Pediatricians, parents, teachersand community leaders fromaround the state are taking partin a statewide study to improvethe lives of children with autism.The Autism Diagnosis Educa-

tion Pilot Project (ADEPP), a newproject initiative of the OhioAAP, plans to improve autismeducation and get children andtheir families a quicker diagno-sis.“Early diagnosis is essential to

improving the quality of life andcare for children with autism,”says John Duby, MD, medicaldirector of the Autism DiagnosisEducation Pilot Project of theOhio AAP.Autism affects 1 in 150 chil-

dren. The typical time from aparent’s initial concern abouttheir child’s development untildiagnois is one year. Dr. Duby

said that year is “a lost oppor-tunity for early intervention.”“Many studies now suggest

that autism may be recognizedeven in the first year of life,” hesays. “The earlier the disorder isfound, the more likely it is thatearly intervention will be bene-ficial.”In the past two months, the

ADEPP team has met with fami-lies, child-care providers, educa-tors, health-care professionals,and leaders in various commu-nities throughout the state toidentify opportunities to promoteearly identification of autismusing standardized methods. TheADEPP team has also workedwith local contacts to link timely

See Autism...on page 6

Newsmagazine of the Ohio Chapter, American Academy of Pediatrics Spring 2008

Autism Pilot Projectholds focus groups

See Open Forum...on page 6

What would you do to addresshealth disparities in your commu-nity? Bring your ideas on how theOhio AAP and you can work to-gether to tackle the issues of LowBirth Weight, Medical/Legal Part-nership (MLP) and ChildhoodObesity to the Ohio AAP’s OpenForum Meeting May 14 from 9a.m. to 1 p.m. at the University ofToledo, College of Medicine.During this meeting attendees

will identify significant healthdisparities and the community

Check out ournew Web siteThe Ohio AAP’s Web site

(www.ohioaap.org) has beenredesigned.The Chapter’s goal was to

make the site more user-friendly and provide moreinformation to members.A few of the new things

you’ll find are: online meet-ing registration; online con-tribution capabilities; com-mittee minutes; and moreeducational materials.Send your comments to

chapter@ohioaap.org.

Toledo OpenForum set forMay 14

• Next Autism Focus GroupMay 7-8 in Cleveland

Ohio Pediatrics • Spring 20082

Ohio Pediatrics

A Publication of the Ohio Chapter,American Academy of PediatricsOfficersPresident....William H. Cotton, MDPresident-Elect..... Terry P. Barber, MDTreasurer....Gerald Tiberio, MDDelegates at large:Robert Frenck, MDJames Duffee, MDJudith Romano, MD

Executive Director:Melissa Wervey Arnold450 W. Wilson Bridge Road, Suite 215Worthington, OH 43085(614) 846-6258, (614) 846-4025 (fax)

Lobbyist:Dan JonesCapitol Consulting Group37 West Broad Street, Suite 820Columbus, OH 43215(614) 224-3855, (614) 224-3872 (fax)

Editor:Karen Kirk, (614) 846-6258 or (614) 486-3750

www.ohioaap.org

quality health care, Rep. Jim Raus-sen has introduced HB 456. The billincludes a number of proposed pol-icies to improve access to healthcare. Issues of interest to pediatri-cians include the following:• Tax credits for individuals and

families who purchase their ownhealth insurance policies.• High-risk insurance pool for

those Ohioans with high risk dis-eases or conditions that make pur-chasing their own insurance im-possible.• Requirement for every public

employee benefit plan in Ohio toinclude coverage for chronic caremanagement.

Legislative Update

Update from the StatehouseThe Ohio Legislature is expected

to continue working through abusy agenda through the springmonths. Top priorities includeelectric restructuring, the state’scapital appropriations bill to bud-get for state infrastructure projectsand a budget corrections bill. Also,state leaders will be working to filla budget gap that exceeds $700million. While these “hot topics”make up the headlines in dailynewspapers around the state forthe action at the Ohio Statehouse,a number of other important pol-icy issues are of interest to OhioAAP and create our own head-lines.

House Bill 125 – Health CareSimplification ActAfter months of hearings and

negotiations, House Bill 125, legis-lation proposed by the Ohio StateMedical Association and support-ed by a number of health-care pro-viders including Ohio AAP, wasenacted in March 2008. The billtakes a number of critical stepsforward improving the relation-ship between health-care providersand third-party payers. Despitestrong opposition from both theinsurance and business lobbies inOhio, the bill includes provisionsto ensure transparency and fair-ness in the contracting process.The bill now heads to Gov. TedStrickland for his consideration.Thank you to Ohio AAP mem-

bers who answered our call to ac-tion and contacted legislators tourge their support of HB 125. Yourinvolvement made a difference!

House Bill 320 – Booster SeatsOhio AAP continues to support

HB 320, legislation sponsored byRep. Shannon Jones to requirebooster seats for children betweenthe age of 4 and 8 years of age andthose under 4-feet, 9-inches tall.Passing this bill out of the HouseInfrastructure, Homeland Securityand Veterans Affairs Committeewill be a top priority in the spring.Please look for Ohio AAP actionalerts on this issue and be ready totell your legislators about the im-portance of booster seats.

House Bill 355 – MedicaidWhistleblowersHB 355 is legislation sponsored

by Rep. Jim Hughes and wouldcreate a civil right of action forMedicaid fraud schemes, and ulti-mately, a financial incentive forwhistleblowers who allege Medi-caid fraud. Ohio AAP and otherhealth-care providers and entitiescontracting with Medicaid are op-posed to the bill and voicing con-cerns with the bill’s sponsor andproponents. Opponents believethat law enforcement and theAttorney General already have thetools they need to stop Medicaidfraud, and the proposal as writtencompromises Medicaid providercompliance efforts and will act asan additional deterrent for attract-ing qualified providers in theMedicaid program.

House Bill 456 – Health CareAccessIn response to field hearings

held last year across the state todiscuss issues related to access to

See Legislation...on page 16

The AAP has recently introduceda program,”Promoting the Valueof Pediatrics.” The AAP’s docu-ments focus on the quality andlong-term benefits of pediatrics.The documents also focus on thefact that the pediatrician’s officeprovides the full spectrum ofcare by providers who are speci-fically trained in diagnosing andtreating children and adoles-cents. Parents benefit from thepediatrician’s expertise, and thepediatrician benefits by knowingeverything about his or her pa-tient. And while retail healthclinics may seem to be a bargainif they charge less than the costof a visit to the pediatrician, theyare not. Every visit to the pedia-trician’s office is an opportunityfor specialized care, additionalcounseling, and optimal follow-up.May I suggest that you visit the

AAP national Web site to getmore information about theAAP’s efforts to promote ourprofession.

