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Commercially available enzyme immunoassays (EIAs) traditionally have been used to detect rotavirus in children who have acute gastroenteritis (AGE). The rate of rotavirus detection is higher with EIAs than with [...]

A study seeks to determine rates of medical visits attributable to influenza through the surveillance of children younger than five years of age who presented to the inpatient and outpatient settings with acute respiratory tract infections or fever. Results show that among young children, outpatient visits associated with influenza were 10 to 250 times as common as hospitalizations, and that most influenza infections were not diagnosed clinically.

ABBREVIATIONS. ARI, acute respiratory illness; RSV, respiratory syncytial virus; PIV, parainfluenza virus; RT-PCR, reverse transcription polymerase chain reaction; NVSN, New Vaccine Surveillance Network; CDC, Centers for Disease Control and Prevention. [...], Objective. Respiratory syncytial virus (RSV), influenza virus, and parainfluenza viruses (PIV) cause significant morbidity in young children. Although only influenza virus infection and illness is currently vaccine-preventable, vaccines are under development for RSV and PIV. We established a prospective, active population-based surveillance network to provide precise estimates of hospitalization rates for viral acute respiratory illness (ARI) in young children and to measure the potential impact of enhanced vaccine usage on these rates. Methods. Prospective, active population-based surveillance was conducted in young children who were hospitalized for ARI from October 1, 2000, to September 30, 2001, in Monroe County, New York (Rochester area) and Davidson County, Tennessee (Nashville area). Eligible children younger than 5 years were those who resided in surveillance counties and were hospitalized for febrile or acute respiratory illness. Viral culture and polymerase chain reaction identified viruses from nasal and throat samples obtained from all surveillance children. We measured population-based rates of hospitalization for RSV, influenza virus, and PIV as well as demographic, clinical, and risk factor assessment for each virus. Results. Of 812 eligible hospital admissions, 592 (73%) children were enrolled. Of the enrolled children, RSV was identified in 20%, influenza in 3%, PIV in 7%, other respiratory viruses in 36%, and no detectable virus in 39%. Population-based rates of ARI hospitalizations in children younger than 5 years were 18 per 1000. Viruspositive hospitalization rates per 1000 children were 3.5 for RSV, 1.2 for PIV, and 0.6 for influenza virus. Younger age (particularly Conclusions. This study confirms that children younger than 5 years and particularly children younger than 1 year have a high burden of hospitalization from RSV, influenza, and PIV. The enhanced use of influenza vaccine and the development of RSV and PIV vaccines have the potential to reduce markedly the pediatric morbidity from ARIs. Pediatrics 2004;113:1758-1764; influenza, RSV, parainfluenza, population-based, hospitalizations.

Recent studies have associated human metapneumovirus (HMPV) infection in children with respiratory disease of similar severity as respiratory syncytial virus (RSV) infection. We studied 668 banked swab specimens (one per [...]

ABBREVIATIONS. RSV, respiratory syncytial virus; IVIG, intravenous immune globulin; LRI, lower respiratory tract infection; RSVIG, respiratory syncytial virus immune globulin; BPD, bronchopulmonary dysplasia; Ig, immunoglobulin; MPHBL, Massachusetts Public Health Biological [...]

Pediatricians and other professionals providing care for children and adolescents refer to a variety of information sources for guidelines regarding optimal therapy or preventive care. In some instances, the guidelines [...]

