Immunization Rates among Kindergarten Students
Vaccination coverage among kindergarten students in the United States for the measles, mumps, and rubella vaccine (MMR), as well as other essential vaccines, is declining. After maintaining near 95% coverage for a decade, rates dropped to approximately 93% during the 2020 to 2023 school years, prompting a summary of state and local immunization data reported to the Centers for Disease Control and Prevention (CDC) for the 2023 to 2024 school year.
READ MORE...
Parents are required to provide vaccination records or exemption documents to schools, which collaborate with health departments to assess compliance. The CDC utilizes data from 49 states and Washington, D.C. to estimate vaccination rates and exemptions among kindergarteners. For the 2023 to 2024 school year, the reported vaccination coverage reflects a significant drop compared to previous years, with only a few jurisdictions achieving the desired 95% coverage threshold.
The analysis shows that national MMR coverage stands at 92.7%, with considerable variations among states. States with the lowest coverage reported figures below 80%, while some states exceeded 98%. Exemptions from vaccinations increased to 3.3%, primarily due to nonmedical reasons, which poses a risk for vaccine-preventable diseases and has implications for achieving public health targets.
The findings underscore the need for immunization programs, health care providers, and schools to actively promote vaccination and counteract the rising exemption rates, which contribute to the potential for outbreaks of preventable diseases. Strategies, such as simplifying vaccination processes and improving access to vaccines, are essential for reversing the trends of declining coverage and increasing exemptions, ensuring the health and safety of children and communities. (Seither, R., et al. [2024]. Coverage with selected vaccines and exception rates among children in kindergarten United States, 2023—24 school year. MMWR Morb Mortal Wkly Rep, 73, 925—932. Retrieved October 2024 from https://www.cdc.gov/mmwr/volumes/73/wr/mm7341a3.htm)
Released: November 2024
Nursing Drug Handbook
© 2024 Wolters Kluwer
Nivolumab with AVD Enhances Progression-Free Survival in Classic Hodgkin Lymphoma
Brentuximab vedotin has been used to improve outcomes in patients with classic Hodgkin lymphoma, but toxic side effects and relapse rates remain a problem. The S1826 trial aimed to improve progression-free survival (PFS) while addressing the side effects common with current treatments. S1826 investigated the efficacy and safety of combining nivolumab (N) with doxorubicin, vinblastine, and dacarbazine (AVD) compared to brentuximab vedotin (BV) combined with AVD in patients with newly diagnosed advanced-stage classic Hodgkin lymphoma.
READ MORE...
The study enrolled 994 patients age 12 and older between July 2019 and October 2022. The participants were randomized with a focus on evaluating the time from randomization to disease progression or death. With a median follow-up of 12.1 months, results favored N+AVD with a 52% reduction in the risk of disease progression or death compared to BV+AVD. This trend continued with extended follow-up, showing a 92% PFS at 2 years for N+AVD compared to 83% for BV+AVD, further emphasizing the treatment's effectiveness. In addition, results demonstrated that N+AVD could reduce the need for consolidative radiation therapy, which has associated long-term risks, including secondary cancers.
Adverse effects revealed a generally favorable safety profile for N+AVD compared to BV+AVD. Although neutropenia was more common in the N+AVD group, other significant adverse events, particularly those leading to treatment discontinuation, were more prevalent in the BV+AVD cohort.
The S1826 trial presents compelling evidence supporting the use of N+AVD as a primary treatment for advanced-stage classic Hodgkin lymphoma, offering enhanced progression-free survival and a better side-effect profile. Given these promising results, N+AVD warrants consideration for integration into standard Hodgkin lymphoma treatment protocols. (Herrera, A. F., et al. [2024]. Nivolumab+AVD in advanced-stage classic Hodgkin's lymphoma. NEJM, 391[15], 1379—1389. Retrieved October 2024 from https://www.nejm.org/doi/full/10.1056/NEJMoa2405888)
Released: November 2024
Nursing Drug Handbook
© 2024 Wolters Kluwer
Regorafenib for Patients with Advanced Gastric or Gastroesophageal Junction Cancer
Patients diagnosed with refractory advanced gastric or gastroesophageal junction cancer (AGOC) face a dire prognosis, where the overall survival (OS) is less than 6 months, and the 2-year OS rate is below 10%. New therapies, like trifluridine/tipiracil and immune checkpoint inhibitors are shifting the treatment standards for AGOC, and with the INTEGRATE IIa study, regorafenib has been added to this evolving landscape.
