Reports

Optimizing Immunosuppression Adherence to Improve Long-term Graft Function
Managing Inequities in Protection Against HPV-related Disease Through Gender-neutral Vaccination

Prevention and Minimization of Potential Complications from Infection and Disorders in Infancy

This report is based on medical evidence presented at sanctioned medical congress, from peer reviewed literature or opinion provided by a qualified healthcare practitioner. The consumption of the information contained within this report is intended for qualified Canadian healthcare practitioners only.

PRIORITY PRESS - 89th Annual Meeting of the Canadian Paediatric Society

London, Ontario / June 6-9, 2012

London, Ontario - Vaccination is the premier strategy recommended for preventing common and rare childhood infections and its track record is exceedingly impressive. Yet as delegates heard during the CPS meeting, there appears to be a growing confidence gap between the medical community and the public as anti-vaccination voices undermine public trust in childhood vaccination which health care professionals must now address. Though rare, invasive meningococcal disease (IMD) is among the most feared of childhood infections and with the development of a new vaccine against serogroup B disease, IMD may soon be prevented. CPS attendees also learned that nutrition plays an elemental role in the optimal maturation of the eye and the brain during infancy, with a special emphasis on certain carotenoids which help foster both visual and cognitive development. For infants born with certain ophthalmological disorders, early intervention is critical in order to minimize long-term complications.

Chief Medical Editor: Dr. Léna Coïc, Montréal, Quebec

Prevention or minimization of serious complications from childhood infectious disease and disorders was a frequent theme here during the annual meeting of the Canadian Paediatric Society (CPS), including during two educational symposia held within the context of the event.

As the leading strategy for the prevention of childhood infectious disease, vaccination was widely discussed by a number of speakers, among them William Fisher, PhD, Professor of Psychology, University of Western Ontario, London. He remarked that there is a growing “vaccine confidence gap” between health care providers and the public and providers must address the public’s concerns directly. Public acceptance of vaccines is often shaped by what they read and hear from questionable sources, the most powerful of these being the Internet. Here, anti-vaccination voices have previously unheard-of influence, as Dr. Fisher noted, and the public is highly susceptible to emotional parent testimonies attributing negative medical consequences to a single inoculation.

The public is also wary of industry who now offers a confusing array of new vaccines, accompanied by complicated schedules now required to have children adequately vaccinated. In a recent survey by Ekos Research (2011, submitted to the Public Health Agency of Canada), 89% of parents surveyed indicated that their child had received all recommended age-appropriate vaccines. Yet of those who had not had their child fully vaccinated, 28% of respondents felt that vaccines were unnecessary; 17% had concerns about safety; 16% said they did not believe in vaccines; and 12% said vaccines have too many side effects. About half of those surveyed also indicated that the newer vaccines are not as safe as the older ones and over 40% were more concerned about the safety of vaccines now than they were 5 years ago. “The good news,” as Dr. Fisher noted, is that the majority of Canadian parents follow their physician’s advice to have their child vaccinated.

Preventable Childhood Infections

Among the most worrisome of preventable childhood infections is invasive meningococcal disease (IMD). Though very rare, its consequences can be devastating if not fatal. Because of its short incubation time, an anamnestic (memory) response to Neisseria meningitidis cannot be relied upon to prevent disease, as observed by Dr. Marina Salvadori, Associate Professor of Paediatrics, University of Western Ontario, and booster shots against IMD will be necessary. The CPS recommends infants receive 1 dose of the conjugate C vaccine at 12 months; for infants at increased risk for IMD, the same vaccine may be given at 2, 4 and 12 months of age. However, infants who received the conjugate C vaccine before 12 months of age require a second dose during their second year of life. The same conjugate C vaccine may be given as an adolescent booster as well, ideally at 12 years of age.

Quadrivalent meningococcal conjugate vaccines against serogroups A, C, Y and W-135 (Menactra or Menveo) may also be given at 2 years of age in infants at increased risk for IMD; either vaccine may also be used as a booster dose during adolescence. Because of the success of widespread vaccination against serogroup C IMD, “serogroup B disease is now more common than serogroup C disease,” Dr. Salvadori confirmed. Serogroup B disease occurs endemically in Canada, as the CPS pointed out in their 2011 statement (Paediatr Child Health 2011;16(8):485-6), with a peak incidence in children under the age of 5 years. In fact, over 70% of IMD in this age group is now due to serogroup B infection, according to the CPS.

Estimates from studies evaluating 4CMenB, a new vaccine against serogroup B disease, suggest that the vaccine will protect about 75% of infants and over 80% of adolescents and adults against current meningococcal strains in Canada. With the introduction of the vaccine against serogroup B IMD, health care professionals will be able to prevent IMD from all 5 serogroups.

Healthy Development in Infancy

Good nutrition is another cornerstone of healthy development in infancy and childhood, especially during the period of accelerated growth following birth. As noted by Dr. Lewis Rubin, Chair, Neonatology and Professor of Pediatrics, University of South Florida, Tampa and St. Petersburg, several dietary nutrients selectively accumulate in the brain and the retina during the period of rapid brain growth after birth, one of the most important of which is docosahexaenoic acid (DHA), derived from omega-3 long-chain polyunsaturated fatty acids. Studies indicate that higher DHA levels in the brain and the retina are associated with improved cognitive function and vision in infants as well as in adults, as Dr. Rubin discussed.

