CDC Studies the Effectiveness of PCV7 Immunization in Children

The 7-valent pneumococcal conjugate vaccine (PCV7) was approved in 2000 to prevent pneumococcal disease in children younger than five years. The Centers for Disease Control and Prevention (CDC) has released results from a study evaluating the vaccine’s impact on invasive pneumococcal disease in children since its approval. The report, “Direct and Indirect Effects of Routine Vaccination of Children with 7-Valent Pneumococcal Conjugate Vaccine on Incidence of Invasive Pneumococcal Disease—United States, 1998–2003,” was published in the September 16, 2005, issue of Morbidity and Mortality Weekly Report and is available online at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5436a1.htm.

The population-based study showed that the vaccine effectively prevented invasive pneumococcal disease in the targeted age group as well as in older children and adults; more than twice as many cases were prevented through indirect effects on the disease than through the direct protective effects of the vaccine. Increases in disease caused by serotypes not included in the vaccine were small compared with the overall decrease in vaccine-serotype disease. Ongoing surveillance is needed to confirm the effectiveness of PCV7.

AHA Evaluates Exercise Testing as a Screening Tool in Asymptomatic Patients

The Council on Clinical Cardiology, Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention of the American Heart Association (AHA) has released a scientific statement on exercise testing to screen asymptomatic patients for disease. The full report was published in the August 2, 2005, issue of Circulation and is available online at http://circ.ahajournals.org/cgi/content/full/112/5/771.

Exercise testing has been considered an inexpensive, convenient, and safe way to screen asymptomatic patients for disease. However, data have shown that this modality may be inaccurate, even in symptomatic patients. This led the U.S. Preventive Services Task Force to recommend against using exercise testing as a routine screening tool. These data may be attributable to the limitations of the ST segment for diagnosing coronary disease in asymptomatic patients. In the report, the AHA subcommittee analyzes the role of exercise testing as a prognostic tool, focusing on nonelectrocardiographic measures (e.g., functional capacity, chronotropic response, heart rate recovery, ventricular ectopy).

Although the AHA subcommittee found data to suggest that nonelectrocardiographic measures can predict adverse events in asymptomatic patients, there is no evidence to suggest that exercise testing improves outcomes. The subcommittee concludes that there is insufficient evidence to recommend exercise testing as a routine screening tool in asymptomatic adults. However, the AHA subcommittee says that the prognostic capabilities of exercise testing warrant a large-scale randomized trial to evaluate how it affects outcomes.

AAP Guidelines on Health Supervision of Patients with Achondroplasia

The Committee on Genetics of the American Academy of Pediatrics (AAP) has released a clinical report that includes guidelines to help physicians oversee the health of patients with achondroplasia. The report was published in the September 2005 issue ofPediatrics and is available online at http://www.pediatrics.org/cgi/content/full/116/3/771.

Most patients with achondroplasia have normal intelligence and can live independently; however, they are at a high risk of certain health and psychosocial problems. Anticipatory care directed at identifying high-risk patients is a significant factor in preventing serious sequelae.

The AAP guidelines for overseeing the health of patients with achondroplasia at various ages include the following:

Prenatal

• Diagnose achondroplasia through ultrasonography and molecular testing.

• Explain the condition and treatment options to the parents and assist them with decision making.

Birth to one month of age

• Confirm the diagnosis with radiography.

• Document the child’s measurements (i.e., occipitofrontal circumference, body length, and body weight).

• Provide an overview of the condition and what to expect as well as education materials and support resources.

One month to one year of age

• Confirm diagnosis if needed.

• Assess growth and development.

• Counsel parents on how to help prevent kyphosis and how to deal with otitis media.

• Assess parents’ emotional well-being and social support systems.

One to five years of age

• Continue to follow growth and development.

• Evaluate child for bowed legs, hip flexion contractures, sleep apnea, and gastroesophageal reflux and screen for speech and hearing development.

• Discuss adapting the home, toys, and clothing to fit the child’s needs.

• Discuss weight control and toileting.

• Determine if occupational therapy is needed.

• Discuss preparing the child for school.

Five to 13 years of age

• Assess growth, development, and social adaptation.

• Review weight-control issues and appropriate physical activities.

• Perform a physical examination.

• Evaluate for signs and symptoms of spinal stenosis, sleep apnea, and orthodontic problems and screen for hearing and speech development. Consider orthopedic referral at approximately five years of age.

• Emphasize correct posture and consider physical therapy if needed.

• Prepare child for school and interaction with others, provide support resources for the child, and emphasize socialization and independence.

13 to 21 years of age

• Monitor growth.

• Review weight-control issues.

• Continue to evaluate for sleep apnea and orthodontic problems.

• Ensure that the patient has a proper understanding of the condition.

• Discuss contraception.

• Reevaluate the patient’s social adaptation; encourage social participation.

• Assist with transition into adulthood (e.g., long-term goals, higher education, career, independence).