Brandon Salke, PharmD, is the general manager and pharmacist in charge at Optime Care, in Bridgeton, Missouri.

Brandon Salke, PharmD

Following the removal of restrictions on mifepristone—a pill to induce abortions—in Canada, abortions remained safe in the country, according to a study published in the 

. The study examined government health data on 315,000 abortions in Ontario between 2012 and 2020, finding no increase in abortion-related health complications following the removal of restrictions on mifepristone.

"Complications were already very rare, and we found that abortion continued to be safe and effective when mifepristone was prescribed without restrictions," said Laura Schummers, ScD, the study's lead author and a postdoctoral fellow in UBC's department of family practice, in a press release. “This is the strongest evidence yet that it is safe to provide the abortion pill like most other prescriptions—meaning any doctor or nurse practitioner can prescribe, any pharmacist can dispense, and patients can take the pills if, when and where they choose.”

The original restrictions, first put into place when the drug was approved in 2015, required that physicians observe patients taking the medication. Further, the drug could only be dispensed by specially trained physicians who registered with the manufacturer, and not pharmacists. Many of these restrictions remain in place throughout the world, including the United States.

“Our study is a signal to other countries that restrictions are not necessary to ensure patient safety,” said Wendy Norman, MD, CCFP, FCFP, DTM&H, MHSc, professor in UBC's department of family practice, in a press release. “There is no scientific justification for mifepristone restrictions, which only make it harder for people to access the care they need. Canada's experience offers a roadmap for other countries on how to safely improve access to family planning services.”

Following the availability of mifepristone, the percentage of abortions performed medically as opposed to surgically rose from 2.2% to 31.4% over 2 years after the drug became available as a normal prescription. During this same time period, the overall abortion rate continued to decline after restrictions were removed, decreasing from 11.9 to 11.3 abortions per 1000 female residents aged 15-49 years.

"We saw that patients and their health care providers rapidly began choosing medical abortion, which can sometimes be preferred over surgical methods by offering care closer to home and earlier in pregnancy," said Sheila Dunn, MD, MSC, CCFP (EM), FCFP, scientist and family physician at Women's College Hospital in Toronto, in a press release. "As other studies have shown, making abortion more accessible does not increase the number of people seeking abortion. We found that abortion rates continued to decrease after mifepristone's availability as a normal prescription."

Prescribing the abortion pill without restrictions is safe and effective, study finds [news release]. Science Daily; December 8, 2021. Accessed December 14, 2021. 

https://www.sciencedaily.com/releases/2021/12/211208182541.htm

The study examined government health data on 315,000 abortions in Ontario between 2012 and 2020, finding no increase in abortion-related health complications following the removal of restrictions on mifepristone.

Study: Abortions Remain Safe Following Lifted Restrictions on Mifepristone

Skylar Kenney, Assistant Editor

Estimates show sexual assault occurs every 68 seconds in the United States. In the past 10 years, there have been 15 times more sexual assault-related emergency department (ED) visits, according to the authors of a study published in 

This number is believed to outpace reports of sexual assault by law enforcement.

The number of adults (aged 18 to 65 years), who visited the ED for sexual assault increased by 51,689 between the years of 2006 and 2019.

"Sexual assault is a disturbing and prevalent trend in the U.S.,” said senior study author Erica Marsh, MD, chief of the division of reproductive endocrinology and infertility at the Center for Reproductive Medicine at the University of Michigan. “We know that people who experience sexual assault face numerous emergent health problems, but few seek emergency medical care."

The FBI reports that sexual assault (and rape) rose from 93,000 to 139,815 between 2006 and 2019. Victims are more prone to depression, suicidal thoughts, posttraumatic stress disorder, substance use, and chronic conditions than individuals who have not been assaulted.

The data shows that older people aged 46 to 65 years were more likely to be admitted to the hospital than younger people aged 18 to 25 years. Disproportionately, younger women with lower incomes sought ED help after assault.

Data suggests that 1 in 5 sexual assault survivors seek medical care, but care is often inadequate or incomplete. Additionally, few studies have looked at how individuals seek care after a sexual assault—that is what this study aimed to address.

