Doug Brunk

Women who followed the Dietary Approaches to Stop Hypertension diet had significant risk reductions of coronary heart disease and stroke, results from a cohort of participants in the ongoing Nurses Health Study showed.

Previous studies have shown that the diet—heavy in fruits and vegetables—lowers blood pressure and blood lipids, but this marks the first time benefit on a disease state has been demonstrated.

Developed by researchers funded by the National Heart, Lung and Blood Institute in the 1990s, the Dietary Approaches to Stop Hypertension (DASH) diet is low in cholesterol and sodium and contains no more than 30% of calories from fat.

Teresa Fung, Sc.D., and associates, who presented the study at the annual scientific sessions of the American Heart Association, evaluated 88,415 women from the Nurses Health Study who were aged 34–59 years in 1980 and had no history of cardiovascular disease or diabetes. The researchers used a questionnaire to assess the women's diet seven times over 24 years of follow-up and used medical records to tabulate their incidence of cardiovascular disease and stroke.

Patients were divided into quintiles on the basis of how closely they followed the diet, with quintile 1 being poorly followed (the bottom 20%) and quintile 5 being well followed (the top 20%). Cox proportional hazard analysis was used to adjust for potential confounders such as age, smoking, family history of coronary heart disease (CHD) and stroke, and level of physical activity.

Over the 24-year follow-up there were 1,876 cases of nonfatal myocardial infarction, 883 deaths due to coronary heart disease, and 2,317 strokes. The researchers observed significantly lower risks of CHD and stroke when they compared quintile 5 with quintile 1. (See box.)

“This is more evidence to promote this diet,” said Dr. Fung, associate professor of nutrition at Simmons College, Boston.

She said she was surprised that the magnitude of effect was greater for CHD than for stroke.

The researchers also observed that the risk reduction for stroke was much stronger in women who had a history of hypertension at baseline, compared with those who did not. The study was funded by the National Institutes of Health.

ELSEVIER GLOBAL MEDICAL NEWS

Women who followed the Dietary Approaches to Stop Hypertension diet had significant risk reductions of coronary heart disease and stroke, results from a cohort of participants in the ongoing Nurses Health Study showed.

Previous studies have shown that the diet—heavy in fruits and vegetables—lowers blood pressure and blood lipids, but this marks the first time benefit on a disease state has been demonstrated.

Developed by researchers funded by the National Heart, Lung and Blood Institute in the 1990s, the Dietary Approaches to Stop Hypertension (DASH) diet is low in cholesterol and sodium and contains no more than 30% of calories from fat.

Teresa Fung, Sc.D., and associates, who presented the study at the annual scientific sessions of the American Heart Association, evaluated 88,415 women from the Nurses Health Study who were aged 34–59 years in 1980 and had no history of cardiovascular disease or diabetes. The researchers used a questionnaire to assess the women's diet seven times over 24 years of follow-up and used medical records to tabulate their incidence of cardiovascular disease and stroke.

Patients were divided into quintiles on the basis of how closely they followed the diet, with quintile 1 being poorly followed (the bottom 20%) and quintile 5 being well followed (the top 20%). Cox proportional hazard analysis was used to adjust for potential confounders such as age, smoking, family history of coronary heart disease (CHD) and stroke, and level of physical activity.

Over the 24-year follow-up there were 1,876 cases of nonfatal myocardial infarction, 883 deaths due to coronary heart disease, and 2,317 strokes. The researchers observed significantly lower risks of CHD and stroke when they compared quintile 5 with quintile 1. (See box.)

“This is more evidence to promote this diet,” said Dr. Fung, associate professor of nutrition at Simmons College, Boston.

She said she was surprised that the magnitude of effect was greater for CHD than for stroke.

The researchers also observed that the risk reduction for stroke was much stronger in women who had a history of hypertension at baseline, compared with those who did not. The study was funded by the National Institutes of Health.

ELSEVIER GLOBAL MEDICAL NEWS

Women who followed the Dietary Approaches to Stop Hypertension diet had significant risk reductions of coronary heart disease and stroke, results from a cohort of participants in the ongoing Nurses Health Study showed.

Previous studies have shown that the diet—heavy in fruits and vegetables—lowers blood pressure and blood lipids, but this marks the first time benefit on a disease state has been demonstrated.

Developed by researchers funded by the National Heart, Lung and Blood Institute in the 1990s, the Dietary Approaches to Stop Hypertension (DASH) diet is low in cholesterol and sodium and contains no more than 30% of calories from fat.

Teresa Fung, Sc.D., and associates, who presented the study at the annual scientific sessions of the American Heart Association, evaluated 88,415 women from the Nurses Health Study who were aged 34–59 years in 1980 and had no history of cardiovascular disease or diabetes. The researchers used a questionnaire to assess the women's diet seven times over 24 years of follow-up and used medical records to tabulate their incidence of cardiovascular disease and stroke.

Patients were divided into quintiles on the basis of how closely they followed the diet, with quintile 1 being poorly followed (the bottom 20%) and quintile 5 being well followed (the top 20%). Cox proportional hazard analysis was used to adjust for potential confounders such as age, smoking, family history of coronary heart disease (CHD) and stroke, and level of physical activity.

Over the 24-year follow-up there were 1,876 cases of nonfatal myocardial infarction, 883 deaths due to coronary heart disease, and 2,317 strokes. The researchers observed significantly lower risks of CHD and stroke when they compared quintile 5 with quintile 1. (See box.)

“This is more evidence to promote this diet,” said Dr. Fung, associate professor of nutrition at Simmons College, Boston.

She said she was surprised that the magnitude of effect was greater for CHD than for stroke.

The researchers also observed that the risk reduction for stroke was much stronger in women who had a history of hypertension at baseline, compared with those who did not. The study was funded by the National Institutes of Health.

ELSEVIER GLOBAL MEDICAL NEWS

Women with a so-called empty calorie diet—high in sweetened beverages, red meat, and desserts—had significantly elevated intima-media thickness, compared with women who followed other dietary patterns, including those high in fat.

The finding comes from an analysis of the Framingham Heart Offspring/Spouse Study that was presented during a poster session at the annual scientific sessions of the American Heart Association.

“Any diet that consists of regular intake of a lot of fatty food, a lot of sugary food including sugary drinks, and not a lot of low-fat dairy, fruits, or vegetables is probably setting a woman up for cardiovascular problems,” lead study author Lisa S. Brown, said in an interview.

Ms. Brown and her associates analyzed data from 1,278 women with a mean age of 58 years who participated in the Framingham Offspring/Spouse Study and who completed the Framingham food frequency questionnaire during 1984–1988, underwent intima-media thickness measurement via ultrasound at exam 6 (1996–1998), and were free of cardiovascular disease at exam 6.

“A lot of intima-media thickness and diet work has looked at specific nutrients—especially antioxidants and different types of fats,” noted Ms. Brown, a registered dietitian who is a doctoral candidate in medical nutrition sciences at Boston University. “None have looked at diet in such a comprehensive manner.” Based on how the women responded to validated Framingham food frequency questionnaire, the researchers placed them into one of five dietary patterns:

▸ Heart healthy. The 250 women in this group eat more fruits and vegetables than women in the other groups. “We think this is a group that changed their diet some time in their adult life and that they make an effort to be health conscious,” she said.

▸ Light eating. The 612 women in this group are chronic dieters who consume the least amount of sweets and take in the least amount of calories. “But they tend to be a little heavier than we would expect them to be based on their dietary intake,” she said.

▸ Wine and moderate eating. The 45 women in this group consume about two alcoholic drinks per day. Their diet also is highest in cholesterol and lowest in calcium.

▸ High fat. The 266 women in this group “get a lot of their calories from refined grains and vegetable fats both hard and soft, so they get a lot of margarine and oils,” Ms. Brown said. “Their saturated fat is the highest [among] all the groups but for some reason they are also the least likely to be overweight or obese. We don't know why, and we are still trying to figure out what makes this group different from what we expect.”

▸ Empty calorie. The 105 women in this group consume seven to eight times more soda and other sweetened beverages, compared with their counterparts. They also consume more red meat and desserts and eat fewer fruits, vegetables, and micronutrients than women in the other groups. In addition, empty calories dieters are likely to smoke and have a higher body mass index than women in the other groups.

Women in the empty calorie group had maximum carotid intima-media thickness of 1.46 mm, which was significantly higher than that of women in the heart healthy group (1.18 mm), light eating group (1.22 mm), wine and moderate eating group (1.27 mm), and high fat group (1.17 mm). This relationship remained significant even after controlling for risk factors.

“We suspect that … intima-media thickness is a really good indicator of lifetime exposure to all the things that cause heart disease risk including poor diet, high blood pressure, high cholesterol, smoking, and physical inactivity,” Ms. Brown said.

Women with a so-called empty calorie diet—high in sweetened beverages, red meat, and desserts—had significantly elevated intima-media thickness, compared with women who followed other dietary patterns, including those high in fat.

The finding comes from an analysis of the Framingham Heart Offspring/Spouse Study that was presented during a poster session at the annual scientific sessions of the American Heart Association.

“Any diet that consists of regular intake of a lot of fatty food, a lot of sugary food including sugary drinks, and not a lot of low-fat dairy, fruits, or vegetables is probably setting a woman up for cardiovascular problems,” lead study author Lisa S. Brown, said in an interview.

Ms. Brown and her associates analyzed data from 1,278 women with a mean age of 58 years who participated in the Framingham Offspring/Spouse Study and who completed the Framingham food frequency questionnaire during 1984–1988, underwent intima-media thickness measurement via ultrasound at exam 6 (1996–1998), and were free of cardiovascular disease at exam 6.

“A lot of intima-media thickness and diet work has looked at specific nutrients—especially antioxidants and different types of fats,” noted Ms. Brown, a registered dietitian who is a doctoral candidate in medical nutrition sciences at Boston University. “None have looked at diet in such a comprehensive manner.” Based on how the women responded to validated Framingham food frequency questionnaire, the researchers placed them into one of five dietary patterns:

▸ Heart healthy. The 250 women in this group eat more fruits and vegetables than women in the other groups. “We think this is a group that changed their diet some time in their adult life and that they make an effort to be health conscious,” she said.

