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It’s imperative to protect adolescents with HPV vaccine
Low vaccination rates in the United States are in large part due to parental and religious objections to this vaccination that can be overcome by better education and support by pediatricians. It’s been demonstrated that physicians encourage the HPV vaccine less strongly than the other adolescent vaccinations such as Tdap and the meningococcal conjugate vaccine1. In addition, there is a lack of legislation promoting this vaccine. There are only two states and Washington, D.C., that currently have opt-out state mandates for HPV immunization, compared with 46 states plus Washington, D.C., with similar policies for Tdap2. The HPV vaccine is safe, efficacious, and has been demonstrated to reduce mortality and morbidity in our population. It is imperative that we, as pediatricians, strongly encourage and provide these vaccinations to our adolescent patients to help protect our community.
The human papillomavirus (HPV) vaccine was approved for girls in 2008 and for boys in 20113. However, the adoption rate for HPV immunization in the United States has been dismal. Data from 2014 show only 60% of adolescent girls have received at least one HPV vaccine dose, and only 40% have received three doses4. The rates for boys are far worse, with 42% of adolescent boys receiving at least one dose, and only 22% receiving three doses4.
HPV is currently the most common sexually transmitted infection in the United States, with an estimated 14 million new infections per year3. Of these, approximately 11,000 will progress to cervical cancers and 9,000 to male anogenital cancers each year. Annually there are about 4,000 cervical cancer deaths in the United States3.
Three vaccines are approved by the Food and Drug Administration to prevent HPV infection: Gardasil, Gardasil 9, and Cervarix. All three vaccines prevent infections with HPV types 16 and 18, two high-risk HPVs that cause about 70% of cervical cancers (as well as oropharyngeal and other anogenital cancers). Gardasil also prevents infection with HPV types 6 and 11, associated with approximately 90% of anogenital warts. Gardasil 9 prevents infection with the same four HPV types plus five other high-risk HPV types (31, 33, 45, 52, and 58); it is called a nonavalent, or 9-valent, vaccine.
The HPV vaccines have the ability to reduce mortality and morbidity in our patients. A study published in the New England Journal of Medicine in 2011 demonstrated that vaccination with the full HPV series in males 16-26 years prior to HPV exposure led to a 90% efficacy in preventing HPV-related disease5, compared with a 60% efficacy if given after HPV exposure or if the individual received an incomplete dose series.
A recent Pediatrics study reported data since initiation of the vaccination program in American adolescent and young adult women6. The data showed a reduction in HPV-related disease of 64% in the 14- to 19-year age group and a reduction of 34% in the older age group (aged 20-24 years). This is impressive given our currently low vaccination rates.
A Lancet meta-analysis shows evidence of herd immunity and cross-protective effects when vaccination rates are greater than 50% in the population7. This allows groups that aren’t currently approved for vaccination to have a reduction in disease and allows for some protection against HPV types that aren’t currently covered by the vaccines.
So we pediatricians have a job to do in protecting our patients by encouraging HPV immunization.
References
1. Pediatrics. 2016 Feb;137(2):1-9.
3. www.cdc.gov/hpv/hcp/clinician-factsheet.html
5. N Engl J Med. 2011;364(5):401-11.
6. Pediatrics. 2016;137(3):1-9.
7. Lancet Infect Dis. 2015;15(5):565-80.
Dr. Denby is a second-year internal medicine/pediatrics resident at Vanderbilt University Medical Center in Nashville, Tenn.
Low vaccination rates in the United States are in large part due to parental and religious objections to this vaccination that can be overcome by better education and support by pediatricians. It’s been demonstrated that physicians encourage the HPV vaccine less strongly than the other adolescent vaccinations such as Tdap and the meningococcal conjugate vaccine1. In addition, there is a lack of legislation promoting this vaccine. There are only two states and Washington, D.C., that currently have opt-out state mandates for HPV immunization, compared with 46 states plus Washington, D.C., with similar policies for Tdap2. The HPV vaccine is safe, efficacious, and has been demonstrated to reduce mortality and morbidity in our population. It is imperative that we, as pediatricians, strongly encourage and provide these vaccinations to our adolescent patients to help protect our community.
The human papillomavirus (HPV) vaccine was approved for girls in 2008 and for boys in 20113. However, the adoption rate for HPV immunization in the United States has been dismal. Data from 2014 show only 60% of adolescent girls have received at least one HPV vaccine dose, and only 40% have received three doses4. The rates for boys are far worse, with 42% of adolescent boys receiving at least one dose, and only 22% receiving three doses4.
HPV is currently the most common sexually transmitted infection in the United States, with an estimated 14 million new infections per year3. Of these, approximately 11,000 will progress to cervical cancers and 9,000 to male anogenital cancers each year. Annually there are about 4,000 cervical cancer deaths in the United States3.
Three vaccines are approved by the Food and Drug Administration to prevent HPV infection: Gardasil, Gardasil 9, and Cervarix. All three vaccines prevent infections with HPV types 16 and 18, two high-risk HPVs that cause about 70% of cervical cancers (as well as oropharyngeal and other anogenital cancers). Gardasil also prevents infection with HPV types 6 and 11, associated with approximately 90% of anogenital warts. Gardasil 9 prevents infection with the same four HPV types plus five other high-risk HPV types (31, 33, 45, 52, and 58); it is called a nonavalent, or 9-valent, vaccine.
The HPV vaccines have the ability to reduce mortality and morbidity in our patients. A study published in the New England Journal of Medicine in 2011 demonstrated that vaccination with the full HPV series in males 16-26 years prior to HPV exposure led to a 90% efficacy in preventing HPV-related disease5, compared with a 60% efficacy if given after HPV exposure or if the individual received an incomplete dose series.
A recent Pediatrics study reported data since initiation of the vaccination program in American adolescent and young adult women6. The data showed a reduction in HPV-related disease of 64% in the 14- to 19-year age group and a reduction of 34% in the older age group (aged 20-24 years). This is impressive given our currently low vaccination rates.
A Lancet meta-analysis shows evidence of herd immunity and cross-protective effects when vaccination rates are greater than 50% in the population7. This allows groups that aren’t currently approved for vaccination to have a reduction in disease and allows for some protection against HPV types that aren’t currently covered by the vaccines.
So we pediatricians have a job to do in protecting our patients by encouraging HPV immunization.
References
1. Pediatrics. 2016 Feb;137(2):1-9.
3. www.cdc.gov/hpv/hcp/clinician-factsheet.html
5. N Engl J Med. 2011;364(5):401-11.
6. Pediatrics. 2016;137(3):1-9.
7. Lancet Infect Dis. 2015;15(5):565-80.
Dr. Denby is a second-year internal medicine/pediatrics resident at Vanderbilt University Medical Center in Nashville, Tenn.
Low vaccination rates in the United States are in large part due to parental and religious objections to this vaccination that can be overcome by better education and support by pediatricians. It’s been demonstrated that physicians encourage the HPV vaccine less strongly than the other adolescent vaccinations such as Tdap and the meningococcal conjugate vaccine1. In addition, there is a lack of legislation promoting this vaccine. There are only two states and Washington, D.C., that currently have opt-out state mandates for HPV immunization, compared with 46 states plus Washington, D.C., with similar policies for Tdap2. The HPV vaccine is safe, efficacious, and has been demonstrated to reduce mortality and morbidity in our population. It is imperative that we, as pediatricians, strongly encourage and provide these vaccinations to our adolescent patients to help protect our community.
