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Objectives. To determine physician success at designing catch-up regimens for children delayed in immunizations and physician knowledge regarding contraindications to immunization. Methods. A self-administered survey was completed by pediatricians, general practitioners, and family practitioners in Cook County, Illinois. Surveys included 6 open-ended vignettes describing hypothetical children delayed in immunization for whom participants were asked to design catch-up regimens. Bivariate and multivariate logistic regression were used to determine predictors of correct response. The surveys also inquired about management of scenarios that might be perceived as contraindications to immunize with the Haemophilus influenzae type b or measles-mumps-rubella vaccines. Results. The mean score of correct responses was 1.83 of a possible 6.0. Almost one third of respondents answered all 6 vignettes incorrectly. The proportion of incorrect responses was high for all 6 vignettes (39%-86%), but higher for questions that addressed the immunization of children older than 12 months. Errors in vaccine administration were most commonly attributed to omitted vaccines, with varicella-zoster vaccine and pneumococcal conjugate vaccine omitted most frequently. Pediatricians were >4 times more likely to answer correctly than were family practitioners. Participants in the Vaccines for Children (VFC) program were more than twice as likely to answer correctly than were non-VFC providers. Knowledge of contraindications was inconsistent, particularly for measles-mumps-rubella vaccine. Conclusions. Childhood vaccine providers have substantial knowledge deficits of recommended immunization schedules and vaccine contraindications that may contribute to missed opportunities to immunize. Pediatricians and participants in the VFC program were more successful at designing catch-up regimens for children with immunization delay. Pediatrics 2003;111:925-932; vaccination, immunization, immunization delay, children, provider practices, vaccine contraindications., ABBREVIATIONS. AAP, American Academy of Pediatrics; ACIP, Advisory Committee on Immunization Practices; VFC, Vaccines for Children; AMA, American Medical Association; Hib, Haemophilus influenzae type b; MMR, measles-mumps-rubella; HIV, human immunodeficiency [...]

Immunizing children against Haemophilus influenzae Type b with a two-dose regimen of two different types of vaccine may be as effective as the currently recommended three-dose regimen with a single type. Researchers randomly assigned 321 infants to various regimens of Haemophilus b immunization. Infants receiving the two-dose mixed regimen had higher antibody titers between two and seven months. Although infants receiving the mixed two-dose regimen had lower average antibody titers at seven months, similar percentages of children had antibody titers in the range considered protective against disease., Objective. To evaluate two- or three-dose "mixed" regimens of Haemophilus influenzae type b conjugate vaccines in the priming series. Design. Two randomized clinical trials with 140 and 181 infants, respectively. Setting. Private practices in New Orleans and Chicago. Methods. In trial I, infants received one of four regimens. Two were recommended regimens for polyribosylribitol phosphate (PRP)--meningococcal protein conjugate (M) and PRP--tetanus toxoid conjugate (T). Two mixed regimens consisted of M at 2 months followed by two doses of T or PRP--diphtheria toxoid conjugate (D) at 4 and 6 months. Trial II consisted of three groups. Two were recommended regimens for M and T. The third was a two-dose mixed regimen consisting of M at 2 months and T at 4 months. Parents were interviewed and instructed to record side effects after each vaccination. Serum was assayed for H influenzae type b anticapsular antibody (anti-PRP). Results. Minor differences in safety profiles likely reflected [alpha] error. In trial I, M (lot 0884T, one of several known to have had decreased immunogenicity), probably primed for substantial increase in serum antibody when D or T was given at 4 and 6 months. In trial II, infants who received the two-dose mixed regimen (M from immunogenic lot 0116W at 2 months and T at 4 months) had a significantly higher mean area under the curve than recipients of the three-dose TTT regimen when antibody concentration was plotted against age, although the geometric mean anti-PRP antibody concentration for the MT-recipients was significantly lower at 7 months. Conclusions. M used in trial I may have primed infants despite poor immunogenicity. The two-dose mixed regimen (MT-) in trial II produced a mean anti-PRP antibody concentration with higher sustained anti-PRP concentrations from 2 to 7 months, as judged by the area under the curve, but a lower mean anti-PRP antibody concentration at 7 months. Pediatrics 1996;98:898-904; Haemophilus influenzae type b vaccines, conjugate vaccines., ABBREVIATIONS. PRP, polyribosylribitol phosphate; M, PRP--meningococcal protein conjugate; T, PRP--tetanus toxoid conjugate; AUC, area under the curve; D, PRP--diphtheria toxoid conjugate; HbOC, oligosaccharide [CRM.sub.197] H influenzae conjugate vaccine; DTP, diphtheria [...]