▸ Light eating. The 612 women in this group are chronic dieters who consume the least amount of sweets and take in the least amount of calories. “But they tend to be a little heavier than we would expect them to be based on their dietary intake,” she said.

▸ Wine and moderate eating. The 45 women in this group consume about two alcoholic drinks per day. Their diet also is highest in cholesterol and lowest in calcium.

▸ High fat. The 266 women in this group “get a lot of their calories from refined grains and vegetable fats both hard and soft, so they get a lot of margarine and oils,” Ms. Brown said. “Their saturated fat is the highest [among] all the groups but for some reason they are also the least likely to be overweight or obese. We don't know why, and we are still trying to figure out what makes this group different from what we expect.”

▸ Empty calorie. The 105 women in this group consume seven to eight times more soda and other sweetened beverages, compared with their counterparts. They also consume more red meat and desserts and eat fewer fruits, vegetables, and micronutrients than women in the other groups. In addition, empty calories dieters are likely to smoke and have a higher body mass index than women in the other groups.

Women in the empty calorie group had maximum carotid intima-media thickness of 1.46 mm, which was significantly higher than that of women in the heart healthy group (1.18 mm), light eating group (1.22 mm), wine and moderate eating group (1.27 mm), and high fat group (1.17 mm). This relationship remained significant even after controlling for risk factors.

“We suspect that … intima-media thickness is a really good indicator of lifetime exposure to all the things that cause heart disease risk including poor diet, high blood pressure, high cholesterol, smoking, and physical inactivity,” Ms. Brown said.

Women with a so-called empty calorie diet—high in sweetened beverages, red meat, and desserts—had significantly elevated intima-media thickness, compared with women who followed other dietary patterns, including those high in fat.

The finding comes from an analysis of the Framingham Heart Offspring/Spouse Study that was presented during a poster session at the annual scientific sessions of the American Heart Association.

“Any diet that consists of regular intake of a lot of fatty food, a lot of sugary food including sugary drinks, and not a lot of low-fat dairy, fruits, or vegetables is probably setting a woman up for cardiovascular problems,” lead study author Lisa S. Brown, said in an interview.

Ms. Brown and her associates analyzed data from 1,278 women with a mean age of 58 years who participated in the Framingham Offspring/Spouse Study and who completed the Framingham food frequency questionnaire during 1984–1988, underwent intima-media thickness measurement via ultrasound at exam 6 (1996–1998), and were free of cardiovascular disease at exam 6.

“A lot of intima-media thickness and diet work has looked at specific nutrients—especially antioxidants and different types of fats,” noted Ms. Brown, a registered dietitian who is a doctoral candidate in medical nutrition sciences at Boston University. “None have looked at diet in such a comprehensive manner.” Based on how the women responded to validated Framingham food frequency questionnaire, the researchers placed them into one of five dietary patterns:

▸ Heart healthy. The 250 women in this group eat more fruits and vegetables than women in the other groups. “We think this is a group that changed their diet some time in their adult life and that they make an effort to be health conscious,” she said.

▸ Light eating. The 612 women in this group are chronic dieters who consume the least amount of sweets and take in the least amount of calories. “But they tend to be a little heavier than we would expect them to be based on their dietary intake,” she said.

▸ Wine and moderate eating. The 45 women in this group consume about two alcoholic drinks per day. Their diet also is highest in cholesterol and lowest in calcium.

▸ High fat. The 266 women in this group “get a lot of their calories from refined grains and vegetable fats both hard and soft, so they get a lot of margarine and oils,” Ms. Brown said. “Their saturated fat is the highest [among] all the groups but for some reason they are also the least likely to be overweight or obese. We don't know why, and we are still trying to figure out what makes this group different from what we expect.”

▸ Empty calorie. The 105 women in this group consume seven to eight times more soda and other sweetened beverages, compared with their counterparts. They also consume more red meat and desserts and eat fewer fruits, vegetables, and micronutrients than women in the other groups. In addition, empty calories dieters are likely to smoke and have a higher body mass index than women in the other groups.

Women in the empty calorie group had maximum carotid intima-media thickness of 1.46 mm, which was significantly higher than that of women in the heart healthy group (1.18 mm), light eating group (1.22 mm), wine and moderate eating group (1.27 mm), and high fat group (1.17 mm). This relationship remained significant even after controlling for risk factors.

“We suspect that … intima-media thickness is a really good indicator of lifetime exposure to all the things that cause heart disease risk including poor diet, high blood pressure, high cholesterol, smoking, and physical inactivity,” Ms. Brown said.

SAN DIEGO — Cases of Rocky Mountain spotted fever increased nearly threefold between 2001 and 2005, John Openshaw reported at the annual meeting of the Infectious Diseases Society of America.

The rising number of suburban homes that encroach on rural areas is one possible reason for the spike in reported cases. “Increased physician awareness and increased surveillance efforts are [also] involved,” Mr. Openshaw said during a press briefing. “The true explanation is likely a combination of many factors.”

Rocky Mountain spotted fever is caused by the Rickettsia rickettsii bacteria, which are typically spread through tick bites. Early signs include acute onset of fever and other flulike symptoms followed by rash.

“The biggest problem is that people don't often remember being bitten by a tick, and by the time the classic rash appears, the disease has already progressed significantly, and it may be too late,” Dr. David Swerdlow, previous team leader for the rickettsial zoonoses branch of the Centers for Disease Control and Prevention, said in a statement.

Researchers analyzed data from the National Electronic Telecommunications System for Surveillance and found that during 2001–2005, there were 6,598 cases of Rocky Mountain spotted fever reported in 45 states, said Mr. Openshaw, a medical student at the University of Pennsylvania, Philadelphia, who worked on the study during a CDC Applied Epidemiology Fellowship in 2006. The disease resulted in death in 22 people (0.3%).

The number of cases in the United States increased from 695 cases in 2001 to 1,936 cases in 2005. The incidence was higher in suburban areas than rural ones, and the largest increase was in the southern Atlantic states.

Despite the increase in cases, the rates of hospitalization fell from 29% in 2001 to 18% in 2005, while the rates of complications from the disease fell from 8% to 4%. Immunocompromised patients were most likely to be hospitalized with the disease (41%), followed by adults over the age of 70 (40%) and children under the age of 5 (35%).

The disease was reported in every state except Alaska, California, Hawaii, Maine, and Washington. “Physicians should be aware of the increase in Rocky Mountain spotted fever,” he said.

'Physicians should be aware of the increase in Rocky Mountain spotted fever.' MR. OPENSHAW

SAN DIEGO — Cases of Rocky Mountain spotted fever increased nearly threefold between 2001 and 2005, John Openshaw reported at the annual meeting of the Infectious Diseases Society of America.

The rising number of suburban homes that encroach on rural areas is one possible reason for the spike in reported cases. “Increased physician awareness and increased surveillance efforts are [also] involved,” Mr. Openshaw said during a press briefing. “The true explanation is likely a combination of many factors.”

Rocky Mountain spotted fever is caused by the Rickettsia rickettsii bacteria, which are typically spread through tick bites. Early signs include acute onset of fever and other flulike symptoms followed by rash.

“The biggest problem is that people don't often remember being bitten by a tick, and by the time the classic rash appears, the disease has already progressed significantly, and it may be too late,” Dr. David Swerdlow, previous team leader for the rickettsial zoonoses branch of the Centers for Disease Control and Prevention, said in a statement.

Researchers analyzed data from the National Electronic Telecommunications System for Surveillance and found that during 2001–2005, there were 6,598 cases of Rocky Mountain spotted fever reported in 45 states, said Mr. Openshaw, a medical student at the University of Pennsylvania, Philadelphia, who worked on the study during a CDC Applied Epidemiology Fellowship in 2006. The disease resulted in death in 22 people (0.3%).

The number of cases in the United States increased from 695 cases in 2001 to 1,936 cases in 2005. The incidence was higher in suburban areas than rural ones, and the largest increase was in the southern Atlantic states.

Despite the increase in cases, the rates of hospitalization fell from 29% in 2001 to 18% in 2005, while the rates of complications from the disease fell from 8% to 4%. Immunocompromised patients were most likely to be hospitalized with the disease (41%), followed by adults over the age of 70 (40%) and children under the age of 5 (35%).

The disease was reported in every state except Alaska, California, Hawaii, Maine, and Washington. “Physicians should be aware of the increase in Rocky Mountain spotted fever,” he said.

'Physicians should be aware of the increase in Rocky Mountain spotted fever.' MR. OPENSHAW

SAN DIEGO — Cases of Rocky Mountain spotted fever increased nearly threefold between 2001 and 2005, John Openshaw reported at the annual meeting of the Infectious Diseases Society of America.

The rising number of suburban homes that encroach on rural areas is one possible reason for the spike in reported cases. “Increased physician awareness and increased surveillance efforts are [also] involved,” Mr. Openshaw said during a press briefing. “The true explanation is likely a combination of many factors.”

Rocky Mountain spotted fever is caused by the Rickettsia rickettsii bacteria, which are typically spread through tick bites. Early signs include acute onset of fever and other flulike symptoms followed by rash.

“The biggest problem is that people don't often remember being bitten by a tick, and by the time the classic rash appears, the disease has already progressed significantly, and it may be too late,” Dr. David Swerdlow, previous team leader for the rickettsial zoonoses branch of the Centers for Disease Control and Prevention, said in a statement.

Researchers analyzed data from the National Electronic Telecommunications System for Surveillance and found that during 2001–2005, there were 6,598 cases of Rocky Mountain spotted fever reported in 45 states, said Mr. Openshaw, a medical student at the University of Pennsylvania, Philadelphia, who worked on the study during a CDC Applied Epidemiology Fellowship in 2006. The disease resulted in death in 22 people (0.3%).

The number of cases in the United States increased from 695 cases in 2001 to 1,936 cases in 2005. The incidence was higher in suburban areas than rural ones, and the largest increase was in the southern Atlantic states.

Despite the increase in cases, the rates of hospitalization fell from 29% in 2001 to 18% in 2005, while the rates of complications from the disease fell from 8% to 4%. Immunocompromised patients were most likely to be hospitalized with the disease (41%), followed by adults over the age of 70 (40%) and children under the age of 5 (35%).

