RECENT I.D. PUBLICATIONS 2007 That Have Moved The Art, But .

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Forty-Eighth Annual Teaching Conference Pediatrics for the Practitioner -UT Health Science CenterSan Antonio School of Medicine –June 10-12, 201110 Recent Publications That Have orShould Have Changed Your PracticeThe 48th Annual Pediatrics for the PractitionerSan Antonio, TX; June 10, 2011Russell Steele, M.D.Ochsner’s Children’s Health Center andTulane University School of MedicineNew Orleans, LouisianaRussell Steele, M.D. has no relevant financialrelationships with commercial interests to disclose.OBJECTIVES To incorporate into practice new observations forpatient management To carefully evaluate recent publications related toinfectious diseases To update standards of care for treating infections To improve diagnostic approaches to potential severeinfectious processesThis presentation is the intellectual property of the author/presenter. Contact them for permission toreprint and/or distribute.

Forty-Eighth Annual Teaching Conference Pediatrics for the Practitioner -UT Health Science CenterSan Antonio School of Medicine –June 10-12, 2011DISCLOSURESNONEALL OF MY MONEY WENT TO COLLEGE ANDMEDICAL SCHOOL TUITIONS FOR THE KIDS Triatoma rubida40-60% ofKissing Bugs areinfected withTrypanosomacruzi in Tucson,AZ(Emerg. Inf. Dis.March 201016:400-5)Chagas DiseaseA 19 y/o healthy adolescent, a college student in Arizona, wasnotified by the blood bank after donating blood that his screenfor Chagas disease was positive and advised to contact you.Your management is:a. contact CDCb. no treatment is indicatedc. treat with nifurtimoxd. treat if there are cardiac or GI symptomse. treat if immunosuppressedThis presentation is the intellectual property of the author/presenter. Contact them for permission toreprint and/or distribute.

Forty-Eighth Annual Teaching Conference Pediatrics for the Practitioner -UT Health Science CenterSan Antonio School of Medicine –June 10-12, 2011Most Recent U.S. Case – New Orleans 2006Emerg Infect Dis. 2007;13:605-7 Testing began in December 2006 193 positive tests 12/06 through 9/07 300,000 T. cruzi infected individuals of Hispanicorigin currently live in the U.S. Only 11% of Chagas seropositive blood donors havecontacted CDC Physician lack of awareness Treatment is nifurtimox 15 mg/kg/ddiv. q 8-12 hr. x 90 daysChagas DiseaseKissing Bugs with Trypanosoma cruzi 7.7 million infected in Mexico, Central andSouth America Cardiomyopathy in 25-30% Treatment now recommended for:1. acute infections2. congenital infections3. immunosuppressed4. childrenKissing bugs and AnaphylaxisClin. Infect. Dis.; 50:1629 (15 June) Severe allergic reactions Widespread occurrence amongst vertebrate hosts T. crusi infects 50% of kissing bugs Seen mainly in the Southwest U.S. 5 cases presented:Case #1 : March 2008; 57 y/o/ woman who lived“near coastal marches in southern Louisiana”Other cases: 3 Arizona, one California.This presentation is the intellectual property of the author/presenter. Contact them for permission toreprint and/or distribute.

Forty-Eighth Annual Teaching Conference Pediatrics for the Practitioner -UT Health Science CenterSan Antonio School of Medicine –June 10-12, 2011Immunizations: #1 Medical AchievementVACCINES 2010 Meningococcal conjugateBooster oAdacel/BoostrixRotaTeq/RotarixGardasil, CervarixZostavaxCOMBINATION MMR-VZ DTap/Hib/Polio Hep A,BProQuadPentacelTwinrixNEW RECOMMENDATIONS HPV – males Prevnar-13 Influenza – universal; high dose (4X) for 65H1N1 in seasonal flu product Varicella – booster for high risk Meningococcal – booster for high riskStatus of Vaccines Cervarix – HPV2 - 10-25 YEARS Menveo – 11-55 yr.; 2-10 yrs. Pending licensure MenHibrix – MenCY-Hib ; 2, 4, 6 mo. pendinglicensure; filing 6/10; ?booster at 12 mo. Prevnar 13 - 2 mo. – 6 years; Gardasil – HPV4 males 9-26 yr; covered by Aetna,BC/BS, Cigna ; not by Humana, Coventry, Health Plusof LA, United Health Care, Vantage Health CareThis presentation is the intellectual property of the author/presenter. Contact them for permission toreprint and/or distribute.

Forty-Eighth Annual Teaching Conference Pediatrics for the Practitioner -UT Health Science CenterSan Antonio School of Medicine –June 10-12, 2011Prevnar 13 Types 4, 6B,9V,14, 18C, 19F, and 23Falso 1,3,5,6A,7F, and 19ALicensed 6wk-71 mo. VFC in April Cost 108.75 Return PCV 7 and company will replace with PCV13 14-59 mo. should receive one dose“May Administer” PCV 13to Children 6-18 Years of Age Sickle cell disease HIV Immunocompromising conditions Also give 23-valent polysaccharide vaccineRotavirus DiarrheaThis presentation is the intellectual property of the author/presenter. Contact them for permission toreprint and/or distribute.

