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May 4, 2009JAMA news releases are made available to the public after 3 pm US Central time on the first 4 Tuesdays of each month. The Archives of Journals news releases are made available to the public after 3 pm Central time on Mondays. We also provide a list of previous news releases. THIS WEEK'S CONTENTS
ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, May 4, 2009)
ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE Audio Interview
ARCHIVES OF GENERAL PSYCHIATRY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, May 4, 2009)
INFORMATION CONTAINED IN THESE NEWS RELEASES IS PROTECTED BY COPYRIGHT. JOURNAL ATTRIBUTION IS REQUIRED. JOURNALISTS CAN NOW ACCESS EMBARGOED JAMA/ARCHIVES STUDIES ON-LINE. Go to www.jamamedia.org for more information and to apply for access. Please Note: The FOR THE MEDIA website now has a search feature to enable media to find previous JAMA/Archives news releases on specific medical topics. This search feature link is located on the home page at www.jamamedia.org EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, May 4, 2009
Vaccine Records of Internationally Adopted Children May Not Reflect Protection Against Disease
CHICAGO—Children adopted from countries such as Russia, China and Guatemala may not be protected against polio, measles or other diseases despite records indicating they have been immunized, according to a report in the May issue of Archives of Pediatrics & Adolescent Medicine, a theme issue on vaccines. U.S. families have adopted almost 250,000 foreign-born children in the last 15 years, according to background information in the article. Many of these children were living in orphanages or other institutional settings with few resources and are likely to have incomplete immunization records or none at all. When valid written records do exist, the American Academy of Pediatrics Committee on Infectious Disease advises that they could be considered as evidence of previous vaccination. However, there are reasons to suspect that these records may not accurately reflect immunity, including "documentation inaccuracies, lack of vaccine potency and impaired immune response, possibly due to stress or malnutrition." Emaculate Verla-Tebit, Ph.D., and colleagues at Case Western Reserve University School of Medicine, Cleveland, obtained data from 465 children who visited the International Adoption Clinic at Rainbow Babies and Children's Hospital between 2001 and 2006 and who presented for care within 180 days of arrival to the United States. Most of the adopted children came from Russia (41.7 percent), China (20.9 percent) or Guatemala (15.7 percent). Immunization records were available for 397 (85.4 percent) of adoptees (average age 19.4 months). Blood samples were obtained and tested for evidence of immunity against diphtheria, tetanus, measles, hepatitis B and polio. Evidence of immunity was found in:
"Our results suggest that the predictive value of immunization records in international adoptees may be limited and associated with birth country," the authors write. "Reasons that have been proposed include falsification of vaccine certificates, inaccurate entries and lack of vaccine potency."
Revaccination may be a cost-effective option for parents whose children do not show immunity, the authors note. Parents of children in the current study chose to revaccinate between 5 percent and 21 percent of the time, depending on the vaccine type. "Immunization records should not be accepted as evidence of protective immunity. Parents should be well informed and supported to choose between revaccination or vaccination, based on serologic [blood] testing," they conclude.
