Adding Adenoidectomy No Help
Adenoidectomy in conjunction with tympanostomy tubes failed to reduce the incidence of otitis media, compared with the use of tubes only, in a randomized trial of 217 children aged 12–48 months, said Sari Hammarén-Malmi, M.D., of the University of Helsinki (Finland), and associates (Pediatrics 2005;116:185–9). The children had suffered recurrent acute otitis media (OM), defined as at least three episodes during the 6 months prior to the study, or had chronic otitis media with effusion. Overall, the mean number of episodes of OM in children who had both adenoidectomy and tube placement was 1.7, compared with 1.4 in children who had tube placement only.
In addition, adenoidectomy provided no benefit in reducing the risk of frequent recurrent episodes or when the two groups were subdivided by clinical diagnosis or by frequency of previous episodes.
MRSA Rising in Tennessee
Community-associated methicillin-resistant Staphylococcus aureus (MRSA) among healthy children in Nashville, Tenn., increased from 0.8% in 2001 to 9.2% in 2004, reported Clarence B. Creech II, M.D., of Vanderbilt University Medical Center in Nashville, and his colleagues. In a study sponsored in part by Wyeth Pharmaceuticals, the researchers collected nasal swabs from 500 patients, aged 2 weeks to 21 years, who presented to one of two sites in Nashville, either a clinic or a private practice, for general health maintenance visits between April and September 2004. The researchers found MRSA in 46 of 182 S. aureus isolates (25%) in 2004, compared with 4 of 145 S. aureus isolates (3%) found in 2001.
Of the 46 MRSA isolates identified in 2004, 45 were susceptible to gentamicin, rifampin, and trimethoprim-sulfamethoxazole. In addition, 25 of the 46 isolates (54%) were resistant to erythromycin, 12 (26%) were resistant to clindamycin, and inducible clindamycin resistance appeared in 8 of the 25 (32%) erythromycin-resistant isolates.
Congenital CMV and Hearing Loss
Hearing loss was significantly associated with increased amounts of cytomegalovirus (CMV) in the urine in a screening study of 76 infants with congenital CMV, said Suresh B. Boppana, M.D., of the University of Alabama at Birmingham, and colleagues (J. Pediatr. 2005;146:817–23). The children were observed for an average of 34 months and underwent an average of six hearing evaluations. Overall, 8 of 18 children with symptomatic CMV (44%) had sensorineural hearing loss, compared with 4 of 58 children with asymptomatic infections (7%).
The mean urine CMV level among infants with symptomatic infections was significantly greater than in infants with asymptomatic infections (2.4 × 105 plaque-forming units/mL vs. 3.9 × 104 pfu/mL). The amount of CMV DNA in peripheral blood samples also was significantly higher among children with symptomatic infections.
A total of 4 of the 12 children with sensorineural hearing loss were born at less than 37 weeks' gestation, compared with 6 of the 64 children with normal hearing who were preterm. The results suggest that measuring the virus load in early infancy may help identify children with asymptomatic CMV who would be at increased risk for hearing loss.
Two Doses of Flu Vaccine Protective
The 2003–2004 influenza vaccine was significantly protective against influenza in an analysis of 29,726 Colorado children aged 6–23 months and aged 6 months to 8 years, reported Debra P. Ritzwoller, Ph.D., of Kaiser Permanente Colorado in Denver, and her colleagues (Pediatrics 2005;116:153–9).
The 2003–2004 flu season in Colorado began in November 2003, at which time 7.3% of children aged 6–23 months were fully vaccinated (two doses) and 19.6% partially vaccinated (one dose) In addition, 7.5% and 7.9% of children aged 2–8 years were fully and partially vaccinated, respectively. The predominant circulating virus that year was slightly different from the one used in the vaccine for that flu season.
However, despite this discrepancy, vaccine effectiveness was 25% and 49%, respectively, against influenzalike illness and against pneumonia and influenza in fully vaccinated children aged 6–23 months. The vaccine effectiveness was 23% and 51%, respectively, against influenzalike illness and against pneumonia and influenza in fully vaccinated children aged 6 months to 8 years. Statistically significant reductions in pneumonia and influenza also occurred in partially vaccinated children aged 6 months to 8 years, but reductions were not significant among partially vaccinated children younger than 6 months.