John R. Bell

Multislice CT had greater sensitivity, specificity, and negative predictive value, with equivalent positive predictive value, than did MRI for angiographic diagnosis of 108 patients.

Multislice CT also had less than half the rate of noninterpretable results.

Dr. Marc Dewey of Humboldt University's Charité Medical School, Berlin, and colleagues assessed patients referred to their center for conventional coronary angiography for suspected coronary artery disease (CAD). Patients were a mean of 64 years old and in sinus rhythm (Ann. Intern. Med. 2006;145:407–15).

After undergoing conventional angiography, each patient within 1 day underwent multislice CT and MRI; readers assessed the results without knowing the results of conventional angiography or other clinical data.

Multislice CT had a sensitivity of 92%, versus 74% for MRI. For specificity, CT rendered 79%, versus MRI's 75%. Negative predictive value was 90% and 84%, respectively, and positive predictive value was 95% for both instruments. Only 7% of CT results were noninterpretable, versus 18% of those produced by MRI. However, for both machines, the only findings that reached statistical significance were sensitivity and the percentage of noninterpretable images.

These findings led the investigators to conclude that in their study, CT was superior to MRI in detecting coronary artery stenoses, and its high negative predictive value “makes it potentially useful as a diagnostic tool for ruling out coronary disease in a population with a low to intermediate pretest likelihood.”

Multislice CT had greater sensitivity, specificity, and negative predictive value, with equivalent positive predictive value, than did MRI for angiographic diagnosis of 108 patients.

Multislice CT also had less than half the rate of noninterpretable results.

Dr. Marc Dewey of Humboldt University's Charité Medical School, Berlin, and colleagues assessed patients referred to their center for conventional coronary angiography for suspected coronary artery disease (CAD). Patients were a mean of 64 years old and in sinus rhythm (Ann. Intern. Med. 2006;145:407–15).

After undergoing conventional angiography, each patient within 1 day underwent multislice CT and MRI; readers assessed the results without knowing the results of conventional angiography or other clinical data.

Multislice CT had a sensitivity of 92%, versus 74% for MRI. For specificity, CT rendered 79%, versus MRI's 75%. Negative predictive value was 90% and 84%, respectively, and positive predictive value was 95% for both instruments. Only 7% of CT results were noninterpretable, versus 18% of those produced by MRI. However, for both machines, the only findings that reached statistical significance were sensitivity and the percentage of noninterpretable images.

These findings led the investigators to conclude that in their study, CT was superior to MRI in detecting coronary artery stenoses, and its high negative predictive value “makes it potentially useful as a diagnostic tool for ruling out coronary disease in a population with a low to intermediate pretest likelihood.”

Multislice CT had greater sensitivity, specificity, and negative predictive value, with equivalent positive predictive value, than did MRI for angiographic diagnosis of 108 patients.

Multislice CT also had less than half the rate of noninterpretable results.

Dr. Marc Dewey of Humboldt University's Charité Medical School, Berlin, and colleagues assessed patients referred to their center for conventional coronary angiography for suspected coronary artery disease (CAD). Patients were a mean of 64 years old and in sinus rhythm (Ann. Intern. Med. 2006;145:407–15).

After undergoing conventional angiography, each patient within 1 day underwent multislice CT and MRI; readers assessed the results without knowing the results of conventional angiography or other clinical data.

Multislice CT had a sensitivity of 92%, versus 74% for MRI. For specificity, CT rendered 79%, versus MRI's 75%. Negative predictive value was 90% and 84%, respectively, and positive predictive value was 95% for both instruments. Only 7% of CT results were noninterpretable, versus 18% of those produced by MRI. However, for both machines, the only findings that reached statistical significance were sensitivity and the percentage of noninterpretable images.

These findings led the investigators to conclude that in their study, CT was superior to MRI in detecting coronary artery stenoses, and its high negative predictive value “makes it potentially useful as a diagnostic tool for ruling out coronary disease in a population with a low to intermediate pretest likelihood.”

SAN ANTONIO — People who drank raw milk purchased at an Oklahoma dairy where a cow tested positive for rabies last year were screened for susceptibility—and in some cases given postexposure prophylaxis—yet this did not deter most from continuing to buy raw milk, according to Kristy Bradley, D.V.M., of the Oklahoma State Department of Health.

The situation was of special concern, not only because of the large number of persons at risk for rabies exposure from the dairy, which sold an average of 300 gallons of raw milk per day, but also because some of the raw-milk purchasers were cancer patients.

“There was a physician in the area who told them that [raw milk] would help them counteract the effects of their chemotherapy and radiation therapy,” Dr. Bradley reported at a meeting of the Southwest Conference on Diseases in Nature Transmissible to Man.

The state health department decided to administer rabies postexposure prophylaxis (PEP) to selected persons who had consumed milk from the Swan Bros. dairy in Claremore during the time the infected cow was present, she said. However, the high cost of PEP meant that screening was necessary to identify those in whom the milk likely had contact with the oral mucosa or in whom there was passage of the milk into the sinuses.

Also deemed at high risk were those with an anatomical defect of the sinus, pharynx, or hard/soft palate; open sores in the mouth, pharynx, or esophagus; recent oral surgery; very severe pharyngitis or tonsillitis; or immunosuppression.

An estimated 850 persons were screened via a phone bank, and PEP was given to 125 people (15%). Some persons not deemed at risk insisted on receiving PEP, while others who were advised to receive it chose not to—in some cases upon the advice of their physician, Dr. Bradley said.

The Department of Health later administered a telephone questionnaire to those who received PEP to determine if their milk-buying habits had changed; some refused to respond, believing the questionnaire to be part of a government conspiracy, Dr. Bradley reported. Some even “thought their phones were being tapped” during the phone call.

Of 93 households contacted, 72 responded to the questions. They consumed a mean of 3 gallons per week of raw milk, and 51% of respondents cited a belief that raw milk offers greater health benefits as their primary reason for buying unpasteurized milk. Such benefits cited by the respondents were an absence of the chemicals contained in homogenized milk, improved amino acid content, better intestinal absorption, and greater vitamin and mineral content.

Surprisingly, nearly 75% knew that raw milk can contain disease-causing bacteria or viruses, and 64% said they continued to buy raw milk after the rabies incident.

Oklahoma, unlike Texas, does not normally administer biologics to persons exposed to rabies, Dr. Bradley noted. However, the high-profile nature of the case and the fact that many physicians' offices would be closed for the holidays motivated the commissioner of public health to administer PEP to at-risk persons in this case.

She added that her office also was motivated by a belief that primary care physicians were “not very well informed about rabies PEP.”

The incident began on Dec. 20, 2005, when the state health department received a positive laboratory rabies result for one cow at the dairy, which is near Tulsa. (Oklahoma requires all dairies to test milk for various microbes four times every 6 months.) The cow had started to have symptoms of a neurologic disorder on Dec. 14 but was not culled from the herd; nor had any preventive action been taken by the dairy regarding milk produced by this cow or milk that had been commingled with the milk from the symptomatic animal. The cow died 4 days after showing symptoms, and the state department of health sent the cow's brain to the Centers for Disease Control and Prevention, where it was confirmed that the cow had rabies.

The risk of contracting rabies from cow's milk is poorly defined, Dr. Bradley said.

She explained that transmission of the rabies virus via oral ingestion requires a much higher dose than does transmission via a bite. Moreover, oral transmission requires extended contact with the oral or nasal mucosa, the latter being the more effective transmission medium.

Dr. Robert Baltimore, professor of pediatrics and epidemiology at Yale University, New Haven, and a member of the American Academy of Pediatrics Infectious Diseases Committee, noted in an interview that the risks of raw milk consumption are well established.

“Pasteurization of milk is, of course, one of the public health measures most of us take for granted, and it protects us against a variety of infections,” he said. “While pasteurization does change the chemistry of the milk slightly, there are no health benefits of raw cow's milk. I would be especially cautious about cancer patients receiving raw milk.”

“Milk has been demonstrated to be the transmission agent for brucellosis, tuberculosis, diphtheria, streptococci, Salmonella, Shigella, Campylobacter, Yersinia, Listeria, and staphylococcal enterotoxin,” he added.

“The degree of risk for any of these infections is related to the care and screening of the cows from whom the milk is taken and the care in holding of the milk until it is sold.

“I would not drink raw milk or recommend it to my patients,” he emphasized.

However, fear of rabies transmission generally is not among the reasons physicians advise against drinking raw milk, Dr. Baltimore said.