Editor's Note: This study was supported by a grant from the National Institutes of Health. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc. Please Note: A podcast interview and radio actualities from Anna Maria Mandalakas, M.D., M.S., will be available pre-embargo to the media at www.jamamedia.org. For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org. EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, May 4, 2009
Vaccination Coverage Improves Among Low-Income Children, But Disparities Persist
CHICAGO—More children in low-income households are receiving childhood vaccinations on schedule than in previous years, but disparities based on economic status remain, according to a report in the May issue of Archives of Pediatrics & Adolescent Medicine, a theme issue on vaccines. A measles resurgence in 1989 to 1991 was partially attributed to low vaccination rates among low-income children, according to background information in the article. In response, government officials aimed to address disparities in vaccination coverage. In October 1994, the Vaccines for Children Program was established to eliminate cost barriers and provide publicly purchased vaccines at no cost to eligible children. "An important conclusion of Centers for Disease Control and Prevention [CDC] research conducted during the U.S. measles resurgence was that vaccines need to be administered on time because delays indicate inadequate protection against vaccine-preventable diseases," the authors write. To assess progress since the establishment of the program, Philip J. Smith, Ph.D., and colleagues at the CDC, Atlanta, analyzed data from 232,318 children in low-income households (annual income of 133 percent or less of the federal poverty level) who participated in the U.S. National Immunization Survey between 1995 and 2007. Those who had received the recommended doses of vaccinations against diphtheria, tetanus, pertussis, polio, measles, mumps, rubella, Haemophilus influenza type b, hepatitis B and varicella by age 19 months were categorized as having timely vaccination coverage. Coverage rates were compared with those of children in high-income households (400 percent or more of the federal poverty level) and changes were tracked over time for children born each year between 1994 and 2004. "In our analyses, we found that among low-income children, timely vaccination coverage rates for all vaccines except Hib [Haemophilus influenza type b] have increased significantly between consecutive cohorts born after the measles resurgence," the authors write. For low-income children born between 1994 and 2004, timely coverage increased each year by 5.3 percent for varicella vaccines, 1.2 percent for hepatitis B, 0.6 percent for measles, mumps and rubella (MMR), 0.5 percent for the diphtheria, tetanus and pertussis (DTaP-DTP) vaccine and 0.3 percent for polio. "Also, significant disparities in timely vaccination coverage were found between low- and high-income children for all childhood vaccines and nearly every birth cohort born between 1994 and 2004," the authors write. "However, these disparities have been declining significantly for the MMR [an estimated 0.3 percent decline], hepatitis B [0.3 percent] and varicella [0.5 percent] vaccines." In contrast, disparities increased significantly by 0.4 percent for the DTaP-DTP vaccine and did not change for polio.
The results suggest that progress has been made but that additional efforts are needed, the authors note. "Further progress in timely vaccination may be achieved by improving health care providers' reminder/recall systems, implementing educational interventions that address barriers to vaccination and increasing parents' awareness of the Vaccines for Children Program," they conclude.
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc. For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, May 4, 2009
Infants' Pain Response to Immunization Varies Based on Which Vaccine Is First
CHICAGO—Infants who receive the pneumococcal conjugate vaccine (PCV) following the combination vaccine for diphtheria, polio, tetanus, pertussis and Haemophilus influenzae type b (DPTaP-Hib vaccine) appear to experience less pain than those who are immunized in the opposite order, according to a report in the May issue of Archives of Pediatrics & Adolescent Medicine, a theme issue on vaccines. Injections are the most painful common medical procedure conducted in childhood, according to background information in the article. "Multiple injections are routinely administered during a single visit to a physician," the authors write. "Because some vaccines cause more pain than others, the order in which they are given may affect the overall pain experience." In a recent study of U.S. pediatricians, more than 90 percent reported at least one parent in their practice had refused to have a child vaccinated in the previous year, most commonly due to the pain caused by multiple vaccines. Therefore, reducing the pain associated with vaccines could increase immunization rates and prevent a resurgence of infectious diseases. Moshe Ipp, M.B.B.Ch., of The Hospital for Sick Children, Toronto, Ontario, Canada, and colleagues studied 120 healthy infants age 2 to 6 months undergoing routine immunization at an outpatient pediatric clinic in 2006 or 2007. Sixty infants received the PCV before the DPTaP-Hib vaccine, while 60 received the DPTaP-Hib vaccine first. The procedure was videotaped and pain was assessed on a scale that considered the infant's facial expression, crying and body movements after vaccination. Parents were also asked to rate their children's pain levels on a scale of zero to 10. "Infant pain response during routine intramuscular vaccine injection was affected by the order of administration of the vaccine," the authors write. "Infants given the less painful DPTaP-Hib vaccine first followed by the more painful PCV experienced less pain overall when compared with those given the vaccines in the reverse order. In addition, pain increased from the first to the second injection, regardless of the order of vaccine injection." These data suggest that when two immunizations are given, the least painful vaccine should be administered first, the authors note. Giving the more painful injection first may focus the infant's attention on the procedure and activate pain processing centers in the brain, resulting in a more intense pain signal in response to any shots given afterward.
