Bulletin Today
New data from CDC’s Autism and Developmental Disabilities Monitoring (ADDM) network show that 2.3% of children aged 8 years in 11 communities across the United States had an autism diagnosis in 2018.
A previous estimate, published in March 2020, found a prevalence of 1.9% among children that age. The new findings are published in CDC’s December 2, 2021, Morbidity and Mortality Weekly Report Surveillance Summaries.
A second report involving children aged 4 years in the same 11 communities noted progress in the early identification of children with autism.
According to the report, these children were 50% more likely to receive a diagnosis of autism or a special education classification by age 48 months compared with children aged 8 years.
“The substantial progress in early identification is good news because the earlier that children are identified with autism, the sooner they can be connected to services and support,” said Karen Remley, MD, director of CDC’s National Center on Birth Defects and Developmental Disabilities. “Accessing these services at younger ages can help children do better in school and have a better quality of life.”
However, the new data show racial and ethnic differences in autism diagnoses in some of the 11 communities studied. There were also community differences in autism prevalence, with rates ranging from 1.7% among children in Missouri to 3.9% in California. The variations could be the result of how communities are identifying children with autism.
Majority of mumps cases are among vaccinated, study finds
New research from CDC, published in the December 2021 issue of Pediatrics, shows that the virus that causes mumps continues to circulate in the United States, primarily infecting people vaccinated against it, including children.
The study found that one-third of the reported U.S. mumps cases from 2007 to 2019 occurred in children and adolescents. As many as 94% of those who contracted the respiratory illness had been vaccinated against the disease.
Researchers said possible contributing factors for reduced immunity against mumps include waning immunity; a lack of prior exposure to the virus; and the circulation of genotypes not contained by the measles, mumps, and rubella (MMR) vaccine.
Nearly 91% of the U.S. population has had at least one dose of the two-dose MMR vaccine, which is administered between 12 months and 6 years and is 88% effective against the disease.
In a companion editorial, Charles Grose, MD, from the Department of Pediatrics at the University of Iowa, writes that it might be time to administer a third dose of the MMR vaccine, preferably one that does not contain the genotype A strain, which no longer circulates in the United States.
“There are other live attenuated mumps vaccines being used elsewhere in the world. … Should we consider a third immunization with the Urabe strain or the Zagreb strain of the mumps vaccine? That strategy presumably would broaden the neutralization antibody response in vaccine recipients,” he writes.
Findings confirm safety of simultaneous COVID-19 and influenza vaccine administration
Results of a phase IV study published November 11, 2021, in The Lancet find no safety concerns with coadministration of the COVID-19 vaccine and the influenza vaccine.
The multicenter, randomized controlled trial was designed to compare outcomes in U.K. adults who did and did not receive influenza vaccination as they were given a second dose of the Pfizer or AstraZeneca COVID-19 vaccine.
There were 679 participants in total, distributed across 6 cohorts dictated by which brand of COVID-19 vaccine they received and whether the influenza vaccine they received was the quadrivalent, trivalent, or recombinant quadrivalent formulation.
One-half of the volunteers were randomized to receive a concomitant administration of influenza vaccine and a second dose of COVID-19 vaccine at day 0 followed by placebo at day 21. The remaining participants were allocated to placebo plus a second dose of coronavirus vaccine at day 0 followed by influenza vaccine at day 21. At 6-week follow-up, investigators assessed the primary endpoint for one or more participant-reported solicited systemic reactions in the week following the first trial vaccination.
The researchers determined most systemic reactions to vaccination were mild or moderate in nature, with a similar incidence rate between the randomized groups. Because same-time vaccination against coronavirus and influenza maintains antibody responses to both without triggering safety flags, the study authors conclude that concomitant vaccination is appropriate and promises to lower the burden on health care services.
ISMP warns about confusion with co-packaging, labeling on monoclonal antibody products
The Institute for Safe Medication Practices (ISMP) is alerting health care providers about potential confusion over new alternative packaging for casirivimab and imdevimab. These monoclonal antibodies, administered together as REGEN-COV, are used for treating COVID-19. ISMP recently received multiple reports about these types of errors.
“Due to the high demand for monoclonal antibodies, Regeneron (manufacturer of REGEN-COV) is distributing co-packaged products of the antibodies that are manufactured by Roche Pharmaceuticals. The Roche co-packaged products are intended for distribution outside the U.S. and use labeling that differs in some ways from Regeneron’s other REGEN-COV products,” ISMP stated in a news release. These products also may not contain a barcode.
Currently, casirivimab and imdevimab are available in a co-formulated vial containing both products together, co-packaged in cartons with one vial of casirivimab and one vial of imdevimab, and in Dose Pack bags containing individual vials of casirivimab and imdevimab.
“Most of the errors are associated with preparing and administering only one component of the 2 monoclonal antibodies, or prescribing, preparing, and/or administering the wrong dose,” ISMP noted.
On September 9, 2021, HHS made its 9th amendment to the PREP Act in order to expand the authority of licensed pharmacists, as well as certain pharmacy interns and pharmacy technicians, to deliver COVID-19 therapeutics, such as monoclonal antibodies.
Data show that monoclonal antibody therapy reduces COVID-19 hospital admissions, ED visits, and viral levels in the blood of infected people.
In the news release, ISMP provided the following safe-practice recommendations for health care practitioners:
- Clarify dosing during order entry. In order entry systems and on standardized order sets, make it clear that 600 mg (or 300 mg under certain conditions) of each antibody is required for appropriate dosing.
- Require pharmacy preparation. Wherever possible, outside of emergencies, have the pharmacy prepare and label patient-specific subcutaneous doses and I.V. infusions of monoclonal antibodies rather than have practitioners select vials from automated dispensing cabinets and prepare them in busy patient care areas.
- Update health record with current information from the Fact Sheet. Assign an individual to regularly check the Fact Sheets for monoclonal antibodies to ensure the most current information is readily available to all frontline practitioners. Dosing and administration information on the one-page sheet included in Dose Packs is not necessarily current.
- Create separate storage. Separate the different presentations of the monoclonal antibodies into sequestered storage containers in the refrigerator and other storage locations, and clearly label them.
- Use auxiliary warnings. Include bold, colorful warnings on the product storage containers and on electronic screens or menus where these products are listed, based on the type of errors that have been reported. For example, “Dose pack of casirivimab and imdevimab (must be administered together).”
- Reduce confusion with the Roche co-packaged product. Health care organizations should educate staff about the label differences. Before product use, place (if absent) or replace the barcode on the product with a pharmacy-prepared barcode, or test any available barcodes on the product and manually input the product information into the electronic health care record system to ensure they provide correct information when scanned.
- Educate staff. Educate practitioners handling the monoclonal antibodies, with a particular focus on the various presentations available, possible label confusion, types of errors being reported nationwide, and preparation and/or administration instructions from the most current Fact Sheet.