Based on the study results, the investigators found that the number of individuals who sought ED care increased to 55,296 people in 2019—where social de-stigmatization of sexual assault during the #metoo movement of that year could be a contributing factor. The investigators noted that other factors may include how it is coded by emergency providers and a general increase in sexual assaults in the country, Marsh explained.

From 2006 to 2019, less than 1% of ED cases were classified as sexual assault.

"Although sexual assault comprises a small proportion of total emergency room visits, the magnitude of increase suggest that certain factors may be encouraging people who experience sexual assault to seek emergency care," Marsh said in the press release.

Furthermore, low-income, or government-insured, patients were found to be disproportionally admitted to the hospital. However, the disparity between visits and hospital charges related to sexual assault is stark—as of 2019, sexual assault-related costs were $233 million.

But hospital admission rates decreased in this time. Between the 13-year study period, sexual assault hospital admissions decreased by 8%, which may be due to lower-acuity cases. Also, patients chose to avoid the hospital for confidentiality purposes—or because there was less availability at the hospital.

The CDC suggest that more than 50% of women are affected by sexual assault, and more than 33% of men could be affected in their lifetimes.

"Tracking these trends will help inform policies and potential strategies for better supporting these individuals and for reaching others who may be less likely to seek emergency medical care for various reasons,” study authors wrote.

University of Michigan. Sexual assault-related ER visits increase more than tenfold. Science Daily. October 20, 2022. Accessed on October 25, 2022. https://www.sciencedaily.com/releases/2022/10/221020112820.htm

Data show that an increase in sexual assault-related emergency department visits in 2019 may be due to social de-stigmatization of sexual assault during the #metoo movement of that year.

De-Stigmatization of Sexual Assault May Contribute to Related Increase in Emergency Department Visits

Erin Hunter, Assistant Editor

Study authors of a recent study published in 

 explained that they observed significant new onset morbidity in children, adolescents, and adults across 13 prespecified diagnosis/symptom complexes following COVID-19 infection. Although long-term health issues from COVID-19 are a major public health concern, evidence on post-acute COVID-19 syndrome, or post-COVID-19, is still limited, specifically among children and adolescents.

During the study, the researchers used comprehensive health care data on approximately 46% of the German population and analyzed post-COVID-19-associated morbidity among 2 groups—children/adolescents and adults. The study authors noted that routine data from German statutory health insurance organizations covering the period between January 1, 2019 and December 31, 2020 were used for their analysis, with the base population including all individuals insured for at least 1 day in 2020. The team then identified individuals with polymerase chain reaction (PCR)-confirmed COVID-19 through June 30, 2020.

The researchers then assigned a control cohort using 1:5 exact matching on age and sex, and propensity score matching on preexisting medical conditions. Further, the date of COVID-19 diagnosis was used as index date for both cohorts, which were followed for incident morbidity outcomes documented in the second quarter after index date or later.

In all, 96 prespecified outcomes were aggregated into 13 diagnosis/symptom complexes and 3 domains (physical, mental, and physical/mental overlap). The researchers then used Poisson regression to estimate incidence rate ratios with 95% confidence intervals.

The population of participants included 11,950 children/adolescents between age 0 and 11 years and 145,184 adults between age 18 and 49 years. The mean follow-up time was 236 days in children/adolescents and 254 days in adults, and the COVID-19 and control cohorts were well balanced regarding covariates.

In at least 1/100 person-years in the COVID-19 cohort in children and adolescents, the specific outcomes with the highest incidence rate ratios (IRR) and an incidence rate (IRs) were malaise/fatigue/exhaustion, cough, and throat/chest pain.

In adults, this included disturbances of smell and taste, fever, and dyspnea. For health outcomes combined, IRs per 1000 person-years in the COVID-19 cohort were significantly higher than those in the control in both children/adolescents and adults. The magnitude of increased documented morbidity was similar for the physical, mental, and physical/mental overlap domain.