Pediatricians and family physicians may be able to improve vaccination rates by adhering to current immunization guidelines such as simultaneous immunizations, immunizing children during acute illness visits as well as well child visits, developing tracking systems for underimmunized children, and by lowering vaccination costs. A survey of 746 members of the American Academy of Pediatrics and 429 members of the American Academy of Family Medicine found that pediatricians were slightly more likely than family physicians to vaccinate during follow-up and acute illness visits and to use tracking systems, and were less likely to think cost was a barrier to immunizations. Physicians from both groups who worked with underimmunized groups of children and physicians who had graduated from medical school more recently followed immunization guidelines more closely than did older physicians and solo practitioners., Objective. To assess current practices and attitudes among pediatricians and family physicians across the United States regarding immunizations. Design. Survey of a random sample of pediatricians and family physicians. Subjects. Fellows of the American Academy of Pediatrics (N=746) and American Academy of Family Medicine (N=429). Survey topics. General immunization practices (eg, types of visits during which vaccinations are provided, mechanisms to identify undervaccinated children); and opinions about perceived barriers to immunizations, acceptance of alternative sites for immunizations, and possible immunization requirements for Medicaid and The Special Supplemental Food Program for Women, Infants, and Children (WIC). Results. Pediatricians and family physicians (combined) reported the following immunizing children during acute illness visits (28%), follow-up visits (90%), and chronic illness visits (77%); using computer or reminder files to identify undervaccinated children (13%); and simultaneously administering four vaccines (diphtheria-tetanus-pertussis, oral poliovaccine, measles, mumps, and rubella and Haemophilus influenzae type b) to an eligible 18-month-old child (66%). Physicians perceived the following as barriers to immunizations: missed preventive visits (40%), vaccine costs 24%), lack of insurance coverage (24%), inability to track undervaccinated patients (22%), incomplete immunization records (12%), and missed vaccination opportunities (12%). Physicians agreed with offering vaccinations during hospitalizations (51%,) or emergency department visits (30%), and with immunization requirements for continued eligibility for Medicaid (66%) or WIC (64%). Pediatricians were more likely to vaccinate during chronic illness and follow-up visits, and were more likely to use systems to track undervaccinated children (P < .05); however, most immunization practices and attitudes of pediatrician and family physicians were similar. Physicians who graduated from medical school more recently and those in high-risk urban practices were more likely to vaccinate during acute illness visits, provide simultaneous vaccinations, and favor vaccinations in hospital settings. Conclusions. Vaccination rates might be improved by closer adherence to current immunization guidelines regarding vaccinations during all encounters and simultaneous vaccinations, by developing systems to identify undervaccinated children, and by reducing patient costs for vaccinations. Current immunizations practices fall short of the immunization guidelines; changes in individual practice styles will be required to conform with these standards. Pediatrics 1994;94:517-523; immunizations, vaccination rates, undervaccination, practice standards.

Intravenous administration of high-dose immune globulin may reduce the incidence and severity of respiratory syncytial virus (RSV) infection in susceptible infants and children. RSV infection can be life-threatening in premature infants and in young children with heart or lung disease. Among 249 high-risk infants and young children studied for three years, 81 were given high-dose immune globulin monthly, 79 were given low-dose immune globulin monthly and 89 received no immune globulin (control group). The immune globulin contained a large quantity of antibodies against RSV. Children in the high-dose group had 62% fewer RSV infections of the lower respiratory tract than children in the control group. Most of the 19 cases that did occur in the high-dose group were mild. Children in the low-dose group had only 27% fewer RSV infections than the control group. There were few adverse reactions, and of six deaths, none was attributed to immune globulin administration.

