HTAC Report on MMR Vaccine and Autism

The Health Technology and Advisory Committee (HTAC) has published a report on a theorized link between the measles, mumps, rubella (MMR) vaccine and autism. HTAC was established in 1992 by the Minnesota state legislature. It is an independent, nonpartisan advisory body that evaluates new and emerging health care technologies based on existing scientific research and technology assessments.

Based on the results of a small British study from 1998, there has been much public interest in a possible association between MMR vaccine and autism. According to HTAC, no scientific evidence has been found to support this hypothesis. The Centers for Disease Control and Prevention (CDC) and the British Committee on Safety of Medicines also found no association between the MMR vaccine and autism.

Most medical experts believe that a strong immunization program is the best defense against infectious disease. HTAC reports that the risk of having an adverse reaction to a vaccine is much lower than the risk of having serious consequences from an infectious disease. Measles, mumps, and rubella are all serious contagious diseases that spread rapidly, especially in populations without immunity. The CDC states that if vaccination against measles, mumps, and rubella were to stop, the number of cases would return to pre-vaccine levels.

The report (document no. 010601) and others published by HTAC may be obtained by calling 651-82-374 or by e-mail (htac@health.state.mn.us). There is no charge for the reports. All reports are also available on the HTAC Web site atwww.health.state.mn.us/htac.

Health Supervision for Sickle Cell Disease

The Section on Hematology/Oncology, Committee on Genetics of the American Academy of Pediatrics (AAP) has issued a statement on health supervision for children with sickle cell disease. According to the AAP committee, sickle cell disease is a group of complex, chronic disorders characterized by hemolysis, unpredictable acute complications that can quickly become life-threatening, and the variable development of chronic organ damage. With expert, comprehensive medical care, patients with sickle cell disease have decreased morbidity and prolonged life expectancy. The AAP statement appears in the March 2002 issue of Pediatrics.

The AAP statement provides an overview of the genetics and patho-physiology, neonatal screening and diagnosis, clinical manifestations, and treatment of sickle cell disease. Comprehensive care of such patients involves ongoing patient and family education, periodic comprehensive evaluations and other disease-specific health maintenance services, psychosocial care, and genetic education and counseling.

The AAP committee has provided recommendations for health supervision of children with sickle cell disease in the following age groups: infancy (birth to one year of age), early childhood (one to five years of age), late childhood (five to 13 years of age), and adolescence to early adulthood (13 to 21 years of age and older). The recommendations for each age group are divided into steps for patient and family education, health maintenance, acute illness, and psychosocial care.

AAP Statement on Skateboard and Scooter Injuries

The Committee on Injury and Poison Prevention of the American Academy of Pediatrics (AAP) recently released a position statement on skateboard and scooter injuries among children and adolescents. The statement appears in the March 2002 issue of Pediatrics.

According to the AAP committee, injuries from skateboard accidents cause an estimated 50,000 emergency department visits and 1,500 hospitalizations among children and adolescents in the United States each year. Between January and August 2000, injuries related to nonpowered scooters resulted in about 9,400 trips to the emergency department.

Because the increased use of skateboards and scooters was too new for proper assessment of the effectiveness of the recommendations, the following preliminary recommendations were based on studies concerning the effectiveness of protective gear for in-line skating and bicycling:

• Children younger than 10 years should not use skateboards without close supervision by an adult or responsible adolescent. Children younger than five years should not use skateboards, but rather should be encouraged to participate in activities more appropriate to their age.

• Skateboards must never be used in or near traffic, regardless of traffic volume.

• Holding onto the side or rear of a moving vehicle while riding a skate-board should never be done.

• Physicians should advise parents, teachers, and others to strongly recommend that all skateboarders wear helmets, wrist guards, elbow pads, and knee pads to prevent injuries or reduce the severity of injuries resulting from falls.

• Communities should develop skate-boarding parks and encourage youth to practice in these parks.

• Children younger than eight years should not ride nonpowered scooters without close adult supervision.

• Children should not ride scooters in streets, in traffic, or at night.

• Children riding scooters should wear helmets, knee pads, and elbow pads.

AHRQ Consumer Tips Sheet on Preventing Medical Errors

According to the Agency for Healthcare Research and Quality (AHRQ), medical errors such as dosage problems and surgical mistakes cause between 44,000 and 98,000 deaths each year in hospitals alone. To help patients and their families play an active role in preventing medical errors, the AHRQ has released a new consumer tip sheet, “How to Protect Yourself and Your Family from Medical Errors.”