In the COVID-19 cohort, IRs were higher in all 13 diagnosis/symptom complexes in adults and in 10 diagnosis/symptom complexes in children/adolescents. The IRR estimates were similar for age groups 0 to 11 and 12 to 17, and IRs in children/adolescents were consistently lower than those in adults.

Additionally, the study authors noted that there were study limitations, such as potentially unmeasured confounding and detection bias. However, the study authors also explained that these findings expand the existing available evidence on post-COVID-19 conditions in younger age groups and confirm previous findings in adults.

Roessler M, Tesch F, Batram M, et al. Post-COVID-19-associated morbidity in children, adolescents, and adults: A matched cohort study including more than 157,000 individuals with COVID-19 in Germany. PLOS Medicine. November 10, 2022. Accessed November 18, 2022. 

https://doi.org/10.1371/journal.pmed.1004122

Although long-term health issues from COVID-19 are a major public health concern, evidence on post-COVID-19 symptoms are still limited, specifically among children and adolescents. 

Data Analysis Shows Significant New Onset Morbidity Post-COVID-19 in Children, Adolescents, Adults

Jill Murphy, Associate Editor

When children get a sense of comfort from spending time with a parent or a caregiver, their experiencing a type of attachment termed a “secure attachment” with that individual. This secure attachment with a parental figure has been shown to play a significant part in socio-emotional development and mental health during an individual’s youth.

On the other end of the spectrum, a child’s insecure attachment with a parent or caregiver has been found to be associated with depression and anxiety, delinquency and substance use problems, and poorer social competence.

"When mothers struggle in their own interpersonal relationships, the passing on of secure attachment and healthy relationship functioning to adolescent offspring seem to be impeded," said Carla Sharp, PhD, professor of psychology and director of the University of Houston Developmental Psychopathology Lab, in the journal 

Borderline Personality Disorder and Emotion Dysregulation

. "Maternal interpersonal problems were associated with higher levels of insecure attachment in adolescent offspring such that adolescents would either dismiss the need for attachment with their moms or show angry preoccupation with the relationship with their moms."

Although there has been an accumulation of data showing the presence of an association between a mothers' mental health issues and their child’s maladaptive attachment in close or romantic relationships in adulthood, the study published in 

 is the first to investigate adolescent relationships and their association with offspring attachment.

The study authors noted that after infancy and early childhood, the parent-child attachment during adolescence is considered to be the second most critical developmental window. Due to the importance of this period, the investigators wanted to assess this period in an individual’s development further to shed light on the impact of the parent-child attachment in adolescence to inform potential interventions that may prevent or reduce youth psychopathology and other adverse outcomes.

During the study, the investigators interviewed 351 adolescents who were inpatient at a psychiatric program or facility and those adolescents’ biological mothers. The adolescents interviewed had an average age of 15 years and 64% of them were female.

During the interviews, the adolescent participants were asked about distressing interpersonal behaviors that they find "hard to do," such as feeling close to other people, or behaviors that they "do too much," such as trying to please other people. Following the interviews, the participants were then assessed on their ability to describe their attachment experiences in a manner that was coherent and collaborative, as well as to reflect on these attachment experiences and how they have impacted the participants personally.

Additionally, the investigators interviewed the biological mothers of the adolescents and asked them to recall experiences from their relationships with their mothers. During these interviews, the investigators looked at whether the relationship dynamic that the mothers recalled having with their mothers helped to explain their present relationship with their children. The results showed a strong correlation between the two.

"The way that parents recalled their experiences with their caregivers is likely impacted by their own interpersonal functioning and may impact the relationship that they build with their children," first study author Sophie Kerr, a graduate student working with Sharp at the University of Houston Developmental Psychopathology Lab, said in a press release.

The authors further noted that these study results will help to drive research to examine the mechanisms of intergenerational risk to tailor interventions that can help to improve parent-child relationships and attachment.

"Findings highlight the mediating role of the mothers' recalled experiences with caregivers in the impact of their interpersonal problems on adolescents, suggesting interventions that enhance interpersonal function such as mentalization-based interventions may be helpful for mothers with interpersonal problems and personality pathology," said Sharp in the press release.