The human papillomavirus (HPV) vaccine was approved for girls in 2008 and for boys in 20113. However, the adoption rate for HPV immunization in the United States has been dismal. Data from 2014 show only 60% of adolescent girls have received at least one HPV vaccine dose, and only 40% have received three doses4. The rates for boys are far worse, with 42% of adolescent boys receiving at least one dose, and only 22% receiving three doses4.
HPV is currently the most common sexually transmitted infection in the United States, with an estimated 14 million new infections per year3. Of these, approximately 11,000 will progress to cervical cancers and 9,000 to male anogenital cancers each year. Annually there are about 4,000 cervical cancer deaths in the United States3.
Three vaccines are approved by the Food and Drug Administration to prevent HPV infection: Gardasil, Gardasil 9, and Cervarix. All three vaccines prevent infections with HPV types 16 and 18, two high-risk HPVs that cause about 70% of cervical cancers (as well as oropharyngeal and other anogenital cancers). Gardasil also prevents infection with HPV types 6 and 11, associated with approximately 90% of anogenital warts. Gardasil 9 prevents infection with the same four HPV types plus five other high-risk HPV types (31, 33, 45, 52, and 58); it is called a nonavalent, or 9-valent, vaccine.
The HPV vaccines have the ability to reduce mortality and morbidity in our patients. A study published in the New England Journal of Medicine in 2011 demonstrated that vaccination with the full HPV series in males 16-26 years prior to HPV exposure led to a 90% efficacy in preventing HPV-related disease5, compared with a 60% efficacy if given after HPV exposure or if the individual received an incomplete dose series.
A recent Pediatrics study reported data since initiation of the vaccination program in American adolescent and young adult women6. The data showed a reduction in HPV-related disease of 64% in the 14- to 19-year age group and a reduction of 34% in the older age group (aged 20-24 years). This is impressive given our currently low vaccination rates.
A Lancet meta-analysis shows evidence of herd immunity and cross-protective effects when vaccination rates are greater than 50% in the population7. This allows groups that aren’t currently approved for vaccination to have a reduction in disease and allows for some protection against HPV types that aren’t currently covered by the vaccines.
So we pediatricians have a job to do in protecting our patients by encouraging HPV immunization.
References
1. Pediatrics. 2016 Feb;137(2):1-9.
3. www.cdc.gov/hpv/hcp/clinician-factsheet.html
5. N Engl J Med. 2011;364(5):401-11.
6. Pediatrics. 2016;137(3):1-9.
7. Lancet Infect Dis. 2015;15(5):565-80.
Dr. Denby is a second-year internal medicine/pediatrics resident at Vanderbilt University Medical Center in Nashville, Tenn.
It’s imperative to protect adolescents with HPV vaccine
Low vaccination rates in the United States are in large part due to parental and religious objections to this vaccination that can be overcome by better education and support by pediatricians. It’s been demonstrated that physicians encourage the HPV vaccine less strongly than the other adolescent vaccinations such as Tdap and the meningococcal conjugate vaccine1. In addition, there is a lack of legislation promoting this vaccine. There are only two states and Washington, D.C., that currently have opt-out state mandates for HPV immunization, compared with 46 states plus Washington, D.C., with similar policies for Tdap2. The HPV vaccine is safe, efficacious, and has been demonstrated to reduce mortality and morbidity in our population. It is imperative that we, as pediatricians, strongly encourage and provide these vaccinations to our adolescent patients to help protect our community.
The human papillomavirus (HPV) vaccine was approved for girls in 2008 and for boys in 20113. However, the adoption rate for HPV immunization in the United States has been dismal. Data from 2014 show only 60% of adolescent girls have received at least one HPV vaccine dose, and only 40% have received three doses4. The rates for boys are far worse, with 42% of adolescent boys receiving at least one dose, and only 22% receiving three doses4.
HPV is currently the most common sexually transmitted infection in the United States, with an estimated 14 million new infections per year3. Of these, approximately 11,000 will progress to cervical cancers and 9,000 to male anogenital cancers each year. Annually there are about 4,000 cervical cancer deaths in the United States3.
Three vaccines are approved by the Food and Drug Administration to prevent HPV infection: Gardasil, Gardasil 9, and Cervarix. All three vaccines prevent infections with HPV types 16 and 18, two high-risk HPVs that cause about 70% of cervical cancers (as well as oropharyngeal and other anogenital cancers). Gardasil also prevents infection with HPV types 6 and 11, associated with approximately 90% of anogenital warts. Gardasil 9 prevents infection with the same four HPV types plus five other high-risk HPV types (31, 33, 45, 52, and 58); it is called a nonavalent, or 9-valent, vaccine.
The HPV vaccines have the ability to reduce mortality and morbidity in our patients. A study published in the New England Journal of Medicine in 2011 demonstrated that vaccination with the full HPV series in males 16-26 years prior to HPV exposure led to a 90% efficacy in preventing HPV-related disease5, compared with a 60% efficacy if given after HPV exposure or if the individual received an incomplete dose series.
A recent Pediatrics study reported data since initiation of the vaccination program in American adolescent and young adult women6. The data showed a reduction in HPV-related disease of 64% in the 14- to 19-year age group and a reduction of 34% in the older age group (aged 20-24 years). This is impressive given our currently low vaccination rates.
A Lancet meta-analysis shows evidence of herd immunity and cross-protective effects when vaccination rates are greater than 50% in the population7. This allows groups that aren’t currently approved for vaccination to have a reduction in disease and allows for some protection against HPV types that aren’t currently covered by the vaccines.
So we pediatricians have a job to do in protecting our patients by encouraging HPV immunization.
References
1. Pediatrics. 2016 Feb;137(2):1-9.
3. www.cdc.gov/hpv/hcp/clinician-factsheet.html
5. N Engl J Med. 2011;364(5):401-11.
6. Pediatrics. 2016;137(3):1-9.
7. Lancet Infect Dis. 2015;15(5):565-80.
Dr. Denby is a second-year internal medicine/pediatrics resident at Vanderbilt University Medical Center in Nashville, Tenn.
Low vaccination rates in the United States are in large part due to parental and religious objections to this vaccination that can be overcome by better education and support by pediatricians. It’s been demonstrated that physicians encourage the HPV vaccine less strongly than the other adolescent vaccinations such as Tdap and the meningococcal conjugate vaccine1. In addition, there is a lack of legislation promoting this vaccine. There are only two states and Washington, D.C., that currently have opt-out state mandates for HPV immunization, compared with 46 states plus Washington, D.C., with similar policies for Tdap2. The HPV vaccine is safe, efficacious, and has been demonstrated to reduce mortality and morbidity in our population. It is imperative that we, as pediatricians, strongly encourage and provide these vaccinations to our adolescent patients to help protect our community.
The human papillomavirus (HPV) vaccine was approved for girls in 2008 and for boys in 20113. However, the adoption rate for HPV immunization in the United States has been dismal. Data from 2014 show only 60% of adolescent girls have received at least one HPV vaccine dose, and only 40% have received three doses4. The rates for boys are far worse, with 42% of adolescent boys receiving at least one dose, and only 22% receiving three doses4.
HPV is currently the most common sexually transmitted infection in the United States, with an estimated 14 million new infections per year3. Of these, approximately 11,000 will progress to cervical cancers and 9,000 to male anogenital cancers each year. Annually there are about 4,000 cervical cancer deaths in the United States3.
Three vaccines are approved by the Food and Drug Administration to prevent HPV infection: Gardasil, Gardasil 9, and Cervarix. All three vaccines prevent infections with HPV types 16 and 18, two high-risk HPVs that cause about 70% of cervical cancers (as well as oropharyngeal and other anogenital cancers). Gardasil also prevents infection with HPV types 6 and 11, associated with approximately 90% of anogenital warts. Gardasil 9 prevents infection with the same four HPV types plus five other high-risk HPV types (31, 33, 45, 52, and 58); it is called a nonavalent, or 9-valent, vaccine.
