Robert Finn

The birth rate for U.S. teens aged 15–19 years fell to the lowest level since recording began in 1940, according to new data for 2009.

The 2009 teen birth rate was 39.1 births per 1,000 teens, down 6% from the 2008 rate of 41.5 births per 1,000, according to the report by the CDC National Center for Health Statistics. The 2009 rate was 37% lower than in 1991, the peak year for teen births.

The CDC's annual report is based on virtually 100% of vital records collected in the 50 U.S. states, the District of Columbia, and U.S. territories.

The report is available at www.cdc.gov/nchs

Overall fertility also fell in 2009 to 66.7 births per 1,000 women aged 15–44 years, compared with 68.6 per 1,000 women in 2008.

The CDC's preliminary estimate of births in 2009 was 4,131,019, 3% less than 2008.

Early data through June 2010 suggest that the decline in fertility has continued, according to the report.

Fertility rates increased in only one age group: women aged 40–44 years. In that group, the 2009 rate was 10.1 births per 1,000 women, up 3% from the 2008 figure and the highest rate since 1967.

The rate of preterm births declined for the third straight year, to 12.2% of all births in 2009.

The rate of cesarean deliveries rose to a record high of 32.9% in 2009, up from 32.3% in 2008.

The low-birth-weight rate remained unchanged at about 8.2% between 2008 and 2009.

The CDC also reported the total fertility rate (TFR) – an estimate of the number of births that a hypothetical group of 1,000 women would have over their lifetimes, based on the age-specific rates of a particular year.

The TFR for 2009 was 2,007.5, down 4% from the rate in 2008. This is the largest decline in TFR since 1973.

The 2008 and 2009 rates were both below the replacement rate of 2,100 births per 1,000 women.

Replacement is the rate at which a given generation can exactly replace itself.

The U.S. TFR was below replacement for every year between 1972 and 2005 and above replacement in 2006 and 2007.

The birth rate for U.S. teens aged 15–19 years fell to the lowest level since recording began in 1940, according to new data for 2009.

The 2009 teen birth rate was 39.1 births per 1,000 teens, down 6% from the 2008 rate of 41.5 births per 1,000, according to the report by the CDC National Center for Health Statistics. The 2009 rate was 37% lower than in 1991, the peak year for teen births.

The CDC's annual report is based on virtually 100% of vital records collected in the 50 U.S. states, the District of Columbia, and U.S. territories.

The report is available at www.cdc.gov/nchs

Overall fertility also fell in 2009 to 66.7 births per 1,000 women aged 15–44 years, compared with 68.6 per 1,000 women in 2008.

The CDC's preliminary estimate of births in 2009 was 4,131,019, 3% less than 2008.

Early data through June 2010 suggest that the decline in fertility has continued, according to the report.

Fertility rates increased in only one age group: women aged 40–44 years. In that group, the 2009 rate was 10.1 births per 1,000 women, up 3% from the 2008 figure and the highest rate since 1967.

The rate of preterm births declined for the third straight year, to 12.2% of all births in 2009.

The rate of cesarean deliveries rose to a record high of 32.9% in 2009, up from 32.3% in 2008.

The low-birth-weight rate remained unchanged at about 8.2% between 2008 and 2009.

The CDC also reported the total fertility rate (TFR) – an estimate of the number of births that a hypothetical group of 1,000 women would have over their lifetimes, based on the age-specific rates of a particular year.

The TFR for 2009 was 2,007.5, down 4% from the rate in 2008. This is the largest decline in TFR since 1973.

The 2008 and 2009 rates were both below the replacement rate of 2,100 births per 1,000 women.

Replacement is the rate at which a given generation can exactly replace itself.

The U.S. TFR was below replacement for every year between 1972 and 2005 and above replacement in 2006 and 2007.

The birth rate for U.S. teens aged 15–19 years fell to the lowest level since recording began in 1940, according to new data for 2009.

The 2009 teen birth rate was 39.1 births per 1,000 teens, down 6% from the 2008 rate of 41.5 births per 1,000, according to the report by the CDC National Center for Health Statistics. The 2009 rate was 37% lower than in 1991, the peak year for teen births.

The CDC's annual report is based on virtually 100% of vital records collected in the 50 U.S. states, the District of Columbia, and U.S. territories.

The report is available at www.cdc.gov/nchs

Overall fertility also fell in 2009 to 66.7 births per 1,000 women aged 15–44 years, compared with 68.6 per 1,000 women in 2008.

The CDC's preliminary estimate of births in 2009 was 4,131,019, 3% less than 2008.

Early data through June 2010 suggest that the decline in fertility has continued, according to the report.

Fertility rates increased in only one age group: women aged 40–44 years. In that group, the 2009 rate was 10.1 births per 1,000 women, up 3% from the 2008 figure and the highest rate since 1967.

The rate of preterm births declined for the third straight year, to 12.2% of all births in 2009.

The rate of cesarean deliveries rose to a record high of 32.9% in 2009, up from 32.3% in 2008.

The low-birth-weight rate remained unchanged at about 8.2% between 2008 and 2009.

The CDC also reported the total fertility rate (TFR) – an estimate of the number of births that a hypothetical group of 1,000 women would have over their lifetimes, based on the age-specific rates of a particular year.

The TFR for 2009 was 2,007.5, down 4% from the rate in 2008. This is the largest decline in TFR since 1973.

The 2008 and 2009 rates were both below the replacement rate of 2,100 births per 1,000 women.

Replacement is the rate at which a given generation can exactly replace itself.

The U.S. TFR was below replacement for every year between 1972 and 2005 and above replacement in 2006 and 2007.

Children younger than 1 year of age may be given oseltamivir for influenza treatment and prophylaxis despite the expiration of the Food and Drug Administration's emergency authorization allowing use of the drug in that age group. The Centers for Disease Control and Prevention issued new guidelines Jan. 21.

In an interview, the CDC's Dr. Tim Uyeki said, “ACIP [the Advisory Committee on Immunization Practices] and CDC are recommending use of oseltamivir for treatment or chemoprophylaxis in children less than 1 year of age with suspected or confirmed influenza, because of the high risk for complications – including serious complications – in children less than 1 year of age, as well as the fact that the 2009 H1N1 virus continues to circulate worldwide including in the U.S.”

The FDA issued its emergency use authorization during the 2009–2010 pandemic of influenza A(H1N1). The authorization expired in June 2010.

While encouraging the use of the neuraminidase inhibitors oseltamivir (Tamiflu) and zanamivir (Relenza), the new guidelines emphasize that the antivirals amantadine (Symmetrel) and rimantadine (Flumadine) should not be used for influenza. Those drugs are inactive against influenza B, and the circulating strains of influenza A have developed resistance.

In another significant change, the guidelines now emphasize that it's permissible to treat individuals with influenza who are at low risk of complications with oseltamivir and zanamivir.

“We never said, 'Don't treat persons who are not hospitalized and not high risk,'” said Dr. Uyeki, a pediatrician and medical epidemiologist. “The emphasis on high-risk patients and hospitalized patients might have been interpreted as, 'Don't treat persons with mild, uncomplicated illness who were previously healthy.'”

The guidelines encourage physicians to rely on their clinical judgment in making treatment decisions regarding patients with suspected or confirmed influenza. Knowledge of the locally prevalent influenza strains as well as local patterns of antiviral resistance should inform that judgment.

In other influenza news:

▸ The CDC reports in its latest update that eight children have died from influenza in the United States so far this season. In comparison, there were 282 pediatric deaths during the full 2009–2010 season and 133 during the 2008–2009 season. The CDC continues to find no evidence of resistance to oseltamivir and zanamivir by any influenza strain currently circulating. In the week ending Jan. 8, 2011, 11 states were reporting widespread influenza activity (Alabama, Arizona, Connecticut, Kentucky, Louisiana, Maryland, Nevada, New York, North Carolina, Tennessee, and Virginia). Another 17 states were reporting regional influenza activity (Colorado, Florida, Georgia, Illinois, Indiana, Kansas, Maine, Massachusetts, Mississippi, Missouri, New Hampshire, New Jersey, Ohio, Oklahoma, Pennsylvania, South Carolina, and Texas). The remaining states were reporting only local or sporadic influenza activity.

▸ The World Health Organization reports that influenza cases are increasing in North America, and that the primary strain is influenza A(H3N2). In the United Kingdom, severe and fatal cases of influenza A(H1N1) have increased, and 25% of all intensive care beds are occupied by influenza patients. Severe disease associated with influenza A(H1N1) and, to a lesser extent, influenza B are also increasing throughout the European continent and the Middle East.

Children younger than 1 year of age may be given oseltamivir for influenza treatment and prophylaxis despite the expiration of the Food and Drug Administration's emergency authorization allowing use of the drug in that age group. The Centers for Disease Control and Prevention issued new guidelines Jan. 21.

