Link Newsletter - December 2023
Our December issue features the latest news and updates on pediatric care from Children's Mercy clinicians.
Heavy Menstrual Bleeding: Evidence Based Strategies
Heavy menstrual bleeding (HMB) can be overlooked as a regular part of puberty or menses, but if left untreated can cause significant medical complications such as anemia, fatigue and even reduced quality of life. Initial assessment for HMB, along with appropriate evaluation and long-term management, should be a regular part of every health care provider’s arsenal given the positive impact that care can provide to a patient’s quality of life.
ACIP Approves the First Pentavalent Meningococcal Vaccine: Vaccine Update
On Oct. 25, 2023, after significant review and discussion, the Advisory Committee on Immunization Practices (ACIP) voted to approve the use of Penbraya, the first pentavalent meningococcal vaccine that targets serogroups A, B, C, W and Y, the top serogroups that lead to most cases of invasive meningococcal disease. Pfizer, manufacturer of the new vaccine MenABCWY/ Penbraya, combined MenACWY/ Nimenrix, which has been used in Europe since 2017, with MenB/ Trumenba to develop this new vaccine.1
Congenital Syphilis Cases Are Rapidly Rising: How to Manage Them: Outbreaks, Alerts and Hot Topics
Syphilis rates reached an all-time low in the year 2000 with 5,979 total cases of primary and secondary syphilis reported. Jeffrey Koplan, then director of the Centers for Disease Control and Prevention (CDC), noted that progress was being made in eliminating the infection.1 Since that time the trend in the annual number of reported cases has reversed, at first slowly, and then in the past decade much more rapidly. In 2020 there were 133,954 total case of syphilis and in 2021, the most recent year for which the CDC provides data, there were 176,713 cases. Men who have sex with men (MSM) have long been the most affected group, but cases in women have more than tripled since 2017 (from 3,722 to 11,772). Consequently, cases of congenital syphilis have also been rising dramatically in the past decade: 334 cases were reported in 2012, but 2,157 cases in 2020 and 2,855 cases in 2021.2,3 The increases in case numbers from 2020 to 2021 appear to be related to the COVID-19 pandemic, likely due to a number of associated factors including reduced screening because of altered health department priorities during the pandemic, reduced access to in-person medical care, and changes in sexual behavior.4 Causes for the longer-term increases in cases are likely similarly complex and do not appear to be fully understood.
Can You Keep a Secret?: Bioethics
Keeping a secret can be morally burdening and distressing, because there is unspoken pressure to not discuss “the secret” with the person that it affects the most. Unfortunately, clinicians who provide care for children often encounter situations where parents request to conceal their child’s diagnosis or prognosis from the patient. In the recent October American Academy of Pediatrics (AAP) publication, Taub and Macauley highlight the importance of truth-telling or veracity, the act of providing thorough, accurate and comprehensive information to the patient in pediatric care.1,2 Telling the truth is rooted in the principle of respect for persons, which contends that even people who “cannot legally make their own decisions,”3 such as children, deserve respect. In pediatrics, abiding by the values of veracity is fundamental to foster a trusting relationship between the patient, parents and clinicians. However, deciding to tell the truth can be ethically challenging when there is no certainty that disclosure of the diagnosis or prognosis is in the child’s best interest.4 In the United States, physicians typically do not want to override parents’ medical decisions and choices for their child,5 but parents’ requests to withhold information from the pediatric patient can have difficult repercussions.
Bacterial Conjunctivitis … Does It Always Need Antibiotics?: Wise Use of Antibiotics
Acute infectious conjunctivitis affects 1 in 8 children annually, impacting 6 million people every year in the United States. The illness is estimated to result in over $1 billion in costs annually in the U.S. with $800 million in direct health care cost alone.1 Most cases of conjunctivitis are managed by primary care providers. Although the American Academy of Ophthalmology has guidance recommending avoiding topical antibiotics for most cases of pink eye,2 ophthalmic antibiotics continue to be one of the most commonly prescribed topical antibiotics, with nearly 60% of patients with conjunctivitis filling at least one topical antibiotic prescription.3
We want to hear from you!
Do you have ideas, questions or suggestions for future articles in The Link? Send us a note at thelink@cmh.edu.
Learn More and Subscribe to The Link
Visit the homepage for The Link to:
- Find out more about the content and authors featured in The Link
- Subscribe to receive future issues by email
- Read past articles in the archive