The importance of the carotenoid lutein in the maternal diet for visual and brain development has also recently been recognized. As a powerful antioxidant with anti-inflammatory properties, lutein is felt to protect the eyes and the brain against oxidative damage caused by free radicals. Lutein and the closely related zeaxanthin are also major components of the filtering function of the eye. Indeed, the macular pigment is composed almost entirely of lutein and zeaxanthin, such that they are frequently referred to as the “macular pigments” in the eye. It is now known that the loss of macular pigment is associated with a variety of eye disorders, notably acute macular degeneration and diabetic retinopathy.

In western societies, omega-3 fatty acid and lutein intake is typically well below recommended levels. Consequently, “infants have very low lutein levels and tissues stores,” Dr. Rubin observed, as human milk is the only source of lutein until the child is weaned.

Evidence has also implicated low serum levels of lutein and zeaxanthin in preterm infants as a risk factor for progressive retinopathy of prematurity. In his own study of preterm infants, Rubin and colleagues (J Perinatol 2012;32:418-24) found that plasma carotenoid levels were significantly higher in preterm infants fed a formula supplemented with lutein, zeaxanthin, lycopene and beta-carotene (all carotenoids) compared to control infants fed a non-supplemented formula and were similar to term infants fed human milk.

Infants fed the carotenoid-supplemented formula also had greater rod photoreceptor sensitivity than controls. “This study showed for the first time that lutein supplementation early in life can decrease the severity of the major cause of acquired blindness in children which is retinopathy of prematurity, and that it also improved measures of retinal function,” Dr. Rubin stated.

Infant Eye Disorders

Regarding management of infant eye disorders, early intervention is now felt to be critical for maximal preservation of vision. “We used to operate on congenital strabismus, the most common one being congenital esotropia, by the child’s second birthday,” noted Dr. Sapna Sharan, Assistant Professor of Paediatrics (Ophthalmology), University of Western Ontario. However, this delay means that the infant does not learn how to put images together and the visual cortex begins to atrophy when it is not being appropriated stimulated. In view of this, “we tend to operate now somewhere before the first birthday,” she added.

Disorders such as cataracts, corneal opacity and congenital glaucoma require even more urgent intervention and should be operated on immediately before 6 weeks of age. “Before 6 weeks, the eyes just wander, but when fixation starts to occur, the eye stops to look at something and you need to sort it out before 6 weeks of age as the brain needs to start training from very early on,” Dr. Sharan reported.

Summary

It has been said that vaccination against childhood infectious disease is the most successful intervention ever in the history of modern medicine, sparing millions of infants and children each year from serious morbidity and not infrequent mortality due to preventable illness. The challenge now is to continue encouraging acceptance of childhood vaccination among a public that is increasingly skeptical about the safety of vaccines and to offer age-appropriate vaccines based on the epidemiology of organisms most likely to cause illness. Optimizing infant nutrition to ensure an adequate supply of micronutrients helps promote visual and cognitive development, while specialists need to be alert to potential eye disorders in infants and attend to them in a timely manner.

This report is based on presentations given during recognized educational symposia entitled “Paediatric Meningococcal Immunization: Guidelines and Issues of Vaccine Uptake,” and  “Brain and Eye Development in Infancy: The Role of Nutrition in Vision and Eye Health,” Wednesday, June 6, 11:45-13:15, during the 89th Canadian Paediatric Society Annual Conference, June 6-9, 2012, in London, Ontario. Unless specifically stated otherwise, the opinions expressed in this report are those of individual(s) presenting during the conference and do not necessarily represent the opinions of the Canadian Paediatric Society.

Mednet reports which have been accredited by McGill University under the MedPoint Accredited Conference Report Series are eligible for Mainpro-M1 and MOC Program credits.

© 2012 Mednet Inc. All rights reserved. Priority Press™ is an independent medical news reporting service providing educational updates reflecting peer opinion from accredited scientific medical meetings worldwide and/or published peer-reviewed medical literature. Distribution of this educational publication is made possible through the support of industry under written agreement that ensures independence. Views expressed are those of the participants and do not necessarily reflect those of the publisher, McGill University or the sponsor. No claims or endorsements are made for any products, uses or doses. Specific medicines or treatment strategies discussed in this publication may not yet be approved in Canada. Prior to prescribing any medication, the complete prescribing information in Canada, including indications, contraindications, warnings, precautions, and adverse effects should be consulted. No part of this publication may be reproduced in any form or distributed without written consent of the publisher. Information provided herein is not intended to serve as the sole basis for individual care. Our objective is to facilitate physicians’ and allied health care providers’ understanding of current trends in medicine. Your comments are encouraged.

Mednet Inc. 132 chemin de l’Anse, Vaudreuil, Quebec J7V 8P3 www.mednet.ca

We Appreciate Your Feedback

Please take 30 seconds to help us better understand your educational needs.