Melinda Tanzola

ATLANTA — Single-dose oral metronidazole—one of two recommended first-line treatment regimens for Trichomonas vaginalis—is less effective than a second-line, 7-day regimen of oral metronidazole in HIV-positive women, results from a randomized trial suggest.

Among 255 patients evaluated 6-12 days after treatment, those who received metronidazole 500 mg twice daily for 7 days were about half as likely as those receiving a single 2-g dose of metronidazole to have recurrent T. vaginalis infections (9% vs. 17%), according to the findings of a phase IV trial of medications that were already approved for this intended use.

The 7-day regimen also was associated with a lower rate of T. vaginalis positivity among 152 women who were assessed 3 months after treatment, with rates of 11% and 24%, respectively, said Dr. Patricia Kissinger, professor of epidemiology at Tulane University in New Orleans.

There was no difference in adherence between groups, with almost all patients (96%) reporting haven taken all of their metronidazole as instructed, and there were no significant differences in adverse event rates between the two arms.

Based on these findings, metronidazole administered as a single 2-g dose should no longer be recommended for the treatment of T. vaginalis among HIV-positive women, Dr. Kissinger said at a conference on STD prevention sponsored by the Centers for Disease Control and Prevention.

The National Institutes of Health funded the study. Dr. Kissinger reported having no relevant conflicts of interest.

ATLANTA — Single-dose oral metronidazole—one of two recommended first-line treatment regimens for Trichomonas vaginalis—is less effective than a second-line, 7-day regimen of oral metronidazole in HIV-positive women, results from a randomized trial suggest.

Among 255 patients evaluated 6-12 days after treatment, those who received metronidazole 500 mg twice daily for 7 days were about half as likely as those receiving a single 2-g dose of metronidazole to have recurrent T. vaginalis infections (9% vs. 17%), according to the findings of a phase IV trial of medications that were already approved for this intended use.

The 7-day regimen also was associated with a lower rate of T. vaginalis positivity among 152 women who were assessed 3 months after treatment, with rates of 11% and 24%, respectively, said Dr. Patricia Kissinger, professor of epidemiology at Tulane University in New Orleans.

There was no difference in adherence between groups, with almost all patients (96%) reporting haven taken all of their metronidazole as instructed, and there were no significant differences in adverse event rates between the two arms.

Based on these findings, metronidazole administered as a single 2-g dose should no longer be recommended for the treatment of T. vaginalis among HIV-positive women, Dr. Kissinger said at a conference on STD prevention sponsored by the Centers for Disease Control and Prevention.

The National Institutes of Health funded the study. Dr. Kissinger reported having no relevant conflicts of interest.

ATLANTA — Single-dose oral metronidazole—one of two recommended first-line treatment regimens for Trichomonas vaginalis—is less effective than a second-line, 7-day regimen of oral metronidazole in HIV-positive women, results from a randomized trial suggest.

Among 255 patients evaluated 6-12 days after treatment, those who received metronidazole 500 mg twice daily for 7 days were about half as likely as those receiving a single 2-g dose of metronidazole to have recurrent T. vaginalis infections (9% vs. 17%), according to the findings of a phase IV trial of medications that were already approved for this intended use.

The 7-day regimen also was associated with a lower rate of T. vaginalis positivity among 152 women who were assessed 3 months after treatment, with rates of 11% and 24%, respectively, said Dr. Patricia Kissinger, professor of epidemiology at Tulane University in New Orleans.

There was no difference in adherence between groups, with almost all patients (96%) reporting haven taken all of their metronidazole as instructed, and there were no significant differences in adverse event rates between the two arms.

Based on these findings, metronidazole administered as a single 2-g dose should no longer be recommended for the treatment of T. vaginalis among HIV-positive women, Dr. Kissinger said at a conference on STD prevention sponsored by the Centers for Disease Control and Prevention.

The National Institutes of Health funded the study. Dr. Kissinger reported having no relevant conflicts of interest.

ATLANTA — Physicians who are in private practice identify more cases of chlamydia than any other type of provider in both urban and rural communities, according to the results of a retrospective analysis of sexually transmitted disease detection trends in a single state.

These findings indicate that private practice physicians are taking a leading role in the identification of new cases of STDs, the study's lead investigator, Wiley D. Jenkins, Ph.D., said at a conference on STD prevention sponsored by the Centers for Disease Control and Prevention.

Between 2002 and 2006, private medical physicians diagnosed one-third of all the chlamydia cases in Illinois. Hospitals were the second greatest source of chlamydia diagnoses in most counties, followed by family planning clinics and STD clinics, he said.

Private physicians also accounted for 25% of the diagnoses of gonorrhea in the state, which placed them second behind hospitals at 34%. Hospitals and STD clinics were the greatest sources of gonorrhea diagnoses in the 36 most densely populated counties, whereas private physicians were the greatest source in the 66 remaining counties, which were mostly rural, Dr. Jenkins reported.

Overall, 247,725 cases of chlamydia and 106,645 cases of gonorrhea were reported during the 4-year study period. Females were diagnosed at a higher rate than males, accounting for 74% of the chlamydia cases and 54% of the gonorrhea cases.

African Americans accounted for the majority of both infections (52% of chlamydia and 68% of gonorrhea), though race was not listed in 18%–20% of cases, limiting the usefulness of this finding.

The proportion of cases occurring in females also increased as county populations decreased.

Private practice physicians and hospital providers were more widely distributed than other provider types, accounting for 539 providers in 100 counties and 229 providers in 66 counties, respectively.

Providers from other settings who reported STD diagnoses included those who worked in 158 family planning clinics located in 66 counties and 54 STD clinics in 35 counties. However, nearly half of the STD clinics (24 of 54) were located in Cook County (Chicago), leaving 30 clinics to serve the remaining 101 counties in the state.

“It might be easier and more effective to encourage existing physicians to screen according to USPSTF [U.S. Preventive Services Task Force] guidelines rather than establish new/expensive screening sites in areas of lower population and incidence,” suggested Dr. Jenkins, who is with the department of family and community medicine at Southern Illinois University in Springfield.

The USPSTF recommends that annual screening for chlamydia be performed in sexually active females under the age of 25 years, but CDC data indicate that many women are not being screened according to guidelines.

In 2007, only 42% of sexually active women aged 16-25 years who had accessed care and were enrolled in U.S. commercial or Medicaid health plans were screened for chlamydia. Coverage varied by region, from 46% in the Northeast to 37% in the South (MMWR 2009;58:362-65).

According to USPSTF guidelines, depending on the local prevalence of chlamydia and gonorrhea, the screening of females for gonorrhea or males for chlamydia and/or gonorrhea may be justified.

ATLANTA — Physicians who are in private practice identify more cases of chlamydia than any other type of provider in both urban and rural communities, according to the results of a retrospective analysis of sexually transmitted disease detection trends in a single state.

These findings indicate that private practice physicians are taking a leading role in the identification of new cases of STDs, the study's lead investigator, Wiley D. Jenkins, Ph.D., said at a conference on STD prevention sponsored by the Centers for Disease Control and Prevention.

Between 2002 and 2006, private medical physicians diagnosed one-third of all the chlamydia cases in Illinois. Hospitals were the second greatest source of chlamydia diagnoses in most counties, followed by family planning clinics and STD clinics, he said.

Private physicians also accounted for 25% of the diagnoses of gonorrhea in the state, which placed them second behind hospitals at 34%. Hospitals and STD clinics were the greatest sources of gonorrhea diagnoses in the 36 most densely populated counties, whereas private physicians were the greatest source in the 66 remaining counties, which were mostly rural, Dr. Jenkins reported.

Overall, 247,725 cases of chlamydia and 106,645 cases of gonorrhea were reported during the 4-year study period. Females were diagnosed at a higher rate than males, accounting for 74% of the chlamydia cases and 54% of the gonorrhea cases.

African Americans accounted for the majority of both infections (52% of chlamydia and 68% of gonorrhea), though race was not listed in 18%–20% of cases, limiting the usefulness of this finding.

The proportion of cases occurring in females also increased as county populations decreased.