In an interview, the CDC's Dr. Tim Uyeki said, “ACIP [the Advisory Committee on Immunization Practices] and CDC are recommending use of oseltamivir for treatment or chemoprophylaxis in children less than 1 year of age with suspected or confirmed influenza, because of the high risk for complications – including serious complications – in children less than 1 year of age, as well as the fact that the 2009 H1N1 virus continues to circulate worldwide including in the U.S.”

The FDA issued its emergency use authorization during the 2009–2010 pandemic of influenza A(H1N1). The authorization expired in June 2010.

While encouraging the use of the neuraminidase inhibitors oseltamivir (Tamiflu) and zanamivir (Relenza), the new guidelines emphasize that the antivirals amantadine (Symmetrel) and rimantadine (Flumadine) should not be used for influenza. Those drugs are inactive against influenza B, and the circulating strains of influenza A have developed resistance.

In another significant change, the guidelines now emphasize that it's permissible to treat individuals with influenza who are at low risk of complications with oseltamivir and zanamivir.

“We never said, 'Don't treat persons who are not hospitalized and not high risk,'” said Dr. Uyeki, a pediatrician and medical epidemiologist. “The emphasis on high-risk patients and hospitalized patients might have been interpreted as, 'Don't treat persons with mild, uncomplicated illness who were previously healthy.'”

The guidelines encourage physicians to rely on their clinical judgment in making treatment decisions regarding patients with suspected or confirmed influenza. Knowledge of the locally prevalent influenza strains as well as local patterns of antiviral resistance should inform that judgment.

In other influenza news:

▸ The CDC reports in its latest update that eight children have died from influenza in the United States so far this season. In comparison, there were 282 pediatric deaths during the full 2009–2010 season and 133 during the 2008–2009 season. The CDC continues to find no evidence of resistance to oseltamivir and zanamivir by any influenza strain currently circulating. In the week ending Jan. 8, 2011, 11 states were reporting widespread influenza activity (Alabama, Arizona, Connecticut, Kentucky, Louisiana, Maryland, Nevada, New York, North Carolina, Tennessee, and Virginia). Another 17 states were reporting regional influenza activity (Colorado, Florida, Georgia, Illinois, Indiana, Kansas, Maine, Massachusetts, Mississippi, Missouri, New Hampshire, New Jersey, Ohio, Oklahoma, Pennsylvania, South Carolina, and Texas). The remaining states were reporting only local or sporadic influenza activity.

▸ The World Health Organization reports that influenza cases are increasing in North America, and that the primary strain is influenza A(H3N2). In the United Kingdom, severe and fatal cases of influenza A(H1N1) have increased, and 25% of all intensive care beds are occupied by influenza patients. Severe disease associated with influenza A(H1N1) and, to a lesser extent, influenza B are also increasing throughout the European continent and the Middle East.

Children younger than 1 year of age may be given oseltamivir for influenza treatment and prophylaxis despite the expiration of the Food and Drug Administration's emergency authorization allowing use of the drug in that age group. The Centers for Disease Control and Prevention issued new guidelines Jan. 21.

In an interview, the CDC's Dr. Tim Uyeki said, “ACIP [the Advisory Committee on Immunization Practices] and CDC are recommending use of oseltamivir for treatment or chemoprophylaxis in children less than 1 year of age with suspected or confirmed influenza, because of the high risk for complications – including serious complications – in children less than 1 year of age, as well as the fact that the 2009 H1N1 virus continues to circulate worldwide including in the U.S.”

The FDA issued its emergency use authorization during the 2009–2010 pandemic of influenza A(H1N1). The authorization expired in June 2010.

While encouraging the use of the neuraminidase inhibitors oseltamivir (Tamiflu) and zanamivir (Relenza), the new guidelines emphasize that the antivirals amantadine (Symmetrel) and rimantadine (Flumadine) should not be used for influenza. Those drugs are inactive against influenza B, and the circulating strains of influenza A have developed resistance.

In another significant change, the guidelines now emphasize that it's permissible to treat individuals with influenza who are at low risk of complications with oseltamivir and zanamivir.

“We never said, 'Don't treat persons who are not hospitalized and not high risk,'” said Dr. Uyeki, a pediatrician and medical epidemiologist. “The emphasis on high-risk patients and hospitalized patients might have been interpreted as, 'Don't treat persons with mild, uncomplicated illness who were previously healthy.'”

The guidelines encourage physicians to rely on their clinical judgment in making treatment decisions regarding patients with suspected or confirmed influenza. Knowledge of the locally prevalent influenza strains as well as local patterns of antiviral resistance should inform that judgment.

In other influenza news:

▸ The CDC reports in its latest update that eight children have died from influenza in the United States so far this season. In comparison, there were 282 pediatric deaths during the full 2009–2010 season and 133 during the 2008–2009 season. The CDC continues to find no evidence of resistance to oseltamivir and zanamivir by any influenza strain currently circulating. In the week ending Jan. 8, 2011, 11 states were reporting widespread influenza activity (Alabama, Arizona, Connecticut, Kentucky, Louisiana, Maryland, Nevada, New York, North Carolina, Tennessee, and Virginia). Another 17 states were reporting regional influenza activity (Colorado, Florida, Georgia, Illinois, Indiana, Kansas, Maine, Massachusetts, Mississippi, Missouri, New Hampshire, New Jersey, Ohio, Oklahoma, Pennsylvania, South Carolina, and Texas). The remaining states were reporting only local or sporadic influenza activity.

▸ The World Health Organization reports that influenza cases are increasing in North America, and that the primary strain is influenza A(H3N2). In the United Kingdom, severe and fatal cases of influenza A(H1N1) have increased, and 25% of all intensive care beds are occupied by influenza patients. Severe disease associated with influenza A(H1N1) and, to a lesser extent, influenza B are also increasing throughout the European continent and the Middle East.

The vaccine for pandemic 2009 H1N1 influenza was about 72% effective across seven European countries, according to findings from a case-control study.

“The results of this study provide early estimates of the pandemic influenza vaccine effectiveness suggesting that the monovalent pandemic vaccines have been effective. The findings also give an indication of the vaccine effectiveness” for the influenza A(H1N1) 2009 strain included in the 2010-2011 seasonal vaccines, although specific vaccine effectiveness studies will have to be conducted to verify if similar rates of effectiveness are observed with 2010-2011 trivalent vaccines, Marta Valenciano, a veterinarian and epidemiologist at EpiConcept, Paris, and colleagues wrote in an accompanying summary of the study.

The study involved 2,902 patients with influenzalike illnesses (ILI) from France, Hungary, Ireland, Italy, Portugal, Romania, and Spain during the 2009-2010 season. All had throat swabs fewer than 8 days after the onset of symptoms. Among those patients, roughly 32% tested positive for pandemic H1N1.

Investigators compared these confirmed H1N1 cases to patients with ILI who tested negative for any influenza virus.

Overall, 7% of all the patients – ranging from 0% in Italy to 29% in Hungary – had received at least one dose of the H1N1 vaccine more than 14 days before symptom onset.

The investigators adjusted their effectiveness results for confounding factors, including age; sex; presence and severity of chronic conditions; pregnancy; obesity; smoking history; number of practitioner visits in the preceding 12 months; use of influenza antivirals; and seasonal influenza vaccination during the previous two seasons.

As expected, vaccines that were delivered fewer than 8 days before the onset of ILI symptoms showed a relatively low adjusted effectiveness rate (19%), compared with 67% among those who were vaccinated more than 14 days before symptom onset.

The investigators also found that the 2009-2010 seasonal influenza vaccine was only 9.9% effective against H1N1 (PLoS Med. 2011 Jan. 11 [doi:10.1371/journal. pmed.1000388]).

The results of this study should be interpreted with caution because of limitations in the pandemic context (such as late timing of the studies, low incidence, and low vaccine coverage leading to imprecise estimates) and potential biases because of the study design, confounding factors, and missing values. The researchers recommended that, in the future, the sample size per country be enlarged in order to allow for precise pooled and stratified analyses.

Other influenza-related reports included the following:

▸ The U.K. Department of Health has warned physicians to watch for bacterial coinfections in patients with influenza. According to a report in Pulse, an online newsletter for general practitioners, a “number of data sources suggest recent increases in some bacterial infections, particularly invasive Group A streptococcal infection and meningococcal disease.” The report urged physicians to start antiviral and antibiotic treatment as soon as possible, when appropriate.

▸ According to a U.S. Centers for Disease Control and Prevention report, as of Jan. 1, ILI activity was high in Alabama, Georgia, Illinois, Louisiana, Mississippi, Oklahoma, and New York City; moderate in Nevada and New Jersey; and minimal to low in the rest of the country.

▸ Of 4,911 specimens from people with ILI, 20.3% tested positive for influenza, according to a CDC weekly report. http://www.cdc.gov/flu/weekly/

Among those, 34.1% proved to be influenza B, and 65.9% were influenza A. No subtyping was performed in 52.3% of the influenza A samples, 41% were subtype A(H3), and 6.7% were A(2009 H1N1).

