Heidi Splete

BOSTON — Delayed examinations following sexual assaults significantly reduced the frequency of documented anogenital injuries in the victims, based on data from 2,799 cases.

Data on the nature and documentation of anogenital injuries beyond 24-48 hours after a sexual assault are limited, and 72 hours generally is suggested as the maximum time after the assault to document anogenital injuries, Catherine Burger, a medical student at Michigan State University, Grand Rapids, and her colleagues said at the annual meeting of the American College of Emergency Physicians.

The researchers reviewed data from consecutive female patients aged 13 years and older who presented to the community-based Sexual Assault Nurse Examiner program—funded by the Michigan Department of Community Health—during a 10-year period. Their goal was to analyze how the types, location, and frequency of anogenital injuries related to both the victim's age and the time from assault to examination. The researchers also looked for demographic factors that might be linked to the delay in seeking care. A total of 1,192 patients were 19 years or younger (adolescents) and 1,607 were older than 19 years (adults). The results were presented in a poster at the meeting.

A total of 776 victims (26%) delayed seeking medical care for at least 24 hours after an assault. Those who delayed care were significantly younger (20.7 vs. 23.6 years), significantly more likely to have been victimized by a family member or acquaintance (86% vs. 79%), and significantly less likely to report the assault to the police (64% vs. 84%), compared with those who sought care within 24 hours. Adolescents who delayed care were significantly more likely to report alcohol or drug use before the assault, compared with adults who delayed seeking care (58% vs. 47%).

Overall, “the frequency of anogenital lacerations and abrasions decreased from 71% at less than 24 hours to 28% at greater than 96 hours,” the researchers wrote.

In both adolescents and adults, the frequency of documented anogenital injuries dropped by about 8% each day after the assault. But at the 72-hour mark, 50% of adolescents and 38% of adults had documented anogenital injuries. Adolescents had a greater frequency of genital injuries, compared with adults across all time periods.

The results suggest that anogenital injuries can still be documented in medicolegal examinations, even at 72 hours after the assault, the researchers said.

The researchers had no financial conflicts to disclose.

BOSTON — Delayed examinations following sexual assaults significantly reduced the frequency of documented anogenital injuries in the victims, based on data from 2,799 cases.

Data on the nature and documentation of anogenital injuries beyond 24-48 hours after a sexual assault are limited, and 72 hours generally is suggested as the maximum time after the assault to document anogenital injuries, Catherine Burger, a medical student at Michigan State University, Grand Rapids, and her colleagues said at the annual meeting of the American College of Emergency Physicians.

The researchers reviewed data from consecutive female patients aged 13 years and older who presented to the community-based Sexual Assault Nurse Examiner program—funded by the Michigan Department of Community Health—during a 10-year period. Their goal was to analyze how the types, location, and frequency of anogenital injuries related to both the victim's age and the time from assault to examination. The researchers also looked for demographic factors that might be linked to the delay in seeking care. A total of 1,192 patients were 19 years or younger (adolescents) and 1,607 were older than 19 years (adults). The results were presented in a poster at the meeting.

A total of 776 victims (26%) delayed seeking medical care for at least 24 hours after an assault. Those who delayed care were significantly younger (20.7 vs. 23.6 years), significantly more likely to have been victimized by a family member or acquaintance (86% vs. 79%), and significantly less likely to report the assault to the police (64% vs. 84%), compared with those who sought care within 24 hours. Adolescents who delayed care were significantly more likely to report alcohol or drug use before the assault, compared with adults who delayed seeking care (58% vs. 47%).

Overall, “the frequency of anogenital lacerations and abrasions decreased from 71% at less than 24 hours to 28% at greater than 96 hours,” the researchers wrote.

In both adolescents and adults, the frequency of documented anogenital injuries dropped by about 8% each day after the assault. But at the 72-hour mark, 50% of adolescents and 38% of adults had documented anogenital injuries. Adolescents had a greater frequency of genital injuries, compared with adults across all time periods.

The results suggest that anogenital injuries can still be documented in medicolegal examinations, even at 72 hours after the assault, the researchers said.

The researchers had no financial conflicts to disclose.

BOSTON — Delayed examinations following sexual assaults significantly reduced the frequency of documented anogenital injuries in the victims, based on data from 2,799 cases.

Data on the nature and documentation of anogenital injuries beyond 24-48 hours after a sexual assault are limited, and 72 hours generally is suggested as the maximum time after the assault to document anogenital injuries, Catherine Burger, a medical student at Michigan State University, Grand Rapids, and her colleagues said at the annual meeting of the American College of Emergency Physicians.

The researchers reviewed data from consecutive female patients aged 13 years and older who presented to the community-based Sexual Assault Nurse Examiner program—funded by the Michigan Department of Community Health—during a 10-year period. Their goal was to analyze how the types, location, and frequency of anogenital injuries related to both the victim's age and the time from assault to examination. The researchers also looked for demographic factors that might be linked to the delay in seeking care. A total of 1,192 patients were 19 years or younger (adolescents) and 1,607 were older than 19 years (adults). The results were presented in a poster at the meeting.

A total of 776 victims (26%) delayed seeking medical care for at least 24 hours after an assault. Those who delayed care were significantly younger (20.7 vs. 23.6 years), significantly more likely to have been victimized by a family member or acquaintance (86% vs. 79%), and significantly less likely to report the assault to the police (64% vs. 84%), compared with those who sought care within 24 hours. Adolescents who delayed care were significantly more likely to report alcohol or drug use before the assault, compared with adults who delayed seeking care (58% vs. 47%).

Overall, “the frequency of anogenital lacerations and abrasions decreased from 71% at less than 24 hours to 28% at greater than 96 hours,” the researchers wrote.

In both adolescents and adults, the frequency of documented anogenital injuries dropped by about 8% each day after the assault. But at the 72-hour mark, 50% of adolescents and 38% of adults had documented anogenital injuries. Adolescents had a greater frequency of genital injuries, compared with adults across all time periods.

The results suggest that anogenital injuries can still be documented in medicolegal examinations, even at 72 hours after the assault, the researchers said.

The researchers had no financial conflicts to disclose.

SAN FRANCISCO — Many women experience minor skin conditions such as pruritus, stretch marks, and melasma during pregnancy, but several serious skin diseases can emerge.

When it comes to treating skin conditions in pregnant women, it is important to remember that there is a great deal of variation in how these patients experience symptoms, Dr. Kristin M. Leiferman explained at a meeting sponsored by Skin Disease Education Foundation.

Many mothers-to-be will endure some degree of skin discomfort such as itching, rather than take medications, she said. “But pregnant women need to be monitored closely for secondary problems associated with skin disorders, including cutaneous infection, fluid balance problems, excessive blistering or erosion, and lack of sleep due to discomfort from itching.”

Dr. Kristin M. Leiferman of the University of Utah, Salt Lake City, reviewed several dermatoses of pregnancy, including:

▸ Polymorphic eruption of pregnancy/pruritic urticarial papules and plaques of pregnancy (PEP/PUPPP). The pathogenesis of PEP/PUPPP remains unknown but many theories persist, including those citing the role of hormones, fetal DNA, and placental factors, Dr. Leiferman said. The condition has a nonspecific inflammatory pattern, and there may be perivascular lymphocytic infiltration in the upper and middle dermis.

The differential diagnosis for PEP/PUPPP should start by ruling out scabies, Dr. Leiferman noted. Once scabies is ruled out, a dermatologist's differential should include pemphigoid gestationis, atopic eruption of pregnancy, contact dermatitis, drug eruption, erythema multiforme, and pityriasis rosea, she said.

▸ Pemphigoid gestationis. This condition is an autoimmune disorder that typically begins with urticaria or blistering around the umbilicus, Dr. Leiferman noted. Until or unless blistering occurs, this condition may be difficult to distinguish from PEP/PUPPP, she said, although PEP/PUPPP does not usually involve the area immediately around the umbilicus.

Pemphigoid gestationis may occur during or immediately after pregnancy, or it can occur with hormone use. The condition can present with urticarial, arch-shaped plaques in addition to dermatitis and blisters. The current evidence suggests that pemphigoid gestationis occurs when the protection of a fetus from the mother's immune response breaks down. When diagnosing pemphigoid gestationis, be sure to rule out varicella and pemphigus vulgaris, Dr. Leiferman emphasized.

▸ Cholestasis of pregnancy. This condition is characterized by a sudden onset of itching, first on the palms and soles, and then the itching becomes generalized. Cholestasis of pregnancy does not include primary skin lesions, but it can have serious effects for both mother and fetus. It may cause gallstones or jaundice in the mother, and increased levels of serum bile salts can enter the fetal circulation and cause a reduction in the level of oxygen in the placenta. The oxygen dip can lead to cardiac depression and increase the risk of prematurity, fetal distress, and stillbirth.

▸ Atopic eruption of pregnancy. This condition encompasses three previously recognized distinct skin conditions—prurigo of pregnancy, pruritic folliculitis of pregnancy, and eczema of pregnancy, Dr. Leiferman explained. Most patients have atopic dermatitis, from which the name derives. Studies suggest that approximately half of these patients have signs of eczema and approximately one-third have signs of papules and prurigo.

