Pediatrics
February 2016, VOLUME 137 / ISSUE 2
http://pediatrics.aappublications.org/content/137/2?current-issue=y

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Articles
Primary Care Physicians’ Perspectives About HPV Vaccine
Mandy A. Allison, Laura P. Hurley, Lauri Markowitz, Lori A. Crane, Michaela Brtnikova, Brenda L. Beaty, Megan Snow, Janine Cory, Shannon Stokley, Jill Roark, Allison Kempe
Pediatrics Feb 2016, 137 (2) 1-9; DOI: 10.1542/peds.2015-2488
Abstract
BACKGROUND AND OBJECTIVES: Because physicians’ practices could be modified to reduce missed opportunities for human papillomavirus (HPV) vaccination, our goal was to: (1) describe self-reported practices regarding recommending the HPV vaccine; (2) estimate the frequency of parental deferral of HPV vaccination; and (3)identify characteristics associated with not discussing it.
METHODS: A national survey among pediatricians and family physicians (FP) was conducted between October 2013 and January 2014. Using multivariable analysis, characteristics associated with not discussing HPV vaccination were examined.
RESULTS: Response rates were 82% for pediatricians (364 of 442) and 56% for FP (218 of 387). For 11-12 year-old girls, 60% of pediatricians and 59% of FP strongly recommend HPV vaccine; for boys,52% and 41% ostrongly recommen. More than one-half reported ≥25% of parents deferred HPV vaccination. At the 11-12 year well visit, 84% of pediatricians and 75% of FP frequently/always discuss HPV vaccination. Compared with physicians who frequently/always discuss , those who occasionally/rarely discuss(18%) were more likely to be FP (adjusted odds ratio [aOR]: 2.0 [95% confidence interval (CI): 1.1–3.5), be male (aOR: 1.8 [95% CI: 1.1–3.1]), disagree that parents will accept HPV vaccine if discussed with other vaccines (aOR: 2.3 [95% CI: 1.3–4.2]), report that 25% to 49% (aOR: 2.8 [95% CI: 1.1–6.8]) or ≥50% (aOR: 7.8 [95% CI: 3.4–17.6]) of parents defer, and express concern about waning immunity (aOR: 3.4 [95% CI: 1.8–6.4]).
CONCLUSIONS: Addressing physicians’ perceptions about parental acceptance of HPV vaccine, the possible advantages of discussing HPV vaccination with other recommended vaccines, and concerns about waning immunity could lead to increased vaccination rates

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Seasonal Effectiveness of Live Attenuated and Inactivated Influenza Vaccine
Jessie R. Chung, Brendan Flannery, Mark G. Thompson, Manjusha Gaglani, Michael L. Jackson, Arnold S. Monto, Mary Patricia Nowalk, H. Keipp Talbot, John J. Treanor, Edward A. Belongia, Kempapura Murthy, Lisa A. Jackson, Joshua G. Petrie, Richard K. Zimmerman, Marie R. Griffin, Huong Q. McLean, Alicia M. Fry
Pediatrics Feb 2016, 137 (2) 1-10; DOI: 10.1542/peds.2015-3279

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Safety and Immunogenicity of Sequential Rotavirus Vaccine Schedules
Romina Libster, Monica McNeal, Emmanuel B. Walter, Andi L. Shane, Patricia Winokur, Gretchen Cress, Andrea A. Berry, Karen L. Kotloff, Kwabena Sarpong, Christine B. Turley, Christopher J. Harrison, Barbara A. Pahud, Jyothi Marbin, John Dunn, Jill El-Khorazaty, Jill Barrett, Kathryn M. Edwards, for the VTEU Rotavirus Vaccine Study Work Group
Pediatrics Feb 2016, 137 (2) 1-10; DOI: 10.1542/peds.2015-2603

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From the American Academy of Pediatrics
Medical Countermeasures for Children in Public Health Emergencies, Disasters, or Terrorism
DISASTER PREPAREDNESS ADVISORY COUNCIL
Pediatrics Feb 2016, 137 (2) 1-9; DOI: 10.1542/peds.2015-4273
Abstract
Significant strides have been made over the past 10 to 15 years to develop medical countermeasures (MCMs) to address potential disaster hazards, including chemical, biological, radiologic, and nuclear threats. Significant and effective collaboration between the pediatric health community, including the American Academy of Pediatrics, and federal partners, such as the Office of the Assistant Secretary for Preparedness and Response, Centers for Disease Control and Prevention, Federal Emergency Management Agency, National Institutes of Health, Food and Drug Administration, and other federal agencies, over the past 5 years has resulted in substantial gains in addressing the needs of children related to disaster preparedness in general and MCMs in particular. Yet, major gaps still remain related to MCMs for children, a population highly vulnerable to the effects of exposure to such threats, because many vaccines and pharmaceuticals approved for use by adults as MCMs do not yet have pediatric formulations, dosing information, or safety information. As a result, the nation’s stockpiles and other caches (designated supply of MCMs) where pharmacotherapeutic and other MCMs are stored are less prepared to address the needs of children compared with those of adults in the event of a disaster. This policy statement provides recommendations to close the remaining gaps for the development and use of MCMs in children during public health emergencies or disasters. The progress made by federal agencies to date to address the needs of children and the shared commitment of collaboration that characterizes the current relationship between the pediatric health community and the federal agencies responsible for MCMs should encourage all child advocates to invest the necessary energy and resources now to complete the process of remedying the remaining significant gaps in preparedness.

