Heidi Splete With Staff Reports

Paxil Fails to Improve Children's MDD

Paroxetine was no more effective than a placebo in reducing the symptoms of major depressive disorder in a population that, for the first time, included patients younger than 12 years, reported Dr. Graham J. Emslie of the University of Texas, Dallas, and his colleagues.

Overall, the average change from baseline on the Children's Depression Rating Scale-Revised (CDRS-R) was −22.58 points in patients who took paroxetine (Paxil) and −23.38 in a placebo group.

The randomized, double-blind, multicenter study of the effectiveness of paroxetine included an intent-to-treat population of 203 children aged 7–17 years who met the DSM-IV diagnostic criteria for major depressive disorder (J. Am. Acad. Child Adolesc. Psychiatry 2006;45:709–19).

The patients received either 10–50 mg/kg paroxetine daily or placebo for 8 weeks. The average age at diagnosis was 10 years, and about half of the patients in each group had experienced at least one prior major depressive disorder episode.

The dropout rate in the paroxetine group was significantly higher among children aged 7–11 years, compared with the placebo group (39% vs. 13%), which suggests a lower tolerance for the drug among younger children compared with adolescents. The overall dropout rate was not significantly different between the paroxetine and placebo groups.

Possible reasons for paroxetine's lack of efficacy include a lower average daily dosage compared with a previous adolescent-only study (20.4 mg/kg vs. 28 mg/kg) and a lower adherence rate in the treatment group compared with the placebo group, the researchers said. The incidence of adverse events was similar and quite low in both groups, notably the incidence of suicidal behavior or suicidal ideation, which was 1.92% in the paroxetine group and 0.98% in the placebo group.

Paroxetine has not been approved by the Food and Drug Administration for use by either children or adolescents. The study was sponsored by GlaxoSmithKline, manufacturer of Paxil; Dr. Emslie has served as a paid consultant for the company.

Predicting Recurrent Abdominal Pain

When a child presents with recurrent abdominal pain, parents' anxiety may be a factor, reported Dr. Paul G. Ramchandani of the University of Oxford (U.K.) and his associates.

Recurrent abdominal pain (RAP)–defined as pain five or more times in the same year–was reported in nearly 12% of 8,272 children born between April 1, 1991, and December 31, 1992, as part of a prospective study. Data on predictive variables were collected when the children were 6–8 months old, and parents completed a survey when the child was almost 7 years old (J. Am. Acad. Child Adolesc. Psychiatry 2006;45:729–36).

Two maternal factors–high anxiety and somatic symptom scores–significantly predicted RAP in the children and were reported by mothers in 24% and 17% of RAP cases, respectively. Fathers' anxiety was significantly associated with RAP in 19% of cases, and the prevalence of RAP was greater when both parents were anxious (22%) than when only one parent was anxious (15%) or when neither parent was anxious (11%). No association appeared between a child's RAP and parental depression or parental stomach ulcers, and there was no significant association between RAP and early gastrointestinal illness or hospitalization in the children.

The study is the first known to present prospective data on the predisposing factors for RAP, but it was limited by the fact that all measures of pain in the children were completed by the parents, and anxious parents may be more inclined to overreport their children's symptoms, the investigators noted.

Family Stress High in ADHD

The results of a large national survey indicate that families of children with attention-deficit hyperactivity disorder show very high levels of stress, compared with families of children with other special health care needs, according to a poster presented by Dr. Ruth E. Stein at the annual meeting of the Pediatric Academic Societies.

By using data from the National Study of Children's Health, Dr. Stein and Ellen J. Silver, Ph.D., of the Albert Einstein College of Medicine, Bronx, N.Y., extracted responses from the parents of 65,613 children between the ages of 6 and 17. Of that total, 3,706 reported a diagnosis of ADHD, 10,248 children were classified as having special care needs other than ADHD, and the rest were healthy.

After adjusting for poverty level, race, family structure, age, and gender of the child, families of children with ADHD had significantly worse results on all 12 of the variables examined, compared with healthy children and compared with other children with special health care needs (CSHCN).

For example, 41% of the families with an ADHD child said they were coping very well with the day-to-day demands of parenthood, compared with 50% of the CSHCN families and 57% of the families with healthy children. That comes to an adjusted odds ratio of 0.69 for ADHD, compared with CSHCN and 0.53, compared with families with healthy children.

Families with an ADHD child are more than three times as likely as CSHCN families and almost six times as likely as families with healthy children to say that in the past month they sometimes, usually, or always felt that their child is harder to care for the most children of his or her age.

Families with an ADHD child were 2.5 times as likely as CSHCN families and 3.3 times as likely as families with healthy children to say that in the past month they sometimes, usually, or always felt that the child does things that really bother them.

And families with an ADHD child were 1.8 times as likely as CSHCN families and 3.2 times as likely as families with healthy children to say that they are very concerned about the child's depression and anxiety.

The investigators wrote that their study suggests that “the impact of ADHD may be far greater than is generally appreciated. It also suggests a need for further exploration of the factors that may contribute to this pattern and of ways to alleviate parental and child stress associated with attention-deficit hyperactivity disorder.”

Paxil Fails to Improve Children's MDD

Paroxetine was no more effective than a placebo in reducing the symptoms of major depressive disorder in a population that, for the first time, included patients younger than 12 years, reported Dr. Graham J. Emslie of the University of Texas, Dallas, and his colleagues.

Overall, the average change from baseline on the Children's Depression Rating Scale-Revised (CDRS-R) was −22.58 points in patients who took paroxetine (Paxil) and −23.38 in a placebo group.

The randomized, double-blind, multicenter study of the effectiveness of paroxetine included an intent-to-treat population of 203 children aged 7–17 years who met the DSM-IV diagnostic criteria for major depressive disorder (J. Am. Acad. Child Adolesc. Psychiatry 2006;45:709–19).

The patients received either 10–50 mg/kg paroxetine daily or placebo for 8 weeks. The average age at diagnosis was 10 years, and about half of the patients in each group had experienced at least one prior major depressive disorder episode.

The dropout rate in the paroxetine group was significantly higher among children aged 7–11 years, compared with the placebo group (39% vs. 13%), which suggests a lower tolerance for the drug among younger children compared with adolescents. The overall dropout rate was not significantly different between the paroxetine and placebo groups.

Possible reasons for paroxetine's lack of efficacy include a lower average daily dosage compared with a previous adolescent-only study (20.4 mg/kg vs. 28 mg/kg) and a lower adherence rate in the treatment group compared with the placebo group, the researchers said. The incidence of adverse events was similar and quite low in both groups, notably the incidence of suicidal behavior or suicidal ideation, which was 1.92% in the paroxetine group and 0.98% in the placebo group.

Paroxetine has not been approved by the Food and Drug Administration for use by either children or adolescents. The study was sponsored by GlaxoSmithKline, manufacturer of Paxil; Dr. Emslie has served as a paid consultant for the company.

Predicting Recurrent Abdominal Pain

When a child presents with recurrent abdominal pain, parents' anxiety may be a factor, reported Dr. Paul G. Ramchandani of the University of Oxford (U.K.) and his associates.

Recurrent abdominal pain (RAP)–defined as pain five or more times in the same year–was reported in nearly 12% of 8,272 children born between April 1, 1991, and December 31, 1992, as part of a prospective study. Data on predictive variables were collected when the children were 6–8 months old, and parents completed a survey when the child was almost 7 years old (J. Am. Acad. Child Adolesc. Psychiatry 2006;45:729–36).

Two maternal factors–high anxiety and somatic symptom scores–significantly predicted RAP in the children and were reported by mothers in 24% and 17% of RAP cases, respectively. Fathers' anxiety was significantly associated with RAP in 19% of cases, and the prevalence of RAP was greater when both parents were anxious (22%) than when only one parent was anxious (15%) or when neither parent was anxious (11%). No association appeared between a child's RAP and parental depression or parental stomach ulcers, and there was no significant association between RAP and early gastrointestinal illness or hospitalization in the children.

The study is the first known to present prospective data on the predisposing factors for RAP, but it was limited by the fact that all measures of pain in the children were completed by the parents, and anxious parents may be more inclined to overreport their children's symptoms, the investigators noted.

Family Stress High in ADHD

The results of a large national survey indicate that families of children with attention-deficit hyperactivity disorder show very high levels of stress, compared with families of children with other special health care needs, according to a poster presented by Dr. Ruth E. Stein at the annual meeting of the Pediatric Academic Societies.

By using data from the National Study of Children's Health, Dr. Stein and Ellen J. Silver, Ph.D., of the Albert Einstein College of Medicine, Bronx, N.Y., extracted responses from the parents of 65,613 children between the ages of 6 and 17. Of that total, 3,706 reported a diagnosis of ADHD, 10,248 children were classified as having special care needs other than ADHD, and the rest were healthy.

After adjusting for poverty level, race, family structure, age, and gender of the child, families of children with ADHD had significantly worse results on all 12 of the variables examined, compared with healthy children and compared with other children with special health care needs (CSHCN).

For example, 41% of the families with an ADHD child said they were coping very well with the day-to-day demands of parenthood, compared with 50% of the CSHCN families and 57% of the families with healthy children. That comes to an adjusted odds ratio of 0.69 for ADHD, compared with CSHCN and 0.53, compared with families with healthy children.

Families with an ADHD child are more than three times as likely as CSHCN families and almost six times as likely as families with healthy children to say that in the past month they sometimes, usually, or always felt that their child is harder to care for the most children of his or her age.

Families with an ADHD child were 2.5 times as likely as CSHCN families and 3.3 times as likely as families with healthy children to say that in the past month they sometimes, usually, or always felt that the child does things that really bother them.

And families with an ADHD child were 1.8 times as likely as CSHCN families and 3.2 times as likely as families with healthy children to say that they are very concerned about the child's depression and anxiety.

The investigators wrote that their study suggests that “the impact of ADHD may be far greater than is generally appreciated. It also suggests a need for further exploration of the factors that may contribute to this pattern and of ways to alleviate parental and child stress associated with attention-deficit hyperactivity disorder.”

Paxil Fails to Improve Children's MDD

Paroxetine was no more effective than a placebo in reducing the symptoms of major depressive disorder in a population that, for the first time, included patients younger than 12 years, reported Dr. Graham J. Emslie of the University of Texas, Dallas, and his colleagues.

Overall, the average change from baseline on the Children's Depression Rating Scale-Revised (CDRS-R) was −22.58 points in patients who took paroxetine (Paxil) and −23.38 in a placebo group.

The randomized, double-blind, multicenter study of the effectiveness of paroxetine included an intent-to-treat population of 203 children aged 7–17 years who met the DSM-IV diagnostic criteria for major depressive disorder (J. Am. Acad. Child Adolesc. Psychiatry 2006;45:709–19).

The patients received either 10–50 mg/kg paroxetine daily or placebo for 8 weeks. The average age at diagnosis was 10 years, and about half of the patients in each group had experienced at least one prior major depressive disorder episode.

