Heidi Splete

For the CDC's Q&A on H1N1 vaccination planning, visit www.cdc.gov/h1n1flu/vaccination/statelocal/qa.htm

The Centers for Disease Control and Prevention offers novel influenza A(H1N1) vaccination planning guidance of interest to clinicians, as well as to state and local governments, on its Web site.

The CDC's vaccination planning Q&A page addresses issues including vaccine administration and cost.

When administering the vaccine, physicians and other health care planners should assume that two doses will be needed. This will not be confirmed "until the late summer- early fall, once clinical trials are completed," the site says. Among other points from the Q&A:

▸Dosage: Physicians should assume 21–28 days between the first and second vaccinations, but at this time there will be no federal requirement to recall individuals for a second dose if necessary. The first and second doses may not be the same product, although ideally they will.

▸Formula: An adjuvanted H1N1 vaccine is unlikely, but the exact formulation of the vaccine will vary by provider, and the CDC will provide more information about adjuvants, storage requirements, and mixing procedures once data from the vaccine's clinical trials are available.

▸Logistics: Clinical trials are ongoing, but the CDC expects that the H1N1 vaccine may be given at the same visit as the seasonal flu vaccine.

▸Pneumococcal vaccine: While there is potential for increased risk of pneumococcal disease associated with influenza, the CDC has no new recommendations for administering the pneumococcal vaccine to groups other than those for whom it is currently recommended. But this could change as summer flu epidemiologic data become available.

In response to a CDC query regarding cost, America's Health Insurance Plans (AHIP) said, "Public health planners can make the assumption that health plans will provide reimbursement for the administration of a novel (A) H1N1 vaccine to their members by private sector providers in both traditional settings e.g., doctor's offices, ambulatory clinics, health care facilities, and in nontraditional settings, where contracts with insurers have been established." AHIP is an organization representing more than 1,000 health insurance companies in the United States.

The CDC's guidance for other issues related to the cost of H1N1 vaccination includes:

▸The uninsured: Private providers will be able to charge uninsured patients up to the allowable Medicare charge for their region.

▸Public health clinics: Public health clinics will receive "implementation funds to support H1N1 vaccination clinics," according to the Web site. "Public health departments can bill … for an H1N1 vaccine administration fee, but cannot turn anyone away due to inability to pay."

For the CDC's Q&A on H1N1 vaccination planning, visit www.cdc.gov/h1n1flu/vaccination/statelocal/qa.htm

The Centers for Disease Control and Prevention offers novel influenza A(H1N1) vaccination planning guidance of interest to clinicians, as well as to state and local governments, on its Web site.

The CDC's vaccination planning Q&A page addresses issues including vaccine administration and cost.

When administering the vaccine, physicians and other health care planners should assume that two doses will be needed. This will not be confirmed "until the late summer- early fall, once clinical trials are completed," the site says. Among other points from the Q&A:

▸Dosage: Physicians should assume 21–28 days between the first and second vaccinations, but at this time there will be no federal requirement to recall individuals for a second dose if necessary. The first and second doses may not be the same product, although ideally they will.

▸Formula: An adjuvanted H1N1 vaccine is unlikely, but the exact formulation of the vaccine will vary by provider, and the CDC will provide more information about adjuvants, storage requirements, and mixing procedures once data from the vaccine's clinical trials are available.

▸Logistics: Clinical trials are ongoing, but the CDC expects that the H1N1 vaccine may be given at the same visit as the seasonal flu vaccine.

▸Pneumococcal vaccine: While there is potential for increased risk of pneumococcal disease associated with influenza, the CDC has no new recommendations for administering the pneumococcal vaccine to groups other than those for whom it is currently recommended. But this could change as summer flu epidemiologic data become available.

In response to a CDC query regarding cost, America's Health Insurance Plans (AHIP) said, "Public health planners can make the assumption that health plans will provide reimbursement for the administration of a novel (A) H1N1 vaccine to their members by private sector providers in both traditional settings e.g., doctor's offices, ambulatory clinics, health care facilities, and in nontraditional settings, where contracts with insurers have been established." AHIP is an organization representing more than 1,000 health insurance companies in the United States.

The CDC's guidance for other issues related to the cost of H1N1 vaccination includes:

▸The uninsured: Private providers will be able to charge uninsured patients up to the allowable Medicare charge for their region.

▸Public health clinics: Public health clinics will receive "implementation funds to support H1N1 vaccination clinics," according to the Web site. "Public health departments can bill … for an H1N1 vaccine administration fee, but cannot turn anyone away due to inability to pay."

For the CDC's Q&A on H1N1 vaccination planning, visit www.cdc.gov/h1n1flu/vaccination/statelocal/qa.htm

The Centers for Disease Control and Prevention offers novel influenza A(H1N1) vaccination planning guidance of interest to clinicians, as well as to state and local governments, on its Web site.

The CDC's vaccination planning Q&A page addresses issues including vaccine administration and cost.

When administering the vaccine, physicians and other health care planners should assume that two doses will be needed. This will not be confirmed "until the late summer- early fall, once clinical trials are completed," the site says. Among other points from the Q&A:

▸Dosage: Physicians should assume 21–28 days between the first and second vaccinations, but at this time there will be no federal requirement to recall individuals for a second dose if necessary. The first and second doses may not be the same product, although ideally they will.

▸Formula: An adjuvanted H1N1 vaccine is unlikely, but the exact formulation of the vaccine will vary by provider, and the CDC will provide more information about adjuvants, storage requirements, and mixing procedures once data from the vaccine's clinical trials are available.

▸Logistics: Clinical trials are ongoing, but the CDC expects that the H1N1 vaccine may be given at the same visit as the seasonal flu vaccine.

▸Pneumococcal vaccine: While there is potential for increased risk of pneumococcal disease associated with influenza, the CDC has no new recommendations for administering the pneumococcal vaccine to groups other than those for whom it is currently recommended. But this could change as summer flu epidemiologic data become available.

In response to a CDC query regarding cost, America's Health Insurance Plans (AHIP) said, "Public health planners can make the assumption that health plans will provide reimbursement for the administration of a novel (A) H1N1 vaccine to their members by private sector providers in both traditional settings e.g., doctor's offices, ambulatory clinics, health care facilities, and in nontraditional settings, where contracts with insurers have been established." AHIP is an organization representing more than 1,000 health insurance companies in the United States.

The CDC's guidance for other issues related to the cost of H1N1 vaccination includes:

▸The uninsured: Private providers will be able to charge uninsured patients up to the allowable Medicare charge for their region.

▸Public health clinics: Public health clinics will receive "implementation funds to support H1N1 vaccination clinics," according to the Web site. "Public health departments can bill … for an H1N1 vaccine administration fee, but cannot turn anyone away due to inability to pay."

WASHINGTON — Surgical mask or N95 respirator? The question of whether the Centers for Disease Control and Prevention should advise the use of respirators as standard protective gear by health care workers at risk for exposure to the novel influenza A(H1N1) virus was featured at a workshop sponsored by the Institute of Medicine.

The workshop served as "an open, on-the-record, information-gathering session" for the Institute of Medicine's Committee on Personal Protective Equipment [PPE] for Healthcare Workers in the Workplace Against Novel H1N1 Influenza A, said Dr. Kenneth Shine, chair of the committee. The committee is charged with sending a draft report to the CDC with recommendations for updated guidance on H1N1-related PPE for health care workers.

Regardless of any changes in recommendations, PPE is only one layer in a health care worker's protection against the virus, said Dr. Toby L. Merlin, deputy director of the CDC's influenza coordination unit.

"We believe emphatically that PPE is one element in a hierarchy of controls," Dr. Merlin explained. Other measures to control the spread of the novel H1N1 virus currently recommended by the CDC include wearing gloves and gowns when in contact with infected persons, practicing proper hand hygiene, covering coughs and sneezes, and isolating individuals who appear ill.

"There's no such thing as a risk-free environment," said Dr. Rosemary Sokas of the Occupational Safety and Health Administration. But Dr. Sokas emphasized that employers are responsible for providing workers with the highest level of protection possible. At the workshop, the committee heard results of several studies about the use of PPE in preventing flu transmission.

In one study, Dr. Raina MacIntyre of the University of New South Wales, Australia, and her colleagues conducted a randomized, controlled trial of more than 1,000 health care workers in 24 hospitals in Beijing.

The study compared infection rates in individuals who wore surgical masks, N95 respirators that were fit tested, N95 respirators that were not fit tested, and controls. The respirators—regardless of whether they were fit tested—were more effective than either surgical masks or controls.

There was no significant difference in effectiveness between the fit-tested and non-fit-tested N95 respirators. The complete study results will be presented at the upcoming Interscience Conference on Antimicrobial Agents and Chemotherapy meeting this month, Dr. MacIntyre said.

Despite such findings supporting the use of N95 respirators to mitigate the spread of the H1N1 virus, requiring their use might not go over well with clinicians in the trenches, said Dr. Alexander Isakov, an emergency medicine physician from Emory University in Atlanta. Dr. Isakov also serves as director of Emory's Section on Prehospital and Disaster Medicine, and as director of the Emory Office of Critical Event Preparedness and Response.

In an emergency setting, it is not always immediately clear what is required for each patient, Dr. Isakov said. Emergency departments that are already busy and may not be able to give infected patients adequate time if personnel are burdened with PPE requirements that may not be supported by sufficient evidence, he emphasized.

"The level of PPE required of emergency health care workers does have implications on their ability to do their jobs," Dr. Isakov said. PPE recommendations must be appropriate to the mission of the health care worker, he stressed. "Adding additional burdens on the health care provider for an extra modicum of safety that can't be measured might not actually benefit the health care worker or the patients they are trying to serve," he said.