Nonetheless, he noted that a 1999 report from the CDC found that “because of the nearly 100% case-fatality ratio of human rabies and the virtually complete effectiveness of PEP, many mass exposure incidents prompt administration of rabies immune globulin and vaccine, even if the circumstances do not meet the criteria for exposure. However, because rabies virus is inactivated by temperatures below those used for cooking and pasteurization, eating cooked meat or drinking pasteurized milk from a rabid animal is not an indication for PEP. … Transmission of rabies virus in unpasteurized milk is theoretically possible” (MMWR 1999;48:228–9).

Although the federal government regulates interstate sales of all milk, intrastate sales are regulated by the states only, which vary in their restrictions. (See chart.)

ELSEVIER GLOBAL MEDICAL NEWS

SAN ANTONIO — People who drank raw milk purchased at an Oklahoma dairy where a cow tested positive for rabies last year were screened for susceptibility—and in some cases given postexposure prophylaxis—yet this did not deter most from continuing to buy raw milk, according to Kristy Bradley, D.V.M., of the Oklahoma State Department of Health.

The situation was of special concern, not only because of the large number of persons at risk for rabies exposure from the dairy, which sold an average of 300 gallons of raw milk per day, but also because some of the raw-milk purchasers were cancer patients.

“There was a physician in the area who told them that [raw milk] would help them counteract the effects of their chemotherapy and radiation therapy,” Dr. Bradley reported at a meeting of the Southwest Conference on Diseases in Nature Transmissible to Man.

The state health department decided to administer rabies postexposure prophylaxis (PEP) to selected persons who had consumed milk from the Swan Bros. dairy in Claremore during the time the infected cow was present, she said. However, the high cost of PEP meant that screening was necessary to identify those in whom the milk likely had contact with the oral mucosa or in whom there was passage of the milk into the sinuses.

Also deemed at high risk were those with an anatomical defect of the sinus, pharynx, or hard/soft palate; open sores in the mouth, pharynx, or esophagus; recent oral surgery; very severe pharyngitis or tonsillitis; or immunosuppression.

An estimated 850 persons were screened via a phone bank, and PEP was given to 125 people (15%). Some persons not deemed at risk insisted on receiving PEP, while others who were advised to receive it chose not to—in some cases upon the advice of their physician, Dr. Bradley said.

The Department of Health later administered a telephone questionnaire to those who received PEP to determine if their milk-buying habits had changed; some refused to respond, believing the questionnaire to be part of a government conspiracy, Dr. Bradley reported. Some even “thought their phones were being tapped” during the phone call.

Of 93 households contacted, 72 responded to the questions. They consumed a mean of 3 gallons per week of raw milk, and 51% of respondents cited a belief that raw milk offers greater health benefits as their primary reason for buying unpasteurized milk. Such benefits cited by the respondents were an absence of the chemicals contained in homogenized milk, improved amino acid content, better intestinal absorption, and greater vitamin and mineral content.

Surprisingly, nearly 75% knew that raw milk can contain disease-causing bacteria or viruses, and 64% said they continued to buy raw milk after the rabies incident.

Oklahoma, unlike Texas, does not normally administer biologics to persons exposed to rabies, Dr. Bradley noted. However, the high-profile nature of the case and the fact that many physicians' offices would be closed for the holidays motivated the commissioner of public health to administer PEP to at-risk persons in this case.

She added that her office also was motivated by a belief that primary care physicians were “not very well informed about rabies PEP.”

The incident began on Dec. 20, 2005, when the state health department received a positive laboratory rabies result for one cow at the dairy, which is near Tulsa. (Oklahoma requires all dairies to test milk for various microbes four times every 6 months.) The cow had started to have symptoms of a neurologic disorder on Dec. 14 but was not culled from the herd; nor had any preventive action been taken by the dairy regarding milk produced by this cow or milk that had been commingled with the milk from the symptomatic animal. The cow died 4 days after showing symptoms, and the state department of health sent the cow's brain to the Centers for Disease Control and Prevention, where it was confirmed that the cow had rabies.

The risk of contracting rabies from cow's milk is poorly defined, Dr. Bradley said.

She explained that transmission of the rabies virus via oral ingestion requires a much higher dose than does transmission via a bite. Moreover, oral transmission requires extended contact with the oral or nasal mucosa, the latter being the more effective transmission medium.

Dr. Robert Baltimore, professor of pediatrics and epidemiology at Yale University, New Haven, and a member of the American Academy of Pediatrics Infectious Diseases Committee, noted in an interview that the risks of raw milk consumption are well established.

“Pasteurization of milk is, of course, one of the public health measures most of us take for granted, and it protects us against a variety of infections,” he said. “While pasteurization does change the chemistry of the milk slightly, there are no health benefits of raw cow's milk. I would be especially cautious about cancer patients receiving raw milk.”

“Milk has been demonstrated to be the transmission agent for brucellosis, tuberculosis, diphtheria, streptococci, Salmonella, Shigella, Campylobacter, Yersinia, Listeria, and staphylococcal enterotoxin,” he added.

“The degree of risk for any of these infections is related to the care and screening of the cows from whom the milk is taken and the care in holding of the milk until it is sold.

“I would not drink raw milk or recommend it to my patients,” he emphasized.

However, fear of rabies transmission generally is not among the reasons physicians advise against drinking raw milk, Dr. Baltimore said.

Nonetheless, he noted that a 1999 report from the CDC found that “because of the nearly 100% case-fatality ratio of human rabies and the virtually complete effectiveness of PEP, many mass exposure incidents prompt administration of rabies immune globulin and vaccine, even if the circumstances do not meet the criteria for exposure. However, because rabies virus is inactivated by temperatures below those used for cooking and pasteurization, eating cooked meat or drinking pasteurized milk from a rabid animal is not an indication for PEP. … Transmission of rabies virus in unpasteurized milk is theoretically possible” (MMWR 1999;48:228–9).

Although the federal government regulates interstate sales of all milk, intrastate sales are regulated by the states only, which vary in their restrictions. (See chart.)

ELSEVIER GLOBAL MEDICAL NEWS

SAN ANTONIO — People who drank raw milk purchased at an Oklahoma dairy where a cow tested positive for rabies last year were screened for susceptibility—and in some cases given postexposure prophylaxis—yet this did not deter most from continuing to buy raw milk, according to Kristy Bradley, D.V.M., of the Oklahoma State Department of Health.

The situation was of special concern, not only because of the large number of persons at risk for rabies exposure from the dairy, which sold an average of 300 gallons of raw milk per day, but also because some of the raw-milk purchasers were cancer patients.

“There was a physician in the area who told them that [raw milk] would help them counteract the effects of their chemotherapy and radiation therapy,” Dr. Bradley reported at a meeting of the Southwest Conference on Diseases in Nature Transmissible to Man.

The state health department decided to administer rabies postexposure prophylaxis (PEP) to selected persons who had consumed milk from the Swan Bros. dairy in Claremore during the time the infected cow was present, she said. However, the high cost of PEP meant that screening was necessary to identify those in whom the milk likely had contact with the oral mucosa or in whom there was passage of the milk into the sinuses.

Also deemed at high risk were those with an anatomical defect of the sinus, pharynx, or hard/soft palate; open sores in the mouth, pharynx, or esophagus; recent oral surgery; very severe pharyngitis or tonsillitis; or immunosuppression.

An estimated 850 persons were screened via a phone bank, and PEP was given to 125 people (15%). Some persons not deemed at risk insisted on receiving PEP, while others who were advised to receive it chose not to—in some cases upon the advice of their physician, Dr. Bradley said.

The Department of Health later administered a telephone questionnaire to those who received PEP to determine if their milk-buying habits had changed; some refused to respond, believing the questionnaire to be part of a government conspiracy, Dr. Bradley reported. Some even “thought their phones were being tapped” during the phone call.

Of 93 households contacted, 72 responded to the questions. They consumed a mean of 3 gallons per week of raw milk, and 51% of respondents cited a belief that raw milk offers greater health benefits as their primary reason for buying unpasteurized milk. Such benefits cited by the respondents were an absence of the chemicals contained in homogenized milk, improved amino acid content, better intestinal absorption, and greater vitamin and mineral content.

Surprisingly, nearly 75% knew that raw milk can contain disease-causing bacteria or viruses, and 64% said they continued to buy raw milk after the rabies incident.

Oklahoma, unlike Texas, does not normally administer biologics to persons exposed to rabies, Dr. Bradley noted. However, the high-profile nature of the case and the fact that many physicians' offices would be closed for the holidays motivated the commissioner of public health to administer PEP to at-risk persons in this case.

She added that her office also was motivated by a belief that primary care physicians were “not very well informed about rabies PEP.”