Moms' problems linked to adolescent attachment issues. Houston, TX: University of Houston; August 9, 2022. Accessed August 15, 2022. https://www.sciencedaily.com/releases/2022/08/220809141259.htm

Research found a strong correlation between a mother’s dynamic with their mother and whether or not their child is able to form secure attachments with others in adolescence.

Maternal Personality Disorder Symptoms May Lead to a Child’s Insecure Attachment in Adolescence

Alana Hippensteele, Managing Editor

Cerebral palsy (CP) is defined as a group of disorders that affect an individual’s motor function, including a movement, muscle tone and posture.

CP is caused by abnormal brain development or damage to the developing brain in early years. This can occur prenatally or during birth, known as congenital CP, or during the first few years of a child’s life as the brain is growing, known as acquired CP.

 There are 4 major types of CP: ataxic CP, dyskinetic CP (includes athetoid, choreoathetoid, and dystonic), mixed CP (includes spastic-dyskinetic), and spastic CP (includes spastic diplegia, spastic hemiplegia, and spastic quadriplegia).

 Classification is based on the clinical features of motor abnormalities.

Patients with CP can have many comorbid conditions. Epilepsy occurs in 25% to 45% of these patients.

 The brain damage that causes CP typically occurs in 1 part of the brain, so these patients are most susceptible to developing a focal epilepsy. Most patients with CP begin having seizures before aged 2 years.

 Focal seizures start in one part of the brain and either stay in that part or spread to other parts of the brain or the whole brain. The commonly used medication choices for patients with focal-onset epilepsy include: brivaracetam (Briviact), carbamazepine (Tegretol), cenobamate (Xcopri), eslicarbazepine (Aptiom), lacosamide (Vimpat), lamotrigine (Lamictal), oxcarbazepine (Trileptal), topiramate (Topamax), and zonisamide (Zonegran).

 Many children with severe CP can have multiple seizure types. For patients with generalized seizures, which affect both sides of the brain, the following medications may be considered: cannabidiol (Epidiolex), clobazam (Onfi), levetiracetam (Keppra), rufinamide (Banzel), and valproic acid (Depakote).

 Adverse effects profile, age of patient, comorbidities, formulation, and insurance coverage are all factors when choosing an anti-seizure medication. Other treatment options that may help in reducing seizure burden include the ketogenic or modified Atkins diets.

When a patient with CP continues to have seizures, despite having tried 2 anti-seizure medications, they should quickly be referred to an epileptologist, who is a neurologist with specific training in epilepsy. Epileptologists often work at hospitals with a comprehensive epilepsy program where patients whose seizures are intractable to medications can be evaluated for potential epilepsy surgery. Several pre-surgical tests can help localize where in the brain the seizures are starting. If all the seizures are starting in the same area, a resective surgery, where the epileptogenic tissue is ablated or removed, can be a good option to help decrease the seizure burden or in some cases provide the patient with seizure freedom. Depending on the seizure types and extent of early brain damage, other surgical options include a corpus callosotomy (cutting a band of fibers so that the nerves cannot send signals between the 2 halves of the brain) or functional hemispherectomy (disconnecting the damaged and seizure-causing part of the brain from the normal hemisphere). When the seizure onset zone cannot be determined, implanting a vagus nerve stimulation device under the skin in the chest can decrease the frequency and intensity of seizures.

Children with CP can have many medical problems throughout their lives that are often complicated for caregivers and health care professionals to manage. For the common comorbidity of epilepsy, it is important to recognize and diagnose seizures as early as possible. All medication and surgical options should be considered for these patients to provide them with the best chance of seizure freedom and thus improvement in quality of life.

Sula Gillespie, MSN, PNP; Jennifer Glenn, MSN, PNP; and Mallory Murphy, MSN, PNP are nurse practitioners at Children’s of Alabama Epilepsy Monitoring Unit in Birmingham, Alabama.