For example, if doctors take longer to manage patients because they must don full protective gear before entering each room, it could slow down operations and cause more backlogs and crowding, he explained.

The committee also heard from representatives of workers' organizations, including the Service Employees Union and the American Federation of State, County, and Municipal Employees, who expressed support for keeping the current recommendation that health care workers use N95 respirators when managing patients with H1N1.

'The level of PPE required of emergency health care workers does have implications on their ability to do their jobs.'

Source DR. ISAKOV

WASHINGTON — Surgical mask or N95 respirator? The question of whether the Centers for Disease Control and Prevention should advise the use of respirators as standard protective gear by health care workers at risk for exposure to the novel influenza A(H1N1) virus was featured at a workshop sponsored by the Institute of Medicine.

The workshop served as "an open, on-the-record, information-gathering session" for the Institute of Medicine's Committee on Personal Protective Equipment [PPE] for Healthcare Workers in the Workplace Against Novel H1N1 Influenza A, said Dr. Kenneth Shine, chair of the committee. The committee is charged with sending a draft report to the CDC with recommendations for updated guidance on H1N1-related PPE for health care workers.

Regardless of any changes in recommendations, PPE is only one layer in a health care worker's protection against the virus, said Dr. Toby L. Merlin, deputy director of the CDC's influenza coordination unit.

"We believe emphatically that PPE is one element in a hierarchy of controls," Dr. Merlin explained. Other measures to control the spread of the novel H1N1 virus currently recommended by the CDC include wearing gloves and gowns when in contact with infected persons, practicing proper hand hygiene, covering coughs and sneezes, and isolating individuals who appear ill.

"There's no such thing as a risk-free environment," said Dr. Rosemary Sokas of the Occupational Safety and Health Administration. But Dr. Sokas emphasized that employers are responsible for providing workers with the highest level of protection possible. At the workshop, the committee heard results of several studies about the use of PPE in preventing flu transmission.

In one study, Dr. Raina MacIntyre of the University of New South Wales, Australia, and her colleagues conducted a randomized, controlled trial of more than 1,000 health care workers in 24 hospitals in Beijing.

The study compared infection rates in individuals who wore surgical masks, N95 respirators that were fit tested, N95 respirators that were not fit tested, and controls. The respirators—regardless of whether they were fit tested—were more effective than either surgical masks or controls.

There was no significant difference in effectiveness between the fit-tested and non-fit-tested N95 respirators. The complete study results will be presented at the upcoming Interscience Conference on Antimicrobial Agents and Chemotherapy meeting this month, Dr. MacIntyre said.

Despite such findings supporting the use of N95 respirators to mitigate the spread of the H1N1 virus, requiring their use might not go over well with clinicians in the trenches, said Dr. Alexander Isakov, an emergency medicine physician from Emory University in Atlanta. Dr. Isakov also serves as director of Emory's Section on Prehospital and Disaster Medicine, and as director of the Emory Office of Critical Event Preparedness and Response.

In an emergency setting, it is not always immediately clear what is required for each patient, Dr. Isakov said. Emergency departments that are already busy and may not be able to give infected patients adequate time if personnel are burdened with PPE requirements that may not be supported by sufficient evidence, he emphasized.

"The level of PPE required of emergency health care workers does have implications on their ability to do their jobs," Dr. Isakov said. PPE recommendations must be appropriate to the mission of the health care worker, he stressed. "Adding additional burdens on the health care provider for an extra modicum of safety that can't be measured might not actually benefit the health care worker or the patients they are trying to serve," he said.

For example, if doctors take longer to manage patients because they must don full protective gear before entering each room, it could slow down operations and cause more backlogs and crowding, he explained.

The committee also heard from representatives of workers' organizations, including the Service Employees Union and the American Federation of State, County, and Municipal Employees, who expressed support for keeping the current recommendation that health care workers use N95 respirators when managing patients with H1N1.

'The level of PPE required of emergency health care workers does have implications on their ability to do their jobs.'

Source DR. ISAKOV

WASHINGTON — Surgical mask or N95 respirator? The question of whether the Centers for Disease Control and Prevention should advise the use of respirators as standard protective gear by health care workers at risk for exposure to the novel influenza A(H1N1) virus was featured at a workshop sponsored by the Institute of Medicine.

The workshop served as "an open, on-the-record, information-gathering session" for the Institute of Medicine's Committee on Personal Protective Equipment [PPE] for Healthcare Workers in the Workplace Against Novel H1N1 Influenza A, said Dr. Kenneth Shine, chair of the committee. The committee is charged with sending a draft report to the CDC with recommendations for updated guidance on H1N1-related PPE for health care workers.

Regardless of any changes in recommendations, PPE is only one layer in a health care worker's protection against the virus, said Dr. Toby L. Merlin, deputy director of the CDC's influenza coordination unit.

"We believe emphatically that PPE is one element in a hierarchy of controls," Dr. Merlin explained. Other measures to control the spread of the novel H1N1 virus currently recommended by the CDC include wearing gloves and gowns when in contact with infected persons, practicing proper hand hygiene, covering coughs and sneezes, and isolating individuals who appear ill.

"There's no such thing as a risk-free environment," said Dr. Rosemary Sokas of the Occupational Safety and Health Administration. But Dr. Sokas emphasized that employers are responsible for providing workers with the highest level of protection possible. At the workshop, the committee heard results of several studies about the use of PPE in preventing flu transmission.

In one study, Dr. Raina MacIntyre of the University of New South Wales, Australia, and her colleagues conducted a randomized, controlled trial of more than 1,000 health care workers in 24 hospitals in Beijing.

The study compared infection rates in individuals who wore surgical masks, N95 respirators that were fit tested, N95 respirators that were not fit tested, and controls. The respirators—regardless of whether they were fit tested—were more effective than either surgical masks or controls.

There was no significant difference in effectiveness between the fit-tested and non-fit-tested N95 respirators. The complete study results will be presented at the upcoming Interscience Conference on Antimicrobial Agents and Chemotherapy meeting this month, Dr. MacIntyre said.

Despite such findings supporting the use of N95 respirators to mitigate the spread of the H1N1 virus, requiring their use might not go over well with clinicians in the trenches, said Dr. Alexander Isakov, an emergency medicine physician from Emory University in Atlanta. Dr. Isakov also serves as director of Emory's Section on Prehospital and Disaster Medicine, and as director of the Emory Office of Critical Event Preparedness and Response.

In an emergency setting, it is not always immediately clear what is required for each patient, Dr. Isakov said. Emergency departments that are already busy and may not be able to give infected patients adequate time if personnel are burdened with PPE requirements that may not be supported by sufficient evidence, he emphasized.

"The level of PPE required of emergency health care workers does have implications on their ability to do their jobs," Dr. Isakov said. PPE recommendations must be appropriate to the mission of the health care worker, he stressed. "Adding additional burdens on the health care provider for an extra modicum of safety that can't be measured might not actually benefit the health care worker or the patients they are trying to serve," he said.

For example, if doctors take longer to manage patients because they must don full protective gear before entering each room, it could slow down operations and cause more backlogs and crowding, he explained.

The committee also heard from representatives of workers' organizations, including the Service Employees Union and the American Federation of State, County, and Municipal Employees, who expressed support for keeping the current recommendation that health care workers use N95 respirators when managing patients with H1N1.

'The level of PPE required of emergency health care workers does have implications on their ability to do their jobs.'

Source DR. ISAKOV

WASHINGTON — Curbing the obesity epidemic requires community intervention, Dr. Thomas R. Frieden, director of the Centers for Disease Control and Prevention, said at the CDC's Weight of the Nation conference.

“The only way on a societal basis to reduce the prevalence of obesity is through community action, not through individual clinical interventions,” Dr. Frieden said in a press conference.

“We got to this stage in the [obesity] epidemic because of a change in our environment,” he said. “Only a change in our environment again will allow us to get back to a healthier place.”

To help communities respond to the obesity epidemic, the CDC launched Common Community Measures for Obesity Prevention. As part of this project, the CDC convened a panel of experts in a variety of areas including nutrition, urban planning, and physical activity, as well as obesity prevention. The complete recommendations, along with supporting evidence and suggestions for implementation, were published in the Morbidity and Mortality Weekly Report (2009:58 [RR-7]:1-26).

“We can't wait for the best possible evidence; we have to act on the best available evidence,” explained Dr. William Dietz, director of the CDC's Division of Nutrition, Physical Activity, and Obesity. Dr. Dietz presented the CDC's recommendations at a press conference.

The panel agreed on 24 strategies, which fall into six categories:

▸ To promote availability of affordable healthy foods and beverages (e.g., adding grocery stores in underserved areas).

▸ To support healthy food and beverage choices (e.g., limiting ads for unhealthy food and beverages).

▸ To encourage breast-feeding (e.g., encouraging workplaces to support breastfeeding mothers).

▸ To encourage physical activity or limit sedentary activity in children and adolescents (e.g., requiring physical education in schools).

▸ To create safe communities that support physical activity (e.g., enhancing infrastructure to support walking and biking).

▸ To encourage communities to organize for change (e.g., participating in coalitions and partnerships to address obesity).

The panel chose strategies that are likely to have a broad reach and a long-term, meaningful impact on health, according to the full report. And the panel deemed the strategies reasonable for a community to implement.

“Of course there are important things that physicians can do in their own practices, in terms of measuring [body mass index], counseling patients, and taking action to encourage weight loss and maintenance of weight loss,” Dr. Frieden said.

But physicians' roles shouldn't begin and end in the office setting, he added.

“I think there is a responsibility to physicians and the medical profession generally to be active in their communities promoting prevention,” said Dr. Frieden. It is often physicians who encourage community actions and influence policy makers, he emphasized.