Through illustrations and easy-to-understand text, the AHRQ tip sheet provides advice on how to reduce the likelihood of medical errors by explaining five keys ways to avert such problems.

The tip sheet is available in English and Spanish. To order a copy of “How to Protect Yourself and Your Family from Medical Errors,” call the AHRQ Publications Clearinghouse at 800-358-9295 or send an e-mail request to ahrqpubs@ahrq.gov.

ACOG Opinion Paper on Placenta Accreta

The Committee on Obstetric Practice of the American College of Obstetricians and Gynecologists (ACOG) has issued an opinion paper on placenta accreta. ACOG Committee Opinion No. 266 appears in the January 2002 issue of Obstetrics and Gynecology.

According to the ACOG opinion paper, placenta accreta occurs when there is a defect of the decidua basalis, resulting in abnormally invasive implantation of the placenta. The incidence of placenta accreta has increased 10-fold in the past 50 years, to a current frequency of 1 per 2,500 deliveries. It has a 7 percent mortality rate as well as intraoperative and postoperative morbidity associated with massive blood transfusions, infection, ureteral damage, and fistula formation.

Risk factors for placenta accreta include placenta previa with or without previous uterine surgery, previous myomectomy, previous cesarean delivery, Asherman's syndrome, sub-mucous leiomyomata, and maternal age of 36 years and older. When any of these conditions are present, the physician should maintain high clinical suspicion for placenta accreta and take the appropriate precautions.

The ACOG committee recommends the use of ultrasonography for diagnosis during the antepartum period. Evidence also indicates that magnetic resonance imaging and color Doppler studies can be useful in defining an abnormally implanted placenta. However, the committee points out that, at this time, no diagnostic technique is 100 percent accurate in diagnosing placenta accreta.

CDC Report on Fluoridation of Public Drinking Water

According to a new report from the Centers for Disease Control and Prevention (CDC), almost two thirds of people in the United States who get their water from public water systems now receive fluoridated water. The report, “Populations Receiving Optimally Fluoridated Public Drinking Water—United States, 2000,” contains the most recent information on water fluoridation by state. For instance, the total number of people who received fluoridated water by the year 2000 was approximately 162 million, up 3.7 percent from 1992.

The CDC has identified the role of fluoridation in dramatically reducing tooth decay as one of the 10 greatest public health achievements of the 20th century. Recent studies estimate that water fluoridation reduces tooth decay in children by 18 to 40 percent. The importance of fluoride in preventing tooth decay was discussed in the first Surgeon General's report on oral health (available atwww.surgeongeneral.gov/library/oralhealth/), issued in May 2000. In addition, the Healthy People 2010 national health initiative set an objective for 75 percent of people in the United States who used public water systems to receive fluoridated water.

Dr. William R. Maas, the director of the CDC's Oral Health Program, reported that “water fluoridation is the most equitable and cost-effective means we have of delivering fluoride to all members of most communities.” He added that while several states have made substantial progress, there is “…considerable need as well as opportunity for additional improvement, particularly in the 24 states that have not yet met the objective of having at least 75 percent of their populations on public water systems receiving fluoridated water.”

The article appears in the February 22, 2002, issue of Morbidity and Mortality Weekly Report and is also available online atwww.cdc.gov/mmwr/preview/mmwrhtml/mm5107a2.htm. Other information on fluoridation and oral health is available online through the oral health Web site atwww.cdc.gov/oralhealth.

FDA Approval of Pimecrolimus Cream

The U.S. Food and Drug Administration (FDA) recently granted marketing approval for pimecrolimus (Elidel) cream 1 percent. Pimecrolimus is the first nonsteroid prescription cream for the treatment of mild to moderate eczema in patients two years and older. The cream is intended for short-term and intermittent long-term treatment of patients who have poor response or side effects with conventional treatments.

The manufacturer reports that pimecrolimus cream can be used on all skin surfaces, including the face, neck, and skinfolds. Pimecrolimus selectively blocks the production and release of cytokines, which cause the inflammation, redness, and itching associated with eczema.

According to the results of clinical trials, the most common side effect of pimecrolimus was a mild to moderate, temporary feeling of warmth or burning. Other common side effects included headache and cold-like symptoms, but these were only temporary and comparable with the side effects experienced by patients taking placebo. Pimecrolimus did not cause contact sensitization, phototoxicity, or photoallergy, and did not elicit skin atrophy, which can occur with use of topical corticosteroids.