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<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_3274"
                     title="New Guidelines Out for Pneumococcal Vaccine (CME/CE)"
                     score="0.013"
                     href="http://www.medpagetoday.com/InfectiousDisease/Vaccines/tb/22034?impressionId=1284019791791"
                     
      &lt;p&gt;Adults with asthma and those who smoke should receive the 23-valent polysaccharide vaccine to prevent pneumococcal disease, according to new recommendations from the CDC.&lt;/p&gt;
&lt;p&gt;But the agency&apos;s Advisory Committee on Immunization Practices (ACIP) is no longer recommending routine use of the vaccine for all Alaska Natives and American Indians younger than 65 unless they have medical or behavioral reasons  --  such as alcohol and tobacco use  --  that put them at increased risk, or if they live in areas where the rates of invasive disease are high.&lt;/p&gt;
&lt;p&gt;The new recommendations were published in the Sept. 3 issue of &lt;em&gt;Morbidity and Mortality Weekly Report&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Herd effects have reduced the overall incidence of pneumococcal infections since the introduction of the 7-valent vaccine in 2000, but invasive disease  --  bacteremia, meningitis, or infection at other normally sterile sites  --  remains a threat, with 43,500 cases and 5,000 deaths occurring in 2009, according to the CDC.&lt;/p&gt;
&lt;p&gt;Between 1998 and 2007, the incidence of invasive disease among adults younger than 65 with high-risk conditions increased from 52% to 59%, and from 69% to 81% in those 65 and older.&lt;/p&gt;
&lt;p&gt;&quot;This trend suggests that adults with high-risk conditions might not have benefited as much from the indirect protective effects of childhood [7-valent pneumococcal conjugate vaccine] immunization as persons who are relatively healthy,&quot; the CDC report stated.&lt;/p&gt;
&lt;p&gt;As support for the asthma recommendation, CDC cited a case-control study in Tennessee that found an adjusted odds ratio of 2.4 (95% CI 1.8 to 3.3) for invasive pneumococcal disease in patients with asthma compared with those without the disease.&lt;/p&gt;
&lt;p&gt;And for smoking, CDC data from 2001 to 2003 suggested that more than half of patients ages 18 to 64 with invasive disease were current cigarette smokers.&lt;/p&gt;
&lt;p&gt;In addition, a case-control study identified a fourfold increased risk for smokers (adjusted OR 4.1, 95% CI 2.4 to 7.3), with risk correlating with number of cigarettes smoked and pack-years of smoking.&lt;/p&gt;
&lt;p&gt;Along with the vaccine, smokers should be given smoking cessation guidance, because the risk for invasive disease decreases by almost 15% each year after quitting.&lt;/p&gt;
&lt;p&gt;Estimated efficacy of the 23-valent vaccine, according to observational studies, ranges from 50% to 80% among immuncompetent adults, but efficacy is less clear, ranging from 10% to 74%, among the immunocompromised and the elderly.&lt;/p&gt;
&lt;p&gt;The report also states that everyone should receive the pneumococcal vaccine at age 65.&lt;/p&gt;
&lt;p&gt;Anyone who received a dose of the vaccine before 65 can be given a second dose if five years have passed since the first dose, and immunocompromised or asplenic patients ages 19 to 64 should be given a second dose five years after the first.&lt;/p&gt;
&lt;p&gt;Multiple revaccinations are not recommended because of uncertainty about benefits and risks.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The authors are employees of the CDC.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_3312"
                     title="Flu Vaccine a Must for All Healthcare Workers, AAP Says (CME/CE)"
                     score="0.011"
                     href="http://www.medpagetoday.com/InfectiousDisease/URItheFlu/tb/22081?impressionId=1284019791791"
                     
      &lt;p&gt;All healthcare personnel should be required to get vaccinated against influenza, according to a new policy statement from the American Academy of Pediatrics.&lt;/p&gt;
&lt;p&gt;The authors, from the AAP&apos;s Committee on Infectious Diseases, said that influenza vaccination is needed to protect patients, and that healthcare personnel have an ethical and professional obligation to be immunized.&lt;/p&gt;