1. Glader L, Barkoudah E. Cerebral palsy: clinical features and classification. 

. Updated September 21, 2021. Accessed November 2, 2021. https://www.uptodate.com/contents/cerebral-palsy-clinical-features-and-classification

2. What is cerebral palsy. CDC. Updated September 2, 2021. Accessed November 2, 2021. 

3. Pavone P, Gulizia C, Le Pira A, et al. Cerebral palsy and epilepsy in children: clinical perspectives on a common comorbidity. 

4. Epilepsy. Epilepsy Foundation. Accessed November 2, 2021. https://www.epilepsy.com/

For the common comorbidity of epilepsy, it is important to recognize and diagnose seizures as early as possible.

Help Pediatric Patients With Cerebral Palsy

Mallory Murphy, MSN, PNP 

Starting that fateful week in March 2020 when everyone’s life changed, health care settings closed their doors en masse.

From primary care to ambulatory surgery, physical therapy to massage therapy, nearly every setting of care suspended operations, except for emergency departments connected to hospitals and pharmacies. Yes, pharmacies. More than 60,000 remained open to patients, and most pharmacists continued their role as a source for OTC products and the free-of-charge counseling that often goes with them.

Telemedicine grew at an unprecedented rate starting in April 2020, but it did not entirely fill the health care void. Individuals needing acute medications, dose adjustments, or treatment for chronic diseases lost direct access to practitioners, but pharmacies remaining open meant patients could still receive their lifesaving medications. Of course, foot traffic slowed, and the flu was practically nonexistent in 2020, but hundreds of millions of Americans had access to basic triage, care delivery, medications, and testing supplies.

More than 80% of adults use OTC products as first-line treatment for common ailments. With Americans making approximately 3 billion trips to purchase OTC products annually and 60 million Americans using them who would otherwise not seek treatment, patient access to these products is essential to a well-functioning health care system. It is inconceivable these days to schedule an office visit, procure a prescription, and have it adjudicated by insurance just to get ibuprofen for an ankle sprain. A prescription for loratadine? Laughable. Yet less than 2 decades ago, nonsedating antihistamines were deemed too unsafe to be sold over the counter.

Making products available without a prescription does not have to mean patients go without care. Pharmacists and other health care professionals can counsel patients on all types of accessible and affordable OTC products. Does an Apple Watch’s electrocardiograph or pulse oximetry app keep patients from seeing their cardiologists? Do pregnancy tests keep women from visiting their gynecologists? Do wetting drops prevent patients from going to their ophthalmologists?

Do niacin or omega oils keep patients from getting their cholesterol checked? The answer to all these questions is no. Pharmacists have multiple encounters with patients every day, and most are just as meaningful to a patient’s care as billable encounters.

Expanding Access Through OTCs and Testing

COVID-19 self-administered testing is approved and available. Health plans have picked up on the power of patient convenience. Waning resistance against self-empowerment, which the pandemic necessitated, has enlisted a host of home-based diagnostics providing accessible and affordable screening and rescreening directly to health plan members—without a prescription. Need to improve A1c testing and reporting? Why not look to pharmacies or even send the tests directly to patients’ residences?

Postpandemic Self-Care and OTC Product Use

We are only a summer away from what will likely be the first widely prevalent cough and cold season of asthma flare ups, influenza, middle-ear infections, and rhinovirus in nearly 2 years. As social distancing and masking disappear, we will again share microbes. Disease surveillance and patient care will still have a prime spot in the consciousness of the frontline pharmacist’s mind in all seasons. Education, triage, testing, and counseling have a greater meaning and purpose than ever before, and much of this purpose is enabled by access to OTC products.

Click here to view the OTC products that pharmacists recommend the most to their patients

is vice president of pharmacy provider partnerships for Community Care of North Carolina, which works collaboratively with more than 2000 medical practices to serve more than 1.6 million Medicaid, Medicare, commercially insured, and uninsured patients. He received his PharmD and MBA degrees from Drake University and a PhD in pharmaceutical outcomes and policy from the University of North Carolina. He also serves on the board of directors of the American Pharmacists Association Foundation and the Pharmacy Quality Alliance.

