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Daily Dose

World Health Organization Virus Alert!

1.15 to read

An article in the news caught my eye today when I noticed that The World Health Organization (WHO) called an emergency meeting to discuss the infectious disease known as MERS (Middle East Respiratory virus, formerly known as nCoV).   This is only the second time that the WHO has called an emergency meeting, the first being in 2009 with the H1N1 bird flu virus.

While the name is complicated the biggest issue is that this VIRUS has only been identified in the past year. It was identified in 2012 as a “novel coronavirus” and is similar to the SARS virus from a decade ago.  This virus which also causes a respiratory illness has been confirmed in 55 patients mainly from the Middle East.  There have been a few cases reported in travelers from other countries ( France, UK, Italy and Tunisia) who had been to the Middle East.  Saudi Arabia has had 40 reported cases.  The alarming fact is that 31 of the 55 cases have died.

Now you may wonder why this really interests me???  I am always interested in emerging infectious diseases and how this infection might make its way to the U.S. as all doctors need to stay abreast about new infections.   But, coincidentally, I have just returned from overseas and 2 days later, I have an upper respiratory infection and cough. Now, I really do FEEL OKAY but as I have reminded people before infectious diseases are just a plane ride away.  You can never really know how you may contract a viral illness and the MER-S virus has been found to have human-to-human transmission. 

The WHO still does not know the original source or route of the virus that caused human illness.   This again reiterates the importance of vaccines and disease prevention!!!! While there is not a vaccine (to date) for MERS, there are plenty of vaccines that when given are working well to prevent communicable diseases.  (another reason to vaccinate your child!)

So.....I am going to be watching for further updates from the WHO and CDC about this virus......and in the meantime I will keep drinking fluids, and covering my mouth when I cough. I will say my trip was really fun!!    

Daily Dose

Dealing With Dog Bites

What should you do if your child is bitten by a dog? I received an email via our iPhone App from a mom who was very worried after her daughter had been bitten by a friend's dog.  This is a common concern/query to the pediatrician.  In fact, one of my own children was severely bitten by a friend's dog, but I had somehow forgotten that experience and the 20 stitches to his face!

Tincture of time is the best remedy for many things. At any rate, I looked at the CDC's website to find that there are over 5 million dog bites a year and about 800,000 require medical attention. No wonder the health care system is overflowing! This mother was concerned as to what was the appropriate treatment. Her daughter's bite was on the face (very common for a child) but small. It did break the skin. The first thing a parent should do is to stop the bleeding by applying pressure. Then, clean the area with warm water and soap. Dogs, like humans, have dirty mouths, so you want to wash and rinse well and even flush out the wound if it is deep. If the bite wound is small, it is usually not sutured, as this may increase the risk for infection. On the other hand, facial wounds, and larger bites have to be well cleansed and irrigated, and may require suturing. The sooner this can be accomplished the better. For a child with a dog bite that has broken the skin, most pediatricians would recommend a 7-day course of an antibiotic, typically Augmentin (unless the child is penicillin allergic). Rabies is usually not a risk in dogs that are family pets and in homes. If the dog is not known or their rabies status is unclear and you cannot find the dog, check with your pediatrician about rabies prophylaxis. Lastly, you want to ensure minimal scarring by using a topical vitamin E cream on the healed skin and sunscreen. The less the sun exposure, the less scarring, especially if the face is involved.  That really goes for all cuts and scars. That's your daily dose, we'll chat again tomorrow. Send your question to Dr. Sue!

Daily Dose

Keep Your Athletes Hydrated On and Off the Field

With summer heat in full swing all across the country and kids heading back to school athletics, band practice, drill team and the like it is a good time to discuss heat related illnesses and their prevention.