The dropout rate in the paroxetine group was significantly higher among children aged 7–11 years, compared with the placebo group (39% vs. 13%), which suggests a lower tolerance for the drug among younger children compared with adolescents. The overall dropout rate was not significantly different between the paroxetine and placebo groups.

Possible reasons for paroxetine's lack of efficacy include a lower average daily dosage compared with a previous adolescent-only study (20.4 mg/kg vs. 28 mg/kg) and a lower adherence rate in the treatment group compared with the placebo group, the researchers said. The incidence of adverse events was similar and quite low in both groups, notably the incidence of suicidal behavior or suicidal ideation, which was 1.92% in the paroxetine group and 0.98% in the placebo group.

Paroxetine has not been approved by the Food and Drug Administration for use by either children or adolescents. The study was sponsored by GlaxoSmithKline, manufacturer of Paxil; Dr. Emslie has served as a paid consultant for the company.

Predicting Recurrent Abdominal Pain

When a child presents with recurrent abdominal pain, parents' anxiety may be a factor, reported Dr. Paul G. Ramchandani of the University of Oxford (U.K.) and his associates.

Recurrent abdominal pain (RAP)–defined as pain five or more times in the same year–was reported in nearly 12% of 8,272 children born between April 1, 1991, and December 31, 1992, as part of a prospective study. Data on predictive variables were collected when the children were 6–8 months old, and parents completed a survey when the child was almost 7 years old (J. Am. Acad. Child Adolesc. Psychiatry 2006;45:729–36).

Two maternal factors–high anxiety and somatic symptom scores–significantly predicted RAP in the children and were reported by mothers in 24% and 17% of RAP cases, respectively. Fathers' anxiety was significantly associated with RAP in 19% of cases, and the prevalence of RAP was greater when both parents were anxious (22%) than when only one parent was anxious (15%) or when neither parent was anxious (11%). No association appeared between a child's RAP and parental depression or parental stomach ulcers, and there was no significant association between RAP and early gastrointestinal illness or hospitalization in the children.

The study is the first known to present prospective data on the predisposing factors for RAP, but it was limited by the fact that all measures of pain in the children were completed by the parents, and anxious parents may be more inclined to overreport their children's symptoms, the investigators noted.

Family Stress High in ADHD

The results of a large national survey indicate that families of children with attention-deficit hyperactivity disorder show very high levels of stress, compared with families of children with other special health care needs, according to a poster presented by Dr. Ruth E. Stein at the annual meeting of the Pediatric Academic Societies.

By using data from the National Study of Children's Health, Dr. Stein and Ellen J. Silver, Ph.D., of the Albert Einstein College of Medicine, Bronx, N.Y., extracted responses from the parents of 65,613 children between the ages of 6 and 17. Of that total, 3,706 reported a diagnosis of ADHD, 10,248 children were classified as having special care needs other than ADHD, and the rest were healthy.

After adjusting for poverty level, race, family structure, age, and gender of the child, families of children with ADHD had significantly worse results on all 12 of the variables examined, compared with healthy children and compared with other children with special health care needs (CSHCN).

For example, 41% of the families with an ADHD child said they were coping very well with the day-to-day demands of parenthood, compared with 50% of the CSHCN families and 57% of the families with healthy children. That comes to an adjusted odds ratio of 0.69 for ADHD, compared with CSHCN and 0.53, compared with families with healthy children.

Families with an ADHD child are more than three times as likely as CSHCN families and almost six times as likely as families with healthy children to say that in the past month they sometimes, usually, or always felt that their child is harder to care for the most children of his or her age.

Families with an ADHD child were 2.5 times as likely as CSHCN families and 3.3 times as likely as families with healthy children to say that in the past month they sometimes, usually, or always felt that the child does things that really bother them.

And families with an ADHD child were 1.8 times as likely as CSHCN families and 3.2 times as likely as families with healthy children to say that they are very concerned about the child's depression and anxiety.

The investigators wrote that their study suggests that “the impact of ADHD may be far greater than is generally appreciated. It also suggests a need for further exploration of the factors that may contribute to this pattern and of ways to alleviate parental and child stress associated with attention-deficit hyperactivity disorder.”

Borderline Traits Tracked in Teens

Borderline personality disorder appears to encompass a much broader range of psychopathology in adolescent inpatients than in hospitalized adults, reported Dr. Daniel F. Becker of the University of California, San Francisco, and his colleagues.

The investigators interviewed 123 adolescent inpatients, aged 13–18 years, who were a mean age of 15.9 years. Most (104) were white; 67 (54%) were boys (Compr. Psychiatry 2006;47:99–105).

Based on interviews, borderline personality disorder (BPD) was diagnosed in 65 adolescents–45% of boys and 65% of girls–and four factors associated with BPD presentation accounted for 67% of the overall variance.

Factor 1 reflected negative or self-deprecating aspects of BPD presentation, such as suicidal threats and gestures, and feelings of emptiness or boredom. Factor 2 covered affective dysregulation or irritability, including uncontrolled anger. Factor 3 reflected interpersonal problems, such as unstable relationships. Factor 4 reflected impulsiveness.

These factors suggest that BPD in teens may be associated with Axis I disorders, and more research is needed on the heterogeneity of BPD, the investigators noted.

The existence of the four BPD factors that appear to differ from those reported for similar studies in adults raises “the question whether BPD is different in its nature and underlying structure in adolescents,” the authors wrote.

Methylphenidate and Cell Abnormalities

Methylphenidate is associated with significant increases in cell abnormalities when given to children at therapeutic levels, reported Dr. Randa A. El-Zein of the University of Texas M.D. Anderson Cancer Center, Houston, and colleagues.

Data from 12 children showed significant increases in several genotoxic end points after 3 months of daily treatment with methylphenidate. The children, whose average age was 9 years, received doses ranging from 20 mg/day to 54 mg/day (Cancer Letters 2005;230:284–91).

Peripheral blood lymphocyte samples were collected from the children at baseline and after 3 months of treatment and evaluated for cell abnormalities.

Compared with baseline values, the children demonstrated a threefold increase in the mean number of chromosomal abnormalities, from 1.7 per 50 cells to 5.1 per 50 cells. They also showed a 4.3-fold increase in the mean number of sister chromatid exchanges (the number of crossover events in a chromosome pair), from 6.1 to 26.3, and a 2.4-fold increase in micronuclei frequencies per 1,000 cells, from 3.6 to 8.5.

Despite the small sample size, the investigators said, their study was “remarkable in the consistency of the increase of every type of cytogenetic end point monitored, in every child receiving the drug.” The study opens the door for further larger studies that address these issues in order to establish the safety of methylphenidate, as well as possible replacement drugs, for treating ADHD, they said.

Psychosocial Support, Pregnant Teens

Pregnant adolescents who receive interdisciplinary prenatal and postpartum care and psychosocial support have lower rates of rapid pregnancy recurrence, Amanda Melhado reported at the annual meeting of the Society for Adolescent Medicine.

In a prospective study of a “global care” model, Ms. Melhado, Dr. Maria José Carvalho Sant'Anna, and Dr. Verônica Coates of Faculdade de Ciências Médicas da Santa Casa in São Paolo, Brazil, compared the outcomes of 30 adolescents who received specialized prenatal medical care and psychoeducational support with those of 39 age-matched adolescents who received standard prenatal care only. All of the young women in the study were 18 years old or younger at the time of conception and gave birth in the maternity ward of the same hospital between July 1, 2004, and June 30, 2005.

No significant differences were found between the two groups with respect to marital status or relationship with the babies' fathers, Ms. Melhado said. More than half of the young women in both groups were not married at the time of the study.

The psychoeducational support component included group and individual sessions with a team of providers–including mental health professionals, obstetricians, and pediatricians–focusing on such topics as self-esteem, contraception, relationships, and infant development.

As of March 2006, the rate of pregnancy recurrence among the young women who received the intervention was 3%, compared with 15% in the standard care group.

Borderline Traits Tracked in Teens

Borderline personality disorder appears to encompass a much broader range of psychopathology in adolescent inpatients than in hospitalized adults, reported Dr. Daniel F. Becker of the University of California, San Francisco, and his colleagues.

The investigators interviewed 123 adolescent inpatients, aged 13–18 years, who were a mean age of 15.9 years. Most (104) were white; 67 (54%) were boys (Compr. Psychiatry 2006;47:99–105).

Based on interviews, borderline personality disorder (BPD) was diagnosed in 65 adolescents–45% of boys and 65% of girls–and four factors associated with BPD presentation accounted for 67% of the overall variance.

Factor 1 reflected negative or self-deprecating aspects of BPD presentation, such as suicidal threats and gestures, and feelings of emptiness or boredom. Factor 2 covered affective dysregulation or irritability, including uncontrolled anger. Factor 3 reflected interpersonal problems, such as unstable relationships. Factor 4 reflected impulsiveness.

These factors suggest that BPD in teens may be associated with Axis I disorders, and more research is needed on the heterogeneity of BPD, the investigators noted.

The existence of the four BPD factors that appear to differ from those reported for similar studies in adults raises “the question whether BPD is different in its nature and underlying structure in adolescents,” the authors wrote.

Methylphenidate and Cell Abnormalities

Methylphenidate is associated with significant increases in cell abnormalities when given to children at therapeutic levels, reported Dr. Randa A. El-Zein of the University of Texas M.D. Anderson Cancer Center, Houston, and colleagues.

Data from 12 children showed significant increases in several genotoxic end points after 3 months of daily treatment with methylphenidate. The children, whose average age was 9 years, received doses ranging from 20 mg/day to 54 mg/day (Cancer Letters 2005;230:284–91).

Peripheral blood lymphocyte samples were collected from the children at baseline and after 3 months of treatment and evaluated for cell abnormalities.

Compared with baseline values, the children demonstrated a threefold increase in the mean number of chromosomal abnormalities, from 1.7 per 50 cells to 5.1 per 50 cells. They also showed a 4.3-fold increase in the mean number of sister chromatid exchanges (the number of crossover events in a chromosome pair), from 6.1 to 26.3, and a 2.4-fold increase in micronuclei frequencies per 1,000 cells, from 3.6 to 8.5.

Despite the small sample size, the investigators said, their study was “remarkable in the consistency of the increase of every type of cytogenetic end point monitored, in every child receiving the drug.” The study opens the door for further larger studies that address these issues in order to establish the safety of methylphenidate, as well as possible replacement drugs, for treating ADHD, they said.

Psychosocial Support, Pregnant Teens

Pregnant adolescents who receive interdisciplinary prenatal and postpartum care and psychosocial support have lower rates of rapid pregnancy recurrence, Amanda Melhado reported at the annual meeting of the Society for Adolescent Medicine.

