Pulmonary Health Hub

SAN DIEGO – Obtaining blood cultures in children hospitalized for community-acquired pneumonia led to longer hospital stays and caused physicians to order more broad-spectrum antibiotics, results from a retrospective cohort study showed.

The 2011 Pediatric Infectious Diseases Society/Infectious Diseases Society of America Community Acquired Pneumonia guidelines included a strong recommendation to obtain blood cultures for all children admitted with moderate to severe CAP, “but that was based on low-quality evidence,” Dr. Michael P. Koster said in an interview at the annual meeting of the American Academy of Pediatrics. “Very little is known about how blood cultures influence the management of pneumonia. Our question was getting at whether or not getting a blood culture changes practice management.”

Doug Brunk/Frontline Medical News

To investigate, Dr. Koster and his associates at four separate medical institutions retrospectively evaluated the charts of 1,142 children aged 3 months to 18 years who were hospitalized for community-acquired pneumonia (CAP) during 2011 and 2012 according to ICD-9 codes for CAP or respiratory distress. Children with severe medical comorbidities were excluded. Dr. Koster, a pediatrician at Hasbro Children’s Hospital, Providence, R.I., and his associates collected data on patient demographics, medical history, laboratory tests, diagnostic radiography, antimicrobials administered, length of stay, ICU transfer, and readmission.

Of the 1,142 initially identified, 763 were used in the final analysis. Of these, 462 had blood cultures and the remaining 301 did not.

Dr. Koster reported that patients in the blood culture group had a significantly longer mean length of stay, compared with the no culture group (3.4 vs. 1.9 days, respectively; P < .0001). This difference persisted when ICU patients were removed from the analysis (2.5 vs. 1.8 days; P < .0001).

The researchers observed no statistically significant differences between those who had blood cultures and those who did not in receipt of antibiotics prior to presentation (41.6% vs. 40.9%, respectively; P = .85), the presence of any pulmonary effusion (57.6% vs. 61.1%; P = .33), or in the 14-day readmission rates (4.1% vs. 3%; P = .42).

However, in the emergency department, the blood culture group was more likely receive a third-generation cephalosporin (68.9% vs. 42.9%; P < .0001) while the no culture group was more likely to receive penicillin/ampicillin alone (38.4% vs. 21.3%; P = .0001).

Among patients in the blood culture group, 2.4% were positive for pathogens and 2.2% were contaminated, for a positive predictive value of 52.4%.

“Blood cultures aren’t free of harm,” Dr. Koster concluded. “They increase how long you stay in the hospital, and they increase the prescription of third-generation cephalosporins. Practice variation among physicians is probably what resulted in these findings. Until we recognize the variance around the interventions that we give to kids, we won’t be able to decrease the variance around their outcomes.”

The study was supported by the Rhode Island Foundation. Dr. Koster reported having no financial disclosures.

dbrunk@frontlinemedcom.com

On Twitter @dougbrunk

SAN DIEGO – Obtaining blood cultures in children hospitalized for community-acquired pneumonia led to longer hospital stays and caused physicians to order more broad-spectrum antibiotics, results from a retrospective cohort study showed.

The 2011 Pediatric Infectious Diseases Society/Infectious Diseases Society of America Community Acquired Pneumonia guidelines included a strong recommendation to obtain blood cultures for all children admitted with moderate to severe CAP, “but that was based on low-quality evidence,” Dr. Michael P. Koster said in an interview at the annual meeting of the American Academy of Pediatrics. “Very little is known about how blood cultures influence the management of pneumonia. Our question was getting at whether or not getting a blood culture changes practice management.”

Doug Brunk/Frontline Medical News

To investigate, Dr. Koster and his associates at four separate medical institutions retrospectively evaluated the charts of 1,142 children aged 3 months to 18 years who were hospitalized for community-acquired pneumonia (CAP) during 2011 and 2012 according to ICD-9 codes for CAP or respiratory distress. Children with severe medical comorbidities were excluded. Dr. Koster, a pediatrician at Hasbro Children’s Hospital, Providence, R.I., and his associates collected data on patient demographics, medical history, laboratory tests, diagnostic radiography, antimicrobials administered, length of stay, ICU transfer, and readmission.

Of the 1,142 initially identified, 763 were used in the final analysis. Of these, 462 had blood cultures and the remaining 301 did not.

Dr. Koster reported that patients in the blood culture group had a significantly longer mean length of stay, compared with the no culture group (3.4 vs. 1.9 days, respectively; P < .0001). This difference persisted when ICU patients were removed from the analysis (2.5 vs. 1.8 days; P < .0001).

The researchers observed no statistically significant differences between those who had blood cultures and those who did not in receipt of antibiotics prior to presentation (41.6% vs. 40.9%, respectively; P = .85), the presence of any pulmonary effusion (57.6% vs. 61.1%; P = .33), or in the 14-day readmission rates (4.1% vs. 3%; P = .42).

However, in the emergency department, the blood culture group was more likely receive a third-generation cephalosporin (68.9% vs. 42.9%; P < .0001) while the no culture group was more likely to receive penicillin/ampicillin alone (38.4% vs. 21.3%; P = .0001).

Among patients in the blood culture group, 2.4% were positive for pathogens and 2.2% were contaminated, for a positive predictive value of 52.4%.

“Blood cultures aren’t free of harm,” Dr. Koster concluded. “They increase how long you stay in the hospital, and they increase the prescription of third-generation cephalosporins. Practice variation among physicians is probably what resulted in these findings. Until we recognize the variance around the interventions that we give to kids, we won’t be able to decrease the variance around their outcomes.”

The study was supported by the Rhode Island Foundation. Dr. Koster reported having no financial disclosures.

dbrunk@frontlinemedcom.com

On Twitter @dougbrunk

SAN DIEGO – Obtaining blood cultures in children hospitalized for community-acquired pneumonia led to longer hospital stays and caused physicians to order more broad-spectrum antibiotics, results from a retrospective cohort study showed.

The 2011 Pediatric Infectious Diseases Society/Infectious Diseases Society of America Community Acquired Pneumonia guidelines included a strong recommendation to obtain blood cultures for all children admitted with moderate to severe CAP, “but that was based on low-quality evidence,” Dr. Michael P. Koster said in an interview at the annual meeting of the American Academy of Pediatrics. “Very little is known about how blood cultures influence the management of pneumonia. Our question was getting at whether or not getting a blood culture changes practice management.”

Doug Brunk/Frontline Medical News

To investigate, Dr. Koster and his associates at four separate medical institutions retrospectively evaluated the charts of 1,142 children aged 3 months to 18 years who were hospitalized for community-acquired pneumonia (CAP) during 2011 and 2012 according to ICD-9 codes for CAP or respiratory distress. Children with severe medical comorbidities were excluded. Dr. Koster, a pediatrician at Hasbro Children’s Hospital, Providence, R.I., and his associates collected data on patient demographics, medical history, laboratory tests, diagnostic radiography, antimicrobials administered, length of stay, ICU transfer, and readmission.

Of the 1,142 initially identified, 763 were used in the final analysis. Of these, 462 had blood cultures and the remaining 301 did not.

Dr. Koster reported that patients in the blood culture group had a significantly longer mean length of stay, compared with the no culture group (3.4 vs. 1.9 days, respectively; P < .0001). This difference persisted when ICU patients were removed from the analysis (2.5 vs. 1.8 days; P < .0001).

The researchers observed no statistically significant differences between those who had blood cultures and those who did not in receipt of antibiotics prior to presentation (41.6% vs. 40.9%, respectively; P = .85), the presence of any pulmonary effusion (57.6% vs. 61.1%; P = .33), or in the 14-day readmission rates (4.1% vs. 3%; P = .42).

However, in the emergency department, the blood culture group was more likely receive a third-generation cephalosporin (68.9% vs. 42.9%; P < .0001) while the no culture group was more likely to receive penicillin/ampicillin alone (38.4% vs. 21.3%; P = .0001).

Among patients in the blood culture group, 2.4% were positive for pathogens and 2.2% were contaminated, for a positive predictive value of 52.4%.

“Blood cultures aren’t free of harm,” Dr. Koster concluded. “They increase how long you stay in the hospital, and they increase the prescription of third-generation cephalosporins. Practice variation among physicians is probably what resulted in these findings. Until we recognize the variance around the interventions that we give to kids, we won’t be able to decrease the variance around their outcomes.”

