Archive for November, 2009

The jury is still out on one or two doses of H1N1 vaccine for small kids: PHAC

TORONTO – The jury is still out on whether there will be a change in the recommendation on how many H1N1 shots children need, the head of the Public Health Agency of Canada suggested Tuesday.

But a vaccine expert said he would be uncomfortable with a decision to move to a single dose for toddlers, saying it would be unwise to assume all Canadian kids would respond to vaccine in the way a very small group of Spanish children did in a clinical trial.

“I think it takes almost magical thinking to imagine that we can generalize those limited data from Spain to a Canadian population,” said Dr. David Scheifele, director of the University of British Columbia’s Vaccine Evaluation Centre.

Scheifele, who is based at B.C. Children’s Hospital, said the only data currently available is a study of 51 young children in Spain who received GlaxoSmithKline’s adjuvanted H1N1 vaccine. Canada is also using GSK’s vaccine with an adjuvant, an additive that boosts one’s response to the serum.

The study showed that even at the youngest age group, kids six months to 35 months, one shot generated antibody levels that are predictive of protection.

Based on those promising results, Public Health Agency head Dr. David Butler-Jones said there might be a possibility kids could be immunized with a single shot, not the two currently recommended.

But he said Tuesday that the agency is not yet ready to make that call.

“(It’s a) very small sample,” said Butler-Jones, Canada’s chief public health officer.

“So we’re reviewing not only that data but expert opinion – pediatricians, others, experts in vaccine – and we hope to have a recommendation shortly, certainly in time before anybody needs to consider a second dose. Which will be coming in the next couple of weeks.”

In fact, children who were vaccinated in the first days of the vaccination program are closer to their second dose than that.

The recommendation is that the two shots be given 21 days apart. With this week marking the third week of the effort, parents and young kids could be lining up again next week for a second shot.

Scheifele believes at least the youngest children ought to get two shots. They are the ones whose immune systems have the least experience with flu viruses. They are also the ones being hit hardest by this particular virus, he said.

“Ideally it would be the under fives being offered a second dose, but I could live with the under threes.”

Scheifele noted the children in the clinical trial were healthy, and their response to vaccine doesn’t necessarily predict how First Nations children, children who were born prematurely, who have chronic illnesses or who are malnourished due to poverty or disease will respond to the vaccine.

“So I would guess at least 20 per cent of the Canadian population of young children may not behave the way those selected Spanish kids did,” he said.

Treating mild diabetes in pregnancy reduces weight gain, birth problems: study

NEW YORK – Treating even mild diabetes that develops during pregnancy helps keep moms and babies from gaining too much weight and makes for easier deliveries, new research shows.

Pregnant women in the U.S. are routinely tested and treated for high blood sugar levels, although it hasn’t been clear whether treating the mildest cases really benefited them and their infants.

In a study of 950 women, those with mild gestational diabetes who were treated had fewer overly large babies, fewer cesarean sections and fewer pregnancy complications, compared to women who didn’t have their diabetes treated.

“There is every reason to fully treat women with even the mildest (gestational diabetes) based on our results,” said the study’s leader, Dr. Mark Landon of Ohio State University Medical Center in Columbus.

Gestational diabetes begins during pregnancy and usually goes away after childbirth. It affects as many as one in seven pregnant women, depending on the population. The mother’s elevated blood sugar can cause the fetus to grow too large, sometimes requiring a C-section and can bring on other health problems for the mother and baby.

Risk factors include being over 25, being obese and a family history of diabetes.

Medical groups support testing pregnant women for the condition and treatment, although the U.S. Preventive Services Task Force, a government health panel, said last year there wasn’t enough evidence to recommend screening.

Landon said he’d had doubts about treating mild cases, and was surprised by the study’s results.

“I did it, yet I wondered, ‘Was I overtreating?”‘ he said.

For the government-funded study, 958 women with mild gestational diabetes were recruited at 15 medical centres. They got either diabetes treatment or standard prenatal care. Treatment included diet counselling and insulin if needed to get their blood sugar under control.

In the treatment group, there were fewer babies of unusually large size (seven per cent versus 15 per cent in the untreated group) and fewer babies weighed more than about nine pounds (six per cent versus 14 per cent). On average, the treated women gained five fewer pounds after their diagnosis than the untreated ones.

There were also fewer C-sections and cases of preeclampsia, a serious pregnancy complication. There were no deaths in either group, and no difference in other birth-related complications.

Landon noted that a “remarkable” 93 per cent of the women in the treatment group kept their blood sugar under control with diet alone; only seven per cent needed insulin.

The findings are reported in Thursday’s New England Journal of Medicine.

Dr. David A. Sacks of Kaiser Foundation Hospital in Bellflower, Calif., said switching to a healthier diet could help other pregnant women limit weight gain, too. More large babies are born to overweight or obese women who don’t have diabetes, he said.

“This is a real easy therapy to apply to every single pregnant lady,” said Sacks, who wrote an editorial about the study in the journal.

Even before she got pregnant, Lorenda Donaugh knew all about gestational diabetes. She works with Landon at Ohio State, doing ultrasounds for his patients, and ended up becoming one after she was diagnosed at 28 weeks with a mild case.

“I knew it was going to be hard work. It takes a lot of time and planning,” said the 27-year-old, who lives in the Columbus suburb of Westerville.

Donaugh, who was not part of the study, monitored her blood sugar several times a day, modified her diet and took extra walks. She eventually took a diabetes medication.

Planning meals and cutting back on sugar was the hardest part, she said. Whenever she was tempted, she thought of her baby. “Being pregnant, you have all those cravings, but you still have to limit that food,” she said.

The work paid off. She delivered a healthy daughter on Sept. 14. Adelynn weighed six pounds, four ounces and her mom had only gained a modest 22 pounds.

Record-holding 19.2-pound baby boy draws crowds to Indonesian hospital

KISARAN, Indonesia – Indonesia’s heaviest-ever newborn drew curious crowds Friday to a hospital where the boy named Akbar – or the Great in Arabic – came into the world at a record 19.2 pounds (8.7 kilograms).

Akbar Risuddin was born to a diabetic mother in a 40-minute cesarean delivery that was complicated because of his unusual weight and size, Dr. Binsar Sitanggang said.

“I’m very happy that my baby and his mother are in good health,” father Muhammad Hasanuddin said Friday. “I hope I can afford to feed the baby enough, because he needs more milk than other babies.”

Crowds pushed to get a peek of the extraordinary boy, who measured nearly 24 inches (62 centimetres) when he was born Monday, at the Abdul Manan hospital in the northern town of Kisaran on the island of Sumatra.

“This is fantastic,” Dewi Miranti, a mother from a nearby village, said as she peered through a window with about a hundred other people. “He looks very well and is cute.”

The baby’s extreme weight was the result of excessive glucose from his mother during pregnancy, Dr. Sitanggang said.

“He is greedy and has a strong appetite, nursing almost nonstop,” the doctor said.

The boy was the third child of Hasanuddin, 50, and mother Ani, 41, who like many Indonesians goes by a single name. His two “little” brothers weighed 11.6 pounds (5.3 kilograms) and 9.9 pounds (4.5 kilograms) at birth.

The former Indonesian record holder was a 14.7-pound (6.7-kilogram) baby boy born on the outskirts of the capital, Jakarta, in 2007.

Guinness World Records cites the heaviest baby as being born in the U.S. in 1879, weighing 23.75 pounds (10.4 kilograms). However, it died 11 hours after birth. The book also cites 22.5-pound (10.2-kilogram) babies born in Italy in 1955 and in South Africa in 1982.

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