The HPV vaccines have the ability to reduce mortality and morbidity in our patients. A study published in the New England Journal of Medicine in 2011 demonstrated that vaccination with the full HPV series in males 16-26 years prior to HPV exposure led to a 90% efficacy in preventing HPV-related disease5, compared with a 60% efficacy if given after HPV exposure or if the individual received an incomplete dose series.
A recent Pediatrics study reported data since initiation of the vaccination program in American adolescent and young adult women6. The data showed a reduction in HPV-related disease of 64% in the 14- to 19-year age group and a reduction of 34% in the older age group (aged 20-24 years). This is impressive given our currently low vaccination rates.
A Lancet meta-analysis shows evidence of herd immunity and cross-protective effects when vaccination rates are greater than 50% in the population7. This allows groups that aren’t currently approved for vaccination to have a reduction in disease and allows for some protection against HPV types that aren’t currently covered by the vaccines.
So we pediatricians have a job to do in protecting our patients by encouraging HPV immunization.
References
1. Pediatrics. 2016 Feb;137(2):1-9.
3. www.cdc.gov/hpv/hcp/clinician-factsheet.html
5. N Engl J Med. 2011;364(5):401-11.
6. Pediatrics. 2016;137(3):1-9.
7. Lancet Infect Dis. 2015;15(5):565-80.
Dr. Denby is a second-year internal medicine/pediatrics resident at Vanderbilt University Medical Center in Nashville, Tenn.
Low vaccination rates in the United States are in large part due to parental and religious objections to this vaccination that can be overcome by better education and support by pediatricians. It’s been demonstrated that physicians encourage the HPV vaccine less strongly than the other adolescent vaccinations such as Tdap and the meningococcal conjugate vaccine1. In addition, there is a lack of legislation promoting this vaccine. There are only two states and Washington, D.C., that currently have opt-out state mandates for HPV immunization, compared with 46 states plus Washington, D.C., with similar policies for Tdap2. The HPV vaccine is safe, efficacious, and has been demonstrated to reduce mortality and morbidity in our population. It is imperative that we, as pediatricians, strongly encourage and provide these vaccinations to our adolescent patients to help protect our community.
The human papillomavirus (HPV) vaccine was approved for girls in 2008 and for boys in 20113. However, the adoption rate for HPV immunization in the United States has been dismal. Data from 2014 show only 60% of adolescent girls have received at least one HPV vaccine dose, and only 40% have received three doses4. The rates for boys are far worse, with 42% of adolescent boys receiving at least one dose, and only 22% receiving three doses4.
HPV is currently the most common sexually transmitted infection in the United States, with an estimated 14 million new infections per year3. Of these, approximately 11,000 will progress to cervical cancers and 9,000 to male anogenital cancers each year. Annually there are about 4,000 cervical cancer deaths in the United States3.
Three vaccines are approved by the Food and Drug Administration to prevent HPV infection: Gardasil, Gardasil 9, and Cervarix. All three vaccines prevent infections with HPV types 16 and 18, two high-risk HPVs that cause about 70% of cervical cancers (as well as oropharyngeal and other anogenital cancers). Gardasil also prevents infection with HPV types 6 and 11, associated with approximately 90% of anogenital warts. Gardasil 9 prevents infection with the same four HPV types plus five other high-risk HPV types (31, 33, 45, 52, and 58); it is called a nonavalent, or 9-valent, vaccine.
The HPV vaccines have the ability to reduce mortality and morbidity in our patients. A study published in the New England Journal of Medicine in 2011 demonstrated that vaccination with the full HPV series in males 16-26 years prior to HPV exposure led to a 90% efficacy in preventing HPV-related disease5, compared with a 60% efficacy if given after HPV exposure or if the individual received an incomplete dose series.
A recent Pediatrics study reported data since initiation of the vaccination program in American adolescent and young adult women6. The data showed a reduction in HPV-related disease of 64% in the 14- to 19-year age group and a reduction of 34% in the older age group (aged 20-24 years). This is impressive given our currently low vaccination rates.
A Lancet meta-analysis shows evidence of herd immunity and cross-protective effects when vaccination rates are greater than 50% in the population7. This allows groups that aren’t currently approved for vaccination to have a reduction in disease and allows for some protection against HPV types that aren’t currently covered by the vaccines.
So we pediatricians have a job to do in protecting our patients by encouraging HPV immunization.
References
1. Pediatrics. 2016 Feb;137(2):1-9.
3. www.cdc.gov/hpv/hcp/clinician-factsheet.html
5. N Engl J Med. 2011;364(5):401-11.
6. Pediatrics. 2016;137(3):1-9.
7. Lancet Infect Dis. 2015;15(5):565-80.
Dr. Denby is a second-year internal medicine/pediatrics resident at Vanderbilt University Medical Center in Nashville, Tenn.
ED bedside flu test accurate across flu seasons
A rapid bedside diagnostic test for influenza showed consistent sensitivity and specificity across four consecutive flu seasons in a single pediatric ED in France, according to a report in Diagnostic Microbiology and Infectious Disease.
During flu seasons, it is difficult to distinguish young children who have the flu from those who have serious bacterial infections because clinical symptoms alone cannot differentiate the two conditions and fever may be the only symptom during the onset of a bacterial infection. Rapid influenza diagnostic tests purport to help ED clinicians estimate the probability of influenza at the bedside, which in turn can reduce the need for further diagnostic testing, length of ED stay, inappropriate use of antibiotics, and the costs of care, said Dr. E. Avril of the pediatric ED, University Hospital in Nantes, France, and associates.
To assess the diagnostic value of one rapid influenza diagnostic test used in this setting every winter, the investigators studied 764 patients younger than age 5 years who were admitted to the ED during four consecutive flu seasons with fever of no known origin. The prevalence of influenza varied widely during the study period, from a low of 30% to a high of 62%.
The rapid diagnostic test performed comparably well across the four flu seasons, with only a modest decrease in sensitivity and specificity during the 2010 H1N1 flu pandemic. The bedside test had an overall sensitivity of 0.82, a specificity of 0.98, a positive likelihood ratio of 37.8, and a negative likelihood ratio of 0.19. These results are similar to those of two previous small-scale studies that found sensitivities of 69%-85% and specificities of 83%-98%, Dr. Avril and associates said (Diag Microbiol Infect Dis. 2016 doi:10.1016/j.diagmicrobio.2016.03.015).
These findings “support the rational use of rapid influenza diagnostic tests in clinical practice for young children presenting with fever without a source during flu season,” the investigators said.
Dr. Avril and associates added that they assessed only one rapid diagnostic test for influenza (QuickVue) – the only one available in their ED because of cost – but that there are 22 such tests commercially available. Nantes University Hospital supported the study. Dr. Avril and associates reported having no relevant disclosures.
A rapid bedside diagnostic test for influenza showed consistent sensitivity and specificity across four consecutive flu seasons in a single pediatric ED in France, according to a report in Diagnostic Microbiology and Infectious Disease.
During flu seasons, it is difficult to distinguish young children who have the flu from those who have serious bacterial infections because clinical symptoms alone cannot differentiate the two conditions and fever may be the only symptom during the onset of a bacterial infection. Rapid influenza diagnostic tests purport to help ED clinicians estimate the probability of influenza at the bedside, which in turn can reduce the need for further diagnostic testing, length of ED stay, inappropriate use of antibiotics, and the costs of care, said Dr. E. Avril of the pediatric ED, University Hospital in Nantes, France, and associates.
