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Medscape
12-06-2025
- Health
- Medscape
Managing Complex Acute Otitis Media Infections
Most acute otitis media (AOM) infections resolve without complications, whether treated with antibiotics or observed under 'watchful waiting.' In recent years, these infections have been termed uncomplicated AOM. However, some children have more serious infections, and these infections have been termed complex AOM. Michael E. Pichichero, MD Children with complex AOM have become a focus of investigation by those doing research in the otitis media field, driven by the recognition that these children experience greater consequences from infections, and their medical management accounts for more than half the costs of care associated with AOM. Complex AOM may be defined according to five differing clinical presentations: 1) recurrent AOM (defined as children with three AOM episodes within 6 months or = 4 AOM episodes within 12 months), ie, otitis prone; 2) treatment failure (second AOM episode occurring within 14 days from an initial AOM visit); 3) relapsed AOM (second AOM episode occurring > 2 weeks from the initial AOM visit but < 1 month from an initial otitis media episode; 4) eardrum rupture; and 5) AOM with local or systemic complications such as mastoiditis, intracranial abscess, or facial nerve palsy. The frequency of the complex AOM types above are ranked from most to least frequent in the US and other high-income countries. In low- and middle-income countries — where AOM is infrequently diagnosed by clinicians — the frequency of presentation is quite different, with the more common being eardrum rupture and AOM with complications. My group recently reported results of an 18-year longitudinal study of uncomplicated and complex AOM, spanning 2006-2023, during the 7-valent pneumococcal conjugate vaccine (PCV7) era and throughout the 13-valent PCV (PCV13) era. We enrolled 1537 children prospectively, usually at 6 months old, and followed them to 36 months. When clinicians made the clinical diagnosis of AOM, tympanocentesis was performed for middle ear fluid culture in most cases. We used the electronic medical records retrospectively to identify uncomplicated AOM and complex AOM episodes. As an inclusion criterion, all children were required to receive the full primary series of PCV7 or PCV13 immunizations according to US Centers for Disease Control and Prevention schedule (doses at 2, 4, and 6, months; booster dose between 12 and 15 months). Classification of complex AOM was made on an episode basis. If the child met the definition of recurrent AOM, all AOM episodes with middle ear fluid collection were included in the complex AOM group for analysis purposes. One hundred ninety-two children were vaccinated with PCV7 during 2006-2009. Children who received PCV13 immunizations were divided into two groups: 404 children in what we called the early PCV13 era (2010-2014), and 525 children in what we called the late PCV13 era ( 2015-2023). Among the 1537 enrolled children, the first thing we found is that 591 never had an AOM episode (No OM group, 53%). In the 1980s, 80% of young children were said to have at least one AOM, compared to our new result of 53%. Whether the surprisingly low frequency of AOM was due to PCVs, or changes in the clinical diagnostic criteria for AOM promulgated by the American Academy of Pediatrics in their AOM guidelines, or because parents decreased the frequency of how often they sought care for ear pain in their children, is unknown. Of the 530 children with at least one episode of AOM, we found that 53% had uncomplicated AOM, 34% had complex AOM, and 13% had both uncomplicated AOM and complex AOM. To our knowledge, this was the first comprehensive report from primary care practices in the US of this distribution of cases of uncomplicated vs complex AOM. Risk factors for complex AOM compared with uncomplicated AOM were male sex, family history of AOM, and daycare attendance. We found that the frequency of isolating pneumococci from middle ear fluid in episodes of complex AOM decreased over time, between 2006 and 2023. The frequency of isolating Haemophilus influenzae and Moraxella catarrhalis did not change over time. Since pneumococci isolation went down and H influenzae isolation stayed the same, H influenzae became the predominant organism causing complex AOM throughout both PCV13 timespans we studied. Among uncomplicated episodes of AOM, pneumococcal isolation from middle ear fluid