OTC use statistics. Consumer Healthcare Products Association. Accessed May 24, 2021. https://www.chpa.org/about-consumer-healthcare/research-data/otc-use-statistics.

COVID-19 permanently changed how pharmacists recommend and sell nonprescription options.

OTC Products Are Accessible When Traditional Health Care Delivery Is Not

Troy Trygstad, PharmD, PhD, MBA

Mary Koslap-Petraco, DNP, PPCNP-BC, CPNP, FAANP, is a clinical assistant professor at Stony Brook University School of Nursing in New York.

The pandemic has changed life as we knew it, but COVID-19 vaccines are changing lives again, this time for the better.

Grandparents are once again able to hug their grandchildren, but those same grandchildren are still at risk for COVID-19 until we can get all of them who are medically able vaccinated. At press time, children accounted for the largest number of new cases of COVID-19, because most are still not vaccinated (AAP, 2021, April).1 Hospitalization rates for children with COVID-19 have also risen, and serious cases are being seen (AAP, 2021, June).2 From March 1, 2020, through April 30, 2021, approximately 1.5 million COVID-19 cases in individuals aged 11 to 17 years had been reported to the CDC (USFDA, 2021, May 10).3

Most children will return to classrooms for school in the fall, if they have not done so already (Parents, 2021, March).4 Although handwashing, masks, and social distancing are essential public health measures and have slowed the pandemic, the best and most long-lasting way to protect children is to vaccinate them. The number of COVID-19 cases among individuals aged 50 years and older has dropped dramatically. A large segment of this population is fully vaccinated (CDC, 2021, June 13).5 There is also a serious public health threat from other vaccine-preventable diseases, such as measles and pertussis, as the rates of routine immunizations took a precipitous drop during the pandemic (Santoli, et al. 2020).6 The CDC is recommending that children receive all regularly scheduled vaccines, along with the COVID-19 vaccine (CDC, 2021 April 6).7

The Pfizer-BioNTech COVID-19 vaccine, which is an mRNA vaccine, recently received FDA approval for adolescents aged 12 through 15 years (USFDA, 2021, May 10).3 This vaccine is administered intramuscularly as a series of 2 doses (0.3 mL each) 3 weeks apart. The most common adverse effects are chills, fever, headache, joint and muscle pain, pain and redness at the injection site, and tiredness. Aside from pain at the injection site, more adolescents reported these adverse effects after the second dose than after the first dose, so it is important to advise adolescents and parents to expect that there may be some adverse effects after either dose but even more so after the second. The adverse effects in adolescents were consistent with those reported in clinical trial participants aged 16 years and older (USFDA, 2021, May 10).3

Pfizer also said that it plans to request authorization for BioNTech COVID vaccine use in children aged 2 through 11 years in September 2021 and for children younger than aged 2 years later in 2021 (Jenco, 2021, May 6).8

Recently, there have been reports of myocarditis and pericarditis following mRNA vaccines. These events occurred mostly in male adolescents and young adults aged 16 years and older. Myocarditis and pericarditis are seen more often after getting the second dose of either Moderna or Pfizer COVID-19 vaccines than after the first dose. The symptoms typically occur within 4 days after COVID-19 vaccination. As of press time, there have been 275 cases of either myocarditis or pericarditis of more than 600,000 doses administered to adolescents and children in the United States since Pfizer received its emergency use authorization on May 10, 2021 (CDC, 2021, May 18).9 Most patients who received care responded well to rest and treatment and quickly recovered. Patients can usually return to normal daily activities after their symptoms improve, and they should speak with health care providers about returning to exercise or sports. The CDC continues to monitor the situation and recommends COVID-19 vaccinations for everyone aged 12 years and older, given the greater risk of COVID-19 illness and related, possibly severe complications (CDC, 2021, May 27).10 Getting vaccinated is the best way to help protect individuals aged 12 years and older from COVID-19 illness and potential complications.