Private practice physicians and hospital providers were more widely distributed than other provider types, accounting for 539 providers in 100 counties and 229 providers in 66 counties, respectively.

Providers from other settings who reported STD diagnoses included those who worked in 158 family planning clinics located in 66 counties and 54 STD clinics in 35 counties. However, nearly half of the STD clinics (24 of 54) were located in Cook County (Chicago), leaving 30 clinics to serve the remaining 101 counties in the state.

“It might be easier and more effective to encourage existing physicians to screen according to USPSTF [U.S. Preventive Services Task Force] guidelines rather than establish new/expensive screening sites in areas of lower population and incidence,” suggested Dr. Jenkins, who is with the department of family and community medicine at Southern Illinois University in Springfield.

The USPSTF recommends that annual screening for chlamydia be performed in sexually active females under the age of 25 years, but CDC data indicate that many women are not being screened according to guidelines.

In 2007, only 42% of sexually active women aged 16-25 years who had accessed care and were enrolled in U.S. commercial or Medicaid health plans were screened for chlamydia. Coverage varied by region, from 46% in the Northeast to 37% in the South (MMWR 2009;58:362-65).

According to USPSTF guidelines, depending on the local prevalence of chlamydia and gonorrhea, the screening of females for gonorrhea or males for chlamydia and/or gonorrhea may be justified.

ATLANTA — Physicians who are in private practice identify more cases of chlamydia than any other type of provider in both urban and rural communities, according to the results of a retrospective analysis of sexually transmitted disease detection trends in a single state.

These findings indicate that private practice physicians are taking a leading role in the identification of new cases of STDs, the study's lead investigator, Wiley D. Jenkins, Ph.D., said at a conference on STD prevention sponsored by the Centers for Disease Control and Prevention.

Between 2002 and 2006, private medical physicians diagnosed one-third of all the chlamydia cases in Illinois. Hospitals were the second greatest source of chlamydia diagnoses in most counties, followed by family planning clinics and STD clinics, he said.

Private physicians also accounted for 25% of the diagnoses of gonorrhea in the state, which placed them second behind hospitals at 34%. Hospitals and STD clinics were the greatest sources of gonorrhea diagnoses in the 36 most densely populated counties, whereas private physicians were the greatest source in the 66 remaining counties, which were mostly rural, Dr. Jenkins reported.

Overall, 247,725 cases of chlamydia and 106,645 cases of gonorrhea were reported during the 4-year study period. Females were diagnosed at a higher rate than males, accounting for 74% of the chlamydia cases and 54% of the gonorrhea cases.

African Americans accounted for the majority of both infections (52% of chlamydia and 68% of gonorrhea), though race was not listed in 18%–20% of cases, limiting the usefulness of this finding.

The proportion of cases occurring in females also increased as county populations decreased.

Private practice physicians and hospital providers were more widely distributed than other provider types, accounting for 539 providers in 100 counties and 229 providers in 66 counties, respectively.

Providers from other settings who reported STD diagnoses included those who worked in 158 family planning clinics located in 66 counties and 54 STD clinics in 35 counties. However, nearly half of the STD clinics (24 of 54) were located in Cook County (Chicago), leaving 30 clinics to serve the remaining 101 counties in the state.

“It might be easier and more effective to encourage existing physicians to screen according to USPSTF [U.S. Preventive Services Task Force] guidelines rather than establish new/expensive screening sites in areas of lower population and incidence,” suggested Dr. Jenkins, who is with the department of family and community medicine at Southern Illinois University in Springfield.

The USPSTF recommends that annual screening for chlamydia be performed in sexually active females under the age of 25 years, but CDC data indicate that many women are not being screened according to guidelines.

In 2007, only 42% of sexually active women aged 16-25 years who had accessed care and were enrolled in U.S. commercial or Medicaid health plans were screened for chlamydia. Coverage varied by region, from 46% in the Northeast to 37% in the South (MMWR 2009;58:362-65).

According to USPSTF guidelines, depending on the local prevalence of chlamydia and gonorrhea, the screening of females for gonorrhea or males for chlamydia and/or gonorrhea may be justified.

ATLANTA – Many young women are uncomfortable talking to their health care providers about their sexual health and lack accurate information about the STD testing process, based on the results of a survey on STD testing beliefs.

In the study presented at a conference on STD prevention sponsored by the U.S. Centers for Disease Control and Prevention, Dr. Heather R. Royer of the University of Wisconsin, Madison, recruited 302 women aged 18-24 years: 201 women from four women’s health clinics and 101 women from a university class.

Participants were an average of 20 years old; 78% were white, 13% were nonwhite, and 5% were multiple races; this information was missing for the remaining 4%. The group was well educated, with 75% having some college or technical school experience. Nearly two-thirds of participants (62%) had undergone any prior STD testing, with 13% (44 women) having been diagnosed with an STD, including 23 women with HPV and 13 women with chlamydia.

The vast majority of respondents (84%) said that they would rather not go to their family doctor for STD testing; 79% said that it is easier to talk with an STD testing specialist than with a family doctor. Moreover, 88% said that it is easier to talk with a female health care provider than a male.

Nearly a quarter of participants said that they feel embarrassed about talking with a health care provider about STD testing (23%) and that talking with a health care provider about STD testing is difficult (22%).

Dr. Royer found significant associations between never having been tested for STDs and reporting embarrassment about sexual health communication. Women who had never been tested were more than twice as likely as those who had been tested to respond that they feel embarrassed about discussing STD testing (odds ratio, 2.37); that talking about STD testing is difficult (OR, 2.48); or that filling out forms about their sexual past is embarrassing (OR, 2.06).

Women also lacked knowledge about the STD testing process: 41% assumed that STD testing includes screening for “all STDs.” Regarding specific pathogens, participants thought that testing would include chlamydia (51%), gonorrhea (47%), syphilis (29%), Trichomonas species (21%), herpes simplex virus (28%), HPV (18%), HIV/AIDS (16%), and hepatitis B (13%).

In an interview, Dr. Royer explained that if women seeking STD testing believe that they are being tested for “all STDs,” they may inaccurately believe that they have tested negative for pathogens that have not been included, such as HIV or herpes.

Many women also thought that if the health care provider performs a Pap smear, they are being tested for STDs, including HPV (41%), gonorrhea (23%), chlamydia (26%), Trichomonas species (17%), syphilis (15%), herpes (14%), hepatitis B (4%), HIV/AIDS (2%), and “all STDs” (6%).

“It is striking that a quarter of women think that they are being tested for chlamydia and gonorrhea during a Pap smear,” commented Dr. Royer. “If women think they are automatically being tested for STDs during their annual Pap smear ... they would have no reason to ask to be tested.”

Finally, many women believed that STDs could be detected by a visual inspection of the genital area, most notably for herpes (77%), but also for gonorrhea (35%), chlamydia (32%), syphilis (30%), HPV (19%), Trichomonas species (15%), and hepatitis B (1%).

Dr. Royer concluded that health care providers must be cognizant of women’s discomfort in discussing their sexual health. “Providers should consider ways to help young women reframe the sexual health discussion from one of embarrassment to one of empowerment,” she concluded.

Dr. Royer said she had no conflicts of interest.

ATLANTA – Many young women are uncomfortable talking to their health care providers about their sexual health and lack accurate information about the STD testing process, based on the results of a survey on STD testing beliefs.

In the study presented at a conference on STD prevention sponsored by the U.S. Centers for Disease Control and Prevention, Dr. Heather R. Royer of the University of Wisconsin, Madison, recruited 302 women aged 18-24 years: 201 women from four women’s health clinics and 101 women from a university class.

Participants were an average of 20 years old; 78% were white, 13% were nonwhite, and 5% were multiple races; this information was missing for the remaining 4%. The group was well educated, with 75% having some college or technical school experience. Nearly two-thirds of participants (62%) had undergone any prior STD testing, with 13% (44 women) having been diagnosed with an STD, including 23 women with HPV and 13 women with chlamydia.