"Steps to minimize vaccine-related pain reduces the pain experienced by the child and improves the immunization experience of parents and health care workers," the authors conclude. "Varying the order of vaccine administration to reduce pain is a strategy that is simple and effective, cost-free and easily incorporated into clinical practice. In considering methods of reducing pain with vaccination, vaccine manufacturers must play a more integral role in attempting to produce vaccine formulations that are less painful."
Editor's Note: This study was funded by an unrestricted grant from Sanofi Pasteur, Toronto, Ontario, Canada. Co-author Dr. Taddio is supported by a New Investigator Award by the Canadian Institutes of Health Research. The Pediatric Outcomes Research Team is supported by a grant from The Hospital for Sick Children Foundation. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc. For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, May 4, 2009
New Strategies Help Ensure That Vaccines Remain Effective in Preventing Disease
Studies on immunization highlighted in Archives of Pediatrics & Adolescent Medicine theme issue CHICAGO—"Childhood vaccination represents one of the most successful public health interventions ever," write Matthew M. Davis, M.D., M.A.P.P., of the University of Michigan, Ann Arbor, and Samir S. Shah, M.D., M.S.C.E., of The Children's Hospital of Philadelphia, in an editorial in the May issue of Archives of Pediatrics & Adolescent Medicine, a theme issue on vaccines. "Diseases that once killed thousands of children each year have been virtually eliminated." "Nevertheless, childhood vaccination in the 21st century faces multiple challenges that threaten its success," write Dr. Davis and Dr. Shah, both members of the Archives editorial board. For example, a skeptical public questions the safety of vaccines, vaccine shortages lead to delayed immunization and low vaccination rates among adults leave the children they care for vulnerable to preventable diseases. "These challenges demand innovative responses from the generation of researchers and policymakers now engaged in work regarding vaccines around the globe," they continue. "In this issue of the Archives, authors present many compelling ideas and research findings that set the stage for the next phase of efforts designed to protect children and their families through the use of safe and effective vaccines." Articles published in the issue find that:
"Vaccine-preventable diseases still result in significant morbidity and other societal costs," Dr. Davis and Dr. Shah conclude. "As research for new and more effective vaccines continues, medical personnel must optimize the way they use existing vaccines. The articles included in this issue of the Archives highlight novel strategies for improving the uptake and effectiveness of currently available vaccines."
Editor's Note: Please see the article for additional information, including author contributions and affiliations, financial disclosures, funding and support, etc. For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org. ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE AUDIO INTERVIEWS Interview with Anna Maria Mandalakas, M.D., M.S., senior and corresponding author of "Predictive Value of Immunization Records and Risk Factors for Immunization Failure in Internationally Adopted Children" (Arch Pediatr Adolesc Med. 2008;163[5]:473-479).Full podcast (05:24) Transcript: CLIP 2 (0:37): The findings of our study are important to parents in the U.S. who have already adopted children from other countries because we clearly show that even with a valid written immunization record, children may not be protected against these diseases. So for a family whose child had a good written record and the pediatrician accepted that written record, their child may not be protected against these diseases. In those situations, those families may want to go back and have their children tested to see if those vaccines were effective. CLIP 3 (0:42): The value of the findings of our study to pediatricians in the United States are multiple. Most importantly, our study clearly illustrates that even in children with a valid written immunization record, there is immunization failure. Next, our study illustrates that malnutrition status at the time of evaluation in the U.S. does not predict whether the vaccines were effective or not. Thirdly, I think our study illustrates that you cannot guarantee vaccines will be effective based on the country that the child was born in.
