Kevin M. Sullivan

OpenEpi: a web-based epidemiologic and statistical calculator for public health.

Public Health Reports / May–June 2009 / Volume 124 8. Schmidt CW. Bordering on environmental disaster. Environ Health Perspect 200;108:308-15. 9. Shalat SL, Donnelly KC, Freeman NC, Calvin JA, Ramesh S, Jimenez M, et al. Nondietary ingestion of pesticides by children in an agricultural community on the U.S./Mexico border: preliminary results. J Expo Anal Environ Epidemiol 2003;13:42-50. 10. Carrillo-Zuniga G, Coutino C, Shalat SL, Freeman NCG, Black K, Jimenez W, et al. Potential sources of childhood exposure to pesticides in an agricultural community. J Child Health 2004;2:29-39. 11. Sumaya C, Carrillo-Zuniga G, Kelley M, May M, Zhu L, Donnelly KC. Linking research to health promotion in Texas colonias. Am J Health Studies 2006;21:245-52.

The Pediatric Radiofrequency Ablation Registry's Experience with Ebstein's Anomaly

Radiofrequency Ablation in Pediatric Ebsteins Anomaly. Introduction: Abnormal anatomy and complex electrophysiology in patients with Ebsteins anomaly of the tricuspid valve may confound attempts at radiofrequency ablation (RFA).

Effectiveness of the 7-Valent Pneumococcal Conjugate Vaccine in Children With Sickle Cell Disease in the First Decade of Life

BACKGROUND. The incidence of and mortality from invasive pneumococcal disease are significantly higher in children with sickle cell disease than in the general pediatric population. The objective of this population-based study was to assess the effect of pneumococcal conjugate vaccine on rates of invasive pneumococcal disease among children with sickle cell disease. PATIENTS AND METHODS. Records, including the history of pneumococcal conjugate vaccine administration, of 1247 children born after 1983 residing in metropolitan Atlanta, Georgia, with confirmed hemoglobinopathies were linked to an active surveillance database for invasive pneumococcal disease for the period of January 1, 1995, through January 1, 2003. The incidence of invasive pneumococcal disease and the percentage of rate reduction were estimated before and after pneumococcal conjugate vaccine licensure. Survival analysis was used to estimate the effect of pneumococcal conjugate vaccine on invasive pneumococcal disease rates while accounting for herd immunity. RESULTS. A significant decline in invasive pneumococcal disease in children with sickle cell disease ≤10 years of age was noted after pneumococcal conjugate vaccine licensure, from 1.7 infections per 100 person-years (1995–2000) to 0.5 infections per 100 person-years (2001–2002), which represents a 68% reduction. The effectiveness of ≥1 dose of pneumococcal conjugate vaccine was estimated by crude analysis to be 84.5% and by stratified survival analysis to be 81.4% when controlling for the presence of herd immunity in the 2 years after pneumococcal conjugate vaccine licensure. Serotype 6A invasive pneumococcal disease represented 36% of invasive pneumococcal disease before pneumococcal conjugate vaccine licensure and 0% after pneumococcal conjugate vaccine licensure, suggesting a protective effect against this pneumococcal conjugate vaccine-related serotype. CONCLUSIONS. Invasive pneumococcal disease significantly decreased in children with sickle cell disease ≤10 years of age after pneumococcal conjugate vaccine licensure. Pneumococcal conjugate vaccine was effective even when controlling for herd immunity. Extending guideline recommendations for catch-up vaccination beyond 4 years of age should be considered.

Invasive pneumococcal infections in children with sickle cell disease in the era of penicillin prophylaxis, antibiotic resistance, and 23-valent pneumococcal polysaccharide vaccination

Rates and severity of pneumococcal infections in children with sickle cell disease were examined before licensure of pneumococcal-conjugated vaccine (PVC). Rates of peak invasive infection rates in 1-year-old children with hemoglobin SS and mortality in those 0 to 10 years of age were 36.5 to 63.4 and 1.4 to 2.8 per 1000 person-years, respectively (>10 and 100 times as frequent as in the general population). Overall, 71% of serotyped isolates (n=80) were PVC serotypes and 71% of nonvaccine serotype strains were penicillin-sensitive. Clinical presentation in children with hemoglobin SS (n=71; more with hypotension) and hemoglobin SC (n=18; more with acute chest syndrome, otitis media) differed. Penicillin nonsusceptibility (38% of isolates) varied between geographic study sites. Penicillin prophylaxis appeared less effective against intermediate and resistant strains. Of all infected children, meningitis developed in 20% and 15% died (hemoglobin SS, n=15 and 11; hemoglobin SC, n=1 each). Factors associated with death included age >4 years (58%), serotype 19F, and not being followed by a hematologist (42% each). The pneumococcal-polysaccharide vaccine was 80.4% effective within 3 years after vaccination (95% CI, 39.7, 93.6). Children with sickle cell disease of all ages may benefit from PVC boosted with polysaccharide vaccination.

Mortality rates in displaced and resident populations of central Somalia during 1992 famine

Famine and civil war have resulted in high mortality rates and large population displacements in Somalia. To assess mortality rates and risk factors for mortality, we carried out surveys in the central Somali towns of Afgoi and Baidoa in November and December, 1992. In Baidoa we surveyed displaced persons living in camps; the average daily crude mortality rate was 16.8 (95% CI 14.6-19.1) per 10,000 population during the 232 days before the survey. An estimated 74% of children under 5 years living in displaced persons camps died during this period. In Afgoi, where both displaced and resident populations were surveyed, the crude mortality rate was 4.7 (3.9-5.5) deaths per 10,000 per day. Although mortality rates for all displaced persons were high, people living in temporary camps were at highest risk of death. As in other famine-related disasters, preventable infectious diseases such as measles and diarrhoea were the primary causes of death in both towns. These mortality rates are among the highest documented for a civilian population over a long period. Community-based public health interventions to prevent and control common infectious diseases are needed to reduce these exceptionally high mortality rates in Somalia.

