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    <recommendedItem id="20100101_19_432"
                     title="Short Needle May Short HBV Protection for Obese (CME/CE)"
                     score="0.012"
                     href="http://www.medpagetoday.com/Pediatrics/Vaccines/tb/18348?impressionId=1265781990539"
                     
      &lt;p&gt;Obese adolescents and young adults may not generate an adequate immune response to hepatitis B (HBV) vaccine because the needles used to vaccinate them are too short, a randomized study suggests.&lt;/p&gt;
&lt;p&gt;Immunization with a 1.5-inch needle was associated with 80% higher anti-HBV titers than a 1.0-inch needle, researchers reported online in &lt;em&gt;Pediatrics.&lt;/em&gt;&lt;/p&gt;
&lt;p&gt;The difference persisted in analyses performed to correct for imbalances in the study population.&lt;/p&gt;
&lt;p&gt;&quot;This supports the hypothesis that inadequate muscle penetration is responsible, at least in part, for lower immune response to HBV vaccine among obese adolescent and adult vaccine recipients,&quot; Amy Middleman, MD, of Baylor College of Medicine in Houston, and colleagues concluded.&lt;/p&gt;
&lt;p&gt;Several studies have shown that adolescents and adults with a higher body mass index (BMI) have lower antibody titers after HBV vaccination. The observations have taken on new significance, given that an increasing number of vaccines target a population that has a rising BMI, the authors wrote.&lt;/p&gt;
&lt;p&gt;Researchers hypothesize that standard-length needles do not penetrate through the deltoid fat and into the muscle of obese adolescents and adults. Because of its less abundant blood supply, adipose tissue may delay antigen presentation to B and T cells responsible for immune response, the authors continued.&lt;/p&gt;
&lt;p&gt;To test the hypothesis, Middleman and colleagues conducted a randomized, clinical trial involving adolescents and adults ages 14 to 24 with no prior exposure to HBV vaccine. Eligibility criteria included weight &amp;gt;90 kg for female patients and &amp;gt;120 kg for male patients.&lt;/p&gt;
&lt;p&gt;Patients were randomized to receive the HBV vaccine series with a standard one-inch needle or a 1.5-inch needle. Patients younger than 19 received 0.5-mL injections, and older patients received 1.0-mL injections.&lt;/p&gt;
&lt;p&gt;Investigators used a standardized injection procedure: insertion of the needle at a 90&amp;#176; angle to the deltoid muscle, leaving 2 to 3 mm of needle visible between the skin and the hub.&lt;/p&gt;
&lt;p&gt;Patients received three doses of vaccine at baseline, one month, and four months. Blood samples were obtained at baseline and two months after the final injection.&lt;/p&gt;
&lt;p&gt;The two groups did not differ significantly with respect to median age (21), BMI (~40), deltoid skinfold (41 mm), triceps skinfold (~40 mm), days between vaccine doses one and three (~135), and days from third vaccine dose to titer assessment (65).&lt;/p&gt;
&lt;p&gt;At the end of the study, 24 patients had completed the immunization protocol, 10 in the one-inch group and 14 in the 1.5-inch group.&lt;/p&gt;
&lt;p&gt;Patients vaccinated with a one-inch needle had a median antibody titer of 189.8 mIU/mL compared with 345.4 mIU/mL for patients vaccinated with the 1.5-inch needle (&lt;em&gt;P&lt;/em&gt;=0.03).&lt;/p&gt;
&lt;p&gt;The between-group difference remained significant in analyses that excluded an outlier from the 1.5-inch group (&lt;em&gt;P&lt;/em&gt;=0.047) and that excluded the only two male patients in the study (&lt;em&gt;P&lt;/em&gt;=0.035).&lt;/p&gt;
&lt;p&gt;&quot;As we continue to experience high rates of obesity in the U.S. and throughout the world, additional evidence-based research on optimizing the effective delivery of immunizations to adolescents and young adults will be critical,&quot; the authors wrote.&lt;/p&gt;
&lt;p&gt;&quot;Following updated needle length recommendations will be a first step toward improving the health of our youth and young adults by preventing vaccine-preventable diseases.&quot;&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 federal grants and awards. GlaxoSmithKline provided the vaccine.&lt;/p&gt;&lt;p&gt;The authors had no disclosures.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_349"
                     title="Motavizumab Reduces Preemie Lung Infections (CME/CE)"
                     score="0.008"
                     href="http://www.medpagetoday.com/Pediatrics/Vaccines/tb/18232?impressionId=1265781990539"
                     