Among the 19 authors of the European study, several disclosed relationships with various pharmaceutical companies and European government agencies. The European Centre for Disease Prevention and Control funded the study.

The vaccine for pandemic 2009 H1N1 influenza was about 72% effective across seven European countries, according to findings from a case-control study.

“The results of this study provide early estimates of the pandemic influenza vaccine effectiveness suggesting that the monovalent pandemic vaccines have been effective. The findings also give an indication of the vaccine effectiveness” for the influenza A(H1N1) 2009 strain included in the 2010-2011 seasonal vaccines, although specific vaccine effectiveness studies will have to be conducted to verify if similar rates of effectiveness are observed with 2010-2011 trivalent vaccines, Marta Valenciano, a veterinarian and epidemiologist at EpiConcept, Paris, and colleagues wrote in an accompanying summary of the study.

The study involved 2,902 patients with influenzalike illnesses (ILI) from France, Hungary, Ireland, Italy, Portugal, Romania, and Spain during the 2009-2010 season. All had throat swabs fewer than 8 days after the onset of symptoms. Among those patients, roughly 32% tested positive for pandemic H1N1.

Investigators compared these confirmed H1N1 cases to patients with ILI who tested negative for any influenza virus.

Overall, 7% of all the patients – ranging from 0% in Italy to 29% in Hungary – had received at least one dose of the H1N1 vaccine more than 14 days before symptom onset.

The investigators adjusted their effectiveness results for confounding factors, including age; sex; presence and severity of chronic conditions; pregnancy; obesity; smoking history; number of practitioner visits in the preceding 12 months; use of influenza antivirals; and seasonal influenza vaccination during the previous two seasons.

As expected, vaccines that were delivered fewer than 8 days before the onset of ILI symptoms showed a relatively low adjusted effectiveness rate (19%), compared with 67% among those who were vaccinated more than 14 days before symptom onset.

The investigators also found that the 2009-2010 seasonal influenza vaccine was only 9.9% effective against H1N1 (PLoS Med. 2011 Jan. 11 [doi:10.1371/journal. pmed.1000388]).

The results of this study should be interpreted with caution because of limitations in the pandemic context (such as late timing of the studies, low incidence, and low vaccine coverage leading to imprecise estimates) and potential biases because of the study design, confounding factors, and missing values. The researchers recommended that, in the future, the sample size per country be enlarged in order to allow for precise pooled and stratified analyses.

Other influenza-related reports included the following:

▸ The U.K. Department of Health has warned physicians to watch for bacterial coinfections in patients with influenza. According to a report in Pulse, an online newsletter for general practitioners, a “number of data sources suggest recent increases in some bacterial infections, particularly invasive Group A streptococcal infection and meningococcal disease.” The report urged physicians to start antiviral and antibiotic treatment as soon as possible, when appropriate.

▸ According to a U.S. Centers for Disease Control and Prevention report, as of Jan. 1, ILI activity was high in Alabama, Georgia, Illinois, Louisiana, Mississippi, Oklahoma, and New York City; moderate in Nevada and New Jersey; and minimal to low in the rest of the country.

▸ Of 4,911 specimens from people with ILI, 20.3% tested positive for influenza, according to a CDC weekly report. http://www.cdc.gov/flu/weekly/

Among those, 34.1% proved to be influenza B, and 65.9% were influenza A. No subtyping was performed in 52.3% of the influenza A samples, 41% were subtype A(H3), and 6.7% were A(2009 H1N1).

Among the 19 authors of the European study, several disclosed relationships with various pharmaceutical companies and European government agencies. The European Centre for Disease Prevention and Control funded the study.

The vaccine for pandemic 2009 H1N1 influenza was about 72% effective across seven European countries, according to findings from a case-control study.

“The results of this study provide early estimates of the pandemic influenza vaccine effectiveness suggesting that the monovalent pandemic vaccines have been effective. The findings also give an indication of the vaccine effectiveness” for the influenza A(H1N1) 2009 strain included in the 2010-2011 seasonal vaccines, although specific vaccine effectiveness studies will have to be conducted to verify if similar rates of effectiveness are observed with 2010-2011 trivalent vaccines, Marta Valenciano, a veterinarian and epidemiologist at EpiConcept, Paris, and colleagues wrote in an accompanying summary of the study.

The study involved 2,902 patients with influenzalike illnesses (ILI) from France, Hungary, Ireland, Italy, Portugal, Romania, and Spain during the 2009-2010 season. All had throat swabs fewer than 8 days after the onset of symptoms. Among those patients, roughly 32% tested positive for pandemic H1N1.

Investigators compared these confirmed H1N1 cases to patients with ILI who tested negative for any influenza virus.

Overall, 7% of all the patients – ranging from 0% in Italy to 29% in Hungary – had received at least one dose of the H1N1 vaccine more than 14 days before symptom onset.

The investigators adjusted their effectiveness results for confounding factors, including age; sex; presence and severity of chronic conditions; pregnancy; obesity; smoking history; number of practitioner visits in the preceding 12 months; use of influenza antivirals; and seasonal influenza vaccination during the previous two seasons.

As expected, vaccines that were delivered fewer than 8 days before the onset of ILI symptoms showed a relatively low adjusted effectiveness rate (19%), compared with 67% among those who were vaccinated more than 14 days before symptom onset.

The investigators also found that the 2009-2010 seasonal influenza vaccine was only 9.9% effective against H1N1 (PLoS Med. 2011 Jan. 11 [doi:10.1371/journal. pmed.1000388]).

The results of this study should be interpreted with caution because of limitations in the pandemic context (such as late timing of the studies, low incidence, and low vaccine coverage leading to imprecise estimates) and potential biases because of the study design, confounding factors, and missing values. The researchers recommended that, in the future, the sample size per country be enlarged in order to allow for precise pooled and stratified analyses.

Other influenza-related reports included the following:

▸ The U.K. Department of Health has warned physicians to watch for bacterial coinfections in patients with influenza. According to a report in Pulse, an online newsletter for general practitioners, a “number of data sources suggest recent increases in some bacterial infections, particularly invasive Group A streptococcal infection and meningococcal disease.” The report urged physicians to start antiviral and antibiotic treatment as soon as possible, when appropriate.

▸ According to a U.S. Centers for Disease Control and Prevention report, as of Jan. 1, ILI activity was high in Alabama, Georgia, Illinois, Louisiana, Mississippi, Oklahoma, and New York City; moderate in Nevada and New Jersey; and minimal to low in the rest of the country.

▸ Of 4,911 specimens from people with ILI, 20.3% tested positive for influenza, according to a CDC weekly report. http://www.cdc.gov/flu/weekly/

Among those, 34.1% proved to be influenza B, and 65.9% were influenza A. No subtyping was performed in 52.3% of the influenza A samples, 41% were subtype A(H3), and 6.7% were A(2009 H1N1).

Among the 19 authors of the European study, several disclosed relationships with various pharmaceutical companies and European government agencies. The European Centre for Disease Prevention and Control funded the study.

VANCOUVER, B.C. – There's a new bad bug on the block, and it appears to be making appearances in long-term care facilities, at least in the Chicago area, according to a recent study.

Carbapenem-resistant Enterobacteriaceae, particularly those that produce Klebsiella pneumoniae carbapenemase (KPC), are becoming increasingly problematic in the Chicago area, Dr. Mary K. Hayden said during a press briefing. The first case appeared in Chicago in December 2007, but by March 2009 an Internet-based survey of infection preventionists revealed that 26 of 53 facilities (49%) had reported one case, and the mean number of cases per facility was 3.8.

In a subsequent survey in February 2010, 37 of 57 facilities (65%) had reported at least 1 case, and the mean number of cases per facility was 10.2.

According to the 2009 survey, 81% of the affected patients had been transferred from a long-term care facility or a long-term acute care hospital. In 2010, 75% of patients came from such facilities.

Dr. Hayden, of Rush University Medical Center, Chicago, declined to refer to KPC as a “superbug,” a term favored in the popular press, but she did say, “I think it is an organism that should be identified as requiring particular attention. [It] can cause serious, life-threatening infections in hospitalized patients.”

These organisms, aerobic gram-negative bacilli, produce infections that are particularly difficult to treat because they're resistant to most and sometimes to all available antibiotics.

“This rapid increase in KPC is not unique to the Chicago area,” Dr. Hayden said. “KPC was first identified in North Carolina in the late 1990s, and over the next 10 years remained restricted to the East Coast, causing significant morbidity and mortality in areas such as Brooklyn, N.Y. But in the last couple of years, KPC has spread globally, with reports now from multiple areas in the United States and from South America, Europe, and Asia. An extreme example was seen in Israel, which reported a nationwide outbreak of KPC only about 2 years after their first case was identified.”

Dr. Hayden said that her team believes their findings point to the need for a regional approach to KPC control. “It will require coordinated collaboration between acute care hospitals, long-term care facilities, and public health [departments],” she said.