The incident began on Dec. 20, 2005, when the state health department received a positive laboratory rabies result for one cow at the dairy, which is near Tulsa. (Oklahoma requires all dairies to test milk for various microbes four times every 6 months.) The cow had started to have symptoms of a neurologic disorder on Dec. 14 but was not culled from the herd; nor had any preventive action been taken by the dairy regarding milk produced by this cow or milk that had been commingled with the milk from the symptomatic animal. The cow died 4 days after showing symptoms, and the state department of health sent the cow's brain to the Centers for Disease Control and Prevention, where it was confirmed that the cow had rabies.

The risk of contracting rabies from cow's milk is poorly defined, Dr. Bradley said.

She explained that transmission of the rabies virus via oral ingestion requires a much higher dose than does transmission via a bite. Moreover, oral transmission requires extended contact with the oral or nasal mucosa, the latter being the more effective transmission medium.

Dr. Robert Baltimore, professor of pediatrics and epidemiology at Yale University, New Haven, and a member of the American Academy of Pediatrics Infectious Diseases Committee, noted in an interview that the risks of raw milk consumption are well established.

“Pasteurization of milk is, of course, one of the public health measures most of us take for granted, and it protects us against a variety of infections,” he said. “While pasteurization does change the chemistry of the milk slightly, there are no health benefits of raw cow's milk. I would be especially cautious about cancer patients receiving raw milk.”

“Milk has been demonstrated to be the transmission agent for brucellosis, tuberculosis, diphtheria, streptococci, Salmonella, Shigella, Campylobacter, Yersinia, Listeria, and staphylococcal enterotoxin,” he added.

“The degree of risk for any of these infections is related to the care and screening of the cows from whom the milk is taken and the care in holding of the milk until it is sold.

“I would not drink raw milk or recommend it to my patients,” he emphasized.

However, fear of rabies transmission generally is not among the reasons physicians advise against drinking raw milk, Dr. Baltimore said.

Nonetheless, he noted that a 1999 report from the CDC found that “because of the nearly 100% case-fatality ratio of human rabies and the virtually complete effectiveness of PEP, many mass exposure incidents prompt administration of rabies immune globulin and vaccine, even if the circumstances do not meet the criteria for exposure. However, because rabies virus is inactivated by temperatures below those used for cooking and pasteurization, eating cooked meat or drinking pasteurized milk from a rabid animal is not an indication for PEP. … Transmission of rabies virus in unpasteurized milk is theoretically possible” (MMWR 1999;48:228–9).

Although the federal government regulates interstate sales of all milk, intrastate sales are regulated by the states only, which vary in their restrictions. (See chart.)

ELSEVIER GLOBAL MEDICAL NEWS

Nearly half of children with diarrhea at one emergency department over a 3-year period had stool samples containing pathogens, including Clostridium difficile and Shiga toxin-containing Escherichia coli, according to the results of a new study.

Dr. Eileen J. Klein of the University of Washington Children's Hospital and Regional Medical Center, Seattle, and her colleagues conducted a prospective cohort study in which they analyzed stool samples from 1,626 patients discharged with diarrhea, bloody diarrhea, or gastroenteritis at a Seattle emergency department during 1998–2001. Mean patient age was 2.5 years (Clin. Infect. Dis. 2006;43:807–13).

All stool samples underwent bacterial testing, 417 also underwent tests for viruses, and 656 were tested for parasites as well. A total of 372 samples underwent testing for all three types of pathogens and suspected pathogens C. difficile and Blastocystis hominis.

Of those 372 samples, 176 (47%) were positive for at least one pathogen. Of those tested for viral pathogens, 33% (138 of 417) were positive, and 7% of those tested for bacterial pathogens (118/1,626) were positive (of which 39 contained Shiga toxin-containing E. coli, 39 had salmonella, 25 had Campylobacter species, 14 had Shigella species, and 2 contained Yersinia enterocolitica).

For parasites, 7 (1%) of 656 tested samples were positive.

Moreover, 53 samples were positive for candidate pathogens; 7% (46 of 688) of those tested contained C. difficile, and 1% (7 of 656 tested) were positive for B. hominis.

The investigators also noted which seasons of the year had the greatest incidence of virus- or bacterium-containing stool samples.

For bacteria, winter had the smallest portion of positive samples, 4% vs. 14% for summer. However, the opposite was true for viruses; the summer months had 11% of positive specimens, vs. 53% for winter and 44% for spring.

Dr. Klein and her colleagues noted that they were “unable to develop a model substantially better than physician judgment to identify patients for whom a stool culture would yield positive results.”

Nearly half of children with diarrhea at one emergency department over a 3-year period had stool samples containing pathogens, including Clostridium difficile and Shiga toxin-containing Escherichia coli, according to the results of a new study.

Dr. Eileen J. Klein of the University of Washington Children's Hospital and Regional Medical Center, Seattle, and her colleagues conducted a prospective cohort study in which they analyzed stool samples from 1,626 patients discharged with diarrhea, bloody diarrhea, or gastroenteritis at a Seattle emergency department during 1998–2001. Mean patient age was 2.5 years (Clin. Infect. Dis. 2006;43:807–13).

All stool samples underwent bacterial testing, 417 also underwent tests for viruses, and 656 were tested for parasites as well. A total of 372 samples underwent testing for all three types of pathogens and suspected pathogens C. difficile and Blastocystis hominis.

Of those 372 samples, 176 (47%) were positive for at least one pathogen. Of those tested for viral pathogens, 33% (138 of 417) were positive, and 7% of those tested for bacterial pathogens (118/1,626) were positive (of which 39 contained Shiga toxin-containing E. coli, 39 had salmonella, 25 had Campylobacter species, 14 had Shigella species, and 2 contained Yersinia enterocolitica).

For parasites, 7 (1%) of 656 tested samples were positive.

Moreover, 53 samples were positive for candidate pathogens; 7% (46 of 688) of those tested contained C. difficile, and 1% (7 of 656 tested) were positive for B. hominis.

The investigators also noted which seasons of the year had the greatest incidence of virus- or bacterium-containing stool samples.

For bacteria, winter had the smallest portion of positive samples, 4% vs. 14% for summer. However, the opposite was true for viruses; the summer months had 11% of positive specimens, vs. 53% for winter and 44% for spring.

Dr. Klein and her colleagues noted that they were “unable to develop a model substantially better than physician judgment to identify patients for whom a stool culture would yield positive results.”

Nearly half of children with diarrhea at one emergency department over a 3-year period had stool samples containing pathogens, including Clostridium difficile and Shiga toxin-containing Escherichia coli, according to the results of a new study.

Dr. Eileen J. Klein of the University of Washington Children's Hospital and Regional Medical Center, Seattle, and her colleagues conducted a prospective cohort study in which they analyzed stool samples from 1,626 patients discharged with diarrhea, bloody diarrhea, or gastroenteritis at a Seattle emergency department during 1998–2001. Mean patient age was 2.5 years (Clin. Infect. Dis. 2006;43:807–13).

All stool samples underwent bacterial testing, 417 also underwent tests for viruses, and 656 were tested for parasites as well. A total of 372 samples underwent testing for all three types of pathogens and suspected pathogens C. difficile and Blastocystis hominis.

Of those 372 samples, 176 (47%) were positive for at least one pathogen. Of those tested for viral pathogens, 33% (138 of 417) were positive, and 7% of those tested for bacterial pathogens (118/1,626) were positive (of which 39 contained Shiga toxin-containing E. coli, 39 had salmonella, 25 had Campylobacter species, 14 had Shigella species, and 2 contained Yersinia enterocolitica).

For parasites, 7 (1%) of 656 tested samples were positive.

Moreover, 53 samples were positive for candidate pathogens; 7% (46 of 688) of those tested contained C. difficile, and 1% (7 of 656 tested) were positive for B. hominis.

The investigators also noted which seasons of the year had the greatest incidence of virus- or bacterium-containing stool samples.

For bacteria, winter had the smallest portion of positive samples, 4% vs. 14% for summer. However, the opposite was true for viruses; the summer months had 11% of positive specimens, vs. 53% for winter and 44% for spring.

Dr. Klein and her colleagues noted that they were “unable to develop a model substantially better than physician judgment to identify patients for whom a stool culture would yield positive results.”

WASHINGTON — Much of the public harbors misperceptions about influenza and vaccination against it, according to data from a nationwide survey presented at a press briefing sponsored by the National Foundation for Infectious Diseases.

The Public Perception of Influenza, Vaccination and Treatment Options Survey, randomly administered via telephone to more than 1,000 adults in all 50 states, found that only 48% of the respondents said they planned to be immunized this year.