&lt;p&gt;&quot;Mandatory influenza immunization for all healthcare personnel is ethically justified, necessary, and long overdue to ensure patient safety,&quot; the authors wrote online ahead of the October print issue of &lt;em&gt;Pediatrics&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;The Advisory Committee on Immunization Practices (ACIP), which provides the CDC with guidance, has been recommending influenza vaccination for healthcare personnel since the early 1980s, and earlier this year &lt;a href=&quot;http://www.medpagetoday.com/InfectiousDisease/URItheFlu/18701&quot; mce_href=&quot;http://www.medpagetoday.com/InfectiousDisease/URItheFlu/18701&quot; target=&quot;_blank&quot;&gt;recommended universal immunization&lt;/a&gt; of everybody older than 6 months.&lt;/p&gt;
&lt;p&gt;&quot;Healthcare personnel fail to lead by example if they recommend universal immunization, including influenza, to their patients but do not require it of themselves,&quot; the authors of the new AAP statement wrote. &quot;It is surprising that many healthcare personnel and the organizations that employ them have been inexcusably silent in addressing this patient safety issue.&quot;&lt;/p&gt;
&lt;p&gt;According to the Joint Commission, a vaccination rate of 80% or higher is needed to maintain the herd immunity necessary to substantially dampen the transmission of influenza in healthcare settings. The actual rate, however, has hovered around 40% in recent years.&lt;/p&gt;
&lt;p&gt;There was a slight bump last year during the H1N1 pandemic to 61.9% for trivalent seasonal vaccine, but only 37.1% of healthcare professionals received the pandemic vaccine and 34.7% received both the seasonal and pandemic vaccine.&lt;/p&gt;
&lt;p&gt;Reasons cited in the literature for refusal to receive influenza vaccine among healthcare workers include fears of developing flu-like illness or adverse effects, a perception that the risk of becoming ill with influenza is low, and concerns about exposure to thimerosal, which is found in some influenza vaccines.&lt;/p&gt;
&lt;p&gt;Voluntary programs aimed at increasing immunization rates through free and easily accessible vaccines, educational efforts, and incentives for getting vaccinated have resulted in little improvement in coverage rates, failing to overcome misconceptions about the risks and benefits of the vaccines.&lt;/p&gt;
&lt;p&gt;&quot;These findings highlight the importance of educating healthcare personnel of the risks, benefits, and basic principles of influenza vaccination,&quot; the statement authors wrote.&lt;/p&gt;
&lt;p&gt;They said mandatory vaccination seems to be the only option for achieving coverage rates greater than 80% and cited several examples of health systems that maintained rates of 88% or higher through mandatory programs.&lt;/p&gt;
&lt;p&gt;The authors pointed out that mandatory vaccination is not a new idea, since every state has laws requiring certain vaccines for school entry or attendance.&lt;/p&gt;
&lt;p&gt;Immunization requirements also have been upheld by the Supreme Court if they are a public health necessity, if the vaccines have been proven effective, if the immunization process is not onerous or unfair, and if vaccination does not put the health of the individual at risk.&lt;/p&gt;
&lt;p&gt;&quot;Despite this reality, implementation of mandatory influenza immunization programs for healthcare personnel continues to be controversial to some who argue that a mandatory program violates civil liberties,&quot; the authors wrote.&lt;/p&gt;
&lt;p&gt;The AAP has developed guidance to aid implementation of mandatory vaccination programs, which includes information on supply, payment, coding, and liability issues. It can be found at &lt;a href=&quot;http://aapredbook.aappublications.org/implementation/&quot; mce_href=&quot;http://aapredbook.aappublications.org/implementation/&quot; target=&quot;_blank&quot;&gt;www.aapredbook.org/implementation&lt;/a&gt;.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;All authors have filed conflict of interest statements with the American Academy of Pediatrics. Any conflicts have been resolved through a process approved by the Board of Directors.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_3230"
                     title="Hospital-Acquired Infections Trend Downward"
                     score="0.011"
                     href="http://www.medpagetoday.com/HospitalBasedMedicine/InfectionControl/tb/21985?impressionId=1284019791791"
                     
      &lt;p&gt;Although healthcare-associated infections (HAIs) remain a large and at least partly avoidable problem in hospitals, it appears to be less of one than it was a few years ago, according to the Agency for Healthcare Research and Quality.&lt;/p&gt;