A new vaccine for Haemophilus influenzae type b does not appear to increase adverse effects when injected with diphtheria-tetanus-pertussis vaccine (DTP), but it has advantages and drawbacks compared with a different H influenzae type b vaccine (HbOC). A group of 141 healthy infants attending a private New Orleans pediatric practice were assigned to receive DTP combined with the new vaccine, DTP and the new vaccine as a separate injection, or separate injections of DTP and HbOC at two months, four months, and six months. Blood samples drawn before each immunization and at seven months were analyzed for antibodies. Parents recorded side effects. Infants receiving the combined injection were more likely to experience swelling and redness at the injection site. They had higher antibody titers against H influenzae. However, children receiving HbOC had higher antibody titers to diphtheria and tetanus compared with children receiving the new vaccine. The import of this for disease protection is unknown., ABSTRACT. Objective. To evaluate whether combining Haemophilus influenzae type b capsular polysaccharide covalently linked to tetanus toxoid (PRP-T) and diphtheria-tetanus-pertussis (DTP) in one syringe produced a vaccine that was safe [...]

Stimulation of immunity to bacteria such as Haemophilus influenzae type b varies according to the vaccine used, but one problem common to all these vaccines is that the incidence of infection by these bacteria increases in the week following immunization. One way this could happen is that the vaccine itself may be recognized and carried away by existing antibodies, thereby decreasing the amount of antibody available to fight any bacteria present. This 'negative phase,' or decline in antibody levels, has been studied previously in adults and in young children, as well as in rats that were immunized with several types of H. influenzae Type b vaccines. Most children and adults did show a decline in antibody levels within four days of immunization, but those who received vaccine which consisted of sugars conjugated, or linked, with bacterial protein, did not show as consistent as decline in levels. Similar effects were seen in infant rats that were given protective antibodies and then challenged with bacteria with or without vaccine. The addition of vaccine increased the incidence of bacterial infection, and preliminary results indicate that the conjugate vaccine did so to less of an extent. The urine and blood of infants who had been immunized with conjugate vaccine were studied to determine levels of vaccine activity; vaccine activity in the urine was frequently found. There was no correlation between amounts of vaccine-like compound in the urine and changes in blood levels of antibody. One reason why conjugate vaccine immunization may be associated with less of a decline in antibody levels is that the protein part of the vaccine is large and may block complete binding of the antibody to the sugar part of the vaccine. The data suggest that the negative phase of antibody levels contributes to increased infections following immunization, but the mechanism underlying this phenomenon is still unclear. (Consumer Summary produced by Reliance Medical Information, Inc.)

ABBREVIATIONS. ACIP, Advisory Committee on Immunization Practices; IOM, Institute of Medicine; AAP, American Academy of Pediatrics; USPHS, US Public Health Service., The Advisory Committee on Immunization Practices (ACIP) has established the hepatitis B vaccine birth dose as the preferred time for administering the first dose of hepatitis B vaccine in infants [...]

ABBREVIATIONS. AAP, American Academy of Pediatrics; USPHS, US Public Health Service; HBV, hepatitis B vaccine; FDA, Food and Drug Administration; CDC, Centers for Disease Control and Prevention., On July 7, 1999, the American Academy of Pediatrics (AAP) and the US Public Health Service (USPHS) jointly indicated that the first dose of hepatitis B vaccine (HBV), often given [...]