The histology of atopic eruption of pregnancy is nonspecific, and debate continues as to whether the condition should be considered a distinct dermatosis of pregnancy or an exacerbation of a skin disease with pregnancy, said Dr. Leiferman.

▸ Impetigo herpetiformis. Another disorder previously thought to be a dermatosis of pregnancy is impetigo herpetiformis, now generally regarded as a variant of pustular psoriasis, Dr. Leiferman stated. It rapidly resolves after delivery, but recurrences in subsequent pregnancies are common and are more severe with earlier onset. Neonatal death or stillbirth may result from placental insufficiency. Recurrences with menses can occur for years, she said.

With pregnancy-associated dermatoses, “treatment should be tailored to the symptoms and to the disease with the least amount [of] and least potentially toxic medications that will keep the mother comfortable and the baby safe,” Dr. Leiferman said in an interview.

“Certain pregnancy-associated dermatoses may respond to skin care that helps reduce itching, and to topical medications from which little is absorbed internally,” she explained. By contrast, when the skin is blistered or eroded, more aggressive treatments are needed.

Systemic glucocorticoids, such as prednisone, are the main therapy for pemphigoid gestationis and other severe pregnancy-related skin problems, said Dr. Leiferman. “Their use in pregnancy is well studied, and they generally are tolerated, but they may be associated with placental calcifications and low-birth-weight infants.”

SDEF and this news organization are owned by Elsevier.

SAN FRANCISCO — Many women experience minor skin conditions such as pruritus, stretch marks, and melasma during pregnancy, but several serious skin diseases can emerge.

When it comes to treating skin conditions in pregnant women, it is important to remember that there is a great deal of variation in how these patients experience symptoms, Dr. Kristin M. Leiferman explained at a meeting sponsored by Skin Disease Education Foundation.

Many mothers-to-be will endure some degree of skin discomfort such as itching, rather than take medications, she said. “But pregnant women need to be monitored closely for secondary problems associated with skin disorders, including cutaneous infection, fluid balance problems, excessive blistering or erosion, and lack of sleep due to discomfort from itching.”

Dr. Kristin M. Leiferman of the University of Utah, Salt Lake City, reviewed several dermatoses of pregnancy, including:

▸ Polymorphic eruption of pregnancy/pruritic urticarial papules and plaques of pregnancy (PEP/PUPPP). The pathogenesis of PEP/PUPPP remains unknown but many theories persist, including those citing the role of hormones, fetal DNA, and placental factors, Dr. Leiferman said. The condition has a nonspecific inflammatory pattern, and there may be perivascular lymphocytic infiltration in the upper and middle dermis.

The differential diagnosis for PEP/PUPPP should start by ruling out scabies, Dr. Leiferman noted. Once scabies is ruled out, a dermatologist's differential should include pemphigoid gestationis, atopic eruption of pregnancy, contact dermatitis, drug eruption, erythema multiforme, and pityriasis rosea, she said.

▸ Pemphigoid gestationis. This condition is an autoimmune disorder that typically begins with urticaria or blistering around the umbilicus, Dr. Leiferman noted. Until or unless blistering occurs, this condition may be difficult to distinguish from PEP/PUPPP, she said, although PEP/PUPPP does not usually involve the area immediately around the umbilicus.

Pemphigoid gestationis may occur during or immediately after pregnancy, or it can occur with hormone use. The condition can present with urticarial, arch-shaped plaques in addition to dermatitis and blisters. The current evidence suggests that pemphigoid gestationis occurs when the protection of a fetus from the mother's immune response breaks down. When diagnosing pemphigoid gestationis, be sure to rule out varicella and pemphigus vulgaris, Dr. Leiferman emphasized.

▸ Cholestasis of pregnancy. This condition is characterized by a sudden onset of itching, first on the palms and soles, and then the itching becomes generalized. Cholestasis of pregnancy does not include primary skin lesions, but it can have serious effects for both mother and fetus. It may cause gallstones or jaundice in the mother, and increased levels of serum bile salts can enter the fetal circulation and cause a reduction in the level of oxygen in the placenta. The oxygen dip can lead to cardiac depression and increase the risk of prematurity, fetal distress, and stillbirth.

▸ Atopic eruption of pregnancy. This condition encompasses three previously recognized distinct skin conditions—prurigo of pregnancy, pruritic folliculitis of pregnancy, and eczema of pregnancy, Dr. Leiferman explained. Most patients have atopic dermatitis, from which the name derives. Studies suggest that approximately half of these patients have signs of eczema and approximately one-third have signs of papules and prurigo.

The histology of atopic eruption of pregnancy is nonspecific, and debate continues as to whether the condition should be considered a distinct dermatosis of pregnancy or an exacerbation of a skin disease with pregnancy, said Dr. Leiferman.

▸ Impetigo herpetiformis. Another disorder previously thought to be a dermatosis of pregnancy is impetigo herpetiformis, now generally regarded as a variant of pustular psoriasis, Dr. Leiferman stated. It rapidly resolves after delivery, but recurrences in subsequent pregnancies are common and are more severe with earlier onset. Neonatal death or stillbirth may result from placental insufficiency. Recurrences with menses can occur for years, she said.

With pregnancy-associated dermatoses, “treatment should be tailored to the symptoms and to the disease with the least amount [of] and least potentially toxic medications that will keep the mother comfortable and the baby safe,” Dr. Leiferman said in an interview.

“Certain pregnancy-associated dermatoses may respond to skin care that helps reduce itching, and to topical medications from which little is absorbed internally,” she explained. By contrast, when the skin is blistered or eroded, more aggressive treatments are needed.

Systemic glucocorticoids, such as prednisone, are the main therapy for pemphigoid gestationis and other severe pregnancy-related skin problems, said Dr. Leiferman. “Their use in pregnancy is well studied, and they generally are tolerated, but they may be associated with placental calcifications and low-birth-weight infants.”

SDEF and this news organization are owned by Elsevier.

SAN FRANCISCO — Many women experience minor skin conditions such as pruritus, stretch marks, and melasma during pregnancy, but several serious skin diseases can emerge.

When it comes to treating skin conditions in pregnant women, it is important to remember that there is a great deal of variation in how these patients experience symptoms, Dr. Kristin M. Leiferman explained at a meeting sponsored by Skin Disease Education Foundation.

Many mothers-to-be will endure some degree of skin discomfort such as itching, rather than take medications, she said. “But pregnant women need to be monitored closely for secondary problems associated with skin disorders, including cutaneous infection, fluid balance problems, excessive blistering or erosion, and lack of sleep due to discomfort from itching.”

Dr. Kristin M. Leiferman of the University of Utah, Salt Lake City, reviewed several dermatoses of pregnancy, including:

▸ Polymorphic eruption of pregnancy/pruritic urticarial papules and plaques of pregnancy (PEP/PUPPP). The pathogenesis of PEP/PUPPP remains unknown but many theories persist, including those citing the role of hormones, fetal DNA, and placental factors, Dr. Leiferman said. The condition has a nonspecific inflammatory pattern, and there may be perivascular lymphocytic infiltration in the upper and middle dermis.

The differential diagnosis for PEP/PUPPP should start by ruling out scabies, Dr. Leiferman noted. Once scabies is ruled out, a dermatologist's differential should include pemphigoid gestationis, atopic eruption of pregnancy, contact dermatitis, drug eruption, erythema multiforme, and pityriasis rosea, she said.

▸ Pemphigoid gestationis. This condition is an autoimmune disorder that typically begins with urticaria or blistering around the umbilicus, Dr. Leiferman noted. Until or unless blistering occurs, this condition may be difficult to distinguish from PEP/PUPPP, she said, although PEP/PUPPP does not usually involve the area immediately around the umbilicus.

Pemphigoid gestationis may occur during or immediately after pregnancy, or it can occur with hormone use. The condition can present with urticarial, arch-shaped plaques in addition to dermatitis and blisters. The current evidence suggests that pemphigoid gestationis occurs when the protection of a fetus from the mother's immune response breaks down. When diagnosing pemphigoid gestationis, be sure to rule out varicella and pemphigus vulgaris, Dr. Leiferman emphasized.

▸ Cholestasis of pregnancy. This condition is characterized by a sudden onset of itching, first on the palms and soles, and then the itching becomes generalized. Cholestasis of pregnancy does not include primary skin lesions, but it can have serious effects for both mother and fetus. It may cause gallstones or jaundice in the mother, and increased levels of serum bile salts can enter the fetal circulation and cause a reduction in the level of oxygen in the placenta. The oxygen dip can lead to cardiac depression and increase the risk of prematurity, fetal distress, and stillbirth.

▸ Atopic eruption of pregnancy. This condition encompasses three previously recognized distinct skin conditions—prurigo of pregnancy, pruritic folliculitis of pregnancy, and eczema of pregnancy, Dr. Leiferman explained. Most patients have atopic dermatitis, from which the name derives. Studies suggest that approximately half of these patients have signs of eczema and approximately one-third have signs of papules and prurigo.

The histology of atopic eruption of pregnancy is nonspecific, and debate continues as to whether the condition should be considered a distinct dermatosis of pregnancy or an exacerbation of a skin disease with pregnancy, said Dr. Leiferman.