The disease was reported in every state except Alaska, California, Hawaii, Maine, and Washington. “Physicians should be aware of the increase in Rocky Mountain spotted fever,” he said.

'Physicians should be aware of the increase in Rocky Mountain spotted fever.' MR. OPENSHAW

CORONADO, CALIF. — It is a wise rheumatologist who knows when to refer a child to a dermatologist, judging from cases reported at the annual meeting of the Pacific Dermatologic Association. Dr. Anna L. Bruckner discussed two such cases.

The first was that of a 9-year-old girl who was referred by a rheumatologist for evaluation of possible dermatomyositis.

The girl had a 4-month history of intermittent redness and swelling of the hands that worsened after prolonged outdoor activities.

The girl was healthy and described one remote episode of burning hands following a hike several years before. She was on naproxen and ranitidine, which had been prescribed by the rheumatologist as treatment for the redness and swelling.

“The work-up by the rheumatologist was negative for autoimmune disease,” said Dr. Bruckner.

Clinical exam revealed a few waxy papules and plaques distributed over the knuckles. Her hands also had a slightly weather-beaten appearance. A skin biopsy showed cuffs of hyaline material around the superficial blood vessels in the upper dermis, suggesting a diagnosis of erythropoietic protoporphyria (EPP). Confirmatory studies demonstrated that the patient had elevated total red blood cell porphyrins with a predominance of free protoporphyrin.

EPP is the most common type of porphyria in children. It presents between 1 and 6 years of age and symptoms include burning, stinging, redness, and edema, all of which occur following sun exposure.

The condition is caused by a deficiency of ferrochelatase, which leads to accumulation of protoporphyrin IX.

Treatment involves sun avoidance, sunscreens, and beta-carotene 30–150 mg/day.

In the second case, a 6-year-old girl with suspected loose anagen syndrome was referred to Dr. Bruckner, who is director of pediatric dermatology at Lucile Packard Children's Hospital in Palo Alto, Calif. In this condition, the anagen hairs are loosely anchored into the scalp so that the hair will fall out with very minor trauma. The hair is short, sparse, and seldom cut. It typically is seen in blond girls aged 2–5 years, but can affect boys and brunettes as well.

Many of the girl's friends at school “had long, flowing hair and she wanted to see if there was something we could do about her hair,” Dr. Bruckner said. She did a gentle hair pull test and only two hairs came out. The girl's hair was very short and had a matted appearance in the back.

Dr. Bruckner prescribed 5% minoxidil lotion and scheduled a 3-month follow-up visit. On follow-up the girl's hair was fuller but it remained short and gentle hair pull tests remained negative.

“We obtained some additional history,” Dr. Bruckner recalled. “Her nails were thin, often peeled, and never required trimming. She had no history of dental anomalies, and she'd had a coarse, deep voice since age 2. Her mother said that she looked different than her siblings.”

She also had sparse lateral eyebrows, a pear-shaped nose, and a thin upper lip.

The girl's combination of short, sparse hair and abnormal facial features led Dr. Bruckner to consider trichorhinophalangeal syndrome (TRPS) type 1 as the diagnosis.

An x-ray of the girl's hand performed after her follow-up visit revealed cone-shaped epiphyses of the phalanges, which confirmed the diagnosis. TRPS type 1 is an autosomal dominant disorder characterized by craniofacial and bony abnormalities that include sparse, slow-growing hair and thin lateral eyebrows, a pear-shaped nose, elongated philtrum and thin upper lip, prominent ears, and cone-shaped epiphyses of the phalanges.

Variable findings include short stature (the patient was in the 25th percentile for height), nail abnormalities, teeth abnormalities, and a deep voice. The condition is caused by mutations in the TRPS1 gene.

Although there is no specific treatment for TRPS type 1, the girl's parents were happy to better understand why their daughter's hair failed to grow normally. She has continued to use 5% minoxidil for 6 months with some improvement.

Variable findings of TRPS type 1 include short stature, nail and/or teeth abnormalities, and a deep voice. DR. BRUCKNER

Waxy papules and plaques are shown on a girl with erythropoietic protoporphyria. Courtesy Dr. Anna L. Bruckner

CORONADO, CALIF. — It is a wise rheumatologist who knows when to refer a child to a dermatologist, judging from cases reported at the annual meeting of the Pacific Dermatologic Association. Dr. Anna L. Bruckner discussed two such cases.

The first was that of a 9-year-old girl who was referred by a rheumatologist for evaluation of possible dermatomyositis.

The girl had a 4-month history of intermittent redness and swelling of the hands that worsened after prolonged outdoor activities.

The girl was healthy and described one remote episode of burning hands following a hike several years before. She was on naproxen and ranitidine, which had been prescribed by the rheumatologist as treatment for the redness and swelling.

“The work-up by the rheumatologist was negative for autoimmune disease,” said Dr. Bruckner.

Clinical exam revealed a few waxy papules and plaques distributed over the knuckles. Her hands also had a slightly weather-beaten appearance. A skin biopsy showed cuffs of hyaline material around the superficial blood vessels in the upper dermis, suggesting a diagnosis of erythropoietic protoporphyria (EPP). Confirmatory studies demonstrated that the patient had elevated total red blood cell porphyrins with a predominance of free protoporphyrin.

EPP is the most common type of porphyria in children. It presents between 1 and 6 years of age and symptoms include burning, stinging, redness, and edema, all of which occur following sun exposure.

The condition is caused by a deficiency of ferrochelatase, which leads to accumulation of protoporphyrin IX.

Treatment involves sun avoidance, sunscreens, and beta-carotene 30–150 mg/day.

In the second case, a 6-year-old girl with suspected loose anagen syndrome was referred to Dr. Bruckner, who is director of pediatric dermatology at Lucile Packard Children's Hospital in Palo Alto, Calif. In this condition, the anagen hairs are loosely anchored into the scalp so that the hair will fall out with very minor trauma. The hair is short, sparse, and seldom cut. It typically is seen in blond girls aged 2–5 years, but can affect boys and brunettes as well.

Many of the girl's friends at school “had long, flowing hair and she wanted to see if there was something we could do about her hair,” Dr. Bruckner said. She did a gentle hair pull test and only two hairs came out. The girl's hair was very short and had a matted appearance in the back.

Dr. Bruckner prescribed 5% minoxidil lotion and scheduled a 3-month follow-up visit. On follow-up the girl's hair was fuller but it remained short and gentle hair pull tests remained negative.

“We obtained some additional history,” Dr. Bruckner recalled. “Her nails were thin, often peeled, and never required trimming. She had no history of dental anomalies, and she'd had a coarse, deep voice since age 2. Her mother said that she looked different than her siblings.”

She also had sparse lateral eyebrows, a pear-shaped nose, and a thin upper lip.

The girl's combination of short, sparse hair and abnormal facial features led Dr. Bruckner to consider trichorhinophalangeal syndrome (TRPS) type 1 as the diagnosis.

An x-ray of the girl's hand performed after her follow-up visit revealed cone-shaped epiphyses of the phalanges, which confirmed the diagnosis. TRPS type 1 is an autosomal dominant disorder characterized by craniofacial and bony abnormalities that include sparse, slow-growing hair and thin lateral eyebrows, a pear-shaped nose, elongated philtrum and thin upper lip, prominent ears, and cone-shaped epiphyses of the phalanges.

Variable findings include short stature (the patient was in the 25th percentile for height), nail abnormalities, teeth abnormalities, and a deep voice. The condition is caused by mutations in the TRPS1 gene.

Although there is no specific treatment for TRPS type 1, the girl's parents were happy to better understand why their daughter's hair failed to grow normally. She has continued to use 5% minoxidil for 6 months with some improvement.

Variable findings of TRPS type 1 include short stature, nail and/or teeth abnormalities, and a deep voice. DR. BRUCKNER

Waxy papules and plaques are shown on a girl with erythropoietic protoporphyria. Courtesy Dr. Anna L. Bruckner

CORONADO, CALIF. — It is a wise rheumatologist who knows when to refer a child to a dermatologist, judging from cases reported at the annual meeting of the Pacific Dermatologic Association. Dr. Anna L. Bruckner discussed two such cases.

The first was that of a 9-year-old girl who was referred by a rheumatologist for evaluation of possible dermatomyositis.

The girl had a 4-month history of intermittent redness and swelling of the hands that worsened after prolonged outdoor activities.

The girl was healthy and described one remote episode of burning hands following a hike several years before. She was on naproxen and ranitidine, which had been prescribed by the rheumatologist as treatment for the redness and swelling.

“The work-up by the rheumatologist was negative for autoimmune disease,” said Dr. Bruckner.

Clinical exam revealed a few waxy papules and plaques distributed over the knuckles. Her hands also had a slightly weather-beaten appearance. A skin biopsy showed cuffs of hyaline material around the superficial blood vessels in the upper dermis, suggesting a diagnosis of erythropoietic protoporphyria (EPP). Confirmatory studies demonstrated that the patient had elevated total red blood cell porphyrins with a predominance of free protoporphyrin.

EPP is the most common type of porphyria in children. It presents between 1 and 6 years of age and symptoms include burning, stinging, redness, and edema, all of which occur following sun exposure.

The condition is caused by a deficiency of ferrochelatase, which leads to accumulation of protoporphyrin IX.

Treatment involves sun avoidance, sunscreens, and beta-carotene 30–150 mg/day.

In the second case, a 6-year-old girl with suspected loose anagen syndrome was referred to Dr. Bruckner, who is director of pediatric dermatology at Lucile Packard Children's Hospital in Palo Alto, Calif. In this condition, the anagen hairs are loosely anchored into the scalp so that the hair will fall out with very minor trauma. The hair is short, sparse, and seldom cut. It typically is seen in blond girls aged 2–5 years, but can affect boys and brunettes as well.

Many of the girl's friends at school “had long, flowing hair and she wanted to see if there was something we could do about her hair,” Dr. Bruckner said. She did a gentle hair pull test and only two hairs came out. The girl's hair was very short and had a matted appearance in the back.

Dr. Bruckner prescribed 5% minoxidil lotion and scheduled a 3-month follow-up visit. On follow-up the girl's hair was fuller but it remained short and gentle hair pull tests remained negative.