&lt;p&gt;After peaking in 2004 and 2005 at 2.30 per 1,000 hospital stays, HAI rates among adults declined to 2.03 per 1,000 stays in 2007, according to the most recent data from the Healthcare Cost and Utilization Project, summarized in an AHRQ statistical brief.&lt;/p&gt;
&lt;p&gt;The 2007 figure was identical to the rate seen in 2000 when the project first began collecting data, according to AHRQ researchers led by Claudia Steiner, MD, MPH.&lt;/p&gt;
&lt;p&gt;HAIs were recorded in just 0.2% of hospital stays in 2007.&lt;/p&gt;
&lt;p&gt;All patient subgroups, stratified by age, geographic region, and type of payer, shared in the decline, the researchers also found.&lt;/p&gt;
&lt;p&gt;The findings were seemingly at odds with &lt;a href=&quot;http://www.medpagetoday.com/Washington-Watch/Washington-Watch/19568&quot; mce_href=&quot;http://www.medpagetoday.com/Washington-Watch/Washington-Watch/19568&quot; target=&quot;_blank&quot;&gt;another AHRQ report&lt;/a&gt; issued earlier in the year. The agency&apos;s 2009 National Healthcare Quality Report, released in April, struck a pessimistic note by highlighting increases in the 2007 data for certain types of infections  --  postoperative sepsis and urinary tract infections  --  from 2006.&lt;/p&gt;
&lt;p&gt;But the new report indicates that, overall, 2007 was better than the previous year for HAIs, with the rate per 1,000 hospital stays down from 2.19 in 2006.&lt;/p&gt;
&lt;p&gt;No explanation for the downward trend was offered by Steiner and colleagues, but other investigators who have identified declining hospital infection rates have suggested that improved adherence to treatment guidelines and better management of risk factors for HAIs are responsible.&lt;/p&gt;
&lt;p&gt;The new report identified several hospital characteristics that were significantly (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.05) associated with increased rates of HAIs: &lt;ul&gt; &lt;li&gt;Hospital size of 500 beds or more&lt;/li&gt; &lt;li&gt;Location in metropolitan area&lt;/li&gt; &lt;li&gt;Teaching hospital&lt;/li&gt; &lt;li&gt;Private for-profit status&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;The report also indicated that stays marked by HAIs were distributed almost equally between male and female patients, in contrast with the nearly 2:1 ratio of women to men among hospital patients overall.&lt;/p&gt;
&lt;p&gt;The Healthcare Cost and Utilization Project collects data on all inpatients treated at a rotating nationwide sample of about 1,000 short-term, non-federal hospitals.&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_3275"
                     title="Kids on HAART Would Benefit from Revaccinations (CME/CE)"
                     score="0.01"
                     href="http://www.medpagetoday.com/clinical-context/HIVAIDS/tb/22037?impressionId=1284019791791"
                     
      &lt;p&gt;Children with HIV who received standard childhood immunizations before starting on highly active antiretroviral therapy (HAART) could benefit from revaccination, a review published in the September issue of &lt;em&gt;Lancet Infectious Diseases&lt;/em&gt; suggests.&lt;/p&gt;
&lt;p&gt;The proportion of those with an immune response after HAART began was highly variable, with no clear trend by type of vaccine, according to a meta-analysis of 38 studies conducted by Catherine G. Sutcliffe, PhD, and William J. Moss, MD, of Johns Hopkins University.&lt;/p&gt;
&lt;p&gt;For instance, they found for tetanus the proportion with an immune response ranged from 38% to 77%. Proportions ranged from 40% to 65% for diphtheria, 1% to 100% for hepatitis B virus (HBV), and 25% to 87% by serotype for pneumococcal vaccines.&lt;/p&gt;
&lt;p&gt;The proportion of children with an immune response to the measles, mumps, rubella vaccine (MMR) after starting HAART ranged from 42% to 45% for measles virus and 27% to 66% for rubella virus.&lt;/p&gt;
&lt;p&gt;Studies looking at revaccinations after HAART was started found that within the first three months, the proportion of children with an immune response was 53% to 100% for tetanus toxoid, 75% for conjugate Hib vaccine, 46% to 92% for HBV vaccine, 29% to 96% by serotype for pneumococcal vaccine, and 50% to 100% by strain for influenza vaccine. &lt;ul&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;For the meta-analysis, Sutcliffe and Moss looked at studies addressing several different questions about HAART and vaccines. For the question of whether children taking HAART have protective immunity to vaccine-preventable diseases, studies were included if children were vaccinated before being started on HAART and measures of immunity were reported after the start of HAART but before revaccination.&lt;/p&gt;
