Institute on Alcohol Abuse and Alcoholism.

As many as one-fourth of patients in primary care settings could be engaging in hazardous or harmful drinking, and discerning that through careful screening–especially in trauma cases–can lead to better care and more accurate flagging of those who abuse alcohol.

According to a study published online, 17.6 million adults abuse alcohol or are alcohol dependent, and 85,000 deaths may be attributable to alcohol each year.

“With brief interventions, primary care clinicians can help 40% of them (compared with 20% in control groups) reduce their drinking to safe levels,” according to Andrea Canagasaby and Dr. Daniel C. Vinson of the department of family and community medicine at the University of Missouri-Columbia (Alcohol Alcohol. 2005;40:208–13).

Physicians in emergency departments or family practice settings generally ask two screening questions: How often do you drink, and on those days, how much do you drink on average? But these have been shown to be somewhat inaccurate for identifying alcohol-use disorder, Dr. Vinson said in an interview with this newspaper. It's hard for people to say how much they drink on average when they might consume two drinks each weeknight but a six-pack on the weekend, he said. So physicians might miss some people who abuse alcohol by asking only about frequency and quantity.

Dr. Vinson, who is a professor in the department of family and community medicine and lead author of the study, found that asking, “When was the last time you had more than five drinks in 1 day [or four for a woman]?” flagged people who should be further queried.

The study comprised interviews with 1,537 patients presenting to the ED for an acute injury, 1,151 who came to the ED due to illness, and 1,112 persons randomly phoned in the community to serve as controls.

They were first asked about tobacco use, and then about number of drinks consumed in a day. A yes to four or five drinks in the past 3 months was considered a positive screen. Those patients were then asked to review, day-by-day, their drinking behavior during the previous 28 days, and to answer questions about the quantity and frequency of alcohol use from the Diagnostic Interview Schedule (DIS).

Hazardous drinking was defined as drinking more than four drinks in 1 day or more than 14 in a week for men, and more than three in a day or seven in a week for women, according to National Institute on Alcohol Abuse and Alcoholism criteria.

The investigators calculated results by estimating the area under the receiver operating characteristic (ROC) curve with 95% confidence intervals. The area under the ROC curve is commonly used as a summary measure of diagnostic accuracy. They compared the ability to identify hazardous drinking or alcohol-use disorders for the three approaches: the single question developed by Dr. Vinson, the quantity-frequency responses to the DIS questions, and a question solely about average quantity consumed.

The ROC area for the quantity-frequency questions was slightly higher than for the single question devised by Dr. Vinson, which in turn was higher than the quantity question alone.

But, Dr. Vinson told this newspaper, physicians in busy EDs or primary care practice settings might not always have the time to go through the quantity-frequency questions, and these questions may not be sensitive enough to detect an alcohol-use disorder. A threshold of three or more drinks per occasion has a sensitivity of 77%, but that declines when a threshold of four or more drinks is used. And the scores can be confusing: A quantity-frequency score of 6 could be derived from six drinks less than once a month, three drinks 1–3 days a month, or two drinks once or twice a week.

The single question could be used as a quicker, more efficient screen, although any of the approaches would be better than nothing, he said. One-third of all ED injuries are caused by people who have harmed themselves while drinking, and 10% of people seen in EDs have been harmed by others who were drinking, Dr. Vinson said in the interview.

Identification can lead to treatment and intervention, which inevitably are cost effective, he said. “We can reduce that person's risks for being reinjured just by talking to that person.”

Dr. Vinson's study was funded by the National Institute on Alcohol Abuse and Alcoholism.

WASHINGTON — Wisconsin health authorities were able to put a stop to a spiraling outbreak of pertussis by advocating faster testing and use of antibiotics in all suspect cases, a state health department official reported at the National Immunization Conference sponsored by the Centers for Disease Control and Prevention.

Jeffrey Davis, M.D., of the Wisconsin Division of Public Health, gave the details of the epidemic, which lasted from May 2003 until February 2004 and occurred primarily in Fond du Lac County. In the 5 years before the outbreak, there had only been five cases of pertussis in Wisconsin.

Cases were defined using the Centers for Disease Control and Prevention's definition of pertussis: a cough illness lasting more than 2 weeks with paroxysms, whoop, or posttussive vomiting. Cases were confirmed through patient follow-up interviews and/or lab confirmation by isolating Bordetella pertussis in culture, or through a positive polymerase chain reaction (PCR) assay.

During the outbreak, 313 cases were reported in the county (total population 97,296); 193 were confirmed in the lab, and 120 were confirmed by epidemiology. Just over half the cases were in females, and the median age was 14 years. Of those 313, 70% were aged 10–19 years; 43% were aged 10–14 years. The incidence rate exceeded 1,000 per 100,000 in that younger cohort, said Dr. Davis.

The health department determined that the outbreak probably started with two unvaccinated adolescents using a high school weight room. Of the initial 53 cases, 55% were linked to that weight room.

During the epidemic's initial peak in mid-October, the health department alerted physicians to keep a close eye on potential cases. As new cases appeared in November, the department issued another alert, suggesting more testing and use of antibiotics in any suspect cases.

That alert led to a sharp decline in cases, said Dr. Davis. During the first peak, a median of 10.5 days passed between the onset of cough and initiation of antibiotics. By the last peak, medication was generally started within 4 days of cough onset. More than 5,000 courses of antibiotics were dispensed; 90% of the prescriptions were for azithromycin.

As physicians became more aware, they stepped up reporting, also, said Dr. Davis.

And PCR testing by the health department allowed for a rapid response—results were generally back to physicians within 24–48 hours.

The health department's successful response was costly, however—about $2,000 per case, Dr. Davis said.

WASHINGTON — Wisconsin health authorities were able to put a stop to a spiraling outbreak of pertussis by advocating faster testing and use of antibiotics in all suspect cases, a state health department official reported at the National Immunization Conference sponsored by the Centers for Disease Control and Prevention.

Jeffrey Davis, M.D., of the Wisconsin Division of Public Health, gave the details of the epidemic, which lasted from May 2003 until February 2004 and occurred primarily in Fond du Lac County. In the 5 years before the outbreak, there had only been five cases of pertussis in Wisconsin.

Cases were defined using the Centers for Disease Control and Prevention's definition of pertussis: a cough illness lasting more than 2 weeks with paroxysms, whoop, or posttussive vomiting. Cases were confirmed through patient follow-up interviews and/or lab confirmation by isolating Bordetella pertussis in culture, or through a positive polymerase chain reaction (PCR) assay.

During the outbreak, 313 cases were reported in the county (total population 97,296); 193 were confirmed in the lab, and 120 were confirmed by epidemiology. Just over half the cases were in females, and the median age was 14 years. Of those 313, 70% were aged 10–19 years; 43% were aged 10–14 years. The incidence rate exceeded 1,000 per 100,000 in that younger cohort, said Dr. Davis.

The health department determined that the outbreak probably started with two unvaccinated adolescents using a high school weight room. Of the initial 53 cases, 55% were linked to that weight room.

During the epidemic's initial peak in mid-October, the health department alerted physicians to keep a close eye on potential cases. As new cases appeared in November, the department issued another alert, suggesting more testing and use of antibiotics in any suspect cases.

That alert led to a sharp decline in cases, said Dr. Davis. During the first peak, a median of 10.5 days passed between the onset of cough and initiation of antibiotics. By the last peak, medication was generally started within 4 days of cough onset. More than 5,000 courses of antibiotics were dispensed; 90% of the prescriptions were for azithromycin.

As physicians became more aware, they stepped up reporting, also, said Dr. Davis.

And PCR testing by the health department allowed for a rapid response—results were generally back to physicians within 24–48 hours.

The health department's successful response was costly, however—about $2,000 per case, Dr. Davis said.

WASHINGTON — Wisconsin health authorities were able to put a stop to a spiraling outbreak of pertussis by advocating faster testing and use of antibiotics in all suspect cases, a state health department official reported at the National Immunization Conference sponsored by the Centers for Disease Control and Prevention.

Jeffrey Davis, M.D., of the Wisconsin Division of Public Health, gave the details of the epidemic, which lasted from May 2003 until February 2004 and occurred primarily in Fond du Lac County. In the 5 years before the outbreak, there had only been five cases of pertussis in Wisconsin.

Cases were defined using the Centers for Disease Control and Prevention's definition of pertussis: a cough illness lasting more than 2 weeks with paroxysms, whoop, or posttussive vomiting. Cases were confirmed through patient follow-up interviews and/or lab confirmation by isolating Bordetella pertussis in culture, or through a positive polymerase chain reaction (PCR) assay.

During the outbreak, 313 cases were reported in the county (total population 97,296); 193 were confirmed in the lab, and 120 were confirmed by epidemiology. Just over half the cases were in females, and the median age was 14 years. Of those 313, 70% were aged 10–19 years; 43% were aged 10–14 years. The incidence rate exceeded 1,000 per 100,000 in that younger cohort, said Dr. Davis.

The health department determined that the outbreak probably started with two unvaccinated adolescents using a high school weight room. Of the initial 53 cases, 55% were linked to that weight room.

During the epidemic's initial peak in mid-October, the health department alerted physicians to keep a close eye on potential cases. As new cases appeared in November, the department issued another alert, suggesting more testing and use of antibiotics in any suspect cases.

That alert led to a sharp decline in cases, said Dr. Davis. During the first peak, a median of 10.5 days passed between the onset of cough and initiation of antibiotics. By the last peak, medication was generally started within 4 days of cough onset. More than 5,000 courses of antibiotics were dispensed; 90% of the prescriptions were for azithromycin.