READ MORE...
The phase 3, randomized, controlled trial, conducted from October 2016 to September 2021, enrolled 251 patients with AGOC whose disease had progressed after two previous therapies. Patients were randomized to receive either regorafenib 160 mg on days 1 to 21 of a 28-day cycle, or placebo. The trial showed that regorafenib considerably extends OS (19%) for patients with refractory AGOC versus placebo (6%). It also demonstrated a 32% reduction in the risk of death when regorafenib was added to best supportive care.
Additionally, patients receiving regorafenib experienced a longer time to deterioration in quality of life, as measured by the European Organisation for Research and Treatment of Cancer QLQ-C30 and STO22 modules (hazard ratio = 0.68). This suggests that regorafenib not only improves survival but also maintains a better quality of life for patients facing advanced cancer.
These important findings of INTEGRATE IIa underscore the potential benefits of regorafenib as a treatment option in AGOC for a patient population with limited alternatives. (Pavlakis, N. [2024]. INTEGRATE IIa phase III study: Regorafenib for refractory advanced gastric cancer. Journal of Clinical Oncology. Advance online publication. Retrieved October 2024 from https://ascopubs.org/doi/10.1200/JCO.24.00055?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed; Stenger, M. [2024]. Regorafenib in refractory advanced gastric cancer. The ASCO Post. Retrieved October 2024 from https://ascopost.com/news/october-2024/regorafenib-in-refractory-advanced-gastric-cancer/)
Released: November 2024
Nursing Drug Handbook
© 2024 Wolters Kluwer
Tenecteplase Versus Alteplase for Stroke in Patients with Diabetes and Hyperglycemia on Admission
Diabetes is prevalent among stroke patients and is associated with poorer neurologic outcomes, increased risk of symptomatic intracerebral hemorrhage (sICH), and generally unfavorable clinical results post-stroke. Although thrombolytic therapy can be beneficial, elevated admission glucose levels are common and complicate treatment, leading to worse outcomes and longer hospital stays.
READ MORE...
Alteplase is the only approved fibrinolytic for acute ischemic stroke (AIS), while tenecteplase, a modified variant of alteplase, has advantages like a longer half-life and faster administration. The TRACE-2 trial, a phase 3 multicenter study, which ran from June 2021 to May 2022, aimed to assess the efficacy and safety of tenecteplase against alteplase in AIS patients, especially considering their diabetic status and admission glucose levels.
TRACE-2 included adult AIS patients eligible for thrombolysis but not for thrombectomy, enrolling participants with varying histories of diabetes and hyperglycemia. The study compared the functional outcomes at 90 days and the incidence of adverse events between patients receiving tenecteplase (0.25 mg/kg IV) and those receiving alteplase (0.9 mg/kg IV).
Results indicated that although patients with a history of diabetes had significantly lower rates of excellent functional outcomes compared to those without diabetes, the efficacy of tenecteplase was comparable to alteplase in both diabetic and nondiabetic groups. The safety profiles were also similar, though patients with diabetes exhibited a higher incidence of sICH and other serious adverse events overall. Interestingly, tenecteplase was associated with shorter door-to-needle times in patients with diabetes, suggesting potential operational benefits.
The study concluded that tenecteplase could be a viable alternative to alteplase for AIS patients, including those with diabetes and hyperglycemia, while also emphasizing the need for further research to confirm these findings across diverse patient groups. (Liu, H., et al. [2024]. Efficacy and safety of intravenous tenecteplase versus alteplase in treating acute ischemic stroke with diabetes and admission hyperglycemia. Journal of the American Heart Association, 13[20], Article e036393. Retrieved October 2024 from https://www.ahajournals.org/doi/full/10.1161/JAHA.124.036393)
Released: November 2024
Nursing Drug Handbook
© 2024 Wolters Kluwer