Dr. Hayden stated that she had no relevant financial disclosures.

VANCOUVER, B.C. – There's a new bad bug on the block, and it appears to be making appearances in long-term care facilities, at least in the Chicago area, according to a recent study.

Carbapenem-resistant Enterobacteriaceae, particularly those that produce Klebsiella pneumoniae carbapenemase (KPC), are becoming increasingly problematic in the Chicago area, Dr. Mary K. Hayden said during a press briefing. The first case appeared in Chicago in December 2007, but by March 2009 an Internet-based survey of infection preventionists revealed that 26 of 53 facilities (49%) had reported one case, and the mean number of cases per facility was 3.8.

In a subsequent survey in February 2010, 37 of 57 facilities (65%) had reported at least 1 case, and the mean number of cases per facility was 10.2.

According to the 2009 survey, 81% of the affected patients had been transferred from a long-term care facility or a long-term acute care hospital. In 2010, 75% of patients came from such facilities.

Dr. Hayden, of Rush University Medical Center, Chicago, declined to refer to KPC as a “superbug,” a term favored in the popular press, but she did say, “I think it is an organism that should be identified as requiring particular attention. [It] can cause serious, life-threatening infections in hospitalized patients.”

These organisms, aerobic gram-negative bacilli, produce infections that are particularly difficult to treat because they're resistant to most and sometimes to all available antibiotics.

“This rapid increase in KPC is not unique to the Chicago area,” Dr. Hayden said. “KPC was first identified in North Carolina in the late 1990s, and over the next 10 years remained restricted to the East Coast, causing significant morbidity and mortality in areas such as Brooklyn, N.Y. But in the last couple of years, KPC has spread globally, with reports now from multiple areas in the United States and from South America, Europe, and Asia. An extreme example was seen in Israel, which reported a nationwide outbreak of KPC only about 2 years after their first case was identified.”

Dr. Hayden said that her team believes their findings point to the need for a regional approach to KPC control. “It will require coordinated collaboration between acute care hospitals, long-term care facilities, and public health [departments],” she said.

Dr. Hayden stated that she had no relevant financial disclosures.

VANCOUVER, B.C. – There's a new bad bug on the block, and it appears to be making appearances in long-term care facilities, at least in the Chicago area, according to a recent study.

Carbapenem-resistant Enterobacteriaceae, particularly those that produce Klebsiella pneumoniae carbapenemase (KPC), are becoming increasingly problematic in the Chicago area, Dr. Mary K. Hayden said during a press briefing. The first case appeared in Chicago in December 2007, but by March 2009 an Internet-based survey of infection preventionists revealed that 26 of 53 facilities (49%) had reported one case, and the mean number of cases per facility was 3.8.

In a subsequent survey in February 2010, 37 of 57 facilities (65%) had reported at least 1 case, and the mean number of cases per facility was 10.2.

According to the 2009 survey, 81% of the affected patients had been transferred from a long-term care facility or a long-term acute care hospital. In 2010, 75% of patients came from such facilities.

Dr. Hayden, of Rush University Medical Center, Chicago, declined to refer to KPC as a “superbug,” a term favored in the popular press, but she did say, “I think it is an organism that should be identified as requiring particular attention. [It] can cause serious, life-threatening infections in hospitalized patients.”

These organisms, aerobic gram-negative bacilli, produce infections that are particularly difficult to treat because they're resistant to most and sometimes to all available antibiotics.

“This rapid increase in KPC is not unique to the Chicago area,” Dr. Hayden said. “KPC was first identified in North Carolina in the late 1990s, and over the next 10 years remained restricted to the East Coast, causing significant morbidity and mortality in areas such as Brooklyn, N.Y. But in the last couple of years, KPC has spread globally, with reports now from multiple areas in the United States and from South America, Europe, and Asia. An extreme example was seen in Israel, which reported a nationwide outbreak of KPC only about 2 years after their first case was identified.”

Dr. Hayden said that her team believes their findings point to the need for a regional approach to KPC control. “It will require coordinated collaboration between acute care hospitals, long-term care facilities, and public health [departments],” she said.

Dr. Hayden stated that she had no relevant financial disclosures.

Children younger than 1 year of age may be given oseltamivir for influenza treatment and prophylaxis despite the expiration of the Food and Drug Administration's emergency authorization allowing use of the drug in that age group. The Centers for Disease Control and Prevention issued new guidelines Jan. 21.

In an interview, the CDC's Dr. Tim Uyeki said, "ACIP [the Advisory Committee on Immunization Practices] and CDC are recommending use of oseltamivir for treatment or chemoprophylaxis in children less than 1 year of age with suspected or confirmed influenza, because of the high risk for complications – including serious complications – in children less than 1 year of age, as well as the fact that the 2009 H1N1 virus continues to circulate worldwide including in the U.S."

The FDA issued its emergency use authorization during the 2009-2010 pandemic of influenza A(H1N1). The authorization expired in June 2010.

While encouraging the use of the neuraminidase inhibitors oseltamivir (Tamiflu) and zanamivir (Relenza), the new guidelines emphasize that the antivirals amantadine (Symmetrel) and rimantadine (Flumadine) should not be used for influenza. Those drugs are inactive against influenza B, and the currently circulating strains of influenza A have developed resistance.

In another significant change, the guidelines now emphasize that it's permissible to treat individuals with influenza who are at low risk of complications with oseltamivir and zanamivir.

"We never said, "Don't treat persons who are not hospitalized and not high risk,' " said Dr. Uyeki, a pediatrician and medical epidemiologist. "The emphasis on high-risk patients and hospitalized patients might have been interpreted as, 'Don't treat persons with mild, uncomplicated illness who were previously healthy.' "

The guidelines encourage physicians to rely on their clinical judgment in making treatment decisions regarding patients with suspected or confirmed influenza. Knowledge of the locally prevalent influenza strains as well as local patterns of antiviral resistance should inform that judgment.

In other influenza news:

• The CDC reports in its latest update that eight children have died from influenza in the United States so far this season. In comparison, there were 282 pediatric deaths during the full 2009-2010 season and 133 during the 2008-2009 season. The CDC continues to find no evidence of resistance to oseltamivir and zanamivir by any influenza strain currently circulating. In the week ending Jan. 8, 2010, 11 states were reporting widespread influenza activity (Alabama, Arizona, Connecticut, Kentucky, Louisiana, Maryland, Nevada, New York, North Carolina, Tennessee, and Virginia). Another 17 states were reporting regional influenza activity (Colorado, Florida, Georgia, Illinois, Indiana, Kansas, Maine, Massachusetts, Mississippi, Missouri, New Hampshire, New Jersey, Ohio, Oklahoma, Pennsylvania, South Carolina, and Texas). The remaining states were reporting only local or sporadic influenza activity.

• In its latest influenza update, the World Health Organization reports that influenza cases are continuing to increase in North America, and that the primary strain is influenza A(H3N2). In the United Kingdom, severe and fatal cases of influenza A(H1N1) have increased compared with 2 weeks ago, and 25% of all intensive care beds are occupied by influenza patients. Severe disease associated with influenza A(H1N1) and, to a lesser extent, influenza B are also increasing throughout the European continent and the Middle East. On the other hand, tropical countries throughout the world and temperate countries in the Southern Hemisphere are reporting very little influenza circulation.

Children younger than 1 year of age may be given oseltamivir for influenza treatment and prophylaxis despite the expiration of the Food and Drug Administration's emergency authorization allowing use of the drug in that age group. The Centers for Disease Control and Prevention issued new guidelines Jan. 21.

In an interview, the CDC's Dr. Tim Uyeki said, "ACIP [the Advisory Committee on Immunization Practices] and CDC are recommending use of oseltamivir for treatment or chemoprophylaxis in children less than 1 year of age with suspected or confirmed influenza, because of the high risk for complications – including serious complications – in children less than 1 year of age, as well as the fact that the 2009 H1N1 virus continues to circulate worldwide including in the U.S."

The FDA issued its emergency use authorization during the 2009-2010 pandemic of influenza A(H1N1). The authorization expired in June 2010.

While encouraging the use of the neuraminidase inhibitors oseltamivir (Tamiflu) and zanamivir (Relenza), the new guidelines emphasize that the antivirals amantadine (Symmetrel) and rimantadine (Flumadine) should not be used for influenza. Those drugs are inactive against influenza B, and the currently circulating strains of influenza A have developed resistance.

In another significant change, the guidelines now emphasize that it's permissible to treat individuals with influenza who are at low risk of complications with oseltamivir and zanamivir.

"We never said, "Don't treat persons who are not hospitalized and not high risk,' " said Dr. Uyeki, a pediatrician and medical epidemiologist. "The emphasis on high-risk patients and hospitalized patients might have been interpreted as, 'Don't treat persons with mild, uncomplicated illness who were previously healthy.' "

The guidelines encourage physicians to rely on their clinical judgment in making treatment decisions regarding patients with suspected or confirmed influenza. Knowledge of the locally prevalent influenza strains as well as local patterns of antiviral resistance should inform that judgment.