The study was supported by the Rhode Island Foundation. Dr. Koster reported having no financial disclosures.

dbrunk@frontlinemedcom.com

On Twitter @dougbrunk

Cigarette smoking caused at least 14 million cases of major medical conditions among U.S. adults in 2009, investigators reported online Oct. 13 in JAMA Internal Medicine.

The statistic substantially exceeds a 2000 estimate by the Centers for Disease Control and Prevention of 12.7 million smoking-related conditions among 8.6 million individuals, said Brian L. Rostron, Ph.D., at the U.S. Food and Drug Administration, Silver Spring, Md., and his associates.

©ricky_68fr/fotolia.com

The discrepancy most likely stems from the fact that respondents in national health surveys tend to underreport chronic obstructive pulmonary disease (COPD), the leading medical consequence of smoking, the researchers said. Using spirometry data, they estimated more than 7.4 million cases of COPD attributable to smoking in 2009, which was 70% higher than past statistics based on self-reported data, they said (JAMA Intern. Med. 2014 Oct. 13 [doi:10.1001/ jamainternmed.2014.5219]). For the study, the researchers used data from the 2009 U.S. Census Bureau, the 2006-2012 National Health Interview Survey, and the National Health and Nutrition Examination Survey to calculate the population-attributable risk of major smoking-related conditions among U.S. adults aged 35 years and older. Besides COPD, these conditions included diabetes mellitus, heart attacks, cancer, and stroke.

This approach yielded an estimate of 6.9 million adults in the United States with at least one major medical condition secondary to smoking (95% confidence interval, 6.5-7.4 million), with a total of 10.9 million conditions identified (95% CI, 10.3-11.5 million), the researchers said.

To better estimate the burden of COPD secondary to smoking, the investigators then used self-reported and spirometry data from the National Health and Nutrition Examination Survey. This analysis identified 14 million smoking-attributable conditions overall (95% CI, 12.9 to 15.1 million), including more than 7.4 million cases of COPD, they said. Notably, COPD was 3.78 times more common among current female smokers than never smokers (95% CI, 3.46-4.12), and four times more common among male smokers than never smokers (95% CI, 3.54-4.52), they said.

The results are “generally conservative, owing to the existence of other diseases and medical events that were not included in these estimates,” the researchers wrote, adding that “the International Agency for Research on Cancer has concluded, for example, that ovarian cancer, specifically mucinous tumors, is caused by smoking.” Current estimates also do not capture the prevalence of cardiovascular surgeries, congestive heart failure, peripheral arterial disease, rheumatoid arthritis, and macular degeneration attributable to smoking, said the investigators.

Descriptions of medical diagnoses were self-reported and therefore might not always be accurate, Dr. Rostron and associates noted. They reported no funding sources or conflicts of interest.

Cigarette smoking caused at least 14 million cases of major medical conditions among U.S. adults in 2009, investigators reported online Oct. 13 in JAMA Internal Medicine.

The statistic substantially exceeds a 2000 estimate by the Centers for Disease Control and Prevention of 12.7 million smoking-related conditions among 8.6 million individuals, said Brian L. Rostron, Ph.D., at the U.S. Food and Drug Administration, Silver Spring, Md., and his associates.

©ricky_68fr/fotolia.com

The discrepancy most likely stems from the fact that respondents in national health surveys tend to underreport chronic obstructive pulmonary disease (COPD), the leading medical consequence of smoking, the researchers said. Using spirometry data, they estimated more than 7.4 million cases of COPD attributable to smoking in 2009, which was 70% higher than past statistics based on self-reported data, they said (JAMA Intern. Med. 2014 Oct. 13 [doi:10.1001/ jamainternmed.2014.5219]). For the study, the researchers used data from the 2009 U.S. Census Bureau, the 2006-2012 National Health Interview Survey, and the National Health and Nutrition Examination Survey to calculate the population-attributable risk of major smoking-related conditions among U.S. adults aged 35 years and older. Besides COPD, these conditions included diabetes mellitus, heart attacks, cancer, and stroke.

This approach yielded an estimate of 6.9 million adults in the United States with at least one major medical condition secondary to smoking (95% confidence interval, 6.5-7.4 million), with a total of 10.9 million conditions identified (95% CI, 10.3-11.5 million), the researchers said.

To better estimate the burden of COPD secondary to smoking, the investigators then used self-reported and spirometry data from the National Health and Nutrition Examination Survey. This analysis identified 14 million smoking-attributable conditions overall (95% CI, 12.9 to 15.1 million), including more than 7.4 million cases of COPD, they said. Notably, COPD was 3.78 times more common among current female smokers than never smokers (95% CI, 3.46-4.12), and four times more common among male smokers than never smokers (95% CI, 3.54-4.52), they said.

The results are “generally conservative, owing to the existence of other diseases and medical events that were not included in these estimates,” the researchers wrote, adding that “the International Agency for Research on Cancer has concluded, for example, that ovarian cancer, specifically mucinous tumors, is caused by smoking.” Current estimates also do not capture the prevalence of cardiovascular surgeries, congestive heart failure, peripheral arterial disease, rheumatoid arthritis, and macular degeneration attributable to smoking, said the investigators.

Descriptions of medical diagnoses were self-reported and therefore might not always be accurate, Dr. Rostron and associates noted. They reported no funding sources or conflicts of interest.

Cigarette smoking caused at least 14 million cases of major medical conditions among U.S. adults in 2009, investigators reported online Oct. 13 in JAMA Internal Medicine.

The statistic substantially exceeds a 2000 estimate by the Centers for Disease Control and Prevention of 12.7 million smoking-related conditions among 8.6 million individuals, said Brian L. Rostron, Ph.D., at the U.S. Food and Drug Administration, Silver Spring, Md., and his associates.

©ricky_68fr/fotolia.com

The discrepancy most likely stems from the fact that respondents in national health surveys tend to underreport chronic obstructive pulmonary disease (COPD), the leading medical consequence of smoking, the researchers said. Using spirometry data, they estimated more than 7.4 million cases of COPD attributable to smoking in 2009, which was 70% higher than past statistics based on self-reported data, they said (JAMA Intern. Med. 2014 Oct. 13 [doi:10.1001/ jamainternmed.2014.5219]). For the study, the researchers used data from the 2009 U.S. Census Bureau, the 2006-2012 National Health Interview Survey, and the National Health and Nutrition Examination Survey to calculate the population-attributable risk of major smoking-related conditions among U.S. adults aged 35 years and older. Besides COPD, these conditions included diabetes mellitus, heart attacks, cancer, and stroke.

This approach yielded an estimate of 6.9 million adults in the United States with at least one major medical condition secondary to smoking (95% confidence interval, 6.5-7.4 million), with a total of 10.9 million conditions identified (95% CI, 10.3-11.5 million), the researchers said.

To better estimate the burden of COPD secondary to smoking, the investigators then used self-reported and spirometry data from the National Health and Nutrition Examination Survey. This analysis identified 14 million smoking-attributable conditions overall (95% CI, 12.9 to 15.1 million), including more than 7.4 million cases of COPD, they said. Notably, COPD was 3.78 times more common among current female smokers than never smokers (95% CI, 3.46-4.12), and four times more common among male smokers than never smokers (95% CI, 3.54-4.52), they said.

The results are “generally conservative, owing to the existence of other diseases and medical events that were not included in these estimates,” the researchers wrote, adding that “the International Agency for Research on Cancer has concluded, for example, that ovarian cancer, specifically mucinous tumors, is caused by smoking.” Current estimates also do not capture the prevalence of cardiovascular surgeries, congestive heart failure, peripheral arterial disease, rheumatoid arthritis, and macular degeneration attributable to smoking, said the investigators.

Descriptions of medical diagnoses were self-reported and therefore might not always be accurate, Dr. Rostron and associates noted. They reported no funding sources or conflicts of interest.

PHILADELPHIA – Pleconaril, an oral capsid binder with activity against enterovirus infections, shows promise for the treatment of neonates with enterovirus sepsis, according to findings from a randomized, double-blind, placebo-controlled trial.

Time to culture-negativity for all types of collected specimens combined – including those from the oropharynx, rectum, urine, and serum – was faster in 43 patients treated with 5 mg/kg of pleconaril every 8 hours for 7 days than in18 patients who received placebo (median of 4.0 vs. 7.0 days). The difference approached statistical significance.