It is often physicians who encourage community actions and influence policy makers.

Source DR. FRIEDEN

WASHINGTON — Curbing the obesity epidemic requires community intervention, Dr. Thomas R. Frieden, director of the Centers for Disease Control and Prevention, said at the CDC's Weight of the Nation conference.

“The only way on a societal basis to reduce the prevalence of obesity is through community action, not through individual clinical interventions,” Dr. Frieden said in a press conference.

“We got to this stage in the [obesity] epidemic because of a change in our environment,” he said. “Only a change in our environment again will allow us to get back to a healthier place.”

To help communities respond to the obesity epidemic, the CDC launched Common Community Measures for Obesity Prevention. As part of this project, the CDC convened a panel of experts in a variety of areas including nutrition, urban planning, and physical activity, as well as obesity prevention. The complete recommendations, along with supporting evidence and suggestions for implementation, were published in the Morbidity and Mortality Weekly Report (2009:58 [RR-7]:1-26).

“We can't wait for the best possible evidence; we have to act on the best available evidence,” explained Dr. William Dietz, director of the CDC's Division of Nutrition, Physical Activity, and Obesity. Dr. Dietz presented the CDC's recommendations at a press conference.

The panel agreed on 24 strategies, which fall into six categories:

▸ To promote availability of affordable healthy foods and beverages (e.g., adding grocery stores in underserved areas).

▸ To support healthy food and beverage choices (e.g., limiting ads for unhealthy food and beverages).

▸ To encourage breast-feeding (e.g., encouraging workplaces to support breastfeeding mothers).

▸ To encourage physical activity or limit sedentary activity in children and adolescents (e.g., requiring physical education in schools).

▸ To create safe communities that support physical activity (e.g., enhancing infrastructure to support walking and biking).

▸ To encourage communities to organize for change (e.g., participating in coalitions and partnerships to address obesity).

The panel chose strategies that are likely to have a broad reach and a long-term, meaningful impact on health, according to the full report. And the panel deemed the strategies reasonable for a community to implement.

“Of course there are important things that physicians can do in their own practices, in terms of measuring [body mass index], counseling patients, and taking action to encourage weight loss and maintenance of weight loss,” Dr. Frieden said.

But physicians' roles shouldn't begin and end in the office setting, he added.

“I think there is a responsibility to physicians and the medical profession generally to be active in their communities promoting prevention,” said Dr. Frieden. It is often physicians who encourage community actions and influence policy makers, he emphasized.

It is often physicians who encourage community actions and influence policy makers.

Source DR. FRIEDEN

WASHINGTON — Curbing the obesity epidemic requires community intervention, Dr. Thomas R. Frieden, director of the Centers for Disease Control and Prevention, said at the CDC's Weight of the Nation conference.

“The only way on a societal basis to reduce the prevalence of obesity is through community action, not through individual clinical interventions,” Dr. Frieden said in a press conference.

“We got to this stage in the [obesity] epidemic because of a change in our environment,” he said. “Only a change in our environment again will allow us to get back to a healthier place.”

To help communities respond to the obesity epidemic, the CDC launched Common Community Measures for Obesity Prevention. As part of this project, the CDC convened a panel of experts in a variety of areas including nutrition, urban planning, and physical activity, as well as obesity prevention. The complete recommendations, along with supporting evidence and suggestions for implementation, were published in the Morbidity and Mortality Weekly Report (2009:58 [RR-7]:1-26).

“We can't wait for the best possible evidence; we have to act on the best available evidence,” explained Dr. William Dietz, director of the CDC's Division of Nutrition, Physical Activity, and Obesity. Dr. Dietz presented the CDC's recommendations at a press conference.

The panel agreed on 24 strategies, which fall into six categories:

▸ To promote availability of affordable healthy foods and beverages (e.g., adding grocery stores in underserved areas).

▸ To support healthy food and beverage choices (e.g., limiting ads for unhealthy food and beverages).

▸ To encourage breast-feeding (e.g., encouraging workplaces to support breastfeeding mothers).

▸ To encourage physical activity or limit sedentary activity in children and adolescents (e.g., requiring physical education in schools).

▸ To create safe communities that support physical activity (e.g., enhancing infrastructure to support walking and biking).

▸ To encourage communities to organize for change (e.g., participating in coalitions and partnerships to address obesity).

The panel chose strategies that are likely to have a broad reach and a long-term, meaningful impact on health, according to the full report. And the panel deemed the strategies reasonable for a community to implement.

“Of course there are important things that physicians can do in their own practices, in terms of measuring [body mass index], counseling patients, and taking action to encourage weight loss and maintenance of weight loss,” Dr. Frieden said.

But physicians' roles shouldn't begin and end in the office setting, he added.

“I think there is a responsibility to physicians and the medical profession generally to be active in their communities promoting prevention,” said Dr. Frieden. It is often physicians who encourage community actions and influence policy makers, he emphasized.

It is often physicians who encourage community actions and influence policy makers.

Source DR. FRIEDEN

WASHINGTON — The health cost of obesity in the United States jumped from $74 billion in 1998 to approximately $147 billion (inflation adjusted) today, based on data from a study conducted by the Centers for Disease Control and Prevention and the Research Triangle Institute. The data were presented last month at the CDC's inaugural Weight of the Nation conference on obesity.

“Obesity affects every body system,” Dr. Thomas R. Frieden, director of the CDC, said during opening remarks at the conference.

Obesity accounted for 6.5% of overall annual medical costs in the United States in 1998, but that proportion increased to 9.1% by 2006, said the study's lead author, Eric Finkelstein, Ph.D., of the independent Research Triangle Institute.

The annual cost of medical care per adult in the United States is 41% less for a normal-weight individual than for an obese individual, Dr. Finkelstein said. In this study, obesity was defined as a body mass index of 30 kg/m

Prescription drugs are among the top contributors to the costs of obesity, Dr. Finkelstein said. In 2006, across all insurance payers, the average annual prescription drug cost for a normal-weight individual was $707, compared with $1,275 for an obese individual. This difference represents an 80% increase in drug costs for the obese, Dr. Finkelstein said. The data were collected from annual Medical Expenditure Panel Surveys, which are nationally representative surveys of medical expenses for the civilian, noninstitutionalized U.S. population. The complete data were published online on July 27 in the journal Health Affairs (doi: 10.1377/hlthaff.28.5.w822).

If the obesity prevalence had remained the same between 1998 and 2006, 2006 medical costs in the United States would have been approximately $40 billion less, Dr. Finkelstein emphasized.

The study results were limited by the reliance on self-reports of body mass index, Dr. Finkelstein noted. The study examined only aggregate health costs and did not look at disease-specific costs, but “diabetes is one of the largest drivers of health care costs,” he said.

At a media briefing, Dr. Frieden said that the most effective strategies to reduce obesity and its associated costs in the United States may involve community intervention rather than clinical intervention. But physicians have a responsibility to promote healthy living in their communities, as well as to encourage patients'weight-loss efforts in a clinical practice setting, he added.

The study was sponsored in part by the CDC.

WASHINGTON — The health cost of obesity in the United States jumped from $74 billion in 1998 to approximately $147 billion (inflation adjusted) today, based on data from a study conducted by the Centers for Disease Control and Prevention and the Research Triangle Institute. The data were presented last month at the CDC's inaugural Weight of the Nation conference on obesity.

“Obesity affects every body system,” Dr. Thomas R. Frieden, director of the CDC, said during opening remarks at the conference.

Obesity accounted for 6.5% of overall annual medical costs in the United States in 1998, but that proportion increased to 9.1% by 2006, said the study's lead author, Eric Finkelstein, Ph.D., of the independent Research Triangle Institute.

The annual cost of medical care per adult in the United States is 41% less for a normal-weight individual than for an obese individual, Dr. Finkelstein said. In this study, obesity was defined as a body mass index of 30 kg/m

Prescription drugs are among the top contributors to the costs of obesity, Dr. Finkelstein said. In 2006, across all insurance payers, the average annual prescription drug cost for a normal-weight individual was $707, compared with $1,275 for an obese individual. This difference represents an 80% increase in drug costs for the obese, Dr. Finkelstein said. The data were collected from annual Medical Expenditure Panel Surveys, which are nationally representative surveys of medical expenses for the civilian, noninstitutionalized U.S. population. The complete data were published online on July 27 in the journal Health Affairs (doi: 10.1377/hlthaff.28.5.w822).

If the obesity prevalence had remained the same between 1998 and 2006, 2006 medical costs in the United States would have been approximately $40 billion less, Dr. Finkelstein emphasized.

The study results were limited by the reliance on self-reports of body mass index, Dr. Finkelstein noted. The study examined only aggregate health costs and did not look at disease-specific costs, but “diabetes is one of the largest drivers of health care costs,” he said.

At a media briefing, Dr. Frieden said that the most effective strategies to reduce obesity and its associated costs in the United States may involve community intervention rather than clinical intervention. But physicians have a responsibility to promote healthy living in their communities, as well as to encourage patients'weight-loss efforts in a clinical practice setting, he added.

The study was sponsored in part by the CDC.

WASHINGTON — The health cost of obesity in the United States jumped from $74 billion in 1998 to approximately $147 billion (inflation adjusted) today, based on data from a study conducted by the Centers for Disease Control and Prevention and the Research Triangle Institute. The data were presented last month at the CDC's inaugural Weight of the Nation conference on obesity.

“Obesity affects every body system,” Dr. Thomas R. Frieden, director of the CDC, said during opening remarks at the conference.

Obesity accounted for 6.5% of overall annual medical costs in the United States in 1998, but that proportion increased to 9.1% by 2006, said the study's lead author, Eric Finkelstein, Ph.D., of the independent Research Triangle Institute.