&lt;p&gt;For questions about the short-term (three months or less) and the long-term (more than three months) immune response to vaccination while on HAART, studies were included if children were revaccinated or received new vaccines to which they had no prior exposure after being started on HAART and either short-term or long-term immune responses were measured.&lt;/p&gt;
&lt;p&gt;Two studies looked at by the authors reported antibody concentrations before and after HAART. In one of those, a Kenyan study of the measles vaccine, researchers found that the proportion of children who were seropositive increased from 33% before HAART to 42% after HAART.&lt;/p&gt;
&lt;p&gt;However, 53% of the children who were seropositive before HAART lost protective immunity, whereas 40% of children who were seronegative or had borderline antibody concentrations became seropositive after receiving HAART for six months.&lt;/p&gt;
&lt;p&gt;In terms of the strength of immunizations, in general the studies found that immunity declined but a high proportion of children maintained immunity about a year after vaccination.&lt;/p&gt;
&lt;p&gt;For tetanus toxoid, one U.S. study reported a decline from 74% seropositive at four weeks to 38% by 32 weeks after vaccination, although in three other studies 85% to 90% of children maintained immunity one year after vaccination.&lt;/p&gt;
&lt;p&gt;For pertussis, antibody concentration declined from 22.3 EU/mL at eight weeks to 10.1 EU/mL by 48 weeks and 6.8 EU/mL by 96 weeks after vaccination.&lt;/p&gt;
&lt;p&gt;For HBV, the proportion of seropositive children decreased from 46% eight weeks after revaccination to 38% after 96 weeks and 25% after a median of 4.6 years.&lt;/p&gt;
&lt;p&gt;All children remaining in the HBV study after a median of 4.6 years were revaccinated a second time. Of the children who were seronegative within one week of the second revaccination, 37% seroconverted four weeks after vaccination.&lt;/p&gt;
&lt;p&gt;The authors wrote that although HAART is effective in reducing morbidity and mortality in HIV-infected children by suppressing viral replication and restoring immune function, &quot;immune reconstitution in children is primarily through the generation of naive T cells rather than expansion of memory T cells, as in adults.&quot;&lt;/p&gt;
&lt;p&gt;Therefore, they wrote, &quot;HAART is unlikely to restore memory T cells for vaccine antigens to which children were exposed before treatment, but should restore the ability of the immune system to respond to new antigens.&quot;&lt;/p&gt;
&lt;p&gt;Because levels of immunity to vaccine-preventable diseases in HIV-infected children were generally low, the majority of children on HAART would benefit from revaccination, although the best timing of vaccination after starting HAART is still not known, either for revaccination or for primary vaccination with new vaccines, according to the researchers.&lt;/p&gt;
&lt;p&gt;&quot;Waning immunity after revaccination and vaccination with new vaccines was greater and more rapid than in children not infected with HIV, who typically maintain high antibody concentrations years after vaccination,&quot; they added.&lt;/p&gt;
&lt;p&gt;The authors cited several limitations to their meta-analysis, including the fact that few studies were identified for each vaccine and there was great heterogeneity in study design, eligibility criteria, characteristics of study populations, definitions of immunity, and presence of a comparison group. In addition, vaccine-induced immunity could not be distinguished from immunity derived from natural infection.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The authors declared that they had no conflicts of interest. No funding information for the study was given.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_3145"
                     title="Hand Cleansers Cut Absenteeism (CME/CE)"
                     score="0.005"
                     href="http://www.medpagetoday.com/InfectiousDisease/InfectionControl/tb/21868?impressionId=1284019791791"
                     
      Putting alcohol-based hand cleansers in work places slashed the incidence of several common infections and reduced the number of workdays lost, a randomized trial showed.&lt;br&gt;
&lt;br&gt;Access to the disinfectants was associated with odds ratios of 0.35 to 0.45 (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.05) for reported colds, fevers, and coughs in an unblinded trial with 129 participants, according to Nils-Olaf H&amp;#252;bner, MD, of the Institute of Hygiene and Environmental Medicine in Greifswald, Germany, and colleagues.&lt;br&gt;