▸ Impetigo herpetiformis. Another disorder previously thought to be a dermatosis of pregnancy is impetigo herpetiformis, now generally regarded as a variant of pustular psoriasis, Dr. Leiferman stated. It rapidly resolves after delivery, but recurrences in subsequent pregnancies are common and are more severe with earlier onset. Neonatal death or stillbirth may result from placental insufficiency. Recurrences with menses can occur for years, she said.

With pregnancy-associated dermatoses, “treatment should be tailored to the symptoms and to the disease with the least amount [of] and least potentially toxic medications that will keep the mother comfortable and the baby safe,” Dr. Leiferman said in an interview.

“Certain pregnancy-associated dermatoses may respond to skin care that helps reduce itching, and to topical medications from which little is absorbed internally,” she explained. By contrast, when the skin is blistered or eroded, more aggressive treatments are needed.

Systemic glucocorticoids, such as prednisone, are the main therapy for pemphigoid gestationis and other severe pregnancy-related skin problems, said Dr. Leiferman. “Their use in pregnancy is well studied, and they generally are tolerated, but they may be associated with placental calcifications and low-birth-weight infants.”

SDEF and this news organization are owned by Elsevier.

WASHINGTON — Successful weight loss for patients who undergo gastric banding is significantly associated with the number of follow-up visits to a surgeon's office during the first year after the procedure, according to a study involving 113 adults who had gastric banding surgery between 2005 and 2007.

Gastric band surgery can be a safe and effective strategy for weight loss, but studies have shown that the percentage of excess weight lost after the procedure ranges from −8.5% to 79% after 1 year, said Dr. Julio Teixeira of St. Luke's Roosevelt Hospital in New York.

To identify predictors of weight loss 1 year after gastric band surgery, researchers reviewed baseline demographics, body mass index, comorbidities, number of office visits, and gastric band adjustments for up to 15 months after the procedure. The single-center findings were presented in a poster at the annual meeting of the Obesity Society.

The patients ranged in age from 22 to 71 years, with an average age of 41 years. The patients' body mass indexes ranged from 36 kg/m

After 1 year, the average total weight loss was 16 kg, and the percentage of weight lost was 24%. Participants had an average of six follow-up visits to a surgeon's office during the first year after the procedure. There was a significant correlation between the number of follow-up visits and both the amount of weight lost and the percentage of excess weight lost.

The number of adjustments to the band during the first year was not predictive of weight loss, according to the researchers. Patient age also had no apparent effect on weight loss, nor did comorbidities including type 2 diabetes, hypertension, obstructive sleep apnea, and asthma.

“Prospective trials are needed to define strategies to improve weight loss outcomes after gastric banding,” the investigators concluded.

Dr. Teixeira has served as an adviser to Allergan, which manufactures an adjustable gastric banding system.

WASHINGTON — Successful weight loss for patients who undergo gastric banding is significantly associated with the number of follow-up visits to a surgeon's office during the first year after the procedure, according to a study involving 113 adults who had gastric banding surgery between 2005 and 2007.

Gastric band surgery can be a safe and effective strategy for weight loss, but studies have shown that the percentage of excess weight lost after the procedure ranges from −8.5% to 79% after 1 year, said Dr. Julio Teixeira of St. Luke's Roosevelt Hospital in New York.

To identify predictors of weight loss 1 year after gastric band surgery, researchers reviewed baseline demographics, body mass index, comorbidities, number of office visits, and gastric band adjustments for up to 15 months after the procedure. The single-center findings were presented in a poster at the annual meeting of the Obesity Society.

The patients ranged in age from 22 to 71 years, with an average age of 41 years. The patients' body mass indexes ranged from 36 kg/m

After 1 year, the average total weight loss was 16 kg, and the percentage of weight lost was 24%. Participants had an average of six follow-up visits to a surgeon's office during the first year after the procedure. There was a significant correlation between the number of follow-up visits and both the amount of weight lost and the percentage of excess weight lost.

The number of adjustments to the band during the first year was not predictive of weight loss, according to the researchers. Patient age also had no apparent effect on weight loss, nor did comorbidities including type 2 diabetes, hypertension, obstructive sleep apnea, and asthma.

“Prospective trials are needed to define strategies to improve weight loss outcomes after gastric banding,” the investigators concluded.

Dr. Teixeira has served as an adviser to Allergan, which manufactures an adjustable gastric banding system.

WASHINGTON — Successful weight loss for patients who undergo gastric banding is significantly associated with the number of follow-up visits to a surgeon's office during the first year after the procedure, according to a study involving 113 adults who had gastric banding surgery between 2005 and 2007.

Gastric band surgery can be a safe and effective strategy for weight loss, but studies have shown that the percentage of excess weight lost after the procedure ranges from −8.5% to 79% after 1 year, said Dr. Julio Teixeira of St. Luke's Roosevelt Hospital in New York.

To identify predictors of weight loss 1 year after gastric band surgery, researchers reviewed baseline demographics, body mass index, comorbidities, number of office visits, and gastric band adjustments for up to 15 months after the procedure. The single-center findings were presented in a poster at the annual meeting of the Obesity Society.

The patients ranged in age from 22 to 71 years, with an average age of 41 years. The patients' body mass indexes ranged from 36 kg/m

After 1 year, the average total weight loss was 16 kg, and the percentage of weight lost was 24%. Participants had an average of six follow-up visits to a surgeon's office during the first year after the procedure. There was a significant correlation between the number of follow-up visits and both the amount of weight lost and the percentage of excess weight lost.

The number of adjustments to the band during the first year was not predictive of weight loss, according to the researchers. Patient age also had no apparent effect on weight loss, nor did comorbidities including type 2 diabetes, hypertension, obstructive sleep apnea, and asthma.

“Prospective trials are needed to define strategies to improve weight loss outcomes after gastric banding,” the investigators concluded.

Dr. Teixeira has served as an adviser to Allergan, which manufactures an adjustable gastric banding system.

WASHINGTON — The 2008 seasonal flu vaccine showed an overall vaccine effectiveness of 45% against infection with the pandemic influenza A(H1N1) virus in a study of military personnel conducted between April and October 2009, according to findings presented at the annual meeting of the American Society of Tropical Medicine and Hygiene.

This rate of vaccine effectiveness means that those vaccinated have a 45% lower chance of developing an infection, Dr. Jose Sanchez of the Armed Forces Health Surveillance Center in Silver Spring, Md., said in an interview. The confidence interval for the overall 45% seasonal vaccine effectiveness rate was 33%-55%.

Surprisingly, the greatest effectiveness was seen among individuals aged 17-24 years and in those aged 40 years and older, Dr. Sanchez said. Dr. Sanchez and colleagues conducted a case-control study of flu-related medical visits by active duty members of the U.S. military, compared with a control group of military individuals who presented with acute, nonrespiratory illness.

The study included 1,205 cases of H1N1 influenza and approximately four controls for each case.

Overall, 58% of the H1N1 cases occurred in individuals younger than age 25 years. After controlling for age, gender, and previous vaccination status, the seasonal flu vaccine effectiveness was 50% among those younger than 25 years, and 55% in those older than 39 years, Dr. Sanchez said. But there was no noticeable vaccine effectiveness among individuals aged 25-29 years (−6%) and an insignificant effect among those aged 30-39 years (9%).

In this military population, the live attenuated influenza vaccine (LAIV) and the trivalent inactivated vaccine (TIV) showed vaccine effectiveness of 22% and 35%, respectively. The effects of both types were significant, although the effectiveness of the LAIV just reached significance, Dr. Sanchez noted.

A total of 78 of the 1,205 H1N1 patients (6.5%) required hospitalization. The seasonal flu vaccination appeared to offer more protection against severe H1N1 disease, Dr. Sanchez said. The effectiveness of the seasonal flu vaccination was 62% among hospitalized patients, compared with 42% among outpatients.

Dr. Sanchez cited four previous studies of the impact of seasonal flu vaccine on H1N1 infection. Data from two studies suggested a protective effect, while data from two others, including a study from the Centers for Disease Control and Prevention, did not. “The increasing momentum of the H1N1 pandemic underscores the need for vaccination, yet there is a wide variance in vaccine effectiveness depending on the strain-match for a particular season,” Dr. Sanchez said in a statement.

The U.S. military is a highly immunized population, and the results may not be applicable to civilian populations, Dr. Sanchez said.

In addition, he suggested that a combination of natural influenza infections and prior influenza immunizations may contribute to “immunological priming” and create a cross-protective effect in active-duty military settings.

But he emphasized the importance of seasonal flu vaccination, even with the flood of attention being given to the H1N1 influenza virus. In an interview, he encouraged physicians not to forget about the seasonal flu vaccine, and to remind their patients to get vaccinated.

The military is in a unique position to monitor vaccine effectiveness in young and middle-aged adults, including groups of at-risk individuals that can be studied in randomized clinical trials, and data collection is ongoing, said Dr. Sanchez.

The results may help guide both seasonal and H1N1 vaccination in the military and Department of Defense dependents, he added.

Dr. Sanchez had no financial conflicts to disclose.

WASHINGTON — The 2008 seasonal flu vaccine showed an overall vaccine effectiveness of 45% against infection with the pandemic influenza A(H1N1) virus in a study of military personnel conducted between April and October 2009, according to findings presented at the annual meeting of the American Society of Tropical Medicine and Hygiene.