“We obtained some additional history,” Dr. Bruckner recalled. “Her nails were thin, often peeled, and never required trimming. She had no history of dental anomalies, and she'd had a coarse, deep voice since age 2. Her mother said that she looked different than her siblings.”

She also had sparse lateral eyebrows, a pear-shaped nose, and a thin upper lip.

The girl's combination of short, sparse hair and abnormal facial features led Dr. Bruckner to consider trichorhinophalangeal syndrome (TRPS) type 1 as the diagnosis.

An x-ray of the girl's hand performed after her follow-up visit revealed cone-shaped epiphyses of the phalanges, which confirmed the diagnosis. TRPS type 1 is an autosomal dominant disorder characterized by craniofacial and bony abnormalities that include sparse, slow-growing hair and thin lateral eyebrows, a pear-shaped nose, elongated philtrum and thin upper lip, prominent ears, and cone-shaped epiphyses of the phalanges.

Variable findings include short stature (the patient was in the 25th percentile for height), nail abnormalities, teeth abnormalities, and a deep voice. The condition is caused by mutations in the TRPS1 gene.

Although there is no specific treatment for TRPS type 1, the girl's parents were happy to better understand why their daughter's hair failed to grow normally. She has continued to use 5% minoxidil for 6 months with some improvement.

Variable findings of TRPS type 1 include short stature, nail and/or teeth abnormalities, and a deep voice. DR. BRUCKNER

Waxy papules and plaques are shown on a girl with erythropoietic protoporphyria. Courtesy Dr. Anna L. Bruckner

SAN DIEGO — Postacquisition processing using Astonish software technology results in improved image quality and similar diagnostic accuracy to conventional 64-frame filtered back-projection processing, even at a 32-frame SPECT acquisition, results from a multicenter study showed.

“These findings confirm the value of half-acquisition Astonish, which may lead to important improvement in laboratory efficiency,” Dr. Gary V. Heller said at the annual meeting of the American Society of Nuclear Cardiology.

Manufactured by Philips Medical Systems, Astonish is a program that includes depth-dependent collimator resolution and scatter correction to permit reduced angular or shortened acquisition times.

Dr. Heller and his associates evaluated 221 patients who presented to three nuclear cardiology laboratories for clinically indicated rest/stress technetium-99m sestamibi or tetrofosmin single-photon emission computed tomography (SPECT) imaging. The purpose was to compare conventional 64-frame filtered back-projection processing with 64-frame (full-time) and 32-frame (half-time) Astonish processing. The researchers measured image quality of both stress and rest perfusion, image quality of rest and stress ECG-gated, diagnostic certainty of perfusion, diagnostic accuracy of the perfusion, and the size of the perfusion abnormalities. Comparison of the three imaging methods was made in blinded fashion by consensus interpretation.

The mean age of the 221 patients was 65 years, and 36% were women. Their average body mass index was 30 kg/m

The stress and rest perfusion image quality was “quite good” in all three groups, Dr. Heller said, although there were significantly higher rates of fair- or poor-quality images in the conventional 64-frame filtered back-projection group compared with the full-time and half-time Astonish groups.

There were also significantly higher rates of fair or poor stress functional image quality in the conventional group compared with the full-time and half-time Astonish groups. However, the rate of fair or poor rest functional image quality was the same between patients in the conventional group and the full-time Astonish group, but was slightly higher among patients in the half-time Astonish group.

Dr. Heller, director of nuclear cardiology at Hartford (Conn.) Hospital, reported that there were no differences in interpretive certainty of stress myocardial perfusion imaging between the three groups of patients. There also were no differences between the groups in the diagnostic accuracy of 50% stenosis, “although there was a trend toward reduced specificity with regard to patients in the half-time Astonish processing group,” he said.

The researchers observed significantly higher summed stress scores among patients in the half-time and full-time Astonish groups, compared with those in the conventional 64-frame filtered back-projection group (10.7, 9.7, and 8.8, respectively), but there were no statistically significant differences in the summed rest score between the three groups (2.7, 2.4, and 2.6, respectively).

There were no differences between the groups in poststress ejection fraction between the three groups (a rate of 57% for all). The ejection fraction at rest was similar between the three groups (61% for the half-time Astonish group, 63% for the full-time Astonish group, and 62% for the conventional 64-frame filtered back-projection group).

“If labs use Astonish without changing acquisition times, it will result in higher-quality images, easier to interpret,” Dr. Heller concluded in a later interview. “If labs choose to improve efficiency by using half acquisition, the image quality is actually superior to filtered back projection.”

The study was funded with an unrestricted research grant from Philips Medical Systems. The company was not involved in the development of the study or in the interpretation of the results.

Dr. Heller disclosed that he has received grants from Philips Medical Systems and that he is a member of the company's speakers' bureau.

In these perfusion images of normal stress, the top three rows show processing with 64-frame (full-time) Astonish. The middle three rows show processing with conventional 64-frame filtered back projection. The bottom three rows show processing with 32-frame (half-time) Astonish. Courtesy Dr. Gary V. Heller

SAN DIEGO — Postacquisition processing using Astonish software technology results in improved image quality and similar diagnostic accuracy to conventional 64-frame filtered back-projection processing, even at a 32-frame SPECT acquisition, results from a multicenter study showed.

“These findings confirm the value of half-acquisition Astonish, which may lead to important improvement in laboratory efficiency,” Dr. Gary V. Heller said at the annual meeting of the American Society of Nuclear Cardiology.

Manufactured by Philips Medical Systems, Astonish is a program that includes depth-dependent collimator resolution and scatter correction to permit reduced angular or shortened acquisition times.

Dr. Heller and his associates evaluated 221 patients who presented to three nuclear cardiology laboratories for clinically indicated rest/stress technetium-99m sestamibi or tetrofosmin single-photon emission computed tomography (SPECT) imaging. The purpose was to compare conventional 64-frame filtered back-projection processing with 64-frame (full-time) and 32-frame (half-time) Astonish processing. The researchers measured image quality of both stress and rest perfusion, image quality of rest and stress ECG-gated, diagnostic certainty of perfusion, diagnostic accuracy of the perfusion, and the size of the perfusion abnormalities. Comparison of the three imaging methods was made in blinded fashion by consensus interpretation.

The mean age of the 221 patients was 65 years, and 36% were women. Their average body mass index was 30 kg/m

The stress and rest perfusion image quality was “quite good” in all three groups, Dr. Heller said, although there were significantly higher rates of fair- or poor-quality images in the conventional 64-frame filtered back-projection group compared with the full-time and half-time Astonish groups.

There were also significantly higher rates of fair or poor stress functional image quality in the conventional group compared with the full-time and half-time Astonish groups. However, the rate of fair or poor rest functional image quality was the same between patients in the conventional group and the full-time Astonish group, but was slightly higher among patients in the half-time Astonish group.

Dr. Heller, director of nuclear cardiology at Hartford (Conn.) Hospital, reported that there were no differences in interpretive certainty of stress myocardial perfusion imaging between the three groups of patients. There also were no differences between the groups in the diagnostic accuracy of 50% stenosis, “although there was a trend toward reduced specificity with regard to patients in the half-time Astonish processing group,” he said.

The researchers observed significantly higher summed stress scores among patients in the half-time and full-time Astonish groups, compared with those in the conventional 64-frame filtered back-projection group (10.7, 9.7, and 8.8, respectively), but there were no statistically significant differences in the summed rest score between the three groups (2.7, 2.4, and 2.6, respectively).

There were no differences between the groups in poststress ejection fraction between the three groups (a rate of 57% for all). The ejection fraction at rest was similar between the three groups (61% for the half-time Astonish group, 63% for the full-time Astonish group, and 62% for the conventional 64-frame filtered back-projection group).

“If labs use Astonish without changing acquisition times, it will result in higher-quality images, easier to interpret,” Dr. Heller concluded in a later interview. “If labs choose to improve efficiency by using half acquisition, the image quality is actually superior to filtered back projection.”

The study was funded with an unrestricted research grant from Philips Medical Systems. The company was not involved in the development of the study or in the interpretation of the results.

Dr. Heller disclosed that he has received grants from Philips Medical Systems and that he is a member of the company's speakers' bureau.

In these perfusion images of normal stress, the top three rows show processing with 64-frame (full-time) Astonish. The middle three rows show processing with conventional 64-frame filtered back projection. The bottom three rows show processing with 32-frame (half-time) Astonish. Courtesy Dr. Gary V. Heller

SAN DIEGO — Postacquisition processing using Astonish software technology results in improved image quality and similar diagnostic accuracy to conventional 64-frame filtered back-projection processing, even at a 32-frame SPECT acquisition, results from a multicenter study showed.

“These findings confirm the value of half-acquisition Astonish, which may lead to important improvement in laboratory efficiency,” Dr. Gary V. Heller said at the annual meeting of the American Society of Nuclear Cardiology.

Manufactured by Philips Medical Systems, Astonish is a program that includes depth-dependent collimator resolution and scatter correction to permit reduced angular or shortened acquisition times.

Dr. Heller and his associates evaluated 221 patients who presented to three nuclear cardiology laboratories for clinically indicated rest/stress technetium-99m sestamibi or tetrofosmin single-photon emission computed tomography (SPECT) imaging. The purpose was to compare conventional 64-frame filtered back-projection processing with 64-frame (full-time) and 32-frame (half-time) Astonish processing. The researchers measured image quality of both stress and rest perfusion, image quality of rest and stress ECG-gated, diagnostic certainty of perfusion, diagnostic accuracy of the perfusion, and the size of the perfusion abnormalities. Comparison of the three imaging methods was made in blinded fashion by consensus interpretation.

The mean age of the 221 patients was 65 years, and 36% were women. Their average body mass index was 30 kg/m

The stress and rest perfusion image quality was “quite good” in all three groups, Dr. Heller said, although there were significantly higher rates of fair- or poor-quality images in the conventional 64-frame filtered back-projection group compared with the full-time and half-time Astonish groups.

There were also significantly higher rates of fair or poor stress functional image quality in the conventional group compared with the full-time and half-time Astonish groups. However, the rate of fair or poor rest functional image quality was the same between patients in the conventional group and the full-time Astonish group, but was slightly higher among patients in the half-time Astonish group.