To the Editor. -- Before the introduction of Haemophilus influenzae type b (Hib) vaccines in the United States, ~20 000 cases of Hib invasive disease occurred annually.1 Conjugate vaccine use [...]

Pneumonia is an uncommon manifestation of Neisseria meningitidis infection, and empyema is rarely reported. Uniform penicillin susceptibility has been assumed for meningococcal infections for many years, but decreased penicillin susceptibility has been recognized recently with increasing frequency. Breakpoints to define different categories of susceptibility were published recently by the Clinical and Laboratory Standards Institute. We report the case of a teenage girl with sepsis and extensive bilateral pneumonia with empyema caused by an N meningitidis isolate that was resistant to penicillin. Her protracted clinical course suggested that penicillin resistance contributed to her delayed recovery. Our experience with this patient suggests that susceptibility testing should be performed in every case of N meningitidis isolation, and treatment with a third-generation cephalosporin should be provided until the susceptibility results are known. Clinical suspicion of N meningitidis as a possible cause of respiratory symptoms accompanied by hypotension, even in the absence of a rash, may aid in diagnosis and therefore in the treatment and provision of prophylaxis to contacts of patients with meningococcal disease. KEY WORDS. Neisseria meningitidis, pneumonia, empyema, penicillin resistance.

Objective. A primary objective of the Healthy People 2010 initiatives is to increase on-time immunization rates during the first 2 years of life and to decrease racial disparities in coverage. [...]

Presents a study which examined the benefits of dexamethasone therapy for bacterial meningitis in infants and children in the United States. Epidemiologic prevalence of bacterial meningitis in infants and children; Pathophysiologic events related to bacterial meningitis; Effect of dexamethasone on hearing loss.

Addresses a comment on a study on the safety and efficacy of Hemophilus influenzae type b vaccines. Failure to consider the temporal aspects of the performance of the type b capsular polysaccharide vaccines; Failure of the study to show biologic plausability; Differences in the estimates of efficacy. [ABSTRACT FROM AUTHOR]

Abstract. A cost-benefit analysis for Haemophilus influenzae type b disease prevention was developed to examine two officially recommended preventive strategies: H influenzae type b capsular polysaccharide immunization and rifampin prophylaxis of exposed contacts. The social costs of H influenzae type b disease in the 1984 US birth cohort will be $1.937 billion when base case assumptions are made. If it is assumed that 60% of all children could be vaccinated at 24 months of age, universal vaccination has the highest economic benefits of any single preventive strategy considered (net savings $64.8 million). Rifampin prophylaxis of appropriate household contacts has the highest benefit to cost ratio (59:1), but because rifampin prevents only secondary disease, only half as many cases can be prevented with rifampin prophylaxis of appropriate household contacts (501 cases prevented, $1,994 per case prevented) as with universal vaccination at 24 months (985 cases prevented, $63,484 per case prevented). Single-dose vaccination of day-care attendees at 18 months of age is the most expensive preventive strategy considered ($148,445 per case prevented, 306 cases prevented). Rifampin prophylaxis of appropriate day-care contacts prevents the fewest H infiuenzae type b cases ($46,041 per case prevented, 72 cases prevented). Pediatrics 1987;80:319-329; Haemophilus influenzae type b infection, cost-benefit analysis, capsular polysaccharide immunization, rifampin. [ABSTRACT FROM AUTHOR]

Provides guidelines for pediatricians in identifying the children or infants who should be considered for ribavirin therapy for respiratory syncytial virus. Information on respiratory syncytial virus disease; Details of ribavirin; Costs of ribavirin treatment; Categories of infants and children who should be considered for treatment with ribavirin aerosol.

Discusses the risk of transmission of the HIV virus to children in day-care centers in the United States. Definition of day care; Factors that increase the transmission of communicable diseases in day care settings; Signs of AIDS-related complex in children; Recommendations for the management of HIV-infected children in day care.