remained the same, whereas isolation of H influenzae went up and M catarrhalis went down. Isolation of H influenzae was 44% more likely in children with complex AOM vs uncomplicated AOM. This is consistent with the association between H influenzae and complex AOM, particularly recurrent AOM, as previously reported. PCV13 significantly reduced the isolation from middle ear fluid strains of pneumococci-expressing various capsular polysaccharide serotypes, throughout the entire timespan that PCV13 was used. The result was consistent with our earlier report in Lancet Child and Adolescent Health , when we studied the effectiveness of PCV13 shortly after its introduction in 2010. However, consistent with a wide literature, over time, pneumococci-expressing PCV13 serotypes were replaced by organisms expressing other serotypes not in the vaccine, especially serotype 35B in the late PCV13 era. In terms of antibiotic susceptibility, the odds of antibiotic nonsusceptibility of pneumococci to penicillin were 2.65 times higher in children with complex AOM compared to children experiencing uncomplicated AOM. The proportion of H influenzae that was beta lactamase-producing (amoxicillin resistant) increased during the PCV13 eras compared to the PCV7 era. Key Points: Risk factors for developing complex AOM and uncomplicated AOM are similar. PCV13 significantly reduced complex AOM and penicillin nonsusceptibility associated with pneumococci driven by near complete elimination of strains expressing serotype 19A. H influenzae is the dominant cause of complex AOM. is the dominant cause of complex AOM. Although non-PCV13 pneumococcal serotypes emerged in the late PCV13 era, the lower level of complex AOM caused by pneumococci remained lower compared to the PCV7 era. Rochester General Hospital Research Institute was the study sponsor/co-funder and Pfizer provided additional funding for the study analysis that resulted in this paper: N Fuji et al. Eighteen-year longitudinal study of uncomplicated and complex acute otitis media during the pneumococcal conjugate vaccine era, 2006-2023. The Journal of Infectious Diseases , 2025. Funding was provided by the National Institute on Deafness and Other Communication Disorders of the National Institutes of Health and the Centers for Disease Control and Prevention for the collection of middle ear samples leading to the publication.
The Star
27-05-2025
- Health
- The Star
South Sudan launches vaccines to prevent pneumonia, diarrhea in children
JUBA, May 27 (Xinhua) -- South Sudan, in partnership with United Nations agencies, on Tuesday launched two vaccines to prevent pneumonia and severe diarrhea in children under five. Anin Ngot Ngot Mou, undersecretary in the Ministry of Health, described the rollout as a game changer in the fight against two of the country's leading causes of child mortality. "Today, we are taking a bold step forward in protecting the health and future of our children in South Sudan. Pneumococcal disease is the leading cause of pneumonia, meningitis, and sepsis, especially among children under five years old," Ngot said during the launch in Juba, the capital of South Sudan. The new vaccines -- pneumococcal conjugate vaccine (PCV) and rotavirus vaccine -- will be integrated into the Expanded Program on Immunization (EPI), launched by the World Health Organization (WHO) in 1974. Health workers are being trained, and public awareness campaigns are underway to promote community acceptance and ensure wide coverage, Ngot added. Obia Achieng, deputy representative of the UN Children's Fund in South Sudan, said the vaccination campaign will extend across all 10 states and three administrative areas, with a focus on reaching vulnerable children in remote and conflict-affected regions. He highlighted that the campaign marks a milestone for South Sudan, coinciding with the formal introduction of both PCV and rotavirus vaccines into the national immunization system. Despite this progress, he noted that about 40 percent of children in South Sudan live more than 5 km from the nearest health facility, with many displaced due to ongoing insecurity. Mutale Senkwe, WHO deputy representative in South Sudan, said the campaign reinforces the country's commitment to protecting children from preventable diseases. Senkwe said since the launch of the EPI, vaccines have saved over 50 million children in Africa, and in 2024, a child in Africa is 50 percent more likely to survive to their next birthday than in a world without vaccines.