The annual cost of medical care per adult in the United States is 41% less for a normal-weight individual than for an obese individual, Dr. Finkelstein said. In this study, obesity was defined as a body mass index of 30 kg/m

Prescription drugs are among the top contributors to the costs of obesity, Dr. Finkelstein said. In 2006, across all insurance payers, the average annual prescription drug cost for a normal-weight individual was $707, compared with $1,275 for an obese individual. This difference represents an 80% increase in drug costs for the obese, Dr. Finkelstein said. The data were collected from annual Medical Expenditure Panel Surveys, which are nationally representative surveys of medical expenses for the civilian, noninstitutionalized U.S. population. The complete data were published online on July 27 in the journal Health Affairs (doi: 10.1377/hlthaff.28.5.w822).

If the obesity prevalence had remained the same between 1998 and 2006, 2006 medical costs in the United States would have been approximately $40 billion less, Dr. Finkelstein emphasized.

The study results were limited by the reliance on self-reports of body mass index, Dr. Finkelstein noted. The study examined only aggregate health costs and did not look at disease-specific costs, but “diabetes is one of the largest drivers of health care costs,” he said.

At a media briefing, Dr. Frieden said that the most effective strategies to reduce obesity and its associated costs in the United States may involve community intervention rather than clinical intervention. But physicians have a responsibility to promote healthy living in their communities, as well as to encourage patients'weight-loss efforts in a clinical practice setting, he added.

The study was sponsored in part by the CDC.

BETHESDA, MD. — President Obama joined other U.S. government and health leaders at a preparedness summit in urging Americans to plan now for a likely surge in cases of the novel influenza A(H1N1) this fall.

“We want to make sure that we are not promoting panic, but we are promoting vigilance and preparation,” President Obama, who was in Italy, said by phone during the summit at the National Institutes of Health.

“Our goals are straightforward: to reduce illness and death and minimize social disruption,” said Dr. Thomas R. Frieden, director of the Centers for Disease Control and Prevention.

Dr. Frieden, along with Kathleen Sebelius, secretary of the Department of Health and Human Services, Janet Napolitano, secretary of the Department of Homeland Security, and Arne Duncan, secretary of the Department of Education, reviewed the status of the government's efforts to prepare for an anticipated surge in the volume of cases of the novel H1N1 flu in the fall.

Secretary Sebelius summarized the government's four-pronged strategy of surveillance, community mitigation, vaccination, and communication. She encouraged all Americans to visit the government's flu-specific Web site, flu.gov, which reinforces ways to prevent spreading the flu. In an effort to engage an Internet-savvy population in public health, the site offers visitors the opportunity to create a 60-second H1N1 video public service announcement. One of the announcements submitted will be chosen by the government for widespread distribution, she said, with a $2,500 prize going to the maker of the winning video, according to the site.

In addition, Secretary Sebelius outlined the government's intentions for minimizing the impact of H1N1. The H1N1 vaccine, if it is found to be safe and effective, will be purchased by the federal government, she said, and medical and scientific experts will help prioritize vaccination efforts and “get the shots in the arms of the people who need them most.” A vaccine is currently being evaluated in clinical trials, and safety and effectiveness information should be available this month, she said. If the vaccine is found to be safe and effective, it should be available in limited amounts in October. Based on current evidence, likely high-risk groups that would be the first candidates for the H1N1 vaccine might include younger adults with comorbid conditions, children, and pregnant women.

Federal grants for state health departments to help with preparedness are available, Secretary Sebelius also announced. She added that $90 million will be available for hospitals to help them prepare for the potential surge in flu-related activity.

The Department of Homeland Security is focusing on the importance of maintaining essential services if widespread illness contributes to widespread absenteeism, Secretary Napolitano said. She encouraged state and local leaders to host their own local flu preparedness summits.

Because the novel H1N1 virus has disproportionately affected children, it is important to “get clear guidance out early” to schools, said Secretary Duncan. School-closing decisions should be made at the local level, on a school-by-school basis, and only as a last resort, he said.

Secretary Napolitano said that even if the novel H1N1 flu is less severe than expected, the procedures being put in place will improve the public health system for future emergencies. It's possible the H1N1 virus won't be as bad as anticipated, Secretary Sebelius said, but it's wise to prepare for a worst-case scenario.

For the latest information on H1N1 preparedness, visit flu.gov

'Our goals are straightforward: to reduce illness and death and minimize social disruption.'

Source DR. FRIEDEN

BETHESDA, MD. — President Obama joined other U.S. government and health leaders at a preparedness summit in urging Americans to plan now for a likely surge in cases of the novel influenza A(H1N1) this fall.

“We want to make sure that we are not promoting panic, but we are promoting vigilance and preparation,” President Obama, who was in Italy, said by phone during the summit at the National Institutes of Health.

“Our goals are straightforward: to reduce illness and death and minimize social disruption,” said Dr. Thomas R. Frieden, director of the Centers for Disease Control and Prevention.

Dr. Frieden, along with Kathleen Sebelius, secretary of the Department of Health and Human Services, Janet Napolitano, secretary of the Department of Homeland Security, and Arne Duncan, secretary of the Department of Education, reviewed the status of the government's efforts to prepare for an anticipated surge in the volume of cases of the novel H1N1 flu in the fall.

Secretary Sebelius summarized the government's four-pronged strategy of surveillance, community mitigation, vaccination, and communication. She encouraged all Americans to visit the government's flu-specific Web site, flu.gov, which reinforces ways to prevent spreading the flu. In an effort to engage an Internet-savvy population in public health, the site offers visitors the opportunity to create a 60-second H1N1 video public service announcement. One of the announcements submitted will be chosen by the government for widespread distribution, she said, with a $2,500 prize going to the maker of the winning video, according to the site.

In addition, Secretary Sebelius outlined the government's intentions for minimizing the impact of H1N1. The H1N1 vaccine, if it is found to be safe and effective, will be purchased by the federal government, she said, and medical and scientific experts will help prioritize vaccination efforts and “get the shots in the arms of the people who need them most.” A vaccine is currently being evaluated in clinical trials, and safety and effectiveness information should be available this month, she said. If the vaccine is found to be safe and effective, it should be available in limited amounts in October. Based on current evidence, likely high-risk groups that would be the first candidates for the H1N1 vaccine might include younger adults with comorbid conditions, children, and pregnant women.

Federal grants for state health departments to help with preparedness are available, Secretary Sebelius also announced. She added that $90 million will be available for hospitals to help them prepare for the potential surge in flu-related activity.

The Department of Homeland Security is focusing on the importance of maintaining essential services if widespread illness contributes to widespread absenteeism, Secretary Napolitano said. She encouraged state and local leaders to host their own local flu preparedness summits.

Because the novel H1N1 virus has disproportionately affected children, it is important to “get clear guidance out early” to schools, said Secretary Duncan. School-closing decisions should be made at the local level, on a school-by-school basis, and only as a last resort, he said.

Secretary Napolitano said that even if the novel H1N1 flu is less severe than expected, the procedures being put in place will improve the public health system for future emergencies. It's possible the H1N1 virus won't be as bad as anticipated, Secretary Sebelius said, but it's wise to prepare for a worst-case scenario.

For the latest information on H1N1 preparedness, visit flu.gov

'Our goals are straightforward: to reduce illness and death and minimize social disruption.'

Source DR. FRIEDEN

BETHESDA, MD. — President Obama joined other U.S. government and health leaders at a preparedness summit in urging Americans to plan now for a likely surge in cases of the novel influenza A(H1N1) this fall.

“We want to make sure that we are not promoting panic, but we are promoting vigilance and preparation,” President Obama, who was in Italy, said by phone during the summit at the National Institutes of Health.

“Our goals are straightforward: to reduce illness and death and minimize social disruption,” said Dr. Thomas R. Frieden, director of the Centers for Disease Control and Prevention.

Dr. Frieden, along with Kathleen Sebelius, secretary of the Department of Health and Human Services, Janet Napolitano, secretary of the Department of Homeland Security, and Arne Duncan, secretary of the Department of Education, reviewed the status of the government's efforts to prepare for an anticipated surge in the volume of cases of the novel H1N1 flu in the fall.

Secretary Sebelius summarized the government's four-pronged strategy of surveillance, community mitigation, vaccination, and communication. She encouraged all Americans to visit the government's flu-specific Web site, flu.gov, which reinforces ways to prevent spreading the flu. In an effort to engage an Internet-savvy population in public health, the site offers visitors the opportunity to create a 60-second H1N1 video public service announcement. One of the announcements submitted will be chosen by the government for widespread distribution, she said, with a $2,500 prize going to the maker of the winning video, according to the site.

In addition, Secretary Sebelius outlined the government's intentions for minimizing the impact of H1N1. The H1N1 vaccine, if it is found to be safe and effective, will be purchased by the federal government, she said, and medical and scientific experts will help prioritize vaccination efforts and “get the shots in the arms of the people who need them most.” A vaccine is currently being evaluated in clinical trials, and safety and effectiveness information should be available this month, she said. If the vaccine is found to be safe and effective, it should be available in limited amounts in October. Based on current evidence, likely high-risk groups that would be the first candidates for the H1N1 vaccine might include younger adults with comorbid conditions, children, and pregnant women.

Federal grants for state health departments to help with preparedness are available, Secretary Sebelius also announced. She added that $90 million will be available for hospitals to help them prepare for the potential surge in flu-related activity.

The Department of Homeland Security is focusing on the importance of maintaining essential services if widespread illness contributes to widespread absenteeism, Secretary Napolitano said. She encouraged state and local leaders to host their own local flu preparedness summits.