The vast majority of respondents (84%) said that they would rather not go to their family doctor for STD testing; 79% said that it is easier to talk with an STD testing specialist than with a family doctor. Moreover, 88% said that it is easier to talk with a female health care provider than a male.

Nearly a quarter of participants said that they feel embarrassed about talking with a health care provider about STD testing (23%) and that talking with a health care provider about STD testing is difficult (22%).

Dr. Royer found significant associations between never having been tested for STDs and reporting embarrassment about sexual health communication. Women who had never been tested were more than twice as likely as those who had been tested to respond that they feel embarrassed about discussing STD testing (odds ratio, 2.37); that talking about STD testing is difficult (OR, 2.48); or that filling out forms about their sexual past is embarrassing (OR, 2.06).

Women also lacked knowledge about the STD testing process: 41% assumed that STD testing includes screening for “all STDs.” Regarding specific pathogens, participants thought that testing would include chlamydia (51%), gonorrhea (47%), syphilis (29%), Trichomonas species (21%), herpes simplex virus (28%), HPV (18%), HIV/AIDS (16%), and hepatitis B (13%).

In an interview, Dr. Royer explained that if women seeking STD testing believe that they are being tested for “all STDs,” they may inaccurately believe that they have tested negative for pathogens that have not been included, such as HIV or herpes.

Many women also thought that if the health care provider performs a Pap smear, they are being tested for STDs, including HPV (41%), gonorrhea (23%), chlamydia (26%), Trichomonas species (17%), syphilis (15%), herpes (14%), hepatitis B (4%), HIV/AIDS (2%), and “all STDs” (6%).

“It is striking that a quarter of women think that they are being tested for chlamydia and gonorrhea during a Pap smear,” commented Dr. Royer. “If women think they are automatically being tested for STDs during their annual Pap smear ... they would have no reason to ask to be tested.”

Finally, many women believed that STDs could be detected by a visual inspection of the genital area, most notably for herpes (77%), but also for gonorrhea (35%), chlamydia (32%), syphilis (30%), HPV (19%), Trichomonas species (15%), and hepatitis B (1%).

Dr. Royer concluded that health care providers must be cognizant of women’s discomfort in discussing their sexual health. “Providers should consider ways to help young women reframe the sexual health discussion from one of embarrassment to one of empowerment,” she concluded.

Dr. Royer said she had no conflicts of interest.

ATLANTA – Many young women are uncomfortable talking to their health care providers about their sexual health and lack accurate information about the STD testing process, based on the results of a survey on STD testing beliefs.

In the study presented at a conference on STD prevention sponsored by the U.S. Centers for Disease Control and Prevention, Dr. Heather R. Royer of the University of Wisconsin, Madison, recruited 302 women aged 18-24 years: 201 women from four women’s health clinics and 101 women from a university class.

Participants were an average of 20 years old; 78% were white, 13% were nonwhite, and 5% were multiple races; this information was missing for the remaining 4%. The group was well educated, with 75% having some college or technical school experience. Nearly two-thirds of participants (62%) had undergone any prior STD testing, with 13% (44 women) having been diagnosed with an STD, including 23 women with HPV and 13 women with chlamydia.

The vast majority of respondents (84%) said that they would rather not go to their family doctor for STD testing; 79% said that it is easier to talk with an STD testing specialist than with a family doctor. Moreover, 88% said that it is easier to talk with a female health care provider than a male.

Nearly a quarter of participants said that they feel embarrassed about talking with a health care provider about STD testing (23%) and that talking with a health care provider about STD testing is difficult (22%).

Dr. Royer found significant associations between never having been tested for STDs and reporting embarrassment about sexual health communication. Women who had never been tested were more than twice as likely as those who had been tested to respond that they feel embarrassed about discussing STD testing (odds ratio, 2.37); that talking about STD testing is difficult (OR, 2.48); or that filling out forms about their sexual past is embarrassing (OR, 2.06).

Women also lacked knowledge about the STD testing process: 41% assumed that STD testing includes screening for “all STDs.” Regarding specific pathogens, participants thought that testing would include chlamydia (51%), gonorrhea (47%), syphilis (29%), Trichomonas species (21%), herpes simplex virus (28%), HPV (18%), HIV/AIDS (16%), and hepatitis B (13%).

In an interview, Dr. Royer explained that if women seeking STD testing believe that they are being tested for “all STDs,” they may inaccurately believe that they have tested negative for pathogens that have not been included, such as HIV or herpes.

Many women also thought that if the health care provider performs a Pap smear, they are being tested for STDs, including HPV (41%), gonorrhea (23%), chlamydia (26%), Trichomonas species (17%), syphilis (15%), herpes (14%), hepatitis B (4%), HIV/AIDS (2%), and “all STDs” (6%).

“It is striking that a quarter of women think that they are being tested for chlamydia and gonorrhea during a Pap smear,” commented Dr. Royer. “If women think they are automatically being tested for STDs during their annual Pap smear ... they would have no reason to ask to be tested.”

Finally, many women believed that STDs could be detected by a visual inspection of the genital area, most notably for herpes (77%), but also for gonorrhea (35%), chlamydia (32%), syphilis (30%), HPV (19%), Trichomonas species (15%), and hepatitis B (1%).

Dr. Royer concluded that health care providers must be cognizant of women’s discomfort in discussing their sexual health. “Providers should consider ways to help young women reframe the sexual health discussion from one of embarrassment to one of empowerment,” she concluded.

Dr. Royer said she had no conflicts of interest.

ATLANTA — About one in six Americans aged 14-49 years is infected with herpes simplex virus type 2, and 81% of these individuals are unaware of their infection, according to data presented at a conference on STD prevention sponsored by the Centers for Disease Control and Prevention.

The overall seroprevalence of herpes simplex virus type 2 (HSV-2) in a national survey conducted from 2005 to 2008 was 16%, with women and African Americans disproportionately affected. Rates of infection were almost twice as high in women than in men (21% vs. 12%) and were more than three times higher in African Americans than in whites (39% vs. 12%). The population most affected was African American women, who had a herpes prevalence of 48%.

“As stark as these disparities are, they are not substantially different from CDC’s previous estimates of these populations,” said the lead study author, La'Shan Taylor, Dr.P.H., an Epidemic Intelligence Service officer at the CDC.

These estimates, based on data gathered from 7,293 participants in the National Health and Nutrition Examination Survey (NHANES), indicate that the prevalence of HSV-2 has remained stable since the 1999-2004 estimate of 17%, which had followed a decreasing trend in herpes prevalence that had occurred in the last decade, down from 21% in 1988-1994.

The prevalence of HSV-2 increased with age, from 1.4% among 14- to 19-year-olds to 26% among 40- to 49-year-olds, reflecting the lifelong, incurable nature of the infection. Those with a higher number of lifetime sex partners were also more likely to have HSV-2 infection, with the prevalence ranging from 4% among those with 1 lifetime sex partner to 27% in those with 10 or more reported partners.

Regarding the gender and ethnic disparities in herpes prevalence, Dr. Taylor explained that biological factors among women may increase their susceptibility to HSV-2 infection, and that complex social, biological, and environmental factors could contribute to the higher HSV-2 prevalence among African Americans. “Once this disparity exists, herpes infections are likely perpetuated because of the higher prevalence of infections within black communities,” she said.

Dr. John M. Douglas, director of CDC’s Division of STD Prevention, commented that the high prevalence of herpes in African Americans is particularly concerning given the linkage between HSV-2 infection and HIV. Studies have shown that individuals with genital herpes are two to three times more likely to acquire HIV infection. Moreover, among HIV-infected individuals, HSV-2 coinfection increases the likelihood of transmitting HIV. Dr. Douglas suggested that the high rates of genital herpes among African Americans might be contributing to the high rates of HIV in this population.

He added that herpes can cause symptoms other than genital sores, including redness or burning in the genital area that can be mild or mistaken for another condition. Visible sores are not necessary for transmission; individuals with no visible sores or symptoms can still transmit the infection. Thus, “many individuals are transmitting herpes to others without even knowing it,” said Dr. Douglas.

