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Effect of expanded US recommendations for seasonal influenza vaccination: comparison of two pediatric emergency departments in the United States and Canada.

https://arctichealth.org/en/permalink/ahliterature131173
Source
CMAJ. 2011 Sep 20;183(13):E1025-32
Publication Type
Article
Date
Sep-20-2011
Author
Anne Gatewood Hoen
David L Buckeridge
Katia M L Charland
Kenneth D Mandl
Caroline Quach
John S Brownstein
Author Affiliation
Computational Epidemiology Group, Children's Hospital Informatics Program, Children's Hospital Boston, Boston, MA, USA.
Source
CMAJ. 2011 Sep 20;183(13):E1025-32
Date
Sep-20-2011
Language
English
Publication Type
Article
Keywords
Adolescent
Age Distribution
Canada
Child
Child, Preschool
Emergency Service, Hospital
Humans
Infant
Influenza Vaccines
Influenza, Human - epidemiology - prevention & control
Pediatrics
Practice Guidelines as Topic
Retrospective Studies
United States
Abstract
Starting in the 2006/2007 influenza season, the US Advisory Committee on Immunization Practices expanded its recommendations for seasonal influenza vaccination to include healthy children aged 24-59 months. The parallel Canadian organization, the National Advisory Committee on Immunization, did not at that time issue a similar recommendation, thereby creating a natural experiment to evaluate the effect of the policy in the United States.
We examined data for 2000/2001 through 2008/2009 and estimated relative changes in visits to the emergency department for influenza-like illness at two pediatric hospitals, one in Boston, Massachusetts, and the other in Montréal, Quebec, following the US policy change. Models were adjusted for virologic factors, seasonal trends and all-cause utilization of the emergency department.
Of 1 043 989 visits to the emergency departments of the two hospitals for any reason during the study period, 114 657 visits were related to influenza-like illness. Adjusted models estimated a 34% decline in rates of influenza-like illness among children two to four years old in the US hospital relative to the Canadian hospital (rate ratio 0.66, 95% confidence interval 0.58-0.75) following the 2006 policy change of the Advisory Committee on Immunization Practices. This was accompanied by more modest declines of 11% to 18% for the other age groups studied.
The divergence in influenza rates among children in the US and Canadian sample populations after institution of the US policy to vaccinate children two to four years of age is evidence that the recommendation of the US Advisory Committee on Immunization Practices resulted in a reduction in influenza-related morbidity in the target group and may have indirectly affected other pediatric age groups. Provincial adoption of the 2010 recommendation of the National Advisory Committee on Immunization in Canada to vaccinate children two to four years of age might positively affect influenza morbidity in Canada.
Notes
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Comment In: CMAJ. 2011 Sep 20;183(13):1464-521930746
PubMed ID
21930745 View in PubMed
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Pediatric versus adult drug trials for conditions with high pediatric disease burden.

https://arctichealth.org/en/permalink/ahliterature122347
Source
Pediatrics. 2012 Aug;130(2):285-92
Publication Type
Article
Date
Aug-2012
Author
Florence T Bourgeois
Srinivas Murthy
Catia Pinto
Karen L Olson
John P A Ioannidis
Kenneth D Mandl
Author Affiliation
Division of Emergency Medicine, Children's Hospital Boston, 300 Longwood Ave, Boston, MA 02115, USA. florence.bourgeois@childrens.harvard.edu
Source
Pediatrics. 2012 Aug;130(2):285-92
Date
Aug-2012
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
Child
Cost of Illness
Drug Industry - statistics & numerical data
Drugs, Investigational - adverse effects - therapeutic use
Evidence-Based Medicine - statistics & numerical data
Female
Humans
Male
Quality Indicators, Health Care - standards - statistics & numerical data
Randomized Controlled Trials as Topic - standards - statistics & numerical data
Research Support as Topic
Sweden
Treatment Outcome
Abstract
Optimal treatment decisions in children require sufficient evidence on the safety and efficacy of pharmaceuticals in pediatric patients. However, there is concern that not enough trials are conducted in children and that pediatric trials differ from those performed in adults. Our objective was to measure the prevalence of pediatric studies among clinical drug trials and compare trial characteristics and quality indicators between pediatric and adult drug trials.
For conditions representing a high burden of pediatric disease, we identified all drug trials registered in ClinicalTrials.gov with start dates between 2006 and 2011 and tracked the resulting publications. We measured the proportion of pediatric trials and subjects for each condition and compared pediatric and adult trial characteristics and quality indicators.
For the conditions selected, 59.9% of the disease burden was attributable to children, but only 12.0% (292/2440) of trials were pediatric (P
Notes
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PubMed ID
22826574 View in PubMed
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