MEETING WITH THE U.S.SURGEON GENERALI also had a great experience in

late February attending a meet-ing with the U.S. Surgeon Gen-eral Steven K. Galson, MD, MPH.Dr. Galson was in Columbus fora series of meetings one of whichwas held at Columbus Nation-wide Children’s Hospital. In around table discussion the Sur-geon General heard presenta-tions from several of our OhioAAP colleagues. Drs. Peter

Rogers and Rich Heyman spokeon their efforts at preventing andtreating adolescent alcohol abuse.Dr. Bob Murray presented sev-eral of his projects focusing onnutrition and obesity prevention.Dr. Kelly Kelleher shared theresearch he has done using elec-tronic computer tablets to screenadolescents for substance use,depression, and suicide in theprimary care setting.The Surgeon General was very

interested in all of the presenta-tions. He asked great questionsand requested additional infor-mation from the presenters. Asone of our members said, “Wecan only hope that somehow thenew administration keeps Dr.Galson.”I was so proud seeing Ohio

AAP members share their cuttingedge work that has the possi-bility of making a difference withour patients and their families, aswell as with families across thecountry. This was just one ex-ample of the great work that theOhio AAP does.

– William Cotton, MDOhio AAP President

I recently attended a presenta-tion at the Ohio Medical Boardmeeting by aphysician who isthe senior med-ical advisor forLittle Clinics.This corporationis planning onopening morethan 500 retailhealth clinicsacross the coun-try. In Ohio theLittle Clinics are located inKroger grocery stores. The phy-sician said that the clinics providehigh quality, convenient, and af-fordable care. Their focus of careis on low-risk minor illnesses andinjury. Care is provided by exper-ienced nurse practitioners. Theyhire nurses who have at least fiveyears of experience working withphysicians.The nurse practitioners colla-

borate with physicians, usuallyfamily physicians. The collabora-ting physicians can collaboratewith no more than four nursepractitioners. The physiciansmust be available by phone whenthe clinics are open. The collabo-rating physicians also oversee anextensive QI program. Little Clin-ics provide care that consists ofcomplementing services providedby primary care physicians. Theseclinics refer patients back to thepatient’s medical home and referpatients without a medical hometo local physicians.How have, and will, these retail

health clinics affect your practice?

Ohio Pediatrics • Spring 2008 3

Ohio Pediatrics

www.ohioaap.org

President’s Message

Will Little Clinics affect your practice?

William Cotton, MD

tives to states that pass legisla-tion. To qualify for a new incen-tive package of federal grantfunds, states must first enact andenforce a law requiring any childriding in a passenger motor ve-hicle (i.e., a passenger car, pick-up truck, van, minivan or sportutility vehicle) who is under 8years of age be secured in an ap-propriate child restraint which isa booster seat, as defined by fed-eral law. The state child restraintlaw must also allow for primaryenforcement which means stop-ping or detaining a passengermotor vehicle and issuing a ci-tation because a child under 8years of age is not properly se-cured. States that are able todraw down these federal incen-tive dollars may use grant fundsfor programs to purchase anddistribute child restraints to low-income families.As a result of the data, the pre-

ventable injuries occurring, andthe incentive packages encour-

aged by the federal government,two legislative leaders within ourstate Sen Eric Kearney (SenateBill 27) and Rep. Shannon Jones(House Bill 320) have each putforth legislation for the state.Currently, Rep. Jones’ bill isbeing heard in the House Trans-portation Committee. If passed,the entire general body will beable to vote on it.Please be sure to contact, or

write, your local legislators tosupport this bill to make thechildren in our state safer.If you would like more in-

formation about the booster seatslegislation, please contact theOhio AAP at chapter@ohioaap.org orMike Gittelman, MD,chair of the Section on InjuryPrevention at mike.gittelman@cchmc.org,

– Mike Gittelman, MDChair, Injury, Violence andPoison Prevention

(See related story on Page 13)

Ohio Pediatrics • Spring 20084

Ohio Pediatrics

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Belt-positioning booster seats saves livesMotor vehicle collisions con-

tinue to be the leading cause ofdeath for children 4 to 8 years ofage within our state and nation-ally. Belt-positioning booster seatsare recommended for a child whohas outgrown a convertible safetyseat, but who is too small to use avehicle’s safety belt. The purposeof the booster seat is to elevate achild in the automobile’s chair sothat the lap belt fits across thechild’s pelvis, not abdomen, andthat the shoulder arm belt doesnot ride up on the child’s neck.Researchers at the Children’sHospital of Philadelphia reviewedapproximately 48,000 crashes in-volving roughly 56,000 childrenand showed that youth restrainedin a belt-positioning booster were59% less likely to sustain an in-jury. Plus, children restrained in abooster suffered no abdominal,neck, back, or lower extremity in-juries.Although booster seats have

been proven to be effective in re-ducing injuries to children be-tween 4 and 8 years of age, manyfamilies are still not using boosterseats. Data collected by the Part-ners For Child Passenger Safetyshowed that only 27% of U.S.children aged 4 to 8 years wereappropriately restrained in boos-ter seats. States around the coun-try are enacting Booster Seat Leg-islation in an effort to restrain ap-propriate youth in an automobileappropriately and to reduce thehigh number of injuries seen na-tionally. Thirty-nine states and theDistrict of Columbia have passedlegislation thus far; Ohio, how-ever, has not. Also, the federalgovernment is offering incen-

Meeting with Rep. Shannon Jones (center) to discuss the Booster Seatlegislation are from left: Belinda Jones of Capitol Consulting Group, OhioAAP Executive Director Melissa Arnold, Ohio AAP President WilliamCotton, MD, and Tracy Intihar, government relations consultant.

Ohio Pediatrics • Spring 2008 5

Ohio Pediatrics

www.ohioaap.org

Editor’s Note: The Ohio AAP’sPediatric Care Council was recog-nized by national AAP in its AAPPrivate Payer Advocacy e-news-letter for its efforts in advocating forimmunization administration pay-ments by Medical Mutual of Ohio.

The Chapter's Pediatric CareCouncil met on Feb. 15 withmedical directors from Anthemof Southern Ohio, ParamountHealth Care, Medical Mutual ofOhio, AmeriGroup, UHC, andCaresource and covered severalsubjects

Vaccines – Medical Mutualannounced that later this year itwill begin to pay physicians avaccine administration fee.While this amount will come outof the amount it currently paysfor the vaccines themselves, thenew policy will allow practicesto develop coherent charges forvaccines and eliminate a majorpayer’s variance from CPT cod-ing. As such, it will be a wel-come advance in supporting thenational vaccine program.National research continues in

order to ascertain the true cost ofadministering vaccines: includ-ing counseling time (increased inrecent years due to misinforma-tion about preservatives, au-tism), cost for storage, manage-ment of inventory, wastage, in-surance for inventory, etc. Mostof these were not includedamong the items used to developthe RVU for vaccine administra-tion.The Merck 4% increase in

charges for MMR, rotavirus,HPV and varicella vaccine prod-ucts was discussed, effective Jan.31, 2008. National insurers wereinformed of the change by theAAP. A plan representative ob-served that it is difficult to findthe actual acquisition cost of vac-cines. The pediatricians notedthat it will be important that re-imbursement rise promptly toreflect the price increase, espe-cially since the increase is aknown issue.