It is always at this time of year that I begin worrying about heat exhaustion and heat stroke and I find myself re-emphasizing the importance of maintaining hydration, even before you start back to outside activities. The Centers for Disease Control and Prevention reported 3,442 deaths between 1999-2003 due to heat and exposure to elevated temperatures, while children under 15 years of age accounted for approximately 7% of the total deaths. Among high school athletes, exertional heat stroke is the third leading cause of death and is often related to lack of acclimation to the heat and dehydration. You can’t just head out to run three miles in the heat or work out in pads or march in the band on the hot field without preparing ahead of time. Heat exhaustion occurs when the core body temperature is elevated between 100.4 and 104 degrees. This is different than having a fever secondary to illness. Symptoms are typically non-specific but include muscle cramps, fatigue, thirst, nausea, vomiting and headaches. The skin is usually cool and moist from sweating and is indicative that the body’s cooling mechanism is working. The pulse rate is rapid and weak and breathing is fast and shallow. Coaches, athletes and others should all be aware of these symptoms. This is the body saying, “I am overheated” and don’t keep going! (You would not drive your car when overheated; you pull over, and at least add water.) The mainstay of treatment is to prevent progression to heat stroke by moving to a cooler place, in the shade, air conditioning etc. Remove as much clothing as possible (uniforms, pads, helmets etc) to help heat dissipation. Water misting fans may be helpful. Begin rehydration with appropriate oral electrolyte solutions and water. When treated quickly and appropriately, symptoms usually resolve in 20 -30 minutes. The child should not return to activities that day, and should avoid heat stress for several days. Heat stroke is a MEDICAL EMERGENCY and will require transportation to the ER for aggressive treatment. In this case the previous symptoms have been missed and the core body temperature rises to 104 degrees or greater. The skin is flushed, hot and dry from lack of sweating. The athlete is confused, or even unconscious. The heart rate is fast and there is hyperventilation. The blood pools away from vital organs and can result in encephalopathy, liver, kidney and multiple organ failure. While awaiting transportation to the ER the athlete should be moved to a shaded area, clothing removed and ice packs may be applied to surface areas overlying major vessels, (i.e. the neck, beneath the arm pits, and the groin). Cooling and misting fans may also be used. Continue to educate your children about the need for hydrating the evening prior to events, and for continuous hydration while exercising in the heat. They should know to drink fluids even when not thirsty, as once you become thirsty you are already behind in your fluid intake. With good education, and recognition of early signs over overheating heat related illnesses are preventable. That’s your daily dose, we’ll chat again soon! Send your question to Dr. Sue!

Daily Dose

Testing Your Child's Lead Levels

It is estimated that about 1.5% of U.S. children have high blood lead levels.I received an email via our iPhone App from a mom who was concerned about lead poisoning. Ironically, it came at a time when I was reading an article on reducing lead exposure in children.

Despite awareness of the risks to young children who have lead exposure and changes in regulatory policies regarding lead in gasoline, paint, plumbing components and food cans, it is still estimated that about 1.5% of U.S. children have blood lead levels greater than 10mcg/dL which is considered high, while almost 14% of children had lead levels of 5-9mcg/dL. You should be aware of the mounting evidence that there may be subtle effects on IQ at lead levels within these ranges. One of the problems is there is not a uniform policy on who (which children) and when to screen for lead exposure. The Centers for Disease Control and Prevention states that states should develop policies based on their data of lead exposure. They also recommend universal screening for newly arrived refugee children from six months to 16 years old. Federal guidelines require that all children enrolled in Medicaid be screened. But many states do not recommend routine lead screening, and I am sure many parents are not clear on their state's guidelines, as they do not make front-page news. The American Academy of Pediatrics recommends universal screening if there are not state guidelines. This screening is recommended at 12 and 24 months of age, so basically at your child's one and two year checkup. This timing is chosen as it reflects historical data of blood lead levels peaking at this age, when children are putting everything into their mouths. We routinely screen our patients at their one and two year old visit and surprisingly find several per year in the 5 - 10 mcg/dL level and on a rare occasion on in the teens. The majority has levels under 5mcg/dL. Ask your doctor if your child has been screened. It is an easy test and may be another number worth knowing. That's your daily dose, we'll chat again tomorrow. Send your question to Dr. Sue!

