Linda O. Eckert

Physical injury after sexual assault: Findings of a large case series

OBJECTIVEnThis study was undertaken to determine characteristics associated with physical injury in female sexual assault victims.nnnSTUDY DESIGNnAll females who were 15 years or older presenting after sexual assault to an urban emergency department during a 34-month period underwent standardized evaluation. Analysis was performed by chi(2) and logistic regression.nnnRESULTSnOf 819 women, 52% had general body and 20% had genital-anal trauma; 41% were without injury. General body trauma was independently associated with being hit or kicked (odds ratio [OR]=7.7, 95% CI, 5.1-11.7), attempted strangulation (OR=4.2, 95% CI, 2.5-7.2), oral or anal penetration (OR=1.7, 95% CI, 1.2-2.3), and stranger (OR=2.4, 95% CI, 1.7-3.4) assault. Genital-anal injury was more frequent in victims younger than 20 and older than 49 years (P<.05), in virgins (OR=2.7, 95% CI, 1.4-5.4) and those examined within 24 hours (OR=1.7, 95% CI, 1.2-2.4) and after anal assault (OR=1.7, 95% CI, 1.1-2.6).nnnCONCLUSIONnGeneral body injury is primarily associated with situational factors, whereas genital-anal injury is less frequent and related to victim age, virginal status, and time to examination.

Approaches to monitoring biological outcomes for HPV vaccination: Challenges of early adopter countries

In this review, we describe plans to monitor the impact of human papillomavirus (HPV) vaccine on biologic outcomes in selected international areas (Australia, Canada, Mexico, the Nordic countries, Scotland, and the United States) that have adopted this vaccine. This summary of monitoring plans provides a background for discussing the challenges of vaccine monitoring in settings where resources and capacity may vary. A variety of approaches that depend on existing infrastructure and resources are planned or underway for monitoring HPV vaccine impact. Monitoring HPV vaccine impact on biologic outcomes is a complex and challenging task, but also plays an important role in documenting the benefit of vaccination, monitoring the progress of vaccination programs, and providing data to inform vaccination and disease prevention policies.

Older victims of sexual assault: an underrecognized population

OBJECTIVEnWe performed this study to determine if sexual assault characteristics differ in women presenting for evaluation as women age.nnnSTUDY DESIGNnAll females 20 years or older presenting after sexual assault to an urban emergency department during a nine year period underwent standardized evaluation. Analysis was performed by chi(2).nnnRESULTSnWe evaluated 2399 women: 1743 women 20-39 years, 554 women 40-55 years, and 102 women over 55 years of age. Compared with the other age groups, older women were more commonly assaulted in their own home (36%) or care facility (33%), P < .001, assaulted by a service provider (16.7%) or stranger (18.6%), P < .001, impaired (54.9%), P < .001, admitted to the hospital (15.7%), P < .001, incur genital trauma (35.6%), P = .04, and less likely to have a weapon used (7.8%), P = .003.nnnCONCLUSIONnSexual assault in older women has distinct characteristics, which may be useful in planning intervention and prevention strategies.

Immunizing school-age children and adolescents: Experience from low- and middle-income countries

OBJECTIVEnGiven the increased attention on the need for booster immunizations of older children and adolescents, as well as new primary vaccine series that specifically target school-age children and adolescents, we reviewed the current state of vaccine delivery to school-age children and adolescents in low- and middle-income countries.nnnMETHODSnWe searched the published literature and unpublished sources for articles, meeting presentations, technical reports and program documents related to immunization policies and programs for school-age children and/or adolescents between 6 and 19 years of age in low- and middle-income countries.nnnFINDINGSnWe found several examples of ongoing school-age children and adolescent immunization in low- and middle-income countries. Reasons to vaccinate this age group include vaccines specifically targeted for this age group, waning immunity from prior vaccination, catch-up vaccination, acceleration of disease control or elimination efforts, and age distribution shift in the incidence of vaccine-preventable diseases. Multiple delivery strategies are currently in use: routine immunization, supplementary immunization activities, and Child Health Days and similar activities. Vaccines can be delivered in fixed sites, or through outreach. Most immunization programs that target adolescents and school-aged children are providing boosters of infant vaccines at school entry age, with scant experience in delivery of primary vaccination series in adolescents. Few of these programs have been formally evaluated and dissemination of lessons learned is limited.nnnCONCLUSIONSnThis baseline description may facilitate immunization program planning in countries considering vaccinating this age group. Additionally, this summary may inform plans for operational research and program evaluation designed to expand vaccine delivery to school-age children and adolescents in low- and middle-income countries.