Appropriate diagnosis andmanagement of ADHD – MedMutual in Ohio will be sending500 practitioners an Academy ofChild and Adolescent Psychiatrymini-reference on diagnostic cri-teria, dosage forms of ADHDmedications, and a decision al-gorithm. The mini-reference is ina laminated brochure format.Much discussion ensued on pub-licizing the appropriate steps indecision making for diagnosisand treatment. The AAP in Mayis expected to have an update ofit's well-received tool kit on thesubject, including the use ofeasy-to-use validated tools fordiagnosis and follow-up. Plansmay monitor the use of thesetools for pay-for-performanceincentives and/or for prerequi-sites to covering prescriptions forADHD meds.It was noted that the Vander-

bilt tool was designed for follow-up ADHD visits as well as forinitial diagnosis and is availablefree of charge.It was further noted that spe-

cial circumstances exist when achild comes to a provider with apsychologist’s work-up alreadycompleted; likewise when an al-ready-diagnosed child comesnew into an insurance plan orinto a physician’s practice.On the education front, the

Ohio AAP’s Annual MeetingNov. 7-8 at Cherry Valley Lodge,Newark, will feature a discus-sion on ADHD treatment op-tions.

Mental Health – Children’sHospitals in Cincinnati andCleveland are trying to createinterest in a statewide phoneconsultation service putting pri-mary care physicians in touchwith child psychiatrists. Giventhe shortage of child psychia-trists, plans have good reason toencourage this development andpractitioners will have goodreason to participate in this ser-vice, which exists statewide inMassachusetts and regionally inupstate New York.

Developmental Screening –Discussion from previous meet-ings continued on the use of CPT96110 (Developmental testing:limited, with interpretation andreport). The code is for validat-ed tools used for a variety ofreasons, such as for infant andtoddler developmental evalua-tions, including the newly rec-ommended standardized screensat 9, 18 and 24 or 30 months, forADHD questionnaires for

Medical Mutual will begin payingphysicians a vaccine administration fee

See Care Council...on page 13

Ohio Pediatrics

6 www.ohioaap.orgOhio Pediatrics • Spring 2008

and effective services for childrenwith autism spectrum disorders.The ADEPP will be tested in

five counties which reflect the di-verse population of Ohio. Focusgroups have been held in WarrenCounty – a rapidly growing su-burban community in southwes-tern Ohio; Belmont County – arural community in southeasternOhio; Wood County – a stableagricultural and university com-munity in northwest Ohio; Frank-lin County – representing an esta-blished suburban county in Cen-tral Ohio. The sessions will wrapup in Cleveland on May 7-8.Within these communities, the

project leadership has been work-ing with local health departmentsto identify key stakeholders whocan contribute to identifying theneeds of their communities withregard to education regarding thediagnosis and treatment of au-tism. In addition, leaders of stateagencies who care for children, aswell as statewide experts in thediagnosis and treatment of autismwill be asked to participate in theneeds assessment.“We’re looking at what’s work-

ing well in these communities, aswell as opportunities to closesome gaps and strengthen otherservices,” says Dr. Duby.Parents of young children, par-

ents of children recently found tohave autism, child-care providers,preschool teachers, special educa-tors, education administrators,public and private providers ofservices to children with autism,health-care professionals, andlocal Family and Children FirstCouncils have also participated inthe focus groups contributing

Autism... from page 1

Open Forum... from page 1

resources needed to addressthem.Ohio AAP PresidentWilliam

Cotton, MD, and David M. Krol,MD,MPH, FAAP, University ofToledo College of Medicine, De-partment of Pediatrics, will kick-off the meeting with an openingpresentation and objectives.Dianne S. Mantel, attorney,

Legal Aid of Western Ohio, willspeak on Medical Legal/Partner-ship (MLP) from 9:30-10-15 a.m.Ohio AAP Past-President Eliza-

beth Ruppert, MD, JonnaMcRury, MD, both of the Uni-versity of Toledo College of Med-icine, Department of Pediatrics;andMark Redding, MD, Mans-

field pediatrician and chair of theHealth Equity Committee, willspeak on Low Birth Weight Initia-tive from 10:15-11 a.m.At 11:15 a.m., Joan R. Griffith,

MD,MHA, MPH, University ofToledo College of Medicine, De-partment of Pediatrics, will speakon Childhood Obesity.The free meeting is open to res-

idents, legislators, communityagencies, and other interestedparties. Lunch will provided free.Deadline to register is May 7.This program has been ap-

proved for a maximum of 3.75AMA PRA Category 1 Credits.To register go to the Ohio AAP

Web site, www.ohioaap.org.

ideas from a non-medical per-spective.Based on the results of the

broad-based needs assessmentthat will be conducted in eachcommunity, curricula will be de-veloped, implemented, evalu-ated, and disseminated.The curricula will be developed

to address the needs of each com-munity. In some cases, radio ortelevision public service an-nouncements may be produced.Other ideas include: local cableaccess programming, brochures,growth charts, Web sites, Web-based seminars, community-based seminars and workshops,ongoing technical assistance, andquality improvement initiativesin health-care settings. Decisionson the content and the model ofpresentation will be made basedon analysis of data from thefocus groups.

The results will be shared withthe Ohio Department of Health,the Ohio Legislature, the gover-nor and his cabinet, members ofOhio AAP and the Ohio PrimaryCare Coalition, and the commu-nities themselves.Project Manager Dan Farkas

said that a model will be devel-oped that can be used statewideto:1) Heighten public awareness

of the early signs of autism.2) Improve access to develop-

mental screening, includingspecific screening for autism.3) Increase coordination of

medical diagnosis of autism, and4) Enhance access to evidence-

based intervention services forchildren with autism.To learn more about the project

contact Dan Farkas, Project Man-ager, at dfarkas@ohioaap.org orcall (614) 846-6258.

7

Ohio Pediatrics

www.ohioaap.org Ohio Pediatrics • Spring 2008

Visit the Ohio AAP’s new Web sitewww.ohioaap.org

Ohio Pediatrics • Spring 20088

Ohio Pediatrics

www.ohioaap.org

Recap of Athens Open Forum MeetingMore than 100 attendees gathered in Athens on the

Ohio University campus Feb. 8 for the Ohio AAP’sOpen Forum meeting.The audience consisted of school administrators,

school nurses, wellness educators, residents, pediatri-cians and even Early Education majors from the univer-sity.The audience discussed what they would you do to

increase awareness of early literacy and childhood obe-sity in their communities.

