Infant Immunizations at Record Levels, but Adolescent Vaccinations Lag

Three-quarters of U.S. children 19 to 35 months of age received the recommended series of childhood vaccines in 2006, meaning they had four doses of diphtheria, tetanus and pertussis vaccine; three doses of polio vaccine; one or more doses of measles, mumps, and rubella vaccine; three doses of Haemophilus influenzae type b vaccine (Hib); three doses of hepatitis B vaccine; and one or more doses of varicella or chickenpox vaccine. There were substantial state and regional differences in the percentages of children who were fully immunized, ranging from 83.6 percent in Massachusetts to 59.5 percent in Nevada and from 81.4 percent in Boston to 65.2 percent in Detroit. For the first time this year, the Centers for Disease Control and Prevention (CDC) also looked at how many adolescents had ever received the full range of vaccinations and found that rates for 13- to 17-year-olds were lowest for the most recently recommended vaccines; only 11.7 percent had received a meningococcal vaccination, for example. “We have more work to do to protect older children from vaccine preventable diseases,” said Dr. Melinda Wharton, deputy director of CDC’s National Center for Immunization and Respiratory Diseases.

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Perceived Lactose Intolerance Found to Affect Bone Mineral Content

A study reported in the September 2007 issue of the journal Pediatrics indicates that children as young as 10 years who believe themselves to be lactose-intolerant tend to avoid milk, the major source of calcium essential to adolescent bone development.  Studies of a cross-section of ethnic groups in middle schools in California and Indiana found that many of the girls who thought themselves to be lactose-intolerant were not actually “lactose-maldigesters” (meaning that their bodies do not process calcium). But the failure of self-identified lactose-intolerants to consume milk resulted in damage to bone development, leading researchers to urge that education programs and focus groups address misconceptions surrounding lactose intolerance at an early age, to prevent it from reducing calcium intake.

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August News Alerts

The following information appeared during the month of August 2007 in the News Alerts section of the website of the Center for Health and Health Care in Schools, at www.healthinschools.org.

August 1, 2007
Senate Begins Debate on SCHIP Reauthorization

Debate began yesterday on a bill now before the Senate that would reauthorize the State Children’s Health Insurance Program, which is set to expire next month. As expected, in hours of debate, Senators differed on whether the program that provides health insurance to children in working-poor families should be reined in or expanded, though all Senators who spoke favored continuing the program at some level. A bill reported by a large majority in the Senate Finance Committee last week calls for increasing federal spending for SCHIP by $35 billion over the next five years, to enable states to bring additional children into the program, while the Bush administration in its proposed budget for next year calls for an increase of only $5 billion over five years, which would limit SCHIP largely to children already being covered. In the Senate, the debate triggered questions about whether adults and parents should also be covered by SCHIP, and how high states should be allowed to set the income levels at which families are eligible for the program. It was also pointed out that there is wide diversity between states in the way SCHIP operates, as the result of waivers that have been granted to states by the federal Department of Health and Human Services. Debate on the bill is expected to continue all of this week.

August 2, 2007
House Passes CHIP Reauthorization

As the Senate continued debate yesterday on a reauthorization of the State Children’s Health Insurance Program (SCHIP), the House of Representatives abruptly passed its own bill, the Child Health Care and Medicare Protection Act of 2007, which authorizes an increase of almost $50 billion over the next five years for CHIP and makes school-based health centers eligible for reimbursement. The House voted 225 to 204 on party lines for the bill, which will now go to conference with whatever legislation the Senate finally passes, with supporters hoping to retain at least $35 billion in new money for the child health program. That would far exceed the $5 billion increase President Bush asked for SCHIP in his budget and the President has said he will veto any bill that provides the program more new money. The House bill would fund its proposed $50 billion increase by raising the federal tax on cigarettes 45 cents a pack, to 84 cents. The House bill in addition to the CHIP reauthorization includes a number of changes in the federal Medicare program aimed at reducing the role of private Medicare plans and reversing expected cuts in Medicare reimbursements to doctors. 