&lt;br&gt;The researchers also found that putting disinfectants on employees&apos; desks helped reduce absenteeism. The effect was modest overall, but workdays lost because of diarrhea were cut dramatically, they reported in the online open-access journal &lt;em&gt;BMC Infectious Diseases&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Eight workers in the control group said they took days off because of diarrhea, compared with one in the intervention group (OR 0.11, 95% CI 0.01 to 0.93).&lt;/p&gt;
&lt;p&gt;&quot;Our results confirm the findings from other authors, that hand disinfection has preventive effects against acute respiratory and gastrointestinal infections,&quot; H&amp;#252;bner and colleagues wrote.&lt;/p&gt;
&lt;p&gt;Participants were white-collar workers reporting frequent contact with customers or archived paper&lt;strong&gt; &lt;/strong&gt;at a local university and at city and state administrative offices and were recruited by mail or e-mail (response rate 16%). The study period lasted about 13 months from 2005 to 2006.&lt;/p&gt;
&lt;p&gt;Those assigned to the intervention were initially given an ethanol-based antiseptic hand rub. Those who had skin reactions such as dryness or erythema were given a different product containing propanol and mecetronium etilsulfate.&lt;/p&gt;
&lt;p&gt;Both were liquids provided in bottles for desktop use. Participants were told to wet their hands fully with the rubs at least five times a day, especially after visiting the restroom, blowing their noses, before eating, and after touching other people or papers. However, they were also told not to use the rubs at home or otherwise change their hand hygiene away from work.&lt;/p&gt;
&lt;p&gt;No hand-hygiene behaviors were suggested to the control group.&lt;/p&gt;
&lt;p&gt;Both groups completed monthly questionnaires on the incidence of nine respiratory and gastrointestinal symptoms or diagnoses and whether workdays were missed as a result. At the end of the study, participants in the intervention also indicated their compliance with the hand-hygiene protocol.&lt;/p&gt;
&lt;p&gt;No significant benefit for the disinfectants was found for five of the symptoms and conditions: sinusitis, sore throat, bronchitis, pneumonia, and influenza.&lt;/p&gt;
&lt;p&gt;Significant reductions in rates of colds, fevers, and coughing were seen, expressed as odds ratios relative to the control group: &lt;ul&gt; &lt;li&gt;Colds: OR 0.35 (95% CI 0.17 to 0.71)&lt;/li&gt; &lt;li&gt;Fever: OR 0.38 (95% CI 0.14 to 0.99)&lt;/li&gt; &lt;li&gt;Coughing: OR 0.45 (95% CI 0.22 to 0.91)&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;When H&amp;#252;bner and colleagues looked at lost workdays, they found that these differed significantly for two of the conditions  --  diarrhea, as noted earlier, and also bronchitis.&lt;/p&gt;
&lt;p&gt;But in the latter case, it went in the opposite direction  --  workdays lost because of bronchitis were more common in the intervention group, with nine of those employees reporting lost workdays compared with two in the control group (OR 5.16, 95% CI 1.07 to 24.88).&lt;/p&gt;
&lt;p&gt;H&amp;#252;bner and colleagues offered no explanation for this paradoxical-seeming result. They noted, though, that effects on relatively uncommon but long-lasting conditions for which individuals may have a predisposition, such as bronchitis and sinusitis, &quot;are hard to interpret&quot; because one such episode can have a large effect on the data.&lt;/p&gt;
&lt;p&gt;Another discordant result was that, although lost workdays because of diarrhea were much less common in the intervention group, the rates of diarrhea overall did not differ significantly between groups (OR 0.48 for the intervention versus control, 95% CI 0.19 to 1.22).&lt;/p&gt;
&lt;p&gt;Limitations to the study included the low response rate to the invitations to participate, the use of both semichronic and acute conditions as endpoints, reliance on participants&apos; self-reports of symptom incidence and duration, and lack of data on work place productivity other than missed workdays.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was supported by Bode Chemie, manufacturer of the hand rubs used in the study.&lt;/p&gt;&lt;p&gt;Hu&amp;#776;bner and one co-author reported past grant support from Bode Chemie. Another co-author was an employee of Bode Chemie.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
</recommendedContent>