In other influenza news:

• The CDC reports in its latest update that eight children have died from influenza in the United States so far this season. In comparison, there were 282 pediatric deaths during the full 2009-2010 season and 133 during the 2008-2009 season. The CDC continues to find no evidence of resistance to oseltamivir and zanamivir by any influenza strain currently circulating. In the week ending Jan. 8, 2010, 11 states were reporting widespread influenza activity (Alabama, Arizona, Connecticut, Kentucky, Louisiana, Maryland, Nevada, New York, North Carolina, Tennessee, and Virginia). Another 17 states were reporting regional influenza activity (Colorado, Florida, Georgia, Illinois, Indiana, Kansas, Maine, Massachusetts, Mississippi, Missouri, New Hampshire, New Jersey, Ohio, Oklahoma, Pennsylvania, South Carolina, and Texas). The remaining states were reporting only local or sporadic influenza activity.

• In its latest influenza update, the World Health Organization reports that influenza cases are continuing to increase in North America, and that the primary strain is influenza A(H3N2). In the United Kingdom, severe and fatal cases of influenza A(H1N1) have increased compared with 2 weeks ago, and 25% of all intensive care beds are occupied by influenza patients. Severe disease associated with influenza A(H1N1) and, to a lesser extent, influenza B are also increasing throughout the European continent and the Middle East. On the other hand, tropical countries throughout the world and temperate countries in the Southern Hemisphere are reporting very little influenza circulation.

Children younger than 1 year of age may be given oseltamivir for influenza treatment and prophylaxis despite the expiration of the Food and Drug Administration's emergency authorization allowing use of the drug in that age group. The Centers for Disease Control and Prevention issued new guidelines Jan. 21.

In an interview, the CDC's Dr. Tim Uyeki said, "ACIP [the Advisory Committee on Immunization Practices] and CDC are recommending use of oseltamivir for treatment or chemoprophylaxis in children less than 1 year of age with suspected or confirmed influenza, because of the high risk for complications – including serious complications – in children less than 1 year of age, as well as the fact that the 2009 H1N1 virus continues to circulate worldwide including in the U.S."

The FDA issued its emergency use authorization during the 2009-2010 pandemic of influenza A(H1N1). The authorization expired in June 2010.

While encouraging the use of the neuraminidase inhibitors oseltamivir (Tamiflu) and zanamivir (Relenza), the new guidelines emphasize that the antivirals amantadine (Symmetrel) and rimantadine (Flumadine) should not be used for influenza. Those drugs are inactive against influenza B, and the currently circulating strains of influenza A have developed resistance.

In another significant change, the guidelines now emphasize that it's permissible to treat individuals with influenza who are at low risk of complications with oseltamivir and zanamivir.

"We never said, "Don't treat persons who are not hospitalized and not high risk,' " said Dr. Uyeki, a pediatrician and medical epidemiologist. "The emphasis on high-risk patients and hospitalized patients might have been interpreted as, 'Don't treat persons with mild, uncomplicated illness who were previously healthy.' "

The guidelines encourage physicians to rely on their clinical judgment in making treatment decisions regarding patients with suspected or confirmed influenza. Knowledge of the locally prevalent influenza strains as well as local patterns of antiviral resistance should inform that judgment.

In other influenza news:

• The CDC reports in its latest update that eight children have died from influenza in the United States so far this season. In comparison, there were 282 pediatric deaths during the full 2009-2010 season and 133 during the 2008-2009 season. The CDC continues to find no evidence of resistance to oseltamivir and zanamivir by any influenza strain currently circulating. In the week ending Jan. 8, 2010, 11 states were reporting widespread influenza activity (Alabama, Arizona, Connecticut, Kentucky, Louisiana, Maryland, Nevada, New York, North Carolina, Tennessee, and Virginia). Another 17 states were reporting regional influenza activity (Colorado, Florida, Georgia, Illinois, Indiana, Kansas, Maine, Massachusetts, Mississippi, Missouri, New Hampshire, New Jersey, Ohio, Oklahoma, Pennsylvania, South Carolina, and Texas). The remaining states were reporting only local or sporadic influenza activity.

• In its latest influenza update, the World Health Organization reports that influenza cases are continuing to increase in North America, and that the primary strain is influenza A(H3N2). In the United Kingdom, severe and fatal cases of influenza A(H1N1) have increased compared with 2 weeks ago, and 25% of all intensive care beds are occupied by influenza patients. Severe disease associated with influenza A(H1N1) and, to a lesser extent, influenza B are also increasing throughout the European continent and the Middle East. On the other hand, tropical countries throughout the world and temperate countries in the Southern Hemisphere are reporting very little influenza circulation.

Children younger than 1 year of age may be given oseltamivir for influenza treatment and prophylaxis despite the expiration of the Food and Drug Administration’s emergency authorization allowing use of the drug in that age group. The Centers for Disease Control and Prevention issued new guidelines Jan. 21.

In an interview, the CDC’s Dr. Tim Uyeki said, "ACIP [the Advisory Committee on Immunization Practices] and CDC are recommending use of oseltamivir for treatment or chemoprophylaxis in children less than 1 year of age with suspected or confirmed influenza, because of the high risk for complications – including serious complications – in children less than 1 year of age, as well as the fact that the 2009 H1N1 virus continues to circulate worldwide including in the U.S."

The FDA issued its emergency use authorization during the 2009-2010 pandemic of influenza A(H1N1). The authorization expired in June 2010.

While encouraging the use of the neuraminidase inhibitors oseltamivir (Tamiflu) and zanamivir (Relenza), the new guidelines emphasize that the antivirals amantadine (Symmetrel) and rimantadine (Flumadine) should not be used for influenza. Those drugs are inactive against influenza B, and the currently circulating strains of influenza A have developed resistance.

In another significant change, the guidelines now emphasize that it’s permissible to treat individuals with influenza who are at low risk of complications with oseltamivir and zanamivir.

"We never said, ‘Don’t treat persons who are not hospitalized and not high risk,’ " said Dr. Uyeki, a pediatrician and medical epidemiologist. "The emphasis on high-risk patients and hospitalized patients might have been interpreted as, ‘Don’t treat persons with mild, uncomplicated illness who were previously healthy.’ "

The guidelines encourage physicians to rely on their clinical judgment in making treatment decisions regarding patients with suspected or confirmed influenza. Knowledge of the locally prevalent influenza strains as well as local patterns of antiviral resistance should inform that judgment.

In other influenza news:

• The CDC reports in its latest update that eight children have died from influenza in the United States so far this season. In comparison, there were 282 pediatric deaths during the full 2009-2010 season and 133 during the 2008-2009 season. The CDC continues to find no evidence of resistance to oseltamivir and zanamivir by any influenza strain currently circulating. In the week ending Jan. 8, 2010, 11 states were reporting widespread influenza activity (Alabama, Arizona, Connecticut, Kentucky, Louisiana, Maryland, Nevada, New York, North Carolina, Tennessee, and Virginia). Another 17 states were reporting regional influenza activity (Colorado, Florida, Georgia, Illinois, Indiana, Kansas, Maine, Massachusetts, Mississippi, Missouri, New Hampshire, New Jersey, Ohio, Oklahoma, Pennsylvania, South Carolina, and Texas). The remaining states were reporting only local or sporadic influenza activity.

• In its latest influenza update, the World Health Organization reports that influenza cases are continuing to increase in North America, and that the primary strain is influenza A(H3N2). In the United Kingdom, severe and fatal cases of influenza A(H1N1) have increased compared with 2 weeks ago, and 25% of all intensive care beds are occupied by influenza patients. Severe disease associated with influenza A(H1N1) and, to a lesser extent, influenza B are also increasing throughout the European continent and the Middle East. On the other hand, tropical countries throughout the world and temperate countries in the Southern Hemisphere are reporting very little influenza circulation.

Children younger than 1 year of age may be given oseltamivir for influenza treatment and prophylaxis despite the expiration of the Food and Drug Administration’s emergency authorization allowing use of the drug in that age group. The Centers for Disease Control and Prevention issued new guidelines Jan. 21.

In an interview, the CDC’s Dr. Tim Uyeki said, "ACIP [the Advisory Committee on Immunization Practices] and CDC are recommending use of oseltamivir for treatment or chemoprophylaxis in children less than 1 year of age with suspected or confirmed influenza, because of the high risk for complications – including serious complications – in children less than 1 year of age, as well as the fact that the 2009 H1N1 virus continues to circulate worldwide including in the U.S."

The FDA issued its emergency use authorization during the 2009-2010 pandemic of influenza A(H1N1). The authorization expired in June 2010.