To assess the diagnostic value of one rapid influenza diagnostic test used in this setting every winter, the investigators studied 764 patients younger than age 5 years who were admitted to the ED during four consecutive flu seasons with fever of no known origin. The prevalence of influenza varied widely during the study period, from a low of 30% to a high of 62%.
The rapid diagnostic test performed comparably well across the four flu seasons, with only a modest decrease in sensitivity and specificity during the 2010 H1N1 flu pandemic. The bedside test had an overall sensitivity of 0.82, a specificity of 0.98, a positive likelihood ratio of 37.8, and a negative likelihood ratio of 0.19. These results are similar to those of two previous small-scale studies that found sensitivities of 69%-85% and specificities of 83%-98%, Dr. Avril and associates said (Diag Microbiol Infect Dis. 2016 doi:10.1016/j.diagmicrobio.2016.03.015).
These findings “support the rational use of rapid influenza diagnostic tests in clinical practice for young children presenting with fever without a source during flu season,” the investigators said.
Dr. Avril and associates added that they assessed only one rapid diagnostic test for influenza (QuickVue) – the only one available in their ED because of cost – but that there are 22 such tests commercially available. Nantes University Hospital supported the study. Dr. Avril and associates reported having no relevant disclosures.
A rapid bedside diagnostic test for influenza showed consistent sensitivity and specificity across four consecutive flu seasons in a single pediatric ED in France, according to a report in Diagnostic Microbiology and Infectious Disease.
During flu seasons, it is difficult to distinguish young children who have the flu from those who have serious bacterial infections because clinical symptoms alone cannot differentiate the two conditions and fever may be the only symptom during the onset of a bacterial infection. Rapid influenza diagnostic tests purport to help ED clinicians estimate the probability of influenza at the bedside, which in turn can reduce the need for further diagnostic testing, length of ED stay, inappropriate use of antibiotics, and the costs of care, said Dr. E. Avril of the pediatric ED, University Hospital in Nantes, France, and associates.
To assess the diagnostic value of one rapid influenza diagnostic test used in this setting every winter, the investigators studied 764 patients younger than age 5 years who were admitted to the ED during four consecutive flu seasons with fever of no known origin. The prevalence of influenza varied widely during the study period, from a low of 30% to a high of 62%.
The rapid diagnostic test performed comparably well across the four flu seasons, with only a modest decrease in sensitivity and specificity during the 2010 H1N1 flu pandemic. The bedside test had an overall sensitivity of 0.82, a specificity of 0.98, a positive likelihood ratio of 37.8, and a negative likelihood ratio of 0.19. These results are similar to those of two previous small-scale studies that found sensitivities of 69%-85% and specificities of 83%-98%, Dr. Avril and associates said (Diag Microbiol Infect Dis. 2016 doi:10.1016/j.diagmicrobio.2016.03.015).
These findings “support the rational use of rapid influenza diagnostic tests in clinical practice for young children presenting with fever without a source during flu season,” the investigators said.
Dr. Avril and associates added that they assessed only one rapid diagnostic test for influenza (QuickVue) – the only one available in their ED because of cost – but that there are 22 such tests commercially available. Nantes University Hospital supported the study. Dr. Avril and associates reported having no relevant disclosures.
FROM DIAGNOSTIC MICROBIOLOGY AND INFECTIOUS DISEASE
Key clinical point: A rapid bedside diagnostic test for influenza was accurate across four consecutive flu seasons in a pediatric ED.
Major finding: The bedside test had an overall sensitivity of 0.82, a specificity of 0.98, a positive likelihood ratio of 37.8, and a negative likelihood ratio of 0.19.
Data source: A prospective analysis of the sensitivity and specificity of one rapid bedside diagnostic test in 764 children seen over a 4-year period.
Disclosures: Nantes University Hospital supported the study. Dr. Avril and associates reported having no relevant disclosures.
ED bedside flu test accurate across flu seasons
A rapid bedside diagnostic test for influenza showed consistent sensitivity and specificity across four consecutive flu seasons in a single pediatric ED in France, according to a report in Diagnostic Microbiology and Infectious Disease.
During flu seasons, it is difficult to distinguish young children who have the flu from those who have serious bacterial infections because clinical symptoms alone cannot differentiate the two conditions and fever may be the only symptom during the onset of a bacterial infection. Rapid influenza diagnostic tests purport to help ED clinicians estimate the probability of influenza at the bedside, which in turn can reduce the need for further diagnostic testing, length of ED stay, inappropriate use of antibiotics, and the costs of care, said Dr. E. Avril of the pediatric ED, University Hospital in Nantes, France, and associates.
To assess the diagnostic value of one rapid influenza diagnostic test used in this setting every winter, the investigators studied 764 patients younger than age 5 years who were admitted to the ED during four consecutive flu seasons with fever of no known origin. The prevalence of influenza varied widely during the study period, from a low of 30% to a high of 62%.
The rapid diagnostic test performed comparably well across the four flu seasons, with only a modest decrease in sensitivity and specificity during the 2010 H1N1 flu pandemic. The bedside test had an overall sensitivity of 0.82, a specificity of 0.98, a positive likelihood ratio of 37.8, and a negative likelihood ratio of 0.19. These results are similar to those of two previous small-scale studies that found sensitivities of 69%-85% and specificities of 83%-98%, Dr. Avril and associates said (Diag Microbiol Infect Dis. 2016 doi:10.1016/j.diagmicrobio.2016.03.015).
These findings “support the rational use of rapid influenza diagnostic tests in clinical practice for young children presenting with fever without a source during flu season,” the investigators said.
Dr. Avril and associates added that they assessed only one rapid diagnostic test for influenza (QuickVue) – the only one available in their ED because of cost – but that there are 22 such tests commercially available. Nantes University Hospital supported the study. Dr. Avril and associates reported having no relevant disclosures.
A rapid bedside diagnostic test for influenza showed consistent sensitivity and specificity across four consecutive flu seasons in a single pediatric ED in France, according to a report in Diagnostic Microbiology and Infectious Disease.
During flu seasons, it is difficult to distinguish young children who have the flu from those who have serious bacterial infections because clinical symptoms alone cannot differentiate the two conditions and fever may be the only symptom during the onset of a bacterial infection. Rapid influenza diagnostic tests purport to help ED clinicians estimate the probability of influenza at the bedside, which in turn can reduce the need for further diagnostic testing, length of ED stay, inappropriate use of antibiotics, and the costs of care, said Dr. E. Avril of the pediatric ED, University Hospital in Nantes, France, and associates.
To assess the diagnostic value of one rapid influenza diagnostic test used in this setting every winter, the investigators studied 764 patients younger than age 5 years who were admitted to the ED during four consecutive flu seasons with fever of no known origin. The prevalence of influenza varied widely during the study period, from a low of 30% to a high of 62%.
The rapid diagnostic test performed comparably well across the four flu seasons, with only a modest decrease in sensitivity and specificity during the 2010 H1N1 flu pandemic. The bedside test had an overall sensitivity of 0.82, a specificity of 0.98, a positive likelihood ratio of 37.8, and a negative likelihood ratio of 0.19. These results are similar to those of two previous small-scale studies that found sensitivities of 69%-85% and specificities of 83%-98%, Dr. Avril and associates said (Diag Microbiol Infect Dis. 2016 doi:10.1016/j.diagmicrobio.2016.03.015).
These findings “support the rational use of rapid influenza diagnostic tests in clinical practice for young children presenting with fever without a source during flu season,” the investigators said.