Because the novel H1N1 virus has disproportionately affected children, it is important to “get clear guidance out early” to schools, said Secretary Duncan. School-closing decisions should be made at the local level, on a school-by-school basis, and only as a last resort, he said.

Secretary Napolitano said that even if the novel H1N1 flu is less severe than expected, the procedures being put in place will improve the public health system for future emergencies. It's possible the H1N1 virus won't be as bad as anticipated, Secretary Sebelius said, but it's wise to prepare for a worst-case scenario.

For the latest information on H1N1 preparedness, visit flu.gov

'Our goals are straightforward: to reduce illness and death and minimize social disruption.'

Source DR. FRIEDEN

WASHINGTON — Pregnant women's snoring has no apparent negative impact on fetal outcomes, despite some differences in fetal umbilical arterial blood gases, based on data from two studies including more than 600 women.

Previous research has suggested that habitual snoring in pregnant women may be a risk factor for poor fetal outcomes, but the available data were primarily from case studies, said Dr. Alexandra Bullough and Louise O'Brien, Ph.D., of the University of Michigan in Ann Arbor.

As part of a larger study of the impact of sleep-disordered breathing (SDB) on both maternal and fetal outcomes, the researchers recruited 380 women aged 18 years and older in the third trimester of singleton, uncomplicated pregnancies to complete sleep questionnaires. This study is the first known to examine the impact of maternal SDB on fetal outcomes after delivery, based on umbilical blood gas values for arterial pH, partial pressure of carbon dioxide (PCO₂), HCO₃, and base excess.

Overall, 129 women met the criteria for SDB, and they were compared with 251 nonsnoring controls. The women with SDB averaged a significantly higher body mass index than controls both before pregnancy (35 kg/m

In this study, there were no significant differences between the SDB and control groups in average measures of arterial pH (7.3 vs. 7.3), PCO₂ (54.4 mm Hg vs. 57.4 mm Hg), HCO₃ (23.6 mmol/L vs. 24.4 mmol/L), and base excess (−1.82 mmol vs. −1.85 mmol).

These preliminary findings suggest that maternal SDB may not be associated with adverse fetal outcomes. But the study is ongoing, and data that haven't yet been fully analyzed suggest a possible association. “We're not sure how [maternal SDB] might affect fetal outcome,” Dr. Bullough said in a poster presentation at the annual meeting of the Society for Obstetric Anesthesia and Perinatology.

Habitual snoring was not significantly associated with low birth weight or Apgar scores, based on a second study of 429 women with uncomplicated singleton pregnancies. In this study, also conducted by Dr. O'Brien and Dr. Bullough, 35% of the women reported habitual snoring (at least 3 nights each week) and 25% were obese (with a BMI of at least 30 kg/m

Overall, habitual snoring was not significantly associated with low birth weight and Apgar scores. These results held after controlling for variables including maternal diabetes, age, and race. Only the gestational age at delivery and the mother's BMI before pregnancy were independent significant predictors of birth weight and 1-minute Apgar scores, and only gestational age at delivery was an independent and significant predictor of 5-minute Apgar scores. Regardless of sleep apnea status, “women with high BMI were going to have bigger babies,” Dr. Bullough said.

These results contrasted with previous studies suggesting that maternal sleep apnea may predict poor infant outcomes, and more research is needed to evaluate the association.

The researchers said they had no financial conflicts to disclose.

WASHINGTON — Pregnant women's snoring has no apparent negative impact on fetal outcomes, despite some differences in fetal umbilical arterial blood gases, based on data from two studies including more than 600 women.

Previous research has suggested that habitual snoring in pregnant women may be a risk factor for poor fetal outcomes, but the available data were primarily from case studies, said Dr. Alexandra Bullough and Louise O'Brien, Ph.D., of the University of Michigan in Ann Arbor.

As part of a larger study of the impact of sleep-disordered breathing (SDB) on both maternal and fetal outcomes, the researchers recruited 380 women aged 18 years and older in the third trimester of singleton, uncomplicated pregnancies to complete sleep questionnaires. This study is the first known to examine the impact of maternal SDB on fetal outcomes after delivery, based on umbilical blood gas values for arterial pH, partial pressure of carbon dioxide (PCO₂), HCO₃, and base excess.

Overall, 129 women met the criteria for SDB, and they were compared with 251 nonsnoring controls. The women with SDB averaged a significantly higher body mass index than controls both before pregnancy (35 kg/m

In this study, there were no significant differences between the SDB and control groups in average measures of arterial pH (7.3 vs. 7.3), PCO₂ (54.4 mm Hg vs. 57.4 mm Hg), HCO₃ (23.6 mmol/L vs. 24.4 mmol/L), and base excess (−1.82 mmol vs. −1.85 mmol).

These preliminary findings suggest that maternal SDB may not be associated with adverse fetal outcomes. But the study is ongoing, and data that haven't yet been fully analyzed suggest a possible association. “We're not sure how [maternal SDB] might affect fetal outcome,” Dr. Bullough said in a poster presentation at the annual meeting of the Society for Obstetric Anesthesia and Perinatology.

Habitual snoring was not significantly associated with low birth weight or Apgar scores, based on a second study of 429 women with uncomplicated singleton pregnancies. In this study, also conducted by Dr. O'Brien and Dr. Bullough, 35% of the women reported habitual snoring (at least 3 nights each week) and 25% were obese (with a BMI of at least 30 kg/m

Overall, habitual snoring was not significantly associated with low birth weight and Apgar scores. These results held after controlling for variables including maternal diabetes, age, and race. Only the gestational age at delivery and the mother's BMI before pregnancy were independent significant predictors of birth weight and 1-minute Apgar scores, and only gestational age at delivery was an independent and significant predictor of 5-minute Apgar scores. Regardless of sleep apnea status, “women with high BMI were going to have bigger babies,” Dr. Bullough said.

These results contrasted with previous studies suggesting that maternal sleep apnea may predict poor infant outcomes, and more research is needed to evaluate the association.

The researchers said they had no financial conflicts to disclose.

WASHINGTON — Pregnant women's snoring has no apparent negative impact on fetal outcomes, despite some differences in fetal umbilical arterial blood gases, based on data from two studies including more than 600 women.

Previous research has suggested that habitual snoring in pregnant women may be a risk factor for poor fetal outcomes, but the available data were primarily from case studies, said Dr. Alexandra Bullough and Louise O'Brien, Ph.D., of the University of Michigan in Ann Arbor.

As part of a larger study of the impact of sleep-disordered breathing (SDB) on both maternal and fetal outcomes, the researchers recruited 380 women aged 18 years and older in the third trimester of singleton, uncomplicated pregnancies to complete sleep questionnaires. This study is the first known to examine the impact of maternal SDB on fetal outcomes after delivery, based on umbilical blood gas values for arterial pH, partial pressure of carbon dioxide (PCO₂), HCO₃, and base excess.

Overall, 129 women met the criteria for SDB, and they were compared with 251 nonsnoring controls. The women with SDB averaged a significantly higher body mass index than controls both before pregnancy (35 kg/m

In this study, there were no significant differences between the SDB and control groups in average measures of arterial pH (7.3 vs. 7.3), PCO₂ (54.4 mm Hg vs. 57.4 mm Hg), HCO₃ (23.6 mmol/L vs. 24.4 mmol/L), and base excess (−1.82 mmol vs. −1.85 mmol).

These preliminary findings suggest that maternal SDB may not be associated with adverse fetal outcomes. But the study is ongoing, and data that haven't yet been fully analyzed suggest a possible association. “We're not sure how [maternal SDB] might affect fetal outcome,” Dr. Bullough said in a poster presentation at the annual meeting of the Society for Obstetric Anesthesia and Perinatology.

Habitual snoring was not significantly associated with low birth weight or Apgar scores, based on a second study of 429 women with uncomplicated singleton pregnancies. In this study, also conducted by Dr. O'Brien and Dr. Bullough, 35% of the women reported habitual snoring (at least 3 nights each week) and 25% were obese (with a BMI of at least 30 kg/m

Overall, habitual snoring was not significantly associated with low birth weight and Apgar scores. These results held after controlling for variables including maternal diabetes, age, and race. Only the gestational age at delivery and the mother's BMI before pregnancy were independent significant predictors of birth weight and 1-minute Apgar scores, and only gestational age at delivery was an independent and significant predictor of 5-minute Apgar scores. Regardless of sleep apnea status, “women with high BMI were going to have bigger babies,” Dr. Bullough said.

These results contrasted with previous studies suggesting that maternal sleep apnea may predict poor infant outcomes, and more research is needed to evaluate the association.

The researchers said they had no financial conflicts to disclose.

WASHINGTON — When equal access to epidural anesthesia is available, patient ethnicity is not a factor in choosing whether to have an epidural, according to results of a study of 797 consecutive women with singleton pregnancies at a hospital in Flushing, N.Y.

Although epidural anesthesia is widely available in the United States, previous studies have suggested that ethnic disparities persist in the provision of epidurals, according to Dr. Isaac P. Lowenwirt of the New York Hospital Queens, Flushing.

To describe the use of epidural anesthesia during labor in a multiethnic population, Dr. Lowenwirt and his colleagues conducted a prospective study of 800 consecutive singleton pregnancies at a single hospital.

The average age of the women across all ethnic groups ranged from 27 to 32 years. Women who had multiples, malpresentation, or planned cesarean deliveries were excluded from the study.

Complete data from 797 women were presented in a poster at the annual meeting of the Society for Obstetric Anesthesia and Perinatology.

The women were offered three options: parenteral fentanyl, patient-controlled anesthesia (bupivacaine), or no medication. The severity of pain was measured with a visual analog scale.