Reasons given by respondents for not seeking immunization included the belief that influenza is not a serious enough disease to warrant vaccination (43%), that they were personally not at risk for infection (38%), that they previously contracted the flu even after being vaccinated (23%), and that vaccination in a prior influenza season would offer protection against current infection (15%).

Of the entire study cohort, 46% of respondents believed influenza vaccine can cause influenza. In addition, 30% responded that getting the vaccine is not worthwhile because it protects against only three strains of influenza, and many said that vaccination in December or later was too late to be effective.

These findings underscore the need for physicians to recommend vaccination to their patients, said Dr. Susan J. Rehm, medical director of the National Foundation for Infectious Diseases. A direct recommendation from a health care provider “was one of the major drivers for individuals getting influenza vaccine,” she said.

“The medical community must also reinforce the public health benefits of vaccination in the later season,” Dr. Rehm said, “by educating patients throughout the winter months… about the benefits of the vaccine, even if disease has already begun to be seen in their area.”

Moreover, only 68% of respondents knew about the CDC's recently expanded recommendation for influenza vaccination in all children aged 6 months to 5 years.

“Immunization vaccination rates among children are not what they should be—especially for those with chronic medical conditions, such as asthma,” said Dr. Julia McMillan of the American Academy of Pediatrics. “Now is the time for parents to call their child's pediatrician and schedule an appointment to get influenza vaccine this fall,” she said. “It's critical for at-risk children to be immunized.”

“Children are the great distributor of this virus,” Dr. William Schaffner of Vanderbilt University, Nashville, Tenn., said at the briefing.

Also of concern was that only 49% of all respondents knew that annual influenza vaccination is recommended for pregnant women.

WASHINGTON — Much of the public harbors misperceptions about influenza and vaccination against it, according to data from a nationwide survey presented at a press briefing sponsored by the National Foundation for Infectious Diseases.

The Public Perception of Influenza, Vaccination and Treatment Options Survey, randomly administered via telephone to more than 1,000 adults in all 50 states, found that only 48% of the respondents said they planned to be immunized this year.

Reasons given by respondents for not seeking immunization included the belief that influenza is not a serious enough disease to warrant vaccination (43%), that they were personally not at risk for infection (38%), that they previously contracted the flu even after being vaccinated (23%), and that vaccination in a prior influenza season would offer protection against current infection (15%).

Of the entire study cohort, 46% of respondents believed influenza vaccine can cause influenza. In addition, 30% responded that getting the vaccine is not worthwhile because it protects against only three strains of influenza, and many said that vaccination in December or later was too late to be effective.

These findings underscore the need for physicians to recommend vaccination to their patients, said Dr. Susan J. Rehm, medical director of the National Foundation for Infectious Diseases. A direct recommendation from a health care provider “was one of the major drivers for individuals getting influenza vaccine,” she said.

“The medical community must also reinforce the public health benefits of vaccination in the later season,” Dr. Rehm said, “by educating patients throughout the winter months… about the benefits of the vaccine, even if disease has already begun to be seen in their area.”

Moreover, only 68% of respondents knew about the CDC's recently expanded recommendation for influenza vaccination in all children aged 6 months to 5 years.

“Immunization vaccination rates among children are not what they should be—especially for those with chronic medical conditions, such as asthma,” said Dr. Julia McMillan of the American Academy of Pediatrics. “Now is the time for parents to call their child's pediatrician and schedule an appointment to get influenza vaccine this fall,” she said. “It's critical for at-risk children to be immunized.”

“Children are the great distributor of this virus,” Dr. William Schaffner of Vanderbilt University, Nashville, Tenn., said at the briefing.

Also of concern was that only 49% of all respondents knew that annual influenza vaccination is recommended for pregnant women.

WASHINGTON — Much of the public harbors misperceptions about influenza and vaccination against it, according to data from a nationwide survey presented at a press briefing sponsored by the National Foundation for Infectious Diseases.

The Public Perception of Influenza, Vaccination and Treatment Options Survey, randomly administered via telephone to more than 1,000 adults in all 50 states, found that only 48% of the respondents said they planned to be immunized this year.

Reasons given by respondents for not seeking immunization included the belief that influenza is not a serious enough disease to warrant vaccination (43%), that they were personally not at risk for infection (38%), that they previously contracted the flu even after being vaccinated (23%), and that vaccination in a prior influenza season would offer protection against current infection (15%).

Of the entire study cohort, 46% of respondents believed influenza vaccine can cause influenza. In addition, 30% responded that getting the vaccine is not worthwhile because it protects against only three strains of influenza, and many said that vaccination in December or later was too late to be effective.

These findings underscore the need for physicians to recommend vaccination to their patients, said Dr. Susan J. Rehm, medical director of the National Foundation for Infectious Diseases. A direct recommendation from a health care provider “was one of the major drivers for individuals getting influenza vaccine,” she said.

“The medical community must also reinforce the public health benefits of vaccination in the later season,” Dr. Rehm said, “by educating patients throughout the winter months… about the benefits of the vaccine, even if disease has already begun to be seen in their area.”

Moreover, only 68% of respondents knew about the CDC's recently expanded recommendation for influenza vaccination in all children aged 6 months to 5 years.

“Immunization vaccination rates among children are not what they should be—especially for those with chronic medical conditions, such as asthma,” said Dr. Julia McMillan of the American Academy of Pediatrics. “Now is the time for parents to call their child's pediatrician and schedule an appointment to get influenza vaccine this fall,” she said. “It's critical for at-risk children to be immunized.”

“Children are the great distributor of this virus,” Dr. William Schaffner of Vanderbilt University, Nashville, Tenn., said at the briefing.

Also of concern was that only 49% of all respondents knew that annual influenza vaccination is recommended for pregnant women.

The Centers for Disease Control and Prevention has reported that data from a nationwide telephone survey indicate that only 18% of children aged 6 months to 2 years were fully vaccinated for influenza in the 2004–2005 influenza season.

To be considered “fully vaccinated,” a child must have received two injections in the September-December 2004 period if he or she had never been vaccinated, or only one injection in that period if the child had any history of influenza vaccination.

The portion of children nationwide who had received at least one dose of flu vaccine in the period was 33% (MMWR 2006;55:1081–5).

The state with the largest portion of fully vaccinated children in this age group was Nebraska, with 33%.

The state with the least was Idaho, with 6%. Children in large cities were even less likely to be fully vaccinated, however; only 3% of children under age 2 years in Detroit were fully vaccinated, compared with 15% of those in Michigan as a whole.

For children who had received at least one influenza vaccine dose during the study period, Massachusetts had the greatest portion of its young children covered, with 59%.

Other states with at least 50% were Nebraska, Connecticut, and Rhode Island. The state with the smallest portion of children having received at least one dose was Nevada, with 12%, and in Clark County, which includes Las Vegas, only 9% of children in this age group had received one or more doses.

Notably, the September-December period of 2004 coincided with a national shortage of vaccine, which the CDC recently reported should not occur this season, because there will be two additional manufacturers supplying vaccine, bringing the total to four, whereas there were only two manufacturers in the 2004–2005 season.

However, the CDC's Advisory Committee on Immunization Practices that year deemed children aged 6–23 months as a priority population for vaccination, and thus the lack of supply in theory should not have affected this group as much as others.

Another possible factor in the low vaccination rates was that the period in question was the first for which routine annual influenza vaccination was recommended (rather than merely encouraged) for children in this age group.

Since then, the recommendation has been expanded to include children up to age 59 months.

In September-December 2004 there was a national shortage of vaccine, which the CDC said should not occur this season. James Reinaker/Elsevier Global Medical News

The Centers for Disease Control and Prevention has reported that data from a nationwide telephone survey indicate that only 18% of children aged 6 months to 2 years were fully vaccinated for influenza in the 2004–2005 influenza season.

To be considered “fully vaccinated,” a child must have received two injections in the September-December 2004 period if he or she had never been vaccinated, or only one injection in that period if the child had any history of influenza vaccination.

The portion of children nationwide who had received at least one dose of flu vaccine in the period was 33% (MMWR 2006;55:1081–5).

The state with the largest portion of fully vaccinated children in this age group was Nebraska, with 33%.

The state with the least was Idaho, with 6%. Children in large cities were even less likely to be fully vaccinated, however; only 3% of children under age 2 years in Detroit were fully vaccinated, compared with 15% of those in Michigan as a whole.

For children who had received at least one influenza vaccine dose during the study period, Massachusetts had the greatest portion of its young children covered, with 59%.