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Pediatrics Perspectives
Planning for Research on Children During Public Health Emergencies
Laura J. Faherty, Sonja A. Rasmussen, Nicole Lurie
Pediatrics Feb 2016, 137 (2) 1-4; DOI: 10.1542/peds.2015-3611
Extract
The recent Ebola epidemic exposed critical knowledge gaps about the disease and its impact on different populations, particularly children, which hindered the public health and medical response. For instance, unanswered questions remain about the natural history of Ebola virus disease in young children and its transmissibility in breast milk. Other emerging infectious diseases, such as Middle East Respiratory Syndrome (MERS), remind us that there will always be another pathogen lurking around the corner. Public health emergencies (PHEs) resulting from natural disasters are increasing in ferocity and frequency.1 How can we ensure that we address our current knowledge gaps to better prepare for future disasters?
Awareness of the need to integrate scientific research into PHE response is growing,2 but the discussion of research involving children has been limited. Although several efforts have addressed the unique physical and socio-emotional needs of children in PHEs,3,4 pediatric research during PHEs has been lacking, resulting in significant knowledge gaps for children compared to adults. Conducting research, especially in children, without interfering with the PHE response is challenging. The present article discusses the importance of including children in PHE research and proposes components of a robust infrastructure that need to be in place to facilitate this research.
Barriers to Including Children in PHE Research
Including children in PHE research presents special challenges, including issues with recruitment, informed consent, and enrollment.3,5 Institutional review boards (IRBs) have more stringent requirements for inclusion of children in research than for adults.6 A life course …

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Stakeholder Views of Clinical Trials in Low- and Middle-Income Countries: A Systematic Review
Pathma D. Joseph, Patrina H.Y. Caldwell, Allison Tong, Camilla S. Hanson, Jonathan C. Craig
Pediatrics Feb 2016, 137 (2) 1-19; DOI: 10.1542/peds.2015-2800
Abstract
CONTEXT: Clinical trials are necessary to improve the health care of children, but only one-quarter are conducted in the low- to middle-income countries (LMICs) in which 98% of the global burden of disease resides.
OBJECTIVE: To describe stakeholder beliefs and experiences of conducting trials in children in LMICs.
DATA SOURCES: Electronic databases were searched to August 2014.
STUDY SELECTION: Qualitative studies of stakeholder perspectives on conducting clinical trials among children in LMICs.
DATA EXTRACTION: Findingswere analyzed by using thematic synthesis.
RESULTS: Thirty-nine studies involving 3110 participants (children [n = 290], parents or caregivers [n = 1609], community representatives [n = 621], clinical or research team members [n = 376], regulators [n = 18], or sponsors [n = 15]) across 22 countries were included. Five themes were identified: centrality of community engagement (mobilizing community, representatives’ pivotal role, managing expectations, and retaining involvement); cognizance of vulnerability and poverty (therapeutic opportunity and medical mistrust); contending with power differentials (exploitation, stigmatization, and disempowerment); translating research to local context (cultural beliefs, impoverishment constraints, and ethical pluralism); and advocating fair distribution of benefits (health care, sponsor obligation, and collateral community benefits).
LIMITATIONS: Studies not published in English were excluded.
CONCLUSIONS: Conducting trials in children in LMICs is complex due to social disadvantage, economic scarcity, idiosyncratic cultural beliefs, and historical disempowerment, all of which contribute to inequity, mistrust, and fears of exploitation. Effective community engagement in recruiting, building research capacities, and designing trials that are pragmatic, ethical, and relevant to the health care needs of children in LMICs may help to improve the equity and health outcomes of this vulnerable population.

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Commentaries
Rotavirus Vaccines—OK to Mix and Match
Carrie L. Byington, Yvonne Maldonado
Pediatrics Feb 2016, 137 (2) 1-2; DOI: 10.1542/peds.2015-3618