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This week’s CPF picks from the IAC News
 
CDC updates recommendation for timing of postvaccination serologic testing of infants born to HBsAg-positive women
An estimated 25,000 infants are born to HBV-positive mothers each year in the United States. However, post-exposure prophylaxis (PEP) is highly effective in preventing perinatal HBV transmission; only 1 percent of infants receiving PEP develop infection. Infants born to HBV-infected mothers should receive hepatitis B vaccine (consisting of a 3- or 4-dose series) and hepatitis B immune globulin within 12 hours of birth to prevent perinatal HBV transmission. In order to determine whether the infant requires revaccination, [postvaccination serologic testing] PVST was previously recommended at age 9–18 months. Because new evidence suggests that hepatitis B antibody levels decline following vaccination, CDC now recommends that PVST take place earlier—at age 9–12 months, or 1–2 months after the final dose of the hepatitis B vaccine series—in order to ensure antibodies are detected. Benefits to this shortened interval include a reduction in the time that non-responders are at risk for transmission from close contacts with HBV infection, opportunity for prompt revaccination when needed, and conservation of public health resources. Additionally, the authors note that a shortened interval might increase adherence with recommendations for timely completion of PVST. 
 
CDC study finds anaphylactic reactions rare after immunization
A recently published CDC-authored study based on a large population group that received currently used vaccines confirmed the rarity of anaphylaxis after vaccination. Risk of Anaphylaxis after Vaccination in Children and Adults was published online on October 7 in the Journal of Allergy and Clinical Immunology. The "Abstract" is reprinted below. Background Anaphylaxis is a potentially life-threatening allergic reaction. The risk of anaphylaxis after vaccination has not been well described in adults or with newer vaccines in children. Objective We sought to estimate the incidence of anaphylaxis after vaccines and describe the demographic and clinical characteristics of confirmed cases of anaphylaxis. Methods Using health care data from the Vaccine Safety Datalink, we determined rates of anaphylaxis after vaccination in children and adults. We first identified all patients with a vaccination record from January 2009 through December 2011 and used diagnostic and procedure codes to identify potential anaphylaxis cases. Medical records of potential cases were reviewed. Confirmed cases met the Brighton Collaboration definition for anaphylaxis and had to be determined to be vaccine triggered. We calculated the incidence of anaphylaxis after all vaccines combined and for selected individual vaccines. Results We identified 33 confirmed vaccine-triggered anaphylaxis cases that occurred after 25,173,965 vaccine doses. The rate of anaphylaxis was 1.31 (95% CI, 0.90–1.84) per million vaccine doses. The incidence did not vary significantly by age, and there was a nonsignificant female predominance. Vaccine-specific rates included 1.35 (95% CI, 0.65–2.47) per million doses for inactivated trivalent influenza vaccine (10 cases, 7,434,628 doses given alone) and 1.83 (95% CI, 0.22–6.63) per million doses for inactivated monovalent influenza vaccine (2 cases, 1,090,279 doses given alone). The onset of symptoms among cases was within 30 minutes (8 cases), 30 to less than 120 minutes (8 cases), 2 to less than 4 hours (10 cases), 4 to 8 hours (2 cases), the next day (1 case), and not documented (4 cases). Conclusion Anaphylaxis after vaccination is rare in all age groups. Despite its rarity, anaphylaxis is a potentially life-threatening medical emergency that vaccine providers need to be prepared to treat. 
 
WHO announces recommended composition of influenza virus vaccines for use in the 2016 southern hemisphere influenza season
The World Health Organization (WHO) recently released information about the composition of the strains that will be used for seasonal influenza vaccination in the southern hemisphere in 2016. It is recommended that trivalent vaccines for use in the 2016 influenza season (southern hemisphere winter) contain the following:
 An A/California/7/2009 (H1N1)pdm09-like virus
 An A/Hong Kong/4801/2014 (H3N2)-like virus
 A B/Brisbane/60/2008-like virus
It is recommended that quadrivalent vaccines containing two influenza B viruses contain the above three viruses and a B/Phuket/3073/2013-like virus. Read WHO's Recommended composition of influenza virus vaccines for use in the 2016 southern hemisphere influenza season. 
 
Question of the Week
If a child only received a half dose of live attenuated influenza vaccine (LAIV, FluMist, MedImmune), I understand they are not considered immunized. Can the child receive inactivated influenza vaccine (IIV) on the same day?
You are correct that a half dose of LAIV (or any other vaccine) is a non-standard dose and should not be counted. If you weren’t able to give the second half of the LAIV at that same appointment, you will need to provide another full dose of influenza vaccine at another visit. If you want to try using a different type of vaccine, you can give IIV any time after the partial dose of LAIV. If you want to give LAIV again, you should wait four weeks because it is a live vaccine.
 
New Article from SOCKS!
 
Putting the Pieces Together: Endoscopic vs. Traditional Treatment of Craniosynostosis
The skull of the human brain is made of many bones that fit together like an anatomical jigsaw puzzle. Normally, the pieces gradually fuse together over stages of prenatal and childhood development. However, in approximately one out of every 2,200 live births, craniosynostosis occurs. Craniosynostosis is a premature fusion of bones in the skull, often before a baby is born. In this case, the remaining open sutures must compensate for the closed parts of the skull resulting in deformities of the head. If not treated in a timely manner, the closed portions of the skull can prevent the brain from developing properly, at times even affecting normal childhood maturing processes.
Previously, the main method of treatment was to make an incision from ear to ear on an infant’s scalp, totally or partially removing skull pieces, and placing them back together using additional prosthetic materials as necessary. Typically taking three to seven hours with a three to five day recovery, postoperative swelling and discomfort was present. Although the surgery produced good results, another goal of physicians was to reduce pain, hospitalization time, and blood loss.
With that goal in mind, an endoscopic assisted repair for craniosynostosis treatment has now become more prevalent in patients less than 6 months old. Utilizing a small endoscope, doctors now use one or two small incisions, approximately 1.5 inches long. Instead of physically re-structuring the skull with additional materials, the endoscopic surgery removes small pieces of fused bone, leaves space for the brain to grow, and uses a post-operative, custom-made helmet to ensure the protection and correct growth of an infant’s head. The patient wears this helmet for up to a year in order for the skull to grow according to the structure of the helmet.
As both procedures offer positive results with the intention of giving the brain room to grow and restoring a patient’s head to a normal shape, researchers were compelled to measure the effectiveness of both surgeries. In a retrospective studies published in the Journal of Craniofacial Surgery in 2013 and Journal of Neurosurgery: Pediatrics in 2014, patients underwent the craniosynostosis repair either by traditional or endoscopic means, comparing operating room times, blood loss, volume of transfused blood, length of hospital stay, and overall costs. Outcomes showed that the endoscopic procedure resulted in shorter operating room times, lower estimated blood loss, less transfused blood, shorter hospital stays, and decreased costs. The studies also recognized issues with compliance in wearing the molded helmet as well as minor skin breakdown after extended helmet use. Therefore, the research concluded that, with compliant patients, the endoscopic procedure was a viable option for craniosynostosis repair. These studies also illustrate the importance of recognizing craniosynostosis early, as the endoscopic repair is only considered in patients less than 6 months old.
Overall, both procedures have produced positive results. However, the endoscopic procedure seems to fit all the pieces together for a cost-effective, safe surgery to ensure a better future for a patient’s neurological development.

 

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