Other states with at least 50% were Nebraska, Connecticut, and Rhode Island. The state with the smallest portion of children having received at least one dose was Nevada, with 12%, and in Clark County, which includes Las Vegas, only 9% of children in this age group had received one or more doses.

Notably, the September-December period of 2004 coincided with a national shortage of vaccine, which the CDC recently reported should not occur this season, because there will be two additional manufacturers supplying vaccine, bringing the total to four, whereas there were only two manufacturers in the 2004–2005 season.

However, the CDC's Advisory Committee on Immunization Practices that year deemed children aged 6–23 months as a priority population for vaccination, and thus the lack of supply in theory should not have affected this group as much as others.

Another possible factor in the low vaccination rates was that the period in question was the first for which routine annual influenza vaccination was recommended (rather than merely encouraged) for children in this age group.

Since then, the recommendation has been expanded to include children up to age 59 months.

In September-December 2004 there was a national shortage of vaccine, which the CDC said should not occur this season. James Reinaker/Elsevier Global Medical News

The Centers for Disease Control and Prevention has reported that data from a nationwide telephone survey indicate that only 18% of children aged 6 months to 2 years were fully vaccinated for influenza in the 2004–2005 influenza season.

To be considered “fully vaccinated,” a child must have received two injections in the September-December 2004 period if he or she had never been vaccinated, or only one injection in that period if the child had any history of influenza vaccination.

The portion of children nationwide who had received at least one dose of flu vaccine in the period was 33% (MMWR 2006;55:1081–5).

The state with the largest portion of fully vaccinated children in this age group was Nebraska, with 33%.

The state with the least was Idaho, with 6%. Children in large cities were even less likely to be fully vaccinated, however; only 3% of children under age 2 years in Detroit were fully vaccinated, compared with 15% of those in Michigan as a whole.

For children who had received at least one influenza vaccine dose during the study period, Massachusetts had the greatest portion of its young children covered, with 59%.

Other states with at least 50% were Nebraska, Connecticut, and Rhode Island. The state with the smallest portion of children having received at least one dose was Nevada, with 12%, and in Clark County, which includes Las Vegas, only 9% of children in this age group had received one or more doses.

Notably, the September-December period of 2004 coincided with a national shortage of vaccine, which the CDC recently reported should not occur this season, because there will be two additional manufacturers supplying vaccine, bringing the total to four, whereas there were only two manufacturers in the 2004–2005 season.

However, the CDC's Advisory Committee on Immunization Practices that year deemed children aged 6–23 months as a priority population for vaccination, and thus the lack of supply in theory should not have affected this group as much as others.

Another possible factor in the low vaccination rates was that the period in question was the first for which routine annual influenza vaccination was recommended (rather than merely encouraged) for children in this age group.

Since then, the recommendation has been expanded to include children up to age 59 months.

In September-December 2004 there was a national shortage of vaccine, which the CDC said should not occur this season. James Reinaker/Elsevier Global Medical News

SAN ANTONIO — People who drank raw milk purchased at an Oklahoma dairy where a cow tested positive for rabies last year were screened for susceptibility—and in some cases given postexposure prophylaxis—but this did not deter most from continuing to buy raw milk, according to Kristy Bradley, D.V.M., of the Oklahoma State Department of Health.

The situation was of special concern, not only because of the large number of persons at risk for rabies exposure from the dairy, which sold an average of 300 gallons of raw milk per day, but because some of the purchasers were cancer patients.

“There was a physician in the area who told them that [raw milk] would help them counteract the effects of their chemotherapy and radiation therapy,” Dr. Bradley reported at a meeting of the Southwest Conference on Diseases in Nature Transmissible to Man.

The state health department decided to administer rabies postexposure prophylaxis (PEP) to selected persons who had consumed milk from the Swan Bros. dairy in Claremore during the time the infected cow was present, she said. However, the high cost of PEP meant that screening was necessary to identify those who in whom the milk likely had contact with the oral mucosa or in whom there was passage of the milk into the sinuses.

Also deemed at high risk were those with an anatomical defect of the sinus, pharynx, or hard/soft palate; open sores in the mouth, pharynx, or esophagus; recent oral surgery; very severe pharyngitis or tonsillitis; or immunosuppression.

An estimated 850 persons were screened via a phone bank, and PEP was given to 125 people (15%). Some persons not deemed at risk insisted on receiving PEP, whereas others who were advised to receive it chose not to—in some cases on the advice of their physician, Dr. Bradley said.

The Department of Health later administered a telephone questionnaire to those who received PEP to determine if their milk-buying habits had changed; some refused to respond, believing the questionnaire to be part of a government conspiracy, Dr. Bradley reported. Some even “thought their phones were being tapped” during the phone call, she said.

Of 93 households contacted, 72 responded to the questions. They consumed a mean of 3 gallons per week of raw milk, and 51% of respondents cited a belief that raw milk offers greater health benefits as their primary reason for buying unpasteurized milk. Such benefits cited by the respondents were an absence of the chemicals contained in homogenized milk, improved amino acid content, better intestinal absorption, and greater vitamin and mineral content.

Surprisingly, nearly 75% knew that raw milk can contain disease-causing bacteria or viruses, and 64% said they continued to buy raw milk after the rabies incident.

Oklahoma, unlike Texas, does not normally administer biologics to persons exposed to rabies, Dr. Bradley noted. However, the high-profile nature of the case and the fact that many physicians' offices would be closed for the December holidays motivated the commissioner of public health to administer PEP to at-risk persons in this case.

She added that her office also was motivated by a belief that primary care physicians were “not very well informed about rabies PEP.”

The risk of contracting rabies from cow's milk is poorly defined, Dr. Bradley said, but she observed that the mammary gland—unlike the salivary gland, through which bite-transmitted rabies is spread—is significantly distal to the brain, the source of the virus in the host. She said that transmission of the rabies virus via oral ingestion requires a much higher dose than does transmission via a bite. Moreover, oral transmission requires extended contact with the oral or nasal mucosa, the latter being the more effective transmission medium.

Although the federal government regulates interstate sales of all milk, intrastate sales are regulated by the states only, which vary in their restrictions. (See chart.)

Two prior cases were reported in the literature in 1996 and 1998, both in Massachusetts, she said at the meeting, which was held in conjunction with the International Conference on Diseases in Nature Communicable to Man. In both cases, rabies PEP was administered to all persons who had consumed the milk.

Dr. Bradley said that before the rabies case, two Campylobacter outbreaks had been linked to consumption of raw milk from the Oklahoma dairy.

ELSEVIER GLOBAL MEDICAL NEWS

SAN ANTONIO — People who drank raw milk purchased at an Oklahoma dairy where a cow tested positive for rabies last year were screened for susceptibility—and in some cases given postexposure prophylaxis—but this did not deter most from continuing to buy raw milk, according to Kristy Bradley, D.V.M., of the Oklahoma State Department of Health.

The situation was of special concern, not only because of the large number of persons at risk for rabies exposure from the dairy, which sold an average of 300 gallons of raw milk per day, but because some of the purchasers were cancer patients.

“There was a physician in the area who told them that [raw milk] would help them counteract the effects of their chemotherapy and radiation therapy,” Dr. Bradley reported at a meeting of the Southwest Conference on Diseases in Nature Transmissible to Man.

The state health department decided to administer rabies postexposure prophylaxis (PEP) to selected persons who had consumed milk from the Swan Bros. dairy in Claremore during the time the infected cow was present, she said. However, the high cost of PEP meant that screening was necessary to identify those who in whom the milk likely had contact with the oral mucosa or in whom there was passage of the milk into the sinuses.

Also deemed at high risk were those with an anatomical defect of the sinus, pharynx, or hard/soft palate; open sores in the mouth, pharynx, or esophagus; recent oral surgery; very severe pharyngitis or tonsillitis; or immunosuppression.

An estimated 850 persons were screened via a phone bank, and PEP was given to 125 people (15%). Some persons not deemed at risk insisted on receiving PEP, whereas others who were advised to receive it chose not to—in some cases on the advice of their physician, Dr. Bradley said.

The Department of Health later administered a telephone questionnaire to those who received PEP to determine if their milk-buying habits had changed; some refused to respond, believing the questionnaire to be part of a government conspiracy, Dr. Bradley reported. Some even “thought their phones were being tapped” during the phone call, she said.

Of 93 households contacted, 72 responded to the questions. They consumed a mean of 3 gallons per week of raw milk, and 51% of respondents cited a belief that raw milk offers greater health benefits as their primary reason for buying unpasteurized milk. Such benefits cited by the respondents were an absence of the chemicals contained in homogenized milk, improved amino acid content, better intestinal absorption, and greater vitamin and mineral content.