While the CDC does not recommend routine HSV-2 screening for the general population, Dr. Douglas and his colleagues said that testing may be useful in at-risk populations, such as those with multiple sex partners, HIV-positive individuals, and gay and bisexual men.

“We can’t afford to be complacent about this infection,” concluded Dr. Douglas.

Dr. Douglas and Dr. Taylor have no conflicts of interest related to the findings of this study, according to a spokesperson for the CDC.

ATLANTA — About one in six Americans aged 14-49 years is infected with herpes simplex virus type 2, and 81% of these individuals are unaware of their infection, according to data presented at a conference on STD prevention sponsored by the Centers for Disease Control and Prevention.

The overall seroprevalence of herpes simplex virus type 2 (HSV-2) in a national survey conducted from 2005 to 2008 was 16%, with women and African Americans disproportionately affected. Rates of infection were almost twice as high in women than in men (21% vs. 12%) and were more than three times higher in African Americans than in whites (39% vs. 12%). The population most affected was African American women, who had a herpes prevalence of 48%.

“As stark as these disparities are, they are not substantially different from CDC’s previous estimates of these populations,” said the lead study author, La'Shan Taylor, Dr.P.H., an Epidemic Intelligence Service officer at the CDC.

These estimates, based on data gathered from 7,293 participants in the National Health and Nutrition Examination Survey (NHANES), indicate that the prevalence of HSV-2 has remained stable since the 1999-2004 estimate of 17%, which had followed a decreasing trend in herpes prevalence that had occurred in the last decade, down from 21% in 1988-1994.

The prevalence of HSV-2 increased with age, from 1.4% among 14- to 19-year-olds to 26% among 40- to 49-year-olds, reflecting the lifelong, incurable nature of the infection. Those with a higher number of lifetime sex partners were also more likely to have HSV-2 infection, with the prevalence ranging from 4% among those with 1 lifetime sex partner to 27% in those with 10 or more reported partners.

Regarding the gender and ethnic disparities in herpes prevalence, Dr. Taylor explained that biological factors among women may increase their susceptibility to HSV-2 infection, and that complex social, biological, and environmental factors could contribute to the higher HSV-2 prevalence among African Americans. “Once this disparity exists, herpes infections are likely perpetuated because of the higher prevalence of infections within black communities,” she said.

Dr. John M. Douglas, director of CDC’s Division of STD Prevention, commented that the high prevalence of herpes in African Americans is particularly concerning given the linkage between HSV-2 infection and HIV. Studies have shown that individuals with genital herpes are two to three times more likely to acquire HIV infection. Moreover, among HIV-infected individuals, HSV-2 coinfection increases the likelihood of transmitting HIV. Dr. Douglas suggested that the high rates of genital herpes among African Americans might be contributing to the high rates of HIV in this population.

He added that herpes can cause symptoms other than genital sores, including redness or burning in the genital area that can be mild or mistaken for another condition. Visible sores are not necessary for transmission; individuals with no visible sores or symptoms can still transmit the infection. Thus, “many individuals are transmitting herpes to others without even knowing it,” said Dr. Douglas.

While the CDC does not recommend routine HSV-2 screening for the general population, Dr. Douglas and his colleagues said that testing may be useful in at-risk populations, such as those with multiple sex partners, HIV-positive individuals, and gay and bisexual men.

“We can’t afford to be complacent about this infection,” concluded Dr. Douglas.

Dr. Douglas and Dr. Taylor have no conflicts of interest related to the findings of this study, according to a spokesperson for the CDC.

ATLANTA — About one in six Americans aged 14-49 years is infected with herpes simplex virus type 2, and 81% of these individuals are unaware of their infection, according to data presented at a conference on STD prevention sponsored by the Centers for Disease Control and Prevention.

The overall seroprevalence of herpes simplex virus type 2 (HSV-2) in a national survey conducted from 2005 to 2008 was 16%, with women and African Americans disproportionately affected. Rates of infection were almost twice as high in women than in men (21% vs. 12%) and were more than three times higher in African Americans than in whites (39% vs. 12%). The population most affected was African American women, who had a herpes prevalence of 48%.

“As stark as these disparities are, they are not substantially different from CDC’s previous estimates of these populations,” said the lead study author, La'Shan Taylor, Dr.P.H., an Epidemic Intelligence Service officer at the CDC.

These estimates, based on data gathered from 7,293 participants in the National Health and Nutrition Examination Survey (NHANES), indicate that the prevalence of HSV-2 has remained stable since the 1999-2004 estimate of 17%, which had followed a decreasing trend in herpes prevalence that had occurred in the last decade, down from 21% in 1988-1994.

The prevalence of HSV-2 increased with age, from 1.4% among 14- to 19-year-olds to 26% among 40- to 49-year-olds, reflecting the lifelong, incurable nature of the infection. Those with a higher number of lifetime sex partners were also more likely to have HSV-2 infection, with the prevalence ranging from 4% among those with 1 lifetime sex partner to 27% in those with 10 or more reported partners.

Regarding the gender and ethnic disparities in herpes prevalence, Dr. Taylor explained that biological factors among women may increase their susceptibility to HSV-2 infection, and that complex social, biological, and environmental factors could contribute to the higher HSV-2 prevalence among African Americans. “Once this disparity exists, herpes infections are likely perpetuated because of the higher prevalence of infections within black communities,” she said.

Dr. John M. Douglas, director of CDC’s Division of STD Prevention, commented that the high prevalence of herpes in African Americans is particularly concerning given the linkage between HSV-2 infection and HIV. Studies have shown that individuals with genital herpes are two to three times more likely to acquire HIV infection. Moreover, among HIV-infected individuals, HSV-2 coinfection increases the likelihood of transmitting HIV. Dr. Douglas suggested that the high rates of genital herpes among African Americans might be contributing to the high rates of HIV in this population.

He added that herpes can cause symptoms other than genital sores, including redness or burning in the genital area that can be mild or mistaken for another condition. Visible sores are not necessary for transmission; individuals with no visible sores or symptoms can still transmit the infection. Thus, “many individuals are transmitting herpes to others without even knowing it,” said Dr. Douglas.

While the CDC does not recommend routine HSV-2 screening for the general population, Dr. Douglas and his colleagues said that testing may be useful in at-risk populations, such as those with multiple sex partners, HIV-positive individuals, and gay and bisexual men.

“We can’t afford to be complacent about this infection,” concluded Dr. Douglas.

Dr. Douglas and Dr. Taylor have no conflicts of interest related to the findings of this study, according to a spokesperson for the CDC.

The inflammatory markers interleukin-6 and C-reactive protein as well as macroalbuminuria are independently predictive of heart failure, according to a study that followed nearly 7,000 Americans for a median of 4 years.

Each standard deviation increase in serum interleukin-6 or CRP level raised the risk of heart failure (HF) by 50% and 38%, respectively, while the presence of macroalbuminuria increased the risk 4.3-fold (J. Am. Coll. Cardiol. 2008;51:1775–83).

These associations were strong “even after adjustment for established risk factors, LV [left ventricular] dysfunction, and interim MI,” wrote Dr. Hossein Bahrami of Johns Hopkins University, Baltimore, and colleagues.

The community-based Multi-Ethnic Study of Atherosclerosis is a multicenter cohort study of 6,814 whites, blacks, Hispanics, and Chinese Americans with no history of symptomatic cardiovascular disease. Overall, 79 participants developed HF during the study period and 26 of those individuals (33%) had an interim MI. Participants who developed HF were more likely to be older, male, obese, and current smokers and to have hypertension and diabetes.

The presence of metabolic syndrome at baseline (seen in 35% of participants) more than doubled the risk of HF. Specifically, the absolute risk of HF in obese individuals was 16/1,000, compared with 10/1,000 in the nonobese. However, the association between obesity and incident HF was no longer significant after the model was adjusted to include the two inflammatory markers, they reported.

Very few participants (1.3%) had left ventricular ejection fraction (LVEF) below 50%, though 10% of participants had left ventricular hypertrophy (LVH) at baseline by Framingham criteria. Among the individuals who developed HF, rates of LVEF below 50% and LVH were 15% and 32%, respectively.