As physicians became more aware, they stepped up reporting, also, said Dr. Davis.

And PCR testing by the health department allowed for a rapid response—results were generally back to physicians within 24–48 hours.

The health department's successful response was costly, however—about $2,000 per case, Dr. Davis said.

WASHINGTON — The incidence of tetanus has declined precipitously in recent decades, as have deaths from the toxin, but the elderly, diabetics, and injection-drug users are still at risk, according to research presented at the National Immunization Conference, sponsored by the Centers for Disease Control and Prevention.

Pamela Srivastava of the CDC's National Immunization Program, reported the results of an epidemiologic look at tetanus from 1972 to 2001.

During that period, 1,842 cases of tetanus were reported to the CDC, Ms. Srivastava said.

Tetanus occurs from exposure to Clostridium tetani, a bacterium that releases a toxin initially causing headache, fever, sore throat, muscle spasms, and stiffness in the neck, arms, and legs. Left unchecked, the toxin will spread and lead to the characteristic “lockjaw,” as well as rigidity of other muscles.

C. tetani can live for years in soil and feces. Infection usually comes through wounds. Historically, tetanus occurred more frequently in the southeast, and primarily in the summer, but most regional differences have disappeared, and there is not as much seasonal variation, either, Ms. Srivastava said.

The incidence of the infection has been on the decline in the United States, dropping 59% from 1972 to 2001. During that time, the case fatality rate decreased by 64%, she said.

Vaccination history was reported for 932 of the 1,842 cases. Among those, 644 (49%) were unvaccinated, and the case death rate was 28%. Among the 172 (18%) who had received one or two doses of vaccine, the death rate was 17%. Among the 114 persons (12%) who had received three or more doses, the death rate was 4%.

The number of cases and death rates were highest among people aged 60 or older, in whom the incidence was 0.78 per million and the death rate was 40%, Ms. Srivastava said. She hypothesized that there was a low prevalence of immunity and high incidence of tetanus in the elderly, at least early in the study period, because they more likely had not received a primary immunization series. The incidence in the elderly declined somewhat from 1991 to 2001, however.

Patients with diabetes were at increased risk for dying from tetanus. Looking at one slice of the study period (1987–2001) diabetes patients accounted for 13% of all cases and 29% of all deaths. Of the diabetics with tetanus, 44% died, Ms. Srivastava said.

There may be more people at risk, because a surprising number of tetanus cases come from nonacute, or chronic wounds, she said. About 16% of all the cases reported were from nonacute wounds; 76% were from acute wounds, and the rest from other sources.

Tetanus also has been steadily increasing over the decades in injection drug users. From 1992 to 2001, there was a threefold increase from previous decades, driven partly by an epidemic among users in California. During that decade, they accounted for 12% of all adult cases, Ms. Srivastava said.

And although there tend to be no differences in incidence overall among ethnic groups, that equality disappears among injection-drug users, where Hispanics account for 48% of cases, she said.

Tetanus is not a high-cost disease in this country, costing only about $12 million a year, but it is severely disabling, and 78% of those affected are hospitalized.

WASHINGTON — The incidence of tetanus has declined precipitously in recent decades, as have deaths from the toxin, but the elderly, diabetics, and injection-drug users are still at risk, according to research presented at the National Immunization Conference, sponsored by the Centers for Disease Control and Prevention.

Pamela Srivastava of the CDC's National Immunization Program, reported the results of an epidemiologic look at tetanus from 1972 to 2001.

During that period, 1,842 cases of tetanus were reported to the CDC, Ms. Srivastava said.

Tetanus occurs from exposure to Clostridium tetani, a bacterium that releases a toxin initially causing headache, fever, sore throat, muscle spasms, and stiffness in the neck, arms, and legs. Left unchecked, the toxin will spread and lead to the characteristic “lockjaw,” as well as rigidity of other muscles.

C. tetani can live for years in soil and feces. Infection usually comes through wounds. Historically, tetanus occurred more frequently in the southeast, and primarily in the summer, but most regional differences have disappeared, and there is not as much seasonal variation, either, Ms. Srivastava said.

The incidence of the infection has been on the decline in the United States, dropping 59% from 1972 to 2001. During that time, the case fatality rate decreased by 64%, she said.

Vaccination history was reported for 932 of the 1,842 cases. Among those, 644 (49%) were unvaccinated, and the case death rate was 28%. Among the 172 (18%) who had received one or two doses of vaccine, the death rate was 17%. Among the 114 persons (12%) who had received three or more doses, the death rate was 4%.

The number of cases and death rates were highest among people aged 60 or older, in whom the incidence was 0.78 per million and the death rate was 40%, Ms. Srivastava said. She hypothesized that there was a low prevalence of immunity and high incidence of tetanus in the elderly, at least early in the study period, because they more likely had not received a primary immunization series. The incidence in the elderly declined somewhat from 1991 to 2001, however.

Patients with diabetes were at increased risk for dying from tetanus. Looking at one slice of the study period (1987–2001) diabetes patients accounted for 13% of all cases and 29% of all deaths. Of the diabetics with tetanus, 44% died, Ms. Srivastava said.

There may be more people at risk, because a surprising number of tetanus cases come from nonacute, or chronic wounds, she said. About 16% of all the cases reported were from nonacute wounds; 76% were from acute wounds, and the rest from other sources.

Tetanus also has been steadily increasing over the decades in injection drug users. From 1992 to 2001, there was a threefold increase from previous decades, driven partly by an epidemic among users in California. During that decade, they accounted for 12% of all adult cases, Ms. Srivastava said.

And although there tend to be no differences in incidence overall among ethnic groups, that equality disappears among injection-drug users, where Hispanics account for 48% of cases, she said.

Tetanus is not a high-cost disease in this country, costing only about $12 million a year, but it is severely disabling, and 78% of those affected are hospitalized.

WASHINGTON — The incidence of tetanus has declined precipitously in recent decades, as have deaths from the toxin, but the elderly, diabetics, and injection-drug users are still at risk, according to research presented at the National Immunization Conference, sponsored by the Centers for Disease Control and Prevention.

Pamela Srivastava of the CDC's National Immunization Program, reported the results of an epidemiologic look at tetanus from 1972 to 2001.

During that period, 1,842 cases of tetanus were reported to the CDC, Ms. Srivastava said.

Tetanus occurs from exposure to Clostridium tetani, a bacterium that releases a toxin initially causing headache, fever, sore throat, muscle spasms, and stiffness in the neck, arms, and legs. Left unchecked, the toxin will spread and lead to the characteristic “lockjaw,” as well as rigidity of other muscles.

C. tetani can live for years in soil and feces. Infection usually comes through wounds. Historically, tetanus occurred more frequently in the southeast, and primarily in the summer, but most regional differences have disappeared, and there is not as much seasonal variation, either, Ms. Srivastava said.

The incidence of the infection has been on the decline in the United States, dropping 59% from 1972 to 2001. During that time, the case fatality rate decreased by 64%, she said.

Vaccination history was reported for 932 of the 1,842 cases. Among those, 644 (49%) were unvaccinated, and the case death rate was 28%. Among the 172 (18%) who had received one or two doses of vaccine, the death rate was 17%. Among the 114 persons (12%) who had received three or more doses, the death rate was 4%.

The number of cases and death rates were highest among people aged 60 or older, in whom the incidence was 0.78 per million and the death rate was 40%, Ms. Srivastava said. She hypothesized that there was a low prevalence of immunity and high incidence of tetanus in the elderly, at least early in the study period, because they more likely had not received a primary immunization series. The incidence in the elderly declined somewhat from 1991 to 2001, however.

Patients with diabetes were at increased risk for dying from tetanus. Looking at one slice of the study period (1987–2001) diabetes patients accounted for 13% of all cases and 29% of all deaths. Of the diabetics with tetanus, 44% died, Ms. Srivastava said.

There may be more people at risk, because a surprising number of tetanus cases come from nonacute, or chronic wounds, she said. About 16% of all the cases reported were from nonacute wounds; 76% were from acute wounds, and the rest from other sources.

Tetanus also has been steadily increasing over the decades in injection drug users. From 1992 to 2001, there was a threefold increase from previous decades, driven partly by an epidemic among users in California. During that decade, they accounted for 12% of all adult cases, Ms. Srivastava said.

And although there tend to be no differences in incidence overall among ethnic groups, that equality disappears among injection-drug users, where Hispanics account for 48% of cases, she said.

Tetanus is not a high-cost disease in this country, costing only about $12 million a year, but it is severely disabling, and 78% of those affected are hospitalized.

An experimental vaccine that combines coverage for nine strains of pneumococcus and a single meningococcal strain appears to be less effective than a meningitis vaccine alone, and also decreases the immunogenicity of some other vaccinations given concomitantly, according to a recent report.

The study results provide a cautionary tale for vaccine makers and pediatricians, said John Bradley, M.D., director of the division of infectious disease at Children's Hospital, San Diego, who was asked to comment on the findings.

“It is not easy to put together a vaccine that has all these components,” he said. “When you mix them all together you don't get the nice brisk responses you expect when you administer each separately, and we're probably further off from a single vaccine than we were all hoping,” added Dr. Bradley, who is a member of the American Academy of Pediatrics Committee on Infectious Diseases.

Lead author Jim P. Buttery, M.D., agreed that the study showed the technical difficulty of building a single-shot package. “Each new antigen is successively more difficult,” he said in an interview with this newspaper.