Fewer subjects in the treatment group remained polymerase chain reaction-positive at last oropharynx sample (83% and 23% were positive on day 1 and at a median of day 14 in the treatment group, vs. 100% and 58%, respectively, in the placebo group), Dr. Mark Abzug of the University of Colorado, Aurora, reported at an annual scientific meeting on infectious diseases.

Mortality in an intention-to-treat analysis was 23% in the treatment group, compared with 44% in the placebo group, and mortality in those with confirmed enterovirus infection was 23% and 42% in the treatment and placebo groups, respectively, Dr. Abzug said at the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

Patients were neonates with suspected enterovirus sepsis with illness onset in the first 15 days of life. They were randomized 2:1 to receive active treatment or placebo for 7 days. Specimens were obtained serially for 14 days for viral culture and PCR, pharmacokinetic analysis, and safety evaluations, and clinical assessments were performed over 24 months.

Enterovirus was confirmed by culture or PCR in 43 of the 61 patients, including 31 in the treatment group and 12 in the placebo group. The two groups were similar with respect to baseline characteristics, including median age at illness onset (4.5 and 5.0 days, respectively) and time until enrollment (6 to 7 days into the course of their illness).

Of note, pleconaril concentrations exceeded the 90% inhibitory concentration (IC90) level after the first day of treatment in the treatment group, but 41% of subjects did not achieve this target until after day 4, suggesting the need for a loading dose.

Neonatal enterovirus infections are associated with high morbidity and mortality, and therapy is mainly supportive. While intravenous immunoglobulin is thought to confer potential benefit, it remains unproven, and no specific antiviral therapies are currently available, Dr. Abzug said.

Pleconaril has been shown previously to have activity against most enteroviruses and many rhinoviruses. It is well tolerated: In the current study, treatment-related adverse effects occurred in 1 subject in the treatment group, and in 3 in the placebo group.

While the unexpectedly low yield of viral cultures in this study precluded the demonstration of a difference between the groups with regard to the primary endpoint of day 5 oropharyngeal culture positivity, which was 25% on day 1 and 0% on day 5 in the treatment group, vs. 30% on day 1 and 0% on day 5 in the placebo group, the shorter times to culture and PCR negativity and the suggestion of greater survival in the treatment group are encouraging, Dr. Abzug said.

These indicators of biological and clinical efficacy warrant further investigation of pleconaril for neonatal enteroviral disease, he concluded.The study was funded by the National Institute of Allergy and Infectious Diseases. Dr. Abzug reported having no disclosures.

PHILADELPHIA – Pleconaril, an oral capsid binder with activity against enterovirus infections, shows promise for the treatment of neonates with enterovirus sepsis, according to findings from a randomized, double-blind, placebo-controlled trial.

Time to culture-negativity for all types of collected specimens combined – including those from the oropharynx, rectum, urine, and serum – was faster in 43 patients treated with 5 mg/kg of pleconaril every 8 hours for 7 days than in18 patients who received placebo (median of 4.0 vs. 7.0 days). The difference approached statistical significance.

Fewer subjects in the treatment group remained polymerase chain reaction-positive at last oropharynx sample (83% and 23% were positive on day 1 and at a median of day 14 in the treatment group, vs. 100% and 58%, respectively, in the placebo group), Dr. Mark Abzug of the University of Colorado, Aurora, reported at an annual scientific meeting on infectious diseases.

Mortality in an intention-to-treat analysis was 23% in the treatment group, compared with 44% in the placebo group, and mortality in those with confirmed enterovirus infection was 23% and 42% in the treatment and placebo groups, respectively, Dr. Abzug said at the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

Patients were neonates with suspected enterovirus sepsis with illness onset in the first 15 days of life. They were randomized 2:1 to receive active treatment or placebo for 7 days. Specimens were obtained serially for 14 days for viral culture and PCR, pharmacokinetic analysis, and safety evaluations, and clinical assessments were performed over 24 months.

Enterovirus was confirmed by culture or PCR in 43 of the 61 patients, including 31 in the treatment group and 12 in the placebo group. The two groups were similar with respect to baseline characteristics, including median age at illness onset (4.5 and 5.0 days, respectively) and time until enrollment (6 to 7 days into the course of their illness).

Of note, pleconaril concentrations exceeded the 90% inhibitory concentration (IC90) level after the first day of treatment in the treatment group, but 41% of subjects did not achieve this target until after day 4, suggesting the need for a loading dose.

Neonatal enterovirus infections are associated with high morbidity and mortality, and therapy is mainly supportive. While intravenous immunoglobulin is thought to confer potential benefit, it remains unproven, and no specific antiviral therapies are currently available, Dr. Abzug said.

Pleconaril has been shown previously to have activity against most enteroviruses and many rhinoviruses. It is well tolerated: In the current study, treatment-related adverse effects occurred in 1 subject in the treatment group, and in 3 in the placebo group.

While the unexpectedly low yield of viral cultures in this study precluded the demonstration of a difference between the groups with regard to the primary endpoint of day 5 oropharyngeal culture positivity, which was 25% on day 1 and 0% on day 5 in the treatment group, vs. 30% on day 1 and 0% on day 5 in the placebo group, the shorter times to culture and PCR negativity and the suggestion of greater survival in the treatment group are encouraging, Dr. Abzug said.

These indicators of biological and clinical efficacy warrant further investigation of pleconaril for neonatal enteroviral disease, he concluded.The study was funded by the National Institute of Allergy and Infectious Diseases. Dr. Abzug reported having no disclosures.

PHILADELPHIA – Pleconaril, an oral capsid binder with activity against enterovirus infections, shows promise for the treatment of neonates with enterovirus sepsis, according to findings from a randomized, double-blind, placebo-controlled trial.

Time to culture-negativity for all types of collected specimens combined – including those from the oropharynx, rectum, urine, and serum – was faster in 43 patients treated with 5 mg/kg of pleconaril every 8 hours for 7 days than in18 patients who received placebo (median of 4.0 vs. 7.0 days). The difference approached statistical significance.

Fewer subjects in the treatment group remained polymerase chain reaction-positive at last oropharynx sample (83% and 23% were positive on day 1 and at a median of day 14 in the treatment group, vs. 100% and 58%, respectively, in the placebo group), Dr. Mark Abzug of the University of Colorado, Aurora, reported at an annual scientific meeting on infectious diseases.

Mortality in an intention-to-treat analysis was 23% in the treatment group, compared with 44% in the placebo group, and mortality in those with confirmed enterovirus infection was 23% and 42% in the treatment and placebo groups, respectively, Dr. Abzug said at the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

Patients were neonates with suspected enterovirus sepsis with illness onset in the first 15 days of life. They were randomized 2:1 to receive active treatment or placebo for 7 days. Specimens were obtained serially for 14 days for viral culture and PCR, pharmacokinetic analysis, and safety evaluations, and clinical assessments were performed over 24 months.

Enterovirus was confirmed by culture or PCR in 43 of the 61 patients, including 31 in the treatment group and 12 in the placebo group. The two groups were similar with respect to baseline characteristics, including median age at illness onset (4.5 and 5.0 days, respectively) and time until enrollment (6 to 7 days into the course of their illness).

Of note, pleconaril concentrations exceeded the 90% inhibitory concentration (IC90) level after the first day of treatment in the treatment group, but 41% of subjects did not achieve this target until after day 4, suggesting the need for a loading dose.

Neonatal enterovirus infections are associated with high morbidity and mortality, and therapy is mainly supportive. While intravenous immunoglobulin is thought to confer potential benefit, it remains unproven, and no specific antiviral therapies are currently available, Dr. Abzug said.

Pleconaril has been shown previously to have activity against most enteroviruses and many rhinoviruses. It is well tolerated: In the current study, treatment-related adverse effects occurred in 1 subject in the treatment group, and in 3 in the placebo group.

While the unexpectedly low yield of viral cultures in this study precluded the demonstration of a difference between the groups with regard to the primary endpoint of day 5 oropharyngeal culture positivity, which was 25% on day 1 and 0% on day 5 in the treatment group, vs. 30% on day 1 and 0% on day 5 in the placebo group, the shorter times to culture and PCR negativity and the suggestion of greater survival in the treatment group are encouraging, Dr. Abzug said.

These indicators of biological and clinical efficacy warrant further investigation of pleconaril for neonatal enteroviral disease, he concluded.The study was funded by the National Institute of Allergy and Infectious Diseases. Dr. Abzug reported having no disclosures.