Overall, 82% of the patients chose an epidural.

The average baseline pain scores were higher among the women who chose an epidural, compared with those who did not (8.8 vs. 3.7). But there was no significant difference in epidural use among the ethnic groups, and patients in all groups reported similarly effective pain relief after epidural placement.

The ethnic groups were defined as white (103 patients), black (78 patients), Hispanic (150 patients), Chinese or Korean (338 patients), Indian (67 patients), and other ethnicities (61 patients).

Socioeconomic factors and maternal education were not factors in the use of an epidural, Dr. Lowenwirt reported.

In addition, nulliparous women were four times more likely to choose an epidural than multiparous women, regardless of ethnicity.

On further analysis, Chinese or Korean patients averaged the shortest duration of analgesia, and black patients averaged the longest duration (141 minutes vs. 185 minutes).

And there was a significant difference in average bupivacaine use between the group with the highest use (Hispanic patients) and the lowest use (Chinese or Korean patients).

The Hispanic patients who chose bupivacaine averaged 7.3 mg/hr, compared with an average of 5.5 mg/hr for the Chinese or Korean patients who chose bupivacaine, he said..

The results suggest that when equal access to epidural analgesia is available, women of all ethnic groups choose it in similar proportions, compared with no medication, the researchers wrote in the poster.

Dr. Lowenwirt said he had no financial conflicts to disclose.

WASHINGTON — When equal access to epidural anesthesia is available, patient ethnicity is not a factor in choosing whether to have an epidural, according to results of a study of 797 consecutive women with singleton pregnancies at a hospital in Flushing, N.Y.

Although epidural anesthesia is widely available in the United States, previous studies have suggested that ethnic disparities persist in the provision of epidurals, according to Dr. Isaac P. Lowenwirt of the New York Hospital Queens, Flushing.

To describe the use of epidural anesthesia during labor in a multiethnic population, Dr. Lowenwirt and his colleagues conducted a prospective study of 800 consecutive singleton pregnancies at a single hospital.

The average age of the women across all ethnic groups ranged from 27 to 32 years. Women who had multiples, malpresentation, or planned cesarean deliveries were excluded from the study.

Complete data from 797 women were presented in a poster at the annual meeting of the Society for Obstetric Anesthesia and Perinatology.

The women were offered three options: parenteral fentanyl, patient-controlled anesthesia (bupivacaine), or no medication. The severity of pain was measured with a visual analog scale.

Overall, 82% of the patients chose an epidural.

The average baseline pain scores were higher among the women who chose an epidural, compared with those who did not (8.8 vs. 3.7). But there was no significant difference in epidural use among the ethnic groups, and patients in all groups reported similarly effective pain relief after epidural placement.

The ethnic groups were defined as white (103 patients), black (78 patients), Hispanic (150 patients), Chinese or Korean (338 patients), Indian (67 patients), and other ethnicities (61 patients).

Socioeconomic factors and maternal education were not factors in the use of an epidural, Dr. Lowenwirt reported.

In addition, nulliparous women were four times more likely to choose an epidural than multiparous women, regardless of ethnicity.

On further analysis, Chinese or Korean patients averaged the shortest duration of analgesia, and black patients averaged the longest duration (141 minutes vs. 185 minutes).

And there was a significant difference in average bupivacaine use between the group with the highest use (Hispanic patients) and the lowest use (Chinese or Korean patients).

The Hispanic patients who chose bupivacaine averaged 7.3 mg/hr, compared with an average of 5.5 mg/hr for the Chinese or Korean patients who chose bupivacaine, he said..

The results suggest that when equal access to epidural analgesia is available, women of all ethnic groups choose it in similar proportions, compared with no medication, the researchers wrote in the poster.

Dr. Lowenwirt said he had no financial conflicts to disclose.

WASHINGTON — When equal access to epidural anesthesia is available, patient ethnicity is not a factor in choosing whether to have an epidural, according to results of a study of 797 consecutive women with singleton pregnancies at a hospital in Flushing, N.Y.

Although epidural anesthesia is widely available in the United States, previous studies have suggested that ethnic disparities persist in the provision of epidurals, according to Dr. Isaac P. Lowenwirt of the New York Hospital Queens, Flushing.

To describe the use of epidural anesthesia during labor in a multiethnic population, Dr. Lowenwirt and his colleagues conducted a prospective study of 800 consecutive singleton pregnancies at a single hospital.

The average age of the women across all ethnic groups ranged from 27 to 32 years. Women who had multiples, malpresentation, or planned cesarean deliveries were excluded from the study.

Complete data from 797 women were presented in a poster at the annual meeting of the Society for Obstetric Anesthesia and Perinatology.

The women were offered three options: parenteral fentanyl, patient-controlled anesthesia (bupivacaine), or no medication. The severity of pain was measured with a visual analog scale.

Overall, 82% of the patients chose an epidural.

The average baseline pain scores were higher among the women who chose an epidural, compared with those who did not (8.8 vs. 3.7). But there was no significant difference in epidural use among the ethnic groups, and patients in all groups reported similarly effective pain relief after epidural placement.

The ethnic groups were defined as white (103 patients), black (78 patients), Hispanic (150 patients), Chinese or Korean (338 patients), Indian (67 patients), and other ethnicities (61 patients).

Socioeconomic factors and maternal education were not factors in the use of an epidural, Dr. Lowenwirt reported.

In addition, nulliparous women were four times more likely to choose an epidural than multiparous women, regardless of ethnicity.

On further analysis, Chinese or Korean patients averaged the shortest duration of analgesia, and black patients averaged the longest duration (141 minutes vs. 185 minutes).

And there was a significant difference in average bupivacaine use between the group with the highest use (Hispanic patients) and the lowest use (Chinese or Korean patients).

The Hispanic patients who chose bupivacaine averaged 7.3 mg/hr, compared with an average of 5.5 mg/hr for the Chinese or Korean patients who chose bupivacaine, he said..

The results suggest that when equal access to epidural analgesia is available, women of all ethnic groups choose it in similar proportions, compared with no medication, the researchers wrote in the poster.

Dr. Lowenwirt said he had no financial conflicts to disclose.

WASHINGTON — Women who were able to bite down on a mouth guard had a significantly shorter second stage of labor, compared with women who didn't use a mouth guard, based on the results of a randomized trial of 64 women with uncomplicated singleton pregnancies.

Developing a way to help women push harder may shorten the second stage of labor and reduce the number of cesarean or instrumental deliveries that are associated with a longer second stage, Dr. Janna Mudd said at the annual meeting of the Society of Obstetric Anesthesia and Perinatology.

“We wanted to come up with a method that would maximize maternal expulsive effort,” she explained.

Previous studies have shown that wearing a mouth guard increases the isometric strength of different muscle groups, and the researchers hypothesized that the device (a plastic mouth guard similar to those used in sports) would encourage women to push harder during the second stage of labor.

To test this theory, Dr. Mudd and her colleagues at the University of Maryland in Baltimore randomized women at a single hospital in Baltimore to wear or not wear a mouth guard during the second stage of labor. The women were nulliparous with uncomplicated singleton term pregnancies, and an average gestational age of 39 weeks. There were no significant obstetrical demographic differences between the two groups, Dr. Mudd commented.

The researchers excluded women with diabetes, preeclampsia, or other comorbidities; those whose babies were large for gestational age; or those who had shoulder dystocia or other potential complications. A total of 38 women (19 in each group) were evaluated during the second stage of labor. Overall, the average duration of the second stage was 19 minutes in the mouth guard group vs. 31 minutes in the control group.

Each of the women in the study had received an epidural, and their pushing was directed by a doctor or midwife. The women were instructed to start pushing when they were deemed fully dilated based on a digital exam.

There were no significant differences in birth weight, head circumference, Apgar scores, umbilical arterial and venous pH, and rate of NICU admission among infants of women who used the mouth guards, compared with those women who did not wear a mouth guard.

“We also were very interested in patient satisfaction,” Dr. Mudd said. “I was surprised how many people seemed very enthusiastic and willing to try anything to avoid an operative deliver,”

Overall, the patients were very satisfied with the device and said they thought that wearing it helped them to focus while pushing, although some women reported discomfort and nausea while using the mouth guard. On average, the women who used the mouth guards rated their satisfaction as 4 on a scale of 1–5.

The researchers considered three possible mechanisms of action for the impact of a mouth guard on the second stage of labor: a direct effect on the muscles, a secondary effect on posture, and increased endurance during isometric muscle activity.

In response to a question from the audience, Dr. Mudd noted that she had no explanation for why the second stage of labor in the study population as a whole was shorter than average for nulliparous women. (The American Pregnancy Association says the second stage lasts anywhere from approximately 20 minutes to 2 hours.)

The study was limited by its small size, and more research is needed to confirm the results, Dr. Mudd said. Factors to consider in future studies include measuring the uterine pressure to identify whether the expulsive effort is greater in women who wear mouth guards during the second stage of labor, she commented.

The researchers had no financial conflicts to disclose related to the study.

WASHINGTON — Women who were able to bite down on a mouth guard had a significantly shorter second stage of labor, compared with women who didn't use a mouth guard, based on the results of a randomized trial of 64 women with uncomplicated singleton pregnancies.

Developing a way to help women push harder may shorten the second stage of labor and reduce the number of cesarean or instrumental deliveries that are associated with a longer second stage, Dr. Janna Mudd said at the annual meeting of the Society of Obstetric Anesthesia and Perinatology.

“We wanted to come up with a method that would maximize maternal expulsive effort,” she explained.

Previous studies have shown that wearing a mouth guard increases the isometric strength of different muscle groups, and the researchers hypothesized that the device (a plastic mouth guard similar to those used in sports) would encourage women to push harder during the second stage of labor.