LVEF was the strongest predictor of incident HF and was therefore incorporated into the multivariate analysis. Among the 60 participants with LV function data at time of HF diagnosis, 87% had LVEF of 30% or greater, 65% had LVEF of 40% or greater, and 55% had LVEF of 50% or greater, the investigators wrote.

The inflammatory markers interleukin-6 and C-reactive protein as well as macroalbuminuria are independently predictive of heart failure, according to a study that followed nearly 7,000 Americans for a median of 4 years.

Each standard deviation increase in serum interleukin-6 or CRP level raised the risk of heart failure (HF) by 50% and 38%, respectively, while the presence of macroalbuminuria increased the risk 4.3-fold (J. Am. Coll. Cardiol. 2008;51:1775–83).

These associations were strong “even after adjustment for established risk factors, LV [left ventricular] dysfunction, and interim MI,” wrote Dr. Hossein Bahrami of Johns Hopkins University, Baltimore, and colleagues.

The community-based Multi-Ethnic Study of Atherosclerosis is a multicenter cohort study of 6,814 whites, blacks, Hispanics, and Chinese Americans with no history of symptomatic cardiovascular disease. Overall, 79 participants developed HF during the study period and 26 of those individuals (33%) had an interim MI. Participants who developed HF were more likely to be older, male, obese, and current smokers and to have hypertension and diabetes.

The presence of metabolic syndrome at baseline (seen in 35% of participants) more than doubled the risk of HF. Specifically, the absolute risk of HF in obese individuals was 16/1,000, compared with 10/1,000 in the nonobese. However, the association between obesity and incident HF was no longer significant after the model was adjusted to include the two inflammatory markers, they reported.

Very few participants (1.3%) had left ventricular ejection fraction (LVEF) below 50%, though 10% of participants had left ventricular hypertrophy (LVH) at baseline by Framingham criteria. Among the individuals who developed HF, rates of LVEF below 50% and LVH were 15% and 32%, respectively.

LVEF was the strongest predictor of incident HF and was therefore incorporated into the multivariate analysis. Among the 60 participants with LV function data at time of HF diagnosis, 87% had LVEF of 30% or greater, 65% had LVEF of 40% or greater, and 55% had LVEF of 50% or greater, the investigators wrote.

The inflammatory markers interleukin-6 and C-reactive protein as well as macroalbuminuria are independently predictive of heart failure, according to a study that followed nearly 7,000 Americans for a median of 4 years.

Each standard deviation increase in serum interleukin-6 or CRP level raised the risk of heart failure (HF) by 50% and 38%, respectively, while the presence of macroalbuminuria increased the risk 4.3-fold (J. Am. Coll. Cardiol. 2008;51:1775–83).

These associations were strong “even after adjustment for established risk factors, LV [left ventricular] dysfunction, and interim MI,” wrote Dr. Hossein Bahrami of Johns Hopkins University, Baltimore, and colleagues.

The community-based Multi-Ethnic Study of Atherosclerosis is a multicenter cohort study of 6,814 whites, blacks, Hispanics, and Chinese Americans with no history of symptomatic cardiovascular disease. Overall, 79 participants developed HF during the study period and 26 of those individuals (33%) had an interim MI. Participants who developed HF were more likely to be older, male, obese, and current smokers and to have hypertension and diabetes.

The presence of metabolic syndrome at baseline (seen in 35% of participants) more than doubled the risk of HF. Specifically, the absolute risk of HF in obese individuals was 16/1,000, compared with 10/1,000 in the nonobese. However, the association between obesity and incident HF was no longer significant after the model was adjusted to include the two inflammatory markers, they reported.

Very few participants (1.3%) had left ventricular ejection fraction (LVEF) below 50%, though 10% of participants had left ventricular hypertrophy (LVH) at baseline by Framingham criteria. Among the individuals who developed HF, rates of LVEF below 50% and LVH were 15% and 32%, respectively.

LVEF was the strongest predictor of incident HF and was therefore incorporated into the multivariate analysis. Among the 60 participants with LV function data at time of HF diagnosis, 87% had LVEF of 30% or greater, 65% had LVEF of 40% or greater, and 55% had LVEF of 50% or greater, the investigators wrote.

ATLANTA — Healthy children between 2 and 5 years of age who have been incompletely vaccinated against pneumococcal disease should receive one dose of 7-valent pneumococcal conjugate vaccine, the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices voted at its fall meeting.

The panel also voted that children aged 24-59 months with underlying medical conditions who are incompletely vaccinated should receive two doses of 7-valent pneumococcal conjugate vaccine (PCV7) at least 2 months apart, unless they have already received three doses, in which case one dose should be given.

The definition of underlying conditions includes sickle-cell disease or related conditions, splenic dysfunction, HIV infection, immunocompromising conditions, chronic cardiac or pulmonary disease, cerebrospinal fluid leaks, and diabetes mellitus (MMWR 2000;49[RR-9]:1-38).

"The Work Group feels that simplifying and expanding the catch-up recommendation may improve PCV7 coverage among healthy, unvaccinated or incompletely vaccinated children aged 24-59 months, including immigrants and adoptees," said Dr. Pekka Nuorti of the CDC.

The catch-up recommendations could apply to a significant proportion of children, given that 32% of children aged 2-5 years have received fewer than four doses of PCV7, according to 2006 National Immunization Survey data. However, the majority of children (87%) have received at least three doses of the vaccine.

The ACIP vote passed 11-3, with panel members raising several concerns. Some questioned the extent of disease prevention that the change would provide and the cost-effectiveness of the recommendation. No formal cost-effectiveness analysis has been done, and panel members explained that the aim was just to clarify the existing recommendations. ACIP plans to revise its statement on pneumococcal diseases this year.

ATLANTA — Healthy children between 2 and 5 years of age who have been incompletely vaccinated against pneumococcal disease should receive one dose of 7-valent pneumococcal conjugate vaccine, the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices voted at its fall meeting.

The panel also voted that children aged 24-59 months with underlying medical conditions who are incompletely vaccinated should receive two doses of 7-valent pneumococcal conjugate vaccine (PCV7) at least 2 months apart, unless they have already received three doses, in which case one dose should be given.

The definition of underlying conditions includes sickle-cell disease or related conditions, splenic dysfunction, HIV infection, immunocompromising conditions, chronic cardiac or pulmonary disease, cerebrospinal fluid leaks, and diabetes mellitus (MMWR 2000;49[RR-9]:1-38).

"The Work Group feels that simplifying and expanding the catch-up recommendation may improve PCV7 coverage among healthy, unvaccinated or incompletely vaccinated children aged 24-59 months, including immigrants and adoptees," said Dr. Pekka Nuorti of the CDC.

The catch-up recommendations could apply to a significant proportion of children, given that 32% of children aged 2-5 years have received fewer than four doses of PCV7, according to 2006 National Immunization Survey data. However, the majority of children (87%) have received at least three doses of the vaccine.

The ACIP vote passed 11-3, with panel members raising several concerns. Some questioned the extent of disease prevention that the change would provide and the cost-effectiveness of the recommendation. No formal cost-effectiveness analysis has been done, and panel members explained that the aim was just to clarify the existing recommendations. ACIP plans to revise its statement on pneumococcal diseases this year.

ATLANTA — Healthy children between 2 and 5 years of age who have been incompletely vaccinated against pneumococcal disease should receive one dose of 7-valent pneumococcal conjugate vaccine, the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices voted at its fall meeting.

The panel also voted that children aged 24-59 months with underlying medical conditions who are incompletely vaccinated should receive two doses of 7-valent pneumococcal conjugate vaccine (PCV7) at least 2 months apart, unless they have already received three doses, in which case one dose should be given.

The definition of underlying conditions includes sickle-cell disease or related conditions, splenic dysfunction, HIV infection, immunocompromising conditions, chronic cardiac or pulmonary disease, cerebrospinal fluid leaks, and diabetes mellitus (MMWR 2000;49[RR-9]:1-38).

"The Work Group feels that simplifying and expanding the catch-up recommendation may improve PCV7 coverage among healthy, unvaccinated or incompletely vaccinated children aged 24-59 months, including immigrants and adoptees," said Dr. Pekka Nuorti of the CDC.