This rate of vaccine effectiveness means that those vaccinated have a 45% lower chance of developing an infection, Dr. Jose Sanchez of the Armed Forces Health Surveillance Center in Silver Spring, Md., said in an interview. The confidence interval for the overall 45% seasonal vaccine effectiveness rate was 33%-55%.

Surprisingly, the greatest effectiveness was seen among individuals aged 17-24 years and in those aged 40 years and older, Dr. Sanchez said. Dr. Sanchez and colleagues conducted a case-control study of flu-related medical visits by active duty members of the U.S. military, compared with a control group of military individuals who presented with acute, nonrespiratory illness.

The study included 1,205 cases of H1N1 influenza and approximately four controls for each case.

Overall, 58% of the H1N1 cases occurred in individuals younger than age 25 years. After controlling for age, gender, and previous vaccination status, the seasonal flu vaccine effectiveness was 50% among those younger than 25 years, and 55% in those older than 39 years, Dr. Sanchez said. But there was no noticeable vaccine effectiveness among individuals aged 25-29 years (−6%) and an insignificant effect among those aged 30-39 years (9%).

In this military population, the live attenuated influenza vaccine (LAIV) and the trivalent inactivated vaccine (TIV) showed vaccine effectiveness of 22% and 35%, respectively. The effects of both types were significant, although the effectiveness of the LAIV just reached significance, Dr. Sanchez noted.

A total of 78 of the 1,205 H1N1 patients (6.5%) required hospitalization. The seasonal flu vaccination appeared to offer more protection against severe H1N1 disease, Dr. Sanchez said. The effectiveness of the seasonal flu vaccination was 62% among hospitalized patients, compared with 42% among outpatients.

Dr. Sanchez cited four previous studies of the impact of seasonal flu vaccine on H1N1 infection. Data from two studies suggested a protective effect, while data from two others, including a study from the Centers for Disease Control and Prevention, did not. “The increasing momentum of the H1N1 pandemic underscores the need for vaccination, yet there is a wide variance in vaccine effectiveness depending on the strain-match for a particular season,” Dr. Sanchez said in a statement.

The U.S. military is a highly immunized population, and the results may not be applicable to civilian populations, Dr. Sanchez said.

In addition, he suggested that a combination of natural influenza infections and prior influenza immunizations may contribute to “immunological priming” and create a cross-protective effect in active-duty military settings.

But he emphasized the importance of seasonal flu vaccination, even with the flood of attention being given to the H1N1 influenza virus. In an interview, he encouraged physicians not to forget about the seasonal flu vaccine, and to remind their patients to get vaccinated.

The military is in a unique position to monitor vaccine effectiveness in young and middle-aged adults, including groups of at-risk individuals that can be studied in randomized clinical trials, and data collection is ongoing, said Dr. Sanchez.

The results may help guide both seasonal and H1N1 vaccination in the military and Department of Defense dependents, he added.

Dr. Sanchez had no financial conflicts to disclose.

WASHINGTON — The 2008 seasonal flu vaccine showed an overall vaccine effectiveness of 45% against infection with the pandemic influenza A(H1N1) virus in a study of military personnel conducted between April and October 2009, according to findings presented at the annual meeting of the American Society of Tropical Medicine and Hygiene.

This rate of vaccine effectiveness means that those vaccinated have a 45% lower chance of developing an infection, Dr. Jose Sanchez of the Armed Forces Health Surveillance Center in Silver Spring, Md., said in an interview. The confidence interval for the overall 45% seasonal vaccine effectiveness rate was 33%-55%.

Surprisingly, the greatest effectiveness was seen among individuals aged 17-24 years and in those aged 40 years and older, Dr. Sanchez said. Dr. Sanchez and colleagues conducted a case-control study of flu-related medical visits by active duty members of the U.S. military, compared with a control group of military individuals who presented with acute, nonrespiratory illness.

The study included 1,205 cases of H1N1 influenza and approximately four controls for each case.

Overall, 58% of the H1N1 cases occurred in individuals younger than age 25 years. After controlling for age, gender, and previous vaccination status, the seasonal flu vaccine effectiveness was 50% among those younger than 25 years, and 55% in those older than 39 years, Dr. Sanchez said. But there was no noticeable vaccine effectiveness among individuals aged 25-29 years (−6%) and an insignificant effect among those aged 30-39 years (9%).

In this military population, the live attenuated influenza vaccine (LAIV) and the trivalent inactivated vaccine (TIV) showed vaccine effectiveness of 22% and 35%, respectively. The effects of both types were significant, although the effectiveness of the LAIV just reached significance, Dr. Sanchez noted.

A total of 78 of the 1,205 H1N1 patients (6.5%) required hospitalization. The seasonal flu vaccination appeared to offer more protection against severe H1N1 disease, Dr. Sanchez said. The effectiveness of the seasonal flu vaccination was 62% among hospitalized patients, compared with 42% among outpatients.

Dr. Sanchez cited four previous studies of the impact of seasonal flu vaccine on H1N1 infection. Data from two studies suggested a protective effect, while data from two others, including a study from the Centers for Disease Control and Prevention, did not. “The increasing momentum of the H1N1 pandemic underscores the need for vaccination, yet there is a wide variance in vaccine effectiveness depending on the strain-match for a particular season,” Dr. Sanchez said in a statement.

The U.S. military is a highly immunized population, and the results may not be applicable to civilian populations, Dr. Sanchez said.

In addition, he suggested that a combination of natural influenza infections and prior influenza immunizations may contribute to “immunological priming” and create a cross-protective effect in active-duty military settings.

But he emphasized the importance of seasonal flu vaccination, even with the flood of attention being given to the H1N1 influenza virus. In an interview, he encouraged physicians not to forget about the seasonal flu vaccine, and to remind their patients to get vaccinated.

The military is in a unique position to monitor vaccine effectiveness in young and middle-aged adults, including groups of at-risk individuals that can be studied in randomized clinical trials, and data collection is ongoing, said Dr. Sanchez.

The results may help guide both seasonal and H1N1 vaccination in the military and Department of Defense dependents, he added.

Dr. Sanchez had no financial conflicts to disclose.

WASHINGTON — Large breast size may not predict increased risk of type 2 diabetes, based on data from 92 overweight or obese premenopausal women.

Instead, “the previously documented association between breast size and type 2 diabetes risk may be explained by excess visceral adipose tissue and/or intermuscular adipose tissue,” Peter Janiszewski, a PhD candidate at Queen's University in Kingston, Ont., said in a poster presented at the annual meeting of the Obesity Society.

The researchers reviewed full-body MRI data for overweight or obese women whose average age was 40 years. They were assessed for breast volume, visceral adipose tissue (VAT), abdominal and lower-body subcutaneous adipose tissue, and intermuscular adipose tissue (IMAT).

Breast volume was not significantly associated with any of the cardiometabolic risk factors assessed in the study. Instead, visceral adipose tissue was associated with high levels of glucose and insulin on a 2-hour oral glucose tolerance test, Mr. Janiszewski said.

After controlling for age, body mass index, and waist circumference, breast volume remained significantly associated with greater amounts of visceral adipose tissue and intermuscular adipose tissue. Overall, women with the greatest breast volume had approximately 1.1 kg more VAT and 1.3 kg more IMAT, compared with women with the smallest breasts. But abdominal and lower-body subcutaneous adipose tissue mass was not significantly different between women with the largest and smaller breast volumes.

The researchers had no financial conflicts to disclose.

WASHINGTON — Large breast size may not predict increased risk of type 2 diabetes, based on data from 92 overweight or obese premenopausal women.

Instead, “the previously documented association between breast size and type 2 diabetes risk may be explained by excess visceral adipose tissue and/or intermuscular adipose tissue,” Peter Janiszewski, a PhD candidate at Queen's University in Kingston, Ont., said in a poster presented at the annual meeting of the Obesity Society.

The researchers reviewed full-body MRI data for overweight or obese women whose average age was 40 years. They were assessed for breast volume, visceral adipose tissue (VAT), abdominal and lower-body subcutaneous adipose tissue, and intermuscular adipose tissue (IMAT).

Breast volume was not significantly associated with any of the cardiometabolic risk factors assessed in the study. Instead, visceral adipose tissue was associated with high levels of glucose and insulin on a 2-hour oral glucose tolerance test, Mr. Janiszewski said.

After controlling for age, body mass index, and waist circumference, breast volume remained significantly associated with greater amounts of visceral adipose tissue and intermuscular adipose tissue. Overall, women with the greatest breast volume had approximately 1.1 kg more VAT and 1.3 kg more IMAT, compared with women with the smallest breasts. But abdominal and lower-body subcutaneous adipose tissue mass was not significantly different between women with the largest and smaller breast volumes.

The researchers had no financial conflicts to disclose.

WASHINGTON — Large breast size may not predict increased risk of type 2 diabetes, based on data from 92 overweight or obese premenopausal women.

Instead, “the previously documented association between breast size and type 2 diabetes risk may be explained by excess visceral adipose tissue and/or intermuscular adipose tissue,” Peter Janiszewski, a PhD candidate at Queen's University in Kingston, Ont., said in a poster presented at the annual meeting of the Obesity Society.