First-episode schizophrenia spectrum disorders are associated with a significantly higher prevalence of metabolic risk factors, such as smoking, dyslipidemia, and elevated body mass, compared with the general population. Those risk factors are tied to illness duration and are exacerbated by antipsychotic therapy, data from a cross-sectional study of patients with the disorders show.

Among the 394 patients with cardiometabolic data, about half smoked cigarettes, 39.9% had prehypertension, 10.0% had hypertension, and 13.2% had metabolic syndrome, and 48.3% were obese or overweight – a figure similar to that found among a similarly aged U.S. population – while 56.5% had dyslipidemia, which reflects the incidence in a general population 15-20 years older.

Duration of psychiatric illness was significantly associated with higher body mass index, fat mass, fat percentage, and waist circumference. Antipsychotic treatment was linked to higher measures of non-HDL-C, triglyceride levels, and triglyceride to HDL-C ratios but lower HDL-C measures and systolic blood pressure, according to a paper published online Oct. 8 in JAMA Psychiatry ([doi:10.1001/jamapsychiatry.2014.1314]).

“In patients with [first-episode schizophrenia], cardiometabolic risk factors and abnormalities are present early in the illness and likely related to the underlying illness, unhealthy lifestyle, and antipsychotic medications, which interact with each other,” wrote Dr. Christoph U. Correll, professor, psychiatry and molecular medicine at the Hofstra University, Hempstead, N.Y., and his colleagues. “Prevention of and early interventions for psychiatric illness with lower-risk agents, routine antipsychotic adverse effect monitoring, and smoking cessation interventions are needed from the earliest illness phases.”

The study was supported by the National Institute of Mental Health, and the American Recovery and Reinvestment Act. Dr. Correll disclosed acting as a consultant and/or adviser to or receiving honoraria from several companies and entities, including numerous makers of antipsychotics.

First-episode schizophrenia spectrum disorders are associated with a significantly higher prevalence of metabolic risk factors, such as smoking, dyslipidemia, and elevated body mass, compared with the general population. Those risk factors are tied to illness duration and are exacerbated by antipsychotic therapy, data from a cross-sectional study of patients with the disorders show.

Among the 394 patients with cardiometabolic data, about half smoked cigarettes, 39.9% had prehypertension, 10.0% had hypertension, and 13.2% had metabolic syndrome, and 48.3% were obese or overweight – a figure similar to that found among a similarly aged U.S. population – while 56.5% had dyslipidemia, which reflects the incidence in a general population 15-20 years older.

Duration of psychiatric illness was significantly associated with higher body mass index, fat mass, fat percentage, and waist circumference. Antipsychotic treatment was linked to higher measures of non-HDL-C, triglyceride levels, and triglyceride to HDL-C ratios but lower HDL-C measures and systolic blood pressure, according to a paper published online Oct. 8 in JAMA Psychiatry ([doi:10.1001/jamapsychiatry.2014.1314]).

“In patients with [first-episode schizophrenia], cardiometabolic risk factors and abnormalities are present early in the illness and likely related to the underlying illness, unhealthy lifestyle, and antipsychotic medications, which interact with each other,” wrote Dr. Christoph U. Correll, professor, psychiatry and molecular medicine at the Hofstra University, Hempstead, N.Y., and his colleagues. “Prevention of and early interventions for psychiatric illness with lower-risk agents, routine antipsychotic adverse effect monitoring, and smoking cessation interventions are needed from the earliest illness phases.”

The study was supported by the National Institute of Mental Health, and the American Recovery and Reinvestment Act. Dr. Correll disclosed acting as a consultant and/or adviser to or receiving honoraria from several companies and entities, including numerous makers of antipsychotics.

First-episode schizophrenia spectrum disorders are associated with a significantly higher prevalence of metabolic risk factors, such as smoking, dyslipidemia, and elevated body mass, compared with the general population. Those risk factors are tied to illness duration and are exacerbated by antipsychotic therapy, data from a cross-sectional study of patients with the disorders show.

Among the 394 patients with cardiometabolic data, about half smoked cigarettes, 39.9% had prehypertension, 10.0% had hypertension, and 13.2% had metabolic syndrome, and 48.3% were obese or overweight – a figure similar to that found among a similarly aged U.S. population – while 56.5% had dyslipidemia, which reflects the incidence in a general population 15-20 years older.

Duration of psychiatric illness was significantly associated with higher body mass index, fat mass, fat percentage, and waist circumference. Antipsychotic treatment was linked to higher measures of non-HDL-C, triglyceride levels, and triglyceride to HDL-C ratios but lower HDL-C measures and systolic blood pressure, according to a paper published online Oct. 8 in JAMA Psychiatry ([doi:10.1001/jamapsychiatry.2014.1314]).

“In patients with [first-episode schizophrenia], cardiometabolic risk factors and abnormalities are present early in the illness and likely related to the underlying illness, unhealthy lifestyle, and antipsychotic medications, which interact with each other,” wrote Dr. Christoph U. Correll, professor, psychiatry and molecular medicine at the Hofstra University, Hempstead, N.Y., and his colleagues. “Prevention of and early interventions for psychiatric illness with lower-risk agents, routine antipsychotic adverse effect monitoring, and smoking cessation interventions are needed from the earliest illness phases.”

The study was supported by the National Institute of Mental Health, and the American Recovery and Reinvestment Act. Dr. Correll disclosed acting as a consultant and/or adviser to or receiving honoraria from several companies and entities, including numerous makers of antipsychotics.

In systematic reviews of research on neuraminidase inhibitors for either prevention or treatment of influenza, authors who had ties to drug manufacturers were much more likely to present the evidence as favorable and to recommend the drugs than were authors who had no such conflicts of interest, according to a report published online Oct. 6 in Annals of Internal Medicine.

“Reviewers with such conflicts of interest were also less likely to address issues with the underlying primary clinical evidence, such as publication bias and the lack of access to comprehensive study data,” said Adam G. Dunn, Ph.D., of the Centre for Health Informatics, University of New South Wales, Sydney, and his associates (Ann. Intern. Med. 2014 Oct.6 [doi:10.7326/M14-0933]).

The findings suggest that “further measures may be necessary to ensure that industry collaborations do not compromise the scientific evidence,” the investigators noted.

“If the benefits of neuraminidase inhibitors are eventually found to have been inflated, millions of patients will have been unnecessarily exposed to drugs that may be of little or no benefit,” the researchers added.

Dr. Dunn and his colleagues observed that reviews of neuraminidase inhibitors had widely divergent conclusions, with some strongly endorsing the agents as influenza prophylaxis or treatment, while others questioned the drugs’ safety and efficacy.

To examine whether industry influence may have contributed to these inconsistent conclusions, the investigators analyzed 26 systematic reviews. Thirteen assessed prophylaxis, and 24 assessed treatment; so, there were 37 distinct assessments. Seven of those were Cochrane analyses.

Two of the investigators read redacted copies of the reviews and rated them as favorable or unfavorable toward the use of neuraminidase inhibitors. Those copies showed no identifying information for the authors and no journal name or formatting clues. The agreement between the two investigators was “strong,” at 86%.

At the same time, Dr. Dunn and his associates searched for all the financial conflicts of interest for all the authors of these reviews, paying special attention to ties to the pharmaceutical companies that made the neuraminidase inhibitors under review. To do so, they went beyond the affiliations and funding listed in the systematic reviews, examining the authors’ personal and institutional websites, as well as disclosure lists provided by GlaxoSmithKline and Roche. They also performed Web searches combining the authors’ names, drug names, and manufacturers’ names.

Reviewers who had ties to the pharmaceutical industry rated neuraminidase inhibitors favorably in 88% (seven of eight) systematic reviews. In contrast, reviewers who had no such ties rated the drugs favorably in only 17% (5 of 29) of systematic reviews. That pattern persisted when prophylaxis and treatment were assessed separately.

Regarding prophylaxis, 100% (2 of 2) of the reviews with financial conflicts of interest were favorable, compared with only 9% (1 of 11) of those without conflicts of interest. Regarding treatment, 83% (5 of 6) of the reviews with financial conflicts of interest were favorable, compared with only 22% (4 of 18) of those without conflicts of interest.

In addition, reviewers who had ties to the pharmaceutical industry were less likely to include information about publication bias in their reports (14%, or only 1 of 7), compared with reviewers who had no such ties (79%, or 15 of 19), Dr. Dunn and his associates said.

The study findings indicate that financial conflicts of interest “are associated with product assessments favorable to the sponsors involved,” the authors asserted.