Visits to the emergency department appear to predict undervaccination, even among children with access to primary medical care. The goal of having 90% of US two-year-olds up-to-date on vaccinations has not yet been achieved, and in some cities the vaccination rates among two-year-olds are as low as 10% to 45%. Vaccination rates were compared between 583 preschool children who visited the emergency room and 583 children of the same age with the same primary care provider. Overall, 137 pairs of children attended a hospital-based clinic for primary care, 172 pairs attended a neighborhood health center and 274 pairs attended private practices. While emergency room patients were more likely to be undervaccinated, the difference in vaccination rates was most pronounced among patients who went to private practitioners for primary care. This finding suggests primary care providers should alter their practice to improve vaccination rates., The purpose of this study was to determine (1) whether preschool-age patients who utilize the emergency department (ED) are undervaccinated compared with patients having the same primary care provider and (2) whether reducing missed vaccination opportunities in the primary care office can potentially reduce the differences in undervaccination between the groups. This retrospective cohort study involved two groups: 583 ED patients, aged 4 to 48 months, who had primary care providers; and 583 control subjects randomly selected from primary care sites and matched according to date of birth and primary care site. The major outcome variable was the point prevalence of undervaccination, defined as more than 60 days past due for a vaccine at the time of the ED visit, and for control subjects, at the time of their matched patient&apos;s ED visit. Demographic variables, vaccination history, presence of chronic illness, and office utilization history were abstracted from office charts. The mean age of all patients was 20.0 months. Emergency department patients were more likely to be boys (61% vs 50%) and had more chronic illness, but did not differ racially from those in the control group. Primary care sites included a hospital-based clinic (n = 137), neigh-borhood health centers (n = 172), and private practices (n = 274). The undervaccination rates by primary provider type were for (1) hospital clinic ED patients 21.1%, control subjects 19.7%; (2) neighborhood health center ED patients 29.1%, control subjects 22.7%; and (3) private practice ED patients 26.6%, control subjects 14.9%. Over-all, the odds ratio of ED patients&apos; being undervaccinated compared with control subjects was 1.8 (95% confidence interval 1.3 to 2.5). This association was strongest for private practice patients (odds ratio 2.45, 95% confidence interval 1.5 to 4.2), but not significant for hospital clinic or neighborhood health center patients. Emergency department patients had previously missed more vaccination opportunities in the office than had control subjects (25% vs 16% of office visits). Taking advantage of missed vaccination opportunities would have greatly reduced undervaccination differences between ED patients and their controls. An ED visit is a marker for undervaccination, even for children who have primary care providers. These data support efforts to reach out to ED patients with interventions designed to increase their vaccination rates. Interventions in primary care offices, however, are likely to be the most effective. Pediatrics 1993; 91:605-611; immunization, undervaccination, missed vaccination opportunities, emergency department utilization, primary care utilization.

Many preschool children may not be vaccinated because of missed opportunities at a checkup or follow-up visit. A missed opportunity is failure of their physician or other health care professionals to identify them as needing a vaccination. A study surveyed the vaccination rate among 1,124 children between nine and 32 months old who were patients at several types of medical care settings, including an HMO, a rural health center, a suburban medical practice and an urban medical practice. The percentage of children who were not vaccinated when they should have been ranged from 4% to 63%, and was greater than 20% at most of the practices. Many of the children were not vaccinated because of a missed opportunity at a checkup or at a follow-up visit. Children with Medicaid or no health insurance were more likely to be missed than those with private health insurance., To determine the rate of childhood undervaccination, rate and types of missed opportunities (MOs) for vaccinations, and the contribution of MOs to the undervaccination of preschool-age children, the authors conducted a retrospective medical chart review in seven primary care settings in the Rochester, NY, area: a hospital clinic, a neighborhood health center, a groupmodel health maintenance organization, an urban group practice, a suburban group practice, a rural health center, and a rural private practice. The random sample included 1124 children having birth dates between March 15, 1988, and September 15, 1989. The main outcome measures were cumulative undervaccination rate, defined as the proportion of patients from each practice who were ever >60 days past-due for a vaccination by 12, 18, or 24 months of age; undervaccination time, defined as the median number of months during which children were undervaccinated; number of MOs; visit types and conditions associated with the MOs; and the duration of undervaccination time attributable to MOs. The cumulative undervaccination rate by 12 months was at least 20% in each practice except for the suburban practice, where it was 4%. The frequency of MOs varied from a high of 1.8 MO per patient per year at the rural private practice to a low of 0.3 MO per patient per year at the suburban practice. More than one quarter of MOs occurred during either health supervision or follow-up visits in all practices. In 28% of visits during which an MO occurred, patients had no fever or acute illness. The impact of MOs was twice as great for children having Medicaid or no health insurance as for children covered by private insurance. Missed opportunities contributed 13% of the total undervaccination time in the suburban practice, 27% in the clinic, and more than 40% in the ether practices. It is concluded that missed opportunities for vaccination occur frequently and contribute significantly to the undervaccination of preschool children. The effect of MOs is greatest in practices serving impoverished children. Reducing MOs would substantially improve the vaccination levels of preschool-age children. Pediatrics 1993;91:1-7; preschool children, vaccination, immunization.