The researchers reviewed full-body MRI data for overweight or obese women whose average age was 40 years. They were assessed for breast volume, visceral adipose tissue (VAT), abdominal and lower-body subcutaneous adipose tissue, and intermuscular adipose tissue (IMAT).

Breast volume was not significantly associated with any of the cardiometabolic risk factors assessed in the study. Instead, visceral adipose tissue was associated with high levels of glucose and insulin on a 2-hour oral glucose tolerance test, Mr. Janiszewski said.

After controlling for age, body mass index, and waist circumference, breast volume remained significantly associated with greater amounts of visceral adipose tissue and intermuscular adipose tissue. Overall, women with the greatest breast volume had approximately 1.1 kg more VAT and 1.3 kg more IMAT, compared with women with the smallest breasts. But abdominal and lower-body subcutaneous adipose tissue mass was not significantly different between women with the largest and smaller breast volumes.

The researchers had no financial conflicts to disclose.

WASHINGTON — The 2008 seasonal flu vaccine showed an overall vaccine effectiveness of 45% against infection with the pandemic influenza A(H1N1) virus in a study of military personnel conducted between April and October 2009, according to findings presented at the annual meeting of the American Society of Tropical Medicine and Hygiene.

This rate of vaccine effectiveness means that those vaccinated have a 45% lower chance of developing an infection, Dr. Jose Sanchez of the Armed Forces Health Surveillance Center in Silver Spring, Md., said in an interview. The confidence interval for the overall 45% seasonal vaccine effectiveness rate was 33%-55%.

Surprisingly, the greatest effectiveness was seen among individuals aged 17-24 years and in those aged 40 years and older, Dr. Sanchez said. Dr. Sanchez and colleagues conducted a case-control study of flu-related medical visits by active duty members of the U.S. military, compared with a control group of military individuals who presented with acute, nonrespiratory illness.

The study included 1,205 cases of H1N1 influenza and approximately four controls for each case.

Overall, 58% of the H1N1 cases occurred in individuals younger than age 25 years. After controlling for age, gender, and previous vaccination status, the seasonal flu vaccine effectiveness was 50% among those younger than 25 years, and 55% in those older than 39 years, Dr. Sanchez said. But there was no noticeable vaccine effectiveness among individuals aged 25-29 years (−6%) and an insignificant effect among those aged 30-39 years (9%).

In this military population, the live attenuated influenza vaccine (LAIV) and the trivalent inactivated vaccine (TIV) showed effectiveness of 22% and 35%, respectively. The effects of both types were significant, although the effectiveness of the LAIV just reached significance, Dr. Sanchez noted.

A total of 78 of the 1,205 H1N1 patients (6.5%) required hospitalization. The seasonal flu vaccination appeared to offer more protection against severe H1N1 disease, Dr. Sanchez said. The effectiveness of the seasonal flu vaccination was 62% among hospitalized patients, compared with 42% among outpatients.

Dr. Sanchez cited four previous studies of the impact of seasonal flu vaccine on H1N1 infection. Data from two studies suggested a protective effect, while data from two others, including a study from the Centers for Disease Control and Prevention, did not. “The increasing momentum of the H1N1 pandemic underscores the need for vaccination, yet there is a wide variance in vaccine effectiveness depending on the strain-match for a particular season,” Dr. Sanchez said in a statement.

The U.S. military is a highly immunized population, and the results may not be applicable to civilian populations, Dr. Sanchez said. In addition, he suggested that a combination of natural influenza infections and prior influenza immunizations may contribute to “immunological priming” and create a cross-protective effect in active-duty military settings.

But he emphasized the importance of seasonal flu vaccination, even with the flood of attention being given to the H1N1 influenza virus. In an interview, he encouraged physicians not to forget about the seasonal flu vaccine, and to remind their patients to get vaccinated.

The military is in a unique position to monitor vaccine effectiveness in young and middle-aged adults, including groups of at-risk individuals that can be studied in randomized clinical trials, and data collection is ongoing, Dr. Sanchez said.

Dr. Sanchez had no financial conflicts to disclose.

WASHINGTON — The 2008 seasonal flu vaccine showed an overall vaccine effectiveness of 45% against infection with the pandemic influenza A(H1N1) virus in a study of military personnel conducted between April and October 2009, according to findings presented at the annual meeting of the American Society of Tropical Medicine and Hygiene.

This rate of vaccine effectiveness means that those vaccinated have a 45% lower chance of developing an infection, Dr. Jose Sanchez of the Armed Forces Health Surveillance Center in Silver Spring, Md., said in an interview. The confidence interval for the overall 45% seasonal vaccine effectiveness rate was 33%-55%.

Surprisingly, the greatest effectiveness was seen among individuals aged 17-24 years and in those aged 40 years and older, Dr. Sanchez said. Dr. Sanchez and colleagues conducted a case-control study of flu-related medical visits by active duty members of the U.S. military, compared with a control group of military individuals who presented with acute, nonrespiratory illness.

The study included 1,205 cases of H1N1 influenza and approximately four controls for each case.

Overall, 58% of the H1N1 cases occurred in individuals younger than age 25 years. After controlling for age, gender, and previous vaccination status, the seasonal flu vaccine effectiveness was 50% among those younger than 25 years, and 55% in those older than 39 years, Dr. Sanchez said. But there was no noticeable vaccine effectiveness among individuals aged 25-29 years (−6%) and an insignificant effect among those aged 30-39 years (9%).

In this military population, the live attenuated influenza vaccine (LAIV) and the trivalent inactivated vaccine (TIV) showed effectiveness of 22% and 35%, respectively. The effects of both types were significant, although the effectiveness of the LAIV just reached significance, Dr. Sanchez noted.

A total of 78 of the 1,205 H1N1 patients (6.5%) required hospitalization. The seasonal flu vaccination appeared to offer more protection against severe H1N1 disease, Dr. Sanchez said. The effectiveness of the seasonal flu vaccination was 62% among hospitalized patients, compared with 42% among outpatients.

Dr. Sanchez cited four previous studies of the impact of seasonal flu vaccine on H1N1 infection. Data from two studies suggested a protective effect, while data from two others, including a study from the Centers for Disease Control and Prevention, did not. “The increasing momentum of the H1N1 pandemic underscores the need for vaccination, yet there is a wide variance in vaccine effectiveness depending on the strain-match for a particular season,” Dr. Sanchez said in a statement.

The U.S. military is a highly immunized population, and the results may not be applicable to civilian populations, Dr. Sanchez said. In addition, he suggested that a combination of natural influenza infections and prior influenza immunizations may contribute to “immunological priming” and create a cross-protective effect in active-duty military settings.

But he emphasized the importance of seasonal flu vaccination, even with the flood of attention being given to the H1N1 influenza virus. In an interview, he encouraged physicians not to forget about the seasonal flu vaccine, and to remind their patients to get vaccinated.

The military is in a unique position to monitor vaccine effectiveness in young and middle-aged adults, including groups of at-risk individuals that can be studied in randomized clinical trials, and data collection is ongoing, Dr. Sanchez said.

Dr. Sanchez had no financial conflicts to disclose.

WASHINGTON — The 2008 seasonal flu vaccine showed an overall vaccine effectiveness of 45% against infection with the pandemic influenza A(H1N1) virus in a study of military personnel conducted between April and October 2009, according to findings presented at the annual meeting of the American Society of Tropical Medicine and Hygiene.

This rate of vaccine effectiveness means that those vaccinated have a 45% lower chance of developing an infection, Dr. Jose Sanchez of the Armed Forces Health Surveillance Center in Silver Spring, Md., said in an interview. The confidence interval for the overall 45% seasonal vaccine effectiveness rate was 33%-55%.

Surprisingly, the greatest effectiveness was seen among individuals aged 17-24 years and in those aged 40 years and older, Dr. Sanchez said. Dr. Sanchez and colleagues conducted a case-control study of flu-related medical visits by active duty members of the U.S. military, compared with a control group of military individuals who presented with acute, nonrespiratory illness.

The study included 1,205 cases of H1N1 influenza and approximately four controls for each case.

Overall, 58% of the H1N1 cases occurred in individuals younger than age 25 years. After controlling for age, gender, and previous vaccination status, the seasonal flu vaccine effectiveness was 50% among those younger than 25 years, and 55% in those older than 39 years, Dr. Sanchez said. But there was no noticeable vaccine effectiveness among individuals aged 25-29 years (−6%) and an insignificant effect among those aged 30-39 years (9%).

In this military population, the live attenuated influenza vaccine (LAIV) and the trivalent inactivated vaccine (TIV) showed effectiveness of 22% and 35%, respectively. The effects of both types were significant, although the effectiveness of the LAIV just reached significance, Dr. Sanchez noted.

A total of 78 of the 1,205 H1N1 patients (6.5%) required hospitalization. The seasonal flu vaccination appeared to offer more protection against severe H1N1 disease, Dr. Sanchez said. The effectiveness of the seasonal flu vaccination was 62% among hospitalized patients, compared with 42% among outpatients.

Dr. Sanchez cited four previous studies of the impact of seasonal flu vaccine on H1N1 infection. Data from two studies suggested a protective effect, while data from two others, including a study from the Centers for Disease Control and Prevention, did not. “The increasing momentum of the H1N1 pandemic underscores the need for vaccination, yet there is a wide variance in vaccine effectiveness depending on the strain-match for a particular season,” Dr. Sanchez said in a statement.