Factors that may contribute to biased conclusions include “the design of the review, the patient populations and outcomes assessed, the selective inclusion of primary evidence, [and] the critical appraisal of evidence quality and provenance,” the investigators noted. In addition, “the tone, emphasis, and interpretation provided by the authors may also influence the message that is conveyed,” they said.

The Australian National Health and Medical Research Council funded the study. Dr. Dunn and his associates reported having no financial conflicts of interest.

In systematic reviews of research on neuraminidase inhibitors for either prevention or treatment of influenza, authors who had ties to drug manufacturers were much more likely to present the evidence as favorable and to recommend the drugs than were authors who had no such conflicts of interest, according to a report published online Oct. 6 in Annals of Internal Medicine.

“Reviewers with such conflicts of interest were also less likely to address issues with the underlying primary clinical evidence, such as publication bias and the lack of access to comprehensive study data,” said Adam G. Dunn, Ph.D., of the Centre for Health Informatics, University of New South Wales, Sydney, and his associates (Ann. Intern. Med. 2014 Oct.6 [doi:10.7326/M14-0933]).

The findings suggest that “further measures may be necessary to ensure that industry collaborations do not compromise the scientific evidence,” the investigators noted.

“If the benefits of neuraminidase inhibitors are eventually found to have been inflated, millions of patients will have been unnecessarily exposed to drugs that may be of little or no benefit,” the researchers added.

Dr. Dunn and his colleagues observed that reviews of neuraminidase inhibitors had widely divergent conclusions, with some strongly endorsing the agents as influenza prophylaxis or treatment, while others questioned the drugs’ safety and efficacy.

To examine whether industry influence may have contributed to these inconsistent conclusions, the investigators analyzed 26 systematic reviews. Thirteen assessed prophylaxis, and 24 assessed treatment; so, there were 37 distinct assessments. Seven of those were Cochrane analyses.

Two of the investigators read redacted copies of the reviews and rated them as favorable or unfavorable toward the use of neuraminidase inhibitors. Those copies showed no identifying information for the authors and no journal name or formatting clues. The agreement between the two investigators was “strong,” at 86%.

At the same time, Dr. Dunn and his associates searched for all the financial conflicts of interest for all the authors of these reviews, paying special attention to ties to the pharmaceutical companies that made the neuraminidase inhibitors under review. To do so, they went beyond the affiliations and funding listed in the systematic reviews, examining the authors’ personal and institutional websites, as well as disclosure lists provided by GlaxoSmithKline and Roche. They also performed Web searches combining the authors’ names, drug names, and manufacturers’ names.

Reviewers who had ties to the pharmaceutical industry rated neuraminidase inhibitors favorably in 88% (seven of eight) systematic reviews. In contrast, reviewers who had no such ties rated the drugs favorably in only 17% (5 of 29) of systematic reviews. That pattern persisted when prophylaxis and treatment were assessed separately.

Regarding prophylaxis, 100% (2 of 2) of the reviews with financial conflicts of interest were favorable, compared with only 9% (1 of 11) of those without conflicts of interest. Regarding treatment, 83% (5 of 6) of the reviews with financial conflicts of interest were favorable, compared with only 22% (4 of 18) of those without conflicts of interest.

In addition, reviewers who had ties to the pharmaceutical industry were less likely to include information about publication bias in their reports (14%, or only 1 of 7), compared with reviewers who had no such ties (79%, or 15 of 19), Dr. Dunn and his associates said.

The study findings indicate that financial conflicts of interest “are associated with product assessments favorable to the sponsors involved,” the authors asserted.

Factors that may contribute to biased conclusions include “the design of the review, the patient populations and outcomes assessed, the selective inclusion of primary evidence, [and] the critical appraisal of evidence quality and provenance,” the investigators noted. In addition, “the tone, emphasis, and interpretation provided by the authors may also influence the message that is conveyed,” they said.

The Australian National Health and Medical Research Council funded the study. Dr. Dunn and his associates reported having no financial conflicts of interest.

In systematic reviews of research on neuraminidase inhibitors for either prevention or treatment of influenza, authors who had ties to drug manufacturers were much more likely to present the evidence as favorable and to recommend the drugs than were authors who had no such conflicts of interest, according to a report published online Oct. 6 in Annals of Internal Medicine.

“Reviewers with such conflicts of interest were also less likely to address issues with the underlying primary clinical evidence, such as publication bias and the lack of access to comprehensive study data,” said Adam G. Dunn, Ph.D., of the Centre for Health Informatics, University of New South Wales, Sydney, and his associates (Ann. Intern. Med. 2014 Oct.6 [doi:10.7326/M14-0933]).

The findings suggest that “further measures may be necessary to ensure that industry collaborations do not compromise the scientific evidence,” the investigators noted.

“If the benefits of neuraminidase inhibitors are eventually found to have been inflated, millions of patients will have been unnecessarily exposed to drugs that may be of little or no benefit,” the researchers added.

Dr. Dunn and his colleagues observed that reviews of neuraminidase inhibitors had widely divergent conclusions, with some strongly endorsing the agents as influenza prophylaxis or treatment, while others questioned the drugs’ safety and efficacy.

To examine whether industry influence may have contributed to these inconsistent conclusions, the investigators analyzed 26 systematic reviews. Thirteen assessed prophylaxis, and 24 assessed treatment; so, there were 37 distinct assessments. Seven of those were Cochrane analyses.

Two of the investigators read redacted copies of the reviews and rated them as favorable or unfavorable toward the use of neuraminidase inhibitors. Those copies showed no identifying information for the authors and no journal name or formatting clues. The agreement between the two investigators was “strong,” at 86%.

At the same time, Dr. Dunn and his associates searched for all the financial conflicts of interest for all the authors of these reviews, paying special attention to ties to the pharmaceutical companies that made the neuraminidase inhibitors under review. To do so, they went beyond the affiliations and funding listed in the systematic reviews, examining the authors’ personal and institutional websites, as well as disclosure lists provided by GlaxoSmithKline and Roche. They also performed Web searches combining the authors’ names, drug names, and manufacturers’ names.

Reviewers who had ties to the pharmaceutical industry rated neuraminidase inhibitors favorably in 88% (seven of eight) systematic reviews. In contrast, reviewers who had no such ties rated the drugs favorably in only 17% (5 of 29) of systematic reviews. That pattern persisted when prophylaxis and treatment were assessed separately.

Regarding prophylaxis, 100% (2 of 2) of the reviews with financial conflicts of interest were favorable, compared with only 9% (1 of 11) of those without conflicts of interest. Regarding treatment, 83% (5 of 6) of the reviews with financial conflicts of interest were favorable, compared with only 22% (4 of 18) of those without conflicts of interest.

In addition, reviewers who had ties to the pharmaceutical industry were less likely to include information about publication bias in their reports (14%, or only 1 of 7), compared with reviewers who had no such ties (79%, or 15 of 19), Dr. Dunn and his associates said.

The study findings indicate that financial conflicts of interest “are associated with product assessments favorable to the sponsors involved,” the authors asserted.

Factors that may contribute to biased conclusions include “the design of the review, the patient populations and outcomes assessed, the selective inclusion of primary evidence, [and] the critical appraisal of evidence quality and provenance,” the investigators noted. In addition, “the tone, emphasis, and interpretation provided by the authors may also influence the message that is conveyed,” they said.

The Australian National Health and Medical Research Council funded the study. Dr. Dunn and his associates reported having no financial conflicts of interest.

Early prenatal exposure to bisphenol A was linked to diminished lung function at age 4 years and to persistent childhood wheezing, according to a birth cohort analysis reported online Oct. 6 in JAMA Pediatrics.

“If future studies confirm that prenatal BPA exposure may be a risk factor for impaired respiratory health, it may offer another avenue to prevent the development of asthma,” said Dr. Adam J. Spanier of the University of Maryland in Baltimore and his associates.

In the study, which enrolled 398 pairs of English-speaking mothers and infants in the Cincinnati area, every 10-fold increase in maternal urinary concentration of BPA at 16 weeks’ gestation led to a 4.27-fold rise in the odds of persistent wheezing in offspring (adjusted odds ratio, 4.27; 95% confidence interval, 1.37 to 13.30), the researchers reported. The findings “confirm and extend” the results for parent-reported wheezing from the same cohort at age 3 years, they said (JAMA Pediatr. 2014 Oct. 6 [doi:10.1001/jamapediatrics.2014.1397]). There also was an association of increasing mean maternal urinary BPA level with decreasing percent predicted forced expiratory volume at age 4 years. However, the effect on lung function was not seen for children aged 5 years.

