Use of the influenza vaccine was not associated with preventing hospitalizations or reducing physician visits for the flu in children age five and younger during two recent seasons, say scientists.

As of June 2006, US health officials recommend annual vaccinations for all children age 6 to 59 months. “An inherent assumption of expanded vaccination recommendations is that the vaccine is efficacious in preventing clinical influenza disease,” the authors write. 

Peter G. Szilagyi, MD, MPH and colleagues studied 414 children age five and younger who developed influenza during the 2003-2004 or 2004-2005 seasons. Their vaccination status was compared with that of more than 5,000 children from the same three counties who did not have influenza during those seasons. 

A suboptimal match between the strain of influenza in the vaccine and that circulating in the public during those two seasons may have contributed to the poor effectiveness, the authors note. 

This study comparing cases with controls adds important information about vaccine effectiveness in children but should be combined with additional research, including studies of years with good vaccine match, they conclude. “Further studies of influenza vaccine effectiveness are needed using a variety of study designs (that adjust for confounders) to assess the yearly impact of influenza vaccination programs for children, particularly as higher rates of vaccination are achieved in the study population,” the authors write.  

APAM – October 2008;162:943-51.

archpedi.ama-assn.org

Children born via cesarean section may have a heightened risk of developing allergies, compared with children born vaginally. These findings are from a new study in the Journal of Allergy and Clinical Immunology.

Investigators followed 432 children from birth until age 9 years. At lease one of all the children’s parents had a history of allergies or asthma.

Children born via c-section were 2.1 times more likely to develop atopy and 1.8 times more likely to develop allergic rhinitis, compared with children born vaginally. However, there did not appear to be a link between birth method and asthma.

Journal of Allergy and Clinical Immunology – August 2008;112:274-9.

www.aaaai.org

People with migraines may also be more likely to develop blood clots in their veins, according to a study published in the journal Neurology.

For the study, 574 people in Italy age 55 and up were interviewed to determine whether they had a history of migraine or migraine at the time of the evaluation and their medical records were reviewed for cases of venous thrombosis. The arteries in their necks and thighs were also scanned with ultrasounds to check for atherosclerosis.

Of the participants, 111 people had migraine. A total of 21 people with migraine also had one or more instances of venous thrombosis, or 19 percent. In comparison, 35 people without migraine had the condition, or 8 percent. On the other hand, migraine was not linked with atherosclerosis.

“The thinking has been that because people with migraine are more likely to have strokes and other cardiovascular problems, that they would also have more severe and early atherosclerosis,” comments study author Stefan Kiechl, MD. “This study is the first to use high-resolution ultrasound to examine this theory, and it provides solid evidence to refute it.”

Neurology – September 2008;71:937-43.

www.neurology.org

A review study indicates that chiropractic care is beneficial for pregnancy-related low back pain (LBP). However, more high-quality studies are needed.

Six studies met the review’s inclusion criteria in the form of 1 quasi-experimental single-group pretest-posttest design, 4 case series, and 1 cross-sectional case series study; their quality scores ranged from 5 to 14 of 27.

All of the six studies included showed positive results for chiropractic care of LBP during pregnancy. “However, the low-to-moderate quality of evidence of the included studies preclude any definitive statement as to the efficacy of such care because all studies lacked both randomization and control groups. Given the relatively common use of chiropractic care during pregnancy, there is need for higher quality observational studies and controlled trials to determine efficacy.”

JMPT – August, 2008;31:447-54.

www.mosby.com/jmpt

A comprehensive analysis concludes that the possible adverse effects of chiropractic care are typically very mild, and that serious adverse events are extremely rare.

The researchers write: “This synopsis provides an overview of the benign and serious risks associated with chiropractic care for subjects with neck or low-back pain. Most adverse events associated with spinal manipulation are benign and self-limiting. The incidence of severe complications following chiropractic care and manipulation is extremely low. The best evidence suggests that chiropractic care is a useful therapy for subjects with neck or low-back pain for which the risks of serious adverse events should be considered negligible.” 

JMPT – August, 2008;31:461-4.

www.mosby.com/jmpt 

A new analysis confirms that chiropractic care is safe and effective for infants and toddlers.

Investigators poured over the records of 781 patients younger than three years of age cared for at a teaching clinic practice in Bournemouth , England during a 3-year period.

Most (73.5%) of the patients were 12 weeks of age or younger when they began care.

A total of 697 children “received a total of 5,242 chiropractic treatments, with 85% of parents reporting an improvement. Seven parents reported an adverse effect. There was a reaction rate of approximately 1 child in 100, or one reaction reported for every 749 treatments. There were no serious complications resulting from chiropractic treatment (reactions lasting >24 hours or severe enough to require hospital care).”

“This study shows that for the population studied, chiropractic manipulation produced very few adverse effects and was a safe form of therapy in the treatment of patients in this age group,” conclude the study’s authors.

JMPT – August, 2008;31:419-23.

www.mosby.com/jmpt