Immunologic response to influenza vaccine in at-risk children

January 2012  Volume 160  Number 1

Immunologic response to influenza vaccine in at-risk children — Steven H. Abman, MD

Strategies for management of uncomplicated seasonal influenza — Sarah S. Long, MD

Obesity and survival after stem cell transplant — Stephen R. Daniels, MD, PhD

Copyright ª 2012 by Mosby Inc.

I

nfluenza infection can add particularly significant morbidity and mortality to children with chronic disease, especially those patients with compromised immune systems. In this issue of The Journal, Long et al evaluate the humoral and cell-mediated immune response to the H1N1/2009 monovalent vaccine in high-risk pediatric patients after solid organ transplantation (SOT), systemic lupus erythromatosus (SLE), asthma, and sickle cell disease. These data suggest that patients with SLE or SOT mount suboptimal responses, whereas children with asthma or sickle cell disease have a vigorous response to immunization, even in patients on oral steroids. These findings have important implications regarding strategies to minimize the adverse impact of influenza in at-risk children. The authors speculate that alternate vaccine strategies, such as higher antigen dose or booster regimens, may improve protection for patients with compromised immune systems. Article page 74<

T

his thoughtful, meticulous, and conservative study, a model-based cost-effectiveness analysis, deals with an important topic for US children and their medical providers – how best to manage children coming to medical attention with influenza-like illness (ILI). Investigators studied three potential strategies for management of unvaccinated children with ILI during influenza season: (1) no antiviral treatment; (2) diagnostic testing and oseltamivir treatment if positive; and (3) empiric oseltamivir treatment. Their conclusion is that the strategy of empiric oseltamivir treatment (without testing) for children 1 to <12 years of age with seasonal ILI is associated with the best costeffectiveness ratios, which are highly dependent on the level of oseltamivir resistance of circulating influenza virus(es). Article page 67<

A

llogeneic hematopoietic stem-cell transplantation has been a major advancement in treatment. However, as success has improved, the focus on long-term outcomes has increased. There has been concern about both underweight and overweight, and the adverse long-term health effects associated with them. In this issue of The Journal, Mostoufi-Moab et al report on the results of using dual energy x-ray absorptiometry (DEXA) to evaluate body composition in 54 children and young adults aged 5-25 years who had been treated with stem-cell transplantation. The authors found that even though height was lower, body mass index was similar to a comparison group. However, lean body mass was lower and fat mass was higher in the stem-cell transplant recipients compared with controls. This emphasized that more precise measurement of body composition is important in this population and raises concern that increased fat mass could be associated with future adverse health outcomes. Children and adolescents who have successful stem-cell transplantation should be followed longterm for complications of increased fat mass, such as insulin resistance and metabolic syndrome. Article page 122<

A1