In a prospective study of a “global care” model, Ms. Melhado, Dr. Maria José Carvalho Sant'Anna, and Dr. Verônica Coates of Faculdade de Ciências Médicas da Santa Casa in São Paolo, Brazil, compared the outcomes of 30 adolescents who received specialized prenatal medical care and psychoeducational support with those of 39 age-matched adolescents who received standard prenatal care only. All of the young women in the study were 18 years old or younger at the time of conception and gave birth in the maternity ward of the same hospital between July 1, 2004, and June 30, 2005.

No significant differences were found between the two groups with respect to marital status or relationship with the babies' fathers, Ms. Melhado said. More than half of the young women in both groups were not married at the time of the study.

The psychoeducational support component included group and individual sessions with a team of providers–including mental health professionals, obstetricians, and pediatricians–focusing on such topics as self-esteem, contraception, relationships, and infant development.

As of March 2006, the rate of pregnancy recurrence among the young women who received the intervention was 3%, compared with 15% in the standard care group.

Borderline Traits Tracked in Teens

Borderline personality disorder appears to encompass a much broader range of psychopathology in adolescent inpatients than in hospitalized adults, reported Dr. Daniel F. Becker of the University of California, San Francisco, and his colleagues.

The investigators interviewed 123 adolescent inpatients, aged 13–18 years, who were a mean age of 15.9 years. Most (104) were white; 67 (54%) were boys (Compr. Psychiatry 2006;47:99–105).

Based on interviews, borderline personality disorder (BPD) was diagnosed in 65 adolescents–45% of boys and 65% of girls–and four factors associated with BPD presentation accounted for 67% of the overall variance.

Factor 1 reflected negative or self-deprecating aspects of BPD presentation, such as suicidal threats and gestures, and feelings of emptiness or boredom. Factor 2 covered affective dysregulation or irritability, including uncontrolled anger. Factor 3 reflected interpersonal problems, such as unstable relationships. Factor 4 reflected impulsiveness.

These factors suggest that BPD in teens may be associated with Axis I disorders, and more research is needed on the heterogeneity of BPD, the investigators noted.

The existence of the four BPD factors that appear to differ from those reported for similar studies in adults raises “the question whether BPD is different in its nature and underlying structure in adolescents,” the authors wrote.

Methylphenidate and Cell Abnormalities

Methylphenidate is associated with significant increases in cell abnormalities when given to children at therapeutic levels, reported Dr. Randa A. El-Zein of the University of Texas M.D. Anderson Cancer Center, Houston, and colleagues.

Data from 12 children showed significant increases in several genotoxic end points after 3 months of daily treatment with methylphenidate. The children, whose average age was 9 years, received doses ranging from 20 mg/day to 54 mg/day (Cancer Letters 2005;230:284–91).

Peripheral blood lymphocyte samples were collected from the children at baseline and after 3 months of treatment and evaluated for cell abnormalities.

Compared with baseline values, the children demonstrated a threefold increase in the mean number of chromosomal abnormalities, from 1.7 per 50 cells to 5.1 per 50 cells. They also showed a 4.3-fold increase in the mean number of sister chromatid exchanges (the number of crossover events in a chromosome pair), from 6.1 to 26.3, and a 2.4-fold increase in micronuclei frequencies per 1,000 cells, from 3.6 to 8.5.

Despite the small sample size, the investigators said, their study was “remarkable in the consistency of the increase of every type of cytogenetic end point monitored, in every child receiving the drug.” The study opens the door for further larger studies that address these issues in order to establish the safety of methylphenidate, as well as possible replacement drugs, for treating ADHD, they said.

Psychosocial Support, Pregnant Teens

Pregnant adolescents who receive interdisciplinary prenatal and postpartum care and psychosocial support have lower rates of rapid pregnancy recurrence, Amanda Melhado reported at the annual meeting of the Society for Adolescent Medicine.

In a prospective study of a “global care” model, Ms. Melhado, Dr. Maria José Carvalho Sant'Anna, and Dr. Verônica Coates of Faculdade de Ciências Médicas da Santa Casa in São Paolo, Brazil, compared the outcomes of 30 adolescents who received specialized prenatal medical care and psychoeducational support with those of 39 age-matched adolescents who received standard prenatal care only. All of the young women in the study were 18 years old or younger at the time of conception and gave birth in the maternity ward of the same hospital between July 1, 2004, and June 30, 2005.

No significant differences were found between the two groups with respect to marital status or relationship with the babies' fathers, Ms. Melhado said. More than half of the young women in both groups were not married at the time of the study.

The psychoeducational support component included group and individual sessions with a team of providers–including mental health professionals, obstetricians, and pediatricians–focusing on such topics as self-esteem, contraception, relationships, and infant development.

As of March 2006, the rate of pregnancy recurrence among the young women who received the intervention was 3%, compared with 15% in the standard care group.

Chlamydia Rate Climbs in Teen Girls

Overall rates of chlamydia in the United States increased by 6% in 2004 compared with 2003 levels, officials from the Centers for Disease Control and Prevention said in a telephone news conference. The highest rates of chlamydia continued to be in adolescent females aged 15–19 years old, with a reported rate of 2,761 per 100,000 persons. The increase in the chlamydia rate probably reflects improved screening and better tests, the CDC officials said. Efforts to increase chlamydia screening are a priority for CDC; it recommends annual screening of sexually active women younger than 25 years. Data from a recent CDC study conducted in conjunction with Kaiser Permanente showed that a program prompting primary care physicians to tie chlamydia testing to Pap testing increased chlamydia screening by 30% among the health plan's younger female members.

Missionary Brings Measles to Indiana

A measles outbreak in Indiana in May-June 2005 has been attributed to an unvaccinated 17-year-old girl who had worked as a missionary in an orphanage and hospital in Bucharest, Romania, according to the CDC (MMWR 2005;54;1073–5). The girl returned to the United States with symptoms including prodromal fever, cough, conjunctivitis, and acute rhinitis (coryza) on May 14, and a rash on May 16. She attended a church gathering that included people who had not been vaccinated. The outbreak included 34 patients, aged 9 months to 49 years, with a median age of 12 years. A total of 14 cases (41%) were laboratory confirmed, and the other 20 were epidemiologically linked to confirmed cases. Only two patients had been vaccinated; one had received a single dose of vaccine and the other had received two doses.

Actions taken to control the outbreak included patient isolation; tracing patient contacts and administering vaccine and immunoglobulin to those who were susceptible; and voluntary quarantine for contacts who refused vaccination. In addition, local health officials reviewed the vaccine status of health care workers, alerted hospitals to the outbreak, and raised local media awareness of the need for vaccination. This measles outbreak represents the largest in the United States since 1996, and could have been prevented by adherence to the Advisory Committee on Immunization Practices recommendations, which include vaccination for all international travelers, people who work in medical facilities, and preschool- and school-aged children.

Tx for Noncompliant H. pylori Patients

The clinical potency of metronidazole, despite evidence of in vitro resistance, may make it a more effective choice for children in areas with a high prevalence of Helicobacter pylori, said Dr. Bradford D. Gessner, of the Alaska Division of Public Health, Anchorage, and his colleagues (CID 2005;41;1261–8). Poor treatment compliance, crowded housing, and lower body mass index were some risk factors for failed treatment of H. pylori infection in a randomized study of 219 children aged 7–11 years in rural Alaska. Those in the control group received 3 mg/kg iron sulfate twice daily, up to 60 mg/dose for 6 weeks. Those in the treatment group received iron sulfate plus a triple-barrelled therapy consisting of 40 mg/kg amoxicillin twice daily, up to 1.5 g/dose; 7.5 mg/kg clarithromycin twice daily, up to 500 mg/dose; and 30 mg lansoprazole twice daily. Children who were allergic to amoxicillin or macrolides received 10 mg/kg of metronidazole twice daily, up to 500 mg/dose. Compliance was a factor in the results; 8.3% of children who took their medications fewer than 10 times resolved their infections, compared with 19%, 40%, and 63% of children who took their medications 10–20 times, 20–27 times, and all 28 times, respectively. Posttreatment analyses showed a significant association between metronidazole and treatment success after controlling for multiple confounding variables.

Genotypes Factor in Hepatitis

Interferon therapy for chronic hepatitis C may be less effective in children with a hepatitis C virus (HCV) genotype 1 than in children with hepatitis C virus genotypes other than 1, based on a retrospective study of 50 children aged 3–15 years, said Dr. Raffaele Iorio of the University of Naples (Italy) and his associates. The children had hypertransaminasemia with detectable HCV RNA. A sustained response to interferon was observed in 11 of 17 children (65%) infected with an HCV genotype other than 1, compared with 8 of 33 children (24%) infected with HCV genotype 1. In addition, eight of the children who did not have a favorable response (five with HCV genotype 1 and three with HCV genotype other than 1) received a second cycle at a mean age of 11 years, and only one child with an HCV genotype other than 1 sustained a response to the second cycle.

Chlamydia Rate Climbs in Teen Girls

Overall rates of chlamydia in the United States increased by 6% in 2004 compared with 2003 levels, officials from the Centers for Disease Control and Prevention said in a telephone news conference. The highest rates of chlamydia continued to be in adolescent females aged 15–19 years old, with a reported rate of 2,761 per 100,000 persons. The increase in the chlamydia rate probably reflects improved screening and better tests, the CDC officials said. Efforts to increase chlamydia screening are a priority for CDC; it recommends annual screening of sexually active women younger than 25 years. Data from a recent CDC study conducted in conjunction with Kaiser Permanente showed that a program prompting primary care physicians to tie chlamydia testing to Pap testing increased chlamydia screening by 30% among the health plan's younger female members.

Missionary Brings Measles to Indiana

A measles outbreak in Indiana in May-June 2005 has been attributed to an unvaccinated 17-year-old girl who had worked as a missionary in an orphanage and hospital in Bucharest, Romania, according to the CDC (MMWR 2005;54;1073–5). The girl returned to the United States with symptoms including prodromal fever, cough, conjunctivitis, and acute rhinitis (coryza) on May 14, and a rash on May 16. She attended a church gathering that included people who had not been vaccinated. The outbreak included 34 patients, aged 9 months to 49 years, with a median age of 12 years. A total of 14 cases (41%) were laboratory confirmed, and the other 20 were epidemiologically linked to confirmed cases. Only two patients had been vaccinated; one had received a single dose of vaccine and the other had received two doses.

Actions taken to control the outbreak included patient isolation; tracing patient contacts and administering vaccine and immunoglobulin to those who were susceptible; and voluntary quarantine for contacts who refused vaccination. In addition, local health officials reviewed the vaccine status of health care workers, alerted hospitals to the outbreak, and raised local media awareness of the need for vaccination. This measles outbreak represents the largest in the United States since 1996, and could have been prevented by adherence to the Advisory Committee on Immunization Practices recommendations, which include vaccination for all international travelers, people who work in medical facilities, and preschool- and school-aged children.