Surprisingly, nearly 75% knew that raw milk can contain disease-causing bacteria or viruses, and 64% said they continued to buy raw milk after the rabies incident.

Oklahoma, unlike Texas, does not normally administer biologics to persons exposed to rabies, Dr. Bradley noted. However, the high-profile nature of the case and the fact that many physicians' offices would be closed for the December holidays motivated the commissioner of public health to administer PEP to at-risk persons in this case.

She added that her office also was motivated by a belief that primary care physicians were “not very well informed about rabies PEP.”

The risk of contracting rabies from cow's milk is poorly defined, Dr. Bradley said, but she observed that the mammary gland—unlike the salivary gland, through which bite-transmitted rabies is spread—is significantly distal to the brain, the source of the virus in the host. She said that transmission of the rabies virus via oral ingestion requires a much higher dose than does transmission via a bite. Moreover, oral transmission requires extended contact with the oral or nasal mucosa, the latter being the more effective transmission medium.

Although the federal government regulates interstate sales of all milk, intrastate sales are regulated by the states only, which vary in their restrictions. (See chart.)

Two prior cases were reported in the literature in 1996 and 1998, both in Massachusetts, she said at the meeting, which was held in conjunction with the International Conference on Diseases in Nature Communicable to Man. In both cases, rabies PEP was administered to all persons who had consumed the milk.

Dr. Bradley said that before the rabies case, two Campylobacter outbreaks had been linked to consumption of raw milk from the Oklahoma dairy.

ELSEVIER GLOBAL MEDICAL NEWS

SAN ANTONIO — People who drank raw milk purchased at an Oklahoma dairy where a cow tested positive for rabies last year were screened for susceptibility—and in some cases given postexposure prophylaxis—but this did not deter most from continuing to buy raw milk, according to Kristy Bradley, D.V.M., of the Oklahoma State Department of Health.

The situation was of special concern, not only because of the large number of persons at risk for rabies exposure from the dairy, which sold an average of 300 gallons of raw milk per day, but because some of the purchasers were cancer patients.

“There was a physician in the area who told them that [raw milk] would help them counteract the effects of their chemotherapy and radiation therapy,” Dr. Bradley reported at a meeting of the Southwest Conference on Diseases in Nature Transmissible to Man.

The state health department decided to administer rabies postexposure prophylaxis (PEP) to selected persons who had consumed milk from the Swan Bros. dairy in Claremore during the time the infected cow was present, she said. However, the high cost of PEP meant that screening was necessary to identify those who in whom the milk likely had contact with the oral mucosa or in whom there was passage of the milk into the sinuses.

Also deemed at high risk were those with an anatomical defect of the sinus, pharynx, or hard/soft palate; open sores in the mouth, pharynx, or esophagus; recent oral surgery; very severe pharyngitis or tonsillitis; or immunosuppression.

An estimated 850 persons were screened via a phone bank, and PEP was given to 125 people (15%). Some persons not deemed at risk insisted on receiving PEP, whereas others who were advised to receive it chose not to—in some cases on the advice of their physician, Dr. Bradley said.

The Department of Health later administered a telephone questionnaire to those who received PEP to determine if their milk-buying habits had changed; some refused to respond, believing the questionnaire to be part of a government conspiracy, Dr. Bradley reported. Some even “thought their phones were being tapped” during the phone call, she said.

Of 93 households contacted, 72 responded to the questions. They consumed a mean of 3 gallons per week of raw milk, and 51% of respondents cited a belief that raw milk offers greater health benefits as their primary reason for buying unpasteurized milk. Such benefits cited by the respondents were an absence of the chemicals contained in homogenized milk, improved amino acid content, better intestinal absorption, and greater vitamin and mineral content.

Surprisingly, nearly 75% knew that raw milk can contain disease-causing bacteria or viruses, and 64% said they continued to buy raw milk after the rabies incident.

Oklahoma, unlike Texas, does not normally administer biologics to persons exposed to rabies, Dr. Bradley noted. However, the high-profile nature of the case and the fact that many physicians' offices would be closed for the December holidays motivated the commissioner of public health to administer PEP to at-risk persons in this case.

She added that her office also was motivated by a belief that primary care physicians were “not very well informed about rabies PEP.”

The risk of contracting rabies from cow's milk is poorly defined, Dr. Bradley said, but she observed that the mammary gland—unlike the salivary gland, through which bite-transmitted rabies is spread—is significantly distal to the brain, the source of the virus in the host. She said that transmission of the rabies virus via oral ingestion requires a much higher dose than does transmission via a bite. Moreover, oral transmission requires extended contact with the oral or nasal mucosa, the latter being the more effective transmission medium.

Although the federal government regulates interstate sales of all milk, intrastate sales are regulated by the states only, which vary in their restrictions. (See chart.)

Two prior cases were reported in the literature in 1996 and 1998, both in Massachusetts, she said at the meeting, which was held in conjunction with the International Conference on Diseases in Nature Communicable to Man. In both cases, rabies PEP was administered to all persons who had consumed the milk.

Dr. Bradley said that before the rabies case, two Campylobacter outbreaks had been linked to consumption of raw milk from the Oklahoma dairy.

ELSEVIER GLOBAL MEDICAL NEWS

The Centers for Disease Control and Prevention has reported that data from a nationwide telephone survey indicate that only 18% of children aged 6 months to 2 years were fully vaccinated for influenza in the 2004–2005 influenza season.

To be considered “fully vaccinated,” a child must have received two injections in the September-December 2004 period if he or she had never been vaccinated, or only one injection in that period if the child had any history of influenza vaccination.

The portion of children nationwide who had received at least one dose of flu vaccine in the period was 33% (MMWR 2006;55:1081–5).

The state with the largest portion of fully vaccinated children in this age group was Nebraska, with 33%. The state with the least was Idaho, with 6%. Children in large cites were even less likely to be fully vaccinated, however; only 3% of children under age 2 years in Detroit were fully vaccinated, compared with 15% of those in Michigan as a whole.

Notably, the September-December period of 2004 coincided with a national shortage of vaccine, which the CDC recently reported should not occur this season, because there will be two additional manufacturers supplying vaccine, bringing the total to four, whereas as there where only two manufacturers in the 2004–2005 season. However, the CDC's Advisory Committee on Immunization Practices that year deemed children aged 6–23 months as a priority population for vaccination, and thus the lack of supply in theory should not have affected this group as much as others.

The period in question was the first for which routine annual influenza vaccination was recommended (rather than merely encouraged) for children in this age group. Since then, the recommendation has been expanded to include children up to age 59 months.

The Centers for Disease Control and Prevention has reported that data from a nationwide telephone survey indicate that only 18% of children aged 6 months to 2 years were fully vaccinated for influenza in the 2004–2005 influenza season.

To be considered “fully vaccinated,” a child must have received two injections in the September-December 2004 period if he or she had never been vaccinated, or only one injection in that period if the child had any history of influenza vaccination.

The portion of children nationwide who had received at least one dose of flu vaccine in the period was 33% (MMWR 2006;55:1081–5).

The state with the largest portion of fully vaccinated children in this age group was Nebraska, with 33%. The state with the least was Idaho, with 6%. Children in large cites were even less likely to be fully vaccinated, however; only 3% of children under age 2 years in Detroit were fully vaccinated, compared with 15% of those in Michigan as a whole.

Notably, the September-December period of 2004 coincided with a national shortage of vaccine, which the CDC recently reported should not occur this season, because there will be two additional manufacturers supplying vaccine, bringing the total to four, whereas as there where only two manufacturers in the 2004–2005 season. However, the CDC's Advisory Committee on Immunization Practices that year deemed children aged 6–23 months as a priority population for vaccination, and thus the lack of supply in theory should not have affected this group as much as others.

The period in question was the first for which routine annual influenza vaccination was recommended (rather than merely encouraged) for children in this age group. Since then, the recommendation has been expanded to include children up to age 59 months.

The Centers for Disease Control and Prevention has reported that data from a nationwide telephone survey indicate that only 18% of children aged 6 months to 2 years were fully vaccinated for influenza in the 2004–2005 influenza season.

To be considered “fully vaccinated,” a child must have received two injections in the September-December 2004 period if he or she had never been vaccinated, or only one injection in that period if the child had any history of influenza vaccination.

The portion of children nationwide who had received at least one dose of flu vaccine in the period was 33% (MMWR 2006;55:1081–5).

The state with the largest portion of fully vaccinated children in this age group was Nebraska, with 33%. The state with the least was Idaho, with 6%. Children in large cites were even less likely to be fully vaccinated, however; only 3% of children under age 2 years in Detroit were fully vaccinated, compared with 15% of those in Michigan as a whole.