The U.S. military is a highly immunized population, and the results may not be applicable to civilian populations, Dr. Sanchez said. In addition, he suggested that a combination of natural influenza infections and prior influenza immunizations may contribute to “immunological priming” and create a cross-protective effect in active-duty military settings.

But he emphasized the importance of seasonal flu vaccination, even with the flood of attention being given to the H1N1 influenza virus. In an interview, he encouraged physicians not to forget about the seasonal flu vaccine, and to remind their patients to get vaccinated.

The military is in a unique position to monitor vaccine effectiveness in young and middle-aged adults, including groups of at-risk individuals that can be studied in randomized clinical trials, and data collection is ongoing, Dr. Sanchez said.

Dr. Sanchez had no financial conflicts to disclose.

The Food and Drug Administration encourages health care providers to watch for and report any adverse events associated with vaccination against the pandemic influenza A(H1N1) virus, FDA commissioner Dr. Margaret A. Hamburg said in an open, online letter to American health care professional.

“The benefits of preventing serious consequences from infection with the 2009 H1N1 influenza virus far outweigh the risks associated with vaccination,” Dr. Hamburg said. She emphasized that no shortcuts were taken during production of the vaccine, and that the vaccines are released for distribution only when they are deemed sterile and potent by both the vaccine manufacturer and the FDA.

Dr. Hamburg reviewed the egg-based process for vaccine manufacture and the process of measuring the amount of vaccine antigen, both of which impact the number of vaccine doses available at a given time. As of Nov. 10, more than 41 million doses of the H1N1 vaccine had been allocated for distribution throughout the United States, she said.

Dr. Hamburg also emphasized the safety and effectiveness of the vaccine, shown in early clinical trials, and she encouraged physicians to share information about vaccine production, distribution, and safety with their patients.

The letter can be accessed online at www.fda.gov/NewsEvents/PublicHealthFocus/ucm189691.htmhttp://vaers.hhs.gov/index

The Food and Drug Administration encourages health care providers to watch for and report any adverse events associated with vaccination against the pandemic influenza A(H1N1) virus, FDA commissioner Dr. Margaret A. Hamburg said in an open, online letter to American health care professional.

“The benefits of preventing serious consequences from infection with the 2009 H1N1 influenza virus far outweigh the risks associated with vaccination,” Dr. Hamburg said. She emphasized that no shortcuts were taken during production of the vaccine, and that the vaccines are released for distribution only when they are deemed sterile and potent by both the vaccine manufacturer and the FDA.

Dr. Hamburg reviewed the egg-based process for vaccine manufacture and the process of measuring the amount of vaccine antigen, both of which impact the number of vaccine doses available at a given time. As of Nov. 10, more than 41 million doses of the H1N1 vaccine had been allocated for distribution throughout the United States, she said.

Dr. Hamburg also emphasized the safety and effectiveness of the vaccine, shown in early clinical trials, and she encouraged physicians to share information about vaccine production, distribution, and safety with their patients.

The letter can be accessed online at www.fda.gov/NewsEvents/PublicHealthFocus/ucm189691.htmhttp://vaers.hhs.gov/index

The Food and Drug Administration encourages health care providers to watch for and report any adverse events associated with vaccination against the pandemic influenza A(H1N1) virus, FDA commissioner Dr. Margaret A. Hamburg said in an open, online letter to American health care professional.

“The benefits of preventing serious consequences from infection with the 2009 H1N1 influenza virus far outweigh the risks associated with vaccination,” Dr. Hamburg said. She emphasized that no shortcuts were taken during production of the vaccine, and that the vaccines are released for distribution only when they are deemed sterile and potent by both the vaccine manufacturer and the FDA.

Dr. Hamburg reviewed the egg-based process for vaccine manufacture and the process of measuring the amount of vaccine antigen, both of which impact the number of vaccine doses available at a given time. As of Nov. 10, more than 41 million doses of the H1N1 vaccine had been allocated for distribution throughout the United States, she said.

Dr. Hamburg also emphasized the safety and effectiveness of the vaccine, shown in early clinical trials, and she encouraged physicians to share information about vaccine production, distribution, and safety with their patients.

The letter can be accessed online at www.fda.gov/NewsEvents/PublicHealthFocus/ucm189691.htmhttp://vaers.hhs.gov/index

The response to the pandemic influenza A(H1N1) virus by the governments and public health officials of Mexico City and New York City in the spring of 2009 reveals successful strategies, but also points to issues that need to be addressed, according to a report from the Centers for Disease Control and Prevention.

“In each case, advance planning laid the foundation for enhanced surveillance and a generally effective response, made possible by an extensive public communications campaign and effective political leadership,” wrote Dr. David M. Bell of the CDC, and his associates.

The researchers summarized the responses of Mexico City and New York City to the H1N1 virus in spring 2009 (Emerg. Infect. Dis. 2009 [doi: 10.3201/eid1512.091232]).

“These megacities may not be representative of cities in low-income countries, which face more daunting problems,” the researchers noted.

After the novel H1N1 virus was identified on April 23, 2009, Mexico City followed a pandemic influenza preparedness plan that had been developed for any virus that originated outside Mexico. Efforts to decrease the spread of the virus included an intense media campaign encouraging people to stay home if they were sick and to avoid close contact such as hugging or kissing in greeting.

“Early in the epidemic, the federal government released antiviral drugs from the national strategic reserve and controlled their distribution,” Dr. Bell and his colleagues wrote.

The government successfully introduced a mass media campaign that addressed Mexico City's diverse population and range of literacy rates. In addition, it mobilized private businesses, such as grocery stories and pharmacies, to deliver health messages. The Ministry of Health also used text messages and e-mails to convey public health messages.

The closure of thousands of businesses in Mexico City and throughout Mexico is estimated to have cost the country more than $2.3 billion, and large gatherings such as sporting events were canceled or postponed, the researchers said.

Despite these costs, the researchers concluded that Mexico City's preparations paid off. “The preexisting pandemic plan and planning process facilitated collaboration, decision making, and rapid development of a communications campaign,” they said. But the emergency of the pandemic illustrated several areas in need of improvement, including a limited capacity of laboratories to handle tests and a lack of criteria for reopening schools that closed because of the outbreak.

In New York City, 77% of emergency departments collect electronic information from more than 90% of patient visits. “During spring 2009, these systems were essential for real-time monitoring of the pandemic in NYC,” allowing public health officials to track the spread of the virus through the city, the investigators emphasized.

The New York City government kept the public informed during the spring 2009 H1N1 outbreak with press conferences in both English and Spanish, and a government information hotline staffed with live operators answered 98% of calls within 30 seconds, the researchers said. About 50 schools in New York City closed for approximately 1 week.

Unlike Mexico City, New York City did not distribute antiviral drugs from the emergency stockpile because “normal distribution channels sufficed,” Dr. Bell and his associates said, but emergency plans called for the distribution of antivirals from the stockpile via hospitals, public clinics, and community health centers if necessary.

Decision making based on flu severity in New York City proved challenging, given that the case-fatality ratio was unknown. Other challenges included deciding when and whether to close and reopen schools and how to keep children from gathering in groups elsewhere when schools were closed.

In response to the surge in emergency department visits from individuals with flulike symptoms, New York City hospitals were able to plan for additional care sites to handle the expected surge in cases of influenza-like illness in the fall and winter of 2009, the researchers said.

Overall, they concluded that the early responses of Mexico City and New York City to the H1N1 virus outbreak were promising.

The problems that did occur would likely have been worse if the disease had been more severe or if schools and businesses had remained closed for longer periods, they wrote. More research is needed to continue to identify best practices for pandemic situations in cities.

Advance planning led to a generally effective response to H1N1 outbreaks.

Source ©CDC

The response to the pandemic influenza A(H1N1) virus by the governments and public health officials of Mexico City and New York City in the spring of 2009 reveals successful strategies, but also points to issues that need to be addressed, according to a report from the Centers for Disease Control and Prevention.

“In each case, advance planning laid the foundation for enhanced surveillance and a generally effective response, made possible by an extensive public communications campaign and effective political leadership,” wrote Dr. David M. Bell of the CDC, and his associates.

The researchers summarized the responses of Mexico City and New York City to the H1N1 virus in spring 2009 (Emerg. Infect. Dis. 2009 [doi: 10.3201/eid1512.091232]).

“These megacities may not be representative of cities in low-income countries, which face more daunting problems,” the researchers noted.

After the novel H1N1 virus was identified on April 23, 2009, Mexico City followed a pandemic influenza preparedness plan that had been developed for any virus that originated outside Mexico. Efforts to decrease the spread of the virus included an intense media campaign encouraging people to stay home if they were sick and to avoid close contact such as hugging or kissing in greeting.

“Early in the epidemic, the federal government released antiviral drugs from the national strategic reserve and controlled their distribution,” Dr. Bell and his colleagues wrote.

The government successfully introduced a mass media campaign that addressed Mexico City's diverse population and range of literacy rates. In addition, it mobilized private businesses, such as grocery stories and pharmacies, to deliver health messages. The Ministry of Health also used text messages and e-mails to convey public health messages.