Edinburgh Live
19-05-2025
- Health
- Edinburgh Live
East Lothian nurse gave baby wrong vaccine and 'pulled female colleague on his lap'
Our community members are treated to special offers, promotions and adverts from us and our partners. You can check out at any time. More info An East Lothian nurse who gave a baby the wrong vaccine and gave another child a vaccination without parental consent has been struck off. Jeffrey Saunderson had initially been given a 12-month suspension order for a string of incidents dating back to November 2011. However, during a review meeting with the Nursing and Midwifery Council this month has was struck off the register. The regulator noted how Saunderson has failed to show insight or remorse into his actions and has failed to cooperate with any investigation. He was initially reported to the NMC by NHS Lothian's Deputy Nurse Director in September 2022. Saunderson's location of work on the report was listed as East Lothian, having been a practicing adult nurse since 2003. However, his conduct first came into question in 2011 when he failed to accurately count or document Oxynorm when carrying out a controlled drugs check. He also failed to sign the controlled drugs book to account for the opiod. In 2012, after its stop date, Saunderson administered Co-amoxiclav to a patient. Seven years later, in 2019, while demonstrating a vaccination technique Saunderson grabbed a female colleague, pulled her on his lap and pushed her legs apart. Saunderson's then incorrectly administered the meningitis C, PCV, MMR and meningitis B vaccination to a baby instead of the 6 in 1 vaccination - given to protect babies against six serious diseases. Saunderson then failed to notify the baby's parent of the mistake "in a timely manner." Several others incidents occurred while Saunderson worked in the healthcare profession, including giving a nasal flu vaccination to a child without their content and working on various dates as a registered nurse in breach of an interim suspension order. A 12-month suspension order was imposed by the panel on May 24, 2024. Before the original suspension order was confirmed, the panel decided patients were put at risk of physical and emotional harm as a result of Saunderson's misconduct. They wrote: "Given the pattern in Mr Saunderson's behaviour, namely, lacking in attention to detail which led to incorrect vaccinations and the separate matter of inappropriate conduct with a colleague, the panel took the view that patients and or members of the public may be placed at unwarranted risk of harm. "Furthermore, the panel determined that Mr Saunderson's misconduct had breached the fundamental tenets of the nursing profession and therefore brought its reputation into disrepute. Mr Saunderson's actions could undermine the trust of the public by failing to carry out the basic and fundamental nursing duties particularly towards infants and young children and acting in an inappropriate manner towards Witness 3. "The panel has not seen any evidence before it to demonstrate Mr Saunderson's insight. Mr Saunderson has chosen to disengage from his regulator and has not responded to the Charges as they were initially put to him. Therefore, the concerns remain, particularly as the panel are left with limited information to assess Mr Saunderson's current impairment." Due to the seriousness of Saunderson's behaviour, the panel decided a further suspension order would not be appropriate and as he "has and would continue to put patients at risk of harm," he could not remain on the register. The regulator therefore decided it was necessary to prevent Saunderson from practicing in the future and the only sanction which would adequately protect the public and serve public interest was a striking-off order. Join Edinburgh Live's Whatsapp Community here and get the latest news sent straight to your messages. Alison Macdonald, Executive Nurse Director, NHS Lothian said, 'NHS Lothian is committed to protecting the safety and dignity of our patients and staff and any allegations of wrongdoing are taken extremely seriously. 'We expect all our staff to uphold the highest standards of professionalism, integrity and patient care. We do not comment on individual members or former members of staff.'
Boston Globe
18-02-2025
- Health
- Boston Globe
Hospitality at the end of life: Owners open their homes to terminally ill
Related : Advertisement A similar housing infrastructure for those wanting to die on their schedule is developing in Oregon, which lifted its assisted-dying law's residency requirement in July 2023, two months after Vermont. Of the 10 states and the District of Columbia that allow medically assisted dying, they are the only jurisdictions to have done so. Accommodations typically include extra rooms in private residences, and apartments or second homes that people have traditionally listed independently or through Airbnb or Vrbo. Few are like Suzanne's, specially designed for patients and the loved ones by their side when they die. What the properties have in common is that their owners support the death-with-dignity movement, which in 1997 led Oregon to become the first state to legalize medically assisted dying. Oregon's law, which became a template for other jurisdictions, included residency requirements in response to concerns the state would become a death destination, with bodies washing up on its