Early Literacy: Putting books into the hands of low-incomechildren, was presented by John Duby, MD, President ofthe Ohio AAP Foundation; Karen Montgomery-Reagan,DO, an Athens’ pediatrician and Reach Out and Readparticipant; and Heather Hall, Reach Out and and ReadOhio Coalition Leader.Attendees learned about the impact of early literacy

on school-aged children and their academic success, aswell as about the Reach Out and Read program and itsbenefits.Some of the suggestions to come out of that discussion

included: developing a resource list of how to get booksand how to donate books; recruiting retired teachers asvolunteer readers, partnering with universities for stu-dent volunteer readers; using the AARP database to re-cruit senior volunteers; conduct book exhanges; distri-buting ROR information at local libraries.Presenting the second panel, Healthy and Fit: What

pediatricians, parents, schools and communities can do, wereRobert Murray, MD, chair of Ohio AAP’s Home &School Health Committee, and director of the Center forHealthy Weight & Nutrition at Nationwide Children’s

Hospital; and Andrew Wapner, DO, Departmentof Pediatrics, Ohio University College of Osteopa-thic Medicine.This session addressed the steps physicians can

take to assist in creating community-based weightmanagement programs; discussed new legislationon nutrition, physical education and physicalactivity; and explained the Ounce of Preventionprogram.Ideas generated from this discussion included:1) Promoting tools such as the Ounce of Pre-

vention program to physicians to educate them onthe importance of nutrition and physical activity.2) Working with school systems to get nutrit-

ional information out to students and parents.These suggestions were taken to the Ohio AAP

Executive Board for consideration and action.

9www.ohioaap.org Ohio Pediatrics • Spring 2008

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(7) The toll-free number for VAERS forms and information is 1-800-822-7967 or visit the VAERS website at http://www.fda.gov/cber/vaers/vaers.htmDrug Interactions Immunosuppressive therapies, including irradiation, antimetabolites, alkylating agents, cytotoxic drugs and cor-ticosteroids (used in greater than physiologic doses), may reduce the immune response to vaccines. (See PRECAUTIONS, General.)For information regarding simultaneous administration with other vaccines refer to the ADVERSE REACTIONS and DOSAGE ANDADMINISTRATION sections. Carcinogenesis, Mutagenesis, Impairment of Fertility No studies have been performed with ADACEL vaccine to evaluate carcino-genicity, mutagenic potential, or impairment of fertility.Pregnancy Category C Animal reproduction studies have not been conducted with ADACEL vaccine. It is also not known whetherADACEL vaccine can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. ADACEL vac-cine should be given to a pregnant woman only if clearly needed. Animal fertility studies have not been conducted with ADACELvaccine. The effect of ADACEL vaccine on embryo-fetal and pre-weaning development was evaluated in two developmental tox-icity studies using pregnant rabbits. Animals were administered ADACEL vaccine twice prior to gestation, during the period oforganogenesis (gestation day 6) and later during pregnancy on gestation day 29, 0.5 mL/rabbit/occasion (a 17-fold increase com-pared to the human dose of ADACEL vaccine on a body weight basis), by intramuscular injection. No adverse effects on pregnan-cy, parturition, lactation, embryo-fetal or pre-weaning development were observed. There were no vaccine related fetal malforma-tions or other evidence of teratogenesis noted in this study. (8) Pregnancy Registry Health-care providers are encouraged to register pregnant women who receive ADACEL vaccine in Sanofi PasteurInc.’s vaccination pregnancy registry by calling 1-800-822-2463 (1-800-VACCINE). Nursing Mothers It is not known whether ADACEL vaccine is excreted in human milk. Because many drugs are excreted in humanmilk, caution should be exercised when ADACEL vaccine is given to a nursing woman. Pediatric Use ADACEL vaccine is not indicated for individuals less than 11 years of age. (See INDICATIONS AND USAGE.) For immu-nization of persons 6 weeks through 6 years of age against diphtheria, tetanus and pertussis refer to manufacturers’ package insertsfor DTaP vaccines. Geriatric Use ADACEL vaccine is not indicated for individuals 65 years of age and older. No data are available regarding the safetyand effectiveness of ADACEL vaccine in individuals 65 years of age and older as clinical studies of ADACEL vaccine did not includesubjects in the geriatric population.ADVERSE REACTIONS The safety of ADACEL vaccine was evaluated in 4 clinical studies. A total of 5,841 individuals 11-64 years ofage inclusive (3,393 adolescents 11-17 years of age and 2,448 adults 18-64 years) received a single booster dose of ADACEL vaccine.The principal safety study was a randomized, observer blind, active controlled trial that enrolled participants 11-17 years of age (ADACEL vaccine N = 1,184; Td vaccine N = 792) and 18-64 years of age (ADACEL vaccine N = 1,752; Td vaccine N = 573). Studyparticipants had not received tetanus or diphtheria containing vaccines within the previous 5 years. Observer blind design, ie, study per-sonnel collecting the safety data differed from personnel administering the vaccines, was used due to different vaccine packaging (ADA-