The phase II trial compared Wyeth's Pnc9-MenC vaccine with the company's MenC vaccine alone (JAMA 2005;293:1751–8). MenC (Meningitec) is not used in the United States, and it's not likely that the Pnc9-MenC combination would be sold here, as the strains it covers are not as prevalent.

There is great interest in combination vaccines. Dr. Buttery and his associates noted that if a combination meningococcal/pneumococcal vaccine was adopted, it could spare U.S. infants up to four extra injections by 18 months, and U.K. infants two to three injections at each visit.

Dr. Buttery led the study while at Churchill Hospital in Oxford, England. He is now with Murdoch Children's Research Institute, the University of Melbourne (Australia).

In the trial, Dr. Buttery and his colleagues enrolled 240 healthy infants aged 7–11 weeks at two United Kingdom hospitals from August 2000 to January 2002.

Children who had known immunosuppression, previous vaccination, or confirmed invasive meningococcal or pneumococcal disease were excluded.

They were divided into two groups: 120 received the Pnc9-MenC vaccine, and 120 received MenC, a monovalent group C meningococcal conjugate vaccine. MenC is the standard in the United Kingdom. There is no separate pneumococcal injection. Both groups also were given diphtheria and tetanus toxoids and whole-cell pertussis, Haemophilus influenzae type b (Hib), polyribosylribitol phosphate-tetanus toxoid protein conjugate, and oral polio vaccine.

Vaccinations were given at ages 2, 3 and 4 months—an accelerated schedule, compared with the United States. Home follow-up visits were conducted at 2, 3, 4, and 5 months of age.

At 5 months, serum samples indicated that the combination vaccine was less immunogenic than the MenC vaccine. Antibody concentrations for Hib and diphtheria were lower for infants who received the combination. Dr. Buttery and his colleagues said the effect on diphtheria was unexpected, but he noted that the antibodies were still in the protective range. There was no difference between the groups for tetanus antibodies.

More children in the combination group had to forego second or third vaccinations because of prolonged crying or fever.

The study might not be applicable to U.S. practice because of the accelerated schedule—only a month of separation between each dose—and because of the different vaccinations used. For instance, whole-cell pertussis and oral polio are not usually given in the United States, Dr. Bradley said.

But he said it was important the study was published, especially since it was sponsored by a drug company and was published even though it had negative findings.

Dr. Buttery, who has acted as a consultant for Wyeth and received other assistance from the company, said in an interview that though he is not privy to company decisions, a phase III study “may not occur.”

He and his colleagues concluded that, “The reduced immunogenicity of the serogroup C meningococcal component of Pnc9-MenC as well as concomitantly administered Hib and diphtheria may limit its further development.”

An experimental vaccine that combines coverage for nine strains of pneumococcus and a single meningococcal strain appears to be less effective than a meningitis vaccine alone, and also decreases the immunogenicity of some other vaccinations given concomitantly, according to a recent report.

The study results provide a cautionary tale for vaccine makers and pediatricians, said John Bradley, M.D., director of the division of infectious disease at Children's Hospital, San Diego, who was asked to comment on the findings.

“It is not easy to put together a vaccine that has all these components,” he said. “When you mix them all together you don't get the nice brisk responses you expect when you administer each separately, and we're probably further off from a single vaccine than we were all hoping,” added Dr. Bradley, who is a member of the American Academy of Pediatrics Committee on Infectious Diseases.

Lead author Jim P. Buttery, M.D., agreed that the study showed the technical difficulty of building a single-shot package. “Each new antigen is successively more difficult,” he said in an interview with this newspaper.

The phase II trial compared Wyeth's Pnc9-MenC vaccine with the company's MenC vaccine alone (JAMA 2005;293:1751–8). MenC (Meningitec) is not used in the United States, and it's not likely that the Pnc9-MenC combination would be sold here, as the strains it covers are not as prevalent.

There is great interest in combination vaccines. Dr. Buttery and his associates noted that if a combination meningococcal/pneumococcal vaccine was adopted, it could spare U.S. infants up to four extra injections by 18 months, and U.K. infants two to three injections at each visit.

Dr. Buttery led the study while at Churchill Hospital in Oxford, England. He is now with Murdoch Children's Research Institute, the University of Melbourne (Australia).

In the trial, Dr. Buttery and his colleagues enrolled 240 healthy infants aged 7–11 weeks at two United Kingdom hospitals from August 2000 to January 2002.

Children who had known immunosuppression, previous vaccination, or confirmed invasive meningococcal or pneumococcal disease were excluded.

They were divided into two groups: 120 received the Pnc9-MenC vaccine, and 120 received MenC, a monovalent group C meningococcal conjugate vaccine. MenC is the standard in the United Kingdom. There is no separate pneumococcal injection. Both groups also were given diphtheria and tetanus toxoids and whole-cell pertussis, Haemophilus influenzae type b (Hib), polyribosylribitol phosphate-tetanus toxoid protein conjugate, and oral polio vaccine.

Vaccinations were given at ages 2, 3 and 4 months—an accelerated schedule, compared with the United States. Home follow-up visits were conducted at 2, 3, 4, and 5 months of age.

At 5 months, serum samples indicated that the combination vaccine was less immunogenic than the MenC vaccine. Antibody concentrations for Hib and diphtheria were lower for infants who received the combination. Dr. Buttery and his colleagues said the effect on diphtheria was unexpected, but he noted that the antibodies were still in the protective range. There was no difference between the groups for tetanus antibodies.

More children in the combination group had to forego second or third vaccinations because of prolonged crying or fever.

The study might not be applicable to U.S. practice because of the accelerated schedule—only a month of separation between each dose—and because of the different vaccinations used. For instance, whole-cell pertussis and oral polio are not usually given in the United States, Dr. Bradley said.

But he said it was important the study was published, especially since it was sponsored by a drug company and was published even though it had negative findings.

Dr. Buttery, who has acted as a consultant for Wyeth and received other assistance from the company, said in an interview that though he is not privy to company decisions, a phase III study “may not occur.”

He and his colleagues concluded that, “The reduced immunogenicity of the serogroup C meningococcal component of Pnc9-MenC as well as concomitantly administered Hib and diphtheria may limit its further development.”

An experimental vaccine that combines coverage for nine strains of pneumococcus and a single meningococcal strain appears to be less effective than a meningitis vaccine alone, and also decreases the immunogenicity of some other vaccinations given concomitantly, according to a recent report.

The study results provide a cautionary tale for vaccine makers and pediatricians, said John Bradley, M.D., director of the division of infectious disease at Children's Hospital, San Diego, who was asked to comment on the findings.

“It is not easy to put together a vaccine that has all these components,” he said. “When you mix them all together you don't get the nice brisk responses you expect when you administer each separately, and we're probably further off from a single vaccine than we were all hoping,” added Dr. Bradley, who is a member of the American Academy of Pediatrics Committee on Infectious Diseases.

Lead author Jim P. Buttery, M.D., agreed that the study showed the technical difficulty of building a single-shot package. “Each new antigen is successively more difficult,” he said in an interview with this newspaper.

The phase II trial compared Wyeth's Pnc9-MenC vaccine with the company's MenC vaccine alone (JAMA 2005;293:1751–8). MenC (Meningitec) is not used in the United States, and it's not likely that the Pnc9-MenC combination would be sold here, as the strains it covers are not as prevalent.

There is great interest in combination vaccines. Dr. Buttery and his associates noted that if a combination meningococcal/pneumococcal vaccine was adopted, it could spare U.S. infants up to four extra injections by 18 months, and U.K. infants two to three injections at each visit.

Dr. Buttery led the study while at Churchill Hospital in Oxford, England. He is now with Murdoch Children's Research Institute, the University of Melbourne (Australia).

In the trial, Dr. Buttery and his colleagues enrolled 240 healthy infants aged 7–11 weeks at two United Kingdom hospitals from August 2000 to January 2002.

Children who had known immunosuppression, previous vaccination, or confirmed invasive meningococcal or pneumococcal disease were excluded.

They were divided into two groups: 120 received the Pnc9-MenC vaccine, and 120 received MenC, a monovalent group C meningococcal conjugate vaccine. MenC is the standard in the United Kingdom. There is no separate pneumococcal injection. Both groups also were given diphtheria and tetanus toxoids and whole-cell pertussis, Haemophilus influenzae type b (Hib), polyribosylribitol phosphate-tetanus toxoid protein conjugate, and oral polio vaccine.

Vaccinations were given at ages 2, 3 and 4 months—an accelerated schedule, compared with the United States. Home follow-up visits were conducted at 2, 3, 4, and 5 months of age.

At 5 months, serum samples indicated that the combination vaccine was less immunogenic than the MenC vaccine. Antibody concentrations for Hib and diphtheria were lower for infants who received the combination. Dr. Buttery and his colleagues said the effect on diphtheria was unexpected, but he noted that the antibodies were still in the protective range. There was no difference between the groups for tetanus antibodies.

More children in the combination group had to forego second or third vaccinations because of prolonged crying or fever.

The study might not be applicable to U.S. practice because of the accelerated schedule—only a month of separation between each dose—and because of the different vaccinations used. For instance, whole-cell pertussis and oral polio are not usually given in the United States, Dr. Bradley said.

But he said it was important the study was published, especially since it was sponsored by a drug company and was published even though it had negative findings.

Dr. Buttery, who has acted as a consultant for Wyeth and received other assistance from the company, said in an interview that though he is not privy to company decisions, a phase III study “may not occur.”

He and his colleagues concluded that, “The reduced immunogenicity of the serogroup C meningococcal component of Pnc9-MenC as well as concomitantly administered Hib and diphtheria may limit its further development.”