Dr. Avril and associates added that they assessed only one rapid diagnostic test for influenza (QuickVue) – the only one available in their ED because of cost – but that there are 22 such tests commercially available. Nantes University Hospital supported the study. Dr. Avril and associates reported having no relevant disclosures.
A rapid bedside diagnostic test for influenza showed consistent sensitivity and specificity across four consecutive flu seasons in a single pediatric ED in France, according to a report in Diagnostic Microbiology and Infectious Disease.
During flu seasons, it is difficult to distinguish young children who have the flu from those who have serious bacterial infections because clinical symptoms alone cannot differentiate the two conditions and fever may be the only symptom during the onset of a bacterial infection. Rapid influenza diagnostic tests purport to help ED clinicians estimate the probability of influenza at the bedside, which in turn can reduce the need for further diagnostic testing, length of ED stay, inappropriate use of antibiotics, and the costs of care, said Dr. E. Avril of the pediatric ED, University Hospital in Nantes, France, and associates.
To assess the diagnostic value of one rapid influenza diagnostic test used in this setting every winter, the investigators studied 764 patients younger than age 5 years who were admitted to the ED during four consecutive flu seasons with fever of no known origin. The prevalence of influenza varied widely during the study period, from a low of 30% to a high of 62%.
The rapid diagnostic test performed comparably well across the four flu seasons, with only a modest decrease in sensitivity and specificity during the 2010 H1N1 flu pandemic. The bedside test had an overall sensitivity of 0.82, a specificity of 0.98, a positive likelihood ratio of 37.8, and a negative likelihood ratio of 0.19. These results are similar to those of two previous small-scale studies that found sensitivities of 69%-85% and specificities of 83%-98%, Dr. Avril and associates said (Diag Microbiol Infect Dis. 2016 doi:10.1016/j.diagmicrobio.2016.03.015).
These findings “support the rational use of rapid influenza diagnostic tests in clinical practice for young children presenting with fever without a source during flu season,” the investigators said.
Dr. Avril and associates added that they assessed only one rapid diagnostic test for influenza (QuickVue) – the only one available in their ED because of cost – but that there are 22 such tests commercially available. Nantes University Hospital supported the study. Dr. Avril and associates reported having no relevant disclosures.
FROM DIAGNOSTIC MICROBIOLOGY AND INFECTIOUS DISEASE
Key clinical point: A rapid bedside diagnostic test for influenza was accurate across four consecutive flu seasons in a pediatric ED.
Major finding: The bedside test had an overall sensitivity of 0.82, a specificity of 0.98, a positive likelihood ratio of 37.8, and a negative likelihood ratio of 0.19.
Data source: A prospective analysis of the sensitivity and specificity of one rapid bedside diagnostic test in 764 children seen over a 4-year period.
Disclosures: Nantes University Hospital supported the study. Dr. Avril and associates reported having no relevant disclosures.
Chronic illness associated with lower developmental readiness for school entry
Chronic illnesses such as otitis media, respiratory disease, and epilepsy increase the likelihood that children will be developmentally at risk for difficulties at school entry, a study showed.
The authors’ findings indicated “that chronically poor health in early childhood is a risk for school readiness, over and above the disadvantage conferred by socioeconomic factors,” Megan F. Bell of the University of Western Australia in Perth and her associates reported online (Pediatrics. 2016 April 13. doi: 10.1542/peds.2015-2475). “This increased risk was particularly evident for social and emotional capacities.”
The researchers analyzed developmental school readiness among 22,890 children (average age, 5 years), within the context of having chronic illness. The children were born in Western Australia in 2003-2004, underwent an early development assessment for school readiness in 2009, and did not have special needs, cerebral palsy, or a diagnosed developmental disorder. The assessments’ five domains included physical health and well-being, social competence, emotional maturity, language and cognitive skills, and communication skills and general knowledge. Children were designated “developmentally vulnerable” if they scored in the bottom 10% of a domain and “at risk” if they scored in the bottom 10%-25%. The top 75% were classified as “on track.”
Among 2,879 children with chronic illness, involving 13% of the overall sample, 93% of these children had one chronic illness diagnosis, and 7% had at least two. The most common illnesses were chronic otitis media (71%), chronic respiratory disease (27%), and epilepsy (3%).
Using health and demographic data for 19,227 mothers and 19,030 fathers of the children, the researchers accounted for sociodemographic characteristics of each child, their community, and their parents, including parental chronic illness. After these adjustments, children with a chronic illness were approximately 20%-35% more likely to fall within the vulnerable or at-risk categories in all five developmental domains, compared with their healthier peers. Children with multiple diagnoses, however, were not significantly more likely to be less developmentally ready for school in any of the five domains than their peers with one diagnosis, suggesting that “just one chronic illness is enough to increase a child’s risk for lower school readiness,” the authors wrote.
A 15%-35% increase in the risk of developmental vulnerability was seen in all domains for 1,859 children with a single diagnosis of otitis media and a 24%-45% increase was seen for 618 children with a single diagnosis of respiratory disease. However, there was no significant increase in risk for the 63 children with a diagnosis of epilepsy; all probability values were greater than .05.
“School-based programs targeted at enhancing social and emotional abilities have been shown to lead to improvements in behavioral, social, and academic outcomes,” the authors wrote. “This may therefore be an important focus of intervention for chronically ill children.
“Our findings suggest there is a need to broaden the scope of health conditions eligible for additional support at school entry. For instance, the most prevalent diagnosis was chronic otitis media, a common childhood condition that is associated with delayed language development, reading and spelling difficulties, and auditory processing deficits. Although recurrent ear infections may not be associated with significant limitations in daily activities, our study demonstrated that children with this condition are at increased risk of poor school readiness, even without having a more severe comorbid condition,” Ms. Bell and her associates wrote.
The research was funded by the Australian Research Council Linkage Project. The authors reported no relevant financial disclosures.
Chronic illnesses such as otitis media, respiratory disease, and epilepsy increase the likelihood that children will be developmentally at risk for difficulties at school entry, a study showed.
The authors’ findings indicated “that chronically poor health in early childhood is a risk for school readiness, over and above the disadvantage conferred by socioeconomic factors,” Megan F. Bell of the University of Western Australia in Perth and her associates reported online (Pediatrics. 2016 April 13. doi: 10.1542/peds.2015-2475). “This increased risk was particularly evident for social and emotional capacities.”
The researchers analyzed developmental school readiness among 22,890 children (average age, 5 years), within the context of having chronic illness. The children were born in Western Australia in 2003-2004, underwent an early development assessment for school readiness in 2009, and did not have special needs, cerebral palsy, or a diagnosed developmental disorder. The assessments’ five domains included physical health and well-being, social competence, emotional maturity, language and cognitive skills, and communication skills and general knowledge. Children were designated “developmentally vulnerable” if they scored in the bottom 10% of a domain and “at risk” if they scored in the bottom 10%-25%. The top 75% were classified as “on track.”
Among 2,879 children with chronic illness, involving 13% of the overall sample, 93% of these children had one chronic illness diagnosis, and 7% had at least two. The most common illnesses were chronic otitis media (71%), chronic respiratory disease (27%), and epilepsy (3%).
Using health and demographic data for 19,227 mothers and 19,030 fathers of the children, the researchers accounted for sociodemographic characteristics of each child, their community, and their parents, including parental chronic illness. After these adjustments, children with a chronic illness were approximately 20%-35% more likely to fall within the vulnerable or at-risk categories in all five developmental domains, compared with their healthier peers. Children with multiple diagnoses, however, were not significantly more likely to be less developmentally ready for school in any of the five domains than their peers with one diagnosis, suggesting that “just one chronic illness is enough to increase a child’s risk for lower school readiness,” the authors wrote.