Dr. Heller, director of nuclear cardiology at Hartford (Conn.) Hospital, reported that there were no differences in interpretive certainty of stress myocardial perfusion imaging between the three groups of patients. There also were no differences between the groups in the diagnostic accuracy of 50% stenosis, “although there was a trend toward reduced specificity with regard to patients in the half-time Astonish processing group,” he said.

The researchers observed significantly higher summed stress scores among patients in the half-time and full-time Astonish groups, compared with those in the conventional 64-frame filtered back-projection group (10.7, 9.7, and 8.8, respectively), but there were no statistically significant differences in the summed rest score between the three groups (2.7, 2.4, and 2.6, respectively).

There were no differences between the groups in poststress ejection fraction between the three groups (a rate of 57% for all). The ejection fraction at rest was similar between the three groups (61% for the half-time Astonish group, 63% for the full-time Astonish group, and 62% for the conventional 64-frame filtered back-projection group).

“If labs use Astonish without changing acquisition times, it will result in higher-quality images, easier to interpret,” Dr. Heller concluded in a later interview. “If labs choose to improve efficiency by using half acquisition, the image quality is actually superior to filtered back projection.”

The study was funded with an unrestricted research grant from Philips Medical Systems. The company was not involved in the development of the study or in the interpretation of the results.

Dr. Heller disclosed that he has received grants from Philips Medical Systems and that he is a member of the company's speakers' bureau.

In these perfusion images of normal stress, the top three rows show processing with 64-frame (full-time) Astonish. The middle three rows show processing with conventional 64-frame filtered back projection. The bottom three rows show processing with 32-frame (half-time) Astonish. Courtesy Dr. Gary V. Heller

SAN DIEGO — Pediatric clinicians who have been in practice for less than 10 years were more likely to recommend the RotaTeq vaccine for routine childhood immunization compared with their counterparts who have been in practice for more than 10 years, results from a small survey suggest.

“We hypothesize that this may be due to the previous experience with RotaShield and its withdrawal from the market in 1999 due to intussusception,” Dr. Lara Jacobson said in an interview during a poster presentation given at the annual meeting of the Infectious Diseases Society of America.

In February 2006, the U.S. Food and Drug Administration approved RotaTeq (human-bovine pentavalent reassortment vaccine) as a rotavirus vaccine. In August 2006, the Advisory Committee on Immunization Practices (ACIP) recommended RotaTeq for routine childhood immunization.

In an effort to measure acceptance of the RotaTeq vaccine, Dr. Jacobson's associate, Dr. Aaron M. Milstone, administered a survey to 120 pediatricians, family physicians, and nurse practitioners while they were attending a continuing medical education conference at Johns Hopkins Hospital, Baltimore, in April 2007.

Of the 105 clinicians who completed the survey, 84% agree with ACIP's recommendations for routine administration, 86% inform their patients of the vaccine, and 88% recommend the vaccine to their patients, reported Dr. Jacobson of the department of pediatrics at Johns Hopkins University.

All clinicians who had been in practice for less than 10 years reported recommending the vaccine to their patients, compared with 81% of those in practice for more than 10 years, a difference that was statistically significant.

“I was surprised by the strength of this difference,” Dr. Jacobson said. “That would be hundreds of thousands of vaccines that are not being prescribed per year in a very specific demographic of pediatricians.”

One of the study's coauthors, Dr. Mathuram Santosham, was a principal investigator on a RotaTeq vaccine safety and efficacy trial funded by Merck Sharp & Dohme.

Dr. Milstone and Dr. Jacobson stated that they had no relevant financial relationships to disclose.

SAN DIEGO — Pediatric clinicians who have been in practice for less than 10 years were more likely to recommend the RotaTeq vaccine for routine childhood immunization compared with their counterparts who have been in practice for more than 10 years, results from a small survey suggest.

“We hypothesize that this may be due to the previous experience with RotaShield and its withdrawal from the market in 1999 due to intussusception,” Dr. Lara Jacobson said in an interview during a poster presentation given at the annual meeting of the Infectious Diseases Society of America.

In February 2006, the U.S. Food and Drug Administration approved RotaTeq (human-bovine pentavalent reassortment vaccine) as a rotavirus vaccine. In August 2006, the Advisory Committee on Immunization Practices (ACIP) recommended RotaTeq for routine childhood immunization.

In an effort to measure acceptance of the RotaTeq vaccine, Dr. Jacobson's associate, Dr. Aaron M. Milstone, administered a survey to 120 pediatricians, family physicians, and nurse practitioners while they were attending a continuing medical education conference at Johns Hopkins Hospital, Baltimore, in April 2007.

Of the 105 clinicians who completed the survey, 84% agree with ACIP's recommendations for routine administration, 86% inform their patients of the vaccine, and 88% recommend the vaccine to their patients, reported Dr. Jacobson of the department of pediatrics at Johns Hopkins University.

All clinicians who had been in practice for less than 10 years reported recommending the vaccine to their patients, compared with 81% of those in practice for more than 10 years, a difference that was statistically significant.

“I was surprised by the strength of this difference,” Dr. Jacobson said. “That would be hundreds of thousands of vaccines that are not being prescribed per year in a very specific demographic of pediatricians.”

One of the study's coauthors, Dr. Mathuram Santosham, was a principal investigator on a RotaTeq vaccine safety and efficacy trial funded by Merck Sharp & Dohme.

Dr. Milstone and Dr. Jacobson stated that they had no relevant financial relationships to disclose.

SAN DIEGO — Pediatric clinicians who have been in practice for less than 10 years were more likely to recommend the RotaTeq vaccine for routine childhood immunization compared with their counterparts who have been in practice for more than 10 years, results from a small survey suggest.

“We hypothesize that this may be due to the previous experience with RotaShield and its withdrawal from the market in 1999 due to intussusception,” Dr. Lara Jacobson said in an interview during a poster presentation given at the annual meeting of the Infectious Diseases Society of America.

In February 2006, the U.S. Food and Drug Administration approved RotaTeq (human-bovine pentavalent reassortment vaccine) as a rotavirus vaccine. In August 2006, the Advisory Committee on Immunization Practices (ACIP) recommended RotaTeq for routine childhood immunization.

In an effort to measure acceptance of the RotaTeq vaccine, Dr. Jacobson's associate, Dr. Aaron M. Milstone, administered a survey to 120 pediatricians, family physicians, and nurse practitioners while they were attending a continuing medical education conference at Johns Hopkins Hospital, Baltimore, in April 2007.

Of the 105 clinicians who completed the survey, 84% agree with ACIP's recommendations for routine administration, 86% inform their patients of the vaccine, and 88% recommend the vaccine to their patients, reported Dr. Jacobson of the department of pediatrics at Johns Hopkins University.

All clinicians who had been in practice for less than 10 years reported recommending the vaccine to their patients, compared with 81% of those in practice for more than 10 years, a difference that was statistically significant.

“I was surprised by the strength of this difference,” Dr. Jacobson said. “That would be hundreds of thousands of vaccines that are not being prescribed per year in a very specific demographic of pediatricians.”

One of the study's coauthors, Dr. Mathuram Santosham, was a principal investigator on a RotaTeq vaccine safety and efficacy trial funded by Merck Sharp & Dohme.

Dr. Milstone and Dr. Jacobson stated that they had no relevant financial relationships to disclose.

SAN DIEGO — Children with intracranial complications of sinusitis are significantly older, and have longer hospitalizations and more neurologic sequelae, compared with children who have intraorbital complications of sinusitis, Dr. Veronica K. Goytia reported at the annual meeting of the Infectious Diseases Society of America.

Recognition of clinical features suggestive of either intraorbital extension or intracranial extension is critical to initiating medical and surgical interventions that optimize outcome, said Dr. Goytia, a pediatric infectious diseases fellow at Baylor College of Medicine and Texas Children's Hospital, both in Houston.

In a study that is among the largest of its kind, Dr. Goytia and her mentors, Dr. Carol J. Baker and Dr. Morven S. Edwards, described the features of illness in 58 children under the age of 18 years who were admitted to Texas Children's Hospital with sinusitis complicated by intraorbital and/or intracranial extension from 1997 through 2006.

They defined sinusitis as paranasal sinus opacification on diagnostic imaging performed within 72 hours of admission. Intraorbital extension (IOE) was defined as an infection within or involving the bony confines of the orbit, whereas intracranial extension (ICE) was defined as an infection of sinusitis beyond the confines of the sinuses and orbit.

Of the 58 children, 26 had IOE and 32 had ICE. Intracranial complications consisted of dural enhancement (17 patients), subdural empyema (15), epidural abscess (14), frontal bone osteomyelitis (9), brain abscess (4), and sinus thrombosis (1). Some patients had more than one complication.

Children with ICE were significantly older than children with IOE (a mean of 11 years vs. 6 years, respectively). There was no difference in ethnicity between the two groups, and males outnumbered females by nearly two to one.

Prior to hospital admission, a majority of children with IOE had been seen by their primary care physicians, whereas children with ICE “were more likely to have come to a community hospital for evaluation, and had significantly more preadmission encounters than [did] those with IOE,” Dr. Goytia said.

There were no significant differences between the ICE and IOE groups in history of allergic rhinitis, dental surgery, otitis media, or trauma, but children in the ICE group were more likely than their IOE counterparts to have a history of acute or chronic sinusitis.

The most common presenting features for both groups were fever, headache, and vomiting. There were no differences between groups in the level or duration of fever, but children in the ICE group were more likely to have longer duration of headache, compared with children in the IOE group (a mean of 11 days vs. 3 days).

Dr. Goytia reported that broad-spectrum antibiotics were initiated in all children within 48 hours of admission. “The most common combination of antibiotics was vancomycin, cefotaxime, and metronidazole,” she said. “The most common regimens contained vancomycin, a third-generation cephalosporin, and either metronidazole or clindamycin for anaerobic organisms.” The duration of intravenous therapy was longer for children in the ICE group, compared with those in the IOE group (a mean of 35 days vs. 15 days).

The most common organisms isolated were streptococcus and staphylococcus, including both methicillin-susceptible Staphylococcus aureus and methicillin-resistant S. aureus. Gram-negative aerobic organisms were isolated occasionally in both groups, but anaerobic organisms were isolated exclusively in ICE patients.