WASHINGTON — Wisconsin health authorities stopped a spiraling outbreak of pertussis by advocating faster testing and use of antibiotics in all suspect cases, a state health official reported at the National Immunization Conference sponsored by the Centers for Disease Control and Prevention.

Jeffrey Davis, M.D., of the Wisconsin Division of Public Health, gave the details of the epidemic, which lasted from May 2003 until February 2004 and occurred primarily in Fond du Lac County. In the 5 years before the outbreak, there had only been five cases of pertussis in Wisconsin.

Cases were defined using the Centers for Disease Control and Prevention's (CDC) definition of pertussis: a cough illness lasting more than 2 weeks with paroxysms, whoop, or posttussive vomiting. Cases were confirmed by patient follow-up interviews and/or lab confirmation by isolating Bordetella pertussis in culture, or through a positive polymerase chain reaction (PCR) assay.

During the outbreak, there were 313 cases reported in the county (in a total population of 97,296); 193 were confirmed in the lab, and 120 were confirmed by epidemiology. Just over half the cases were in females, and the median age was 14 years. Of those with confirmed pertussis, 43% were aged 10-14 years; the incidence rate exceeded 1,000 per 100,000 in that cohort, he said.

The health department determined that the outbreak probably started with two unvaccinated adolescents using a high school weight room. Of the initial 53 cases, 55% were linked to that weight room, Dr. Davis said.

Universal pertussis boosters would probably have prevented the outbreak because it likely began with two unvaccinated adolescents, he said.

During the epidemic's initial peak in mid-October, the health department alerted physicians to keep a close eye on potential cases. As the number of new cases continued to rise into November, the department issued another alert, suggesting more testing and use of antibiotics in any suspect cases.

That alert led to a sharp decline in cases. During the first peak, it took a median of 10.5 days between the onset of cough and initiation of antibiotics. By the last peak, medication was generally started within 4 days of cough onset. More than 5,000 courses of antibiotics were dispensed; 90% of the prescriptions were for azithromycin.

As physicians became more aware, they stepped up reporting, Dr. Davis said.

PCR testing by the health department allowed for a rapid response—results were generally back to physicians within 24-48 hours.

Although the health department was able to respond and stop the outbreak's spread, it was costly—about $2,000 per case, Dr. Davis said.

WASHINGTON — Wisconsin health authorities stopped a spiraling outbreak of pertussis by advocating faster testing and use of antibiotics in all suspect cases, a state health official reported at the National Immunization Conference sponsored by the Centers for Disease Control and Prevention.

Jeffrey Davis, M.D., of the Wisconsin Division of Public Health, gave the details of the epidemic, which lasted from May 2003 until February 2004 and occurred primarily in Fond du Lac County. In the 5 years before the outbreak, there had only been five cases of pertussis in Wisconsin.

Cases were defined using the Centers for Disease Control and Prevention's (CDC) definition of pertussis: a cough illness lasting more than 2 weeks with paroxysms, whoop, or posttussive vomiting. Cases were confirmed by patient follow-up interviews and/or lab confirmation by isolating Bordetella pertussis in culture, or through a positive polymerase chain reaction (PCR) assay.

During the outbreak, there were 313 cases reported in the county (in a total population of 97,296); 193 were confirmed in the lab, and 120 were confirmed by epidemiology. Just over half the cases were in females, and the median age was 14 years. Of those with confirmed pertussis, 43% were aged 10-14 years; the incidence rate exceeded 1,000 per 100,000 in that cohort, he said.

The health department determined that the outbreak probably started with two unvaccinated adolescents using a high school weight room. Of the initial 53 cases, 55% were linked to that weight room, Dr. Davis said.

Universal pertussis boosters would probably have prevented the outbreak because it likely began with two unvaccinated adolescents, he said.

During the epidemic's initial peak in mid-October, the health department alerted physicians to keep a close eye on potential cases. As the number of new cases continued to rise into November, the department issued another alert, suggesting more testing and use of antibiotics in any suspect cases.

That alert led to a sharp decline in cases. During the first peak, it took a median of 10.5 days between the onset of cough and initiation of antibiotics. By the last peak, medication was generally started within 4 days of cough onset. More than 5,000 courses of antibiotics were dispensed; 90% of the prescriptions were for azithromycin.

As physicians became more aware, they stepped up reporting, Dr. Davis said.

PCR testing by the health department allowed for a rapid response—results were generally back to physicians within 24-48 hours.

Although the health department was able to respond and stop the outbreak's spread, it was costly—about $2,000 per case, Dr. Davis said.

WASHINGTON — Wisconsin health authorities stopped a spiraling outbreak of pertussis by advocating faster testing and use of antibiotics in all suspect cases, a state health official reported at the National Immunization Conference sponsored by the Centers for Disease Control and Prevention.

Jeffrey Davis, M.D., of the Wisconsin Division of Public Health, gave the details of the epidemic, which lasted from May 2003 until February 2004 and occurred primarily in Fond du Lac County. In the 5 years before the outbreak, there had only been five cases of pertussis in Wisconsin.

Cases were defined using the Centers for Disease Control and Prevention's (CDC) definition of pertussis: a cough illness lasting more than 2 weeks with paroxysms, whoop, or posttussive vomiting. Cases were confirmed by patient follow-up interviews and/or lab confirmation by isolating Bordetella pertussis in culture, or through a positive polymerase chain reaction (PCR) assay.

During the outbreak, there were 313 cases reported in the county (in a total population of 97,296); 193 were confirmed in the lab, and 120 were confirmed by epidemiology. Just over half the cases were in females, and the median age was 14 years. Of those with confirmed pertussis, 43% were aged 10-14 years; the incidence rate exceeded 1,000 per 100,000 in that cohort, he said.

The health department determined that the outbreak probably started with two unvaccinated adolescents using a high school weight room. Of the initial 53 cases, 55% were linked to that weight room, Dr. Davis said.

Universal pertussis boosters would probably have prevented the outbreak because it likely began with two unvaccinated adolescents, he said.

During the epidemic's initial peak in mid-October, the health department alerted physicians to keep a close eye on potential cases. As the number of new cases continued to rise into November, the department issued another alert, suggesting more testing and use of antibiotics in any suspect cases.

That alert led to a sharp decline in cases. During the first peak, it took a median of 10.5 days between the onset of cough and initiation of antibiotics. By the last peak, medication was generally started within 4 days of cough onset. More than 5,000 courses of antibiotics were dispensed; 90% of the prescriptions were for azithromycin.

As physicians became more aware, they stepped up reporting, Dr. Davis said.

PCR testing by the health department allowed for a rapid response—results were generally back to physicians within 24-48 hours.

Although the health department was able to respond and stop the outbreak's spread, it was costly—about $2,000 per case, Dr. Davis said.

WASHINGTON — The incidence of tetanus has declined precipitously in recent decades, as have deaths from the toxin, but the elderly, diabetics, and injection-drug users are still at risk, according to research presented at the National Immunization Conference, sponsored by the Centers for Disease Control and Prevention.

Pamela Srivastava of the CDC's National Immunization Program, reported the results of an epidemiologic look at tetanus from 1972 to 2001. During that period, 1,842 cases of tetanus were reported to the CDC, Ms. Srivastava said.

Tetanus occurs from exposure to Clostridium tetani, a bacterium that releases a toxin initially causing headache, fever, sore throat, muscle spasms, and stiffness in the neck, arms, and legs. Left unchecked, the toxin will spread and lead to the characteristic “lockjaw,” as well as rigidity of other muscles. C. tetani can live for years in soil and feces. Infection usually comes through wounds. Historically, tetanus occurred more frequently in the southeast, and primarily in the summer, but most regional differences have disappeared, and there is not as much seasonal variation, either, she said.

The incidence of the infection has been on the decline in the United States, dropping 59% from 1972 to 2001. During that time, the case fatality rate decreased by 64%, she said.

Vaccination history was reported for 932 of the 1,842 cases. Among those, 644 (49%) were unvaccinated, and the case death rate was 28%. Among the 172 (18%) who had received one or two doses of vaccine, the death rate was 17%. Among the 114 persons (12%) who had received three or more doses, the death rate was 4%.

The number of cases and death rates were highest among people aged 60 or older, in whom the incidence was 0.78 per million and the death rate was 40%. She hypothesized that there was a low prevalence of immunity and high incidence of tetanus in the elderly, at least early in the study period, because they more likely had not received a primary immunization series. The incidence in the elderly declined some from 1991 to 2001.

Patients with diabetes were at increased risk for dying from tetanus. From 1987 to 2001, diabetic patients accounted for 13% of all cases and 29% of all deaths. Of the diabetics with tetanus, 44% died, Ms. Srivastava said.

There may be more people at risk, because a surprising number of tetanus cases come from nonacute, or chronic wounds, she said. About 16% of all the cases reported were from nonacute wounds; 76% were from acute wounds, and the rest from other sources.

Tetanus also has been steadily increasing over the decades in injection drug users. From 1992 to 2001, there was a threefold increase from previous decades, driven partly by an epidemic among users in California. During that decade, they accounted for 12% of all adult cases, Ms. Srivastava said.

Tetanus is not a high-cost disease in this country, costing only about $12 million a year, but it is severely disabling, and 78% of those affected are hospitalized. That argues for making sure vaccinations are up to date, she said.

WASHINGTON — The incidence of tetanus has declined precipitously in recent decades, as have deaths from the toxin, but the elderly, diabetics, and injection-drug users are still at risk, according to research presented at the National Immunization Conference, sponsored by the Centers for Disease Control and Prevention.