© suriyasilsaksom/Thinkstock

Another study reported a postnatal association of BPA exposure with asthma and wheezing in children, but did not find an association with prenatal BPA exposure. “Additional research is needed to clarify the contrasting findings in recent human studies,” Dr. Spanier and his associates wrote.

The study cohort did have worse lung function parameters than the reference sample of healthy children, the researchers said. Furthermore, minority, low-income families were more likely to drop out of the study than were higher-income white families.

The study was supported by a Flight Attendant Medical Research Foundation Young Clinical Scientist Award from the National Institute of Environmental Health Sciences. The authors reported having no relevant financial conflicts.

Early prenatal exposure to bisphenol A was linked to diminished lung function at age 4 years and to persistent childhood wheezing, according to a birth cohort analysis reported online Oct. 6 in JAMA Pediatrics.

“If future studies confirm that prenatal BPA exposure may be a risk factor for impaired respiratory health, it may offer another avenue to prevent the development of asthma,” said Dr. Adam J. Spanier of the University of Maryland in Baltimore and his associates.

In the study, which enrolled 398 pairs of English-speaking mothers and infants in the Cincinnati area, every 10-fold increase in maternal urinary concentration of BPA at 16 weeks’ gestation led to a 4.27-fold rise in the odds of persistent wheezing in offspring (adjusted odds ratio, 4.27; 95% confidence interval, 1.37 to 13.30), the researchers reported. The findings “confirm and extend” the results for parent-reported wheezing from the same cohort at age 3 years, they said (JAMA Pediatr. 2014 Oct. 6 [doi:10.1001/jamapediatrics.2014.1397]). There also was an association of increasing mean maternal urinary BPA level with decreasing percent predicted forced expiratory volume at age 4 years. However, the effect on lung function was not seen for children aged 5 years.

© suriyasilsaksom/Thinkstock

Another study reported a postnatal association of BPA exposure with asthma and wheezing in children, but did not find an association with prenatal BPA exposure. “Additional research is needed to clarify the contrasting findings in recent human studies,” Dr. Spanier and his associates wrote.

The study cohort did have worse lung function parameters than the reference sample of healthy children, the researchers said. Furthermore, minority, low-income families were more likely to drop out of the study than were higher-income white families.

The study was supported by a Flight Attendant Medical Research Foundation Young Clinical Scientist Award from the National Institute of Environmental Health Sciences. The authors reported having no relevant financial conflicts.

Early prenatal exposure to bisphenol A was linked to diminished lung function at age 4 years and to persistent childhood wheezing, according to a birth cohort analysis reported online Oct. 6 in JAMA Pediatrics.

“If future studies confirm that prenatal BPA exposure may be a risk factor for impaired respiratory health, it may offer another avenue to prevent the development of asthma,” said Dr. Adam J. Spanier of the University of Maryland in Baltimore and his associates.

In the study, which enrolled 398 pairs of English-speaking mothers and infants in the Cincinnati area, every 10-fold increase in maternal urinary concentration of BPA at 16 weeks’ gestation led to a 4.27-fold rise in the odds of persistent wheezing in offspring (adjusted odds ratio, 4.27; 95% confidence interval, 1.37 to 13.30), the researchers reported. The findings “confirm and extend” the results for parent-reported wheezing from the same cohort at age 3 years, they said (JAMA Pediatr. 2014 Oct. 6 [doi:10.1001/jamapediatrics.2014.1397]). There also was an association of increasing mean maternal urinary BPA level with decreasing percent predicted forced expiratory volume at age 4 years. However, the effect on lung function was not seen for children aged 5 years.

© suriyasilsaksom/Thinkstock

Another study reported a postnatal association of BPA exposure with asthma and wheezing in children, but did not find an association with prenatal BPA exposure. “Additional research is needed to clarify the contrasting findings in recent human studies,” Dr. Spanier and his associates wrote.

The study cohort did have worse lung function parameters than the reference sample of healthy children, the researchers said. Furthermore, minority, low-income families were more likely to drop out of the study than were higher-income white families.

The study was supported by a Flight Attendant Medical Research Foundation Young Clinical Scientist Award from the National Institute of Environmental Health Sciences. The authors reported having no relevant financial conflicts.

Isolating patients, more than a rollout of vaccines or any change in treatment strategy, is the cornerstone of the international effort to contain the Ebola outbreak in West Africa, say officials leading the response.

Steve Monroe, Ph.D., deputy director of the National Center for Emerging and Infectious diseases at the U.S. Centers for Disease Control and Prevention, summarized the state of the outbreak and the international response in a news conference Sept. 30, hours before the agency revealed the first imported case of Ebola documented in the United States in a traveler returning from Liberia.

In the two worst-affected countries, Sierra Leone and Liberia, cases are doubling approximately every 3 weeks. “One of the things CDC modeling data show is that we must get cases into isolation and treatment,” Dr. Monroe said. “We know how to control these outbreaks: Get patients into isolation so they don’t infect other people, and then follow their contacts.”

Courtesy Wikimedia Commons/Thomas W. Geisbert/Creative Commons License

To stem the outbreak “we need to get, at a minimum, 70% of cases into effective isolation,” he said, and though increasing the number and location of Ebola treatment units was key to this effort, “all strategies should be considered,” including community centers, he said. “We can’t let the perfect be the enemy of the good. Every delay results in an increasing number of people impacted by this disease.”

In Senegal and Nigeria, Dr. Monroe noted, no new cases have been reported in the past 21 days, suggesting that containment efforts have proven effective in these countries and demonstrating that outbreaks “can be brought under control” through rigorous isolation, notification of contacts, and breaking the chain of transmission. Both countries would “recognize if there is another importation and respond quickly,” he said.

Sophie Delaunay, executive director of Doctors Without Borders/Médecins Sans Frontières (MSF), also speaking at the news conference, characterized her organization as feeling “desperate and powerless” in the most affected countries but ready to respond to any sign of outbreak in neighboring countries thanks to extensive preparation work.

Ms. Delaunay added that MSF is also prioritizing isolation and safe burial of patients who have died from Ebola. “In an ideal situation, a safe and effective vaccine would be the best potential game changer … but this is not likely to be available until several months from now. In the meantime, we absolutely need to increase the [capacity for] isolation.”

Dr. Monroe noted that data indicate there has been very little evidence of community transmission related to public transportation or other settings of casual contact, with most cases attributable to direct patient care or funeral practices. “Those are the main drivers of transmission,” he said during the conference, sponsored by the Kaiser Family Foundation.

The U.S. government has, to date, pledged $175 million for the Ebola response, with a little more than half the total already committed, with some $58 million marked for vaccine and antiviral drug development. Two vaccines are sponsored for clinical trials and likely to go into phase 2 testing during the course of the current outbreak, Dr. Monroe said. The U.S. Department of Defense has an additional $500 million to $1 billion in supplemental war funding that can be used to fight Ebola in West Africa, though it is unknown how much of this will be committed to Ebola.

Ms. Delaunay said that MSF has received pledges of $120 million, much of it from private donors, of which about half has been received.

The organization is preparing medical staff weekly in Belgium before they deploy to West Africa, she said, adding that, while getting more treatment units on the ground is a key priority, the quality of the response is dependent on how rigorous and disciplined the treatment of patients is. “You need to have strong discipline and chain of command,” she said.

Isolating patients, more than a rollout of vaccines or any change in treatment strategy, is the cornerstone of the international effort to contain the Ebola outbreak in West Africa, say officials leading the response.

Steve Monroe, Ph.D., deputy director of the National Center for Emerging and Infectious diseases at the U.S. Centers for Disease Control and Prevention, summarized the state of the outbreak and the international response in a news conference Sept. 30, hours before the agency revealed the first imported case of Ebola documented in the United States in a traveler returning from Liberia.

In the two worst-affected countries, Sierra Leone and Liberia, cases are doubling approximately every 3 weeks. “One of the things CDC modeling data show is that we must get cases into isolation and treatment,” Dr. Monroe said. “We know how to control these outbreaks: Get patients into isolation so they don’t infect other people, and then follow their contacts.”