A 15%-35% increase in the risk of developmental vulnerability was seen in all domains for 1,859 children with a single diagnosis of otitis media and a 24%-45% increase was seen for 618 children with a single diagnosis of respiratory disease. However, there was no significant increase in risk for the 63 children with a diagnosis of epilepsy; all probability values were greater than .05.
“School-based programs targeted at enhancing social and emotional abilities have been shown to lead to improvements in behavioral, social, and academic outcomes,” the authors wrote. “This may therefore be an important focus of intervention for chronically ill children.
“Our findings suggest there is a need to broaden the scope of health conditions eligible for additional support at school entry. For instance, the most prevalent diagnosis was chronic otitis media, a common childhood condition that is associated with delayed language development, reading and spelling difficulties, and auditory processing deficits. Although recurrent ear infections may not be associated with significant limitations in daily activities, our study demonstrated that children with this condition are at increased risk of poor school readiness, even without having a more severe comorbid condition,” Ms. Bell and her associates wrote.
The research was funded by the Australian Research Council Linkage Project. The authors reported no relevant financial disclosures.
Chronic illnesses such as otitis media, respiratory disease, and epilepsy increase the likelihood that children will be developmentally at risk for difficulties at school entry, a study showed.
The authors’ findings indicated “that chronically poor health in early childhood is a risk for school readiness, over and above the disadvantage conferred by socioeconomic factors,” Megan F. Bell of the University of Western Australia in Perth and her associates reported online (Pediatrics. 2016 April 13. doi: 10.1542/peds.2015-2475). “This increased risk was particularly evident for social and emotional capacities.”
The researchers analyzed developmental school readiness among 22,890 children (average age, 5 years), within the context of having chronic illness. The children were born in Western Australia in 2003-2004, underwent an early development assessment for school readiness in 2009, and did not have special needs, cerebral palsy, or a diagnosed developmental disorder. The assessments’ five domains included physical health and well-being, social competence, emotional maturity, language and cognitive skills, and communication skills and general knowledge. Children were designated “developmentally vulnerable” if they scored in the bottom 10% of a domain and “at risk” if they scored in the bottom 10%-25%. The top 75% were classified as “on track.”
Among 2,879 children with chronic illness, involving 13% of the overall sample, 93% of these children had one chronic illness diagnosis, and 7% had at least two. The most common illnesses were chronic otitis media (71%), chronic respiratory disease (27%), and epilepsy (3%).
Using health and demographic data for 19,227 mothers and 19,030 fathers of the children, the researchers accounted for sociodemographic characteristics of each child, their community, and their parents, including parental chronic illness. After these adjustments, children with a chronic illness were approximately 20%-35% more likely to fall within the vulnerable or at-risk categories in all five developmental domains, compared with their healthier peers. Children with multiple diagnoses, however, were not significantly more likely to be less developmentally ready for school in any of the five domains than their peers with one diagnosis, suggesting that “just one chronic illness is enough to increase a child’s risk for lower school readiness,” the authors wrote.
A 15%-35% increase in the risk of developmental vulnerability was seen in all domains for 1,859 children with a single diagnosis of otitis media and a 24%-45% increase was seen for 618 children with a single diagnosis of respiratory disease. However, there was no significant increase in risk for the 63 children with a diagnosis of epilepsy; all probability values were greater than .05.
“School-based programs targeted at enhancing social and emotional abilities have been shown to lead to improvements in behavioral, social, and academic outcomes,” the authors wrote. “This may therefore be an important focus of intervention for chronically ill children.
“Our findings suggest there is a need to broaden the scope of health conditions eligible for additional support at school entry. For instance, the most prevalent diagnosis was chronic otitis media, a common childhood condition that is associated with delayed language development, reading and spelling difficulties, and auditory processing deficits. Although recurrent ear infections may not be associated with significant limitations in daily activities, our study demonstrated that children with this condition are at increased risk of poor school readiness, even without having a more severe comorbid condition,” Ms. Bell and her associates wrote.
The research was funded by the Australian Research Council Linkage Project. The authors reported no relevant financial disclosures.
FROM PEDIATRICS
Key clinical point: Chronic illness, including otitis media, is associated with lower developmental readiness for school entry among children.
Major finding: Preschool children with chronic conditions are 20%-35% more likely to be developmentally at risk.
Data source: The findings are based on a cross-sectional cohort analysis of chronic illnesses and developmental assessments for school readiness among 22,890 Western Australian children, with an average age of 5 years.
Disclosures: The research was funded by the Australian Research Council Linkage Project. The authors reported no relevant financial disclosures.
TCD screening underused in sickle cell patients
with sickle cell anemia
Photo courtesy of St. Jude
Results of a large, retrospective study suggest the use of transcranial Doppler (TCD) screening is on the rise in US children and adolescents with sickle cell anemia.
However, the rate of TCD screening in these patients falls well below national recommendations.
In addition, TCD screening rates vary greatly by state, and the use of screening tends to decrease as patients grow older.
Sarah L. Reeves, PhD, of University of Michigan, Ann Arbor, and her colleagues reported these findings in JAMA Pediatrics.
The researchers noted that guidelines from the National Heart, Lung, and Blood Institute recommend that patients with sickle cell anemia receive annual TCD screenings from age 2 to 16 to identify those patients at the highest risk of stroke.
Dr Reeves and her colleagues wanted to determine if this recommendation is being followed. So they analyzed Medicaid claims data from 2005 through 2010 for Florida, Illinois, Louisiana, Michigan, South Carolina, and Texas.
The data included 4775 patients, ages 2 to 16, with sickle cell anemia. For these patients, TCD screening rates increased from 22% in 2005 to 44% in 2010 (P<0.001).
The researchers found that TCD screening rates varied significantly by state (P=0.004), and Texas had the lowest screening rate at any time point (7% in 2005).
The team also analyzed a subset of 2388 patients who were enrolled for 2 or more consecutive years to examine potential predictors of TCD screening.
This analysis revealed that, with each year of increasing age, a patient’s odds of receiving TCD screening decreased (odds ratio=0.97, P=0.002).
On the other hand, an increasing number of well-child visits was associated with higher odds of receiving TCD screening (odds ratio=1.10, P=0.007).
And the odds of receiving TCD screening were higher for patients who previously underwent TCD screening (odds ratio=2.44, P<0.001).
The researchers said these results suggest that, despite national recommendations, TCD screening rates remain low in young patients with sickle cell anemia in the US. 
with sickle cell anemia
Photo courtesy of St. Jude
Results of a large, retrospective study suggest the use of transcranial Doppler (TCD) screening is on the rise in US children and adolescents with sickle cell anemia.
However, the rate of TCD screening in these patients falls well below national recommendations.
In addition, TCD screening rates vary greatly by state, and the use of screening tends to decrease as patients grow older.
Sarah L. Reeves, PhD, of University of Michigan, Ann Arbor, and her colleagues reported these findings in JAMA Pediatrics.
The researchers noted that guidelines from the National Heart, Lung, and Blood Institute recommend that patients with sickle cell anemia receive annual TCD screenings from age 2 to 16 to identify those patients at the highest risk of stroke.
Dr Reeves and her colleagues wanted to determine if this recommendation is being followed. So they analyzed Medicaid claims data from 2005 through 2010 for Florida, Illinois, Louisiana, Michigan, South Carolina, and Texas.
The data included 4775 patients, ages 2 to 16, with sickle cell anemia. For these patients, TCD screening rates increased from 22% in 2005 to 44% in 2010 (P<0.001).
The researchers found that TCD screening rates varied significantly by state (P=0.004), and Texas had the lowest screening rate at any time point (7% in 2005).