The closure of thousands of businesses in Mexico City and throughout Mexico is estimated to have cost the country more than $2.3 billion, and large gatherings such as sporting events were canceled or postponed, the researchers said.

Despite these costs, the researchers concluded that Mexico City's preparations paid off. “The preexisting pandemic plan and planning process facilitated collaboration, decision making, and rapid development of a communications campaign,” they said. But the emergency of the pandemic illustrated several areas in need of improvement, including a limited capacity of laboratories to handle tests and a lack of criteria for reopening schools that closed because of the outbreak.

In New York City, 77% of emergency departments collect electronic information from more than 90% of patient visits. “During spring 2009, these systems were essential for real-time monitoring of the pandemic in NYC,” allowing public health officials to track the spread of the virus through the city, the investigators emphasized.

The New York City government kept the public informed during the spring 2009 H1N1 outbreak with press conferences in both English and Spanish, and a government information hotline staffed with live operators answered 98% of calls within 30 seconds, the researchers said. About 50 schools in New York City closed for approximately 1 week.

Unlike Mexico City, New York City did not distribute antiviral drugs from the emergency stockpile because “normal distribution channels sufficed,” Dr. Bell and his associates said, but emergency plans called for the distribution of antivirals from the stockpile via hospitals, public clinics, and community health centers if necessary.

Decision making based on flu severity in New York City proved challenging, given that the case-fatality ratio was unknown. Other challenges included deciding when and whether to close and reopen schools and how to keep children from gathering in groups elsewhere when schools were closed.

In response to the surge in emergency department visits from individuals with flulike symptoms, New York City hospitals were able to plan for additional care sites to handle the expected surge in cases of influenza-like illness in the fall and winter of 2009, the researchers said.

Overall, they concluded that the early responses of Mexico City and New York City to the H1N1 virus outbreak were promising.

The problems that did occur would likely have been worse if the disease had been more severe or if schools and businesses had remained closed for longer periods, they wrote. More research is needed to continue to identify best practices for pandemic situations in cities.

Advance planning led to a generally effective response to H1N1 outbreaks.

Source ©CDC

The response to the pandemic influenza A(H1N1) virus by the governments and public health officials of Mexico City and New York City in the spring of 2009 reveals successful strategies, but also points to issues that need to be addressed, according to a report from the Centers for Disease Control and Prevention.

“In each case, advance planning laid the foundation for enhanced surveillance and a generally effective response, made possible by an extensive public communications campaign and effective political leadership,” wrote Dr. David M. Bell of the CDC, and his associates.

The researchers summarized the responses of Mexico City and New York City to the H1N1 virus in spring 2009 (Emerg. Infect. Dis. 2009 [doi: 10.3201/eid1512.091232]).

“These megacities may not be representative of cities in low-income countries, which face more daunting problems,” the researchers noted.

After the novel H1N1 virus was identified on April 23, 2009, Mexico City followed a pandemic influenza preparedness plan that had been developed for any virus that originated outside Mexico. Efforts to decrease the spread of the virus included an intense media campaign encouraging people to stay home if they were sick and to avoid close contact such as hugging or kissing in greeting.

“Early in the epidemic, the federal government released antiviral drugs from the national strategic reserve and controlled their distribution,” Dr. Bell and his colleagues wrote.

The government successfully introduced a mass media campaign that addressed Mexico City's diverse population and range of literacy rates. In addition, it mobilized private businesses, such as grocery stories and pharmacies, to deliver health messages. The Ministry of Health also used text messages and e-mails to convey public health messages.

The closure of thousands of businesses in Mexico City and throughout Mexico is estimated to have cost the country more than $2.3 billion, and large gatherings such as sporting events were canceled or postponed, the researchers said.

Despite these costs, the researchers concluded that Mexico City's preparations paid off. “The preexisting pandemic plan and planning process facilitated collaboration, decision making, and rapid development of a communications campaign,” they said. But the emergency of the pandemic illustrated several areas in need of improvement, including a limited capacity of laboratories to handle tests and a lack of criteria for reopening schools that closed because of the outbreak.

In New York City, 77% of emergency departments collect electronic information from more than 90% of patient visits. “During spring 2009, these systems were essential for real-time monitoring of the pandemic in NYC,” allowing public health officials to track the spread of the virus through the city, the investigators emphasized.

The New York City government kept the public informed during the spring 2009 H1N1 outbreak with press conferences in both English and Spanish, and a government information hotline staffed with live operators answered 98% of calls within 30 seconds, the researchers said. About 50 schools in New York City closed for approximately 1 week.

Unlike Mexico City, New York City did not distribute antiviral drugs from the emergency stockpile because “normal distribution channels sufficed,” Dr. Bell and his associates said, but emergency plans called for the distribution of antivirals from the stockpile via hospitals, public clinics, and community health centers if necessary.

Decision making based on flu severity in New York City proved challenging, given that the case-fatality ratio was unknown. Other challenges included deciding when and whether to close and reopen schools and how to keep children from gathering in groups elsewhere when schools were closed.

In response to the surge in emergency department visits from individuals with flulike symptoms, New York City hospitals were able to plan for additional care sites to handle the expected surge in cases of influenza-like illness in the fall and winter of 2009, the researchers said.

Overall, they concluded that the early responses of Mexico City and New York City to the H1N1 virus outbreak were promising.

The problems that did occur would likely have been worse if the disease had been more severe or if schools and businesses had remained closed for longer periods, they wrote. More research is needed to continue to identify best practices for pandemic situations in cities.

Advance planning led to a generally effective response to H1N1 outbreaks.

Source ©CDC

ATLANTA — The Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices recommended a bivalent human papillomavirus vaccine as an alternative to the quadrivalent vaccine for the prevention of cervical cancer and related precancerous conditions in women and girls aged 9–26 years.

ACIP made the recommendation at its annual fall meeting.

The bivalent human papillomavirus (HPV) vaccine (GlaxoSmithKline's Cervarix) was recently approved by the Food and Drug Administration. The vaccine provides clinicians with another option to vaccinate adolescent girls and young women against diseases caused by HPV types 16 and 18.

But unlike the quadrivalent vaccine, the bivalent vaccine is not designed to protect against genital warts, noted Dr. Lauri Markowitz of the CDC, who presented the ACIP recommendations for the use of the bivalent vaccine.

The quadrivalent vaccine (Merck & Co.'s Gardasil) protects against genital warts associated with HPV types 6 and 11, in addition to protecting against diseases caused by HPV types 16 and 18.

ACIP recommended against a statement of no preference between the bivalent and quadrivalent vaccines after a lively debate.

Instead, the recommendations will present the information about the two vaccines without a statement of preference or a statement of nonpreference. The recommendations state that the two vaccines can be used interchangeably to complete the three-dose series, but that using the same vaccine for the entire series is preferable.

The bivalent vaccine, like the quadrivalent vaccine, is not a live vaccine, and it can be given simultaneously with other vaccines.

ACIP also voted to harmonize the age ranges for the two vaccines, with first doses given at ages 11–12 years and recommended second and third doses at 1–2 months and 6 months after the first dose. The recommended minimum dosing intervals remained as 4 weeks between the first and second dose and 12 weeks between the second and third doses.

The vaccine can be initiated as young as 9 years, and catch-up vaccination is recommended for females aged 13–26 years.

In addition, ACIP voted to move information about pregnancy to the precautions section. Pregnancy is not currently a contraindication for the vaccine. But Dr. Frank DeStefano of the CDC's immunization safety office said that postmarketing safety surveillance studies would be conducted on the bivalent HPV vaccine using the Vaccine Adverse Event Reporting System (VAERS), including a study to look at pregnancy outcomes after vaccination with the bivalent vaccine.

The committee voted to add the bivalent vaccine to the CDC's Vaccines for Children program.

For the latest information on ACIP vaccine recommendations, visit cdc.gov/vaccines/recs/acip.

Unlike the quadrivalent vaccine, the bivalent vaccine is not designed to prevent genital warts, Dr. Lauri Markowitz said.

Source Parker Smith/Elsevier Global Medical News

ATLANTA — The Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices recommended a bivalent human papillomavirus vaccine as an alternative to the quadrivalent vaccine for the prevention of cervical cancer and related precancerous conditions in women and girls aged 9–26 years.

ACIP made the recommendation at its annual fall meeting.

The bivalent human papillomavirus (HPV) vaccine (GlaxoSmithKline's Cervarix) was recently approved by the Food and Drug Administration. The vaccine provides clinicians with another option to vaccinate adolescent girls and young women against diseases caused by HPV types 16 and 18.

But unlike the quadrivalent vaccine, the bivalent vaccine is not designed to protect against genital warts, noted Dr. Lauri Markowitz of the CDC, who presented the ACIP recommendations for the use of the bivalent vaccine.

The quadrivalent vaccine (Merck & Co.'s Gardasil) protects against genital warts associated with HPV types 6 and 11, in addition to protecting against diseases caused by HPV types 16 and 18.

ACIP recommended against a statement of no preference between the bivalent and quadrivalent vaccines after a lively debate.

Instead, the recommendations will present the information about the two vaccines without a statement of preference or a statement of nonpreference. The recommendations state that the two vaccines can be used interchangeably to complete the three-dose series, but that using the same vaccine for the entire series is preferable.