The catch-up recommendations could apply to a significant proportion of children, given that 32% of children aged 2-5 years have received fewer than four doses of PCV7, according to 2006 National Immunization Survey data. However, the majority of children (87%) have received at least three doses of the vaccine.

The ACIP vote passed 11-3, with panel members raising several concerns. Some questioned the extent of disease prevention that the change would provide and the cost-effectiveness of the recommendation. No formal cost-effectiveness analysis has been done, and panel members explained that the aim was just to clarify the existing recommendations. ACIP plans to revise its statement on pneumococcal diseases this year.

ATLANTA — Healthy children between 2 and 5 years of age who have been incompletely vaccinated against pneumococcal disease should receive one dose of 7-valent pneumococcal conjugate vaccine, the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices voted at its fall meeting.

The panel also voted that children aged 24–59 months with underlying medical conditions who are incompletely vaccinated should receive two doses of 7-valent pneumococcal conjugate vaccine (PCV7) at least 2 months apart, unless they have already received three doses, in which case one dose should be given.

The definition of underlying conditions is unchanged and includes sickle-cell disease or related conditions, splenic dysfunction, HIV infection, immunocompromising conditions, chronic cardiac or pulmonary disease, cerebrospinal fluid leaks, and diabetes mellitus (MMWR 2000; 49(RR-9):1–38).

“Simplifying and expanding the catch-up recommendation may improve PCV7 coverage in healthy, unvaccinated, or incompletely vaccinated children aged 24–59 months,” said Dr. Pekka Nuorti of the CDC.

The ACIP vote passed 11–3. Some panel members questioned the extent of disease prevention the change would provide and the cost-effectiveness of the recommendation. No formal cost-effectiveness analysis has been done, and members explained the aim was just to clarify the existing recommendations. ACIP plans to revise its statement on pneumococcal diseases in 2008.

ATLANTA — Healthy children between 2 and 5 years of age who have been incompletely vaccinated against pneumococcal disease should receive one dose of 7-valent pneumococcal conjugate vaccine, the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices voted at its fall meeting.

The panel also voted that children aged 24–59 months with underlying medical conditions who are incompletely vaccinated should receive two doses of 7-valent pneumococcal conjugate vaccine (PCV7) at least 2 months apart, unless they have already received three doses, in which case one dose should be given.

The definition of underlying conditions is unchanged and includes sickle-cell disease or related conditions, splenic dysfunction, HIV infection, immunocompromising conditions, chronic cardiac or pulmonary disease, cerebrospinal fluid leaks, and diabetes mellitus (MMWR 2000; 49(RR-9):1–38).

“Simplifying and expanding the catch-up recommendation may improve PCV7 coverage in healthy, unvaccinated, or incompletely vaccinated children aged 24–59 months,” said Dr. Pekka Nuorti of the CDC.

The ACIP vote passed 11–3. Some panel members questioned the extent of disease prevention the change would provide and the cost-effectiveness of the recommendation. No formal cost-effectiveness analysis has been done, and members explained the aim was just to clarify the existing recommendations. ACIP plans to revise its statement on pneumococcal diseases in 2008.

ATLANTA — Healthy children between 2 and 5 years of age who have been incompletely vaccinated against pneumococcal disease should receive one dose of 7-valent pneumococcal conjugate vaccine, the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices voted at its fall meeting.

The panel also voted that children aged 24–59 months with underlying medical conditions who are incompletely vaccinated should receive two doses of 7-valent pneumococcal conjugate vaccine (PCV7) at least 2 months apart, unless they have already received three doses, in which case one dose should be given.

The definition of underlying conditions is unchanged and includes sickle-cell disease or related conditions, splenic dysfunction, HIV infection, immunocompromising conditions, chronic cardiac or pulmonary disease, cerebrospinal fluid leaks, and diabetes mellitus (MMWR 2000; 49(RR-9):1–38).

“Simplifying and expanding the catch-up recommendation may improve PCV7 coverage in healthy, unvaccinated, or incompletely vaccinated children aged 24–59 months,” said Dr. Pekka Nuorti of the CDC.

The ACIP vote passed 11–3. Some panel members questioned the extent of disease prevention the change would provide and the cost-effectiveness of the recommendation. No formal cost-effectiveness analysis has been done, and members explained the aim was just to clarify the existing recommendations. ACIP plans to revise its statement on pneumococcal diseases in 2008.

ATLANTA — The live, attenuated influenza virus vaccine can be used in children 2–5 years of age with no wheezing in the past 12 months, the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices recommended at their fall meeting.

LAIV vaccine, manufactured as FluMist by MedImmune Inc., should not be administered to individuals with asthma or to children younger than age 5 with recurrent wheezing, ACIP said.

Acknowledging the difficulty in identifying recurrent wheezing in young children, the committee suggested physicians ask parents of 2- to 5-year-olds (children aged 24–59 months) the following question before administering FluMist: “In the past 12 months, has a health care provider ever told you that your child had wheezing or asthma?” The vaccine is not recommended for children whose parents answer yes to the question or for those with wheezing noted in their chart within the past year.

For healthy 2- to 49-year-olds, either trivalent inactivated virus (TIV) vaccine or LAIV vaccine can be used for flu immunization.

The Food and Drug Administration approved FluMist for children aged 24 months up to 59 months, on Sept. 19, 2007.

Dr. Joseph Bocchini of Louisiana State University, Shreveport, the American Academy of Pediatrics liaison at the meeting, said the approval “expands our ability to provide vaccine to 2- to 5-year-olds” and provided a choice of which vaccine to give.

ATLANTA — The live, attenuated influenza virus vaccine can be used in children 2–5 years of age with no wheezing in the past 12 months, the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices recommended at their fall meeting.

LAIV vaccine, manufactured as FluMist by MedImmune Inc., should not be administered to individuals with asthma or to children younger than age 5 with recurrent wheezing, ACIP said.

Acknowledging the difficulty in identifying recurrent wheezing in young children, the committee suggested physicians ask parents of 2- to 5-year-olds (children aged 24–59 months) the following question before administering FluMist: “In the past 12 months, has a health care provider ever told you that your child had wheezing or asthma?” The vaccine is not recommended for children whose parents answer yes to the question or for those with wheezing noted in their chart within the past year.

For healthy 2- to 49-year-olds, either trivalent inactivated virus (TIV) vaccine or LAIV vaccine can be used for flu immunization.

The Food and Drug Administration approved FluMist for children aged 24 months up to 59 months, on Sept. 19, 2007.

Dr. Joseph Bocchini of Louisiana State University, Shreveport, the American Academy of Pediatrics liaison at the meeting, said the approval “expands our ability to provide vaccine to 2- to 5-year-olds” and provided a choice of which vaccine to give.

ATLANTA — The live, attenuated influenza virus vaccine can be used in children 2–5 years of age with no wheezing in the past 12 months, the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices recommended at their fall meeting.

LAIV vaccine, manufactured as FluMist by MedImmune Inc., should not be administered to individuals with asthma or to children younger than age 5 with recurrent wheezing, ACIP said.

Acknowledging the difficulty in identifying recurrent wheezing in young children, the committee suggested physicians ask parents of 2- to 5-year-olds (children aged 24–59 months) the following question before administering FluMist: “In the past 12 months, has a health care provider ever told you that your child had wheezing or asthma?” The vaccine is not recommended for children whose parents answer yes to the question or for those with wheezing noted in their chart within the past year.

For healthy 2- to 49-year-olds, either trivalent inactivated virus (TIV) vaccine or LAIV vaccine can be used for flu immunization.

The Food and Drug Administration approved FluMist for children aged 24 months up to 59 months, on Sept. 19, 2007.

Dr. Joseph Bocchini of Louisiana State University, Shreveport, the American Academy of Pediatrics liaison at the meeting, said the approval “expands our ability to provide vaccine to 2- to 5-year-olds” and provided a choice of which vaccine to give.

