Journal Club

• Flu spray is more effective than shots in YOUNG children

A nasal spray containing trivalent live attenuated influenza vaccine protects children 6 to 59 months old significantly better than shots of a trivalent inactivated vaccine, a large prospective trial showed. The trial, conducted during the 2004 to 2005 influenza season, was in almost 8,000 children at 249 sites around the world. About half of the children lived in the US.

Subjects were randomly assigned to receive either the live influenza vaccine spray or the inactivated influenza vaccine injection. Those who had not previously been vaccinated against influenza were given two doses of vaccine, and those who had an earlier vaccination received only one dose. Follow-up was conducted 42 days after administration of the second or single dose.

Among the youngest children-from 6 to 11 months of age-however, those who received the live-attenuated vaccine were significantly more likely than children who received the inactivated vaccine to experience medically significant wheezing. In addition, at 180 days after administration of the last dose of vaccine, more 6- to 11-month-old children were hospitalized (for any cause) in the live-attenuated-vaccine group than in the inactivated-vaccine group (6.1% vs. 2.6%). The incidence of serious adverse events was low-and similar-in both groups (Belshe RB et al: N Engl J Med 2007;356:685).

Commentary:

This study contrasts with similar studies in adults, where the inactivated vaccine seemed to be more effective. Perhaps the live virus nasal spray works better in young children who have had less exposure to any strain of influenza, allowing for viral replication, and a more vigorous immune response. For children who are older than 1 year who don't wheeze, the nose may be the preferred route for flu vaccine next season.

• Which YOUNGSTERS are exposed to online pornography?

Some youngsters seek out online pornography. Others are exposed to it involuntarily. Investigators conducted telephone interviews of 1,500 10- to 17-year-old Internet users to find out how many youngsters are exposed to Internet pornography voluntarily and involuntarily, and the risk factors for each type of exposure.

Forty-two percent of respondents had been exposed to online pornography in the past year. For 66%, the exposure was unwanted. Although only 1% of 10- to 11-year-old boys sought online pornography, the proportion increased with age-to 11% of 12- to 13-year-old boys, 26% of 14- to 15-year-olds, and 38% of 16- to 17-year-olds. Few girls reported wanting to see online pornography. Unwanted exposure also increased with age, in both boys and girls. It was reported by 17% of 10- to 11-year-old boys, and 30% of 16- to 17-year-olds. In girls, unwanted exposure rose from 16% of 10- to 11-year-olds to 38% of 16- to 17-year-olds.

Youngsters who reported being harassed online or receiving unwanted sexual solicitations were more likely to encounter pornography. Two types of prevention efforts seemed to provide some protection from unwanted pornography exposure. Using software to filter, block, or monitor Internet use reduced the likelihood of exposure by 40%. Attending presentations about Internet safety led by law enforcement personnel reduced this likelihood by 30%. Higher rates of wanted exposure were associated with being a teenage boy, using file-sharing programs to download images, talking online to unknown persons about sex, and using the Internet at friends' homes. The one characteristic of Internet use that was associated with unwanted exposure was use of file-sharing programs to download images. Using such programs almost doubled the risk of encountering unwanted pornography.