CEL vaccine supplied in single dose vials; Td vaccine supplied in multi-dose vials). Solicited local and systemic reactions and unsolicitedevents were monitored daily for 14 days post-vaccination using a diary card. From days 14-28 post-vaccination, information on adverseevents necessitating a medical contact, such as a telephone call, visit to an emergency room, physician’s office or hospitalization, wasobtained via telephone interview or at an interim clinic visit. From days 28 to 6 months post-vaccination, participants were monitoredfor unexpected visits to a physician’s office or to an emergency room, onset of serious illness and hospitalizations. Information regard-ing adverse events that occurred in the 6 month post-vaccination time period was obtained via a scripted telephone interview.Approximately 96% of participants completed the 6-month follow-up evaluation. In the concomitant vaccination study with ADACELand Hepatitis B vaccines, local and systemic adverse events were monitored daily for 14 days post-vaccination using a diary card. Localadverse events were only monitored at site/arm of ADACEL vaccine administration. Unsolicited reactions (including immediate reac-tions, serious adverse events and events that elicited seeking medical attention) were collected at a clinic visit or via telephone interviewfor the duration of the trial, ie, up to six months post-vaccination. In the concomitant vaccination study with ADACEL vaccine and triva-lent inactivated influenza vacciness local and systemic adverse events were monitored for 14 days post-vaccination using a diary card.All unsolicited reactions occurring through day 14 were collected. From day 14 to the end of the trial, ie, up to 84 days, only eventsthat elicited seeking medical attention were collected. In all studies, subjects were monitored for serious adverse events throughout theduration of the study. Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clin-ical trials of a vaccine cannot be directly compared to rates in the clinical trials of another vaccine and may not reflect the rates observedin practice. The adverse reaction information from clinical trials does, however, provide a basis for identifying the adverse events thatappear to be related to vaccine use and for approximating rates of those events.Serious Adverse Events in All Safety Studies Throughout the 6-month follow-up period in the principal safety study, serious adverseevents were reported in 1.5% of ADACEL vaccine recipients and 1.4% in Td vaccine recipients. Two serious adverse events in adultswere neuropathic events that occurred within 28 days of ADACEL vaccine administration; one severe migraine with unilateral facialparalysis and one diagnosis of nerve compression in neck and left arm. Similar or lower rates of serious adverse events were reportedin the other trials and there were no additional neuropathic events reported.Solicited Adverse Events in the Principal Safety Study The frequency of selected solicited adverse events (erythema, swelling, painand fever) occurring during Days 0-14 following one dose of ADACEL vaccine or Td vaccine were reported at a similar frequency inboth groups. Few participants (<1%) sought medical attention for these reactions. Pain at the injection site was the most commonadverse reaction occurring in 62-78% of all vaccinees. In addition, overall rates of pain were higher in adolescent recipients of ADA-CEL vaccine compared to Td vaccine recipients. Rates of moderate and severe pain in adolescents did not significantly differ betweenthe two groups. Rates of pain did not significantly differ for adults. Fever of 38°C and higher was uncommon, although in the ado-lescent age group, it occurred significantly more frequently in ADACEL vaccine recipients than Td vaccine recipients. (8) The rates ofother local and systemic solicited reactions occurred at similar rates in ADACEL vaccine and Td vaccine recipients in the 3 day post-vaccination period. Most local reactions occurred within the first 3 days after vaccination (with a mean duration of less than 3 days).Headache was the most frequent systemic reaction and was usually of mild to moderate intensity.Adverse Events in the Concomitant Vaccine StudiesLocal and Systemic Reactions when Given with Hepatitis B Vaccine The rates reported for fever and injection site pain (at the ADA-CEL vaccine administration site) were similar when ADACEL and Hep B vaccines were given concurrently or separately. However, therates of injection site erythema (23.4% for concomitant vaccination and 21.4% for separate administration) and swelling (23.9% forconcomitant vaccination and 17.9% for separate administration) at the ADACEL vaccine administration site were increased when co-administered. Swollen and/or sore joints were reported by 22.5% for concomitant vaccination and 17.9% for separate administra-tion. The rates of generalized body aches in the individuals who reported swollen and/or sore joints were 86.7% for concomitant vac-cination and 72.2% for separate administration. Most joint complaints were mild in intensity with a mean duration of 1.8 days. Theincidence of other solicited and unsolicited adverse events were not different between the 2 study groups. (8)Local and Systemic Reactions when Given with Trivalent Inactivated Influenza Vaccine The rates of fever and injection site erythe-ma and swelling were similar for recipients of concurrent and separate administration of ADACEL vaccine and TIV. However, pain atthe ADACEL vaccine injection site occurred at statistically higher rates following concurrent administration (66.6%) versus separateadministration (60.8%). The rates of sore and/or swollen joints were 13% for concurrent administration and 9% for separate admin-istration. Most joint complaints were mild in intensity with a mean duration of 2.0 days. The incidence of other solicited and unso-licited adverse events were similar between the 2 study groups. (8) Additional Studies An additional 1,806 adolescents received ADACEL vaccine as part of the lot consistency study used to support ADACEL vaccine licensure. This study was a randomized, double-blind, multi-center trial designed to assess lot consistency as meas-ured by the safety and immunogenicity of 3 lots of ADACEL vaccine when given as a booster dose to adolescents 11-17 years of ageinclusive. Local and systemic adverse events were monitored for 14 days post-vaccination using a diary card. Unsolicited adverseevents and serious adverse events were collected for 28 days post-vaccination. Pain was the most frequently reported local adverseevent occurring in approximately 80% of all subjects. Headache was the most frequently reported systemic event occurring in approx-imately 44% of all subjects. Sore and/or swollen joints were reported by approximately 14% of participants. Most joint complaintswere mild in intensity with a mean duration of 2.0 days. (8) An additional 962 adolescents and adults received ADACEL vaccine inthree supportive Canadian studies used as the basis for licensure in other countries. Within these clinical trials, the rates of local andsystemic reactions following ADACEL vaccine were similar to those reported in the four principal trials in the US with the exceptionof a higher rate (86%) of adults experiencing ‘any’ local injection site pain. The rate of severe pain (0.8%), however, was compara-ble to the rates reported in the four principal trials. (8) There was one spontaneous report of whole-arm swelling of the injected limbamong the 277 Td vaccine recipients, and two spontaneous reports among the 962 ADACEL vaccine recipients.Postmarketing Reports The following adverse events have been spontaneously reported during the post-marketing use of ADACELvaccine in other countries. Because these events are reported voluntarily from a population of uncertain size, it is not possible to reli-ably estimate their frequency or establish a causal relationship to vaccine exposure. The following adverse events were included basedon severity, frequency of reporting or the strength of causal association to ADACEL vaccine. General disorders and administration siteconditions: injection site bruising, sterile abscess; skin and subcutaneous tissue disorders: pruritus, urticaria. There have been sponta-neous reports of nervous system disorders such as myelitis, syncope vasovagal, paresthesia, hypoesthesia and musculoskeletal andconnective tissue disorders such as myositis and muscle spasms temporally associated with ADACEL vaccine.Reporting of Adverse Events The National Vaccine Injury Compensation Program, established by the National Childhood VaccineInjury Act of 1986, requires physicians and other health-care providers who administer vaccines to maintain permanent vaccinationrecords of the manufacturer and lot number of the vaccine administered in the vaccine recipient’s permanent medical record alongwith the date of administration of the vaccine and the name, address and title of the person administering the vaccine. The Act fur-ther requires the health-care professional to report to the US Department of Health and Human Services the occurrence followingimmunization of any event set forth in the Vaccine Injury Table. These include anaphylaxis or anaphylactic shock within 7 days;brachial neuritis within 28 days; an acute complication or sequelae (including death) of an illness, disability, injury, or condition referredto above, or any events that would contraindicate further doses of vaccine, according to this ADACEL vaccine package insert. (7) (9)(10) The US Department of Health and Human Services has established the Vaccine Adverse Event Reporting System (VAERS) toaccept all reports of suspected adverse events after the administration of any vaccine. Reporting of all adverse events occurring aftervaccine administration is encouraged from vaccine recipients, parents/guardians and the health-care provider. Adverse events follow-ing immunization should be reported to VAERS. Reporting forms and information about reporting requirements or completion of theform can be obtained from VAERS through a toll-free number 1-800-822-7967 or visit the VAERS website athttp://www.fda.gov/cber/vaers/vaers.htm. (7) (9) (10) Health-care providers should also report these events to PharmacovigilanceDepartment, Sanofi Pasteur Inc., Discovery Drive, Swiftwater, PA 18370 or call 1-800-822-2463 (1-800-VACCINE).DOSAGE AND ADMINISTRATION ADACEL vaccine should be administered as a single injection of one dose (0.5 mL) by the intra-muscular route. SHAKE THE VIAL WELL to distribute the suspension uniformly before withdrawing the 0.5 mL dose for administra-tion. Five years should have elapsed since the recipient’s last dose of tetanus toxoid, diphtheria toxoid and/or pertussis containing vac-cine. Do NOT administer this product intravenously or subcutaneously.STORAGE Store at 2° to 8°C (35° - 46°F). DO NOT FREEZE. Discard product if exposed to freezing. Do not use afterexpiration date. REFERENCES 1. CDC. General recommendations on immunization: recommendations of the Advisory Committee on ImmunizationPractices (ACIP) and the American Academy of Family Physicians (AAFP). MMWR 2002;51(RR-2):1-35. 2. CDC. Pertussis vaccina-tion: Use of acellular pertussis vaccines among infants and young children. Recommendations of the ACIP. MMWR 1997;46(RR-7):1-25. 3. CDC Update. Vaccine side effects, adverse reactions, contraindications and precautions - recommendations of theAdvisory Committee on Immunization Practices (ACIP). MMWR 1996;45(RR-12):1-35. 4. CDC. Update on adult immunization:recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1991;40(RR-12):1-52. 5. CDC.Diphtheria, tetanus and pertussis: recommendations for vaccine use and other preventive measures. Recommendations of theImmunization Practices Advisory Committee (ACIP). MMWR 1991;40(RR-10):1-28. 6. CDC. Use of vaccines and immune globu-lins in persons with altered immunocompetence. Recommendations of the Advisory Committee on Immunization Practices (ACIP).MMWR 1993;42(RR-4):1-18. 7. CDC. Current trends - Vaccine Adverse Event Reporting System (VAERS) United States. MMWR1990;39(41):730-3. 8. Data on file at Sanofi Pasteur Limited. 9. CDC. Current trends - national vaccine injury act: requirements forpermanent vaccination records and for reporting of selected events after vaccination. MMWR 1988;37(13):197-200. 10. FDA. New reporting requirements for vaccine adverse events. FDA Drug Bull 1988;18(2):16-8.