The bivalent vaccine, like the quadrivalent vaccine, is not a live vaccine, and it can be given simultaneously with other vaccines.

ACIP also voted to harmonize the age ranges for the two vaccines, with first doses given at ages 11–12 years and recommended second and third doses at 1–2 months and 6 months after the first dose. The recommended minimum dosing intervals remained as 4 weeks between the first and second dose and 12 weeks between the second and third doses.

The vaccine can be initiated as young as 9 years, and catch-up vaccination is recommended for females aged 13–26 years.

In addition, ACIP voted to move information about pregnancy to the precautions section. Pregnancy is not currently a contraindication for the vaccine. But Dr. Frank DeStefano of the CDC's immunization safety office said that postmarketing safety surveillance studies would be conducted on the bivalent HPV vaccine using the Vaccine Adverse Event Reporting System (VAERS), including a study to look at pregnancy outcomes after vaccination with the bivalent vaccine.

The committee voted to add the bivalent vaccine to the CDC's Vaccines for Children program.

For the latest information on ACIP vaccine recommendations, visit cdc.gov/vaccines/recs/acip.

Unlike the quadrivalent vaccine, the bivalent vaccine is not designed to prevent genital warts, Dr. Lauri Markowitz said.

Source Parker Smith/Elsevier Global Medical News

ATLANTA — The Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices recommended a bivalent human papillomavirus vaccine as an alternative to the quadrivalent vaccine for the prevention of cervical cancer and related precancerous conditions in women and girls aged 9–26 years.

ACIP made the recommendation at its annual fall meeting.

The bivalent human papillomavirus (HPV) vaccine (GlaxoSmithKline's Cervarix) was recently approved by the Food and Drug Administration. The vaccine provides clinicians with another option to vaccinate adolescent girls and young women against diseases caused by HPV types 16 and 18.

But unlike the quadrivalent vaccine, the bivalent vaccine is not designed to protect against genital warts, noted Dr. Lauri Markowitz of the CDC, who presented the ACIP recommendations for the use of the bivalent vaccine.

The quadrivalent vaccine (Merck & Co.'s Gardasil) protects against genital warts associated with HPV types 6 and 11, in addition to protecting against diseases caused by HPV types 16 and 18.

ACIP recommended against a statement of no preference between the bivalent and quadrivalent vaccines after a lively debate.

Instead, the recommendations will present the information about the two vaccines without a statement of preference or a statement of nonpreference. The recommendations state that the two vaccines can be used interchangeably to complete the three-dose series, but that using the same vaccine for the entire series is preferable.

The bivalent vaccine, like the quadrivalent vaccine, is not a live vaccine, and it can be given simultaneously with other vaccines.

ACIP also voted to harmonize the age ranges for the two vaccines, with first doses given at ages 11–12 years and recommended second and third doses at 1–2 months and 6 months after the first dose. The recommended minimum dosing intervals remained as 4 weeks between the first and second dose and 12 weeks between the second and third doses.

The vaccine can be initiated as young as 9 years, and catch-up vaccination is recommended for females aged 13–26 years.

In addition, ACIP voted to move information about pregnancy to the precautions section. Pregnancy is not currently a contraindication for the vaccine. But Dr. Frank DeStefano of the CDC's immunization safety office said that postmarketing safety surveillance studies would be conducted on the bivalent HPV vaccine using the Vaccine Adverse Event Reporting System (VAERS), including a study to look at pregnancy outcomes after vaccination with the bivalent vaccine.

The committee voted to add the bivalent vaccine to the CDC's Vaccines for Children program.

For the latest information on ACIP vaccine recommendations, visit cdc.gov/vaccines/recs/acip.

Unlike the quadrivalent vaccine, the bivalent vaccine is not designed to prevent genital warts, Dr. Lauri Markowitz said.

Source Parker Smith/Elsevier Global Medical News

Collection of an oseltamivir-resistant pandemic influenza A(H1N1) isolate in a 59-year-old man taking the drug prophylactically underscores the need to limit antiviral prophylaxis of pandemic flu, according to correspondence published online in the New England Journal of Medicine on Nov. 11.

Oseltamivir was prescribed to all household contacts of the man's 13-year-old son (the index patient), whose infection was confirmed by a reverse-transcriptase polymerase-chain reaction test. The patient's father, mother, and sisters (aged 15 and 18 years) were prescribed 75 mg oseltamivir once daily for 10 days as prophylaxis.

The patient's father was taking 5 mg prednisone daily and had chronic obstructive pulmonary disease. The father developed flulike symptoms approximately 24 hours after prophylaxis began.

On prophylaxis day 8, the father was seen by his physician for a persistent cough, and an H1N1-positive nasopharyngeal aspirate was collected. After an uneventful course of illness, a second sample was negative, the investigators wrote. The case was reported by Mariana Baz, M.Sc., of the Centre Hospitalier Universitaire de Québec, and colleagues (N. Engl. J. Med. 2009 Nov. 11 [Epub doi: 10.1056/NEJMC0910060]).

The sample from the father showed a neuraminidase mutation (H275Y) that has been associated with oseltamivir resistance in seasonal H1N1

"We hypothesize that the presence of subtherapeutic levels of oseltamivir at a time when viral replication had already begun was an important factor that led to the emergence of the resistant virus in the father of our index patient," they wrote.

The case supports the need to limit prophylactic treatment with oseltamivir in persons who have already been exposed to the H1N1 virus, the investigators noted. They also suggested that patients receiving once-daily antiviral prophylaxis convert to a twice-daily regimen as soon as they develop flulike symptoms.

A conflict of interest disclosure statement for the authors was unavailable at press time.

Collection of an oseltamivir-resistant pandemic influenza A(H1N1) isolate in a 59-year-old man taking the drug prophylactically underscores the need to limit antiviral prophylaxis of pandemic flu, according to correspondence published online in the New England Journal of Medicine on Nov. 11.

Oseltamivir was prescribed to all household contacts of the man's 13-year-old son (the index patient), whose infection was confirmed by a reverse-transcriptase polymerase-chain reaction test. The patient's father, mother, and sisters (aged 15 and 18 years) were prescribed 75 mg oseltamivir once daily for 10 days as prophylaxis.

The patient's father was taking 5 mg prednisone daily and had chronic obstructive pulmonary disease. The father developed flulike symptoms approximately 24 hours after prophylaxis began.

On prophylaxis day 8, the father was seen by his physician for a persistent cough, and an H1N1-positive nasopharyngeal aspirate was collected. After an uneventful course of illness, a second sample was negative, the investigators wrote. The case was reported by Mariana Baz, M.Sc., of the Centre Hospitalier Universitaire de Québec, and colleagues (N. Engl. J. Med. 2009 Nov. 11 [Epub doi: 10.1056/NEJMC0910060]).

The sample from the father showed a neuraminidase mutation (H275Y) that has been associated with oseltamivir resistance in seasonal H1N1

"We hypothesize that the presence of subtherapeutic levels of oseltamivir at a time when viral replication had already begun was an important factor that led to the emergence of the resistant virus in the father of our index patient," they wrote.

The case supports the need to limit prophylactic treatment with oseltamivir in persons who have already been exposed to the H1N1 virus, the investigators noted. They also suggested that patients receiving once-daily antiviral prophylaxis convert to a twice-daily regimen as soon as they develop flulike symptoms.

A conflict of interest disclosure statement for the authors was unavailable at press time.

Collection of an oseltamivir-resistant pandemic influenza A(H1N1) isolate in a 59-year-old man taking the drug prophylactically underscores the need to limit antiviral prophylaxis of pandemic flu, according to correspondence published online in the New England Journal of Medicine on Nov. 11.

Oseltamivir was prescribed to all household contacts of the man's 13-year-old son (the index patient), whose infection was confirmed by a reverse-transcriptase polymerase-chain reaction test. The patient's father, mother, and sisters (aged 15 and 18 years) were prescribed 75 mg oseltamivir once daily for 10 days as prophylaxis.

The patient's father was taking 5 mg prednisone daily and had chronic obstructive pulmonary disease. The father developed flulike symptoms approximately 24 hours after prophylaxis began.

On prophylaxis day 8, the father was seen by his physician for a persistent cough, and an H1N1-positive nasopharyngeal aspirate was collected. After an uneventful course of illness, a second sample was negative, the investigators wrote. The case was reported by Mariana Baz, M.Sc., of the Centre Hospitalier Universitaire de Québec, and colleagues (N. Engl. J. Med. 2009 Nov. 11 [Epub doi: 10.1056/NEJMC0910060]).

The sample from the father showed a neuraminidase mutation (H275Y) that has been associated with oseltamivir resistance in seasonal H1N1

"We hypothesize that the presence of subtherapeutic levels of oseltamivir at a time when viral replication had already begun was an important factor that led to the emergence of the resistant virus in the father of our index patient," they wrote.

The case supports the need to limit prophylactic treatment with oseltamivir in persons who have already been exposed to the H1N1 virus, the investigators noted. They also suggested that patients receiving once-daily antiviral prophylaxis convert to a twice-daily regimen as soon as they develop flulike symptoms.

A conflict of interest disclosure statement for the authors was unavailable at press time.