*"It doesn't matter if the cat is black or white as long as it catches
mice."*

Deng Hsaio P'ing 1904-1997

This a page for sharing "what works" as seen in the published literature
as well as what is done at sites that care for American Indian/Alaskan
Native children. If you have any suggestions, comments or questions
please contact Steve Holve, MD, Chief Clinical Consultant in Pediatrics
at sholve@tcimc.ihs.gov

IHS Child Health Notes

August 2004

# Quote of the month

"*If I ever see the word rat or dog in a paper I cross it out"*

Sir Francis Avery Jones

explaining his success as the editor of Gut

**Articles of Interest**

Impact of childhood vaccination on racial disparities in invasive
Streptococcus pneumoniae infections.\
JAMA. 2004 May 12;291(18):2197-203.\
<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=pubmed>

-   The pneumococcal conjugate vaccine (PCV7) was licensed in 2000 and
    has decreased rates of invasive pneumococcal disease (IPD). The
    decline in IPD has been especially dramatic in blacks. In the
    pre-vaccine era black children had rates of IPD 3 times higher than
    the US population.. The rates of IPD for black children now approach
    those of whites.

Notice to Readers: Updated Recommendations for Use of Pneumococcal
Conjugate Vaccine: MMWR, July 9, 2004 53(26):589-90

Effective immediately, CDC ...recommends that providers administer 3
doses of vaccine. The fourth dose should still be deferred for healthy
children until further production and supply data demonstrate that a
4-dose schedule can be sustained. **[Alaska Native children and American
Indian children who live in Alaska, Arizona, or New Mexico, and Navajo
children who live in Colorado and Utah have a risk for invasive
pneumococcal disease more than twice the national average. These
children should receive the standard 4-dose PCV7 series despite the
shortage.]{.underline}**

<http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5326a7.htm>

-   The recurrent shortages of the PCV7 have been troubling to those of
    use caring for AI/AN children because of the perceived higher risk
    of IPD. Recent analysis of hospital discharge data for IPD from the
    Indian Health Service shows that the burden of this disease does not
    fall equally on all AI/AN children. AI/AN children in Alaska and the
    Southwest had hospitalization rates of IPD 3 times the US average.
    Rates in other IHS areas were equivalent to the overall US rates.

-   This change in policy makes the full four dose series of the
    pneumococcal vaccine available to AI/AN children even in times of
    vaccine shortage. Providers in Alaska and the Southwest should
    request increased vaccine to provide four doses of the pneumococcal
    vaccine to their patients. They should provide catch up doses to
    those with \< 4 doses of the pneumococcal vaccine.

-   Additional data show that rates of IPD have declined almost 60% in
    AI/AN children in Alaska and the Southwest but this decline is less
    than that seen in the US as a whole and far less than that seen in
    black children as noted above. The relative incidence of IPD has
    actually increased in AI/AN children since the introduction of the
    PCV7 vaccine in 2000.

-   The reason for the continued disparity in IPD rates in Alaska and
    the Southwest is unclear. There is no evidence that AI/AN children
    respond less well to a two dose vaccine schedule than other
    children. It is known that Alaskan and Southwest AI/AN have earlier
    nasopharyngeal carriage and higher colonization rates. Four doses of
    PCV7 may provide more lasting protection decreased colonization and
    better her immunity.

**Recent literature on American Indian/Alaskan Native Health**

Validity of self-reported dietary intake at school meals by American
Indian children: the Pathways Study. J Am Diet Assoc. 2004
May;104(5):746-52\
<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15127059>

# You may not like the answers you get when you ask your patients what they eat but this study suggests that their answers are valid.

# 

# Meetings of Interest for Child Health

April 29-May 1, 2005\
Seattle, WA

Join the American Academy of Pediatrics and the Canadian Paediatric
Society, in cooperation with the Indian Health Service, for the first
International Meeting on Inuit and Native American Child Health.
Pediatricians, family physicians, residents, other health care
professionals, clinical researchers, state and federal public health
employees, child advocates, and other professionals and family
representatives dedicated to working with First Nations, Inuit, and
American Indian/Alaska Native (AI/AN) children should attend.
Participants will have the opportunity to share ideas on culturally
effective health care delivery models, present research findings, and
dialogue about strategies to improve the health of First Nations, Inuit,
and AI/AN children and communities.

<http://www.aap.org/nach/InternationalMeeting.htm>

This is the first international meeting on Indian/Inuit health with
sponsorship by both countries pediatric societies. It should be an
excellent forum for education and sharing of ideas.