Tx for Noncompliant H. pylori Patients

The clinical potency of metronidazole, despite evidence of in vitro resistance, may make it a more effective choice for children in areas with a high prevalence of Helicobacter pylori, said Dr. Bradford D. Gessner, of the Alaska Division of Public Health, Anchorage, and his colleagues (CID 2005;41;1261–8). Poor treatment compliance, crowded housing, and lower body mass index were some risk factors for failed treatment of H. pylori infection in a randomized study of 219 children aged 7–11 years in rural Alaska. Those in the control group received 3 mg/kg iron sulfate twice daily, up to 60 mg/dose for 6 weeks. Those in the treatment group received iron sulfate plus a triple-barrelled therapy consisting of 40 mg/kg amoxicillin twice daily, up to 1.5 g/dose; 7.5 mg/kg clarithromycin twice daily, up to 500 mg/dose; and 30 mg lansoprazole twice daily. Children who were allergic to amoxicillin or macrolides received 10 mg/kg of metronidazole twice daily, up to 500 mg/dose. Compliance was a factor in the results; 8.3% of children who took their medications fewer than 10 times resolved their infections, compared with 19%, 40%, and 63% of children who took their medications 10–20 times, 20–27 times, and all 28 times, respectively. Posttreatment analyses showed a significant association between metronidazole and treatment success after controlling for multiple confounding variables.

Genotypes Factor in Hepatitis

Interferon therapy for chronic hepatitis C may be less effective in children with a hepatitis C virus (HCV) genotype 1 than in children with hepatitis C virus genotypes other than 1, based on a retrospective study of 50 children aged 3–15 years, said Dr. Raffaele Iorio of the University of Naples (Italy) and his associates. The children had hypertransaminasemia with detectable HCV RNA. A sustained response to interferon was observed in 11 of 17 children (65%) infected with an HCV genotype other than 1, compared with 8 of 33 children (24%) infected with HCV genotype 1. In addition, eight of the children who did not have a favorable response (five with HCV genotype 1 and three with HCV genotype other than 1) received a second cycle at a mean age of 11 years, and only one child with an HCV genotype other than 1 sustained a response to the second cycle.

Chlamydia Rate Climbs in Teen Girls

Overall rates of chlamydia in the United States increased by 6% in 2004 compared with 2003 levels, officials from the Centers for Disease Control and Prevention said in a telephone news conference. The highest rates of chlamydia continued to be in adolescent females aged 15–19 years old, with a reported rate of 2,761 per 100,000 persons. The increase in the chlamydia rate probably reflects improved screening and better tests, the CDC officials said. Efforts to increase chlamydia screening are a priority for CDC; it recommends annual screening of sexually active women younger than 25 years. Data from a recent CDC study conducted in conjunction with Kaiser Permanente showed that a program prompting primary care physicians to tie chlamydia testing to Pap testing increased chlamydia screening by 30% among the health plan's younger female members.

Missionary Brings Measles to Indiana

A measles outbreak in Indiana in May-June 2005 has been attributed to an unvaccinated 17-year-old girl who had worked as a missionary in an orphanage and hospital in Bucharest, Romania, according to the CDC (MMWR 2005;54;1073–5). The girl returned to the United States with symptoms including prodromal fever, cough, conjunctivitis, and acute rhinitis (coryza) on May 14, and a rash on May 16. She attended a church gathering that included people who had not been vaccinated. The outbreak included 34 patients, aged 9 months to 49 years, with a median age of 12 years. A total of 14 cases (41%) were laboratory confirmed, and the other 20 were epidemiologically linked to confirmed cases. Only two patients had been vaccinated; one had received a single dose of vaccine and the other had received two doses.

Actions taken to control the outbreak included patient isolation; tracing patient contacts and administering vaccine and immunoglobulin to those who were susceptible; and voluntary quarantine for contacts who refused vaccination. In addition, local health officials reviewed the vaccine status of health care workers, alerted hospitals to the outbreak, and raised local media awareness of the need for vaccination. This measles outbreak represents the largest in the United States since 1996, and could have been prevented by adherence to the Advisory Committee on Immunization Practices recommendations, which include vaccination for all international travelers, people who work in medical facilities, and preschool- and school-aged children.

Tx for Noncompliant H. pylori Patients

The clinical potency of metronidazole, despite evidence of in vitro resistance, may make it a more effective choice for children in areas with a high prevalence of Helicobacter pylori, said Dr. Bradford D. Gessner, of the Alaska Division of Public Health, Anchorage, and his colleagues (CID 2005;41;1261–8). Poor treatment compliance, crowded housing, and lower body mass index were some risk factors for failed treatment of H. pylori infection in a randomized study of 219 children aged 7–11 years in rural Alaska. Those in the control group received 3 mg/kg iron sulfate twice daily, up to 60 mg/dose for 6 weeks. Those in the treatment group received iron sulfate plus a triple-barrelled therapy consisting of 40 mg/kg amoxicillin twice daily, up to 1.5 g/dose; 7.5 mg/kg clarithromycin twice daily, up to 500 mg/dose; and 30 mg lansoprazole twice daily. Children who were allergic to amoxicillin or macrolides received 10 mg/kg of metronidazole twice daily, up to 500 mg/dose. Compliance was a factor in the results; 8.3% of children who took their medications fewer than 10 times resolved their infections, compared with 19%, 40%, and 63% of children who took their medications 10–20 times, 20–27 times, and all 28 times, respectively. Posttreatment analyses showed a significant association between metronidazole and treatment success after controlling for multiple confounding variables.

Genotypes Factor in Hepatitis

Interferon therapy for chronic hepatitis C may be less effective in children with a hepatitis C virus (HCV) genotype 1 than in children with hepatitis C virus genotypes other than 1, based on a retrospective study of 50 children aged 3–15 years, said Dr. Raffaele Iorio of the University of Naples (Italy) and his associates. The children had hypertransaminasemia with detectable HCV RNA. A sustained response to interferon was observed in 11 of 17 children (65%) infected with an HCV genotype other than 1, compared with 8 of 33 children (24%) infected with HCV genotype 1. In addition, eight of the children who did not have a favorable response (five with HCV genotype 1 and three with HCV genotype other than 1) received a second cycle at a mean age of 11 years, and only one child with an HCV genotype other than 1 sustained a response to the second cycle.

Ethnicity and Depression in Teen Girls

Depression scores among white girls and young women decrease over time, but the scores tend to hold steady among their African American counterparts, reported Debra L. Franko, Ph.D., of Northeastern University, Boston, and her associates.

Depression scores among white girls and young women tend to start off higher, and that might play a role in the findings.

Previous comparisons of depression scores in African American and white girls have shown either mixed results or higher scores among white girls at younger ages.

The investigators conducted an age-matched study of 2,221 girls and young women aged 16–22 years, including 1,146 African Americans and 1,075 whites. The girls, participants in the 10-year longitudinal National Growth and Health Study, were asked to complete a packet of questionnaires, including the Center for Epidemiological Studies of Depression scale (CES-D) (J. Adolesc. Health 2005;37:526–9).

Adolescent depression was defined as a score of at least 24 on the CES-D.

Overall, as they got older, the percentage of white girls who met the criteria for depression fell, and the percentage of African American girls who met the criteria remained fairly steady. Specifically, 21% of 483 white 16-year-olds scored 24 or higher, compared with 14% of 332 white 22-year-olds. Among African Americans, 14% of 469 16-year-olds scored 24 or higher, compared with 15% of 452 22-year-olds.

The researchers noted that age-specific risk factors–such as body dissatisfaction subsequent to pubertal development–are more common among white girls and could partly account for the results. Other factors, such as access to and use of mental health care, also could explain some of the differences.

Modafinil for ADHD

Modafinil film-coated tablets significantly improved clinical symptoms of attention-deficit hyperactivity disorder in children and adolescents aged 6–17 years, said Dr. Joseph Biederman of Massachusetts General Hospital in Boston and his colleagues.

Modafinil, an agent generally prescribed to promote wakefulness in patients with narcolepsy, has been shown to activate the cortex alone.

In the randomized, double-blind trial conducted by Dr. Biederman and his colleagues, 164 children received a flexible dose of modafinil in tablet form, and 82 children received a placebo. The children began with one 85-mg tablet for the first 2 days; the dose was titrated to 170 mg on days 3–7, 255 mg on days 8–14, 340 mg on days 15–21, and 425 mg on day 22 (Pediatrics 2005;116:777–84).

After 9 weeks, 48% of patients in the modafinil group were deemed responders, compared with 17% of those in the placebo group. Overall, patients in the modafinil group demonstrated significant improvement in symptoms, including oppositional behavior, cognitive problems/inattention, hyperactivity, and the ADHD index on the Conners' Parent Rating Scale Revised, Short Form, compared with those in the placebo group.

Modafinil (Provigil) also was well tolerated. Only five of the patients in the treatment group (3%) and three in the placebo group (4%) discontinued the study because of adverse events. Given modafinil's safety profile and its low potential of abuse, the drug may offer clinicians a new option for treating ADHD in children and adolescents, the investigators said.

Teens' Perception of Body Weight

Many young teens from disadvantaged backgrounds do not perceive obesity as unacceptable, and despite common perceptions, not all of them are striving for thinness, reported Wendy Wills of the Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, England.

In a qualitative study in eastern Scotland of 36 economically disadvantaged 13− to 14-year-olds, half of the subjects were either overweight (body mass index greater than 25 kg/m

The overweight and obese teens had complex views of their weight and body size. Three-quarters of them talked positively about their weight, body size, or parts of their bodies, or expressed comfort with their bodies. A minority who were comfortable with their bodies also reported dissatisfaction with some parts of their bodies, and about half of these subjects wanted to lose weight or had already tried.

Half of the overweight and obese teens had tried to lose weight (as had three in the normal-weight group). These teens experienced an “emotional high” when they lost weight, and a deterioration in well-being when they failed. Only a minority of the subjects cited the health benefits of weight loss, even after expressing a desire to lose weight. Most of the subjects said that family and friends did not need to lose weight and should not feel pressured to do so.

Ethnicity and Depression in Teen Girls

Depression scores among white girls and young women decrease over time, but the scores tend to hold steady among their African American counterparts, reported Debra L. Franko, Ph.D., of Northeastern University, Boston, and her associates.

Depression scores among white girls and young women tend to start off higher, and that might play a role in the findings.

Previous comparisons of depression scores in African American and white girls have shown either mixed results or higher scores among white girls at younger ages.

The investigators conducted an age-matched study of 2,221 girls and young women aged 16–22 years, including 1,146 African Americans and 1,075 whites. The girls, participants in the 10-year longitudinal National Growth and Health Study, were asked to complete a packet of questionnaires, including the Center for Epidemiological Studies of Depression scale (CES-D) (J. Adolesc. Health 2005;37:526–9).

Adolescent depression was defined as a score of at least 24 on the CES-D.

Overall, as they got older, the percentage of white girls who met the criteria for depression fell, and the percentage of African American girls who met the criteria remained fairly steady. Specifically, 21% of 483 white 16-year-olds scored 24 or higher, compared with 14% of 332 white 22-year-olds. Among African Americans, 14% of 469 16-year-olds scored 24 or higher, compared with 15% of 452 22-year-olds.