Ohio Pediatrics

Ohio Pediatrics • Spring 200812 www.ohioaap.org

Ohio AAP welcomes new membersSheila AArmogida, MD, FAAP,ClevelandMoises Auron-Gomez, MDFAAP, Middleburg Hts.John Patrick Bacon, MD, FAAP,CincinnatiCarrie Bohenick, MD, FAAP,Broadview HeightsKrista Elizabeth Carter, MD,FAAP, MainevilleLaura Ann Caserta, MD, FAAP,Shaker HeightsMichael Sean Dell, MD, FAAP,Shaker HeightsAlex R. Dubin, MD, FAAP,New Albany

Jennifer Shine Dyer, MD, FAAP,ColumbusKimberly Anne VolpenheinEilerman, Columbus,Fathalrahman A. Elamin,YoungstownRashed A. Hasan, MD, FAAP,Birmingham, MIStephen J Hersey, MD, FAAP,Columbus,Edward J. Kosnik, MD, FAAP,ColumbusSteven Lee, MD, FAAP, MarinoRonald Stewart Levin, MD,FAAP, CincinnatiDavid Joel Mansour, MD, FAAP,

WestlakeCheryl Morrow-White, MD,FAAP, Cleveland Heights,Lars Ulf Werner Muller, MD,FAAP, CincinnatiCarla Maria Pruden, MD,CincinnatiSatesh Kumar Raju, ColumbusVidya Bijavara Ramakrishi, MD,FairbornVidya Kumar Ramanatha, MD,Ottawa HillsGresham T. Richter, MD,Cincinnati

See New Members...on page 19

Ohio Pediatrics

www.ohioaap.org Ohio Pediatrics • Spring 2008 13

Care Council...from page 5

Golfers tee up for Tartan FieldsAre you interested in golfing at Tartan Fields Golf

Club in Dublin, Ohio? Then you need to mark yourcalendar for the second annual Ohio AAP Founda-tion Golf Outing on Tuesday, Sept. 16. The best ballscramble will begin at 1 p.m., followed by a receptionand awards ceremony when play is finished.Individuals can participate for $190 each, or if you

register a foursome, cost is $175 per person ($700 forthe foursome). Registration fee includes greens fees,golf cart, reception and prizes.Proceeds benefit the Ohio AAP Foundation and the

Foundation’s three major initiatives – Reach Out andRead Ohio, Unfunded CATCH Grants and ChapterInitiatives which are determined by the Foundationand the Ohio AAP Chapter.Register online at www.ohioaap.org or contact

Heather Hall, Development Officer, at hhall@ohioaap.org or (614) 846-6258.

school-age children when indi-cated, and for screens for emo-tional and behavioral issues.Members asked whether this

developmental screening belongswithin the routine work of a well-child visit or an E/M visit fo-cused on a behavioral/develop-mental problem. It turns out thatthe RVU for this code – 0.36, doesnot include a component for phy-sician work. In other words, thecode, which had a 2007 Medicarevalue of $13.64, is designed tocapture the administration andscoring of a brief standardizedquestionnaire by office staff. It isthe physician response to the re-sults that is included in the well-visit or in the E/M visit code.The Chapter will meet again

with medical directors of insur-ance plans in May.

– Jon Price,Chair, Pediatric Care Council

Booster seat survey conductedMembers of the Ohio AAP Section on Injury Prevention will

survey 350 pediatricians throughout the state to determine thebarriers to providing booster seat education to families in apediatric practice. This study juxtaposes the legislation at handwith House Bill 320.The Ohio AAP Injury, Violence and Poison Prevention

Committee has been actively working to get the Booster Seatlegislation passed in Ohio.In the survey, pediatricians will be asked the amount of time

spent at each patient encounter educating families about boosterseats; their comfort zone about discussing booster seats withfamilies; how much more they discuss this issue now ascompared to when they first started to practice; and whatresources could enable them to discuss booster seats with theirpatients more efficeiently and effectively.The purpose of the study is to identify what barriers pediatri-

cians face in discussing appropriate booster seat use with theirfamilies and to determine what interventions could be put intoplace to overcome these barriers so that more families can beeducated about this issue.Once the survey results are tabulated, the Ohio AAP will work

with the Committee on Injury Prevention to craft an appropriateprogram and/or materials to deal with this issue.

(See related story on Page 4)

During a respite from the win-ter snow, representatives fromReach Out and Read (ROR) co-alitions across the country met inWashington D.C. on Feb. 27 toask for support from each state’slegislators for current and futureROR Funding. In one day, morethan 230 meetings were held, in-cluding meetings with Ohio Sen.Sherrod Brown, Sen. GeorgeVoinovich, Rep. David Hobson(17th District), Rep. Ralph Reg-ula (16th District), Rep. PatrickTiberi (12th District) and Rep.Charles Wilson (6th District).ROR relies on federal funding

to provide books and support to

more than 3,600 clinics and hos-pitals implementing the pro-gram, reaching more than 25% ofAmerica’s at-risk children. In

Ohio, ROR is currently found innearly 115 sites, serving morethan 111,000 children.In FY 2005, ROR received a $10

million appropriation with theunderstanding the money was to

be used for expansion. Since thattime, ROR has expanded bynearly 50%, but funding hasbeen reduced to less than half –an average of $4.6 million ineach of the past three years.Without this funding, ROR

may be forced to significantly re-duce book funding for children.Fortunately, ROR Ohio has re-ceived state funding through theOhio Department of Job & Fam-ily Services to support sites pur-chasing books.For more information please

contact, Heather Hall, ROR OhioCoalition Leader at hhall@ohioaap.org, or (614) 846-6258.