While encouraging the use of the neuraminidase inhibitors oseltamivir (Tamiflu) and zanamivir (Relenza), the new guidelines emphasize that the antivirals amantadine (Symmetrel) and rimantadine (Flumadine) should not be used for influenza. Those drugs are inactive against influenza B, and the currently circulating strains of influenza A have developed resistance.

In another significant change, the guidelines now emphasize that it’s permissible to treat individuals with influenza who are at low risk of complications with oseltamivir and zanamivir.

"We never said, ‘Don’t treat persons who are not hospitalized and not high risk,’ " said Dr. Uyeki, a pediatrician and medical epidemiologist. "The emphasis on high-risk patients and hospitalized patients might have been interpreted as, ‘Don’t treat persons with mild, uncomplicated illness who were previously healthy.’ "

The guidelines encourage physicians to rely on their clinical judgment in making treatment decisions regarding patients with suspected or confirmed influenza. Knowledge of the locally prevalent influenza strains as well as local patterns of antiviral resistance should inform that judgment.

In other influenza news:

• The CDC reports in its latest update that eight children have died from influenza in the United States so far this season. In comparison, there were 282 pediatric deaths during the full 2009-2010 season and 133 during the 2008-2009 season. The CDC continues to find no evidence of resistance to oseltamivir and zanamivir by any influenza strain currently circulating. In the week ending Jan. 8, 2010, 11 states were reporting widespread influenza activity (Alabama, Arizona, Connecticut, Kentucky, Louisiana, Maryland, Nevada, New York, North Carolina, Tennessee, and Virginia). Another 17 states were reporting regional influenza activity (Colorado, Florida, Georgia, Illinois, Indiana, Kansas, Maine, Massachusetts, Mississippi, Missouri, New Hampshire, New Jersey, Ohio, Oklahoma, Pennsylvania, South Carolina, and Texas). The remaining states were reporting only local or sporadic influenza activity.

• In its latest influenza update, the World Health Organization reports that influenza cases are continuing to increase in North America, and that the primary strain is influenza A(H3N2). In the United Kingdom, severe and fatal cases of influenza A(H1N1) have increased compared with 2 weeks ago, and 25% of all intensive care beds are occupied by influenza patients. Severe disease associated with influenza A(H1N1) and, to a lesser extent, influenza B are also increasing throughout the European continent and the Middle East. On the other hand, tropical countries throughout the world and temperate countries in the Southern Hemisphere are reporting very little influenza circulation.

Children younger than 1 year of age may be given oseltamivir for influenza treatment and prophylaxis despite the expiration of the Food and Drug Administration’s emergency authorization allowing use of the drug in that age group. The Centers for Disease Control and Prevention issued new guidelines Jan. 21.

In an interview, the CDC’s Dr. Tim Uyeki said, "ACIP [the Advisory Committee on Immunization Practices] and CDC are recommending use of oseltamivir for treatment or chemoprophylaxis in children less than 1 year of age with suspected or confirmed influenza, because of the high risk for complications – including serious complications – in children less than 1 year of age, as well as the fact that the 2009 H1N1 virus continues to circulate worldwide including in the U.S."

The FDA issued its emergency use authorization during the 2009-2010 pandemic of influenza A(H1N1). The authorization expired in June 2010.

While encouraging the use of the neuraminidase inhibitors oseltamivir (Tamiflu) and zanamivir (Relenza), the new guidelines emphasize that the antivirals amantadine (Symmetrel) and rimantadine (Flumadine) should not be used for influenza. Those drugs are inactive against influenza B, and the currently circulating strains of influenza A have developed resistance.

In another significant change, the guidelines now emphasize that it’s permissible to treat individuals with influenza who are at low risk of complications with oseltamivir and zanamivir.

"We never said, ‘Don’t treat persons who are not hospitalized and not high risk,’ " said Dr. Uyeki, a pediatrician and medical epidemiologist. "The emphasis on high-risk patients and hospitalized patients might have been interpreted as, ‘Don’t treat persons with mild, uncomplicated illness who were previously healthy.’ "

The guidelines encourage physicians to rely on their clinical judgment in making treatment decisions regarding patients with suspected or confirmed influenza. Knowledge of the locally prevalent influenza strains as well as local patterns of antiviral resistance should inform that judgment.

In other influenza news:

• The CDC reports in its latest update that eight children have died from influenza in the United States so far this season. In comparison, there were 282 pediatric deaths during the full 2009-2010 season and 133 during the 2008-2009 season. The CDC continues to find no evidence of resistance to oseltamivir and zanamivir by any influenza strain currently circulating. In the week ending Jan. 8, 2010, 11 states were reporting widespread influenza activity (Alabama, Arizona, Connecticut, Kentucky, Louisiana, Maryland, Nevada, New York, North Carolina, Tennessee, and Virginia). Another 17 states were reporting regional influenza activity (Colorado, Florida, Georgia, Illinois, Indiana, Kansas, Maine, Massachusetts, Mississippi, Missouri, New Hampshire, New Jersey, Ohio, Oklahoma, Pennsylvania, South Carolina, and Texas). The remaining states were reporting only local or sporadic influenza activity.

• In its latest influenza update, the World Health Organization reports that influenza cases are continuing to increase in North America, and that the primary strain is influenza A(H3N2). In the United Kingdom, severe and fatal cases of influenza A(H1N1) have increased compared with 2 weeks ago, and 25% of all intensive care beds are occupied by influenza patients. Severe disease associated with influenza A(H1N1) and, to a lesser extent, influenza B are also increasing throughout the European continent and the Middle East. On the other hand, tropical countries throughout the world and temperate countries in the Southern Hemisphere are reporting very little influenza circulation.

Children younger than 1 year of age may be given oseltamivir for influenza treatment and prophylaxis despite the expiration of the Food and Drug Administration’s emergency authorization allowing use of the drug in that age group. The Centers for Disease Control and Prevention issued new guidelines Jan. 21.

In an interview, the CDC’s Dr. Tim Uyeki said, "ACIP [the Advisory Committee on Immunization Practices] and CDC are recommending use of oseltamivir for treatment or chemoprophylaxis in children less than 1 year of age with suspected or confirmed influenza, because of the high risk for complications – including serious complications – in children less than 1 year of age, as well as the fact that the 2009 H1N1 virus continues to circulate worldwide including in the U.S."

The FDA issued its emergency use authorization during the 2009-2010 pandemic of influenza A(H1N1). The authorization expired in June 2010.

While encouraging the use of the neuraminidase inhibitors oseltamivir (Tamiflu) and zanamivir (Relenza), the new guidelines emphasize that the antivirals amantadine (Symmetrel) and rimantadine (Flumadine) should not be used for influenza. Those drugs are inactive against influenza B, and the currently circulating strains of influenza A have developed resistance.

In another significant change, the guidelines now emphasize that it’s permissible to treat individuals with influenza who are at low risk of complications with oseltamivir and zanamivir.

"We never said, ‘Don’t treat persons who are not hospitalized and not high risk,’ " said Dr. Uyeki, a pediatrician and medical epidemiologist. "The emphasis on high-risk patients and hospitalized patients might have been interpreted as, ‘Don’t treat persons with mild, uncomplicated illness who were previously healthy.’ "

The guidelines encourage physicians to rely on their clinical judgment in making treatment decisions regarding patients with suspected or confirmed influenza. Knowledge of the locally prevalent influenza strains as well as local patterns of antiviral resistance should inform that judgment.

In other influenza news:

• The CDC reports in its latest update that eight children have died from influenza in the United States so far this season. In comparison, there were 282 pediatric deaths during the full 2009-2010 season and 133 during the 2008-2009 season. The CDC continues to find no evidence of resistance to oseltamivir and zanamivir by any influenza strain currently circulating. In the week ending Jan. 8, 2010, 11 states were reporting widespread influenza activity (Alabama, Arizona, Connecticut, Kentucky, Louisiana, Maryland, Nevada, New York, North Carolina, Tennessee, and Virginia). Another 17 states were reporting regional influenza activity (Colorado, Florida, Georgia, Illinois, Indiana, Kansas, Maine, Massachusetts, Mississippi, Missouri, New Hampshire, New Jersey, Ohio, Oklahoma, Pennsylvania, South Carolina, and Texas). The remaining states were reporting only local or sporadic influenza activity.

• In its latest influenza update, the World Health Organization reports that influenza cases are continuing to increase in North America, and that the primary strain is influenza A(H3N2). In the United Kingdom, severe and fatal cases of influenza A(H1N1) have increased compared with 2 weeks ago, and 25% of all intensive care beds are occupied by influenza patients. Severe disease associated with influenza A(H1N1) and, to a lesser extent, influenza B are also increasing throughout the European continent and the Middle East. On the other hand, tropical countries throughout the world and temperate countries in the Southern Hemisphere are reporting very little influenza circulation.

Children younger than 1 year of age may be given oseltamivir for influenza treatment and prophylaxis despite the expiration of the Food and Drug Administration’s emergency authorization allowing use of the drug in that age group. The Centers for Disease Control and Prevention issued new guidelines Jan. 21.