To test this theory, Dr. Mudd and her colleagues at the University of Maryland in Baltimore randomized women at a single hospital in Baltimore to wear or not wear a mouth guard during the second stage of labor. The women were nulliparous with uncomplicated singleton term pregnancies, and an average gestational age of 39 weeks. There were no significant obstetrical demographic differences between the two groups, Dr. Mudd commented.

The researchers excluded women with diabetes, preeclampsia, or other comorbidities; those whose babies were large for gestational age; or those who had shoulder dystocia or other potential complications. A total of 38 women (19 in each group) were evaluated during the second stage of labor. Overall, the average duration of the second stage was 19 minutes in the mouth guard group vs. 31 minutes in the control group.

Each of the women in the study had received an epidural, and their pushing was directed by a doctor or midwife. The women were instructed to start pushing when they were deemed fully dilated based on a digital exam.

There were no significant differences in birth weight, head circumference, Apgar scores, umbilical arterial and venous pH, and rate of NICU admission among infants of women who used the mouth guards, compared with those women who did not wear a mouth guard.

“We also were very interested in patient satisfaction,” Dr. Mudd said. “I was surprised how many people seemed very enthusiastic and willing to try anything to avoid an operative deliver,”

Overall, the patients were very satisfied with the device and said they thought that wearing it helped them to focus while pushing, although some women reported discomfort and nausea while using the mouth guard. On average, the women who used the mouth guards rated their satisfaction as 4 on a scale of 1–5.

The researchers considered three possible mechanisms of action for the impact of a mouth guard on the second stage of labor: a direct effect on the muscles, a secondary effect on posture, and increased endurance during isometric muscle activity.

In response to a question from the audience, Dr. Mudd noted that she had no explanation for why the second stage of labor in the study population as a whole was shorter than average for nulliparous women. (The American Pregnancy Association says the second stage lasts anywhere from approximately 20 minutes to 2 hours.)

The study was limited by its small size, and more research is needed to confirm the results, Dr. Mudd said. Factors to consider in future studies include measuring the uterine pressure to identify whether the expulsive effort is greater in women who wear mouth guards during the second stage of labor, she commented.

The researchers had no financial conflicts to disclose related to the study.

WASHINGTON — Women who were able to bite down on a mouth guard had a significantly shorter second stage of labor, compared with women who didn't use a mouth guard, based on the results of a randomized trial of 64 women with uncomplicated singleton pregnancies.

Developing a way to help women push harder may shorten the second stage of labor and reduce the number of cesarean or instrumental deliveries that are associated with a longer second stage, Dr. Janna Mudd said at the annual meeting of the Society of Obstetric Anesthesia and Perinatology.

“We wanted to come up with a method that would maximize maternal expulsive effort,” she explained.

Previous studies have shown that wearing a mouth guard increases the isometric strength of different muscle groups, and the researchers hypothesized that the device (a plastic mouth guard similar to those used in sports) would encourage women to push harder during the second stage of labor.

To test this theory, Dr. Mudd and her colleagues at the University of Maryland in Baltimore randomized women at a single hospital in Baltimore to wear or not wear a mouth guard during the second stage of labor. The women were nulliparous with uncomplicated singleton term pregnancies, and an average gestational age of 39 weeks. There were no significant obstetrical demographic differences between the two groups, Dr. Mudd commented.

The researchers excluded women with diabetes, preeclampsia, or other comorbidities; those whose babies were large for gestational age; or those who had shoulder dystocia or other potential complications. A total of 38 women (19 in each group) were evaluated during the second stage of labor. Overall, the average duration of the second stage was 19 minutes in the mouth guard group vs. 31 minutes in the control group.

Each of the women in the study had received an epidural, and their pushing was directed by a doctor or midwife. The women were instructed to start pushing when they were deemed fully dilated based on a digital exam.

There were no significant differences in birth weight, head circumference, Apgar scores, umbilical arterial and venous pH, and rate of NICU admission among infants of women who used the mouth guards, compared with those women who did not wear a mouth guard.

“We also were very interested in patient satisfaction,” Dr. Mudd said. “I was surprised how many people seemed very enthusiastic and willing to try anything to avoid an operative deliver,”

Overall, the patients were very satisfied with the device and said they thought that wearing it helped them to focus while pushing, although some women reported discomfort and nausea while using the mouth guard. On average, the women who used the mouth guards rated their satisfaction as 4 on a scale of 1–5.

The researchers considered three possible mechanisms of action for the impact of a mouth guard on the second stage of labor: a direct effect on the muscles, a secondary effect on posture, and increased endurance during isometric muscle activity.

In response to a question from the audience, Dr. Mudd noted that she had no explanation for why the second stage of labor in the study population as a whole was shorter than average for nulliparous women. (The American Pregnancy Association says the second stage lasts anywhere from approximately 20 minutes to 2 hours.)

The study was limited by its small size, and more research is needed to confirm the results, Dr. Mudd said. Factors to consider in future studies include measuring the uterine pressure to identify whether the expulsive effort is greater in women who wear mouth guards during the second stage of labor, she commented.

The researchers had no financial conflicts to disclose related to the study.

The rate of serious infections in women who had medical abortions decreased by 93% after a protocol change from vaginal to buccal misoprostol combined with routine antibiotics, based on data from more than 200,000 women.

From 2001 through March 2006, Planned Parenthood health centers in the United States managed medical abortions with a combination of oral mifepristone followed by vaginal misoprostol 24–48 hours later, said Mary Fjerstad of Chapel Hill, N.C., a nurse practitioner with Planned Parenthood.

But at the end of March 2006, in response to several deaths from bacterial infections after medical abortions, the organization switched its protocol from vaginal to buccal misoprostol (200 mg mifepristone followed by 800 mcg buccal misoprostol 24–48 hours later), in addition to either routine antibiotics or screening and treatment for chlamydia. In 2007, Planned Parenthood required all its centers to provide antibiotics for all patients undergoing medical abortions (N. Engl. J. Med. 2009;361:145–51).

In this study, Ms. Fjerstad and her colleagues reviewed data from 227,823 women who had medical abortions at 78 Planned Parenthood sites throughout the United States between 2005 and 2008. The data were divided into four time periods based around changes in protocol.

In period 1 (Jan. 1, 2005, through March 31, 2006), the health care centers used vaginal misoprostol and standard antiseptic measures for fetuses through 63 days' gestation.

In period 2 (April 1, 2006, through June 30, 2007), they used buccal misoprostol for fetuses through 56 days' gestation (or, rarely, oral misoprostol through 49 days' gestation); some centers administered doxycycline to all patients, while others screened for sexually transmitted infections and treated them.

In period 3 (July 1, 2007, through Dec. 31, 2007), the health care centers used buccal misoprostol and routine doxycycline for fetuses through 56 days' gestation.

In period 4 (Jan. 1, 2008, through June 30, 2008), the centers used buccal misoprostol and routine doxycycline for fetuses through 63 days' gestation. The doxycycline regimen, when used, was 100 mg orally twice a day for 7 days.

A total of 92 serious infections were reported in the study population. Of these, most occurred in period 1 (67) and period 2 (20). Two serious infections occurred in period 3, and three occurred in period 4. The relative decrease in infections was statistically significant between periods 1 and 4. In addition, the rate of serious infection decreased significantly between periods 1 and 2 and between periods 2 and 3. The change in serious infection rate was not significant between periods 3 and 4.

“Because there was no significant increase in the rate of serious infection from period 3 to period 4, it is unlikely that a decline in the maximum gestational age from 63 days in period 1 to 56 days in period 2 explains the decline over time in the rates of serious infection observed in both groups,” the researchers noted.

The patients also were evaluated in two groups based on whether they received antibiotics only if they tested positive for a sexually transmitted infection (group 1) or received antibiotics as part of the treatment protocol (group 2). The decline in serious infection rates was significantly greater in group 2, compared with group 1 between periods 1 and 2 (93% vs. 61%), the researchers noted.

The results were limited by the retrospective nature of the study and the lack of long-term follow-up data, they said.

One of Ms. Fjerstad's coauthors, Dr. Vanessa Cullins, was also employed by Planned Parenthood at the time of the study. No other conflicts were reported.

The rate of serious infections in women who had medical abortions decreased by 93% after a protocol change from vaginal to buccal misoprostol combined with routine antibiotics, based on data from more than 200,000 women.

From 2001 through March 2006, Planned Parenthood health centers in the United States managed medical abortions with a combination of oral mifepristone followed by vaginal misoprostol 24–48 hours later, said Mary Fjerstad of Chapel Hill, N.C., a nurse practitioner with Planned Parenthood.

But at the end of March 2006, in response to several deaths from bacterial infections after medical abortions, the organization switched its protocol from vaginal to buccal misoprostol (200 mg mifepristone followed by 800 mcg buccal misoprostol 24–48 hours later), in addition to either routine antibiotics or screening and treatment for chlamydia. In 2007, Planned Parenthood required all its centers to provide antibiotics for all patients undergoing medical abortions (N. Engl. J. Med. 2009;361:145–51).

In this study, Ms. Fjerstad and her colleagues reviewed data from 227,823 women who had medical abortions at 78 Planned Parenthood sites throughout the United States between 2005 and 2008. The data were divided into four time periods based around changes in protocol.

In period 1 (Jan. 1, 2005, through March 31, 2006), the health care centers used vaginal misoprostol and standard antiseptic measures for fetuses through 63 days' gestation.

In period 2 (April 1, 2006, through June 30, 2007), they used buccal misoprostol for fetuses through 56 days' gestation (or, rarely, oral misoprostol through 49 days' gestation); some centers administered doxycycline to all patients, while others screened for sexually transmitted infections and treated them.