August 3, 2007
Senate Passes SCHIP Extension

The United States Senate passed a bill August 2 that reauthorizes the State Children’s Health Insurance Program (SCHIP) for another five years, with a funding increase of $35 billion that is expected to enable states to add 3 million more children to current SCHIP enrollment. A reauthorization bill passed by the House August 1 would allow  $50 billion in added funding, and a conference is expected to reconcile differences on the money figure and other details of the two bills when Congress returns from an August recess. The state/federal children’s health insurance program was enacted in 1997 and is slated to expire.

August 6, 2007
Three Vaccines Urged for Preteens

The Centers for Disease Control and Prevention (CDC) is urging parents whose children are entering the teen years to protect them against some of the most serious health threats to adolescents. In recommendations released August 1, the CDC and the American Academy of Pediatrics stress the importance of health checkups for 11- and 12-year-olds and the importance of preteen vaccinations, including MCV4, which protects against meningitis and its complications; Tdap, which is a booster against tetanus, diphtheria, and pertussis; and, for girls, the newly developed vaccine against human papillomavirus (HPV), the most common sexually transmitted infection in the United States. “Many parents do not realize that some childhood vaccines, such as those for tetanus and whooping cough, wear off over time and, as they get older, young people are at risk for different diseases at school, camp, or in other new situations,” said Dr. Anne Schuchat, director of the CDC’s Center for Immunization and Respiratory Diseases. Detailed information for parents is available in English and Spanish at a new website, www.cdc.gov/vaccines/preteen.

August 8, 2007
School Breakfast Seen Reducing Nurse Visits

Eating breakfast at school before classes begin has been found to improve children’s learning and behavior, but it may also offer health benefits, including reduced numbers of visits to the school nurse, according to the Food Research and Action Center (FRAC). In a report released yesterday, FRAC detailed the experiences of 23 school districts across the country where breakfast was available to students in the form of sit-down eating in the cafeteria,  “grab and go”(packaged meals picked up from serving carts and eaten elsewhere on school grounds), or regularly scheduled time to eat breakfast in the classroom. In some of the surveyed districts, breakfast was a “universal” option, meaning it was free to all students, and in other districts it was offered free of charge to low-income students and at reduced price or full price to those able to pay. A new option called “Second Chance Breakfast,” usually implemented in middle and high schools, allows students time after the first period of the day to eat breakfast either in the cafeteria or from carts in the hallway. The full FRAC report, which details the various ways schools are handling breakfast and the obstacles to breakfast programs, can be accessed online at www.frac.org/pdf/urbanbreakfast07.pdf.

August 10, 2007
ACIP Reminds about Meningococcal Vaccination

The Advisory Committee on Immunization Practices called attention today to the advisability of vaccinating all persons aged 11-18 years against meningoccal disease. That would include routinely vaccinating children at their 11-12 years health visits, the ACIP said, and vaccinating young people at the time of entry into high school (approximately age 15) if they missed the earlier immunization. It is also important, the ACIP pointed out, that college freshmen be vaccinated at the time of entry into college, where they will be at increased risk for meningococcal disease as the result of living in dormitories.  The ACIP expects this year’s supply of the vaccine, MCV4 to be sufficient to meet the peak in demand that occurs when children are returning to school after summer vacation. The committee advises that MCV4 and Tdap (tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis) vaccines be administered during the same visit, but if simultaneous vaccination is not possible, MCV4 and Tdap can be administered in any order. “The goal is routine vaccination of all adolescents with MCV4 beginning at age 11,” the ACIP said. The revised recommendations of the Advisory Committee on Immunization are available as part of the Morbidity and Mortality Weekly Report for August 10, 2007, at www.cdc.gov/mmwr.