In an interview, the CDC’s Dr. Tim Uyeki said, "ACIP [the Advisory Committee on Immunization Practices] and CDC are recommending use of oseltamivir for treatment or chemoprophylaxis in children less than 1 year of age with suspected or confirmed influenza, because of the high risk for complications – including serious complications – in children less than 1 year of age, as well as the fact that the 2009 H1N1 virus continues to circulate worldwide including in the U.S."

The FDA issued its emergency use authorization during the 2009-2010 pandemic of influenza A(H1N1). The authorization expired in June 2010.

While encouraging the use of the neuraminidase inhibitors oseltamivir (Tamiflu) and zanamivir (Relenza), the new guidelines emphasize that the antivirals amantadine (Symmetrel) and rimantadine (Flumadine) should not be used for influenza. Those drugs are inactive against influenza B, and the currently circulating strains of influenza A have developed resistance.

In another significant change, the guidelines now emphasize that it’s permissible to treat individuals with influenza who are at low risk of complications with oseltamivir and zanamivir.

"We never said, ‘Don’t treat persons who are not hospitalized and not high risk,’ " said Dr. Uyeki, a pediatrician and medical epidemiologist. "The emphasis on high-risk patients and hospitalized patients might have been interpreted as, ‘Don’t treat persons with mild, uncomplicated illness who were previously healthy.’ "

The guidelines encourage physicians to rely on their clinical judgment in making treatment decisions regarding patients with suspected or confirmed influenza. Knowledge of the locally prevalent influenza strains as well as local patterns of antiviral resistance should inform that judgment.

In other influenza news:

• The CDC reports in its latest update that eight children have died from influenza in the United States so far this season. In comparison, there were 282 pediatric deaths during the full 2009-2010 season and 133 during the 2008-2009 season. The CDC continues to find no evidence of resistance to oseltamivir and zanamivir by any influenza strain currently circulating. In the week ending Jan. 8, 2010, 11 states were reporting widespread influenza activity (Alabama, Arizona, Connecticut, Kentucky, Louisiana, Maryland, Nevada, New York, North Carolina, Tennessee, and Virginia). Another 17 states were reporting regional influenza activity (Colorado, Florida, Georgia, Illinois, Indiana, Kansas, Maine, Massachusetts, Mississippi, Missouri, New Hampshire, New Jersey, Ohio, Oklahoma, Pennsylvania, South Carolina, and Texas). The remaining states were reporting only local or sporadic influenza activity.

• In its latest influenza update, the World Health Organization reports that influenza cases are continuing to increase in North America, and that the primary strain is influenza A(H3N2). In the United Kingdom, severe and fatal cases of influenza A(H1N1) have increased compared with 2 weeks ago, and 25% of all intensive care beds are occupied by influenza patients. Severe disease associated with influenza A(H1N1) and, to a lesser extent, influenza B are also increasing throughout the European continent and the Middle East. On the other hand, tropical countries throughout the world and temperate countries in the Southern Hemisphere are reporting very little influenza circulation.

Children younger than 1 year of age may be given oseltamivir for influenza treatment and prophylaxis despite the expiration of the Food and Drug Administration’s emergency authorization allowing use of the drug in that age group. The Centers for Disease Control and Prevention issued new guidelines Jan. 21.

In an interview, the CDC’s Dr. Tim Uyeki said, "ACIP [the Advisory Committee on Immunization Practices] and CDC are recommending use of oseltamivir for treatment or chemoprophylaxis in children less than 1 year of age with suspected or confirmed influenza, because of the high risk for complications – including serious complications – in children less than 1 year of age, as well as the fact that the 2009 H1N1 virus continues to circulate worldwide including in the U.S."

The FDA issued its emergency use authorization during the 2009-2010 pandemic of influenza A(H1N1). The authorization expired in June 2010.

While encouraging the use of the neuraminidase inhibitors oseltamivir (Tamiflu) and zanamivir (Relenza), the new guidelines emphasize that the antivirals amantadine (Symmetrel) and rimantadine (Flumadine) should not be used for influenza. Those drugs are inactive against influenza B, and the currently circulating strains of influenza A have developed resistance.

In another significant change, the guidelines now emphasize that it’s permissible to treat individuals with influenza who are at low risk of complications with oseltamivir and zanamivir.

"We never said, ‘Don’t treat persons who are not hospitalized and not high risk,’ " said Dr. Uyeki, a pediatrician and medical epidemiologist. "The emphasis on high-risk patients and hospitalized patients might have been interpreted as, ‘Don’t treat persons with mild, uncomplicated illness who were previously healthy.’ "

The guidelines encourage physicians to rely on their clinical judgment in making treatment decisions regarding patients with suspected or confirmed influenza. Knowledge of the locally prevalent influenza strains as well as local patterns of antiviral resistance should inform that judgment.

In other influenza news:

• The CDC reports in its latest update that eight children have died from influenza in the United States so far this season. In comparison, there were 282 pediatric deaths during the full 2009-2010 season and 133 during the 2008-2009 season. The CDC continues to find no evidence of resistance to oseltamivir and zanamivir by any influenza strain currently circulating. In the week ending Jan. 8, 2010, 11 states were reporting widespread influenza activity (Alabama, Arizona, Connecticut, Kentucky, Louisiana, Maryland, Nevada, New York, North Carolina, Tennessee, and Virginia). Another 17 states were reporting regional influenza activity (Colorado, Florida, Georgia, Illinois, Indiana, Kansas, Maine, Massachusetts, Mississippi, Missouri, New Hampshire, New Jersey, Ohio, Oklahoma, Pennsylvania, South Carolina, and Texas). The remaining states were reporting only local or sporadic influenza activity.

• In its latest influenza update, the World Health Organization reports that influenza cases are continuing to increase in North America, and that the primary strain is influenza A(H3N2). In the United Kingdom, severe and fatal cases of influenza A(H1N1) have increased compared with 2 weeks ago, and 25% of all intensive care beds are occupied by influenza patients. Severe disease associated with influenza A(H1N1) and, to a lesser extent, influenza B are also increasing throughout the European continent and the Middle East. On the other hand, tropical countries throughout the world and temperate countries in the Southern Hemisphere are reporting very little influenza circulation.

The Food and Drug Administration has approved a new topical treatment for head lice in children and adults.

Natroba Topical Suspension (spinosad 0.9%), proved more effective than Nix (permethrin 1%) when compared directly in clinical trials. In two trials involving a total of 1,038 children and adults, after one or two applications of spinosad, 85% and 87% of patients were lice free, compared with 45% and 43% of patients receiving permethrin (Pediatrics 2009;124:e389-95).

Photo (c) CDC/Reed & Carnrick Pharmaceuticals

Another advantage of spinosad, according to its labeling, is that it doesn’t require combing to be effective. A single, 10-minute application of spinosad is followed by a warm-water rinse. If desired, a fine-toothed comb can be used to remove dead lice and nits from the hair. A second application is permissible if the patient continues to harbor live lice 7 days later.

Investigators noted no serious adverse events in the trials, and only a small number of mild to moderate adverse events. The most common were application site erythema (seen in 6.8% of the patients given spinosad), ocular hyperemia (in 3.3% of patients), and application site irritation (in 1.5% of patients).

Spinosad works by causing neuronal excitation in insects. After a period of hyperexcitation, lice become paralyzed and die.

The FDA approval covered the use of spinosad in adults and children aged 4 years and older. The agency said that it is important not to use spinosad in infants younger than age 6 months. The product contains benzyl alcohol, which can cause serious reactions and even death in infants.

The clinical trials reported in Pediatrics were sponsored by ParaPRO, the manufacturer of Natroba. Two of the coauthors received research funding from ParaPRO, and two others served as consultants to the company.

The Food and Drug Administration has approved a new topical treatment for head lice in children and adults.

Natroba Topical Suspension (spinosad 0.9%), proved more effective than Nix (permethrin 1%) when compared directly in clinical trials. In two trials involving a total of 1,038 children and adults, after one or two applications of spinosad, 85% and 87% of patients were lice free, compared with 45% and 43% of patients receiving permethrin (Pediatrics 2009;124:e389-95).

Photo (c) CDC/Reed & Carnrick Pharmaceuticals

Another advantage of spinosad, according to its labeling, is that it doesn’t require combing to be effective. A single, 10-minute application of spinosad is followed by a warm-water rinse. If desired, a fine-toothed comb can be used to remove dead lice and nits from the hair. A second application is permissible if the patient continues to harbor live lice 7 days later.

Investigators noted no serious adverse events in the trials, and only a small number of mild to moderate adverse events. The most common were application site erythema (seen in 6.8% of the patients given spinosad), ocular hyperemia (in 3.3% of patients), and application site irritation (in 1.5% of patients).

Spinosad works by causing neuronal excitation in insects. After a period of hyperexcitation, lice become paralyzed and die.