In period 3 (July 1, 2007, through Dec. 31, 2007), the health care centers used buccal misoprostol and routine doxycycline for fetuses through 56 days' gestation.

In period 4 (Jan. 1, 2008, through June 30, 2008), the centers used buccal misoprostol and routine doxycycline for fetuses through 63 days' gestation. The doxycycline regimen, when used, was 100 mg orally twice a day for 7 days.

A total of 92 serious infections were reported in the study population. Of these, most occurred in period 1 (67) and period 2 (20). Two serious infections occurred in period 3, and three occurred in period 4. The relative decrease in infections was statistically significant between periods 1 and 4. In addition, the rate of serious infection decreased significantly between periods 1 and 2 and between periods 2 and 3. The change in serious infection rate was not significant between periods 3 and 4.

“Because there was no significant increase in the rate of serious infection from period 3 to period 4, it is unlikely that a decline in the maximum gestational age from 63 days in period 1 to 56 days in period 2 explains the decline over time in the rates of serious infection observed in both groups,” the researchers noted.

The patients also were evaluated in two groups based on whether they received antibiotics only if they tested positive for a sexually transmitted infection (group 1) or received antibiotics as part of the treatment protocol (group 2). The decline in serious infection rates was significantly greater in group 2, compared with group 1 between periods 1 and 2 (93% vs. 61%), the researchers noted.

The results were limited by the retrospective nature of the study and the lack of long-term follow-up data, they said.

One of Ms. Fjerstad's coauthors, Dr. Vanessa Cullins, was also employed by Planned Parenthood at the time of the study. No other conflicts were reported.

The rate of serious infections in women who had medical abortions decreased by 93% after a protocol change from vaginal to buccal misoprostol combined with routine antibiotics, based on data from more than 200,000 women.

From 2001 through March 2006, Planned Parenthood health centers in the United States managed medical abortions with a combination of oral mifepristone followed by vaginal misoprostol 24–48 hours later, said Mary Fjerstad of Chapel Hill, N.C., a nurse practitioner with Planned Parenthood.

But at the end of March 2006, in response to several deaths from bacterial infections after medical abortions, the organization switched its protocol from vaginal to buccal misoprostol (200 mg mifepristone followed by 800 mcg buccal misoprostol 24–48 hours later), in addition to either routine antibiotics or screening and treatment for chlamydia. In 2007, Planned Parenthood required all its centers to provide antibiotics for all patients undergoing medical abortions (N. Engl. J. Med. 2009;361:145–51).

In this study, Ms. Fjerstad and her colleagues reviewed data from 227,823 women who had medical abortions at 78 Planned Parenthood sites throughout the United States between 2005 and 2008. The data were divided into four time periods based around changes in protocol.

In period 1 (Jan. 1, 2005, through March 31, 2006), the health care centers used vaginal misoprostol and standard antiseptic measures for fetuses through 63 days' gestation.

In period 2 (April 1, 2006, through June 30, 2007), they used buccal misoprostol for fetuses through 56 days' gestation (or, rarely, oral misoprostol through 49 days' gestation); some centers administered doxycycline to all patients, while others screened for sexually transmitted infections and treated them.

In period 3 (July 1, 2007, through Dec. 31, 2007), the health care centers used buccal misoprostol and routine doxycycline for fetuses through 56 days' gestation.

In period 4 (Jan. 1, 2008, through June 30, 2008), the centers used buccal misoprostol and routine doxycycline for fetuses through 63 days' gestation. The doxycycline regimen, when used, was 100 mg orally twice a day for 7 days.

A total of 92 serious infections were reported in the study population. Of these, most occurred in period 1 (67) and period 2 (20). Two serious infections occurred in period 3, and three occurred in period 4. The relative decrease in infections was statistically significant between periods 1 and 4. In addition, the rate of serious infection decreased significantly between periods 1 and 2 and between periods 2 and 3. The change in serious infection rate was not significant between periods 3 and 4.

“Because there was no significant increase in the rate of serious infection from period 3 to period 4, it is unlikely that a decline in the maximum gestational age from 63 days in period 1 to 56 days in period 2 explains the decline over time in the rates of serious infection observed in both groups,” the researchers noted.

The patients also were evaluated in two groups based on whether they received antibiotics only if they tested positive for a sexually transmitted infection (group 1) or received antibiotics as part of the treatment protocol (group 2). The decline in serious infection rates was significantly greater in group 2, compared with group 1 between periods 1 and 2 (93% vs. 61%), the researchers noted.

The results were limited by the retrospective nature of the study and the lack of long-term follow-up data, they said.

One of Ms. Fjerstad's coauthors, Dr. Vanessa Cullins, was also employed by Planned Parenthood at the time of the study. No other conflicts were reported.

BETHESDA, MD. — The most likely scenario involving the influenza A(H1N1) virus this fall is that young people in schools will be disproportionately affected, said Dr. Anne Schuchat, director of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention.

“We might need to offer interventions to people who aren't used to getting even a seasonal influenza vaccine,” Dr. Schuchat said during a breakout session on vaccine preparation and distribution at an H1N1 Influenza Preparedness Summit sponsored by the National Institutes of Health.

[Since the session, children were named one of the target groups for priority H1N1 vaccination by the CDC's Advisory Committee on Immunization Practices (see page 1)].

The CDC's H1N1 Vaccine Task Force developed a guidance document with a best-case planning scenario, so clinicians have some idea what might unfold if the number of H1N1 viral infections surges in the fall.

The document describes likely target populations and presents ideas for where and how the H1N1 vaccines could be administered.

Students and staff associated with schools, children aged 6 months and older, child care center staff, and health care workers would be among those on the high-priority list in the likely event that the vaccine's availability is limited. In a best-case scenario, students would be vaccinated at schools and child care centers, and health care workers would be vaccinated in their work environments.

The goal in any emergency is to “keep our children safe and keep them learning,” Arne Duncan, secretary of the Department of Education, said at the summit's morning session. School closings are a last resort, and more guidance is needed at the local level to help schools make informed decisions about what level of illness merits a closing. However, “most school districts have developed good emergency plans,” he added.

Heath and Human Services Secretary Kathleen Sebelius encouraged everyone—clinicians and the public—to visit www.flu.gov

The presenters had no financial conflicts to disclose.

The guidance document is available at www.cdc.gov/h1n1flu/vaccination/statelocal/planning.htm

BETHESDA, MD. — The most likely scenario involving the influenza A(H1N1) virus this fall is that young people in schools will be disproportionately affected, said Dr. Anne Schuchat, director of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention.

“We might need to offer interventions to people who aren't used to getting even a seasonal influenza vaccine,” Dr. Schuchat said during a breakout session on vaccine preparation and distribution at an H1N1 Influenza Preparedness Summit sponsored by the National Institutes of Health.

[Since the session, children were named one of the target groups for priority H1N1 vaccination by the CDC's Advisory Committee on Immunization Practices (see page 1)].

The CDC's H1N1 Vaccine Task Force developed a guidance document with a best-case planning scenario, so clinicians have some idea what might unfold if the number of H1N1 viral infections surges in the fall.

The document describes likely target populations and presents ideas for where and how the H1N1 vaccines could be administered.

Students and staff associated with schools, children aged 6 months and older, child care center staff, and health care workers would be among those on the high-priority list in the likely event that the vaccine's availability is limited. In a best-case scenario, students would be vaccinated at schools and child care centers, and health care workers would be vaccinated in their work environments.

The goal in any emergency is to “keep our children safe and keep them learning,” Arne Duncan, secretary of the Department of Education, said at the summit's morning session. School closings are a last resort, and more guidance is needed at the local level to help schools make informed decisions about what level of illness merits a closing. However, “most school districts have developed good emergency plans,” he added.

Heath and Human Services Secretary Kathleen Sebelius encouraged everyone—clinicians and the public—to visit www.flu.gov

The presenters had no financial conflicts to disclose.

The guidance document is available at www.cdc.gov/h1n1flu/vaccination/statelocal/planning.htm

BETHESDA, MD. — The most likely scenario involving the influenza A(H1N1) virus this fall is that young people in schools will be disproportionately affected, said Dr. Anne Schuchat, director of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention.

“We might need to offer interventions to people who aren't used to getting even a seasonal influenza vaccine,” Dr. Schuchat said during a breakout session on vaccine preparation and distribution at an H1N1 Influenza Preparedness Summit sponsored by the National Institutes of Health.

[Since the session, children were named one of the target groups for priority H1N1 vaccination by the CDC's Advisory Committee on Immunization Practices (see page 1)].

The CDC's H1N1 Vaccine Task Force developed a guidance document with a best-case planning scenario, so clinicians have some idea what might unfold if the number of H1N1 viral infections surges in the fall.

The document describes likely target populations and presents ideas for where and how the H1N1 vaccines could be administered.

Students and staff associated with schools, children aged 6 months and older, child care center staff, and health care workers would be among those on the high-priority list in the likely event that the vaccine's availability is limited. In a best-case scenario, students would be vaccinated at schools and child care centers, and health care workers would be vaccinated in their work environments.

The goal in any emergency is to “keep our children safe and keep them learning,” Arne Duncan, secretary of the Department of Education, said at the summit's morning session. School closings are a last resort, and more guidance is needed at the local level to help schools make informed decisions about what level of illness merits a closing. However, “most school districts have developed good emergency plans,” he added.

Heath and Human Services Secretary Kathleen Sebelius encouraged everyone—clinicians and the public—to visit www.flu.gov

The presenters had no financial conflicts to disclose.

The guidance document is available at www.cdc.gov/h1n1flu/vaccination/statelocal/planning.htm