Courtesy Wikimedia Commons/Thomas W. Geisbert/Creative Commons License

To stem the outbreak “we need to get, at a minimum, 70% of cases into effective isolation,” he said, and though increasing the number and location of Ebola treatment units was key to this effort, “all strategies should be considered,” including community centers, he said. “We can’t let the perfect be the enemy of the good. Every delay results in an increasing number of people impacted by this disease.”

In Senegal and Nigeria, Dr. Monroe noted, no new cases have been reported in the past 21 days, suggesting that containment efforts have proven effective in these countries and demonstrating that outbreaks “can be brought under control” through rigorous isolation, notification of contacts, and breaking the chain of transmission. Both countries would “recognize if there is another importation and respond quickly,” he said.

Sophie Delaunay, executive director of Doctors Without Borders/Médecins Sans Frontières (MSF), also speaking at the news conference, characterized her organization as feeling “desperate and powerless” in the most affected countries but ready to respond to any sign of outbreak in neighboring countries thanks to extensive preparation work.

Ms. Delaunay added that MSF is also prioritizing isolation and safe burial of patients who have died from Ebola. “In an ideal situation, a safe and effective vaccine would be the best potential game changer … but this is not likely to be available until several months from now. In the meantime, we absolutely need to increase the [capacity for] isolation.”

Dr. Monroe noted that data indicate there has been very little evidence of community transmission related to public transportation or other settings of casual contact, with most cases attributable to direct patient care or funeral practices. “Those are the main drivers of transmission,” he said during the conference, sponsored by the Kaiser Family Foundation.

The U.S. government has, to date, pledged $175 million for the Ebola response, with a little more than half the total already committed, with some $58 million marked for vaccine and antiviral drug development. Two vaccines are sponsored for clinical trials and likely to go into phase 2 testing during the course of the current outbreak, Dr. Monroe said. The U.S. Department of Defense has an additional $500 million to $1 billion in supplemental war funding that can be used to fight Ebola in West Africa, though it is unknown how much of this will be committed to Ebola.

Ms. Delaunay said that MSF has received pledges of $120 million, much of it from private donors, of which about half has been received.

The organization is preparing medical staff weekly in Belgium before they deploy to West Africa, she said, adding that, while getting more treatment units on the ground is a key priority, the quality of the response is dependent on how rigorous and disciplined the treatment of patients is. “You need to have strong discipline and chain of command,” she said.

Isolating patients, more than a rollout of vaccines or any change in treatment strategy, is the cornerstone of the international effort to contain the Ebola outbreak in West Africa, say officials leading the response.

Steve Monroe, Ph.D., deputy director of the National Center for Emerging and Infectious diseases at the U.S. Centers for Disease Control and Prevention, summarized the state of the outbreak and the international response in a news conference Sept. 30, hours before the agency revealed the first imported case of Ebola documented in the United States in a traveler returning from Liberia.

In the two worst-affected countries, Sierra Leone and Liberia, cases are doubling approximately every 3 weeks. “One of the things CDC modeling data show is that we must get cases into isolation and treatment,” Dr. Monroe said. “We know how to control these outbreaks: Get patients into isolation so they don’t infect other people, and then follow their contacts.”

Courtesy Wikimedia Commons/Thomas W. Geisbert/Creative Commons License

To stem the outbreak “we need to get, at a minimum, 70% of cases into effective isolation,” he said, and though increasing the number and location of Ebola treatment units was key to this effort, “all strategies should be considered,” including community centers, he said. “We can’t let the perfect be the enemy of the good. Every delay results in an increasing number of people impacted by this disease.”

In Senegal and Nigeria, Dr. Monroe noted, no new cases have been reported in the past 21 days, suggesting that containment efforts have proven effective in these countries and demonstrating that outbreaks “can be brought under control” through rigorous isolation, notification of contacts, and breaking the chain of transmission. Both countries would “recognize if there is another importation and respond quickly,” he said.

Sophie Delaunay, executive director of Doctors Without Borders/Médecins Sans Frontières (MSF), also speaking at the news conference, characterized her organization as feeling “desperate and powerless” in the most affected countries but ready to respond to any sign of outbreak in neighboring countries thanks to extensive preparation work.

Ms. Delaunay added that MSF is also prioritizing isolation and safe burial of patients who have died from Ebola. “In an ideal situation, a safe and effective vaccine would be the best potential game changer … but this is not likely to be available until several months from now. In the meantime, we absolutely need to increase the [capacity for] isolation.”

Dr. Monroe noted that data indicate there has been very little evidence of community transmission related to public transportation or other settings of casual contact, with most cases attributable to direct patient care or funeral practices. “Those are the main drivers of transmission,” he said during the conference, sponsored by the Kaiser Family Foundation.

The U.S. government has, to date, pledged $175 million for the Ebola response, with a little more than half the total already committed, with some $58 million marked for vaccine and antiviral drug development. Two vaccines are sponsored for clinical trials and likely to go into phase 2 testing during the course of the current outbreak, Dr. Monroe said. The U.S. Department of Defense has an additional $500 million to $1 billion in supplemental war funding that can be used to fight Ebola in West Africa, though it is unknown how much of this will be committed to Ebola.

Ms. Delaunay said that MSF has received pledges of $120 million, much of it from private donors, of which about half has been received.

The organization is preparing medical staff weekly in Belgium before they deploy to West Africa, she said, adding that, while getting more treatment units on the ground is a key priority, the quality of the response is dependent on how rigorous and disciplined the treatment of patients is. “You need to have strong discipline and chain of command,” she said.

Enterovirus D68, which has been spreading rapidly across the nation causing mild to severe respiratory illnesses, is now under investigation for a possible link to several cases of paralysis in children.

On Sept. 26, the Centers for Disease Control and Prevention issued an alert about the investigation and encouraged physicians to report any cases of acute onset of limb weakness and an MRI showing a spinal cord lesion largely restricted to the gray matter.

In an interview Sept. 30, Dr. Daniel Feikin, the epidemiology branch chief at the division of viral diseases at the CDC, shared what’s known so far about EV-D68, talked about the ongoing investigation into the link with pediatric paralysis cases, and provided clinical advice to physicians.

nmiller@frontlinemedcom.com

On Twitter @naseemmiller

Enterovirus D68, which has been spreading rapidly across the nation causing mild to severe respiratory illnesses, is now under investigation for a possible link to several cases of paralysis in children.

On Sept. 26, the Centers for Disease Control and Prevention issued an alert about the investigation and encouraged physicians to report any cases of acute onset of limb weakness and an MRI showing a spinal cord lesion largely restricted to the gray matter.

In an interview Sept. 30, Dr. Daniel Feikin, the epidemiology branch chief at the division of viral diseases at the CDC, shared what’s known so far about EV-D68, talked about the ongoing investigation into the link with pediatric paralysis cases, and provided clinical advice to physicians.

nmiller@frontlinemedcom.com

On Twitter @naseemmiller

Enterovirus D68, which has been spreading rapidly across the nation causing mild to severe respiratory illnesses, is now under investigation for a possible link to several cases of paralysis in children.

On Sept. 26, the Centers for Disease Control and Prevention issued an alert about the investigation and encouraged physicians to report any cases of acute onset of limb weakness and an MRI showing a spinal cord lesion largely restricted to the gray matter.

In an interview Sept. 30, Dr. Daniel Feikin, the epidemiology branch chief at the division of viral diseases at the CDC, shared what’s known so far about EV-D68, talked about the ongoing investigation into the link with pediatric paralysis cases, and provided clinical advice to physicians.

nmiller@frontlinemedcom.com

On Twitter @naseemmiller

All adults who are 65 years or older should receive 13-valent pneumococcal conjugate vaccine (PCV13) routinely in series with 23-valent pneumococcal polysaccharide vaccine (PPSV23), according to a new recommendation from the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP). The recommendation appears in the Sept. 19 issue of Morbidity and Mortality Weekly Report.

The ACIP recommendation calls for pneumococcal vaccine-naive adults aged 65 and older to receive one dose of PCV13 vaccine, followed by a dose of PPSV23 6-12 months later (MMWR 2014:63;822-5). Older adults who have previously received only PPSV23 should receive a dose of PCV13 at least 12 months later, wrote Sara Tomczyk of the CDC and her associates.

