Thomas T.W. Chiu

Influenza vaccine: Awareness and barriers to immunization in families of children with chronic medical conditions other than asthma

Objectives: Children with chronic medical conditions (CMCs) are considered to be at increased risk for influenza and its related complications. Despite this, influenza immunization rates in the United States for children with CMCs in the primary care setting remain between 7–10%. This was a survey study looking at the barriers to influenza immunization among children with CMCs other than asthma. We examined caregiver knowledge and perceptions regarding influenza vaccine in addition to assessing other barriers, such as availability and perceived safety of the vaccine. Methods: The study was conducted during the fall-winter influenza seasons of 2002–2003 and 2003–2004 at five academic institutions across the southeastern US. Convenience samples of 100–150 families attending pediatric subspecialty clinics were surveyed. Results: A total of 794 surveys were completed. Controlling for disease, failure to recommend vaccination was significantly associated with failure to get the vaccine (P < 0.0001). Of the children who did not receive the vaccine, 61% of their parents believed that the vaccine itself could give influenza, 54% cited other safety concerns, and 30% thought it did not work. Among vaccine recipients, 163 (43%) reported that the primary care provider had given the vaccine, whereas 171 (45%) reported that the vaccine had been given at the subspecialty clinic. Conclusion: This study highlights the importance of physician recommendation, as well as parental education, as some of the key elements crucial to the receipt of influenza vaccination in children with CMCs.

Throat Culture Is Necessary After Negative Rapid Antigen Detection Tests

This study was conducted to determine if culture confirmation is needed for a negative rapid antigen detection test. Data on 18 509 tests done in patients younger than 18 years old were reviewed. Of the 14 167 (76.5%) that were negative, 968 (6.8%) were associated with positive cultures. No significant seasonal variation was noted. Significant differences were found between hospital and pediatric practices in the percentage of patients with a negative rapid antigen detection test who actually had group A β-hemolytic streptococcus (3.5% to 9.8%). This study supports the recommendation of culture confirmation of a negative rapid antigen detection test and validation of results within an individual practice if confirmatory cultures are not being performed. This study showed a high false-negative rate of the negative rapid antigen detection test and variation among hospital and pediatric practices for rates of positive culture after a negative rapid antigen detection test.

Survival Times and Complications of Catheters Used for Outpatient Parenteral Antibiotic Therapy in Children

Outpatient parenteral antibiotic therapy is routinely used in pediatrics, but few data are available on catheter-associated complications and survival times. Catheter-associated complications, defined as mechanical or nonmechanical, and survival times in peripherally inserted central catheters and central venous catheters used for outpatient parenteral antibiotic therapy in childhood were compared. The life test procedure was performed to determine survival time. Cox proportional hazards model was used to compare the independent effect of variables such as age and gender on catheter survival. There were 104 peripheral and 130 central venous catheters, of which 28 peripheral and 19 central catheters had mechanical complications, and 13 peripheral and 17 central catheters had nonmechanical complications. Peripheral catheters are more likely to develop mechanical complications and have a shorter survival time than central venous catheters. For outpatient parenteral antibiotic therapy longer than 6 weeks, central venous catheters appear to be a better choice.

Increase in Invasive Pneumococcal Disease in Children Associated With Shortage of Heptavalent Pneumococcal Conjugate Vaccine

The authors investigated the impact of heptavalent pneumococcal conjugate vaccine (PCV7) shortage on the rate of invasive pneumococcal disease (IPD). Vaccination status and number of doses delivered was determined. Regression analysis using an exponential decay model was used to predict the expected rate of IPD in the shortage period if IPD continued to decline at the same rate as in the availability period. The rate of IPD decreased from 15.5 to 6.5 with vaccine availability (P < .00001) and increased to 7.2 with shortage (P = .69). Based on the model, IPD rate would have been 3.6 if the decrease continued at the same rate when there was no shortage; this was statistically significant (95% prediction interval, 2.7-4.1). The rate of IPD correlated directly with the number of PCV7 doses delivered, r = -.98. Continuous availability of the PCV7 would have resulted in a statistically significant lower IPD rate compared to the measured IPD rate in the vaccine shortage period.