Pamela Srivastava of the CDC's National Immunization Program, reported the results of an epidemiologic look at tetanus from 1972 to 2001. During that period, 1,842 cases of tetanus were reported to the CDC, Ms. Srivastava said.

Tetanus occurs from exposure to Clostridium tetani, a bacterium that releases a toxin initially causing headache, fever, sore throat, muscle spasms, and stiffness in the neck, arms, and legs. Left unchecked, the toxin will spread and lead to the characteristic “lockjaw,” as well as rigidity of other muscles. C. tetani can live for years in soil and feces. Infection usually comes through wounds. Historically, tetanus occurred more frequently in the southeast, and primarily in the summer, but most regional differences have disappeared, and there is not as much seasonal variation, either, she said.

The incidence of the infection has been on the decline in the United States, dropping 59% from 1972 to 2001. During that time, the case fatality rate decreased by 64%, she said.

Vaccination history was reported for 932 of the 1,842 cases. Among those, 644 (49%) were unvaccinated, and the case death rate was 28%. Among the 172 (18%) who had received one or two doses of vaccine, the death rate was 17%. Among the 114 persons (12%) who had received three or more doses, the death rate was 4%.

The number of cases and death rates were highest among people aged 60 or older, in whom the incidence was 0.78 per million and the death rate was 40%. She hypothesized that there was a low prevalence of immunity and high incidence of tetanus in the elderly, at least early in the study period, because they more likely had not received a primary immunization series. The incidence in the elderly declined some from 1991 to 2001.

Patients with diabetes were at increased risk for dying from tetanus. From 1987 to 2001, diabetic patients accounted for 13% of all cases and 29% of all deaths. Of the diabetics with tetanus, 44% died, Ms. Srivastava said.

There may be more people at risk, because a surprising number of tetanus cases come from nonacute, or chronic wounds, she said. About 16% of all the cases reported were from nonacute wounds; 76% were from acute wounds, and the rest from other sources.

Tetanus also has been steadily increasing over the decades in injection drug users. From 1992 to 2001, there was a threefold increase from previous decades, driven partly by an epidemic among users in California. During that decade, they accounted for 12% of all adult cases, Ms. Srivastava said.

Tetanus is not a high-cost disease in this country, costing only about $12 million a year, but it is severely disabling, and 78% of those affected are hospitalized. That argues for making sure vaccinations are up to date, she said.

WASHINGTON — The incidence of tetanus has declined precipitously in recent decades, as have deaths from the toxin, but the elderly, diabetics, and injection-drug users are still at risk, according to research presented at the National Immunization Conference, sponsored by the Centers for Disease Control and Prevention.

Pamela Srivastava of the CDC's National Immunization Program, reported the results of an epidemiologic look at tetanus from 1972 to 2001. During that period, 1,842 cases of tetanus were reported to the CDC, Ms. Srivastava said.

Tetanus occurs from exposure to Clostridium tetani, a bacterium that releases a toxin initially causing headache, fever, sore throat, muscle spasms, and stiffness in the neck, arms, and legs. Left unchecked, the toxin will spread and lead to the characteristic “lockjaw,” as well as rigidity of other muscles. C. tetani can live for years in soil and feces. Infection usually comes through wounds. Historically, tetanus occurred more frequently in the southeast, and primarily in the summer, but most regional differences have disappeared, and there is not as much seasonal variation, either, she said.

The incidence of the infection has been on the decline in the United States, dropping 59% from 1972 to 2001. During that time, the case fatality rate decreased by 64%, she said.

Vaccination history was reported for 932 of the 1,842 cases. Among those, 644 (49%) were unvaccinated, and the case death rate was 28%. Among the 172 (18%) who had received one or two doses of vaccine, the death rate was 17%. Among the 114 persons (12%) who had received three or more doses, the death rate was 4%.

The number of cases and death rates were highest among people aged 60 or older, in whom the incidence was 0.78 per million and the death rate was 40%. She hypothesized that there was a low prevalence of immunity and high incidence of tetanus in the elderly, at least early in the study period, because they more likely had not received a primary immunization series. The incidence in the elderly declined some from 1991 to 2001.

Patients with diabetes were at increased risk for dying from tetanus. From 1987 to 2001, diabetic patients accounted for 13% of all cases and 29% of all deaths. Of the diabetics with tetanus, 44% died, Ms. Srivastava said.

There may be more people at risk, because a surprising number of tetanus cases come from nonacute, or chronic wounds, she said. About 16% of all the cases reported were from nonacute wounds; 76% were from acute wounds, and the rest from other sources.

Tetanus also has been steadily increasing over the decades in injection drug users. From 1992 to 2001, there was a threefold increase from previous decades, driven partly by an epidemic among users in California. During that decade, they accounted for 12% of all adult cases, Ms. Srivastava said.

Tetanus is not a high-cost disease in this country, costing only about $12 million a year, but it is severely disabling, and 78% of those affected are hospitalized. That argues for making sure vaccinations are up to date, she said.

Skin reactions to tumor necrosis factor-α-blocking drugs for rheumatoid arthritis might be more common and more varied than previous studies have indicated, results of a new prospective study show.

The study authors, led by Marcel Flendrie, M.D., of Radboud University Nijmegen (the Netherlands) Medical Centre, said theirs is the first large prospective study of dermatologic conditions in rheumatoid arthritis (RA) patients taking TNF-α-blocking medications.

Overall, 25% of the 289 patients taking the biologics had a dermatologic event, compared with 13% of the same number of control patients.

The odds ratio for a patient taking the biologics to require a dermatologic referral was 2.26 (Arthritis Res. Ther. 2005;7:R666-76). The study was published online at BioMed Central's Web site on April 4 (www.arthritis-research.com/content/7/3/r666

There seemed to be no characteristic at baseline that predicted which patients might be susceptible to a dermatologic event, the authors said.

In the trial, 289 consecutive patients with RA who were started on TNF-α-blocking therapy—infliximab, etanercept, adalimumab, or the experimental agent lenercept—were compared with 289 patients from a cohort of 500 who have been followed at the medical center since 1985 but who had never taken a TNF-α-blocking agent.

Any patient who visited a dermatologist during the follow-up period was identified, and any new manifestation or exacerbation of a skin disease or any drug-related eruptions were recorded. The researchers also recorded diagnoses, topical and systemic therapeutic actions, outcome of the event, and any information on rechallenge.

Median follow-up time was 2.3 years. Among the patients taking anti-TNF therapy, 70 (24%) had received more than one agent, 8 (3%) had a history of taking more than two.

Overall, 167 patients were given infliximab, 108 received adalimumab, 78 received etanercept, and 31 were treated with lenercept. In total, there were 128 dermatologic events in the TNF group; 56 events occurred with adalimumab, 49 with infliximab, 16 with etanercept, and 13 with lenercept.

Skin infections accounted for the largest proportion of these therapy-related events, with 33 fungal, bacterial, and viral infections recorded. TNF-α-blocking therapies are known to increase susceptibility to infections, and the study findings suggest that the immunosuppressive agents might also make patients more vulnerable to skin infections, said the authors.

Eczema was diagnosed 20 times in 19 patients, and 3 patients stopped therapy as a result. One patient was hospitalized. The others were treated with topical corticosteroids.

There were frequent cases of drug-related eruptions in the first 5 months, in particular, said the authors.

Most common was a combination of exanthema, urticarial eruptions, lichenoid skin lesions, and purpura. Of 15 patients diagnosed with an eruption, 7 stopped therapy, and 8 continued. One patient was hospitalized.

In smaller numbers, patients also experienced ulcers, benign and malignant skin tumors, vasculitis, actinic keratosis, edema, chronic venous insufficiency/varices, xerosis cutis, and stasis dermatitis.

The occurrence of psoriasiform eruptions in three patients was “particularly interesting,” given that etanercept is approved for psoriasis, and infliximab may soon get that approval, the researchers said.

The time between the start of therapy and onset of skin conditions varied, but some events looked more likely to be drug related, including the eruptions, cutaneous vasculitis, a case of systemic lupus erythematosus, dermatomyositis, and a lymphomatoid papulosis-like eruption, the authors continued.

Overall, 19 of the 72 patients who experienced skin problems stopped taking the TNF-α-blocking therapy.

Skin reactions to tumor necrosis factor-α-blocking drugs for rheumatoid arthritis might be more common and more varied than previous studies have indicated, results of a new prospective study show.

The study authors, led by Marcel Flendrie, M.D., of Radboud University Nijmegen (the Netherlands) Medical Centre, said theirs is the first large prospective study of dermatologic conditions in rheumatoid arthritis (RA) patients taking TNF-α-blocking medications.

Overall, 25% of the 289 patients taking the biologics had a dermatologic event, compared with 13% of the same number of control patients.

The odds ratio for a patient taking the biologics to require a dermatologic referral was 2.26 (Arthritis Res. Ther. 2005;7:R666-76). The study was published online at BioMed Central's Web site on April 4 (www.arthritis-research.com/content/7/3/r666

There seemed to be no characteristic at baseline that predicted which patients might be susceptible to a dermatologic event, the authors said.

In the trial, 289 consecutive patients with RA who were started on TNF-α-blocking therapy—infliximab, etanercept, adalimumab, or the experimental agent lenercept—were compared with 289 patients from a cohort of 500 who have been followed at the medical center since 1985 but who had never taken a TNF-α-blocking agent.

Any patient who visited a dermatologist during the follow-up period was identified, and any new manifestation or exacerbation of a skin disease or any drug-related eruptions were recorded. The researchers also recorded diagnoses, topical and systemic therapeutic actions, outcome of the event, and any information on rechallenge.