The researchers noted that age-specific risk factors–such as body dissatisfaction subsequent to pubertal development–are more common among white girls and could partly account for the results. Other factors, such as access to and use of mental health care, also could explain some of the differences.

Modafinil for ADHD

Modafinil film-coated tablets significantly improved clinical symptoms of attention-deficit hyperactivity disorder in children and adolescents aged 6–17 years, said Dr. Joseph Biederman of Massachusetts General Hospital in Boston and his colleagues.

Modafinil, an agent generally prescribed to promote wakefulness in patients with narcolepsy, has been shown to activate the cortex alone.

In the randomized, double-blind trial conducted by Dr. Biederman and his colleagues, 164 children received a flexible dose of modafinil in tablet form, and 82 children received a placebo. The children began with one 85-mg tablet for the first 2 days; the dose was titrated to 170 mg on days 3–7, 255 mg on days 8–14, 340 mg on days 15–21, and 425 mg on day 22 (Pediatrics 2005;116:777–84).

After 9 weeks, 48% of patients in the modafinil group were deemed responders, compared with 17% of those in the placebo group. Overall, patients in the modafinil group demonstrated significant improvement in symptoms, including oppositional behavior, cognitive problems/inattention, hyperactivity, and the ADHD index on the Conners' Parent Rating Scale Revised, Short Form, compared with those in the placebo group.

Modafinil (Provigil) also was well tolerated. Only five of the patients in the treatment group (3%) and three in the placebo group (4%) discontinued the study because of adverse events. Given modafinil's safety profile and its low potential of abuse, the drug may offer clinicians a new option for treating ADHD in children and adolescents, the investigators said.

Teens' Perception of Body Weight

Many young teens from disadvantaged backgrounds do not perceive obesity as unacceptable, and despite common perceptions, not all of them are striving for thinness, reported Wendy Wills of the Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, England.

In a qualitative study in eastern Scotland of 36 economically disadvantaged 13− to 14-year-olds, half of the subjects were either overweight (body mass index greater than 25 kg/m

The overweight and obese teens had complex views of their weight and body size. Three-quarters of them talked positively about their weight, body size, or parts of their bodies, or expressed comfort with their bodies. A minority who were comfortable with their bodies also reported dissatisfaction with some parts of their bodies, and about half of these subjects wanted to lose weight or had already tried.

Half of the overweight and obese teens had tried to lose weight (as had three in the normal-weight group). These teens experienced an “emotional high” when they lost weight, and a deterioration in well-being when they failed. Only a minority of the subjects cited the health benefits of weight loss, even after expressing a desire to lose weight. Most of the subjects said that family and friends did not need to lose weight and should not feel pressured to do so.

Ethnicity and Depression in Teen Girls

Depression scores among white girls and young women decrease over time, but the scores tend to hold steady among their African American counterparts, reported Debra L. Franko, Ph.D., of Northeastern University, Boston, and her associates.

Depression scores among white girls and young women tend to start off higher, and that might play a role in the findings.

Previous comparisons of depression scores in African American and white girls have shown either mixed results or higher scores among white girls at younger ages.

The investigators conducted an age-matched study of 2,221 girls and young women aged 16–22 years, including 1,146 African Americans and 1,075 whites. The girls, participants in the 10-year longitudinal National Growth and Health Study, were asked to complete a packet of questionnaires, including the Center for Epidemiological Studies of Depression scale (CES-D) (J. Adolesc. Health 2005;37:526–9).

Adolescent depression was defined as a score of at least 24 on the CES-D.

Overall, as they got older, the percentage of white girls who met the criteria for depression fell, and the percentage of African American girls who met the criteria remained fairly steady. Specifically, 21% of 483 white 16-year-olds scored 24 or higher, compared with 14% of 332 white 22-year-olds. Among African Americans, 14% of 469 16-year-olds scored 24 or higher, compared with 15% of 452 22-year-olds.

The researchers noted that age-specific risk factors–such as body dissatisfaction subsequent to pubertal development–are more common among white girls and could partly account for the results. Other factors, such as access to and use of mental health care, also could explain some of the differences.

Modafinil for ADHD

Modafinil film-coated tablets significantly improved clinical symptoms of attention-deficit hyperactivity disorder in children and adolescents aged 6–17 years, said Dr. Joseph Biederman of Massachusetts General Hospital in Boston and his colleagues.

Modafinil, an agent generally prescribed to promote wakefulness in patients with narcolepsy, has been shown to activate the cortex alone.

In the randomized, double-blind trial conducted by Dr. Biederman and his colleagues, 164 children received a flexible dose of modafinil in tablet form, and 82 children received a placebo. The children began with one 85-mg tablet for the first 2 days; the dose was titrated to 170 mg on days 3–7, 255 mg on days 8–14, 340 mg on days 15–21, and 425 mg on day 22 (Pediatrics 2005;116:777–84).

After 9 weeks, 48% of patients in the modafinil group were deemed responders, compared with 17% of those in the placebo group. Overall, patients in the modafinil group demonstrated significant improvement in symptoms, including oppositional behavior, cognitive problems/inattention, hyperactivity, and the ADHD index on the Conners' Parent Rating Scale Revised, Short Form, compared with those in the placebo group.

Modafinil (Provigil) also was well tolerated. Only five of the patients in the treatment group (3%) and three in the placebo group (4%) discontinued the study because of adverse events. Given modafinil's safety profile and its low potential of abuse, the drug may offer clinicians a new option for treating ADHD in children and adolescents, the investigators said.

Teens' Perception of Body Weight

Many young teens from disadvantaged backgrounds do not perceive obesity as unacceptable, and despite common perceptions, not all of them are striving for thinness, reported Wendy Wills of the Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, England.

In a qualitative study in eastern Scotland of 36 economically disadvantaged 13− to 14-year-olds, half of the subjects were either overweight (body mass index greater than 25 kg/m

The overweight and obese teens had complex views of their weight and body size. Three-quarters of them talked positively about their weight, body size, or parts of their bodies, or expressed comfort with their bodies. A minority who were comfortable with their bodies also reported dissatisfaction with some parts of their bodies, and about half of these subjects wanted to lose weight or had already tried.

Half of the overweight and obese teens had tried to lose weight (as had three in the normal-weight group). These teens experienced an “emotional high” when they lost weight, and a deterioration in well-being when they failed. Only a minority of the subjects cited the health benefits of weight loss, even after expressing a desire to lose weight. Most of the subjects said that family and friends did not need to lose weight and should not feel pressured to do so.

Chlamydia Climbs in Teen Girls

Overall rates of chlamydia in the United States increased by 6% in 2004 compared with 2003 levels, officials from the Centers for Disease Control and Prevention said in a telephone news conference. The highest rates of chlamydia continued to be among adolescent females aged 15–19 years old, with a reported rate of 2,761 per 100,000 persons. The increase in the chlamydia rate probably reflects improved screening and better tests, the CDC officials said. Efforts to increase chlamydia screening are a priority for CDC; the organization recommends annual screening of sexually active women younger than 25 years. Data from a recent CDC study conducted in conjunction with Kaiser Permanente showed that a program that prompted primary care physicians to tie chlamydia testing to Pap testing increased chlamydia screening by 30% among the health plan's younger female members.

Missionary Imports Measles

A measles outbreak in Indiana in May-June 2005 has been attributed to an unvaccinated 17-year-old girl who had worked as a missionary in an orphanage and hospital in Bucharest, Romania, according to the CDC (MMWR 2005;54;1073–5). The girl returned to the United States with symptoms including prodromal fever, cough, conjunctivitis, and acute rhinitis (coryza) on May 14, and a rash on May 16. She attended a church gathering that included people who had not been vaccinated. The outbreak included 34 patients, aged 9 months to 49 years, with a median age of 12 years. A total of 14 cases (41%) were laboratory confirmed, and the other 20 were epidemiologically linked to confirmed cases. Only two patients had been vaccinated; one had received a single dose of vaccine and the other had received two doses.

Actions taken to control the outbreak included patient isolation; tracing patient contacts and administering vaccine and immunoglobulin to those who were susceptible; and voluntary quarantine for contacts who refused vaccination. In addition, local health officials reviewed the vaccine status of health care workers, alerted hospitals to the outbreak, and raised local media awareness of the need for vaccination. This measles outbreak represents the largest in the United States since 1996, and could have been prevented by adherence to the Advisory Committee on Immunization Practices recommendations, which include vaccination for all international travelers, people who work in medical facilities, and preschool and school-aged children.

Tx for Noncompliant H. pylori Patients

The clinical potency of metronidazole, despite evidence of in vitro resistance, may make it a more effective choice for children in areas with a high prevalence of Helicobacter pylori, said Bradford D. Gessner, M.D., of the Alaska Division of Public Health, Anchorage, and his colleagues (CID 2005;41;1261–8). Poor treatment compliance, crowded housing, and lower body mass index were among the risk factors for failed treatment of H. pylori infection in a randomized study of 219 children aged 7–11 years in rural Alaska. Those in the control group received 3 mg/kg iron sulfate twice daily, up to 60 mg/dose for 6 weeks. Those in the treatment group received iron sulfate plus a triple-barrelled therapy consisting of 40 mg/kg amoxicillin twice daily, up to 1.5 g/dose; 7.5 mg/kg clarithromycin twice daily, up to 500 mg/dose; and 30 mg lansoprazole twice daily. Children who were allergic to amoxicillin or macrolides received 10 mg/kg of metronidazole twice daily, up to 500 mg/dose. Compliance was a factor in the results; 8.3% of children who took their medications fewer than 10 times resolved their infections, compared with 19%, 40%, and 63% of children who took their medications 10–20 times, 20–27 times, and all 28 times, respectively. Posttreatment analyses showed a significant association between metronidazole and treatment success after controlling for multiple confounding variables.

Genotypes Factor in Hepatitis C

Interferon therapy for chronic hepatitis C may be less effective in children with a hepatitis C virus (HCV) genotype 1 than in children with hepatitis C virus genotypes other than 1, based on a retrospective study of 50 children aged 3–15 years, said Raffaele Iorio, M.D., of the University of Naples (Italy) and his associates. The children had hypertransaminasemia with detectable HCV RNA. A sustained response to interferon was observed in 11 of 17 children (65%) infected with an HCV genotype other than 1, compared with 8 of 33 children (24%) infected with HCV genotype 1. In addition, eight of the children who did not have a favorable response received a second cycle at a mean age of 11 years, and only one child with an HCV genotype other than 1 sustained a response to the second cycle.