ATLANTA — The tetravalent meningococcal conjugate vaccine is now recommended for children aged 2–10 years with an increased risk of meningococcal disease, the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices voted at its fall meeting.

The tetravalent meningococcal conjugate vaccine (MCV4), marketed as Menactra by Sanofi Pasteur Inc., was approved by the Food and Drug Administration on Oct. 18, 2007, for use in 2- to 10-year-olds.

The committee members voted (12 “yes” and 2 abstentions) to recommend MCV4 over the meningococcal polysaccharide vaccine (MPSV4) that is currently used in children in this age group. They emphasized that this is not a recommendation to administer MCV4 to all 2- to 10-year-olds—only to at-risk children, which includes those with functional or anatomy asplenia, terminal complement deficiencies, or HIV infection, and children traveling to areas endemic for Neisseria meningitidis.

The current vaccine, MPSV4, has shown safety and efficacy in children at least 2 years of age, but serum bacterial antibodies are known to decline after a few years. It's hoped that the new conjugate vaccine might provide a longer duration of protection, though this hasn't been determined.

“For children 2–10 years old with increased risk of meningococcal disease, MCV4 is preferable to MPSV4,” said Dr. Amanda Cohn, of the Meningitis and Vaccine Preventable Diseases Branch of the National Center for Immunizations and Respiratory Diseases (NCIRD), on behalf of the ACIP Meningococcal Working Group.

In 2005, Dr. Michael Pichichero of the University of Rochester, New York, and his colleagues demonstrated comparable immunogenicity with MPSV4 and MCV4 and similar safety profiles (Pediatr. Infect. Dis. J. 2005;24:57–62). MCV4 is associated with a greater incidence of local reactions, including swelling (20%, compared with 15% with MPSV4) and induration (22% vs. 16%); though most reactions resolve within 3 days.

A group of 4- to 5-year-olds who received an MCV4 vaccination followed by an MPSV4 challenge dose 2–3 years later showed booster responses on the challenge.

ACIP also suggested children aged 2–10 years old who have received MPSV4 and remain at risk for meningococcal disease should receive MCV4 about 3–5 years after their MPSV4 shot. The advisory committee will provide recommendations for revaccination when additional data on the duration of protection with MCV4 become available.

The panel did not address what should happen when a child turns 11 and falls outside the recommended age range for the vaccine. However, it noted the increased incidence of Guillain-Barré syndrome (GBS) associated with MCV4, and recommended that a history of GBS should be a precaution to receiving the vaccine.

ACIP anticipates voting on the use of meningococcal vaccine in all 2- to 10-year-olds in February 2008.

GBS, the Vaccine, And Adolescents

Guillain-Barré syndrome is a subacute-onset neuropathy involving bilateral, symmetric, flaccid paralysis. The condition has an autoimmune etiology, with vaccines accounting for some reported cases.

One case of Guillain-Barré syndrome (GBS) after the MPSV4 vaccine was reported to Vaccine Adverse Events Reporting System (VAERS) between 1990 and 1999.

As of October 2007, 24 reports of GBS after MCV4 have been made to VAERS: 20 cases in 15- to 19-year-olds, 2 cases in 11- to 14-year-olds, and 2 cases in persons aged at least 19 years. In the 22 adolescents with GBS, the onset of symptoms occurred between 2 and 33 days after vaccination, with a cluster of 13 cases at 9–16 days. MCV4 thus is predicted to result in five excess cases of GBS predicted per million 11-year-olds vaccinated but would prevent an estimated 359 cases of meningococcal disease and 35 associated deaths in the same group.

Dr. Thomas Clark of the Meningitis and Vaccine Preventable Diseases Branch of the NCIRD said this risk is comparable with that seen in seasonal influenza vaccine in some years.

ATLANTA — The tetravalent meningococcal conjugate vaccine is now recommended for children aged 2–10 years with an increased risk of meningococcal disease, the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices voted at its fall meeting.

The tetravalent meningococcal conjugate vaccine (MCV4), marketed as Menactra by Sanofi Pasteur Inc., was approved by the Food and Drug Administration on Oct. 18, 2007, for use in 2- to 10-year-olds.

The committee members voted (12 “yes” and 2 abstentions) to recommend MCV4 over the meningococcal polysaccharide vaccine (MPSV4) that is currently used in children in this age group. They emphasized that this is not a recommendation to administer MCV4 to all 2- to 10-year-olds—only to at-risk children, which includes those with functional or anatomy asplenia, terminal complement deficiencies, or HIV infection, and children traveling to areas endemic for Neisseria meningitidis.

The current vaccine, MPSV4, has shown safety and efficacy in children at least 2 years of age, but serum bacterial antibodies are known to decline after a few years. It's hoped that the new conjugate vaccine might provide a longer duration of protection, though this hasn't been determined.

“For children 2–10 years old with increased risk of meningococcal disease, MCV4 is preferable to MPSV4,” said Dr. Amanda Cohn, of the Meningitis and Vaccine Preventable Diseases Branch of the National Center for Immunizations and Respiratory Diseases (NCIRD), on behalf of the ACIP Meningococcal Working Group.

In 2005, Dr. Michael Pichichero of the University of Rochester, New York, and his colleagues demonstrated comparable immunogenicity with MPSV4 and MCV4 and similar safety profiles (Pediatr. Infect. Dis. J. 2005;24:57–62). MCV4 is associated with a greater incidence of local reactions, including swelling (20%, compared with 15% with MPSV4) and induration (22% vs. 16%); though most reactions resolve within 3 days.

A group of 4- to 5-year-olds who received an MCV4 vaccination followed by an MPSV4 challenge dose 2–3 years later showed booster responses on the challenge.

ACIP also suggested children aged 2–10 years old who have received MPSV4 and remain at risk for meningococcal disease should receive MCV4 about 3–5 years after their MPSV4 shot. The advisory committee will provide recommendations for revaccination when additional data on the duration of protection with MCV4 become available.

The panel did not address what should happen when a child turns 11 and falls outside the recommended age range for the vaccine. However, it noted the increased incidence of Guillain-Barré syndrome (GBS) associated with MCV4, and recommended that a history of GBS should be a precaution to receiving the vaccine.

ACIP anticipates voting on the use of meningococcal vaccine in all 2- to 10-year-olds in February 2008.

GBS, the Vaccine, And Adolescents

Guillain-Barré syndrome is a subacute-onset neuropathy involving bilateral, symmetric, flaccid paralysis. The condition has an autoimmune etiology, with vaccines accounting for some reported cases.

One case of Guillain-Barré syndrome (GBS) after the MPSV4 vaccine was reported to Vaccine Adverse Events Reporting System (VAERS) between 1990 and 1999.

As of October 2007, 24 reports of GBS after MCV4 have been made to VAERS: 20 cases in 15- to 19-year-olds, 2 cases in 11- to 14-year-olds, and 2 cases in persons aged at least 19 years. In the 22 adolescents with GBS, the onset of symptoms occurred between 2 and 33 days after vaccination, with a cluster of 13 cases at 9–16 days. MCV4 thus is predicted to result in five excess cases of GBS predicted per million 11-year-olds vaccinated but would prevent an estimated 359 cases of meningococcal disease and 35 associated deaths in the same group.

Dr. Thomas Clark of the Meningitis and Vaccine Preventable Diseases Branch of the NCIRD said this risk is comparable with that seen in seasonal influenza vaccine in some years.

ATLANTA — The tetravalent meningococcal conjugate vaccine is now recommended for children aged 2–10 years with an increased risk of meningococcal disease, the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices voted at its fall meeting.

The tetravalent meningococcal conjugate vaccine (MCV4), marketed as Menactra by Sanofi Pasteur Inc., was approved by the Food and Drug Administration on Oct. 18, 2007, for use in 2- to 10-year-olds.

The committee members voted (12 “yes” and 2 abstentions) to recommend MCV4 over the meningococcal polysaccharide vaccine (MPSV4) that is currently used in children in this age group. They emphasized that this is not a recommendation to administer MCV4 to all 2- to 10-year-olds—only to at-risk children, which includes those with functional or anatomy asplenia, terminal complement deficiencies, or HIV infection, and children traveling to areas endemic for Neisseria meningitidis.