The team also analyzed a subset of 2388 patients who were enrolled for 2 or more consecutive years to examine potential predictors of TCD screening.
This analysis revealed that, with each year of increasing age, a patient’s odds of receiving TCD screening decreased (odds ratio=0.97, P=0.002).
On the other hand, an increasing number of well-child visits was associated with higher odds of receiving TCD screening (odds ratio=1.10, P=0.007).
And the odds of receiving TCD screening were higher for patients who previously underwent TCD screening (odds ratio=2.44, P<0.001).
The researchers said these results suggest that, despite national recommendations, TCD screening rates remain low in young patients with sickle cell anemia in the US.
with sickle cell anemia
Photo courtesy of St. Jude
Results of a large, retrospective study suggest the use of transcranial Doppler (TCD) screening is on the rise in US children and adolescents with sickle cell anemia.
However, the rate of TCD screening in these patients falls well below national recommendations.
In addition, TCD screening rates vary greatly by state, and the use of screening tends to decrease as patients grow older.
Sarah L. Reeves, PhD, of University of Michigan, Ann Arbor, and her colleagues reported these findings in JAMA Pediatrics.
The researchers noted that guidelines from the National Heart, Lung, and Blood Institute recommend that patients with sickle cell anemia receive annual TCD screenings from age 2 to 16 to identify those patients at the highest risk of stroke.
Dr Reeves and her colleagues wanted to determine if this recommendation is being followed. So they analyzed Medicaid claims data from 2005 through 2010 for Florida, Illinois, Louisiana, Michigan, South Carolina, and Texas.
The data included 4775 patients, ages 2 to 16, with sickle cell anemia. For these patients, TCD screening rates increased from 22% in 2005 to 44% in 2010 (P<0.001).
The researchers found that TCD screening rates varied significantly by state (P=0.004), and Texas had the lowest screening rate at any time point (7% in 2005).
The team also analyzed a subset of 2388 patients who were enrolled for 2 or more consecutive years to examine potential predictors of TCD screening.
This analysis revealed that, with each year of increasing age, a patient’s odds of receiving TCD screening decreased (odds ratio=0.97, P=0.002).
On the other hand, an increasing number of well-child visits was associated with higher odds of receiving TCD screening (odds ratio=1.10, P=0.007).
And the odds of receiving TCD screening were higher for patients who previously underwent TCD screening (odds ratio=2.44, P<0.001).
The researchers said these results suggest that, despite national recommendations, TCD screening rates remain low in young patients with sickle cell anemia in the US.
Childhood Obesity Predicted by Infant BMI
BOSTON – Infants above the 85th percentile for body mass index at 6 months are up to nine times more likely to be severely obese by the age of 6, according to a Cincinnati Children’s Hospital investigation.
The finding means that pediatricians should routinely plot and follow body mass index (BMI) from an early age, just like height, weight, and head circumference, said investigator Dr. Allison Smego, an endocrinology fellow.
She and her colleagues reviewed the charts from birth to age 6 of 783 lean children and 480 children above the 99th BMI percentile. BMI started differentiating when children were as young as 4 months old, about a year and half before the onset of clinical obesity. The predictive value of the 85th percentile threshold held at 6, 12, and 18 months. The finding was subsequently validated in over 2,600 children.
In an interview at the annual meeting of the Endocrine Society, Dr. Smego explained how to use the findings.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
BOSTON – Infants above the 85th percentile for body mass index at 6 months are up to nine times more likely to be severely obese by the age of 6, according to a Cincinnati Children’s Hospital investigation.
The finding means that pediatricians should routinely plot and follow body mass index (BMI) from an early age, just like height, weight, and head circumference, said investigator Dr. Allison Smego, an endocrinology fellow.
She and her colleagues reviewed the charts from birth to age 6 of 783 lean children and 480 children above the 99th BMI percentile. BMI started differentiating when children were as young as 4 months old, about a year and half before the onset of clinical obesity. The predictive value of the 85th percentile threshold held at 6, 12, and 18 months. The finding was subsequently validated in over 2,600 children.
In an interview at the annual meeting of the Endocrine Society, Dr. Smego explained how to use the findings.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
BOSTON – Infants above the 85th percentile for body mass index at 6 months are up to nine times more likely to be severely obese by the age of 6, according to a Cincinnati Children’s Hospital investigation.
The finding means that pediatricians should routinely plot and follow body mass index (BMI) from an early age, just like height, weight, and head circumference, said investigator Dr. Allison Smego, an endocrinology fellow.
She and her colleagues reviewed the charts from birth to age 6 of 783 lean children and 480 children above the 99th BMI percentile. BMI started differentiating when children were as young as 4 months old, about a year and half before the onset of clinical obesity. The predictive value of the 85th percentile threshold held at 6, 12, and 18 months. The finding was subsequently validated in over 2,600 children.
In an interview at the annual meeting of the Endocrine Society, Dr. Smego explained how to use the findings.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
AT ENDO 2016
VIDEO: Childhood obesity predicted by infant BMI
BOSTON – Infants above the 85th percentile for body mass index at 6 months are up to nine times more likely to be severely obese by the age of 6, according to a Cincinnati Children’s Hospital investigation.
The finding means that pediatricians should routinely plot and follow body mass index (BMI) from an early age, just like height, weight, and head circumference, said investigator Dr. Allison Smego, an endocrinology fellow.
She and her colleagues reviewed the charts from birth to age 6 of 783 lean children and 480 children above the 99th BMI percentile. BMI started differentiating when children were as young as 4 months old, about a year and half before the onset of clinical obesity. The predictive value of the 85th percentile threshold held at 6, 12, and 18 months. The finding was subsequently validated in over 2,600 children.
In an interview at the annual meeting of the Endocrine Society, Dr. Smego explained how to use the findings.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
BOSTON – Infants above the 85th percentile for body mass index at 6 months are up to nine times more likely to be severely obese by the age of 6, according to a Cincinnati Children’s Hospital investigation.
The finding means that pediatricians should routinely plot and follow body mass index (BMI) from an early age, just like height, weight, and head circumference, said investigator Dr. Allison Smego, an endocrinology fellow.
She and her colleagues reviewed the charts from birth to age 6 of 783 lean children and 480 children above the 99th BMI percentile. BMI started differentiating when children were as young as 4 months old, about a year and half before the onset of clinical obesity. The predictive value of the 85th percentile threshold held at 6, 12, and 18 months. The finding was subsequently validated in over 2,600 children.
In an interview at the annual meeting of the Endocrine Society, Dr. Smego explained how to use the findings.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
BOSTON – Infants above the 85th percentile for body mass index at 6 months are up to nine times more likely to be severely obese by the age of 6, according to a Cincinnati Children’s Hospital investigation.
The finding means that pediatricians should routinely plot and follow body mass index (BMI) from an early age, just like height, weight, and head circumference, said investigator Dr. Allison Smego, an endocrinology fellow.
She and her colleagues reviewed the charts from birth to age 6 of 783 lean children and 480 children above the 99th BMI percentile. BMI started differentiating when children were as young as 4 months old, about a year and half before the onset of clinical obesity. The predictive value of the 85th percentile threshold held at 6, 12, and 18 months. The finding was subsequently validated in over 2,600 children.
In an interview at the annual meeting of the Endocrine Society, Dr. Smego explained how to use the findings.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
AT ENDO 2016
Asthma, Eczema in Children Unrelated to Allergic Sensitization
Atopy was not related to development of eczema or asthma in children under age 13 years, according to Ann-Marie Malby Schoos, Ph.D., and her associates at the University of Copenhagen.