We conducted a multicenter trial designed to assess the efficacy of three different drug regimens on eradication of Haemophilus influenzae type b (HIB) from the nasopharynx of household contacts of patients with invasive type b Haemophilus disease. The drug regimens studied were rifampin, 20 mg/kg, once daily for four days; rifampin, 10 mg/kg, twice a day for four days; and placebo, once daily for four days. Shortly after admission of the index patient to the hospital, 26% of 492 household contacts were found to be colonized with HIB. Both rifampin regimens eradicated carriage significantly better than placebo at 10 and 30 days (P = .001). However, among contacts whose cultures were initially negative, new acquisition of the organism occurred infrequently in this 30-day follow-up period regardless of the drug or placebo regimen prescribed. We also measured the concentration of anticapsular antibody in sera obtained from contacts younger than 6 years of age. Samples were obtained soon after admission of the index patient to the hospital and 30 days later. Several carriers younger than 2 years of age had low concentrations of antibody in both specimens. In contrast, nearly all carriers 2 to 5 years of age had high concentrations of antibody even in the first sample. Children who were not carriers usually had low antibody concentrations which did not increase during the period of observation. Our results suggest that most intrafamilial spread of HIB occurs prior to hospitalization of the index patient and stimulates immunity in contacts older than 2 years of age. Although rifampin decreases the carriage rate, new acquisition of HIB continues to occur at a low rate among contacts, even in those who... [ABSTRACT FROM AUTHOR]

Abstract. The effectiveness of a commercially available latex particle agglutination test (Bactogen) in the diagnosis of invasive Haemophilus influenzae type b infection was evaluated. Bactogen correctly diagnosed all 27 patients with bacteriologically proven H influenzae type b infection (sensitivity 100%). Two of 39 patients with proven, non-H influenzae type b infections had false-postive tests (specificity 95%). One of 103 sera and 0 of 55 urine specimens from hospitalized adults contained detectable H influenzae type b antigen. Bactogen is a sensitive, specific, commercially available test for rapid diagnosis of H influenzae type b infection. [ABSTRACT FROM AUTHOR]

Discusses the possibility of increased risk of seizures following diphtheria, tetanus, pertussis (DTP) vaccination in individuals who have a family history of convulsions. Risk of seizures following DTP vaccination; Effects of an initial dose of DTP on infants; Reason for the difficulty in administering erythromycin in the long term.

Focuses on the effects of reactions following measles immunization in children on personal or family history of seizures. Recommendations for children who have personal or family history of seizures; Description of the seizures; Information on the use of measles immunoglobulin for children.

Compares the results of a controlled clinical trial for the treatment of Kawasaki disease using acetylsalicylic acid (aspirin) alone and aspirin with IV gamma-globulin. Dosages of the drugs used; Decrease in the prevalence of coronary artery dilations and aneurysms; Schedule for echocardiographic evaluation of coronary arteries.

Malaria is a disease of global importance and accounts for up to 500 million cases per year. Nearly all malaria cases in the United States occur among persons who have traveled to areas with ongoing malaria transmission. Among the cases of malaria reported in the United States in 2000-2005, 695 were in US residents under the age of 18 years. The association of malaria with the sickle cell hemoglobin is well described in Africa but is a rare occurrence in the United States. Here we report 5 cases of Plasmodium falciparum malaria in siblings of a family who had traveled to Africa without taking chemoprophylaxis. Two of the children had sickle cell anemia, and 1 of them developed severe life-threatening malaria and hemolysis. The 3 other siblings had sickle cell trait, 2 of whom had complicated malaria. Patients who have sickle cell disease and are infected with malaria are prone to hyperhemolytic crisis; therefore, this complication should be anticipated. The patients we describe emphasize the significance of prompt recognition of malaria and comorbidities and institution of appropriate treatment. The importance of antimalarial prophylaxis should be communicated to parents of children who are traveling to endemic areas as part of routine child care.