Chlamydia Climbs in Teen Girls

Overall rates of chlamydia in the United States increased by 6% in 2004 compared with 2003 levels, officials from the Centers for Disease Control and Prevention said in a telephone news conference. The highest rates of chlamydia continued to be among adolescent females aged 15–19 years old, with a reported rate of 2,761 per 100,000 persons. The increase in the chlamydia rate probably reflects improved screening and better tests, the CDC officials said. Efforts to increase chlamydia screening are a priority for CDC; the organization recommends annual screening of sexually active women younger than 25 years. Data from a recent CDC study conducted in conjunction with Kaiser Permanente showed that a program that prompted primary care physicians to tie chlamydia testing to Pap testing increased chlamydia screening by 30% among the health plan's younger female members.

Missionary Imports Measles

A measles outbreak in Indiana in May-June 2005 has been attributed to an unvaccinated 17-year-old girl who had worked as a missionary in an orphanage and hospital in Bucharest, Romania, according to the CDC (MMWR 2005;54;1073–5). The girl returned to the United States with symptoms including prodromal fever, cough, conjunctivitis, and acute rhinitis (coryza) on May 14, and a rash on May 16. She attended a church gathering that included people who had not been vaccinated. The outbreak included 34 patients, aged 9 months to 49 years, with a median age of 12 years. A total of 14 cases (41%) were laboratory confirmed, and the other 20 were epidemiologically linked to confirmed cases. Only two patients had been vaccinated; one had received a single dose of vaccine and the other had received two doses.

Actions taken to control the outbreak included patient isolation; tracing patient contacts and administering vaccine and immunoglobulin to those who were susceptible; and voluntary quarantine for contacts who refused vaccination. In addition, local health officials reviewed the vaccine status of health care workers, alerted hospitals to the outbreak, and raised local media awareness of the need for vaccination. This measles outbreak represents the largest in the United States since 1996, and could have been prevented by adherence to the Advisory Committee on Immunization Practices recommendations, which include vaccination for all international travelers, people who work in medical facilities, and preschool and school-aged children.

Tx for Noncompliant H. pylori Patients

The clinical potency of metronidazole, despite evidence of in vitro resistance, may make it a more effective choice for children in areas with a high prevalence of Helicobacter pylori, said Bradford D. Gessner, M.D., of the Alaska Division of Public Health, Anchorage, and his colleagues (CID 2005;41;1261–8). Poor treatment compliance, crowded housing, and lower body mass index were among the risk factors for failed treatment of H. pylori infection in a randomized study of 219 children aged 7–11 years in rural Alaska. Those in the control group received 3 mg/kg iron sulfate twice daily, up to 60 mg/dose for 6 weeks. Those in the treatment group received iron sulfate plus a triple-barrelled therapy consisting of 40 mg/kg amoxicillin twice daily, up to 1.5 g/dose; 7.5 mg/kg clarithromycin twice daily, up to 500 mg/dose; and 30 mg lansoprazole twice daily. Children who were allergic to amoxicillin or macrolides received 10 mg/kg of metronidazole twice daily, up to 500 mg/dose. Compliance was a factor in the results; 8.3% of children who took their medications fewer than 10 times resolved their infections, compared with 19%, 40%, and 63% of children who took their medications 10–20 times, 20–27 times, and all 28 times, respectively. Posttreatment analyses showed a significant association between metronidazole and treatment success after controlling for multiple confounding variables.

Genotypes Factor in Hepatitis C

Interferon therapy for chronic hepatitis C may be less effective in children with a hepatitis C virus (HCV) genotype 1 than in children with hepatitis C virus genotypes other than 1, based on a retrospective study of 50 children aged 3–15 years, said Raffaele Iorio, M.D., of the University of Naples (Italy) and his associates. The children had hypertransaminasemia with detectable HCV RNA. A sustained response to interferon was observed in 11 of 17 children (65%) infected with an HCV genotype other than 1, compared with 8 of 33 children (24%) infected with HCV genotype 1. In addition, eight of the children who did not have a favorable response received a second cycle at a mean age of 11 years, and only one child with an HCV genotype other than 1 sustained a response to the second cycle.

Chlamydia Climbs in Teen Girls

Overall rates of chlamydia in the United States increased by 6% in 2004 compared with 2003 levels, officials from the Centers for Disease Control and Prevention said in a telephone news conference. The highest rates of chlamydia continued to be among adolescent females aged 15–19 years old, with a reported rate of 2,761 per 100,000 persons. The increase in the chlamydia rate probably reflects improved screening and better tests, the CDC officials said. Efforts to increase chlamydia screening are a priority for CDC; the organization recommends annual screening of sexually active women younger than 25 years. Data from a recent CDC study conducted in conjunction with Kaiser Permanente showed that a program that prompted primary care physicians to tie chlamydia testing to Pap testing increased chlamydia screening by 30% among the health plan's younger female members.

Missionary Imports Measles

A measles outbreak in Indiana in May-June 2005 has been attributed to an unvaccinated 17-year-old girl who had worked as a missionary in an orphanage and hospital in Bucharest, Romania, according to the CDC (MMWR 2005;54;1073–5). The girl returned to the United States with symptoms including prodromal fever, cough, conjunctivitis, and acute rhinitis (coryza) on May 14, and a rash on May 16. She attended a church gathering that included people who had not been vaccinated. The outbreak included 34 patients, aged 9 months to 49 years, with a median age of 12 years. A total of 14 cases (41%) were laboratory confirmed, and the other 20 were epidemiologically linked to confirmed cases. Only two patients had been vaccinated; one had received a single dose of vaccine and the other had received two doses.

Actions taken to control the outbreak included patient isolation; tracing patient contacts and administering vaccine and immunoglobulin to those who were susceptible; and voluntary quarantine for contacts who refused vaccination. In addition, local health officials reviewed the vaccine status of health care workers, alerted hospitals to the outbreak, and raised local media awareness of the need for vaccination. This measles outbreak represents the largest in the United States since 1996, and could have been prevented by adherence to the Advisory Committee on Immunization Practices recommendations, which include vaccination for all international travelers, people who work in medical facilities, and preschool and school-aged children.

Tx for Noncompliant H. pylori Patients

The clinical potency of metronidazole, despite evidence of in vitro resistance, may make it a more effective choice for children in areas with a high prevalence of Helicobacter pylori, said Bradford D. Gessner, M.D., of the Alaska Division of Public Health, Anchorage, and his colleagues (CID 2005;41;1261–8). Poor treatment compliance, crowded housing, and lower body mass index were among the risk factors for failed treatment of H. pylori infection in a randomized study of 219 children aged 7–11 years in rural Alaska. Those in the control group received 3 mg/kg iron sulfate twice daily, up to 60 mg/dose for 6 weeks. Those in the treatment group received iron sulfate plus a triple-barrelled therapy consisting of 40 mg/kg amoxicillin twice daily, up to 1.5 g/dose; 7.5 mg/kg clarithromycin twice daily, up to 500 mg/dose; and 30 mg lansoprazole twice daily. Children who were allergic to amoxicillin or macrolides received 10 mg/kg of metronidazole twice daily, up to 500 mg/dose. Compliance was a factor in the results; 8.3% of children who took their medications fewer than 10 times resolved their infections, compared with 19%, 40%, and 63% of children who took their medications 10–20 times, 20–27 times, and all 28 times, respectively. Posttreatment analyses showed a significant association between metronidazole and treatment success after controlling for multiple confounding variables.

Genotypes Factor in Hepatitis C

Interferon therapy for chronic hepatitis C may be less effective in children with a hepatitis C virus (HCV) genotype 1 than in children with hepatitis C virus genotypes other than 1, based on a retrospective study of 50 children aged 3–15 years, said Raffaele Iorio, M.D., of the University of Naples (Italy) and his associates. The children had hypertransaminasemia with detectable HCV RNA. A sustained response to interferon was observed in 11 of 17 children (65%) infected with an HCV genotype other than 1, compared with 8 of 33 children (24%) infected with HCV genotype 1. In addition, eight of the children who did not have a favorable response received a second cycle at a mean age of 11 years, and only one child with an HCV genotype other than 1 sustained a response to the second cycle.

Storm Disrupts Preventive Care

Missing pediatric vaccinations is one of the health challenges the country faces from Hurricane Katrina, Anthony Fauci, M.D., said at a press briefing sponsored by the Association of Health Care Journalists.

“One of the problems with natural catastrophes and disasters is that when you interrupt the regularly scheduled childhood vaccinations, then you develop areas of vulnerability of children getting infected with common viruses that you generally don't think of as being a problem, like measles,” said Dr. Fauci, director of the National Institute of Allergy and Infectious Diseases, Bethesda, Md. “We've got to keep the children's vaccination schedules up for normal diseases, not necessarily diseases that are peculiar to Katrina.”

Keeping up the vaccination schedule in pediatric Hurricane Katrina survivors has been made even more difficult by the fact that many patients' health care records have been destroyed. “So one of the things we have to be sure of is when in doubt, vaccinate,” Dr. Fauci said, adding that the hurricane “certainly is an argument for electronic versions of medical records.”

STI Vaccination Widely Accepted

Ninety-three percent of 320 parents and 89% of their 320 adolescents endorsed a vaccine against HIV, said Gregory D. Zimet, Ph.D., and his associates at Indiana University, Indianapolis.

Eighty-five percent of parents and 87% of adolescents said that they would get a gonorrhea vaccine if it were available, and 89% and 90% of parents and adolescents, respectively, supported a vaccine for genital herpes. The parents and adolescents were recruited into the study from primary care clinics and private pediatric practices, and responded to anonymous surveys. Parental predictors of vaccine acceptance included a parental history of sexually transmitted infections and a perceived vulnerability of the child to STIs.

Adolescent predictors of vaccine acceptance included having parents who accepted the vaccine and having at least one friend who had engaged in sex. Since the ideal age for immunization against STIs would be preadolescence or early adolescence, prior to the onset of sexual activity, parental acceptance and support of vaccination would be central to any program, the investigators noted (J. Adolesc. Health 2005;37:179–86).

MRSA Joins Football Team

An outbreak of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) occurred among 13 players on a high school football team in Pennsylvania, said Jeffrey A. Rihn, M.D., of the University of Pittsburgh and his colleagues (Pediatr. Infect. Dis. J. 2005;24:841–3).

The outbreak began during the fourth week of football season, when abscesses appeared in four players, and three of them yielded positive cultures for CA-MRSA. Although the team was educated about hygiene behavior, such as washing hands, treating skin lesions promptly, and not sharing towels, the outbreak eventually included 20 infections.

All 102 players and staff members underwent nasal cultures. Overall, 3 of 102 cultures (2.9%) were positive for MRSA and 32 (31.4%) were positive for methicillin-susceptible S. aureus; this low prevalence of colonization means surveillance cultures aren't useful for determining risk of CA-MRSA. Mupirocin was not effective at controlling infections due to noncompliance and nonsimultaneous use. Eight infections were treated with drainage and empiric cephalexin or amoxicillin/clavulanate, and the recurrence rate was slightly lower in cases where the choice of antibiotics was guided by culture. In this outbreak, risk factors did not include personal hygiene practices or sharing towels or equipment.