August 16, 2007
Survey Reports U.S. Schools ‘Infested with Drugs’

“This fall, more than 16 million teens will return to middle and high schools where drug dealing, possession, use, and students high on alcohol or drugs are part of the fabric of their school,” according to the twelfth back-to-school survey conducted by the National Center on Addiction and Substance Abuse (CASA) at Columbia University. Responding to survey questions, students reported increases since 2002 in the numbers of classmates they have seen high on drugs at school and the ease with which illegal drugs are sold and kept on school campuses. “Too many of our nation’s high and middle schools have become marijuana marts and pill palaces,” said CASA president and former Secretary of Health, Education and Welfare Joseph Califano, Jr. In other survey findings, 37 percent of 12- to 17-year-olds said they can buy marijuana within a day at school and 17 percent said they can buy it in an hour or less. Being popular seems to add to the risk of drug abuse, with popular teens at drug-infested schools found 10 times likelier to abuse prescription drugs, 9 times likelier to use illegal drugs other than marijuana or prescription drugs, 5 times likelier to get drunk monthly, and 4 times likelier to smoke or chew tobacco. Information about the 2007 back-to-school survey is available at www.casacolumbia.org.

August 22, 2007
Hypertension Often Missed in Children

Hypertension—elevated blood pressure—is a common chronic disease of children and adolescents that is often underdiagnosed and untreated, according to a research report in today’s issue of the Journal of the American Medical Association. Researchers who studied a group of children 3 to 18 years of age in outpatient clinics at a large academic urban medical system found that a number of factors, including patient age, height, obesity, and the difficulty of getting consistent readings of blood pressure over time, make it hard to diagnose hypertension, even though taking blood pressure is often part of a well-child visit. Stressing the importance of following up on readings of elevated blood pressure, the researchers noted that one form of hypertension—“secondary” hypertension, meaning the high blood pressure results from some other condition such as renal disease—is more common in children than in adults. And although the majority of children with mild to moderate hypertension have the “primary” form, in which a cause is not identifiable, the increased prevalence of childhood weight problems calls for increased attention to weight-related problems such as high blood pressure, the researchers stress. An article, “Underdiagnosis of Hypertension in Children and Adolescents,” appears in the August 22/29, 2007, issue of the Journal of the American Medical Association.

August 23, 2007
FDA Approves Drug for Psychiatric Conditions in Children, Adolescents
A statement issued August 22 by the U.S. Food and Drug Administration (FDA) notes that the FDA has approved Risperdal (risperidone) for the treatment of schizophrenia in adolescents ages 13 to 17, and for the short-term treatment of manic or mixed episodes of bipolar 1 disorder in children and adolescents ages 10 to 17. This is the first FDA approval of an atypical antipsychotic drug to treat either disorder in these age groups. Until now, there has been no FDA-approved drug for the treatment of schizophrenia for
pediatric use and only lithium is approved for the treatment of bipolar disorder in adolescents age 12 and up. The statement points out that evidence to support the new recommendations was collected through studies requested by the FDA as part of its pediatric drug development initiatives. “Schizophrenia is a serious and disabling psychiatric disorder,” the statement says. “Symptoms may include hallucinations, delusions, and disorganized thinking. Bipolar disorder, also known as manic-depressive illness, is a serious psychiatric disorder that causes wide shifts in a person’s mood, energy, and ability to function.” Risperdal is manufactured by Janssen, L.P. of Titusville, New Jersey.

August 29, 2007
New Asthma Guidelines Emphasize Children

The National Heart, Lung, and Blood Institute (NHLBI) in the National Institutes of Health today issued the first comprehensive update in a decade of clinical guidelines for the diagnosis and management of asthma, including an expanded section on childhood asthma. Calling asthma one of the most common health problems in the United States, the new guidelines note that 22 million people in this country have asthma, including 6.5 million children under age 18. Key features of the guidelines include a new approach to assessing and monitoring asthma by using multiple measures of a patient’s current impairment and future risk; new emphasis on the importance of teaching patients skills to self-monitor their asthma; control of environmental factors and other conditions that can affect asthma; and continued use of a “stepwise approach” to control asthma in which medication and dosages are stepped up when needed and stepped down when possible. The stepwise management charts are revised to specify treatment for three age groups: 0-4 years, 5-11 years, and 12 years and older. The NHLBI said the 5-11 age group was added as the result of emerging evidence that children respond differently than adults to asthma medication. The guidelines are available online at www.nhlbi.nih.gov/guidelines/asthma/index.htm.