Lidocaine iontophoresis for topical anesthesia before intravenous line placement in children

In a double-blind randomized trial including 42 children aged 7 to 18 years, less pain occurred with intravenous placement after iontophoresis of 2% lidocaine with epinephrine, as reported by patients (p = 0.005), parents (p = 0.001), intravenous personnel (p = 0.009), and investigators (p = 0.0002) compared with placebo therapy. Lidocaine iontophoresis provides rapid and effective topical anesthesia for intravenous access in children.

Haemoglobin adjustments to define anaemia

Objective  To provide researchers with an unambiguous definition of anaemia using haemoglobin.

Some Subgroups of Reproductive Age Women in the United States May Be at Risk for Iodine Deficiency

Consuming an adequate amount of iodine during pregnancy is critical for fetal neurologic development. Even a mild deficiency can impair cognitive ability. Important sources of iodine in the United States include dairy products and iodized salt. Although the U.S. population has traditionally been considered iodine sufficient, median urinary iodine concentrations (UIC) have decreased 50% since the 1970s. We analyzed 2001-2006 NHANES data from urine iodine spot tests for pregnant (n = 326), lactating (n = 53), and nonpregnant, nonlactating (n = 1437) women of reproductive age (15-44 y). We used WHO criteria to define iodine sufficiency (median UIC: 150-249 microg/L among pregnant women; >or=100 microg/L among lactating women; and 100-199 microg/L among nonpregnant, nonlactating women). The iodine status of pregnant women was borderline sufficient (median UIC = 153 microg/L; 95% CI = 105-196), while lactating (115 microg/L; 95% CI = 62-162) and nonpregnant, nonlactating (130 microg/L; 95% CI = 117-140) women were iodine sufficient. Dairy product consumption was an important contributor to iodine status among both pregnant and nonpregnant, nonlactating women, and those who do not consume dairy products may be at risk for iodine deficiency. Although larger samples are needed to confirm these findings, these results raise concerns about the iodine status of pregnant women and women of reproductive age who are not consuming dairy products. Iodine levels among U.S. women should be monitored, particularly among subgroups at risk for iodine deficiency.

Inflammatory bowel disease in African-American children living in Georgia.

We describe the clinical characteristics of inflammatory bowel disease (IBD) African-American compared with non-African-American children. We identified 172 children with IBD; forty-nine (29%) were African-American. Median symptom duration before IBD diagnosis in African-American children (6 months) was shorter than that of non-African-American children (10 months). The most frequent presenting symptom was hematochezia (ulcerative colitis) and abdominal pain (Crohns disease) in both racial groups. The estimated incidence of Crohns disease in African-Americans ranged from 7 per 100,000 to 12 per 100,000, whereas the observed incidence in those with ulcerative colitis was between 5 and 7 per 100,000 during the 10 years of the study. Our pilot study suggests that IBD may be more common in African-American children than previously reported. Prospective population-based studies would be useful to determine whether inheritable factors linked with ethnicity are associated with IBD.

Trends in Opportunistic Infections in the Pre–and Post–Highly Active Antiretroviral Therapy Eras Among HIV-Infected Children in the Perinatal AIDS Collaborative Transmission Study, 1986–2004

OBJECTIVE. We sought to determine the impact of highly active antiretroviral therapy on the incidence and prevalence of opportunistic infections in HIV-infected children. METHODS. Children born from 1986 to 1998 were monitored until 2004 in the Perinatal AIDS Collaborative Transmission Study, sponsored by the Centers for Disease Control and Prevention. We determined the pre–highly active antiretroviral therapy and post–highly active antiretroviral therapy (before and after January 1, 1997, respectively) incidence rates of opportunistic infections among HIV-infected children and characterized the temporal decreases in percentages of CD4+ cells and the mortality rates among patients with and those without incident opportunistic infections. RESULTS. The overall opportunistic infection incidence declined from 14.4 to 1.1 cases per 100 patient-years; statistically significant reductions were seen in the incidence of the most common opportunistic infections, including Pneumocystis jiroveci pneumonia (5.8 vs 0.3 cases per 100 patient-years), recurrent bacterial infections (4.7 vs 0.2 cases per 100 patient-years), extraocular cytomegalovirus infection (1.4 vs 0.1 cases per 100 patient-years), and disseminated nontuberculous mycobacterial infection (1.3 vs 0.2 cases per 100 patient-years). Kaplan-Meier analysis of time from birth to the first opportunistic infection illustrated more-rapid acquisition of opportunistic infections by HIV-infected children born in the pre–highly active antiretroviral therapy era than by those born later. In the first 3 years of life, there was a faster decline in the percentage of CD4+ cells among children with opportunistic infections. The mortality rate was significantly higher among children with opportunistic infections. CONCLUSIONS. Reduction in the incidence of opportunistic infections and prolongation of the time to the first opportunistic infection were noted during the post–highly active antiretroviral therapy era. Children who experienced opportunistic infections had higher mortality rates than did those who did not. Younger children (<3 years) who experienced opportunistic infections had faster declines in percentages of CD4+ T cells.