NEWS SCAN: Pediatric countermeasure ethics, flu activity slows further, infant infections during H1N1, healthcare-linked hepatitis

May 18, 2012

Bioethics commission takes on pediatric countermeasure issues
Based on a request from the US Department of Health and Human Services (HHS), President Barack Obama's bioethics commission yesterday started discussing issues related to developing medical countermeasures such as anthrax vaccine for children in the event of a bioterror attack or other emergency. On Jan 10 HHS Secretary Kathleen Sebelius asked the Presidential Commission for the Study of Bioethical Issues (PCSBI) to weigh in on the topics, according to a statement from the group. The group's review is related to a recommendation passed by a federal advisory group in October asking HHS to develop a plan to study the use of anthrax vaccine in children. Last spring, Nicole Lurie, MD, MPH, assistant secretary for preparedness and response, asked the National Biodefense Science Board to explore complex issues related to pediatric anthrax vaccination, and the group's final report recommended gathering safety and immunogenicity data about the anthrax vaccine in children before, rather than after, an attack. Amy Gutmann, PhD, chair of the PCSBI, said in the statement, "We are carefully and transparently reviewing all of the ethical considerations surrounding the development of medical countermeasures for children." She added that the group will study the issue and deliver a report to Sebelius and the White House by the end of the year.
May 17 PCSBI press release
Oct 28, 2011, CIDRAP News story "NBSB urges pre-attack studies of anthrax vaccine in kids"

US flu activity continues its spring decline
Influenza activity continued to decline in the United States, the Centers for Disease Control and Prevention (CDC) said in its weekly update today, with only one state—New York—reporting geographically widespread activity. The proportion of outpatient visits for influenza-like illness (ILI) was 1.2% for the week ending May 12, down from 1.4% the week before but well below the national baseline of 2.4%. Also, 6.1% of reported deaths were caused by pneumonia and influenza, down from 6.9% the week before and below the epidemic threshold of 7.5%. However, two more pediatric deaths were reported, one from influenza B and one from an influenza A virus that was not subtyped. They raise the season's total to 24. In addition to the widespread flu activity reported by New York, five states (Alaska, Connecticut, Maine, New Jersey, and Pennsylvania) reported regional activity. Two states—Hawaii and Maryland—reported low ILI activity, while the other states reported minimal ILI activity. Of 2,673 flu viruses subtyped this season, 46% have been H3N2, 43% pandemic H1N1, and 11% influenza B.
May 18 CDC flu update

Infant doc visits high during flu pandemic but H1N1 rarely found
The 2009 H1N1 influenza pandemic brought more infants to physicians' offices for respiratory symptoms, but the virus was rarely the cause of the symptoms, say findings of an ongoing prospective study of infants in the first year of life published in The Pediatric Infectious Disease Journal. The researchers, from the University of Texas, Galveston, monitored 180 healthy infants over 31 months from October 2008 to April 2011 for upper and lower respiratory tract infections (URIs and LRIs) and acute otitis media complications. The infants were enrolled at birth or shortly after and followed for up to 12 months. A total of 373 URI episodes occurred in 139 of the infants (77%), including 20 with LRI. The most common pathogen identified in URI was rhinovirus (55%) and the most common in LRI was respiratory syncytial virus (64%). Influenza occurred in only four infants, all of them younger than 3 months, but three of them presented to the emergency department. The rate of parent-initiated visits during the 15-month pandemic was significantly higher than in the pre- and post-pandemic periods. The authors conclude that the H1N1 influenza pandemic did not change viral epidemiology of URI and LRI in this population, and they state, "Increased parent-initiated visits likely reflect parental awareness and an anxiety about the pandemic."
May 16 Pediatr Infect Dis J abstract

New York officials outline resource-sensitive investigation of hepatitis cases
Just before the first-ever US Hepatitis Testing Day, officials with the New York City Department of Health and Mental Hygiene (DOHMH) outlined their recipe for success in investigating hepatitis B virus (HBV) and hepatitis C virus (HCV) infections potentially related to healthcare practices. Writing in today's Morbidity and Mortality Weekly Report (MMWR), DOHMH researchers explain that they use the least resource-intensive investigation steps first, then decide whether to employ more resource-intensive measures on the basis of the likelihood that a single case represents a cluster of healthcare-associated infections (HAIs). They use two cases to illustrate the process, both of which were likely linked to an anesthesiologist who drew medication for multiple patients from single-dose vials. An editorial accompanying the report said, "Components of the DOHMH approach might be helpful to other health departments that are developing their own approaches to this type of investigation" and cited a toolkit the CDC developed this year for investigating cases of HBV or HCV that may be HAIs. The CDC has declared tomorrow, May 19, to be National Hepatitis Testing Day to remind healthcare providers and the public of the importance of getting tested. The agency recommended today that all baby boomers get a one-time test for HCV.
May 18 MMWR report
CDC toolkit for investigating hepatitis cases
May 18 CDC press release on Hepatitis Testing Day
CDC home page for Hepatitis Testing Day

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