*"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

September 2004

# Quote of the month

"*Progress might have been all right once, but it has gone on too
long."*

Ogden Nash

**Articles of Interest**

Prevention and Control of Influenza: Recommendations of the Advisory
Committee on Immunization Practices (ACIP)

MMWR April 30, 2004

<http://www.cdc.gov/mmwr/preview/mmwrhtml/rr53e430a1.htm>

Recommendations for Influenza Immunization of Children: Committee on
Infectious Diseases, AAP

PEDIATRICS Vol. 113 No. 5 May 2004, pp. 1441-1447\
<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=15121970&dopt=Abstract>

-   Recognition that hospitalization and complications from influenza in
    children \< 2 years are as high as the elderly \> 65 years

-   New recommendation that all healthy children aged 6 -- 23 months and
    their household contacts receive the influenza vaccination this fall

-   The influenza vaccine should be offered to all children 6 months and
    older who have chronic cardiopulmonary conditions such as asthma.

-   The influenza vaccine may be offered to any healthy child \> 6
    months of age whose parents desire vaccine protection

# Editorial Comment

The new recommendation for flu vaccination promises significant benefits
to our patients while posing logistical challenges to our practices. We
need to deliver flu vaccine to many children in a short window between
late October and early January. Maximal success may be achieved by
adopting some of the following:

-   Mail reminder postcards to all children 6 -- 23 months and high risk
    children

-   Give the flu vaccine at well child visits

-   Schedule specific times with a dedicated nurse to provide flu
    vaccinations

It is also important to remember that children \< 36 months of age need
only 0.25 ml per dose and children \> 36 months need 0.5 ml per dose.
The first year a child \< 9 years is vaccinated they also need 2 doses
of vaccine 1 month apart for adequate protection. The trivalent
influenza vaccine is available with trace amounts of thimerasol marketed
as *Fluzone.* The live attenuated influenza vaccine *Flumist,* is
licensed only for patients \> 5 years and \< 49 years and is far more
expensive. The trivalent influenza vaccine is available via the Vaccines
for Children Program and is the preferred choice for children.

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

Hepatitis A incidence and hepatitis A vaccination among American Indians
and Alaska Natives, 1990-2001. Am J Public Health. 2004
Jun;94(6):996-1001.\
<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15249305>

# Say it again; "Vaccines really work". Native Americans had some of the highest rates of vaccination for hepatitis A and the most dramatic decline in disease rates. The risk of hepatitis A for Native Americans is not genetic but environmental. All AI/AN children who live on, or visit, reservation communities should be vaccinated against hepatitis A. 

Asthma Prevalence and Control Characteristics by Race/Ethnicity \-\--
United States, 2002 MMWR February 27, 2004

# 

-   AI/AN had a prevalence rate of asthma of 11% giving them the second
    highest rate of any ethnic group in the US. These rates were for
    adults, and not children but suggest an area in which we need to pay
    attention.

# 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.