Median follow-up time was 2.3 years. Among the patients taking anti-TNF therapy, 70 (24%) had received more than one agent, 8 (3%) had a history of taking more than two.

Overall, 167 patients were given infliximab, 108 received adalimumab, 78 received etanercept, and 31 were treated with lenercept. In total, there were 128 dermatologic events in the TNF group; 56 events occurred with adalimumab, 49 with infliximab, 16 with etanercept, and 13 with lenercept.

Skin infections accounted for the largest proportion of these therapy-related events, with 33 fungal, bacterial, and viral infections recorded. TNF-α-blocking therapies are known to increase susceptibility to infections, and the study findings suggest that the immunosuppressive agents might also make patients more vulnerable to skin infections, said the authors.

Eczema was diagnosed 20 times in 19 patients, and 3 patients stopped therapy as a result. One patient was hospitalized. The others were treated with topical corticosteroids.

There were frequent cases of drug-related eruptions in the first 5 months, in particular, said the authors.

Most common was a combination of exanthema, urticarial eruptions, lichenoid skin lesions, and purpura. Of 15 patients diagnosed with an eruption, 7 stopped therapy, and 8 continued. One patient was hospitalized.

In smaller numbers, patients also experienced ulcers, benign and malignant skin tumors, vasculitis, actinic keratosis, edema, chronic venous insufficiency/varices, xerosis cutis, and stasis dermatitis.

The occurrence of psoriasiform eruptions in three patients was “particularly interesting,” given that etanercept is approved for psoriasis, and infliximab may soon get that approval, the researchers said.

The time between the start of therapy and onset of skin conditions varied, but some events looked more likely to be drug related, including the eruptions, cutaneous vasculitis, a case of systemic lupus erythematosus, dermatomyositis, and a lymphomatoid papulosis-like eruption, the authors continued.

Overall, 19 of the 72 patients who experienced skin problems stopped taking the TNF-α-blocking therapy.

Skin reactions to tumor necrosis factor-α-blocking drugs for rheumatoid arthritis might be more common and more varied than previous studies have indicated, results of a new prospective study show.

The study authors, led by Marcel Flendrie, M.D., of Radboud University Nijmegen (the Netherlands) Medical Centre, said theirs is the first large prospective study of dermatologic conditions in rheumatoid arthritis (RA) patients taking TNF-α-blocking medications.

Overall, 25% of the 289 patients taking the biologics had a dermatologic event, compared with 13% of the same number of control patients.

The odds ratio for a patient taking the biologics to require a dermatologic referral was 2.26 (Arthritis Res. Ther. 2005;7:R666-76). The study was published online at BioMed Central's Web site on April 4 (www.arthritis-research.com/content/7/3/r666

There seemed to be no characteristic at baseline that predicted which patients might be susceptible to a dermatologic event, the authors said.

In the trial, 289 consecutive patients with RA who were started on TNF-α-blocking therapy—infliximab, etanercept, adalimumab, or the experimental agent lenercept—were compared with 289 patients from a cohort of 500 who have been followed at the medical center since 1985 but who had never taken a TNF-α-blocking agent.

Any patient who visited a dermatologist during the follow-up period was identified, and any new manifestation or exacerbation of a skin disease or any drug-related eruptions were recorded. The researchers also recorded diagnoses, topical and systemic therapeutic actions, outcome of the event, and any information on rechallenge.

Median follow-up time was 2.3 years. Among the patients taking anti-TNF therapy, 70 (24%) had received more than one agent, 8 (3%) had a history of taking more than two.

Overall, 167 patients were given infliximab, 108 received adalimumab, 78 received etanercept, and 31 were treated with lenercept. In total, there were 128 dermatologic events in the TNF group; 56 events occurred with adalimumab, 49 with infliximab, 16 with etanercept, and 13 with lenercept.

Skin infections accounted for the largest proportion of these therapy-related events, with 33 fungal, bacterial, and viral infections recorded. TNF-α-blocking therapies are known to increase susceptibility to infections, and the study findings suggest that the immunosuppressive agents might also make patients more vulnerable to skin infections, said the authors.

Eczema was diagnosed 20 times in 19 patients, and 3 patients stopped therapy as a result. One patient was hospitalized. The others were treated with topical corticosteroids.

There were frequent cases of drug-related eruptions in the first 5 months, in particular, said the authors.

Most common was a combination of exanthema, urticarial eruptions, lichenoid skin lesions, and purpura. Of 15 patients diagnosed with an eruption, 7 stopped therapy, and 8 continued. One patient was hospitalized.

In smaller numbers, patients also experienced ulcers, benign and malignant skin tumors, vasculitis, actinic keratosis, edema, chronic venous insufficiency/varices, xerosis cutis, and stasis dermatitis.

The occurrence of psoriasiform eruptions in three patients was “particularly interesting,” given that etanercept is approved for psoriasis, and infliximab may soon get that approval, the researchers said.

The time between the start of therapy and onset of skin conditions varied, but some events looked more likely to be drug related, including the eruptions, cutaneous vasculitis, a case of systemic lupus erythematosus, dermatomyositis, and a lymphomatoid papulosis-like eruption, the authors continued.

Overall, 19 of the 72 patients who experienced skin problems stopped taking the TNF-α-blocking therapy.

WASHINGTON —Two doses of influenza vaccine were up to 55% effective against influenza-like illness and 85% effective against pneumonia or flu, Mandy Allison, M.D., said at the National Immunization Conference sponsored by the Centers for Disease Control and Prevention.

The aim of Dr. Allison and her colleagues at Children's Hospital, Denver, and the University of Colorado Health Sciences Center, was to gather more data on the flu vaccine's effectiveness in children, especially since the CDC's Advisory Committee on Immunization Practices advised in 2004 that the shot should be included as a routine immunization for children aged 6-23 months.

Dr. Allison said that one study in the Journal of the American Medical Association calculated the vaccine's effectiveness at 66% in any given year, but a recent systematic review published in the Lancet found very little data on vaccine efficacy in children under 2 years old (2005;365:773-80).

A study conducted by Kaiser and the CDC found that the flu vaccine was only 25% effective against influenza-like illness (ILI), and 49% effective against pneumonia and flu, which is defined as a subset of ILI (MMWR 2004;53:707-10), she said.

Her group analyzed billing and immunization registry data from 5,913 healthy 6- to 21-month-old children from five Denver area pediatric practices. ICD-9 codes for office visits between Nov. 1 and Dec. 31 were reviewed to determine the first ILI; the same nine codes were used in the Denver study as in the Kaiser/CDC study, Dr. Allison said.

Children were dubbed either partially vaccinated—one shot during the current season and 14 days before the first influenza-like illness—or fully vaccinated, which was defined as two shots more than 14 days before the first ILI, according to Dr. Allison.

During Colorado's flu season, which peaked early, 36% of the children were unvaccinated, 23.5% were partially vaccinated, and 40.2% were fully vaccinated.

Only 5.8% were fully vaccinated by Nov. 1, and 36.3% by Jan. 1, Dr. Allison said.

Twenty-eight percent of children had an ILI, and 5% had pneumonia or flu, during the season, she said.

The researchers also calculated hazard ratios that accounted for age, gender, and immunization status. They determined that fully vaccinated children were less likely to have ILI (a ratio of 0.45), when compared with unvaccinated children, which was not surprising.

But partially vaccinated children were more likely to have ILI, compared with unvaccinated children, Dr. Allison said. She said the researchers weren't sure why one dose seemed to increase the chance of illness, but said there might be something different about those children or families.

She also wasn't certain why the Denver study showed much higher efficacy than the Kaiser/CDC study but noted that it might be that there was a significantly higher vaccination rate in the Denver population.

All the children in the Denver practices came from more affluent socioeconomic groups, which may have made a difference.

That also limited the study's conclusions, though, she added.

WASHINGTON —Two doses of influenza vaccine were up to 55% effective against influenza-like illness and 85% effective against pneumonia or flu, Mandy Allison, M.D., said at the National Immunization Conference sponsored by the Centers for Disease Control and Prevention.

The aim of Dr. Allison and her colleagues at Children's Hospital, Denver, and the University of Colorado Health Sciences Center, was to gather more data on the flu vaccine's effectiveness in children, especially since the CDC's Advisory Committee on Immunization Practices advised in 2004 that the shot should be included as a routine immunization for children aged 6-23 months.

Dr. Allison said that one study in the Journal of the American Medical Association calculated the vaccine's effectiveness at 66% in any given year, but a recent systematic review published in the Lancet found very little data on vaccine efficacy in children under 2 years old (2005;365:773-80).

A study conducted by Kaiser and the CDC found that the flu vaccine was only 25% effective against influenza-like illness (ILI), and 49% effective against pneumonia and flu, which is defined as a subset of ILI (MMWR 2004;53:707-10), she said.

Her group analyzed billing and immunization registry data from 5,913 healthy 6- to 21-month-old children from five Denver area pediatric practices. ICD-9 codes for office visits between Nov. 1 and Dec. 31 were reviewed to determine the first ILI; the same nine codes were used in the Denver study as in the Kaiser/CDC study, Dr. Allison said.

Children were dubbed either partially vaccinated—one shot during the current season and 14 days before the first influenza-like illness—or fully vaccinated, which was defined as two shots more than 14 days before the first ILI, according to Dr. Allison.

During Colorado's flu season, which peaked early, 36% of the children were unvaccinated, 23.5% were partially vaccinated, and 40.2% were fully vaccinated.

