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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EChildren infected with Mycobacterium tuberculosis have a significant risk of developing tuberculosis (TB) and therefore can benefit from preventive therapy and new diagnostic techniques. This article discusses the advantages and disadvantages of some new diagnostic techniques being used to test children for TB.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EVaccinations\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EBacterial Infections\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EChildren infected with \u003Cem\u003EMycobacterium tuberculosis\u003C\/em\u003E have a significant risk of developing tuberculosis (TB) and therefore can benefit from preventive therapy and new diagnostic techniques. Jeffrey R. Starke, MD, Baylor College of Medicine, Houston, Texas, USA, discussed the advantages and disadvantages of some new diagnostic techniques being used to test children for TB.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EThe standard method for diagnosing TB in children consists of a positive tuberculin skin test (TST), an abnormal chest X-ray and\/or physical exam, and a history of recent contact with an infectious adult case of TB. However, new diagnostic techniques are being developed. Those that are successful in adults will need to be tested in children.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EThe interferon-\u03b3 release assay (IGRA) offers several potential advantages over TST and can detect host response to \u003Cem\u003EMycobacterium\u003C\/em\u003E tuberculosis-specific antigens. Two IGRA assays are currently available. Study results have shown that the IGRA and TST have similar accuracy for detection of TB infection and the diagnosis of disease in children. Compared with TST, a higher specificity with IGRA performance has been suggested, making these tests particularly advantegous in children receiving bacillus Calmette\u2013Gu\u00e9rin (BCG) vaccination [Mandalakas AM et al. \u003Cem\u003EInt J Tuberc Lung Dis\u003C\/em\u003E 2011; Chiappini E et al. \u003Cem\u003EInt J Immunopathol Pharmacol Dis\u003C\/em\u003E 2012].\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EUnder current pediatric guidelines the TST is preferred when testing for TB infection in children aged \u0026lt;5 years. In children aged \u22655 years who have received BCG vaccine or who are unlikely to return for TST reading, the IGRA is preferred. Both tests should be considered when the initial and repeat IGRA results are indeterminate, when either test is negative and there exists clinical suspicion for TB disease; when the risk of infection with poor outcome is higher; when the initial TST is positive and the child is aged \u22655 years and has a history of BCG vaccination; when there is a need for additional evidence to increase compliance; and if nontuberculous mycobacteria disease is suspected.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EGiuseppe Indolfi, MD, PhD, Meyer Children\u0027s Hospital, Florence, Italy, reviewed the current hepatitis treatment options in children. One of the characteristics of hepatitis B (HBV) in children is that it is often a chronic infection, particularly when contracted by a newborn. The optimal treatment for chronic HBV infection in children should ideally be started as early as possible before the immune-active phase (when the liver first starts accumulating inflammation and fibrosis) and should be directed toward eradicating HBV and obtaining HBV surface antigen loss [Indolfi G. \u003Cem\u003EFut Virol\u003C\/em\u003E in press]. FDA approved drugs for children include lamivudine (\u22653 years), tenofovir and adefovir (\u226512 years), entecavir (\u226516 years), and interferon (\u22651 year). Guidelines and consensus of expert panels recommend a conservative treatment approach. When needed, the first therapeutic option is treatment of finite duration with interferon to obtain sustained off-therapy virological response. The use of long-term nucleotide analogues can be aimed at obtaining sustained off-therapy virological response but can also result in long-term on-therapy virological response. Children in the immune-active phase for \u0026gt;3 months should be considered for therapy, while there is no indication for treatment in the immune-tolerant phase outside the context of clinical trials.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EHepatitis C virus (HCV) is primarily transmitted perinatally. Chronic infection in children can be asymptomatic and spontaneous clearance is possible. Overall, HCV is a mild disease in children. Cirrhosis is rare (\u0026lt;2%). In general, the chance of liver fibrosis seems to increase either with patient age, disease duration, or both. Although data are discordant, older adolescents and young adults tend to have more severe fibrosis than children. Peginterferon \u03b1-2b (1.5 \u03bcg\/kg per week), peginterferon \u03b1-2a (100 \u03bcg\/m\u003Csup\u003E2\u003C\/sup\u003E per week, max 180 \u03bcg), and ribavirin (15 mg\/kg per day, max 1200 mg) have been approved for treatment of HCV. Treatment duration is 48 weeks for genotypes 1, 4, 5, and 6, and 24 weeks for genotypes 2 and 3. Combination therapy is more effective and better tolerated in children when compared with adults. Sustained virological response in children with genotype 1 infection is around 55%, but it is higher (\u0026gt;90%) in children infected by HCV genotypes 2 and 3. The latter result strongly supports the treatment of children with HCV genotype 2 and 3 infection. A conservative approach is suggested for children infected with HCV genotype 1, given the mild natural history of the disease in childhood and the new highly effective treatment options available for adults.