The FDA approval covered the use of spinosad in adults and children aged 4 years and older. The agency said that it is important not to use spinosad in infants younger than age 6 months. The product contains benzyl alcohol, which can cause serious reactions and even death in infants.

The clinical trials reported in Pediatrics were sponsored by ParaPRO, the manufacturer of Natroba. Two of the coauthors received research funding from ParaPRO, and two others served as consultants to the company.

The Food and Drug Administration has approved a new topical treatment for head lice in children and adults.

Natroba Topical Suspension (spinosad 0.9%), proved more effective than Nix (permethrin 1%) when compared directly in clinical trials. In two trials involving a total of 1,038 children and adults, after one or two applications of spinosad, 85% and 87% of patients were lice free, compared with 45% and 43% of patients receiving permethrin (Pediatrics 2009;124:e389-95).

Photo (c) CDC/Reed & Carnrick Pharmaceuticals

Another advantage of spinosad, according to its labeling, is that it doesn’t require combing to be effective. A single, 10-minute application of spinosad is followed by a warm-water rinse. If desired, a fine-toothed comb can be used to remove dead lice and nits from the hair. A second application is permissible if the patient continues to harbor live lice 7 days later.

Investigators noted no serious adverse events in the trials, and only a small number of mild to moderate adverse events. The most common were application site erythema (seen in 6.8% of the patients given spinosad), ocular hyperemia (in 3.3% of patients), and application site irritation (in 1.5% of patients).

Spinosad works by causing neuronal excitation in insects. After a period of hyperexcitation, lice become paralyzed and die.

The FDA approval covered the use of spinosad in adults and children aged 4 years and older. The agency said that it is important not to use spinosad in infants younger than age 6 months. The product contains benzyl alcohol, which can cause serious reactions and even death in infants.

The clinical trials reported in Pediatrics were sponsored by ParaPRO, the manufacturer of Natroba. Two of the coauthors received research funding from ParaPRO, and two others served as consultants to the company.

The Food and Drug Administration has approved a new topical treatment for head lice in children and adults.

Natroba Topical Suspension (spinosad 0.9%), proved more effective than Nix (permethrin 1%) when compared directly in clinical trials. In two trials involving a total of 1,038 children and adults, after one or two applications of spinosad, 85% and 87% of patients were lice free, compared with 45% and 43% of patients receiving permethrin (Pediatrics 2009;124:e389-95).

© CDC/Reed & Carnrick Pharmaceuticals

Another advantage of spinosad, according to its labeling, is that it doesn’t require combing to be effective. A single, 10-minute application of spinosad is followed by a warm-water rinse. If desired, a fine tooth comb can be used to remove dead lice and nits from the hair. A second application is permissible if the patient continues to harbor live lice 7 days later.

Investigators noted no serious adverse events in the trials, and only a small number of mild to moderate adverse events. The most common were application site erythema (seen in 6.8% of the patients given spinosad), ocular hyperemia (in 3.3% of patients), and application site irritation (in 1.5% of patients).

Spinosad works by causing neuronal excitation in insects. After a period of hyperexcitation, lice become paralyzed and die.

The FDA approval covered the use of spinosad in adults and children aged 4 years and older. The agency said that it is important not to use spinosad in infants younger than age 6 months. The product contains benzyl alcohol, which can cause serious reactions and even death in infants.

The clinical trials reported in Pediatrics were sponsored by ParaPRO, the manufacturer of Natroba. Two of the coauthors received research funding from ParaPRO, and two others served as consultants to the company.

The Food and Drug Administration has approved a new topical treatment for head lice in children and adults.

Natroba Topical Suspension (spinosad 0.9%), proved more effective than Nix (permethrin 1%) when compared directly in clinical trials. In two trials involving a total of 1,038 children and adults, after one or two applications of spinosad, 85% and 87% of patients were lice free, compared with 45% and 43% of patients receiving permethrin (Pediatrics 2009;124:e389-95).

© CDC/Reed & Carnrick Pharmaceuticals

Another advantage of spinosad, according to its labeling, is that it doesn’t require combing to be effective. A single, 10-minute application of spinosad is followed by a warm-water rinse. If desired, a fine tooth comb can be used to remove dead lice and nits from the hair. A second application is permissible if the patient continues to harbor live lice 7 days later.

Investigators noted no serious adverse events in the trials, and only a small number of mild to moderate adverse events. The most common were application site erythema (seen in 6.8% of the patients given spinosad), ocular hyperemia (in 3.3% of patients), and application site irritation (in 1.5% of patients).

Spinosad works by causing neuronal excitation in insects. After a period of hyperexcitation, lice become paralyzed and die.

The FDA approval covered the use of spinosad in adults and children aged 4 years and older. The agency said that it is important not to use spinosad in infants younger than age 6 months. The product contains benzyl alcohol, which can cause serious reactions and even death in infants.

The clinical trials reported in Pediatrics were sponsored by ParaPRO, the manufacturer of Natroba. Two of the coauthors received research funding from ParaPRO, and two others served as consultants to the company.

The Food and Drug Administration has approved a new topical treatment for head lice in children and adults.

Natroba Topical Suspension (spinosad 0.9%), proved more effective than Nix (permethrin 1%) when compared directly in clinical trials. In two trials involving a total of 1,038 children and adults, after one or two applications of spinosad, 85% and 87% of patients were lice free, compared with 45% and 43% of patients receiving permethrin (Pediatrics 2009;124:e389-95).

© CDC/Reed & Carnrick Pharmaceuticals

Another advantage of spinosad, according to its labeling, is that it doesn’t require combing to be effective. A single, 10-minute application of spinosad is followed by a warm-water rinse. If desired, a fine tooth comb can be used to remove dead lice and nits from the hair. A second application is permissible if the patient continues to harbor live lice 7 days later.

Investigators noted no serious adverse events in the trials, and only a small number of mild to moderate adverse events. The most common were application site erythema (seen in 6.8% of the patients given spinosad), ocular hyperemia (in 3.3% of patients), and application site irritation (in 1.5% of patients).

Spinosad works by causing neuronal excitation in insects. After a period of hyperexcitation, lice become paralyzed and die.

The FDA approval covered the use of spinosad in adults and children aged 4 years and older. The agency said that it is important not to use spinosad in infants younger than age 6 months. The product contains benzyl alcohol, which can cause serious reactions and even death in infants.

The clinical trials reported in Pediatrics were sponsored by ParaPRO, the manufacturer of Natroba. Two of the coauthors received research funding from ParaPRO, and two others served as consultants to the company.

The Food and Drug Administration on Jan. 14 issued a safety announcement about reports of rare but severe liver injury in patients taking dronedarone, including two patients who had acute liver failure that required transplantation.

Dronedarone (Multaq) is used to treat abnormal heart rhythm in patients who have those symptoms for the past 6 months, according to the FDA.

The announcement warned physicians and patients to be alert for signs and symptoms of liver injury or toxicity, including anorexia, nausea, vomiting, fever, malaise, fatigue, right upper quadrant pain, jaundice, dark urine, or itching.

Physicians are encouraged to consider ordering periodic hepatic serum enzymes, particularly during the initial 6 months of treatment with dronedarone.

The label’s adverse reactions and warnings and precautions sections are being updated to include information about the potential risk of liver injury.

Adverse events should be reported to MedWatch online or by calling (800) 332-1088.

The Food and Drug Administration on Jan. 14 issued a safety announcement about reports of rare but severe liver injury in patients taking dronedarone, including two patients who had acute liver failure that required transplantation.

Dronedarone (Multaq) is used to treat abnormal heart rhythm in patients who have those symptoms for the past 6 months, according to the FDA.

The announcement warned physicians and patients to be alert for signs and symptoms of liver injury or toxicity, including anorexia, nausea, vomiting, fever, malaise, fatigue, right upper quadrant pain, jaundice, dark urine, or itching.

Physicians are encouraged to consider ordering periodic hepatic serum enzymes, particularly during the initial 6 months of treatment with dronedarone.

The label’s adverse reactions and warnings and precautions sections are being updated to include information about the potential risk of liver injury.

Adverse events should be reported to MedWatch online or by calling (800) 332-1088.

The Food and Drug Administration on Jan. 14 issued a safety announcement about reports of rare but severe liver injury in patients taking dronedarone, including two patients who had acute liver failure that required transplantation.

Dronedarone (Multaq) is used to treat abnormal heart rhythm in patients who have those symptoms for the past 6 months, according to the FDA.

The announcement warned physicians and patients to be alert for signs and symptoms of liver injury or toxicity, including anorexia, nausea, vomiting, fever, malaise, fatigue, right upper quadrant pain, jaundice, dark urine, or itching.

Physicians are encouraged to consider ordering periodic hepatic serum enzymes, particularly during the initial 6 months of treatment with dronedarone.

The label’s adverse reactions and warnings and precautions sections are being updated to include information about the potential risk of liver injury.

Adverse events should be reported to MedWatch online or by calling (800) 332-1088.