Notably, the September-December period of 2004 coincided with a national shortage of vaccine, which the CDC recently reported should not occur this season, because there will be two additional manufacturers supplying vaccine, bringing the total to four, whereas as there where only two manufacturers in the 2004–2005 season. However, the CDC's Advisory Committee on Immunization Practices that year deemed children aged 6–23 months as a priority population for vaccination, and thus the lack of supply in theory should not have affected this group as much as others.

The period in question was the first for which routine annual influenza vaccination was recommended (rather than merely encouraged) for children in this age group. Since then, the recommendation has been expanded to include children up to age 59 months.

WASHINGTON — Much of the public harbors misperceptions about influenza and vaccination against it, according to data from a nationwide survey presented at a press briefing sponsored by the National Foundation for Infectious Diseases.

The Public Perception of Influenza, Vaccination and Treatment Options Survey, randomly administered via telephone to more than 1,000 adults in all 50 states, found that only 48% of respondents said they planned to be immunized this year.

Reasons given by respondents for not seeking immunization included the belief that influenza is not a serious enough disease to warrant vaccination (43%), that they were personally not at risk for infection (38%), that they previously contracted the flu even after being vaccinated (23%), and that vaccination in a prior influenza season would offer protection against current infection (15%).

Of the entire study cohort, 46% of respondents believed influenza vaccine can cause influenza. In addition, 30% responded that getting the vaccine is not worthwhile because it protects against only three strains of influenza, and many said that vaccination in December or later was too late to be effective.

These findings underscore the need for physicians to recommend vaccination to their patients, said Dr. Susan J. Rehm, medical director of the National Foundation for Infectious Diseases. A direct recommendation from a health care provider “was one of the major drivers for individuals getting influenza vaccine,” she said.

“The medical community must also reinforce the public health benefits of vaccination in the later season,” Dr. Rehm said, “by educating patients throughout the winter months… about the benefits of the vaccine, even if disease has already begun to be seen in their area.”

Also of concern was that only 49% of respondents knew that annual influenza vaccination is recommended for pregnant women and only 68% knew about the CDC's recently expanded recommendation for influenza vaccination in all children aged 6 months to 5 years.

WASHINGTON — Much of the public harbors misperceptions about influenza and vaccination against it, according to data from a nationwide survey presented at a press briefing sponsored by the National Foundation for Infectious Diseases.

The Public Perception of Influenza, Vaccination and Treatment Options Survey, randomly administered via telephone to more than 1,000 adults in all 50 states, found that only 48% of respondents said they planned to be immunized this year.

Reasons given by respondents for not seeking immunization included the belief that influenza is not a serious enough disease to warrant vaccination (43%), that they were personally not at risk for infection (38%), that they previously contracted the flu even after being vaccinated (23%), and that vaccination in a prior influenza season would offer protection against current infection (15%).

Of the entire study cohort, 46% of respondents believed influenza vaccine can cause influenza. In addition, 30% responded that getting the vaccine is not worthwhile because it protects against only three strains of influenza, and many said that vaccination in December or later was too late to be effective.

These findings underscore the need for physicians to recommend vaccination to their patients, said Dr. Susan J. Rehm, medical director of the National Foundation for Infectious Diseases. A direct recommendation from a health care provider “was one of the major drivers for individuals getting influenza vaccine,” she said.

“The medical community must also reinforce the public health benefits of vaccination in the later season,” Dr. Rehm said, “by educating patients throughout the winter months… about the benefits of the vaccine, even if disease has already begun to be seen in their area.”

Also of concern was that only 49% of respondents knew that annual influenza vaccination is recommended for pregnant women and only 68% knew about the CDC's recently expanded recommendation for influenza vaccination in all children aged 6 months to 5 years.

WASHINGTON — Much of the public harbors misperceptions about influenza and vaccination against it, according to data from a nationwide survey presented at a press briefing sponsored by the National Foundation for Infectious Diseases.

The Public Perception of Influenza, Vaccination and Treatment Options Survey, randomly administered via telephone to more than 1,000 adults in all 50 states, found that only 48% of respondents said they planned to be immunized this year.

Reasons given by respondents for not seeking immunization included the belief that influenza is not a serious enough disease to warrant vaccination (43%), that they were personally not at risk for infection (38%), that they previously contracted the flu even after being vaccinated (23%), and that vaccination in a prior influenza season would offer protection against current infection (15%).

Of the entire study cohort, 46% of respondents believed influenza vaccine can cause influenza. In addition, 30% responded that getting the vaccine is not worthwhile because it protects against only three strains of influenza, and many said that vaccination in December or later was too late to be effective.

These findings underscore the need for physicians to recommend vaccination to their patients, said Dr. Susan J. Rehm, medical director of the National Foundation for Infectious Diseases. A direct recommendation from a health care provider “was one of the major drivers for individuals getting influenza vaccine,” she said.

“The medical community must also reinforce the public health benefits of vaccination in the later season,” Dr. Rehm said, “by educating patients throughout the winter months… about the benefits of the vaccine, even if disease has already begun to be seen in their area.”

Also of concern was that only 49% of respondents knew that annual influenza vaccination is recommended for pregnant women and only 68% knew about the CDC's recently expanded recommendation for influenza vaccination in all children aged 6 months to 5 years.

The Food and Drug Administration has approved a new drug intended for the prevention of Aspergillus and Candida fungal infections in immunocompromised patients.

Posaconazole, which will be marketed as Noxafil by Schering-Plough, was approved on the basis of two randomized controlled trials that showed greater efficacy than fluconazole in preventing infections in patients aged 13–82 years.

In a study of patients with graft-versus-host disease who had undergone hematopoietic stem cell transplantation, 2% of patients experienced clinical failure due to proven or probable invasive fungal infection (IFI) after 7 days' treatment, versus 7% of patients on fluconazole; after 16 weeks' treatment, these figures were 5% for those on posaconazole and with 9% for those on fluconazole.

In a separate study of patients with hematologic malignancy or prolonged neutropenia, 2% of those on posaconazole had clinical failure due to proven/probable IFI after 7 days, versus 8% of those on fluconazole/itraconazole. After 100 days, these figures were 5% for the posaconazole group and 11% for the fluconazole/itraconazole group.

Reported side effects of posaconazole include nausea, vomiting, diarrhea, changes in QTc interval, and hepatic impairment.

Posaconazole should be given only with a full meal or liquid nutritional supplement, according to the FDA-approved label. No dose adjustment is required for those with mild to moderate renal impairment or for pediatric or geriatric patients.

Coadministration is contraindicated for ergot alkaloids, terfenadine, astemizole, cisapride, pimozide, halofantrine, and quinidine.

The drug works by blocking fungal cells' synthesis of the membrane component ergosterol.

Noxafil was approved in Europe by the European Medicines Agency in October 2005, based on complete or partial resolution of invasive aspergillosis in 42% of patients, compared with 26% of control patients.

The Food and Drug Administration has approved a new drug intended for the prevention of Aspergillus and Candida fungal infections in immunocompromised patients.

Posaconazole, which will be marketed as Noxafil by Schering-Plough, was approved on the basis of two randomized controlled trials that showed greater efficacy than fluconazole in preventing infections in patients aged 13–82 years.

In a study of patients with graft-versus-host disease who had undergone hematopoietic stem cell transplantation, 2% of patients experienced clinical failure due to proven or probable invasive fungal infection (IFI) after 7 days' treatment, versus 7% of patients on fluconazole; after 16 weeks' treatment, these figures were 5% for those on posaconazole and with 9% for those on fluconazole.

In a separate study of patients with hematologic malignancy or prolonged neutropenia, 2% of those on posaconazole had clinical failure due to proven/probable IFI after 7 days, versus 8% of those on fluconazole/itraconazole. After 100 days, these figures were 5% for the posaconazole group and 11% for the fluconazole/itraconazole group.

Reported side effects of posaconazole include nausea, vomiting, diarrhea, changes in QTc interval, and hepatic impairment.

Posaconazole should be given only with a full meal or liquid nutritional supplement, according to the FDA-approved label. No dose adjustment is required for those with mild to moderate renal impairment or for pediatric or geriatric patients.

Coadministration is contraindicated for ergot alkaloids, terfenadine, astemizole, cisapride, pimozide, halofantrine, and quinidine.

The drug works by blocking fungal cells' synthesis of the membrane component ergosterol.

Noxafil was approved in Europe by the European Medicines Agency in October 2005, based on complete or partial resolution of invasive aspergillosis in 42% of patients, compared with 26% of control patients.

