Group B Streptococci Screening Recommendations

A committee of the American College of Obstetricians and Gynecologists (ACOG) has issued new recommendations calling for universal screening of pregnant women for group B streptococci (GBS). Committee Opinion 279 appeared in the December 2002 issue of Obstetrics and Gynecology.

During the past two decades, GBS has emerged as a significant cause of perinatal morbidity and mortality. It is estimated that 10 to 30 percent of all pregnant women are colonized with the gram-positive organism.

Previously, ACOG and other experts had recommended two options for identifying women with GBS: either a culture screening at 35 to 37 weeks of pregnancy or assessment of clinical risk factors at the time of labor. The change in recommendations follows new data from the Centers for Disease Control and Prevention that show routine prenatal screening is significantly more effective than the risk-based approach, resulting in far fewer cases of early-onset GBS disease in newborns. In light of the new data, the risk-based strategy, except in certain circumstances, is no longer an acceptable alternative, the committee said.

HTAC Recommendations on Tumescent Liposuction

The Minnesota Health Technology Advisory Committee (HTAC) has issued recommendations on tumescent liposuction. A summary of the report is available on the HTAC Web site at www.health.state.mn.us/htac.

Controversy about the safety of liposuction involves several issues, such as method of sedation, lidocaine toxicity, fluid balance, physician qualifications, and where the procedure is performed. A census survey of aesthetic plastic surgeons for the period of September 1998 to August 2000 found the estimated liposuction-related death rate to be 8.4 per 100,000 patients.

The committee concluded that liposuction is generally safe, provided that patients are carefully selected, the facility is properly equipped, and the physician is accredited with special training and experience in liposuction. However, the committee noted that controversy exists over the use of lidocaine in the tumescent solution and its potential for toxicity.

The committee recommended that patients carefully choose the physician and the facility where liposuction is to be performed. Potential patients should ask about the qualifications and experience of the entire surgical team, including the anesthesia staff, and ensure that the facility has the technology to care for them during the procedure and in the event of a complication. The facility should have a contingency plan in the event of an emergency, a fully equipped crash cart, staff trained in resuscitation, and a provision for patient transfer to provide acute care.

FDA Approval

• Pediarix. The U.S. Food and Drug Administration (FDA) has approved Pediarix, a combination vaccine that contains diphtheria and tetanus toxoids and acellular pertussis vaccine adsorbed (DTaP), hepatitis B vaccine (recombinant), and inactivated polio-virus vaccine (IPV) for administration as one intramuscular injection.

DTaP vaccine, hepatitis B vaccine, and IPV are available in the United States as separate vaccines. A hepatitis B (recombinant) and Haemophilus influenzae type b combination vaccine is also available in the United States.

Pediarix is recommended for administration as a three-dose primary series to infants at approximately two, four, and six months of age. When DTaP, hepatitis B, and IPV vaccines are administered separately in the same time frame, infants receive nine injections. Pediarix should not be given to infants before the age of six weeks, and it is not indicated for infants born to mothers who are infected with hepatitis B or whose hepatitis B status is unknown. Such infants should receive hepatitis B vaccine shortly after birth and complete their immunization according to a particular schedule.

The most frequently reported adverse reactions to Pediarix in clinical studies were local injection site reactions (pain, redness, swelling), fever, and fussiness. In clinical studies, fever occurred more frequently after administration of Pediarix than separately administered licensed vaccines.