UPDATES

Vaccine news

Keeping up-to-date with the latest developments in vaccines is getting to be a full-time job. Recent events include:

• A recommendation from the Advisory Committee on Immunization Practices (ACIP) that the new conjugate pneumococcal vaccine (Prevnar) be given to all children 23 months of age and younger and to children up to 5 years of age at high risk of serious pneumococcal disease. The ACIP also recommended considering the vaccine for all children up to age 5, with priority given to African-Americans, American Indians and Alaskan natives, and children who attend out-of-home day care. These recommendations are similar to those issued earlier by the American Academy of Pediatrics (AAP). The ACIP also voted to include the vaccine in the Vaccines for Children program.

• A report from the Centers for Disease Control and Prevention (CDC) showing an 80% drop in the incidence of varicella in Los Angeles county since the introduction of varicella vaccine. This drop in the infection rate, even among people who did not receive the vaccine, is evidence of herd immunity produced by the vaccine, the CDC says. And if this news isn't sufficiently persuasive to induce parents and providers to use the vaccine, the opinion of children themselves might turn the tide: A Yankelovitch survey commissioned by the National Association of Pediatric Nurse Associates and Practitioners (NAPNAP) found that seven out of 10 children who have had chickenpox thought it was so unpleasant they would have preferred a shot.

A Red Book for the new millennium

Red Book 2000: Report of the Committee on Infectious Diseases, 25th edition, is now available from the AAP. Developed with the assistance and advice of hundreds of contributors from across the country, the new edition contains a multitude of significant revisions, updates, and additions.

Among them are:

• The immunization schedule for the year 2000

• Revisions to the sections on rotavirus, Lyme disease, varicella, polio, parasitic and fungal infections, and hepatitis A and C

• Updated sources of vaccine information, including Web sites and fax and telephone numbers

• New material on managing injection pain and dealing with parental misconceptions about immunization

• New chapters and sections on chemical and biological terrorism, blood safety, and infection control in the physician's office

• Discussion of West Nile virus

• New data on the epidemiology of hepatitis A

• Updated schedules for hepatitis B immunization

• Guidelines for prevention and treatment of hepatitis C virus infection

• Data on human herpesvirus 7

• Revision and update of the chapter on HIV infection, including guidelines on varicella and hepatitis A vaccine in HIV-infected children

• New chapters on prion diseases, staphylococcal and streptococcal toxic shock syndrome, the judicious use of antimicrobial agents, and the characteristics of antiretroviral drugs

• An updated directory of services that includes Web sites, fax numbers, and international telephone numbers.

The 850-page softcover version costs AAP members $84.95. A version is also available on CD-ROM for both PC and Macintosh users.

Preventing SIDS

The rate of sudden infant death syndrome (SIDS) has decreased by 40% since 1992, when the AAP first recommended that babies be put to sleep on their backs (See graph).But despite these gains, SIDS remains the number one cause of death in infants beyond the neonatal period, responsible for approximately 0.8 deaths/1,000 live births each year. Last month, two studies were published that help explain why this is so.

Day care. According to a study published in the August issue of Pediatrics, a significant percentage of SIDS deaths occur when infants are away from home, taking naps in a child-care center. The analysis of 1,916 SIDS deaths across the country showed that 20.4% occurred while infants were in the care of someone other than a parent. The deaths were most likely to occur on weekdays, between 8 a.m. and 4 p.m., to older, white infants with well-educated parents. The infants who died were more likely to be put to sleep on their tummies, or to be found in that position when the death was discovered. The data prompt speculation that, while the parents of these infants may realize that babies should sleep on their backs, the caregivers at the day-care center may not have gotten the word.

African-American parents. A national survey released by the CPSC and Gerber Products showed that more than half of African-American parents put babies to sleep on their tummies or sides, and 85% keep quilts and comforters in the baby's crib. Prone sleeping and soft bedding are recognized risk factors for SIDS, so this data may go a long way towards explaining why African- American infants are twice as likely to die from SIDS as white infants.

The CPSC, Gerber, the Bureau of Primary Health Care, and the Black Entertainment Television network (BET) are launching a "Safe Sleep" campaign designed to change this grim statistic. The campaign will include public service TV spots, baby "safety showers" at community and migrant health centers , and special programming to air on the BET fall lineup.

EYE ON WASHINGTON

Midsummer in Washington is not a place any self-respecting politician would want to be: The heat is oppressive, Congress is not in session, and the action is elsewhere. This year, elsewhere was Philadelphia—where the Republicans were anointing George W. Bush as their Presidential candidate—and Los Angeles, where the Democrats did the same for Al Gore.

Both parties proclaimed their commitment to multiculturalism, on the podium (the Republicans) and on the ticket (the Democrats). Both espoused improvements in health-care coverage, and each blamed the other for how little Congress had actually accomplished on that score.

Meanwhile, back in the bureaucracy where the machinery of government continues to operate, actions affecting the well-being of children and families continued. For example,

The Centers for Disease Control and Prevention sponsored the 2nd International Conference on Emerging Infectious Diseases in Atlanta, bringing together more than 2,000 experts from all over the world to discuss bioterrorism, emerging pathogens, prevention and control of infectious diseases, and research on surveillance and epidemiology.

The Consumer Product Safety Commission (CPSC) announced a voluntary recall by the manufacturer of some 170,000 infant walkers made to look like cars, after reports of eight babies catching their teeth in parts of the steering wheels. Parents were advised to stop using these walkers immediately. Repair kits can be ordered from the manufacturer, Safety 1st, at 800-964-8489. The CPSC has also persuaded K-mart to recall about 85,500 "Splash Club" swim masks made for children; the masks have a glass lens that can break into dangerously sharp pieces.

The Food and Drug Administration has received petitions from the Center for Science in the Public Interest and the attorney general of Connecticut, asking for a halt to the sale of "functional foods" purporting to contain herbal dietary additives.

The Substance Abuse and Mental Health Services Administration (SAMHSA) announced the availability of up to $1.6 million in grants to help improve local access to substance abuse prevention, addiction treatment, and mental health services by racial and ethnic minority communities. SAMHSA has also released a three-volume compendium of "promising practices" for families, communities, and caregivers working to build exemplary systems of care for children with serious emotional disturbances and their families. The volumes are available on the Internet at www.mentalhealth.org, by clicking on "Children's Campaign."

The surgeon general issued his report, Reducing Tobacco Use, which provides an in-depth analysis of the effectiveness of educational, clinical, regulatory, economic, and social methods for cutting down on smoking. The report calls for widespread use of a combination of methods and approaches that have proven effective in reducing the number of people addicted to nicotine. A detailed summary of the report is available on the CDC's Web site, www.cdc.gov/tobacco.

The National Center for Health Statistics has released the year 2000 version of Health, United States, the nation's yearly gathering of health statistics. For pediatricians, the downside of this year's report is the stubborn persistence of racial and ethnic disparities in health care. The upside includes a sharp drop in the teen birth rate (the lowest in 60 years) and in the numbers of gun deaths among children and teens. Health US:2000 can be downloaded from www.cdc.gov/nchs.

CALENDAR

October 28-November 11, American Academy of Pediatrics Annual Meeting, Chicago, IL. To register, call the AAP at 847-981-7885.

December 1-3, Zero to Three National Training Institute, Washington, DC. To register, call Julia Beckwith or Joan Melner at 202-638-1144.

December 4-7, 2000 National STD Prevention Conference, Milwaukee, WI. To register, go to the conference Web site, www.stdconference.org.

Judith Asch-Goodkin
Contributing Editor

Julia McMillan. Updates.

Contemporary Pediatrics

2000;9:11.