Another COVID-19 vaccine for adolescents is also moving toward approval. Moderna reported that its COVID-19 vaccine is 96% effective for adolescents aged 12 through 17 years after at least 1 dose and has no serious safety concerns (Jenco, 2021, May 6).8 The report did not provide additional details on a projected timeline for requesting FDA approval. Moderna is also continuing to study its vaccine in children aged 6 months to 11 years (Jenco, 2021, May 6).8

COVID-19 vaccines are becoming a reality for children. With the vaccines comes the return to birthday parties, in-classroom school, play dates, and sleepovers. But the COVID vaccine is not the only one children need. Routine vaccination is an essential preventive care service for adolescents, children, and adults, including pregnant women, that should not be delayed because of the COVID-19 pandemic. Parents have not been bringing their children into the offices of health care providers for well-child visits and vaccines. It is essential to assess the vaccination status of all adolescents and children at each patient visit to avoid missed opportunities for vaccination and ensure timely vaccine catch-up. All vaccines due or overdue should be administered according to the recommended CDC immunization schedules during each visit unless there is a specific contraindication. This will provide protection as soon as possible and minimize the number of health care visits needed to complete vaccination. Health care providers should identify children who have missed recommended vaccinations and/or well-child visits. Contact parents to schedule in-person appointments, starting with newborns, infants, and children up to aged 2 years, young children, and extending through adolescence. COVID-19 is still circulating, and cases among children can often be asymptomatic. Consequently, the importance of evidence-based infection prevention practices cannot be overemphasized for all patient encounters. These measures include hand and respiratory hygiene, physical distancing, source control, and surface decontamination (CDC, 2021, April 6).7

Because vaccine administration has decreased during the COVID-19 pandemic, under vaccinated or unvaccinated children are susceptible to preventable illness, such as measles, and communities are at risk for outbreaks. Strategies should be implemented to promote vaccination schedule adherence and ensure catch-up vaccination. Reminder and recall systems should be implemented to identify children who are due for or who have missed vaccine doses. Electronic health records and immunization information systems can be essential to tracking delinquent vaccine doses. In addition, the vaccination status of all children should be assessed at every health care visit to reduce missed opportunities for vaccination, including COVID-19 vaccination, and standing orders should be implemented (CDC, 2021, April 6).7

Health care providers who care for children must ensure that children receive not just COVID-19 vaccines but all age-appropriate vaccines that are due and catch up on any missed doses. It would be a travesty if children headed back to school without the vaccine-induced protection they need to stay healthy. Without all Advisory Committee on Immunization Practices (ACIP)-indicated vaccines, children could be headed back to school and out of the COVID-19 pandemic into a measles or pertussis epidemic.

1. Children and COVID-19: state data report. American Academy of Pediatrics. April 29, 2021. Accessed June 17, 2021. 

https://downloads.aap.org/AAP/PDF/AAP%20and%20CHA%20-%20Children%20and%20COVID-19%20State%20Data%20Report%204.29.21%20FINAL.pdf

2. Children and COVID-19: state data report. American Academy of Pediatrics. June 3, 2021. Accessed June 17, 2021. 

https://downloads.aap.org/AAP/PDF/AAP%20and%20CHA%20-%20Children%20and%20COVID-19%20State%20Data%20Report%206.3.21%20FINAL.pdf

3. United Stated Food and Drug Administration. (2021, May 10). Coronavirus (COVID-19) Update: FDA Authorizes Pfizer-BioNTech COVID-19 Vaccine for Emergency Use in Adolescents in Another Important Action in Fight Against Pandemic. Retrieved from 

https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-pfizer-biontech-covid-19-vaccine-emergency-use

4. Harris N. Will kids go back to school in the fall? Here’s what experts think and what it may look like. 

https://www.parents.com/kids/education/back-to-school/will-kids-go-back-to-school-in-the-fall-heres-what-experts-think-and-what-it-may-look-like/

5. Demographic characteristics of people receiving COVID-19 vaccinations in the United States. CDC. June 16, 2021. Accessed June 17, 2021. 

https://covid.cdc.gov/covid-data-tracker/#vaccination-demographic

6. Santoli JM, Lindley MC, DeSilva MB, et al. Effects of the COVID-19 pandemic on routine pediatric vaccine ordering and administration — United States, 2020. 