\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EWhen it was introduced in 2000, pneumococcal conjugate vaccine (PVC7) contained serotypes 4, 6B, 9V, 14, 18C, 19F, and 23F, which accounted for 80% of invasive disease in children aged \u0026lt;5 years and 89% of penicillin-resistant isolates. By 2006, 93% of children in the United States were receiving 3 doses of PCV7 before the age of 24 months, and by 2007 it was available in more than 70 countries. Following the vaccine\u0027s introduction, the incidence of pneumococcal disease (IPD) declined by 45% in all age groups and by 76% in US children aged \u0026lt;5 years (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E) [Pilishvili T et al. \u003Cem\u003EJ Infect Dis\u003C\/em\u003E 2010]. There was also a reduction in meningitis and bacteremia. However the proportion of invasive pneumococcal infections caused by serotype 19A increased in children [Kaplan SL et al. \u003Cem\u003EPediatrics\u003C\/em\u003E 2010]. Possible mechanisms for the increase in 19A serotypes include vaccine-induced serotype replacement and antibiotic pressure [Reinert R et al. \u003Cem\u003EVaccine\u003C\/em\u003E 2010; Dagan R et al. \u003Cem\u003EJ Infect Dis\u003C\/em\u003E 2009; Moore MR. \u003Cem\u003EJ Infect Dis\u003C\/em\u003E 2009].\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/14\/30\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Invasive Pneumococcal Disease in the USA, 1998 to 2007.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1057814594\u0022 data-figure-caption=\u0022Invasive Pneumococcal Disease in the USA, 1998 to 2007.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/14\/30\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/14\/30\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/14\/30\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/12904\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-9\u0022 class=\u0022first-child\u0022\u003EInvasive Pneumococcal Disease in the USA, 1998 to 2007.\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EReprinted with permission from the American Society for Microbiology. Pilishvili T et al. Sustained reductions in invasive pneumococcal disease in the era of conjugate vaccine. \u003Cem\u003EJ Infect Dis.\u003C\/em\u003E 2010;201(1):32\u201341.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-10\u0022\u003EPCV13, which adds serotypes 1, 3, 5, 6A, 7F, and 19A, was licensed in the USA for children in 2010. It is recommended for all children aged 2 to 59 months and high-risk children aged 60 to 71 months. Recently it was also licensed for use in adults aged \u226550 years; however, the Advisory Committee for Immunization Practices has not made recommendations for its use in adults. Several studies have shown significant reductions in the incidence of pneumococcal disease among children in the USA since the introduction of the PCV13 vaccine [Yildirim I et al., Hsu K et al., Lee GM et al. IDSA 2011; Kaplan SL et al. \u003Cem\u003EPediatr Infect Dis J\u003C\/em\u003E. In press]. The results have been particularly robust among Alaskan Native children who had more than 10 times higher incidence of pneumococcal disease compared with other US children prior to PCV7\u0027s introduction [Singleton R et al. ESPID 2011; Bruce M et al. IDSA 2011]. It is estimated that over a 10-year period, PCVC13 will prevent 106,000 cases of IPD and 2.9 million cases of pneumonia, and save $11.6 billion [Rubin JL et al. \u003Cem\u003EVaccine\u003C\/em\u003E 2010].\u003C\/p\u003E\u003Cdiv id=\u0022F2\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/14\/30\/F2.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022The editors would like to thank the many members of the ICAAC Congress 2012 presenting faculty who generously gave their time to ensure the accuracy and quality of the articles in this publication.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1057814594\u0022 data-figure-caption=\u0022The editors would like to thank the many members of the ICAAC Congress 2012 presenting faculty who generously gave their time to ensure the accuracy and quality of the articles in this publication.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure2\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/14\/30\/F2.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/14\/30\/F2.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure2\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/14\/30\/F2.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/12905\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\n            \u003Cp id=\u0022p-11\u0022 class=\u0022first-child\u0022\u003EThe editors would like to thank the many members of the ICAAC Congress 2012 presenting faculty who generously gave their time to ensure the accuracy and quality of the articles in this publication.\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2012 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/12\/14\/30.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzn9vp\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzn9vp\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}