Immunogenicity of meningitis B vaccine
Antibody levels fell over time in children receiving a new meningitis B vaccination but responded well after 2 booster vaccinations. This follow-up of 125 children from an earlier vaccine trial also found that boosters worked better in children who had received meningitis B vaccine than in those who had not been previously vaccinated. It will be important to monitor disease surveillance to determine whether waning antibodies might influence the effectiveness of any vaccination campaign with this new vaccine. See Research, page E715
Screening useful in treating MRSA
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Methicillin resistance in a culture-positive clinical infection with Staphylococcus aureus is predicted by a positive result from screening at admission. MacFadden and colleagues conducted a 2-year retrospective cohort analysis including 510 patients with documented S. aureus clinical infection and preceding MRSA screening to determine the usefulness of screening in predicting methicillin resistance. Results from screening could offer important information about the likelihood of subsequent methicillin-resistant infections. See Research, page E725
Reducing X-rays for children
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Children will be exposed to less ionizing radiation if the Low Risk Ankle Rule (tenderness and swelling isolated to the distal fibula and/or adjacent lateral ligaments distal to the tibial anterior joint line) is widely applied in hospital emergency settings. This comparative implementation study in 6 diverse hospital settings reduced ankle radiography by 22%. See Research, page E731
Croup in children
Croup is common, affecting more than 80 000 children in Canada each year. The management of this condition has evolved, from cold mist treatment to oral corticosteroid therapy, and in the case of children with severe disease, nebulized epinephrine. Most children can be safely discharged home after treatment and a few hours of observation. See Review, page 1317
Hepatitis C screening
Hepatitis C virus infection is an important public health problem in Canada and is underdiagnosed. New direct-acting antiviral treatments have been licensed, and agents that may be more effective and better tolerated are in development. Canada urgently needs better data on rates of infection to guide future policy on population-based screening. It is likely that routine birth-cohort screening in Canada would be cost-effective. See Analysis, page 1325
Attention-deficit/hyperactivity disorder
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A 7-year-old boy and his parents present to their family physician at the request of the child’s teacher. The child is easily distracted, struggles to remain seated in class and argues with the teacher. The parents have noted similar behaviour at home and wonder if he has attention-deficit/hyperactivity disorder. What approach can we take with a child with these symptoms? See Practice, page 1333
Monoclonal gammopathy
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Affecting almost 10% of men over 80 years of age, monoclonal gammopathy of undetermined significance is common. It may evolve into multiple myeloma or other B cell malignancies — but not in everyone. Anguille and Bryant emphasize that risk stratification is important to determine who is at high risk of malignancy and describe how they should be monitored. See Practice, page 1345
Rat-bite fever
A 28-year-old woman presented with a rash, fever and arthritis. The cause? Rat-bite fever, requiring a month of treatment with penicillin G. She did not remember being bitten by her pet rat. Although scratches and bites are common routes of transmission to humans, simple handling can lead to infection. See Practice, page 1346