Ohio Pediatrics

14 www.ohioaap.orgOhio Pediatrics • Spring 2008

ROR requests support from Capitol Hill

Advertisement

15www.ohioaap.org Ohio Pediatrics • Spring 2008

Ohio Pediatrics

16 Ohio Pediatrics • Spring 2008 www.ohioaap.org

JoinPediatricianson Call –Today!

Frustrated by health-carepolicy in Ohio? Interested inmaking a difference in the livesof children across the state?Sign up to be a pediatrician oncall.

Ohio AAP is excited to kickoff a new advocacy program,“Pediatricians on Call.” Byforming a group of activepediatricians interested infostering relationships withkey health policymakers andadvocating for laws and rulesthat benefit pediatrics, OhioAAP can help make a differ-ence in children’s lives.When you sign up, you

will receive e-mail sugges-tions for identifying and get-ting to know your legislatorsand, when necessary, we willask you to contact your leg-islator to share our positionon a specific issue. We alsomay seek your help inidentifying other pediatri-cians interested in joiningPeds on Call. We will respectyour time and will beselective in our requests andcommunications.Please go to www.ohioaap.

org then see “Peds on Call”to sign up today.Questions? Please call Ohio

AAP at (614) 846-6258, or ourgovernment relations consul-tant, Tracy Intihar, at (614)224-3855.

What is the Ohio AAPFoundation?The Ohio AAP Foundation was

established in 2000 as a 501c3tax-exempt foundation to sup-port the mission and vision ofthe Ohio Chapter, AmericanAcademy of Pediatrics (AAP).The ever changing focus of theFoundation is driven by the stra-tegic plan and goals of the OhioAAP.As the charitable arm of the

Ohio AAP, the Foundation hasthree major initiatives:Chapter Initiatives – Current-

ly, three major programs that theChapter is continuing to expandare immunization education andawareness; behavioral healthawareness, screening and refer-rals; and the development of ayoung female symposium forparents and medical care pro-viders of pre-adolescent girlsbetween 8-12 years old.Reach Out and Read Ohio – A

national early literacy programthat provides books to low-in-come children at well-child visitsfrom the ages of six months to 5years old so that these childrengrow up with books and a love

of reading.Unfunded CATCH Grants –

The Community Access to ChildHealth (CATCH) Program is anational AAP program designedto improve access to health careby supporting pediatricians andcommunities that are involved incommunity-based efforts for chil-dren. The Foundation is dedi-cated to providing assistance tothose CATCH grants which havebeen approved by national AAP,but are unfunded.In 2008, the Ohio AAP Foun-

dation will host three fund-rais-ing events – Breakfast For Bookson May 30 at the Fawcett Centerwhich benefits Reach Out andRead Ohio; the Ohio AAP Foun-dation Golf Outing on Sept.16 atTartan Fields; and a wine raffle atthe Ohio AAP Annual Meetingon Nov. 7 at Cherry Valley Lodge– in an effort to raise funds andawareness for the Foundationand its initiatives.For more information, contact

Heather Hall, Development Of-ficer, at (614) 846-6258 or hhall@ohioaap.org.

Legislation... from page 2

• Requirement that health in-surers offer to cover dependentchildren beyond the insurer's nor-mal age limitations until the ageof 29 if the child is in college andotherwise uninsured, and;• Nutrition standards for

schools.The bill is in early stages of legis-

lative consideration and will be apriority bill for Ohio AAP thisspring.

– Dan JonesOhio AAP Lobbyist

Ohio Pediatrics

www.ohioaap.org 17Ohio Pediatrics • Spring 2008

What will the profession of pe-diatrics look like in the year 2020?What is the future of pediatrics?Anyone who is practicing

pediatrics knowsthat the profes-sion of pediatricshas changed dra-matically in thelast 15 years.The acute in-fectious diseasesthat we diag-nosed andtreated aredisappearing as a result of ournew vaccines. The patients whoremain in the hospital often havecomplex medical illnesses. Whenhospitalized, chronically ill chil-dren are discharged for follow-upin office settings, office structuresare not designed to care for thelong visits. We have few tools tocoordinate care with schools andancillary health-care providers.Families are begging us for helpfor depression anxiety andADHD. We must retrain our-selves so that we can treat psy-chosocial concerns effectively.Payer systems pay for volume ofchildren seen over time spentwith children. We need to addressthese issues now so that pedia-trics as a profession will thrive inthe future.The demographics of our pop-

ulations have changed. There aresizeable immigrant populations inour country. The families arestruggling with English, and wehave trouble making sure that weare communicating in a way thatthe families can follow our direc-

District V Report

Ellen Buerk, MD

tions. In the future families andproviders will work as teams tocare for children.Electronic medical records will

be the tool of the future to man-age our patients, and assure thatwe are standardizing care to ourpatients.As part of the Strategic Priority,

the Vision of Pediatrics 2020, TheAAP will examine the trends thatare driving the transformation ofpediatric care. We will developan action plan that outlines thesteps we need to take to developthe skills we need to care for thepatient of the future. We willlook at critical elements of ouroffice structure and systems thatwe will need to manage the careof the future. We will developstrategies for sustainable fundingthat favors time as well as vol-ume. We will look at the role ofpediatrics as an integral part of

the community.How does a practitioner retrain

himself for the diseases and med-ical trends that emerge by 2020and beyond? We must have aplan of lifelong learning toaddress the future gaps in ourknowledge base. Just as we aredeveloping the skills that weneed to treat ADHD, anxiety anddepression, we will have newchallenges in the office such asunderstanding geneomics andepigenetics, and we mustdevelop a system to learn aboutnew challenges.The pediatrician of the future

will look differently than thepediatrician of today. How canwe vision the future and plan sothat we thrive in the enviromentof tomorrow? Stay tuned!

– Ellen Buerk, MDDistrict V Chair

Pediatricians need to retrain themselves

New ROR Ohio sitesReach Out and Read Ohio

would like to welcome the fol-lowing new sites:Akron Children’s Hospital

C.A.R.E. Center, Stark County– AkronAkron Children’s Hospital St.

Elizabeth’s Boardman Campus– BoardmanAthens City/County Health

Department – AthensNortheast Ohio Neighbor-

hood Health Services, Inc. Su-perior Health Center – Cleve-

landPerrysburg Pediatrics –

PerrysburgJudith T. Romano, MD –

Martins FerrySalud Community Clinic –

Tipp CityYoungstown Community

Health Center – YoungstownFor more information about

becoming a ROR site contact,Heather Hall, ROR Ohio Coa-lition Leader at hhall@ohioaap.org, or (614) 846-6258.