beaches, recalled Peg Sandeen, CEO of the advocacy group Death With Dignity. That hasn't happened, and lawmakers in some states, including New York, are introducing assisted-dying bills without residency requirements. Montana, where a 2009 court ruling made the procedure legal, doesn't have clear-cut residency rules, but people tend not to go there as they do to Vermont and Oregon, according to the advocacy group Compassion and Choices. Advertisement When Vermont lifted its residency requirement, property owners wanting to open their homes to patients seeking medically assisted dying began contacting Patient Choices Vermont, the nonprofit that helped enact the assisted-dying law, known as Act 39. PCV has transitioned into a resource for end-of-life organizations in other states seeking clarity about the law, and everyone from physicians to patients navigating it in the state. The retreat overlooks a mountain range, seen in January. Ian Thomas Jansen-Lonnquist/For The Washington Post PCV's Wayfinders Network, an independent group of hospice nurses, case managers and death doulas, reaches out to doctors, hospices and social workers 'letting folks know we exist, and that people can get support,' said Kasey March, a network member and death doula whose services include companionship, comfort, education and guidance to people at end of life. Terminally ill patients ending their lives prefer the comfort and privacy of a home over a hotel, said March, who keeps a list of four or five accommodations and is always looking for more. She learns about them from friends, acquaintances and fellow Wayfinders. 'You want somewhere that no one is going to knock on your door and ask what's going on and make you feel uncomfortable in some way, shape or form,' she said. Price, availability and location vary. Most people seeking medical aid in dying have mobility challenges and seek accessible accommodations close to urban centers, PCV President Betsy Walkerman said. Cindy, a consultant who lives on the top floor of a two-story duplex in Burlington, Vermont, and whose full name is not being used for privacy reasons, discounts her short-term rental rate for those using the ground floor for Act 39. 'I would not want money to be an issue, so I just make it work,' she said. Advertisement Suzanne works on an offering system — if someone makes a donation, she puts the money back into the property, building the infrastructure for future patients. According to the Vermont Department of Health, as of June, at least 26 people had traveled to the state to die, accounting for nearly 25 percent of the reported assisted deaths there since May 2023. Suzanne hosted three; Cindy, two. Cindy has another scheduled for late January. As with others in their situation, neither lists their space as an assisted-dying destination because they can host only someone who has met strict eligibility criteria, including having less than six months to live. Only a doctor in Vermont can make that determination, and a second consulting doctor has to confirm it. 'The doctors are the ones who are the sentries at the gate,' Suzanne said. 'If you don't have a doctor or meet the eligibility requirements, you can't voluntarily die using Act 39 in Vermont.' Suzanne says she feels this painting symbolizes the mission and purpose of her retreat space. Ian Thomas Jansen-Lonnquist/For The Washington Post As with many states, Vermont has a doctor shortage that can make it hard even for in-state residents to obtain care. Finding a Vermont physician from out of state is even more challenging, as a family that used Suzanne's center last summer discovered. For a month in early summer 2024, the younger daughter, who lives in a western state and asked that her family name not be used for privacy reasons, called at least a dozen palliative care clinics in Vermont and Oregon for her father, 78, who was dying of cancer. The earliest appointment was in September, in Vermont. She wasn't sure her father would live that long, and he'd made it clear he did not want to die in a hospital, surrounded by strangers. Advertisement When she learned that a palliative clinic in Vermont had an opening in August, the family flew there, and the father was approved. The doctor and clinic program director provided Suzanne's contact information and also suggested the family call hotels and Airbnbs and be up front about booking a room. The daughter called Suzanne first. 'I'm so grateful I didn't have to make any of those phone calls saying, 'I need to make a reservation for someone to die here,'' she said. Two weeks later, the family returned to Vermont for the father to die. He and his wife stayed at Suzanne's. Their adult daughters, son-in-law, and granddaughter stayed at a hotel five minutes away. 'Suzanne was very accommodating,' the man's wife said — she gave the family free run of her house adjacent to the center, installed a full-size bed in front of the picture window so the couple could enjoy the view while they rested together, and welcomed the rescue dog the older daughter had brought for emotional support. 'I was able to spend the last night with him,' the man's wife recalled. 'The view was amazing — there's butterflies all over, there's hummingbirds, there's a gazebo on the property. You can see the hills from the big window. We said afterwards, 'It's exactly what he wanted — other than being in his own home.''