In the ICE group, 31 patients underwent surgical procedures, compared with 20 patients in the IOE group. Endoscopic sinus surgery was common in both groups of patients. “More than half of ICE children underwent neurosurgical intervention,” Dr. Goytia said.

All children survived. Neurologic sequelae were seen in five children (16%) in the ICE group, and included one case each of the following: diplopia, hemiparesis, loss of vision, expressive aphasia, and cognitive and speech deficit. No children in the IOE group experienced neurologic sequelae. Frontal sinuses were undeveloped significantly more often in the IOE group, compared with the ICE group (58% vs. 22%).

“We speculate that undeveloped frontal sinuses in younger patients may provide a protective effect from developing intracranial extension of sinusitis,” Dr. Goytia said.

A cranial CT scan of a 12-year-old patient shows orbital abscess (red arrow) in the setting of ethmoid and sphenoid sinusitis. Courtesy Dr. Veronica K. Goytia

SAN DIEGO — Children with intracranial complications of sinusitis are significantly older, and have longer hospitalizations and more neurologic sequelae, compared with children who have intraorbital complications of sinusitis, Dr. Veronica K. Goytia reported at the annual meeting of the Infectious Diseases Society of America.

Recognition of clinical features suggestive of either intraorbital extension or intracranial extension is critical to initiating medical and surgical interventions that optimize outcome, said Dr. Goytia, a pediatric infectious diseases fellow at Baylor College of Medicine and Texas Children's Hospital, both in Houston.

In a study that is among the largest of its kind, Dr. Goytia and her mentors, Dr. Carol J. Baker and Dr. Morven S. Edwards, described the features of illness in 58 children under the age of 18 years who were admitted to Texas Children's Hospital with sinusitis complicated by intraorbital and/or intracranial extension from 1997 through 2006.

They defined sinusitis as paranasal sinus opacification on diagnostic imaging performed within 72 hours of admission. Intraorbital extension (IOE) was defined as an infection within or involving the bony confines of the orbit, whereas intracranial extension (ICE) was defined as an infection of sinusitis beyond the confines of the sinuses and orbit.

Of the 58 children, 26 had IOE and 32 had ICE. Intracranial complications consisted of dural enhancement (17 patients), subdural empyema (15), epidural abscess (14), frontal bone osteomyelitis (9), brain abscess (4), and sinus thrombosis (1). Some patients had more than one complication.

Children with ICE were significantly older than children with IOE (a mean of 11 years vs. 6 years, respectively). There was no difference in ethnicity between the two groups, and males outnumbered females by nearly two to one.

Prior to hospital admission, a majority of children with IOE had been seen by their primary care physicians, whereas children with ICE “were more likely to have come to a community hospital for evaluation, and had significantly more preadmission encounters than [did] those with IOE,” Dr. Goytia said.

There were no significant differences between the ICE and IOE groups in history of allergic rhinitis, dental surgery, otitis media, or trauma, but children in the ICE group were more likely than their IOE counterparts to have a history of acute or chronic sinusitis.

The most common presenting features for both groups were fever, headache, and vomiting. There were no differences between groups in the level or duration of fever, but children in the ICE group were more likely to have longer duration of headache, compared with children in the IOE group (a mean of 11 days vs. 3 days).

Dr. Goytia reported that broad-spectrum antibiotics were initiated in all children within 48 hours of admission. “The most common combination of antibiotics was vancomycin, cefotaxime, and metronidazole,” she said. “The most common regimens contained vancomycin, a third-generation cephalosporin, and either metronidazole or clindamycin for anaerobic organisms.” The duration of intravenous therapy was longer for children in the ICE group, compared with those in the IOE group (a mean of 35 days vs. 15 days).

The most common organisms isolated were streptococcus and staphylococcus, including both methicillin-susceptible Staphylococcus aureus and methicillin-resistant S. aureus. Gram-negative aerobic organisms were isolated occasionally in both groups, but anaerobic organisms were isolated exclusively in ICE patients.

In the ICE group, 31 patients underwent surgical procedures, compared with 20 patients in the IOE group. Endoscopic sinus surgery was common in both groups of patients. “More than half of ICE children underwent neurosurgical intervention,” Dr. Goytia said.

All children survived. Neurologic sequelae were seen in five children (16%) in the ICE group, and included one case each of the following: diplopia, hemiparesis, loss of vision, expressive aphasia, and cognitive and speech deficit. No children in the IOE group experienced neurologic sequelae. Frontal sinuses were undeveloped significantly more often in the IOE group, compared with the ICE group (58% vs. 22%).

“We speculate that undeveloped frontal sinuses in younger patients may provide a protective effect from developing intracranial extension of sinusitis,” Dr. Goytia said.

A cranial CT scan of a 12-year-old patient shows orbital abscess (red arrow) in the setting of ethmoid and sphenoid sinusitis. Courtesy Dr. Veronica K. Goytia

SAN DIEGO — Children with intracranial complications of sinusitis are significantly older, and have longer hospitalizations and more neurologic sequelae, compared with children who have intraorbital complications of sinusitis, Dr. Veronica K. Goytia reported at the annual meeting of the Infectious Diseases Society of America.

Recognition of clinical features suggestive of either intraorbital extension or intracranial extension is critical to initiating medical and surgical interventions that optimize outcome, said Dr. Goytia, a pediatric infectious diseases fellow at Baylor College of Medicine and Texas Children's Hospital, both in Houston.

In a study that is among the largest of its kind, Dr. Goytia and her mentors, Dr. Carol J. Baker and Dr. Morven S. Edwards, described the features of illness in 58 children under the age of 18 years who were admitted to Texas Children's Hospital with sinusitis complicated by intraorbital and/or intracranial extension from 1997 through 2006.

They defined sinusitis as paranasal sinus opacification on diagnostic imaging performed within 72 hours of admission. Intraorbital extension (IOE) was defined as an infection within or involving the bony confines of the orbit, whereas intracranial extension (ICE) was defined as an infection of sinusitis beyond the confines of the sinuses and orbit.

Of the 58 children, 26 had IOE and 32 had ICE. Intracranial complications consisted of dural enhancement (17 patients), subdural empyema (15), epidural abscess (14), frontal bone osteomyelitis (9), brain abscess (4), and sinus thrombosis (1). Some patients had more than one complication.

Children with ICE were significantly older than children with IOE (a mean of 11 years vs. 6 years, respectively). There was no difference in ethnicity between the two groups, and males outnumbered females by nearly two to one.

Prior to hospital admission, a majority of children with IOE had been seen by their primary care physicians, whereas children with ICE “were more likely to have come to a community hospital for evaluation, and had significantly more preadmission encounters than [did] those with IOE,” Dr. Goytia said.

There were no significant differences between the ICE and IOE groups in history of allergic rhinitis, dental surgery, otitis media, or trauma, but children in the ICE group were more likely than their IOE counterparts to have a history of acute or chronic sinusitis.

The most common presenting features for both groups were fever, headache, and vomiting. There were no differences between groups in the level or duration of fever, but children in the ICE group were more likely to have longer duration of headache, compared with children in the IOE group (a mean of 11 days vs. 3 days).

Dr. Goytia reported that broad-spectrum antibiotics were initiated in all children within 48 hours of admission. “The most common combination of antibiotics was vancomycin, cefotaxime, and metronidazole,” she said. “The most common regimens contained vancomycin, a third-generation cephalosporin, and either metronidazole or clindamycin for anaerobic organisms.” The duration of intravenous therapy was longer for children in the ICE group, compared with those in the IOE group (a mean of 35 days vs. 15 days).

The most common organisms isolated were streptococcus and staphylococcus, including both methicillin-susceptible Staphylococcus aureus and methicillin-resistant S. aureus. Gram-negative aerobic organisms were isolated occasionally in both groups, but anaerobic organisms were isolated exclusively in ICE patients.

In the ICE group, 31 patients underwent surgical procedures, compared with 20 patients in the IOE group. Endoscopic sinus surgery was common in both groups of patients. “More than half of ICE children underwent neurosurgical intervention,” Dr. Goytia said.

All children survived. Neurologic sequelae were seen in five children (16%) in the ICE group, and included one case each of the following: diplopia, hemiparesis, loss of vision, expressive aphasia, and cognitive and speech deficit. No children in the IOE group experienced neurologic sequelae. Frontal sinuses were undeveloped significantly more often in the IOE group, compared with the ICE group (58% vs. 22%).

“We speculate that undeveloped frontal sinuses in younger patients may provide a protective effect from developing intracranial extension of sinusitis,” Dr. Goytia said.

A cranial CT scan of a 12-year-old patient shows orbital abscess (red arrow) in the setting of ethmoid and sphenoid sinusitis. Courtesy Dr. Veronica K. Goytia

SAN DIEGO — Cases of Campylobacter infections in the United States declined by an average of 30% between 1996 and 2006, according to an epidemiologist from the Centers for Disease Control and Prevention.

However, the incidence remains highest among children under 5 years of age, and males have a higher incidence compared with females in all age groups except ages 20–29 years.

Those are key findings from an analysis of data from the Foodborne Diseases Active Surveillance Network (FoodNet), which began tracking Campylobacter infections in 1996, reported the CDC's Mary E. Patrick during a poster session at the annual meeting of the Infectious Diseases Society of America. The FoodNet project is a partnership involving the CDC, the U.S. Department of Agriculture-Food Safety Inspection Service, the U.S. Food and Drug Administration, and designated FoodNet sites in 10 states.

Ms. Patrick and her associates calculated gender- and age-specific incidence rates of Campylobacter infections that were reported by FoodNet sites between 1996 and 2006, and compared the changes in rates over the time period.

In 2006, the rates of Campylobacter infections were higher among males (14 per 100,000 persons) than among females (11 per 100,000 persons). The overall crude rate of laboratory-confirmed Campylobacter infections in 2006 was 13 per 100,000 U.S. residents. From baseline to 2006, the incidence declined 30% overall.

The largest decline by age group, 47%, was observed in adults aged 20–29 years, followed by children less than 1 year of age at 41%, adults aged 30–39 years at 40%, and children aged 1–4 years at 30%, reported Ms. Patrick.

Among infants less than 1 year of age, the rate of Campylobacter infections in 2006 was 37 per 100,000 persons and the rate among children aged 1–4 years was 23 per 100,000 persons. These rates were significantly higher compared with any other age group. In fact, the lowest 2006 rate, 7 per 100,000 persons, was found not among adults but in children and adolescents aged 10–14 years.