Forty-Eighth Annual Teaching Conference Pediatrics for the Practitioner -UT Health Science CenterSan Antonio School of Medicine –June 10-12, 2011Rotavirus VaccinesMarch 22, 2010: FDA News Release Extraneous virus detected–Porcine Circovirus (PCV l) Present since early stages of development Not known to cause illness in humans Manufactured by GlaxoSmithKline Rotarix has an excellent safety profile RotaTeq does not contain PCV l FDA temporarily suspends use of RotarixRotavirus Vaccine Updates May 7, 2010: Merck identified porcine circovirus inRotateq using a highly sensitive PCR assay May 14, 2010: FDA advises to resume the use ofRotarixRabies ExposureHow many doses of rabies vaccineare recommended following ananimal bite when the animalescaped or could not beexamined?a. 23b. 5c. 4d. 1e. none-treat with Rocephin (itworks for other viral infections)This presentation is the intellectual property of the author/presenter. Contact them for permission toreprint and/or distribute.

Forty-Eighth Annual Teaching Conference Pediatrics for the Practitioner -UT Health Science CenterSan Antonio School of Medicine –June 10-12, 2011Rabies Exposure TreatmentACIP – June 24, 2009 4 doses over 14 days: 0,3,7,14 days Of 20-40,000 rabies exposures, 1000 get only 3-4 doses Cost: 100-200/dose Novartis (manufacturer) disagreesBooster of Meningococcal Vaccine Serogroup C vaccine, United Kingdom Antibody Persistence: (CID 15 June 2010;50:1601) Antibody sustained in adolescents but rapid waningin children immunized between 2 months and 6 years Booster at 6-12 years highly effectiveThis presentation is the intellectual property of the author/presenter. Contact them for permission toreprint and/or distribute.

Forty-Eighth Annual Teaching Conference Pediatrics for the Practitioner -UT Health Science CenterSan Antonio School of Medicine –June 10-12, 2011Congenital CMV If CNS disease, I.V.ganciclovir 12 mg/kg/ddiv. q. 12 hr. X 6 wks.Would you do this for anotherwise normalneonate withthrombocytopeniaand a single calcification?Screening and Treatment of CongenitalCMV (J Peds – in press) Only 10% of newborns have signs or symptoms 10-15% with no signs/symptoms have hearing loss CNS disease should be treated I.V. for 6 wks., anincredible burden on management. Screening for CMV in dried blood (J Peds 2010) P.O. Valganciclovir 16 mg/kg twice daily achievesconcentrations equivalent to I.V. Longer therapy may be needed.SCID Newborn Screening Jan. 2010: Recommended Uniform Screening Panel PCR for T-cell receptor incision circles Prevalence of SCIDS: 1 in 50,000-100,000 newborns Wisconsin implemented screening in January 2008,screening 71,000 infants in 2008; 8 cases oflymphopenia dx., one receiving a BM transplant This presentation is the intellectual property of the author/presenter. Contact them for permission toreprint and/or distribute.

Forty-Eighth Annual Teaching Conference Pediatrics for the Practitioner -UT Health Science CenterSan Antonio School of Medicine –June 10-12, 2011Mask and Hand Hygienefor Seasonal InfluenzaJ Infect Dis (Feb) 2010;201:491 1437 college students in dorms; influenza outbreak; Study continued for 6 weeks 3 groups: face mask; face mask hand hygiene; control 35-51% reduction in influenza illness for the mask plushand hygiene group Face mask alone showed a similar reduction butadjusted estimates (vaccination and other covariants)were not statistically significant. CONCLUSION: face masks and hand hygiene reduceillness in shared living settings; potential impact onH1N1 pandemicInfluenza Vaccine in Children andBenefit to Unimmunized AdultsJAMA March 10, 2010 303:943-49 Hutterite Communities in Canada 979 children received vaccine; 2326 controls Dx. By PCR and serum antibody Nonrecipients: 7.6% vs. 3.1% had influenza Protective efficacy 61% in the vaccine colonies No serious adverse eventsThis presentation is the intellectual property of the author/presenter. Contact them for permission toreprint and/or distribute.

Forty-Eighth Annual Teaching Conference Pediatrics for the Practitioner -UT Health Science CenterSan Antonio School of Medicine –June 10-12, 2011Mastitis during LactationLactobacilli for the Treatment of Mastitisduring LactationClin. Infect. Dis. 2010; 50:1551-58, 15 June 3%-33% of lactating mothers have mastitis Staph., streptococci, and/or corynebacterium Chronic mastitis – Staphylococcus epidermidis STUDY: Lactobacillus fermentum or L. SalivariusStrains isolated from breast milk352 women: 3 groups – 1) L.f. 2) L.s. 3) antibioticRESULTS: day 21 bacti. counts lower with probioticimproved more and lower recurrence withprobioticThis presentation is the intellectual property of the author/presenter. Contact them for permission toreprint and/or distribute.

Kissing Bugs are infected with Trypanosoma cruzi in Tucson, AZ (Emerg. Inf. Dis. March 2010 16:400-5) Chagas Disease A 19 y/o healthy adolescent, a college student in Arizona, was notified by the blood bank after donating blood that his screen for Chagas disease was positive and advised to contact you. Your management is: a. contact CDC

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