Only 5.8% were fully vaccinated by Nov. 1, and 36.3% by Jan. 1, Dr. Allison said.

Twenty-eight percent of children had an ILI, and 5% had pneumonia or flu, during the season, she said.

The researchers also calculated hazard ratios that accounted for age, gender, and immunization status. They determined that fully vaccinated children were less likely to have ILI (a ratio of 0.45), when compared with unvaccinated children, which was not surprising.

But partially vaccinated children were more likely to have ILI, compared with unvaccinated children, Dr. Allison said. She said the researchers weren't sure why one dose seemed to increase the chance of illness, but said there might be something different about those children or families.

She also wasn't certain why the Denver study showed much higher efficacy than the Kaiser/CDC study but noted that it might be that there was a significantly higher vaccination rate in the Denver population.

All the children in the Denver practices came from more affluent socioeconomic groups, which may have made a difference.

That also limited the study's conclusions, though, she added.

WASHINGTON —Two doses of influenza vaccine were up to 55% effective against influenza-like illness and 85% effective against pneumonia or flu, Mandy Allison, M.D., said at the National Immunization Conference sponsored by the Centers for Disease Control and Prevention.

The aim of Dr. Allison and her colleagues at Children's Hospital, Denver, and the University of Colorado Health Sciences Center, was to gather more data on the flu vaccine's effectiveness in children, especially since the CDC's Advisory Committee on Immunization Practices advised in 2004 that the shot should be included as a routine immunization for children aged 6-23 months.

Dr. Allison said that one study in the Journal of the American Medical Association calculated the vaccine's effectiveness at 66% in any given year, but a recent systematic review published in the Lancet found very little data on vaccine efficacy in children under 2 years old (2005;365:773-80).

A study conducted by Kaiser and the CDC found that the flu vaccine was only 25% effective against influenza-like illness (ILI), and 49% effective against pneumonia and flu, which is defined as a subset of ILI (MMWR 2004;53:707-10), she said.

Her group analyzed billing and immunization registry data from 5,913 healthy 6- to 21-month-old children from five Denver area pediatric practices. ICD-9 codes for office visits between Nov. 1 and Dec. 31 were reviewed to determine the first ILI; the same nine codes were used in the Denver study as in the Kaiser/CDC study, Dr. Allison said.

Children were dubbed either partially vaccinated—one shot during the current season and 14 days before the first influenza-like illness—or fully vaccinated, which was defined as two shots more than 14 days before the first ILI, according to Dr. Allison.

During Colorado's flu season, which peaked early, 36% of the children were unvaccinated, 23.5% were partially vaccinated, and 40.2% were fully vaccinated.

Only 5.8% were fully vaccinated by Nov. 1, and 36.3% by Jan. 1, Dr. Allison said.

Twenty-eight percent of children had an ILI, and 5% had pneumonia or flu, during the season, she said.

The researchers also calculated hazard ratios that accounted for age, gender, and immunization status. They determined that fully vaccinated children were less likely to have ILI (a ratio of 0.45), when compared with unvaccinated children, which was not surprising.

But partially vaccinated children were more likely to have ILI, compared with unvaccinated children, Dr. Allison said. She said the researchers weren't sure why one dose seemed to increase the chance of illness, but said there might be something different about those children or families.

She also wasn't certain why the Denver study showed much higher efficacy than the Kaiser/CDC study but noted that it might be that there was a significantly higher vaccination rate in the Denver population.

All the children in the Denver practices came from more affluent socioeconomic groups, which may have made a difference.

That also limited the study's conclusions, though, she added.

WASHINGTON — Despite the severe shortage of influenza vaccine this winter, most elderly, young children, and others at risk were able to find and receive shots, officials said at the National Immunization Conference sponsored by the Centers for Disease Control and Prevention.

Once it was known last October that Chiron Corp. would not be able to deliver its half of the nation's vaccine supply, the CDC immediately set up a special surveillance team to track where the vaccine was going and who received it, said Susan Chu, Ph.D., acting director of the agency's Office of Science Policy and Technology Transfer.

Seventeen new questions on the flu vaccine were added to the monthly Behavioral Risk Factor Surveillance System survey. From November 2004 to February 2005, 105,473 adults and 35,106 children (by proxy) were interviewed, said Michael Link, Ph.D., of the CDC's behavioral survey branch.

And, in a change of pace designed to keep state and federal agencies on top of the shortage, data were submitted to CDC weekly, not monthly, and were analyzed within days, giving states new data every 12 days or so, Dr. Link said.

As of late March, the survey found that vaccines were received by 63.5% of respondents over age 65 years, 26% of 18- to 64-year-olds at high risk, and 36% of health care workers, said Gary Euler, Dr. P.H., of the CDC National Immunization Program's epidemiology and surveillance division. These figures were slightly higher than those gathered through January and reported in the CDC's Morbidity and Mortality Weekly Report. According to those data, 62.7% of those over age 65 years, 25.5% of those with high-risk conditions who are 18-64 years, and 35.7% of health care workers received vaccinations (MMWR 2005;54:304-7).

Vaccination uptake was higher in October and November and tapered off in December and January.

Through February, among healthy Americans, 7.2% of those aged 18-49 years, and 17.3% of those 50-64 years said they had been vaccinated, compared with 6.9% and 16.5%, respectively, through January.

Fifty-two percent of children aged 6-23 months received a vaccine (up from 48.4% through January), a high uptake rate, given that 2004 was the first year the CDC's Advisory Committee on Immunization Practices recommended adding the flu shot to routine immunizations, said Carolyn Bridges, M.D., an epidemiologist with the agency's influenza branch.

Dr. Euler said there was room for improvement, as the survey found that many parents said they did not get vaccines for their children because they did not think their children needed them.

The demand for vaccine among patients aged 65 years and older was mostly met, though there was some problem getting vaccine in early November, Dr. Euler said.

An audience member questioned whether some of the demand had been met in Canada. As part of the survey, patients were asked where they got a vaccine. So if they went to Canada, those data would be captured, though they have not been analyzed yet, Dr. Euler said.

Vaccination rates also varied from state to state. Preliminary data indicate that states with lower immunization coverage had a smaller vaccine supply. Further analysis of the variation and the entire flu database will be coming over the next 6 months, Dr. Link said.

The CDC researchers acknowledged that the survey was limited because it is self-reported information, and does not cover people who are institutionalized.

Dr. Bridges said the Centers for Disease Control and Prevention currently is researching whether faster analysis of flu data helped states with their shot distribution and management. And, she said, since it was an expensive undertaking, it's not certain whether it will be repeated next year, or only in times of pandemic or flu vaccine shortages.

WASHINGTON — Despite the severe shortage of influenza vaccine this winter, most elderly, young children, and others at risk were able to find and receive shots, officials said at the National Immunization Conference sponsored by the Centers for Disease Control and Prevention.

Once it was known last October that Chiron Corp. would not be able to deliver its half of the nation's vaccine supply, the CDC immediately set up a special surveillance team to track where the vaccine was going and who received it, said Susan Chu, Ph.D., acting director of the agency's Office of Science Policy and Technology Transfer.

Seventeen new questions on the flu vaccine were added to the monthly Behavioral Risk Factor Surveillance System survey. From November 2004 to February 2005, 105,473 adults and 35,106 children (by proxy) were interviewed, said Michael Link, Ph.D., of the CDC's behavioral survey branch.

And, in a change of pace designed to keep state and federal agencies on top of the shortage, data were submitted to CDC weekly, not monthly, and were analyzed within days, giving states new data every 12 days or so, Dr. Link said.

As of late March, the survey found that vaccines were received by 63.5% of respondents over age 65 years, 26% of 18- to 64-year-olds at high risk, and 36% of health care workers, said Gary Euler, Dr. P.H., of the CDC National Immunization Program's epidemiology and surveillance division. These figures were slightly higher than those gathered through January and reported in the CDC's Morbidity and Mortality Weekly Report. According to those data, 62.7% of those over age 65 years, 25.5% of those with high-risk conditions who are 18-64 years, and 35.7% of health care workers received vaccinations (MMWR 2005;54:304-7).

Vaccination uptake was higher in October and November and tapered off in December and January.

Through February, among healthy Americans, 7.2% of those aged 18-49 years, and 17.3% of those 50-64 years said they had been vaccinated, compared with 6.9% and 16.5%, respectively, through January.

Fifty-two percent of children aged 6-23 months received a vaccine (up from 48.4% through January), a high uptake rate, given that 2004 was the first year the CDC's Advisory Committee on Immunization Practices recommended adding the flu shot to routine immunizations, said Carolyn Bridges, M.D., an epidemiologist with the agency's influenza branch.

Dr. Euler said there was room for improvement, as the survey found that many parents said they did not get vaccines for their children because they did not think their children needed them.

The demand for vaccine among patients aged 65 years and older was mostly met, though there was some problem getting vaccine in early November, Dr. Euler said.

An audience member questioned whether some of the demand had been met in Canada. As part of the survey, patients were asked where they got a vaccine. So if they went to Canada, those data would be captured, though they have not been analyzed yet, Dr. Euler said.

Vaccination rates also varied from state to state. Preliminary data indicate that states with lower immunization coverage had a smaller vaccine supply. Further analysis of the variation and the entire flu database will be coming over the next 6 months, Dr. Link said.

The CDC researchers acknowledged that the survey was limited because it is self-reported information, and does not cover people who are institutionalized.

Dr. Bridges said the Centers for Disease Control and Prevention currently is researching whether faster analysis of flu data helped states with their shot distribution and management. And, she said, since it was an expensive undertaking, it's not certain whether it will be repeated next year, or only in times of pandemic or flu vaccine shortages.