Yahoo
18-02-2025
- Health
- Yahoo
Hospitality at the end of life: Owners open their homes to terminally ill
In a pastoral Vermont valley, a former hospice chaplain named Suzanne runs a retreat center for artists, health-care workers and educators - and, since mid-2023, terminally ill people seeking a safe, peaceful place to die. Suzanne, who asked that her last name not be used for privacy reasons, is one of a small but growing number of property owners who have been providing space to people coming to Vermont for physician-assisted dying since the state lifted the residency requirement for a 2013 law allowing terminally ill patients to end their lives on their schedule. Subscribe to The Post Most newsletter for the most important and interesting stories from The Washington Post. 'The thought of someone traveling to Vermont simply because it's a legal state, and not having a home, and dying in a hotel ... it made me cry,' said Suzanne, who was inspired after hearing a radio report about the lawsuit that forced Vermont to lift the requirement. A similar housing infrastructure for those wanting to die on their schedule is developing in Oregon, which lifted its assisted-dying law's residency requirement in July 2023, two months after Vermont. Of the 10 states and the District of Columbia that allow medically assisted dying, they are the only jurisdictions to have done so. Accommodations typically include extra rooms in private residences, and apartments or second homes that people have traditionally listed independently or through Airbnb or Vrbo. Few are like Suzanne's, specially designed for patients and the loved ones by their side when they die. What the properties have in common is that their owners support the death-with-dignity movement, which in 1997 led Oregon to become the first state to legalize medically assisted dying. Oregon's law, which became a template for other jurisdictions, included residency requirements in response to concerns the state would become a death destination, with bodies washing up on its beaches, recalled Peg Sandeen, CEO of the advocacy group Death With Dignity. That hasn't happened, and lawmakers in some states, including New York, are introducing assisted-dying bills without residency requirements. Montana, where a 2009 court ruling made the procedure legal, doesn't have clear-cut residency rules, but people tend not to go there as they do to Vermont and Oregon, according to the advocacy group Compassion and Choices. When Vermont lifted its residency requirement, property owners wanting to open their homes to patients seeking medically assisted dying began contacting Patient Choices Vermont, the nonprofit that helped enact the assisted-dying law, known as Act 39. PCV has transitioned into a resource for end-of-life organizations in other states seeking clarity about the law, and everyone from physicians to patients navigating it in the state. PCV's Wayfinders Network, an independent group of hospice nurses, case managers and death doulas, reaches out to doctors, hospices and social workers 'letting folks know we exist, and that people can get support,' said Kasey March, a network member and death doula whose services include companionship, comfort, education and guidance to people at end of life. Terminally ill patients ending their lives prefer the comfort and privacy of a home over a hotel, said March, who keeps a list of four or five accommodations and is always looking for more. She learns about them from friends, acquaintances and fellow Wayfinders. 'You want somewhere that no one is going to knock on your door and ask what's going on and make you feel uncomfortable in some way, shape or form,' she said. Price, availability and location vary. Most people seeking medical aid in dying have mobility challenges and seek accessible accommodations close to urban centers, PCV President Betsy Walkerman said. Cindy, a consultant who lives on the top floor of a two-story duplex in Burlington, Vermont, and whose full name is not being used for privacy reasons, discounts her short-term rental rate for those using the ground floor for Act 39. 'I would not want money to be an issue, so I just make it work,' she said. Suzanne works on an offering system - if someone makes a donation, she puts the money back into the property, building the infrastructure for future patients. According to the Vermont Department of Health, as of June, at least 26 people had traveled to the state to die, accounting for nearly 25 percent of the reported assisted deaths there since May 2023. Suzanne hosted three; Cindy, two. Cindy has another scheduled for late January. As with others in their situation, neither lists their space as an assisted-dying destination because they can host only someone who has met strict eligibility criteria, including having less than six months to live. Only a doctor in Vermont can make that determination, and a second consulting doctor has to confirm it. 'The doctors are the ones who are the sentries at the gate,' Suzanne said. 'If you don't have a doctor or meet the eligibility requirements, you can't voluntarily die using Act 39 in Vermont.' As with many states, Vermont has a doctor shortage that can make it hard even for in-state residents to obtain care. Finding a Vermont physician from out of state is even more challenging, as a family that used Suzanne's center last summer discovered. For a month in early summer 2024, the younger daughter, who lives in a western state and asked that her family name not be used for privacy reasons, called at least a dozen palliative care clinics in Vermont and Oregon for her father, 78, who was dying of cancer. The earliest appointment was in September, in Vermont. She wasn't sure her father would live that long, and he'd made it clear he did not want to die in a hospital, surrounded by strangers. When she learned that a palliative clinic in Vermont had an opening in August, the family flew there, and the father was approved. The doctor and clinic program director provided Suzanne's contact information and also suggested the family call hotels and Airbnbs and be up front about booking a room. The daughter called Suzanne first. 'I'm so grateful I didn't have to make any of those phone calls saying, 'I need to make a reservation for someone to die here,'' she said. Two weeks later, the family returned to Vermont for the father to die. He and his wife stayed at Suzanne's. Their adult daughters, son-in-law, and granddaughter stayed at a hotel five minutes away. 'Suzanne was very accommodating,' the man's wife said - she gave the family free run of her house adjacent to the center, installed a full-size bed in front of the picture window so the couple could enjoy the view while they rested together, and welcomed the rescue dog the older daughter had brought for emotional support. 'I was able to spend the last night with him,' the man's wife recalled. 'The view was amazing - there's butterflies all over, there's hummingbirds, there's a gazebo on the property. You can see the hills from the big window. We said afterwards, 'It's exactly what he wanted - other than being in his own home.'' 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