Uncircumcised at Greater UTI Risk

Being uncircumcised and having a fever greater than 39° C were significant risk factors for urinary tract infections (UTIs) in a study of 1,025 infants aged 1–60 days, said Joseph J. Zorc, M.D., of the University of Pennsylvania, Philadelphia, and other members of the Multicenter RSV-SBI study group. Overall, 52% of the 291 boys were uncircumcised, and 21% of these had UTIs, compared with UTI rates of 2% among circumcised boys and 5% among girls. In addition, 23 of 68 male infants who were uncircumcised and had fevers greater than 39° C were diagnosed with urinary tract infections.

Hispanic/Latino boys and Asian boys were significantly more likely to be uncircumcised (78% and 72%, respectively), compared with infants of other ethnicities (28%). Circumcision status was often not documented in the records of patients in whom infections were missed. Physicians may not consider circumcision status as a factor in managing UTIs, and an enhanced urinalysis or empiric treatment while awaiting culture results in the absence of enhanced urinalysis may be merited for uncircumcised infants, the investigators said (Pediatrics 2005;116:644–8).

Storm Disrupts Preventive Care

Missing pediatric vaccinations is one of the health challenges the country faces from Hurricane Katrina, Anthony Fauci, M.D., said at a press briefing sponsored by the Association of Health Care Journalists.

“One of the problems with natural catastrophes and disasters is that when you interrupt the regularly scheduled childhood vaccinations, then you develop areas of vulnerability of children getting infected with common viruses that you generally don't think of as being a problem, like measles,” said Dr. Fauci, director of the National Institute of Allergy and Infectious Diseases, Bethesda, Md. “We've got to keep the children's vaccination schedules up for normal diseases, not necessarily diseases that are peculiar to Katrina.”

Keeping up the vaccination schedule in pediatric Hurricane Katrina survivors has been made even more difficult by the fact that many patients' health care records have been destroyed. “So one of the things we have to be sure of is when in doubt, vaccinate,” Dr. Fauci said, adding that the hurricane “certainly is an argument for electronic versions of medical records.”

STI Vaccination Widely Accepted

Ninety-three percent of 320 parents and 89% of their 320 adolescents endorsed a vaccine against HIV, said Gregory D. Zimet, Ph.D., and his associates at Indiana University, Indianapolis.

Eighty-five percent of parents and 87% of adolescents said that they would get a gonorrhea vaccine if it were available, and 89% and 90% of parents and adolescents, respectively, supported a vaccine for genital herpes. The parents and adolescents were recruited into the study from primary care clinics and private pediatric practices, and responded to anonymous surveys. Parental predictors of vaccine acceptance included a parental history of sexually transmitted infections and a perceived vulnerability of the child to STIs.

Adolescent predictors of vaccine acceptance included having parents who accepted the vaccine and having at least one friend who had engaged in sex. Since the ideal age for immunization against STIs would be preadolescence or early adolescence, prior to the onset of sexual activity, parental acceptance and support of vaccination would be central to any program, the investigators noted (J. Adolesc. Health 2005;37:179–86).

MRSA Joins Football Team

An outbreak of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) occurred among 13 players on a high school football team in Pennsylvania, said Jeffrey A. Rihn, M.D., of the University of Pittsburgh and his colleagues (Pediatr. Infect. Dis. J. 2005;24:841–3).

The outbreak began during the fourth week of football season, when abscesses appeared in four players, and three of them yielded positive cultures for CA-MRSA. Although the team was educated about hygiene behavior, such as washing hands, treating skin lesions promptly, and not sharing towels, the outbreak eventually included 20 infections.

All 102 players and staff members underwent nasal cultures. Overall, 3 of 102 cultures (2.9%) were positive for MRSA and 32 (31.4%) were positive for methicillin-susceptible S. aureus; this low prevalence of colonization means surveillance cultures aren't useful for determining risk of CA-MRSA. Mupirocin was not effective at controlling infections due to noncompliance and nonsimultaneous use. Eight infections were treated with drainage and empiric cephalexin or amoxicillin/clavulanate, and the recurrence rate was slightly lower in cases where the choice of antibiotics was guided by culture. In this outbreak, risk factors did not include personal hygiene practices or sharing towels or equipment.

Uncircumcised at Greater UTI Risk

Being uncircumcised and having a fever greater than 39° C were significant risk factors for urinary tract infections (UTIs) in a study of 1,025 infants aged 1–60 days, said Joseph J. Zorc, M.D., of the University of Pennsylvania, Philadelphia, and other members of the Multicenter RSV-SBI study group. Overall, 52% of the 291 boys were uncircumcised, and 21% of these had UTIs, compared with UTI rates of 2% among circumcised boys and 5% among girls. In addition, 23 of 68 male infants who were uncircumcised and had fevers greater than 39° C were diagnosed with urinary tract infections.

Hispanic/Latino boys and Asian boys were significantly more likely to be uncircumcised (78% and 72%, respectively), compared with infants of other ethnicities (28%). Circumcision status was often not documented in the records of patients in whom infections were missed. Physicians may not consider circumcision status as a factor in managing UTIs, and an enhanced urinalysis or empiric treatment while awaiting culture results in the absence of enhanced urinalysis may be merited for uncircumcised infants, the investigators said (Pediatrics 2005;116:644–8).

Storm Disrupts Preventive Care

Missing pediatric vaccinations is one of the health challenges the country faces from Hurricane Katrina, Anthony Fauci, M.D., said at a press briefing sponsored by the Association of Health Care Journalists.

“One of the problems with natural catastrophes and disasters is that when you interrupt the regularly scheduled childhood vaccinations, then you develop areas of vulnerability of children getting infected with common viruses that you generally don't think of as being a problem, like measles,” said Dr. Fauci, director of the National Institute of Allergy and Infectious Diseases, Bethesda, Md. “We've got to keep the children's vaccination schedules up for normal diseases, not necessarily diseases that are peculiar to Katrina.”

Keeping up the vaccination schedule in pediatric Hurricane Katrina survivors has been made even more difficult by the fact that many patients' health care records have been destroyed. “So one of the things we have to be sure of is when in doubt, vaccinate,” Dr. Fauci said, adding that the hurricane “certainly is an argument for electronic versions of medical records.”

STI Vaccination Widely Accepted

Ninety-three percent of 320 parents and 89% of their 320 adolescents endorsed a vaccine against HIV, said Gregory D. Zimet, Ph.D., and his associates at Indiana University, Indianapolis.

Eighty-five percent of parents and 87% of adolescents said that they would get a gonorrhea vaccine if it were available, and 89% and 90% of parents and adolescents, respectively, supported a vaccine for genital herpes. The parents and adolescents were recruited into the study from primary care clinics and private pediatric practices, and responded to anonymous surveys. Parental predictors of vaccine acceptance included a parental history of sexually transmitted infections and a perceived vulnerability of the child to STIs.

Adolescent predictors of vaccine acceptance included having parents who accepted the vaccine and having at least one friend who had engaged in sex. Since the ideal age for immunization against STIs would be preadolescence or early adolescence, prior to the onset of sexual activity, parental acceptance and support of vaccination would be central to any program, the investigators noted (J. Adolesc. Health 2005;37:179–86).

MRSA Joins Football Team

An outbreak of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) occurred among 13 players on a high school football team in Pennsylvania, said Jeffrey A. Rihn, M.D., of the University of Pittsburgh and his colleagues (Pediatr. Infect. Dis. J. 2005;24:841–3).

The outbreak began during the fourth week of football season, when abscesses appeared in four players, and three of them yielded positive cultures for CA-MRSA. Although the team was educated about hygiene behavior, such as washing hands, treating skin lesions promptly, and not sharing towels, the outbreak eventually included 20 infections.

All 102 players and staff members underwent nasal cultures. Overall, 3 of 102 cultures (2.9%) were positive for MRSA and 32 (31.4%) were positive for methicillin-susceptible S. aureus; this low prevalence of colonization means surveillance cultures aren't useful for determining risk of CA-MRSA. Mupirocin was not effective at controlling infections due to noncompliance and nonsimultaneous use. Eight infections were treated with drainage and empiric cephalexin or amoxicillin/clavulanate, and the recurrence rate was slightly lower in cases where the choice of antibiotics was guided by culture. In this outbreak, risk factors did not include personal hygiene practices or sharing towels or equipment.

Uncircumcised at Greater UTI Risk

Being uncircumcised and having a fever greater than 39° C were significant risk factors for urinary tract infections (UTIs) in a study of 1,025 infants aged 1–60 days, said Joseph J. Zorc, M.D., of the University of Pennsylvania, Philadelphia, and other members of the Multicenter RSV-SBI study group. Overall, 52% of the 291 boys were uncircumcised, and 21% of these had UTIs, compared with UTI rates of 2% among circumcised boys and 5% among girls. In addition, 23 of 68 male infants who were uncircumcised and had fevers greater than 39° C were diagnosed with urinary tract infections.

Hispanic/Latino boys and Asian boys were significantly more likely to be uncircumcised (78% and 72%, respectively), compared with infants of other ethnicities (28%). Circumcision status was often not documented in the records of patients in whom infections were missed. Physicians may not consider circumcision status as a factor in managing UTIs, and an enhanced urinalysis or empiric treatment while awaiting culture results in the absence of enhanced urinalysis may be merited for uncircumcised infants, the investigators said (Pediatrics 2005;116:644–8).

Hurricane Health Care Threat

Missing pediatric vaccinations is one of the health challenges the country faces from Hurricane Katrina, Anthony Fauci, M.D., said at a press briefing sponsored by the Association of Health Care Journalists.

“One of the problems with natural catastrophes and disasters is that when you interrupt the regularly scheduled childhood vaccinations, then you develop areas of vulnerability of children getting infected with common viruses that you generally don't think of as being a problem, like measles,” said Dr. Fauci, director of the National Institute of Allergy and Infectious Diseases, Bethesda, Md. “We've got to keep the children's vaccination schedules up for normal diseases, not necessarily diseases that are peculiar to Katrina.”

Keeping up the vaccination schedule in pediatric Hurricane Katrina survivors has been made even more difficult by the fact that many patients' health care records have been destroyed. “So one of the things we have to be sure of is when in doubt, vaccinate,” Dr. Fauci said, adding that the hurricane “certainly is an argument for electronic versions of medical records.”

STI Vaccination Acceptance

Ninety-three percent of 320 parents and 89% of their 320 adolescents endorsed a vaccine against HIV, said Gregory D. Zimet, Ph.D, and his associates at Indiana University, Indianapolis. Eighty-five percent of parents and 87% of adolescents said that they would get a gonorrhea vaccine if it were available, and 89% and 90% of parents and adolescents, respectively, supported a vaccine for genital herpes. The parents and adolescents were recruited into the study from primary care clinics and private pediatric practices, and responded to anonymous surveys. Parental predictors of vaccine acceptance included a parental history of sexually transmitted infections and a perceived vulnerability of the child to STIs. Adolescent predictors of vaccine acceptance included having parents who accepted the vaccine and having at least one friend who had engaged in sex. Since the ideal age for immunization against STIs would be preadolescence or early adolescence, prior to the onset of sexual activity, parental acceptance and support of vaccination would be central to any program, the investigators noted (J. Adolesc. Health 2005;37:179–86).