Allergic sensitization increased with age in the 399 children tested, rising from 12% at 6 months to 54% at 13 years. The incidence of asthma was highest at age 4 years at 16%, but decreased afterward, falling to 12% at 13 years. The incidence of eczema peaked at 39% in children aged 1.5 years old, but decreased steadily to only 12% in 13-year-olds.
Asthma and allergic sensitization were related only in late childhood, with an odds ratio of 4.49 in 13-year-olds. This pattern was seen throughout allergic sensitization subgroups. There were strong associations between eczema and allergic sensitization at 6 months (OR, 6.02), 1.5 years (OR, 2.06), and 6 years (OR, 2.77), but no association at 13 years. The proportion of children with allergic sensitization who did not have asthma or eczema also increased with age.
“The tradition of using atopy as a particular endotype of asthma and eczema seems unfounded because it depends on the method of testing for sensitization, type of allergens, and age of the patient. This questions the relevance of the terms atopic asthma and atopic eczema as true endotypes,” the investigators concluded.
Find the full study in the Journal of Allergy and Clinical Immunology (doi: 10.1016/j.jaci.2015.10.004).
Atopy was not related to development of eczema or asthma in children under age 13 years, according to Ann-Marie Malby Schoos, Ph.D., and her associates at the University of Copenhagen.
Allergic sensitization increased with age in the 399 children tested, rising from 12% at 6 months to 54% at 13 years. The incidence of asthma was highest at age 4 years at 16%, but decreased afterward, falling to 12% at 13 years. The incidence of eczema peaked at 39% in children aged 1.5 years old, but decreased steadily to only 12% in 13-year-olds.
Asthma and allergic sensitization were related only in late childhood, with an odds ratio of 4.49 in 13-year-olds. This pattern was seen throughout allergic sensitization subgroups. There were strong associations between eczema and allergic sensitization at 6 months (OR, 6.02), 1.5 years (OR, 2.06), and 6 years (OR, 2.77), but no association at 13 years. The proportion of children with allergic sensitization who did not have asthma or eczema also increased with age.
“The tradition of using atopy as a particular endotype of asthma and eczema seems unfounded because it depends on the method of testing for sensitization, type of allergens, and age of the patient. This questions the relevance of the terms atopic asthma and atopic eczema as true endotypes,” the investigators concluded.
Find the full study in the Journal of Allergy and Clinical Immunology (doi: 10.1016/j.jaci.2015.10.004).
Atopy was not related to development of eczema or asthma in children under age 13 years, according to Ann-Marie Malby Schoos, Ph.D., and her associates at the University of Copenhagen.
Allergic sensitization increased with age in the 399 children tested, rising from 12% at 6 months to 54% at 13 years. The incidence of asthma was highest at age 4 years at 16%, but decreased afterward, falling to 12% at 13 years. The incidence of eczema peaked at 39% in children aged 1.5 years old, but decreased steadily to only 12% in 13-year-olds.
Asthma and allergic sensitization were related only in late childhood, with an odds ratio of 4.49 in 13-year-olds. This pattern was seen throughout allergic sensitization subgroups. There were strong associations between eczema and allergic sensitization at 6 months (OR, 6.02), 1.5 years (OR, 2.06), and 6 years (OR, 2.77), but no association at 13 years. The proportion of children with allergic sensitization who did not have asthma or eczema also increased with age.
“The tradition of using atopy as a particular endotype of asthma and eczema seems unfounded because it depends on the method of testing for sensitization, type of allergens, and age of the patient. This questions the relevance of the terms atopic asthma and atopic eczema as true endotypes,” the investigators concluded.
Find the full study in the Journal of Allergy and Clinical Immunology (doi: 10.1016/j.jaci.2015.10.004).
FROM THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY
Asthma, eczema in children unrelated to allergic sensitization
Atopy was not related to development of eczema or asthma in children under age 13 years, according to Ann-Marie Malby Schoos, Ph.D., and her associates at the University of Copenhagen.
Allergic sensitization increased with age in the 399 children tested, rising from 12% at 6 months to 54% at 13 years. The incidence of asthma was highest at age 4 years at 16%, but decreased afterward, falling to 12% at 13 years. The incidence of eczema peaked at 39% in children aged 1.5 years old, but decreased steadily to only 12% in 13-year-olds.
Asthma and allergic sensitization were related only in late childhood, with an odds ratio of 4.49 in 13-year-olds. This pattern was seen throughout allergic sensitization subgroups. There were strong associations between eczema and allergic sensitization at 6 months (OR, 6.02), 1.5 years (OR, 2.06), and 6 years (OR, 2.77), but no association at 13 years. The proportion of children with allergic sensitization who did not have asthma or eczema also increased with age.
“The tradition of using atopy as a particular endotype of asthma and eczema seems unfounded because it depends on the method of testing for sensitization, type of allergens, and age of the patient. This questions the relevance of the terms atopic asthma and atopic eczema as true endotypes,” the investigators concluded.
Find the full study in the Journal of Allergy and Clinical Immunology (doi: 10.1016/j.jaci.2015.10.004).
Atopy was not related to development of eczema or asthma in children under age 13 years, according to Ann-Marie Malby Schoos, Ph.D., and her associates at the University of Copenhagen.
Allergic sensitization increased with age in the 399 children tested, rising from 12% at 6 months to 54% at 13 years. The incidence of asthma was highest at age 4 years at 16%, but decreased afterward, falling to 12% at 13 years. The incidence of eczema peaked at 39% in children aged 1.5 years old, but decreased steadily to only 12% in 13-year-olds.
Asthma and allergic sensitization were related only in late childhood, with an odds ratio of 4.49 in 13-year-olds. This pattern was seen throughout allergic sensitization subgroups. There were strong associations between eczema and allergic sensitization at 6 months (OR, 6.02), 1.5 years (OR, 2.06), and 6 years (OR, 2.77), but no association at 13 years. The proportion of children with allergic sensitization who did not have asthma or eczema also increased with age.
“The tradition of using atopy as a particular endotype of asthma and eczema seems unfounded because it depends on the method of testing for sensitization, type of allergens, and age of the patient. This questions the relevance of the terms atopic asthma and atopic eczema as true endotypes,” the investigators concluded.
Find the full study in the Journal of Allergy and Clinical Immunology (doi: 10.1016/j.jaci.2015.10.004).
Atopy was not related to development of eczema or asthma in children under age 13 years, according to Ann-Marie Malby Schoos, Ph.D., and her associates at the University of Copenhagen.
Allergic sensitization increased with age in the 399 children tested, rising from 12% at 6 months to 54% at 13 years. The incidence of asthma was highest at age 4 years at 16%, but decreased afterward, falling to 12% at 13 years. The incidence of eczema peaked at 39% in children aged 1.5 years old, but decreased steadily to only 12% in 13-year-olds.
Asthma and allergic sensitization were related only in late childhood, with an odds ratio of 4.49 in 13-year-olds. This pattern was seen throughout allergic sensitization subgroups. There were strong associations between eczema and allergic sensitization at 6 months (OR, 6.02), 1.5 years (OR, 2.06), and 6 years (OR, 2.77), but no association at 13 years. The proportion of children with allergic sensitization who did not have asthma or eczema also increased with age.
“The tradition of using atopy as a particular endotype of asthma and eczema seems unfounded because it depends on the method of testing for sensitization, type of allergens, and age of the patient. This questions the relevance of the terms atopic asthma and atopic eczema as true endotypes,” the investigators concluded.
Find the full study in the Journal of Allergy and Clinical Immunology (doi: 10.1016/j.jaci.2015.10.004).
FROM THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY