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, May 4, 2009
Being Bullied in Childhood Associated With Psychotic Symptoms Among Pre-Teens
CHICAGO—Children who are consistently victimized by peers appear more likely to develop psychotic symptoms in early adolescence, according to a report in the May issue of Archives of General Psychiatry, one of the JAMA/Archives journals. Some psychosis-like symptoms such as hallucinations and delusions are commonly experienced in childhood and adulthood, according to background information in the article. Children with these symptoms are at increased risk of developing psychosis in adulthood. "Recent studies have demonstrated an association between traumatic events such as abuse in childhood and psychosis in adults," the authors write. Andrea Schreier, Ph.D., of Warwick Medical School, University of Warwick, Coventry, England, and colleagues studied 6,437 individuals in early adolescence (average age 12.9) who were part of the Avon Longitudinal Study of Parents and Children (ALSPAC). Parents had completed regular mailed questionnaires about their child's health and development since birth, and the children underwent yearly physical and psychological assessments from age 7. At each visit, trained interviewers rated the children on whether they had experienced psychotic symptoms (hallucinations, delusions or thought disorders) during the previous six months. Children, parents and teachers reported on whether the child had experienced peer victimization, defined as negative actions by one of more other students with the intention to hurt. A total of 46.2 percent of participants were categorized as victims and 53.8 percent were not victimized at either ages 8 or 10. At age 12.9, 13.7 percent had broad psychosis-like symptoms (one or more symptoms suspected or definitely present), 11.5 percent had intermediate symptoms (one or more of the symptoms was suspected or present at times other than going to sleep, waking from sleep, fever or after substance use) and 5.6 percent had narrow symptoms (one or more symptoms definitely present). The risk of psychotic symptoms was approximately doubled among children who were victims of bullying at age 8 or 10, independent of other psychiatric illness, family adversity or the child's IQ. The association was stronger when victimization was chronic or severe. "A range of mechanisms has been proposed to explain the link between traumatic events, such as victimization, and psychotic symptoms," the authors write. For instance, chronic stress from bullying may act on a genetic predisposition to schizophrenia to trigger symptoms.
"Whether repeated victimization experiences alter cognitive and affective processing or reprogram stress response or whether psychotic symptoms are more likely due to genetic predisposition still needs to be determined in further research," the authors conclude. "A major implication is that chronic or severe peer victimization has non-trivial, adverse, long-term consequences. Reduction of peer victimization and of the resulting stress caused to victims could be a worthwhile target for prevention and early intervention efforts for common mental health problems and psychosis."
Editor's Note: The UK Medical Research Council, the Wellcome Trust and the University of Bristol provide core support for ALSPAC. This study was funded by a grant from the Wellcome Trust. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc. For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, May 4, 2009
Relapse Common Among Women Who Stop Taking Antidepressant Medication for Premenstrual Syndrome
CHICAGO—About half of women whose symptoms of severe premenstrual syndrome are relieved by the antidepressant sertraline appear to experience relapse within six to eight months after stopping medication, according to a report in the May issue of Archives of General Psychiatry, one of the JAMA/Archives journals. Women with more severe symptoms and those who took the drug for a shorter period of time may be more likely to relapse. Premenstrual syndrome (PMS) is one of the most common health problems reported by women of reproductive age, according to background information in the article. Several antidepressant medications, including sertraline hydrochloride, have been approved to treat the most severe form of PMS (known as premenstrual dysphoric disorder, or PMDD). "There is little information about the optimal duration of treatment, although anecdotal reports and small pilot investigations suggest that premenstrual symptoms return rapidly in the absence of effective medication," the authors write. Ellen W. Freeman, Ph.D., and colleagues at the University of Pennsylvania School of Medicine, Philadelphia, conducted an 18-month study involving 174 women with PMS or PMDD. Participants were randomly assigned to either a short-term or long-term treatment group; neither the women nor the researchers knew the treatment assignments. The 87 women assigned to short-term treatment took sertraline for four months and then were switched to placebo for 14 months, while the 87 assigned to long-term treatment took sertraline for 12 months and placebo for six months. A total of 125 of the 174 patients (72 percent) showed improvement following treatment, most within the first four months. Relapse—defined as a return to the level of symptoms experienced before treatment—occurred in 41 percent of women after long-term treatment (median or midpoint time to relapse, eight months) and 60 percent of women after short-term treatment (median time to relapse, four months). "Patients with severe symptoms at baseline were more likely to experience relapse compared with patients in the lower symptom severity group and were more likely to experience relapse with short-term treatment," the authors write. "Duration of treatment did not affect relapse in patients in the lower symptom severity group." The 41 patients (24 percent) who experienced remission, or a reduction of premenstrual symptoms to the normal post-menstrual level, after four months of treatment were least likely to experience relapse.