MRSA Joins Football Team

An outbreak of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) occurred among 13 players on a high school football team in Pennsylvania, said Jeffrey A. Rihn, M.D., of the University of Pittsburgh and his colleagues (Pediatr. Infect. Dis. J. 2005;24:841–3). The outbreak began during the fourth week of football season, when abscesses appeared in four players, and three of them yielded positive cultures for CA-MRSA. Although the team was educated about hygiene behavior, such as washing hands, treating skin lesions promptly, and not sharing towels, the outbreak eventually included 20 infections. All 102 players and staff members underwent nasal cultures. Overall, 3 of 102 cultures (2.9%) were positive for MRSA and 32 (31.4%) were positive for methicillin-susceptible S. aureus; this low prevalence of colonization means surveillance cultures aren't useful for determining risk of CA-MRSA. Mupirocin was not effective at controlling infections due to noncompliance and nonsimultaneous use. Eight infections were treated with drainage and empiric cephalexin or amoxicillin/clavulanate, and the recurrence rate was slightly lower in cases where the choice of antibiotics was guided by culture. In this outbreak, risk factors included playing lineman position, and junior class status, but did not include personal hygiene practices or sharing towels or equipment.

Uncircumcised at Greater UTI Risk

Being uncircumcised and having a fever greater than 39° C were significant risk factors for urinary tract infections (UTIs) in a study of 1,025 infants aged 1–60 days, said Joseph J. Zorc, M.D., of the University of Pennsylvania, Philadelphia, and other members of the Multicenter RSV-SBI study group. Overall, 52% of the 291 boys were uncircumcised, and 21% of these had UTIs, compared with UTI rates of 2% among circumcised boys and 5% among girls. In addition, 23 of 68 male infants who were uncircumcised and had fevers greater than 39° C were diagnosed with urinary tract infections.

Hispanic/Latino boys and Asian boys were significantly more likely to be uncircumcised (78% and 72%, respectively), compared with infants of other ethnicities (28%). Circumcision status was often not documented in the records of patients in whom infections were missed. Physicians may not consider circumcision status as a factor in managing UTIs, and an enhanced urinalysis or empiric treatment while awaiting culture results in the absence of enhanced urinalysis may be merited for uncircumcised infants, the investigators said (Pediatrics 2005;116:644–8).

Hurricane Health Care Threat

Missing pediatric vaccinations is one of the health challenges the country faces from Hurricane Katrina, Anthony Fauci, M.D., said at a press briefing sponsored by the Association of Health Care Journalists.

“One of the problems with natural catastrophes and disasters is that when you interrupt the regularly scheduled childhood vaccinations, then you develop areas of vulnerability of children getting infected with common viruses that you generally don't think of as being a problem, like measles,” said Dr. Fauci, director of the National Institute of Allergy and Infectious Diseases, Bethesda, Md. “We've got to keep the children's vaccination schedules up for normal diseases, not necessarily diseases that are peculiar to Katrina.”

Keeping up the vaccination schedule in pediatric Hurricane Katrina survivors has been made even more difficult by the fact that many patients' health care records have been destroyed. “So one of the things we have to be sure of is when in doubt, vaccinate,” Dr. Fauci said, adding that the hurricane “certainly is an argument for electronic versions of medical records.”

STI Vaccination Acceptance

Ninety-three percent of 320 parents and 89% of their 320 adolescents endorsed a vaccine against HIV, said Gregory D. Zimet, Ph.D, and his associates at Indiana University, Indianapolis. Eighty-five percent of parents and 87% of adolescents said that they would get a gonorrhea vaccine if it were available, and 89% and 90% of parents and adolescents, respectively, supported a vaccine for genital herpes. The parents and adolescents were recruited into the study from primary care clinics and private pediatric practices, and responded to anonymous surveys. Parental predictors of vaccine acceptance included a parental history of sexually transmitted infections and a perceived vulnerability of the child to STIs. Adolescent predictors of vaccine acceptance included having parents who accepted the vaccine and having at least one friend who had engaged in sex. Since the ideal age for immunization against STIs would be preadolescence or early adolescence, prior to the onset of sexual activity, parental acceptance and support of vaccination would be central to any program, the investigators noted (J. Adolesc. Health 2005;37:179–86).

MRSA Joins Football Team

An outbreak of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) occurred among 13 players on a high school football team in Pennsylvania, said Jeffrey A. Rihn, M.D., of the University of Pittsburgh and his colleagues (Pediatr. Infect. Dis. J. 2005;24:841–3). The outbreak began during the fourth week of football season, when abscesses appeared in four players, and three of them yielded positive cultures for CA-MRSA. Although the team was educated about hygiene behavior, such as washing hands, treating skin lesions promptly, and not sharing towels, the outbreak eventually included 20 infections. All 102 players and staff members underwent nasal cultures. Overall, 3 of 102 cultures (2.9%) were positive for MRSA and 32 (31.4%) were positive for methicillin-susceptible S. aureus; this low prevalence of colonization means surveillance cultures aren't useful for determining risk of CA-MRSA. Mupirocin was not effective at controlling infections due to noncompliance and nonsimultaneous use. Eight infections were treated with drainage and empiric cephalexin or amoxicillin/clavulanate, and the recurrence rate was slightly lower in cases where the choice of antibiotics was guided by culture. In this outbreak, risk factors included playing lineman position, and junior class status, but did not include personal hygiene practices or sharing towels or equipment.

Uncircumcised at Greater UTI Risk

Being uncircumcised and having a fever greater than 39° C were significant risk factors for urinary tract infections (UTIs) in a study of 1,025 infants aged 1–60 days, said Joseph J. Zorc, M.D., of the University of Pennsylvania, Philadelphia, and other members of the Multicenter RSV-SBI study group. Overall, 52% of the 291 boys were uncircumcised, and 21% of these had UTIs, compared with UTI rates of 2% among circumcised boys and 5% among girls. In addition, 23 of 68 male infants who were uncircumcised and had fevers greater than 39° C were diagnosed with urinary tract infections.

Hispanic/Latino boys and Asian boys were significantly more likely to be uncircumcised (78% and 72%, respectively), compared with infants of other ethnicities (28%). Circumcision status was often not documented in the records of patients in whom infections were missed. Physicians may not consider circumcision status as a factor in managing UTIs, and an enhanced urinalysis or empiric treatment while awaiting culture results in the absence of enhanced urinalysis may be merited for uncircumcised infants, the investigators said (Pediatrics 2005;116:644–8).

Hurricane Health Care Threat

Missing pediatric vaccinations is one of the health challenges the country faces from Hurricane Katrina, Anthony Fauci, M.D., said at a press briefing sponsored by the Association of Health Care Journalists.

“One of the problems with natural catastrophes and disasters is that when you interrupt the regularly scheduled childhood vaccinations, then you develop areas of vulnerability of children getting infected with common viruses that you generally don't think of as being a problem, like measles,” said Dr. Fauci, director of the National Institute of Allergy and Infectious Diseases, Bethesda, Md. “We've got to keep the children's vaccination schedules up for normal diseases, not necessarily diseases that are peculiar to Katrina.”

Keeping up the vaccination schedule in pediatric Hurricane Katrina survivors has been made even more difficult by the fact that many patients' health care records have been destroyed. “So one of the things we have to be sure of is when in doubt, vaccinate,” Dr. Fauci said, adding that the hurricane “certainly is an argument for electronic versions of medical records.”

STI Vaccination Acceptance

Ninety-three percent of 320 parents and 89% of their 320 adolescents endorsed a vaccine against HIV, said Gregory D. Zimet, Ph.D, and his associates at Indiana University, Indianapolis. Eighty-five percent of parents and 87% of adolescents said that they would get a gonorrhea vaccine if it were available, and 89% and 90% of parents and adolescents, respectively, supported a vaccine for genital herpes. The parents and adolescents were recruited into the study from primary care clinics and private pediatric practices, and responded to anonymous surveys. Parental predictors of vaccine acceptance included a parental history of sexually transmitted infections and a perceived vulnerability of the child to STIs. Adolescent predictors of vaccine acceptance included having parents who accepted the vaccine and having at least one friend who had engaged in sex. Since the ideal age for immunization against STIs would be preadolescence or early adolescence, prior to the onset of sexual activity, parental acceptance and support of vaccination would be central to any program, the investigators noted (J. Adolesc. Health 2005;37:179–86).

MRSA Joins Football Team

An outbreak of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) occurred among 13 players on a high school football team in Pennsylvania, said Jeffrey A. Rihn, M.D., of the University of Pittsburgh and his colleagues (Pediatr. Infect. Dis. J. 2005;24:841–3). The outbreak began during the fourth week of football season, when abscesses appeared in four players, and three of them yielded positive cultures for CA-MRSA. Although the team was educated about hygiene behavior, such as washing hands, treating skin lesions promptly, and not sharing towels, the outbreak eventually included 20 infections. All 102 players and staff members underwent nasal cultures. Overall, 3 of 102 cultures (2.9%) were positive for MRSA and 32 (31.4%) were positive for methicillin-susceptible S. aureus; this low prevalence of colonization means surveillance cultures aren't useful for determining risk of CA-MRSA. Mupirocin was not effective at controlling infections due to noncompliance and nonsimultaneous use. Eight infections were treated with drainage and empiric cephalexin or amoxicillin/clavulanate, and the recurrence rate was slightly lower in cases where the choice of antibiotics was guided by culture. In this outbreak, risk factors included playing lineman position, and junior class status, but did not include personal hygiene practices or sharing towels or equipment.

Uncircumcised at Greater UTI Risk

Being uncircumcised and having a fever greater than 39° C were significant risk factors for urinary tract infections (UTIs) in a study of 1,025 infants aged 1–60 days, said Joseph J. Zorc, M.D., of the University of Pennsylvania, Philadelphia, and other members of the Multicenter RSV-SBI study group. Overall, 52% of the 291 boys were uncircumcised, and 21% of these had UTIs, compared with UTI rates of 2% among circumcised boys and 5% among girls. In addition, 23 of 68 male infants who were uncircumcised and had fevers greater than 39° C were diagnosed with urinary tract infections.

Hispanic/Latino boys and Asian boys were significantly more likely to be uncircumcised (78% and 72%, respectively), compared with infants of other ethnicities (28%). Circumcision status was often not documented in the records of patients in whom infections were missed. Physicians may not consider circumcision status as a factor in managing UTIs, and an enhanced urinalysis or empiric treatment while awaiting culture results in the absence of enhanced urinalysis may be merited for uncircumcised infants, the investigators said (Pediatrics 2005;116:644–8).