“Obviously infants are not consuming the main sources of Campylobacter such as chicken,” Ms. Patrick said in an interview. “We're thinking that there is a lot of cross-contamination from sources such as raw chicken juices in the kitchen. You can reduce the risk of cross-contamination by separating raw and cooked products, and making sure that you wash your hands, utensils, and cutting boards before and after contact with raw poultry.”

The 10 states with FoodNet sites are California, Colorado, Connecticut, Georgia, Maryland, Minnesota, New Mexico, New York, Oregon, and Tennessee.

SAN DIEGO — Cases of Campylobacter infections in the United States declined by an average of 30% between 1996 and 2006, according to an epidemiologist from the Centers for Disease Control and Prevention.

However, the incidence remains highest among children under 5 years of age, and males have a higher incidence compared with females in all age groups except ages 20–29 years.

Those are key findings from an analysis of data from the Foodborne Diseases Active Surveillance Network (FoodNet), which began tracking Campylobacter infections in 1996, reported the CDC's Mary E. Patrick during a poster session at the annual meeting of the Infectious Diseases Society of America. The FoodNet project is a partnership involving the CDC, the U.S. Department of Agriculture-Food Safety Inspection Service, the U.S. Food and Drug Administration, and designated FoodNet sites in 10 states.

Ms. Patrick and her associates calculated gender- and age-specific incidence rates of Campylobacter infections that were reported by FoodNet sites between 1996 and 2006, and compared the changes in rates over the time period.

In 2006, the rates of Campylobacter infections were higher among males (14 per 100,000 persons) than among females (11 per 100,000 persons). The overall crude rate of laboratory-confirmed Campylobacter infections in 2006 was 13 per 100,000 U.S. residents. From baseline to 2006, the incidence declined 30% overall.

The largest decline by age group, 47%, was observed in adults aged 20–29 years, followed by children less than 1 year of age at 41%, adults aged 30–39 years at 40%, and children aged 1–4 years at 30%, reported Ms. Patrick.

Among infants less than 1 year of age, the rate of Campylobacter infections in 2006 was 37 per 100,000 persons and the rate among children aged 1–4 years was 23 per 100,000 persons. These rates were significantly higher compared with any other age group. In fact, the lowest 2006 rate, 7 per 100,000 persons, was found not among adults but in children and adolescents aged 10–14 years.

“Obviously infants are not consuming the main sources of Campylobacter such as chicken,” Ms. Patrick said in an interview. “We're thinking that there is a lot of cross-contamination from sources such as raw chicken juices in the kitchen. You can reduce the risk of cross-contamination by separating raw and cooked products, and making sure that you wash your hands, utensils, and cutting boards before and after contact with raw poultry.”

The 10 states with FoodNet sites are California, Colorado, Connecticut, Georgia, Maryland, Minnesota, New Mexico, New York, Oregon, and Tennessee.

SAN DIEGO — Cases of Campylobacter infections in the United States declined by an average of 30% between 1996 and 2006, according to an epidemiologist from the Centers for Disease Control and Prevention.

However, the incidence remains highest among children under 5 years of age, and males have a higher incidence compared with females in all age groups except ages 20–29 years.

Those are key findings from an analysis of data from the Foodborne Diseases Active Surveillance Network (FoodNet), which began tracking Campylobacter infections in 1996, reported the CDC's Mary E. Patrick during a poster session at the annual meeting of the Infectious Diseases Society of America. The FoodNet project is a partnership involving the CDC, the U.S. Department of Agriculture-Food Safety Inspection Service, the U.S. Food and Drug Administration, and designated FoodNet sites in 10 states.

Ms. Patrick and her associates calculated gender- and age-specific incidence rates of Campylobacter infections that were reported by FoodNet sites between 1996 and 2006, and compared the changes in rates over the time period.

In 2006, the rates of Campylobacter infections were higher among males (14 per 100,000 persons) than among females (11 per 100,000 persons). The overall crude rate of laboratory-confirmed Campylobacter infections in 2006 was 13 per 100,000 U.S. residents. From baseline to 2006, the incidence declined 30% overall.

The largest decline by age group, 47%, was observed in adults aged 20–29 years, followed by children less than 1 year of age at 41%, adults aged 30–39 years at 40%, and children aged 1–4 years at 30%, reported Ms. Patrick.

Among infants less than 1 year of age, the rate of Campylobacter infections in 2006 was 37 per 100,000 persons and the rate among children aged 1–4 years was 23 per 100,000 persons. These rates were significantly higher compared with any other age group. In fact, the lowest 2006 rate, 7 per 100,000 persons, was found not among adults but in children and adolescents aged 10–14 years.

“Obviously infants are not consuming the main sources of Campylobacter such as chicken,” Ms. Patrick said in an interview. “We're thinking that there is a lot of cross-contamination from sources such as raw chicken juices in the kitchen. You can reduce the risk of cross-contamination by separating raw and cooked products, and making sure that you wash your hands, utensils, and cutting boards before and after contact with raw poultry.”

The 10 states with FoodNet sites are California, Colorado, Connecticut, Georgia, Maryland, Minnesota, New Mexico, New York, Oregon, and Tennessee.

SAN DIEGO — Serotype 19A is the most common serotype isolated from children's invasive pneumococcal infections, results from a national multicenter study suggest.

The finding comes from the United States Pediatric Multicenter Pneumococcal Surveillance Study Group, a network of eight children's hospitals that has been identifying patients with systemic pneumococcal infections since 1993. The researchers send the isolates to a central laboratory for serotyping and complete a standardized case report form that includes demographic and clinical information, including the number of 7-valent pneumococcal conjugate vaccinations (PCV7) the child has received.

At the annual meeting of the Infectious Diseases Society of America, Dr. Sheldon L. Kaplan reported on 1,234 isolates collected between April 1, 2000, and Dec. 31, 2006. Ages of patients ranged from 0 to 20 years, but most infections occurred in the first 5 years of life. Serotype 19A accounted for 19% of all nonvaccine serotype isolates in 2000, 22% in 2001, 18% in 2002, 23% in 2003, 39% in 2004, 34% in 2005, and 49% in 2006.

Serotype 19A has been the most common nonvaccine serotype each year since 2003. In 2005 and 2006 combined, the next most common nonvaccine serotypes were 1 (21 cases), 3 (14 cases), 33, 15, and 7 (13 cases each), and 6A (11 cases).

No deaths were reported associated with pneumococcal infections in 2006. “The number of invasive infections reached its lowest point in 2004 and then increased 13% in 2005 and another 5% in 2006,” Dr. Kaplan, chief of the infectious disease service at Texas Children's Hospital, Houston, noted in a later interview. “Nevertheless, the number of cases annually was still 60% less than seen each year before the pneumococcal conjugate vaccine was licensed for routine administration to infants.”

The most common type of infection among children with serotype 19A was bacteremia, followed by pneumonia, bacterial meningitis, and other infections. When the researchers applied the 2007 breakpoints for minimum inhibitory concentration interpretations, they found that 28% of 19A isolates in 2006 were susceptible to penicillin, 34% were immediately susceptible to penicillin, and 37% were resistant to penicillin.

Dr. Kaplan, who is also a professor of pediatrics at Baylor College of Medicine, predicted that the percentage of isolates resistant to penicillin “will go down dramatically” when the Clinical and Laboratory Standards Institute publishes new Streptococcus pneumoniae penicillin breakpoints for nonmeningeal pneumococcal isolates in 2008. He concluded that continued surveillance of invasive pneumococcal infections “will remain necessary following the inclusion of serotype 19A and other serotypes.”

The pneumococcal surveillance group includes clinicians from Texas Children's Hospital, Houston; Children's Hospital of Pittsburgh; Children's Hospital San Diego; Columbus (Ohio) Children's Hospital; Children's Memorial Hospital, Chicago; Arkansas Children's Hospital, Little Rock; Brenner Children's Hospital, Wake Forest, N.C.; and Children's Hospital Los Angeles.

Dr. Kaplan disclosed that he has received research grants from Roche and Wyeth Pharmaceuticals.

SAN DIEGO — Serotype 19A is the most common serotype isolated from children's invasive pneumococcal infections, results from a national multicenter study suggest.

The finding comes from the United States Pediatric Multicenter Pneumococcal Surveillance Study Group, a network of eight children's hospitals that has been identifying patients with systemic pneumococcal infections since 1993. The researchers send the isolates to a central laboratory for serotyping and complete a standardized case report form that includes demographic and clinical information, including the number of 7-valent pneumococcal conjugate vaccinations (PCV7) the child has received.

At the annual meeting of the Infectious Diseases Society of America, Dr. Sheldon L. Kaplan reported on 1,234 isolates collected between April 1, 2000, and Dec. 31, 2006. Ages of patients ranged from 0 to 20 years, but most infections occurred in the first 5 years of life. Serotype 19A accounted for 19% of all nonvaccine serotype isolates in 2000, 22% in 2001, 18% in 2002, 23% in 2003, 39% in 2004, 34% in 2005, and 49% in 2006.

Serotype 19A has been the most common nonvaccine serotype each year since 2003. In 2005 and 2006 combined, the next most common nonvaccine serotypes were 1 (21 cases), 3 (14 cases), 33, 15, and 7 (13 cases each), and 6A (11 cases).

No deaths were reported associated with pneumococcal infections in 2006. “The number of invasive infections reached its lowest point in 2004 and then increased 13% in 2005 and another 5% in 2006,” Dr. Kaplan, chief of the infectious disease service at Texas Children's Hospital, Houston, noted in a later interview. “Nevertheless, the number of cases annually was still 60% less than seen each year before the pneumococcal conjugate vaccine was licensed for routine administration to infants.”

The most common type of infection among children with serotype 19A was bacteremia, followed by pneumonia, bacterial meningitis, and other infections. When the researchers applied the 2007 breakpoints for minimum inhibitory concentration interpretations, they found that 28% of 19A isolates in 2006 were susceptible to penicillin, 34% were immediately susceptible to penicillin, and 37% were resistant to penicillin.