The Food and Drug Administration has approved a new drug intended for the prevention of Aspergillus and Candida fungal infections in immunocompromised patients.

Posaconazole, which will be marketed as Noxafil by Schering-Plough, was approved on the basis of two randomized controlled trials that showed greater efficacy than fluconazole in preventing infections in patients aged 13–82 years.

In a study of patients with graft-versus-host disease who had undergone hematopoietic stem cell transplantation, 2% of patients experienced clinical failure due to proven or probable invasive fungal infection (IFI) after 7 days' treatment, versus 7% of patients on fluconazole; after 16 weeks' treatment, these figures were 5% for those on posaconazole and with 9% for those on fluconazole.

In a separate study of patients with hematologic malignancy or prolonged neutropenia, 2% of those on posaconazole had clinical failure due to proven/probable IFI after 7 days, versus 8% of those on fluconazole/itraconazole. After 100 days, these figures were 5% for the posaconazole group and 11% for the fluconazole/itraconazole group.

Reported side effects of posaconazole include nausea, vomiting, diarrhea, changes in QTc interval, and hepatic impairment.

Posaconazole should be given only with a full meal or liquid nutritional supplement, according to the FDA-approved label. No dose adjustment is required for those with mild to moderate renal impairment or for pediatric or geriatric patients.

Coadministration is contraindicated for ergot alkaloids, terfenadine, astemizole, cisapride, pimozide, halofantrine, and quinidine.

The drug works by blocking fungal cells' synthesis of the membrane component ergosterol.

Noxafil was approved in Europe by the European Medicines Agency in October 2005, based on complete or partial resolution of invasive aspergillosis in 42% of patients, compared with 26% of control patients.

ROCKVILLE, MD. — The Food and Drug Administration has updated the product labeling for the Ortho Evra brand contraceptive patch to include under the warning section data from two studies, one of which indicates possible increased risk of deep vein thrombosis, MI, and other cardiovascular events in women using the patch—especially among smokers.

Acting Deputy Director of FDA's Office of Drug Evaluation III Daniel Shames discussed the studies and the new labeling in a conference call with news media.

The two studies were based on data obtained from large databases of medical insurance claims, he said. One of the studies, conducted by researchers at Boston University—and funded by Ortho Evra's manufacturer, Johnson & Johnson—concluded that women taking the drug had no more risk of thrombotic events (odds ratio 0.9) than women taking 35 mcg oral estradiol (Contraception 2006; 73:223–8).

The other study, by i3 Research, an Ingenix company, showed more than twice the risk (OR 2.4) for serious nonfatal blood clot as women on 35 mcg of estrogen and norgestimate; this study has yet to be published. Dr. Shames said participants in this study will be followed for another 18 months or 2 years. Ortho-Evra is marketed by Merck & Co and contains norelgestromin and ethinyl estradiol (EE).

Dr. Shames said the FDA has asked Merck to conduct studies with longer follow-up regarding serious blood clots and other adverse events, such as MI and stroke, noting that “blood clots occurring in the leg veins or in the lungs are serious and relatively rare events that have been considered a potential risk for all hormone therapies—in particular [in] women who smoke.

“Even though the results of the two studies are conflicting, the results of the second epidemiologic study is [sic] consistent with FDA's concern regarding the potential for Ortho Evra use to increase the risk of blood clots in some women,” he said. However, “Ortho Evra's risk-benefit profile is acceptable for a highly effective hormonal contraceptive.” Women should discuss concerns about adverse events with their health care provider, he said.

The patch was approved in 2001; in 2005 a warning was added noting that women using the patch might experience blood levels of the drug up to 60% higher than in women taking 35 mcg of oral EE.

In 1988, the FDA persuaded the three companies then producing oral contraceptives with more than 50 mcg of estrogen to remove those products from the market. Ortho Evra's product label was updated in November 2005 to disclose that although the peak level of estrogen imparted by the product in one study was 25% lower than that produced by 35 mg of oral EE, the steady-state concentration produced by Ortho Evra is 60% higher, at 56 mcg.

ROCKVILLE, MD. — The Food and Drug Administration has updated the product labeling for the Ortho Evra brand contraceptive patch to include under the warning section data from two studies, one of which indicates possible increased risk of deep vein thrombosis, MI, and other cardiovascular events in women using the patch—especially among smokers.

Acting Deputy Director of FDA's Office of Drug Evaluation III Daniel Shames discussed the studies and the new labeling in a conference call with news media.

The two studies were based on data obtained from large databases of medical insurance claims, he said. One of the studies, conducted by researchers at Boston University—and funded by Ortho Evra's manufacturer, Johnson & Johnson—concluded that women taking the drug had no more risk of thrombotic events (odds ratio 0.9) than women taking 35 mcg oral estradiol (Contraception 2006; 73:223–8).

The other study, by i3 Research, an Ingenix company, showed more than twice the risk (OR 2.4) for serious nonfatal blood clot as women on 35 mcg of estrogen and norgestimate; this study has yet to be published. Dr. Shames said participants in this study will be followed for another 18 months or 2 years. Ortho-Evra is marketed by Merck & Co and contains norelgestromin and ethinyl estradiol (EE).

Dr. Shames said the FDA has asked Merck to conduct studies with longer follow-up regarding serious blood clots and other adverse events, such as MI and stroke, noting that “blood clots occurring in the leg veins or in the lungs are serious and relatively rare events that have been considered a potential risk for all hormone therapies—in particular [in] women who smoke.

“Even though the results of the two studies are conflicting, the results of the second epidemiologic study is [sic] consistent with FDA's concern regarding the potential for Ortho Evra use to increase the risk of blood clots in some women,” he said. However, “Ortho Evra's risk-benefit profile is acceptable for a highly effective hormonal contraceptive.” Women should discuss concerns about adverse events with their health care provider, he said.

The patch was approved in 2001; in 2005 a warning was added noting that women using the patch might experience blood levels of the drug up to 60% higher than in women taking 35 mcg of oral EE.

In 1988, the FDA persuaded the three companies then producing oral contraceptives with more than 50 mcg of estrogen to remove those products from the market. Ortho Evra's product label was updated in November 2005 to disclose that although the peak level of estrogen imparted by the product in one study was 25% lower than that produced by 35 mg of oral EE, the steady-state concentration produced by Ortho Evra is 60% higher, at 56 mcg.

ROCKVILLE, MD. — The Food and Drug Administration has updated the product labeling for the Ortho Evra brand contraceptive patch to include under the warning section data from two studies, one of which indicates possible increased risk of deep vein thrombosis, MI, and other cardiovascular events in women using the patch—especially among smokers.

Acting Deputy Director of FDA's Office of Drug Evaluation III Daniel Shames discussed the studies and the new labeling in a conference call with news media.

The two studies were based on data obtained from large databases of medical insurance claims, he said. One of the studies, conducted by researchers at Boston University—and funded by Ortho Evra's manufacturer, Johnson & Johnson—concluded that women taking the drug had no more risk of thrombotic events (odds ratio 0.9) than women taking 35 mcg oral estradiol (Contraception 2006; 73:223–8).

The other study, by i3 Research, an Ingenix company, showed more than twice the risk (OR 2.4) for serious nonfatal blood clot as women on 35 mcg of estrogen and norgestimate; this study has yet to be published. Dr. Shames said participants in this study will be followed for another 18 months or 2 years. Ortho-Evra is marketed by Merck & Co and contains norelgestromin and ethinyl estradiol (EE).

Dr. Shames said the FDA has asked Merck to conduct studies with longer follow-up regarding serious blood clots and other adverse events, such as MI and stroke, noting that “blood clots occurring in the leg veins or in the lungs are serious and relatively rare events that have been considered a potential risk for all hormone therapies—in particular [in] women who smoke.

“Even though the results of the two studies are conflicting, the results of the second epidemiologic study is [sic] consistent with FDA's concern regarding the potential for Ortho Evra use to increase the risk of blood clots in some women,” he said. However, “Ortho Evra's risk-benefit profile is acceptable for a highly effective hormonal contraceptive.” Women should discuss concerns about adverse events with their health care provider, he said.

The patch was approved in 2001; in 2005 a warning was added noting that women using the patch might experience blood levels of the drug up to 60% higher than in women taking 35 mcg of oral EE.

In 1988, the FDA persuaded the three companies then producing oral contraceptives with more than 50 mcg of estrogen to remove those products from the market. Ortho Evra's product label was updated in November 2005 to disclose that although the peak level of estrogen imparted by the product in one study was 25% lower than that produced by 35 mg of oral EE, the steady-state concentration produced by Ortho Evra is 60% higher, at 56 mcg.