 2020;69(19):591-593. doi:10.15585/mmwr.mm6919e2

7. Interim guidance for routine and influenza immunization services during the COVID-19 pandemic. CDC. April 6, 2021. Accessed June 17, 2021. 

https://www.cdc.gov/vaccines/pandemic-guidance/index.html

8. Jenco M. Moderna reports COVID-19 vaccine for teens safe, effective. 

https://www.aappublications.org/news/2021/05/06/moderna-covid-vaccine-teens-050621

9. Mendez R. CDC says 600,000 kids ages 12 to 15 have received Covid vaccine shots in last week. CDC. May 18, 2021. Accessed June 17, 2021. 

https://www.cnbc.com/2021/05/18/cdc-says-600000-kids-aged-12-to-15-have-received-covid-shots-in-last-week-.html

10. Myocarditis and pericarditis following mRNA COVID-19 vaccination. CDC. May 27, 2021. Accessed June 17, 2021. 

https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/myocarditis.html

Practitioners can help ensure that kids get these and all age-appropriate vaccinations before school starts in the fall.

COVID Vaccines for Children Are Becoming a Reality

Mary Koslap-Petraco, DNP, PPCNP-BC, CPNP, FAANP

Children and young adults with Down syndrome are 4 times more likely to be diagnosed with diabetes, according to the findings of a study published in 

The study, by Queen Mary University of London and King’s College London, examined just under 10,000 individuals with Down syndrome and almost 40,000 individuals without. Data from the UK Clinical Practice Research Datalink, from 1990 to 2020, were used.

This is the first time that investigators examined the incidence of diabetes and obesity in Down syndrome across one of the disorder’s biggest cohorts.

“This is the largest study ever conducted in Down syndrome patients to show that they have unique needs with regards to diabetes and obesity, and that screening and intervention, including a healthy diet and physical activity, at younger ages is required compared to the general population,” Andre Strydom, MRCPsych, MSc, PhD, professor in intellectual disabilities at King’s College London, said in a statement. “The results will help to inform the work of NHSE's LeDeR program to reduce inequalities and premature mortality in people with Down syndrome and learning disabilities.”

Investigators found that children aged 5 to 14 years with Down dyndrome have about a 10 times greater chance of having type 2 diabetes (T2D) than children without. They think, based on the results, that children with Down syndrome must be more closely monitored for early signs of diabetes, excess weight, and obesity.

Investigators emphasize that identifying diabetes as early as possible helps individuals with the complications that diabetes can bring later in life.

Despite the findings, investigators found that individuals with Down syndrome were typically diagnosed with diabetes much earlier. The average age of diagnosis of diabetes for an individual with Down syndrome was aged 38 years compared to with aged 53 years for those without the genetic disorder.

Excess body weight and genetics could be the reason behind the increased risk, investigators said.

Individuals with Down syndrome were found to have a higher body mass index and reach its peak at an earlier age, which increases the risk of T2D at a younger age.

Additionally, investigators found that there was also an increased risk of T1D, because of extra chromosomes and issues with the immune system for those with Down syndrome.

“This study highlights the importance of early screening for diabetes and weight issues in [individuals] with Down syndrome, especially children and young adults,” Li Chan, PhD, reader in Molecular Endocrinology and Metabolism and Consultant Pediatric Endocrinologist at Queen Mary University of London, said in the statement.

“Currently there is a sizeable gap in research into the condition, which affects around 40,000 people in the [United Kingdom],” Chan said. “To help plug this gap in knowledge, we are conducting further research into how genetics affects a[n individual] with Down syndrome’s predisposition to diabetes and obesity and hope to shed further light on this important medical issue."

Children and young adults with Down syndrome four times more likely to have diabetes. News release. Science Daily. October 4, 2022. Accessed October 17, 2022. https://www.sciencedaily.com/releases/2022/10/221004104957.htm

Investigators find that individuals aged 5 to 14 years with the genetic disorder are also at greater risk for TD2.

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