ACIP has recommended PPSV23 for older adults since 2010. In 2012, the committee made its first recommendation for PCV13, targeting patients 19 years and older who have immunocompromising conditions, functional or anatomic asplenia, cerebrospinal fluid leak, or cochlear implants. The new PCV13 recommendation for all older adults is based on a randomized, placebo-controlled trial of the vaccine in about 85,000 adults aged 65 years and older in the Netherlands who had no prior pneumococcal vaccine exposure. The vaccine showed a moderate level of evidence for efficacy against community-acquired pneumonia in this cohort, ACIP determined. Efficacy against nonbacteremic vaccine-type pneumococcal pneumonia was about 45%, while efficacy against vaccine-type invasive pneumococcal disease was about 75%, the reviewers wrote.

ACIP will reevaluate the recommendations in 2018.

Ms. Tomczyk and her colleagues disclosed no funding sources or conflicts of interest.

All adults who are 65 years or older should receive 13-valent pneumococcal conjugate vaccine (PCV13) routinely in series with 23-valent pneumococcal polysaccharide vaccine (PPSV23), according to a new recommendation from the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP). The recommendation appears in the Sept. 19 issue of Morbidity and Mortality Weekly Report.

The ACIP recommendation calls for pneumococcal vaccine-naive adults aged 65 and older to receive one dose of PCV13 vaccine, followed by a dose of PPSV23 6-12 months later (MMWR 2014:63;822-5). Older adults who have previously received only PPSV23 should receive a dose of PCV13 at least 12 months later, wrote Sara Tomczyk of the CDC and her associates.

ACIP has recommended PPSV23 for older adults since 2010. In 2012, the committee made its first recommendation for PCV13, targeting patients 19 years and older who have immunocompromising conditions, functional or anatomic asplenia, cerebrospinal fluid leak, or cochlear implants. The new PCV13 recommendation for all older adults is based on a randomized, placebo-controlled trial of the vaccine in about 85,000 adults aged 65 years and older in the Netherlands who had no prior pneumococcal vaccine exposure. The vaccine showed a moderate level of evidence for efficacy against community-acquired pneumonia in this cohort, ACIP determined. Efficacy against nonbacteremic vaccine-type pneumococcal pneumonia was about 45%, while efficacy against vaccine-type invasive pneumococcal disease was about 75%, the reviewers wrote.

ACIP will reevaluate the recommendations in 2018.

Ms. Tomczyk and her colleagues disclosed no funding sources or conflicts of interest.

All adults who are 65 years or older should receive 13-valent pneumococcal conjugate vaccine (PCV13) routinely in series with 23-valent pneumococcal polysaccharide vaccine (PPSV23), according to a new recommendation from the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP). The recommendation appears in the Sept. 19 issue of Morbidity and Mortality Weekly Report.

The ACIP recommendation calls for pneumococcal vaccine-naive adults aged 65 and older to receive one dose of PCV13 vaccine, followed by a dose of PPSV23 6-12 months later (MMWR 2014:63;822-5). Older adults who have previously received only PPSV23 should receive a dose of PCV13 at least 12 months later, wrote Sara Tomczyk of the CDC and her associates.

ACIP has recommended PPSV23 for older adults since 2010. In 2012, the committee made its first recommendation for PCV13, targeting patients 19 years and older who have immunocompromising conditions, functional or anatomic asplenia, cerebrospinal fluid leak, or cochlear implants. The new PCV13 recommendation for all older adults is based on a randomized, placebo-controlled trial of the vaccine in about 85,000 adults aged 65 years and older in the Netherlands who had no prior pneumococcal vaccine exposure. The vaccine showed a moderate level of evidence for efficacy against community-acquired pneumonia in this cohort, ACIP determined. Efficacy against nonbacteremic vaccine-type pneumococcal pneumonia was about 45%, while efficacy against vaccine-type invasive pneumococcal disease was about 75%, the reviewers wrote.

ACIP will reevaluate the recommendations in 2018.

Ms. Tomczyk and her colleagues disclosed no funding sources or conflicts of interest.

All adults who are 65 years or older should receive 13-valent pneumococcal conjugate vaccine (PCV13) routinely in series with 23-valent pneumococcal polysaccharide vaccine (PPSV23), according to a new recommendation from the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP). The recommendation appears in the Sept. 19 issue of Morbidity and Mortality Weekly Report.

The ACIP recommendation calls for pneumococcal vaccine-naive adults aged 65 and older to receive one dose of PCV13 vaccine, followed by a dose of PPSV23 6-12 months later (MMWR 2014:63;822-5). Older adults who have previously received only PPSV23 should receive a dose of PCV13 at least 12 months later, wrote Sara Tomczyk of the CDC and her associates.

© Micah Young / istockphoto.com

ACIP has recommended PPSV23 for older adults since 2010. In 2012, the committee made its first recommendation for PCV13, targeting patients 19 years and older who have immunocompromising conditions, functional or anatomic asplenia, cerebrospinal fluid leak, or cochlear implants. The new PCV13 recommendation for all older adults is based on a randomized, placebo-controlled trial of the vaccine in about 85,000 adults aged 65 years and older in the Netherlands who had no prior pneumococcal vaccine exposure. The vaccine showed a moderate level of evidence for efficacy against community-acquired pneumonia in this cohort, ACIP determined. Efficacy against nonbacteremic vaccine-type pneumococcal pneumonia was about 45%, while efficacy against vaccine-type invasive pneumococcal disease was about 75%, the reviewers wrote.

ACIP will reevaluate the recommendations in 2018.

Ms. Tomczyk and her colleagues disclosed no funding sources or conflicts of interest.

All adults who are 65 years or older should receive 13-valent pneumococcal conjugate vaccine (PCV13) routinely in series with 23-valent pneumococcal polysaccharide vaccine (PPSV23), according to a new recommendation from the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP). The recommendation appears in the Sept. 19 issue of Morbidity and Mortality Weekly Report.

The ACIP recommendation calls for pneumococcal vaccine-naive adults aged 65 and older to receive one dose of PCV13 vaccine, followed by a dose of PPSV23 6-12 months later (MMWR 2014:63;822-5). Older adults who have previously received only PPSV23 should receive a dose of PCV13 at least 12 months later, wrote Sara Tomczyk of the CDC and her associates.

© Micah Young / istockphoto.com

ACIP has recommended PPSV23 for older adults since 2010. In 2012, the committee made its first recommendation for PCV13, targeting patients 19 years and older who have immunocompromising conditions, functional or anatomic asplenia, cerebrospinal fluid leak, or cochlear implants. The new PCV13 recommendation for all older adults is based on a randomized, placebo-controlled trial of the vaccine in about 85,000 adults aged 65 years and older in the Netherlands who had no prior pneumococcal vaccine exposure. The vaccine showed a moderate level of evidence for efficacy against community-acquired pneumonia in this cohort, ACIP determined. Efficacy against nonbacteremic vaccine-type pneumococcal pneumonia was about 45%, while efficacy against vaccine-type invasive pneumococcal disease was about 75%, the reviewers wrote.

ACIP will reevaluate the recommendations in 2018.

Ms. Tomczyk and her colleagues disclosed no funding sources or conflicts of interest.

All adults who are 65 years or older should receive 13-valent pneumococcal conjugate vaccine (PCV13) routinely in series with 23-valent pneumococcal polysaccharide vaccine (PPSV23), according to a new recommendation from the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP). The recommendation appears in the Sept. 19 issue of Morbidity and Mortality Weekly Report.

The ACIP recommendation calls for pneumococcal vaccine-naive adults aged 65 and older to receive one dose of PCV13 vaccine, followed by a dose of PPSV23 6-12 months later (MMWR 2014:63;822-5). Older adults who have previously received only PPSV23 should receive a dose of PCV13 at least 12 months later, wrote Sara Tomczyk of the CDC and her associates.

© Micah Young / istockphoto.com

ACIP has recommended PPSV23 for older adults since 2010. In 2012, the committee made its first recommendation for PCV13, targeting patients 19 years and older who have immunocompromising conditions, functional or anatomic asplenia, cerebrospinal fluid leak, or cochlear implants. The new PCV13 recommendation for all older adults is based on a randomized, placebo-controlled trial of the vaccine in about 85,000 adults aged 65 years and older in the Netherlands who had no prior pneumococcal vaccine exposure. The vaccine showed a moderate level of evidence for efficacy against community-acquired pneumonia in this cohort, ACIP determined. Efficacy against nonbacteremic vaccine-type pneumococcal pneumonia was about 45%, while efficacy against vaccine-type invasive pneumococcal disease was about 75%, the reviewers wrote.

ACIP will reevaluate the recommendations in 2018.

Ms. Tomczyk and her colleagues disclosed no funding sources or conflicts of interest.