Physician's First Watch: Archives

2009 Adult Immunization Schedule Approved

Updated guidelines on vaccinating adults have been released by the Advisory Committee on Immunization Practices and appear in Annals of Internal Medicine.

No new vaccines have been added since last year, but some of the footnotes to existing vaccines have been revised. Among the changes:

• Smoking and asthma are now indications for the pneumococcal polysaccharide vaccine.
  
• A four-dose schedule is offered for the combined hepatitis A/hepatitis B vaccine.
  

In addition, the immunization schedule has been updated to clarify the following:

• Adults who've received only one dose of varicella vaccine should receive another.
  
• Occupational exposure to human papillomavirus vaccine does not place healthcare professionals at risk.
  

The American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, and the American College of Physicians have all approved these guidelines.

LINK(S):

Immunization schedule in Annals of Internal Medicine (Free)

Annals of Internal Medicine editorial (Subscription required)

Published in Physician's First Watch January 6, 2009

Viral Hepatitis Spread by Health Facilities Almost Entirely Preventable

Cases of hepatitis B and C spread by nonhospital health facilities are more common than reported, and are almost entirely preventable, according to a review of 33 outbreaks (comprising 448 cases) published in Annals of Internal Medicine.

The review finds that each of the cases stemmed from fundamental lapses in infection-control procedures and aseptic technique. Many were caused by shared use of fingerstick devices and glucometers, and many by reuse of syringes or preparation of injectable medications in contaminated environments.

The authors, all from the CDC, say the 33 outbreaks represent the tip of a much larger iceberg that is likely to grow as more procedures — from hemodialysis to day surgery — take place outside of hospitals, where infection control is traditionally more carefully monitored. They call for more case investigation, education of health workers, and professional oversight.

LINK(S):

Annals of Internal Medicine article (Free abstract; full text requires subscription)

Published in Physician's First Watch January 6, 2009

Featured in Journal Watch: Top Psychiatry Stories of 2008

The editors of Journal Watch Psychiatry comment on the year's most important developments.

LINK(S):

Journal Watch Psychiatry story (Free)

Published in Physician's First Watch January 6, 2009

Selective Decontamination in the ICU Lowers 28-Day Mortality Rates

ICU patients undergoing selective decontamination of either the digestive tract or the oropharynx have lower mortality rates at 28 days than those receiving usual care, the New England Journal of Medicine reports.

Dutch researchers enrolled nearly 6000 patients who, they anticipated, would be intubated for longer than 2 days or remain in the ICU for longer than 3 days. The ICUs treated all patients with one of three regimens: selective digestive tract decontamination (4 days of IV cefotaxime plus topical tobramycin, colistin, and amphotericin B in the oropharynx and stomach), selective oropharyngeal decontamination (just the topical drugs), or standard care.

The absolute risk for death by 28 days (the primary endpoint) was about 3 percentage points lower among patients receiving selective decontamination than among those on standard care. The authors calculate that the number needed to treat to prevent one death by day 28 was roughly 30.

LINK(S):

NEJM article (Free abstract; full text requires subscription)

Published in Physician's First Watch January 5, 2009

Heart Attack Rates Still Fall 3 Years After Indoor Smoking Bans

Myocardial infarction rates continue to fall 3 years after indoor smoking bans are implemented, according to a study in MMWR.

The CDC notes that nine studies have shown quick drops in hospitalizations for myocardial infarctions after laws go into effect prohibiting smoking at work and in public places, but the report is the first to show this reduction continues for several years.

The study examined the rate of hospitalization for myocardial infarction in Pueblo, Colorado, after a smoke-free ordinance took effect in 2003. Rates dropped 27% in the first 18 months and an additional 19% in the next 18 months.

"These findings provide support for considering smoke-free policies an important component of interventions to prevent heart disease morbidity and mortality," the CDC concluded.

LINK(S):

MMWR article (Free)

Published in Physician's First Watch January 5, 2009

Find Your Own Pens and Mugs — Drug Company Goodies Vanish in 2009

A New Year's prediction: You will be spending more time in stationery stores and houseware emporiums. Drug companies, according to the New York Times, have agreed to stop handing out pens, mugs, and other objects emblazoned with the logos of their products.

Our check of nearby stores reveals that pens and pencils sell for about a dollar apiece these days; and mugs, about twice that. (They were, it must be reported, strangely devoid of pharmaceutical information.)

LINK(S):

New York Times story (One-time registration required)

Published in Physician's First Watch January 5, 2009

Featured in Journal Watch: Top General Medical Stories of 2008

The editors of Journal Watch General Medicine comment on their choices for the most important clinical research from 2008.

LINK(S):

Journal Watch General Medicine story (Free)

Published in Physician's First Watch January 5, 2009

Featured in Journal Watch: Top HIV/AIDS Stories for 2008

An analysis of the most important developments over the last year in the prevention, diagnosis, and treatment of HIV, from the physician-editors of Journal Watch HIV/AIDS.

LINK(S):

Journal Watch HIV/AIDS story (Free)

Published in Physician's First Watch December 30, 2008

FDA Approves Degarelix for Advanced Prostate Cancer

The FDA has announced the approval of what it calls the "first new drug in several years" for the treatment of advanced prostate cancer.

The agency says that degarelix, a gonadotropin-releasing-hormone receptor inhibitor, does not cause an initial promotion of tumor growth as other hormonal treatments can.

LINK(S):

FDA news release (Free)

Published in Physician's First Watch December 30, 2008

2009 Pediatric Immunization Schedules Approved

Updated vaccination schedules for infants, children, and adolescents have been released by the American Academy of Pediatrics, the Advisory Committee on Immunization Practices, and the American Academy of Family Physicians.

Among the latest changes, published in Pediatrics:

• The influenza vaccine is recommended annually for children aged 6 months to 18 years; for eligible patients who have close contact with children from infancy to 4 years of age; and for those in contact with children 5 to 18 years old who are predisposed to influenza complications.
  
• A second oral rotavirus vaccine has been approved by the FDA. Infants can receive the first dose between 6 and 14 weeks and the second dose by 8 months.
  

The journal also includes a special article critiquing alternative vaccination schedules. The authors conclude: "If more parents insist on [alternative] vaccine schedules, then fewer children will be protected, with the inevitable consequence of continued or worsening outbreaks of vaccine-preventable diseases."

LINK(S):

Pediatrics article (Free)

Pediatrics special article on alternative vaccine schedule (Free)

ACIP provisional recommendations on rotavirus vaccine (Free PDF)

Published in Physician's First Watch December 30, 2008