Ohio Pediatrics

18 Ohio Pediatrics • Spring 2008 www.ohioaap.org

Medicaid providers toreceive 3% increaseOhio pediatricians who are

Medicaid fee-for-service provi-ders will receive a reimburse-ment increase of 3% starting July 1.Thanks to the efforts of the

Ohio AAP Chapter, Ohio individ-uals who need it most will re-ceive the care they need.When it was announced last

November that the fee increasewould be frozen due to Medicaidfunding concerns, the Ohio AAPChapter actively began workingto restore the funding.Ohio AAP Executive Director

Melissa Arnold, Ohio AAP Chap-ter President William Cotton,MD, and Ohio AAP LobbyistDan Jones, met with Gov. Strick-land’s administrative staff to re-quest that the 3% increase be re-stored. The Ohio AAP Chaptervoiced its concerns to the gover-nor’s staff regarding the impactthis would have on Medicaidpatients’ access to care.With expanding the coverage

of children in Ohio to 250,000 ofthe family poverty level, withoutincreasing reimbursement, therewouldn’t be enough providers toserve the children.Ohio AAP leaders also men-

tioned to the governor’s officethat this would be the first in-crease in seven years!For Medicaid Managed Care

providers, they will receive theincrease if their contracts are tiedto the fee-for-service schedule.The process to get the fee

increase started back in July 2007when Medicaid invited physi-cians from around the state in-cluding Ohio AAP leaders

President William Cotton, MD,and President-Elect Terry Barber,MD and pediatricians thatMedicaid had a long-time re-lationship with like RichardTuck, MD, to the table to offerinput about the proposed Medi-caid reimbursement increase.Molly Michael, manager of

Physician Services at Medicaid,said, “We only had so muchmoney and we needed feedbackfrom these physicians as to thebest way to implement the in-crease.” The Ohio pediatriciansalong with family practitionerswere presented several modelsthat Medicaid had developedand were asked how theythought the money would bebest spent. The physicians agreedthat the focus needed to be onseeing patients rather than proce-dures.Instead of applying the in-

crease across the board to allhealth procedural codes, Medi-caid took the advice of the pedia-tricians and focused the moneyon increasing the codes related toprimary care, neonatal care andemergency department services.Ohio AAP leaders were told

that part of the reason the gover-nor’s office reinstated the in-crease was because pediatricianswere terrific advocates in ex-plaining access to care and itsties to the increased reimburse-ment.

Ohio AAPwelcomesnew staffmemberDan Farkas is the newest

member of the Ohio AAPstaff. Joining the staff inFebruary.As Project Manager for

the Autism Diagnosis Edu-cation Pilot Project, Dan willcoordinate the efforts of themedical team with localcommunity members tocreate improved education,diagnosis, and care for chil-dren with autism.Dan will also oversee day-

to-day management of theproject's administration andbudget, which is funded bythe Ohio Department ofHealth's Bureau of Early In-tervention Services. Danwill be working closely withJohn Duby, MD, medicaldirector of the progam.A native of Centerville,

who graduated from OhioUniversity, Dan has traveledthe nation over the pastdecade working as a newsreporter and anchor. Hismost recent stop was atWBIR in Knoxville,Tennessee.Those wanting to learn

more, or participate, in theautism project should con-tact Dan Farkas, ProjectManager, at dfarkas@ohioaap.org or call (614)846-6258.

Ohio Pediatrics

www.ohioaap.org 19Ohio Pediatrics • Spring 2008

Would you like to donateitems to the Ohio AAP

Foundation?Your tax-deductibledonation will be put

to good use at raffles andsilent auction events.

Contact Elizabeth Kelleherat

ekelleher@ohioaap.orgor

call 614-846-6258

The Ohio Department ofHealth’s Impact Statewide Im-munization Information System(SIIS), has reached a milestone.Within six years, Impact SIIS hasmore than 30 million unique un-duplicated immunization histor-ies available to authorized usersvia the Web. The 30 millionthrecord was received via an elec-tronic file from Lakewood CityHealth Department.Approximately half of all im-

munization history records inImpact SIIS come from otherdata systems. The facility thatmanually entered the next shotdirectly into Impact SIIS was Na-tionwide Children’s Close toHome in Whitehall.Facilities that use Impact SIIS

interactively have immunizationrates 15-20% higher than thosesites submitting data electroni-cally.Impact SIIS success has been

achieved by all the hard work ofparticipating private physicians,hospitals and public health facili-ties. More than 55% of children0-6 years of age in urban areashave two or more immunizationhistories in Impact SIIS and morethan 71% of children 0-6 years ofage have two or more immuniza-tion histories from rural counties.Impact SIIS is free, including

free reminder/recall notices.For more information, contact

Robyn Taylor at ODH at (614)752-4488.

Members... from page 12Alaba Devonne Robinson, MD,CincinnatiPaul M. Saluan, MD, FAAPHinckleyJennifer Anne Setlik, MD,CincinnatiSusan Spaeth Shah, MD, FAAPTwinsburgJeffrey Michael Simmons, MD,FAAP, WyomingGregory Louis Simpson, MD,Shaker HeightsLisa Simpson, MD, CincinnatiOliver S. Soldes, MD, ClevelandCharles H. Spencer, MD,ColumbusS. Andrew Spooner, MD,Cincinnati

Richard John Sterba, MD,ClevelandKristin Marie Stout, MD,ColumbusArnold W. Strauss, MD,CincinnatiDennis Michael Super, MD,FAAP, ClevelandSachin Thakur, MD, PerrysburgChristina Jensen Valentine, MD,FAAP, BexleyKendall Vermilion, MD, DaytonChet Ridall Villa, MD, ClevelandSreekanth Viswanatha, MD,ClevelandShernaz Aspi Wadia, MD,CopleyJoshua Robert Watson, MD,

ColumbusStephanie M. Weckesser, MD,NorthwoodDaniel D. Wei, MD, ClevelandNichole Elizabeth Wilcox-Collum, MD, AkronP. Cooper White, MD, ShakerHeightsLaura S. Wills, MD, CincinnatiTyree M.S. Winters, MD, DublinSharice Natasha Wood, MD,CincinnatiTai-Wei Wu, MD, CincinnatiMichael Sunghun Yi, MD, FAAPCincinnatiKenneth G. Zahka, MD, FAAPClevelandHana I. Zibdeh, MD, Columbus

Impact SIIS records morethan 30 million histories

The Ohio AAP announces the following meetings.

May 14, 2008 – Ohio AAP Open ForumToledo, OH

May 14, 2008 – Ohio AAP Executive BoardToledo, OH

May 30, 2008 – Breakfast for BooksFawcett Center, OSU Campus

July 25, 2008 – Ohio AAP Executive BoardOhio AAP Conference Rm., Worthington

Sept. 16, 2008 – Foundation Golf OutingTartan Fields, Dublin

Nov. 7-8, 2008 – Ohio AAP 2008 Annual MeetingCherry Valley Lodge, Newark

Nov. 8, 2008 – Ohio AAP Executive BoardCherry Valley Lodge, Newark

Nov. 13-14, 2009 – Ohio AAP Annual MeetingGreat Wolf Lodge, Cincinnati

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For more information, pleasecall 614-846-6258

Ohio ChapterAmerican Academy of Pediatrics450 W. Wilson Bridge Rd.Suite 215Worthington, OH 43085

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