Histologic endometritis in asymptomatic human immunodeficiency virus-infected women: characterization and effect of antimicrobial therapy.

OBJECTIVE To estimate the prevalence, risk factors, clinical symptoms and signs, and response to antimicrobial therapy of histologic endometritis in human immunodeficiency virus (HIV)-infected women without clinical salpingitis. METHODS This was a cross-sectional study of 42 HIV-infected women enrolled from a single clinic. Subjects underwent standardized history, examination, and laboratory determinations, including endometrial biopsy. Women with suspected pelvic inflammatory disease were excluded. All women were given antibiotics and repeat evaluation in 5–7 weeks. Histologic endometritis was defined by at least one stromal plasma cell per 120× field and five or more surface polymorphonuclear leukocytes per 400× field. Chi-square and Fisher exact tests were used as appropriate. RESULTS Histologic endometritis was present among 16 (38%) of 42 evaluable HIV-infected women, none of whom had Chlamydia trachomatis or Neisseria gonorrhoeae. Douching three or more times per month, history of ectopic pregnancy, and two or more prior urinary tract infections were associated with endometritis, as was elevated erythrocyte sedimentation rate (P ≤ .05). Physical examination findings and mean CD4+ lymphocyte count were similar among those with and without endometritis. In the nine HIV-infected women with a repeat biopsy, endometritis decreased from four (44%) to two (22%) after treatment (P = .30). CONCLUSION The prevalence of histologic endometritis in HIV-infected women was high despite few examination findings and no demonstrated pathogens. Endometritis in HIV-infected women might be related to pathogens not evaluated, to prior infection, or to reduced immunity from HIV.

Achieving High Coverage of H1N1 Influenza Vaccine in an Ethnically Diverse Obstetric Population: Success of a Multifaceted Approach

Objective. To report on a multifaceted approach to increase uptake of the H1N1 vaccine in our ethnically diverse obstetrical population. Methods. A review of our obstetric clinic vaccine registry and the approaches used to increase vaccine uptake. We created a real-time vaccine registry, educated patients in their own language via educational videos and use of cultural case workers, facilitated patient appointments and transportation, educated staff, and used other interventions to enhance immunization uptake. Results. Within the first month of H1N1 availability, we vaccinated 120 of our total 157 obstetrics patients. Our overall coverage rate was 76% (number vaccinated/total number eligible.) Of the enrolled patients, the vaccine acceptance rates were similar in our English (59 (78%) of 76) versus non-English (59 (75%) of 79) speaking patients. Conclusions. High vaccine coverage is possible in an ethnically diverse, highly immigrant obstetrics population.

Development of World Health Organization (WHO) recommendations for appropriate clinical trial endpoints for next-generation Human Papillomavirus (HPV) vaccines

The World Health Organization (WHO) serves as a key organization to bring together experts along the continuum of vaccine development and regulatory approval, among its other functions. Using the revision of WHOs guidelines on prophylactic human papillomavirus (HPV) vaccine as an example, we describe the process by which (1) a need to revise the guidelines was identified; (2) a group of stakeholders with complementary expertise and key questions were identified; (3) a scientific review was conducted; (4) consensus on revisions was achieved; (5) guidelines were updated, reviewed widely, and approved. This multi-year process resulted in the consensus that regulatory agencies could consider additional endpoints, such as persistent HPV infection or immune equivalence, depending on the design of the HPV vaccine trials. Updating the guidelines will now accelerate vaccine development, reduce costs of clinical trials, and lead to faster regulatory approval.