Dr. Kaplan, who is also a professor of pediatrics at Baylor College of Medicine, predicted that the percentage of isolates resistant to penicillin “will go down dramatically” when the Clinical and Laboratory Standards Institute publishes new Streptococcus pneumoniae penicillin breakpoints for nonmeningeal pneumococcal isolates in 2008. He concluded that continued surveillance of invasive pneumococcal infections “will remain necessary following the inclusion of serotype 19A and other serotypes.”

The pneumococcal surveillance group includes clinicians from Texas Children's Hospital, Houston; Children's Hospital of Pittsburgh; Children's Hospital San Diego; Columbus (Ohio) Children's Hospital; Children's Memorial Hospital, Chicago; Arkansas Children's Hospital, Little Rock; Brenner Children's Hospital, Wake Forest, N.C.; and Children's Hospital Los Angeles.

Dr. Kaplan disclosed that he has received research grants from Roche and Wyeth Pharmaceuticals.

SAN DIEGO — Serotype 19A is the most common serotype isolated from children's invasive pneumococcal infections, results from a national multicenter study suggest.

The finding comes from the United States Pediatric Multicenter Pneumococcal Surveillance Study Group, a network of eight children's hospitals that has been identifying patients with systemic pneumococcal infections since 1993. The researchers send the isolates to a central laboratory for serotyping and complete a standardized case report form that includes demographic and clinical information, including the number of 7-valent pneumococcal conjugate vaccinations (PCV7) the child has received.

At the annual meeting of the Infectious Diseases Society of America, Dr. Sheldon L. Kaplan reported on 1,234 isolates collected between April 1, 2000, and Dec. 31, 2006. Ages of patients ranged from 0 to 20 years, but most infections occurred in the first 5 years of life. Serotype 19A accounted for 19% of all nonvaccine serotype isolates in 2000, 22% in 2001, 18% in 2002, 23% in 2003, 39% in 2004, 34% in 2005, and 49% in 2006.

Serotype 19A has been the most common nonvaccine serotype each year since 2003. In 2005 and 2006 combined, the next most common nonvaccine serotypes were 1 (21 cases), 3 (14 cases), 33, 15, and 7 (13 cases each), and 6A (11 cases).

No deaths were reported associated with pneumococcal infections in 2006. “The number of invasive infections reached its lowest point in 2004 and then increased 13% in 2005 and another 5% in 2006,” Dr. Kaplan, chief of the infectious disease service at Texas Children's Hospital, Houston, noted in a later interview. “Nevertheless, the number of cases annually was still 60% less than seen each year before the pneumococcal conjugate vaccine was licensed for routine administration to infants.”

The most common type of infection among children with serotype 19A was bacteremia, followed by pneumonia, bacterial meningitis, and other infections. When the researchers applied the 2007 breakpoints for minimum inhibitory concentration interpretations, they found that 28% of 19A isolates in 2006 were susceptible to penicillin, 34% were immediately susceptible to penicillin, and 37% were resistant to penicillin.

Dr. Kaplan, who is also a professor of pediatrics at Baylor College of Medicine, predicted that the percentage of isolates resistant to penicillin “will go down dramatically” when the Clinical and Laboratory Standards Institute publishes new Streptococcus pneumoniae penicillin breakpoints for nonmeningeal pneumococcal isolates in 2008. He concluded that continued surveillance of invasive pneumococcal infections “will remain necessary following the inclusion of serotype 19A and other serotypes.”

The pneumococcal surveillance group includes clinicians from Texas Children's Hospital, Houston; Children's Hospital of Pittsburgh; Children's Hospital San Diego; Columbus (Ohio) Children's Hospital; Children's Memorial Hospital, Chicago; Arkansas Children's Hospital, Little Rock; Brenner Children's Hospital, Wake Forest, N.C.; and Children's Hospital Los Angeles.

Dr. Kaplan disclosed that he has received research grants from Roche and Wyeth Pharmaceuticals.

SAN DIEGO — The number of adolescents with asthma and other high-risk conditions who received the influenza vaccine increased between 1992 and 2002, but the coverage remains poor at about 15% overall, results from a large health maintenance organization study showed.

“About 85% of these kids who should have been getting the vaccine weren't getting it,” Dr. Mari M. Nakamura said in an interview during a poster session at the annual meeting of the Infectious Diseases Society of America. “A risk-based approach to vaccination isn't working in this population. Universal vaccination … may be warranted instead.”

She and Dr. Grace M. Lee reviewed the medical records of 18,703 patients aged 11–17 years with high-risk conditions who were enrolled in Harvard Pilgrim Health Care, the largest nonprofit health maintenance organization in New England, for at least one influenza season and the preceding 1-year period, from 1992 to 2002.

High-risk conditions were indicated by ICD-9 diagnoses, and included asthma or other chronic pulmonary disease; chronic cardiac disease; immunosuppressive disorders or therapy; sickle cell anemia or other hemoglobinopathy; chronic renal dysfunction; or chronic metabolic disease.

They evaluated the changes in influenza vaccination rates over that period, and the number of missed opportunities for vaccination. The patients' mean age was 14 years, and 48% were female, wrote Dr. Nakamura, a Harvard pediatric health services research fellow at Children's Hospital Boston. Most (90%) had asthma or other chronic pulmonary disease; 2% had more than one type of high-risk condition.

Influenza vaccination rates improved significantly from 1992 to 1993 (8.3% to 12.8%, respectively), and from 1993 to 2002 (12.8% to 15.4%). Female gender, younger age, and use of preventive care were associated with a greater likelihood of vaccination.

Adolescents with asthma or other chronic pulmonary disease were less likely to be vaccinated, compared with those who had other high-risk conditions.

The authors noted about half of all unvaccinated patients had at least one missed opportunity for vaccination between 1992 and 2002. “They came in [mainly for] preventive care and … other vaccinations. This tells us that providers are a group to target, to remind them that these patients should [get the] flu vaccine every year.”

Harvard Pilgrim Health Care and the Agency for Healthcare Research and Quality funded the study. The authors disclosed that they had no conflicts of interest.

SAN DIEGO — The number of adolescents with asthma and other high-risk conditions who received the influenza vaccine increased between 1992 and 2002, but the coverage remains poor at about 15% overall, results from a large health maintenance organization study showed.

“About 85% of these kids who should have been getting the vaccine weren't getting it,” Dr. Mari M. Nakamura said in an interview during a poster session at the annual meeting of the Infectious Diseases Society of America. “A risk-based approach to vaccination isn't working in this population. Universal vaccination … may be warranted instead.”

She and Dr. Grace M. Lee reviewed the medical records of 18,703 patients aged 11–17 years with high-risk conditions who were enrolled in Harvard Pilgrim Health Care, the largest nonprofit health maintenance organization in New England, for at least one influenza season and the preceding 1-year period, from 1992 to 2002.

High-risk conditions were indicated by ICD-9 diagnoses, and included asthma or other chronic pulmonary disease; chronic cardiac disease; immunosuppressive disorders or therapy; sickle cell anemia or other hemoglobinopathy; chronic renal dysfunction; or chronic metabolic disease.

They evaluated the changes in influenza vaccination rates over that period, and the number of missed opportunities for vaccination. The patients' mean age was 14 years, and 48% were female, wrote Dr. Nakamura, a Harvard pediatric health services research fellow at Children's Hospital Boston. Most (90%) had asthma or other chronic pulmonary disease; 2% had more than one type of high-risk condition.

Influenza vaccination rates improved significantly from 1992 to 1993 (8.3% to 12.8%, respectively), and from 1993 to 2002 (12.8% to 15.4%). Female gender, younger age, and use of preventive care were associated with a greater likelihood of vaccination.

Adolescents with asthma or other chronic pulmonary disease were less likely to be vaccinated, compared with those who had other high-risk conditions.

The authors noted about half of all unvaccinated patients had at least one missed opportunity for vaccination between 1992 and 2002. “They came in [mainly for] preventive care and … other vaccinations. This tells us that providers are a group to target, to remind them that these patients should [get the] flu vaccine every year.”

Harvard Pilgrim Health Care and the Agency for Healthcare Research and Quality funded the study. The authors disclosed that they had no conflicts of interest.

SAN DIEGO — The number of adolescents with asthma and other high-risk conditions who received the influenza vaccine increased between 1992 and 2002, but the coverage remains poor at about 15% overall, results from a large health maintenance organization study showed.

“About 85% of these kids who should have been getting the vaccine weren't getting it,” Dr. Mari M. Nakamura said in an interview during a poster session at the annual meeting of the Infectious Diseases Society of America. “A risk-based approach to vaccination isn't working in this population. Universal vaccination … may be warranted instead.”

She and Dr. Grace M. Lee reviewed the medical records of 18,703 patients aged 11–17 years with high-risk conditions who were enrolled in Harvard Pilgrim Health Care, the largest nonprofit health maintenance organization in New England, for at least one influenza season and the preceding 1-year period, from 1992 to 2002.

High-risk conditions were indicated by ICD-9 diagnoses, and included asthma or other chronic pulmonary disease; chronic cardiac disease; immunosuppressive disorders or therapy; sickle cell anemia or other hemoglobinopathy; chronic renal dysfunction; or chronic metabolic disease.

They evaluated the changes in influenza vaccination rates over that period, and the number of missed opportunities for vaccination. The patients' mean age was 14 years, and 48% were female, wrote Dr. Nakamura, a Harvard pediatric health services research fellow at Children's Hospital Boston. Most (90%) had asthma or other chronic pulmonary disease; 2% had more than one type of high-risk condition.

Influenza vaccination rates improved significantly from 1992 to 1993 (8.3% to 12.8%, respectively), and from 1993 to 2002 (12.8% to 15.4%). Female gender, younger age, and use of preventive care were associated with a greater likelihood of vaccination.

Adolescents with asthma or other chronic pulmonary disease were less likely to be vaccinated, compared with those who had other high-risk conditions.

The authors noted about half of all unvaccinated patients had at least one missed opportunity for vaccination between 1992 and 2002. “They came in [mainly for] preventive care and … other vaccinations. This tells us that providers are a group to target, to remind them that these patients should [get the] flu vaccine every year.”

Harvard Pilgrim Health Care and the Agency for Healthcare Research and Quality funded the study. The authors disclosed that they had no conflicts of interest.