"How long medication should be continued after achieving a satisfactory response and the risk of relapse after discontinuing treatment are important concerns for women and clinicians, given the possible adverse effects and cost of drugs vs. the benefit of medication that improves symptoms, functioning and quality of life," the authors write. "These findings suggest that the severity of symptoms at baseline and symptom remission with treatment should be considered in determining the duration of treatment."
Editor's Note: This study was supported by a grant from the Institute of Child Health and Human Development, National Institutes of Health. Sertraline and placebo tablets were provided by Pfizer Inc. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc. For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, May 4, 2009
Imaging Study Finds Evidence of Social Orienting Ability Associated With Brain Abnormalities in Toddlers with Autism
CHICAGO—Toddlers with autism appear more likely to have an enlarged amygdala, a brain area associated with numerous functions, including the processing of faces and emotion, according to a report in the May issue of Archives of General Psychiatry, one of the JAMA/Archives journals. In addition, this brain abnormality appears to be associated with the ability to share attention with others, a fundamental ability thought to predict later social and language function in children with autism. "Autism is a complex neurodevelopmental disorder likely involving multiple brain systems," the authors write as background information in the article. "Converging evidence from magnetic resonance imaging, head circumference and postmortem studies suggests that brain volume enlargement is a characteristic feature of autism, with its onset most likely occurring in the latter part of the first year of life." Based both on its function and studies of changes in its structure, the amygdala has been identified as a brain area potentially associated with autism. Matthew W. Mosconi, Ph.D., and colleagues at the University of North Carolina at Chapel Hill conducted a magnetic resonance imaging study involving 50 autistic children and 33 control children. Participating children underwent brain scans along with testing of certain behavioral features of autism at ages 2 and 4. This included a measure of joint attention, which involves following another person's gaze to initiate a shared experience. Compared to control children, those children with autism were more likely to have amygdala enlargement both at age 2 and age 4. "These findings suggest that, consistent with a previous report of head circumference growth rates in autism and studies of amygdala volume in childhood, amygdala growth trajectories are accelerated before age 2 years in autism and remain enlarged during early childhood," the authors write. "Moreover, amygdala enlargement in 2-year-old children with autism is disproportionate to overall brain enlargement and remains disproportionate at age 4 years." Among children with autism, amygdala volume was associated with an increase in joint attention ability at age 4. This suggests that alterations to this brain structure may be associated with a core deficit of autism, the authors note.
"The amygdala plays a critical role in early-stage processing of facial expression and in alerting cortical areas to the emotional significance of an event," the authors write. "Amygdala disturbances early in development, therefore, disrupt the appropriate assignment of emotional significance to faces and social interaction." Continued follow-up of research participants, now under way, will help determine whether amygdala growth rates continue at the same rate or undergo another period of accelerated growth or a period of decelerated growth in autistic children after age 4.
Editor's Note: This research was supported by National Institutes of Health grants. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc. For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org. |
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