      &lt;p&gt;Premature babies who received preventative treatment with motavizumab (Medi-524) suffered fewer outpatient respiratory infections than those taking palivizumab (Synagis), the current standard of treatment, a large new trial found.&lt;/p&gt;
&lt;p&gt;Compared with children who received palivizumab, those treated with motavizumab had similar rates of hospitalization for respiratory syncytial virus, or RSV (RR 0.74; 95% CI 0.503 to 1.083) and a 50% reduction in outpatient, RSV-specific, medically attended lower respiratory tract infection, or MALRI (2.0% vs 3.9%; &lt;em&gt;P&lt;/em&gt;=0.005), according to a report in the January issue of &lt;em&gt;Pediatrics&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;&quot;Although not better than palivizumab in reducing RSV-associated hospitalizations, motavizumab did demonstrate a significant reduction in outpatient MALRI compared with palivizumab,&quot; Xavier Carbonell-Estrany, MD, PhD, of Hospital Cl&amp;#237;nic, in Barcelona, Spain, and colleagues wrote.&lt;/p&gt;
&lt;p&gt;&quot;As such, motavizumab may offer an improved alternative for preventing serious RSV disease in high-risk infants and children.&quot;&lt;/p&gt;
&lt;p&gt;Most otherwise healthy patients recover within a week or two from RSV, which infects the lungs and breathing passages. However, the infection can be severe in people who are vulnerable, including premature infants and older children who were born prematurely. It&apos;s the most common cause of bronchiolitis and pneumonia in U.S. children in their first year of life, researchers noted.&lt;/p&gt;
&lt;p&gt;Palivizumab is a humanized monoclonal antibody recommended for prevention of RSV in children at high risk. Monthly treatments of high-risk youngsters have been found to reduce RSV-related hospitalizations by 50%, compared with placebo.&lt;/p&gt;
&lt;p&gt;Motavizumab, an investigational monoclonal antibody related to palivizumab, proved more potent at neutralizing the RSV virus in animal studies. Early trials indicated the drug was well-tolerated at treatment doses and reduced viral counts in the nasal aspirates of children hospitalized with RSV.&lt;/p&gt;
&lt;p&gt;Both drugs are manufactured by MedImmune, the sponsor of this phase III clinical trial.&lt;/p&gt;
&lt;p&gt;In the double-blind, multinational study, Carbonell-Estrany and colleagues randomly assembled 6,635 preterm infants (6 months and younger) and children (2 years and younger) suffering from chronic lung disease resulting from premature birth.&lt;/p&gt;
&lt;p&gt;They were randomized to five 15 mg/kg monthly doses of palivizumab or motavizumab between November 2004 and May 2006. The trial was conducted in 24 countries.&lt;/p&gt;
&lt;p&gt;The primary objective was to compare the efficacy of the two drugs at preventing a child from being hospitalized due to respiratory symptoms from an RSV infection, preventing a child already hospitalized from contracting a new infection, and preventing deaths from RSV.&lt;/p&gt;
&lt;p&gt;Of the 6,513 children who received full treatment with the drugs, 43 (1.4%) of those who received motavizumab and 59 (1.9%) of those who received palivizumab were hospitalized for RSV infections (95% CI 0.490 to 1.081).&lt;/p&gt;
&lt;p&gt;The study also compared the drugs&apos; efficacy at preventing RSV-specific outpatient MALRIs. Of the 2,283 outpatients who received full treatment with the drugs, 23 (2%) who received motavizumab and 45 (3.9%) who received palivizumab contracted RSV infections (&lt;em&gt;P&lt;/em&gt;=0.005).&lt;/p&gt;
&lt;p&gt;The authors noted that while the drugs had similar overall safety profiles, participants who took motavizumab had more cutaneous reactions.&lt;/p&gt;
&lt;p&gt;&quot;In this large, multinational, well controlled trial, motavizumab was shown to be noninferior to palivizumab for prevention of RSV hospitalization (primary end point) and was superior to palivizumab for reduction of RSV-specific outpatient MALRI (a secondary end point),&quot; the authors wrote.&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 funded by MedImmune, the manufacturer of motavizumab.&lt;/p&gt;&lt;p&gt;Several of the authors reported being employees of MedImmune or receiving consulting and research services fees from MedImmune and Abbott International.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_10_672"
                     title="Vaccine for Cervical Cancer and Genital Warts Proves Effective"
                     score="-0.005"
                     href="