The current vaccine, MPSV4, has shown safety and efficacy in children at least 2 years of age, but serum bacterial antibodies are known to decline after a few years. It's hoped that the new conjugate vaccine might provide a longer duration of protection, though this hasn't been determined.

“For children 2–10 years old with increased risk of meningococcal disease, MCV4 is preferable to MPSV4,” said Dr. Amanda Cohn, of the Meningitis and Vaccine Preventable Diseases Branch of the National Center for Immunizations and Respiratory Diseases (NCIRD), on behalf of the ACIP Meningococcal Working Group.

In 2005, Dr. Michael Pichichero of the University of Rochester, New York, and his colleagues demonstrated comparable immunogenicity with MPSV4 and MCV4 and similar safety profiles (Pediatr. Infect. Dis. J. 2005;24:57–62). MCV4 is associated with a greater incidence of local reactions, including swelling (20%, compared with 15% with MPSV4) and induration (22% vs. 16%); though most reactions resolve within 3 days.

A group of 4- to 5-year-olds who received an MCV4 vaccination followed by an MPSV4 challenge dose 2–3 years later showed booster responses on the challenge.

ACIP also suggested children aged 2–10 years old who have received MPSV4 and remain at risk for meningococcal disease should receive MCV4 about 3–5 years after their MPSV4 shot. The advisory committee will provide recommendations for revaccination when additional data on the duration of protection with MCV4 become available.

The panel did not address what should happen when a child turns 11 and falls outside the recommended age range for the vaccine. However, it noted the increased incidence of Guillain-Barré syndrome (GBS) associated with MCV4, and recommended that a history of GBS should be a precaution to receiving the vaccine.

ACIP anticipates voting on the use of meningococcal vaccine in all 2- to 10-year-olds in February 2008.

GBS, the Vaccine, And Adolescents

Guillain-Barré syndrome is a subacute-onset neuropathy involving bilateral, symmetric, flaccid paralysis. The condition has an autoimmune etiology, with vaccines accounting for some reported cases.

One case of Guillain-Barré syndrome (GBS) after the MPSV4 vaccine was reported to Vaccine Adverse Events Reporting System (VAERS) between 1990 and 1999.

As of October 2007, 24 reports of GBS after MCV4 have been made to VAERS: 20 cases in 15- to 19-year-olds, 2 cases in 11- to 14-year-olds, and 2 cases in persons aged at least 19 years. In the 22 adolescents with GBS, the onset of symptoms occurred between 2 and 33 days after vaccination, with a cluster of 13 cases at 9–16 days. MCV4 thus is predicted to result in five excess cases of GBS predicted per million 11-year-olds vaccinated but would prevent an estimated 359 cases of meningococcal disease and 35 associated deaths in the same group.

Dr. Thomas Clark of the Meningitis and Vaccine Preventable Diseases Branch of the NCIRD said this risk is comparable with that seen in seasonal influenza vaccine in some years.

ATLANTA — A history of Guillain-Barré syndrome is a precaution for administration of the tetravalent meningococcal conjugate vaccine, the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices voted at its fall meeting.

A precaution is a condition that might increase the risk for a serious adverse reaction or compromise the vaccine's ability to produce immunity, according to the CDC. However, the risk is less than that expected for a contraindication. Although vaccinations normally should be deferred in the case of a precaution, in some instances, the benefit of protection might outweigh the potential risk.

Guillain-Barré syndrome is a subacute-onset neuropathy involving bilateral, symmetric, flaccid paralysis. The condition has an autoimmune etiology, with vaccines accounting for some reported cases.

The most notable episode involved the 1976 “swine flu” vaccine, in which the attributable risk was 5–12 cases per million (Am. J. Epidemiol. 1979;110:105–23).

As of October 2007, VAERS has received 24 reports of Guillain-Barré syndrome following use of the tetravalent meningococcal conjugate vaccine (MCV4), marketed as Menactra by Sanofi Pasteur. There were 20 cases in 15- to 19-year-olds, 2 cases in 11- to 14-year-olds, and 2 cases in persons at least 19 years of age. Among the 22 adolescents, the onset of symptoms occurred 2–33 days after vaccination, with a cluster of 13 cases occurring at 9–16 days.

MCV4 thus is predicted to result in five excess cases of Guillain-Barré syndrome per million 11-year-olds vaccinated. The vaccine would prevent an estimated 359 cases of meningococcal disease and 35 associated deaths in the same group.

Dr. Thomas Clark, of the Meningitis and Vaccine Preventable Diseases Branch of the National Center for Immunizations and Respiratory Diseases, noted that this risk is comparable with that of influenza vaccine.

ATLANTA — A history of Guillain-Barré syndrome is a precaution for administration of the tetravalent meningococcal conjugate vaccine, the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices voted at its fall meeting.

A precaution is a condition that might increase the risk for a serious adverse reaction or compromise the vaccine's ability to produce immunity, according to the CDC. However, the risk is less than that expected for a contraindication. Although vaccinations normally should be deferred in the case of a precaution, in some instances, the benefit of protection might outweigh the potential risk.

Guillain-Barré syndrome is a subacute-onset neuropathy involving bilateral, symmetric, flaccid paralysis. The condition has an autoimmune etiology, with vaccines accounting for some reported cases.

The most notable episode involved the 1976 “swine flu” vaccine, in which the attributable risk was 5–12 cases per million (Am. J. Epidemiol. 1979;110:105–23).

As of October 2007, VAERS has received 24 reports of Guillain-Barré syndrome following use of the tetravalent meningococcal conjugate vaccine (MCV4), marketed as Menactra by Sanofi Pasteur. There were 20 cases in 15- to 19-year-olds, 2 cases in 11- to 14-year-olds, and 2 cases in persons at least 19 years of age. Among the 22 adolescents, the onset of symptoms occurred 2–33 days after vaccination, with a cluster of 13 cases occurring at 9–16 days.

MCV4 thus is predicted to result in five excess cases of Guillain-Barré syndrome per million 11-year-olds vaccinated. The vaccine would prevent an estimated 359 cases of meningococcal disease and 35 associated deaths in the same group.

Dr. Thomas Clark, of the Meningitis and Vaccine Preventable Diseases Branch of the National Center for Immunizations and Respiratory Diseases, noted that this risk is comparable with that of influenza vaccine.

ATLANTA — A history of Guillain-Barré syndrome is a precaution for administration of the tetravalent meningococcal conjugate vaccine, the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices voted at its fall meeting.

A precaution is a condition that might increase the risk for a serious adverse reaction or compromise the vaccine's ability to produce immunity, according to the CDC. However, the risk is less than that expected for a contraindication. Although vaccinations normally should be deferred in the case of a precaution, in some instances, the benefit of protection might outweigh the potential risk.

Guillain-Barré syndrome is a subacute-onset neuropathy involving bilateral, symmetric, flaccid paralysis. The condition has an autoimmune etiology, with vaccines accounting for some reported cases.

The most notable episode involved the 1976 “swine flu” vaccine, in which the attributable risk was 5–12 cases per million (Am. J. Epidemiol. 1979;110:105–23).

As of October 2007, VAERS has received 24 reports of Guillain-Barré syndrome following use of the tetravalent meningococcal conjugate vaccine (MCV4), marketed as Menactra by Sanofi Pasteur. There were 20 cases in 15- to 19-year-olds, 2 cases in 11- to 14-year-olds, and 2 cases in persons at least 19 years of age. Among the 22 adolescents, the onset of symptoms occurred 2–33 days after vaccination, with a cluster of 13 cases occurring at 9–16 days.

MCV4 thus is predicted to result in five excess cases of Guillain-Barré syndrome per million 11-year-olds vaccinated. The vaccine would prevent an estimated 359 cases of meningococcal disease and 35 associated deaths in the same group.

Dr. Thomas Clark, of the Meningitis and Vaccine Preventable Diseases Branch of the National Center for Immunizations and Respiratory Diseases, noted that this risk is comparable with that of influenza vaccine.