WASHINGTON — Despite the severe shortage of influenza vaccine this winter, most elderly, young children, and others at risk were able to find and receive shots, officials said at the National Immunization Conference sponsored by the Centers for Disease Control and Prevention.

Once it was known last October that Chiron Corp. would not be able to deliver its half of the nation's vaccine supply, the CDC immediately set up a special surveillance team to track where the vaccine was going and who received it, said Susan Chu, Ph.D., acting director of the agency's Office of Science Policy and Technology Transfer.

Seventeen new questions on the flu vaccine were added to the monthly Behavioral Risk Factor Surveillance System survey. From November 2004 to February 2005, 105,473 adults and 35,106 children (by proxy) were interviewed, said Michael Link, Ph.D., of the CDC's behavioral survey branch.

And, in a change of pace designed to keep state and federal agencies on top of the shortage, data were submitted to CDC weekly, not monthly, and were analyzed within days, giving states new data every 12 days or so, Dr. Link said.

As of late March, the survey found that vaccines were received by 63.5% of respondents over age 65 years, 26% of 18- to 64-year-olds at high risk, and 36% of health care workers, said Gary Euler, Dr. P.H., of the CDC National Immunization Program's epidemiology and surveillance division. These figures were slightly higher than those gathered through January and reported in the CDC's Morbidity and Mortality Weekly Report. According to those data, 62.7% of those over age 65 years, 25.5% of those with high-risk conditions who are 18-64 years, and 35.7% of health care workers received vaccinations (MMWR 2005;54:304-7).

Vaccination uptake was higher in October and November and tapered off in December and January.

Through February, among healthy Americans, 7.2% of those aged 18-49 years, and 17.3% of those 50-64 years said they had been vaccinated, compared with 6.9% and 16.5%, respectively, through January.

Fifty-two percent of children aged 6-23 months received a vaccine (up from 48.4% through January), a high uptake rate, given that 2004 was the first year the CDC's Advisory Committee on Immunization Practices recommended adding the flu shot to routine immunizations, said Carolyn Bridges, M.D., an epidemiologist with the agency's influenza branch.

Dr. Euler said there was room for improvement, as the survey found that many parents said they did not get vaccines for their children because they did not think their children needed them.

The demand for vaccine among patients aged 65 years and older was mostly met, though there was some problem getting vaccine in early November, Dr. Euler said.

An audience member questioned whether some of the demand had been met in Canada. As part of the survey, patients were asked where they got a vaccine. So if they went to Canada, those data would be captured, though they have not been analyzed yet, Dr. Euler said.

Vaccination rates also varied from state to state. Preliminary data indicate that states with lower immunization coverage had a smaller vaccine supply. Further analysis of the variation and the entire flu database will be coming over the next 6 months, Dr. Link said.

The CDC researchers acknowledged that the survey was limited because it is self-reported information, and does not cover people who are institutionalized.

Dr. Bridges said the Centers for Disease Control and Prevention currently is researching whether faster analysis of flu data helped states with their shot distribution and management. And, she said, since it was an expensive undertaking, it's not certain whether it will be repeated next year, or only in times of pandemic or flu vaccine shortages.

WASHINGTON — Wisconsin health authorities were able to put a stop to a spiraling outbreak of pertussis by advocating faster testing and use of antibiotics in all suspect cases, a state health department official reported at the National Immunization Conference sponsored by the Centers for Disease Control and Prevention.

Jeffrey Davis, M.D., of the Wisconsin Division of Public Health, gave the details of the epidemic, which lasted from May 2003 until February 2004 and occurred primarily in Fond du Lac County. In the 5 years before the outbreak, there had only been five cases of pertussis in Wisconsin.

Cases were defined using the Centers for Disease Control and Prevention's (CDC) definition of pertussis: a cough illness lasting more than 2 weeks with paroxysms, whoop, or posttussive vomiting. Cases were confirmed through patient follow-up interviews and/or lab confirmation by isolating Bordetella pertussis in culture, or through a positive polymerase chain reaction (PCR) assay.

During the outbreak, there were 313 cases reported in the county (in a total population of 97,296); 193 were confirmed in the lab, and 120 were confirmed by epidemiology. Just over half the cases were in females, and the median age was 14 years. Of those with confirmed pertussis, 70% were aged 10-19 years; 43% were aged 10-14 years. The incidence rate exceeded 1,000 per 100,000 in that younger cohort, said Dr. Davis.

After investigating, the health department determined that the outbreak probably started with two unvaccinated adolescents using a high school weight room. Of the initial 53 cases, 55% were linked to that weight room, said Dr. Davis.

During the epidemic's initial peak in mid-October, the health department alerted physicians to keep a close eye on potential cases. As the number of new cases continued to rise into November, the department issued another alert, suggesting more testing and use of antibiotics in any suspect cases.

That alert led to a sharp decline in cases, said Dr. Davis. During the first peak, it took a median of 10.5 days between the onset of cough and initiation of antibiotics. By the last peak, medication was generally started within 4 days of cough onset.

More than 5,000 courses of antibiotics were dispensed; 90% of the prescriptions were for azithromycin.

As physicians became more aware, they stepped up reporting, also, said Dr. Davis.

And PCR testing by the health department allowed for a rapid response—results were generally back to physicians within 24-48 hours.

WASHINGTON — Wisconsin health authorities were able to put a stop to a spiraling outbreak of pertussis by advocating faster testing and use of antibiotics in all suspect cases, a state health department official reported at the National Immunization Conference sponsored by the Centers for Disease Control and Prevention.

Jeffrey Davis, M.D., of the Wisconsin Division of Public Health, gave the details of the epidemic, which lasted from May 2003 until February 2004 and occurred primarily in Fond du Lac County. In the 5 years before the outbreak, there had only been five cases of pertussis in Wisconsin.

Cases were defined using the Centers for Disease Control and Prevention's (CDC) definition of pertussis: a cough illness lasting more than 2 weeks with paroxysms, whoop, or posttussive vomiting. Cases were confirmed through patient follow-up interviews and/or lab confirmation by isolating Bordetella pertussis in culture, or through a positive polymerase chain reaction (PCR) assay.

During the outbreak, there were 313 cases reported in the county (in a total population of 97,296); 193 were confirmed in the lab, and 120 were confirmed by epidemiology. Just over half the cases were in females, and the median age was 14 years. Of those with confirmed pertussis, 70% were aged 10-19 years; 43% were aged 10-14 years. The incidence rate exceeded 1,000 per 100,000 in that younger cohort, said Dr. Davis.

After investigating, the health department determined that the outbreak probably started with two unvaccinated adolescents using a high school weight room. Of the initial 53 cases, 55% were linked to that weight room, said Dr. Davis.

During the epidemic's initial peak in mid-October, the health department alerted physicians to keep a close eye on potential cases. As the number of new cases continued to rise into November, the department issued another alert, suggesting more testing and use of antibiotics in any suspect cases.

That alert led to a sharp decline in cases, said Dr. Davis. During the first peak, it took a median of 10.5 days between the onset of cough and initiation of antibiotics. By the last peak, medication was generally started within 4 days of cough onset.

More than 5,000 courses of antibiotics were dispensed; 90% of the prescriptions were for azithromycin.

As physicians became more aware, they stepped up reporting, also, said Dr. Davis.

And PCR testing by the health department allowed for a rapid response—results were generally back to physicians within 24-48 hours.

WASHINGTON — Wisconsin health authorities were able to put a stop to a spiraling outbreak of pertussis by advocating faster testing and use of antibiotics in all suspect cases, a state health department official reported at the National Immunization Conference sponsored by the Centers for Disease Control and Prevention.

Jeffrey Davis, M.D., of the Wisconsin Division of Public Health, gave the details of the epidemic, which lasted from May 2003 until February 2004 and occurred primarily in Fond du Lac County. In the 5 years before the outbreak, there had only been five cases of pertussis in Wisconsin.

Cases were defined using the Centers for Disease Control and Prevention's (CDC) definition of pertussis: a cough illness lasting more than 2 weeks with paroxysms, whoop, or posttussive vomiting. Cases were confirmed through patient follow-up interviews and/or lab confirmation by isolating Bordetella pertussis in culture, or through a positive polymerase chain reaction (PCR) assay.

During the outbreak, there were 313 cases reported in the county (in a total population of 97,296); 193 were confirmed in the lab, and 120 were confirmed by epidemiology. Just over half the cases were in females, and the median age was 14 years. Of those with confirmed pertussis, 70% were aged 10-19 years; 43% were aged 10-14 years. The incidence rate exceeded 1,000 per 100,000 in that younger cohort, said Dr. Davis.

After investigating, the health department determined that the outbreak probably started with two unvaccinated adolescents using a high school weight room. Of the initial 53 cases, 55% were linked to that weight room, said Dr. Davis.

During the epidemic's initial peak in mid-October, the health department alerted physicians to keep a close eye on potential cases. As the number of new cases continued to rise into November, the department issued another alert, suggesting more testing and use of antibiotics in any suspect cases.

That alert led to a sharp decline in cases, said Dr. Davis. During the first peak, it took a median of 10.5 days between the onset of cough and initiation of antibiotics. By the last peak, medication was generally started within 4 days of cough onset.

More than 5,000 courses of antibiotics were dispensed; 90% of the prescriptions were for azithromycin.

As physicians became more aware, they stepped up reporting, also, said Dr. Davis.

And PCR testing by the health department allowed for a rapid response—results were generally back to physicians within 24-48 hours.