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Daily Dose

More Updates on the Swine Flu Vaccine

This week the U.S. Department of Health and Human Services announced that the first doses of H1N1 vaccine will not be available until mid-October and there will be far fewer doses initially than expected.I know everyone is still concerned about H1N1 (swine flu) and I want to keep updating the information as it is available. This week the U.S. Department of Health and Human Services announced that the first doses of H1N1 vaccine will not be available until mid-October and there will be far fewer doses initially than expected. Only about 45 million doses will be available at that time, with another 20 million doses produced weekly, until the 195 million doses that were ordered are completed.

As discussed previously, making a new vaccine is a difficult process, and despite the fact that “swine flu” is easily spreading within communities, it has been more difficult to grow enough “lab virus” for vaccine production. It is due to this that vaccine production is about 50 percent of what was initially expected. I continue to get questions as to how the vaccine will be distributed, how many doses will be needed etc. Most of this information is not yet available and should be forthcoming in the next several weeks as the preliminary trials on vaccine efficacy are completed. It does appear that the “swine flu” vaccine will probably require two shots that are separated by at least three weeks. It also takes several weeks post vaccination to produce antibodies to prevent infection. Unfortunately, you are not immune the minute the needle is inserted! The logistics of providing the immunizations have not been worked out, and different communities may provide vaccine in different ways. Some state and local health departments may provide school based vaccine clinics, but again that decision may vary. With school just around the corner the concern is that the vaccine may be too late to halt outbreaks as “swine flu” has continued to be diagnosed throughout the summer months and will probably become more prevalent within weeks of school resuming. The concern is that school aged children seem to be the most vulnerable, with the median age for infection being 12 – 17 years. The symptoms of “swine flu” resemble those of seasonal influenza and one type of flu does not prevent the other. In other words, this could be a very long flu season with successive illnesses with different influenza viruses. For now the best advice is to get your seasonal (regular) influenza vaccine, which is already available in both injectable and intranasal formulations. This is not a good year to “miss” your seasonal flu vaccine as it is still the best protection there is for “regular flu”. This vaccine is recommended for ALL children between the ages of six months and 18 years. (See previous links for more details about recommendations for others). Remember the seasonal flu vaccine does not prevent H1N1 (swine flu) and vice a versa. This is going to be a long and complicated flu season, so stay tuned for more information. That’s your daily dose, we’ll chat again soon!

Daily Dose

Recommendations On Who Should Get a Swine Flu Vaccine

I thought it was a good time to re-iterate the recommendations as to who will be prioritized to receive the novel H1N1 (swine flu) vaccine this fall.With more swine flu in the news and the story continuing to evolve I thought it was a good time to re-iterate the ACIP recommendations as to who will be prioritized to receive the novel H1N1 (swine flu) vaccine this fall. The CDC (Centers for Disease Control and Prevention) and ACIP (Advisory Committee on Immunization Practices) are hopeful that a novel H1N1 vaccine will be available by early this fall. They are expecting that when the vaccine becomes initially available (it is currently in clinical trials) there may be a limited supply. The CDC does not expect there to be a shortage of vaccine over the course of the winter but supplies may be limited as production first begins.

There are five key populations that are recommended to receive vaccine when first available:

  • Pregnant women
  • People who live with or care for children younger than six months of age
  • Health care and emergency services personnel
  • Persons between the ages of six months through 24 years of age
  • People from ages 25
Daily Dose

Top Health Risks for Young Adults

When I think of the youth of today, we tend to think they are pretty healthy, but the reality is that our youth are facing numerous health issues now that will have long term consequences as they grow older.The CDC (Centers for Disease Control and Prevention) recently issued a health report entitled "Top Health Risks for Young Adults". When I think of the youth of today, we tend to think they are pretty healthy, but the reality is that our youth are facing numerous health issues now that will have long term consequences as they grow older.

This report was geared at the young adult ages 18 - 29, but many of the same issues are facing even younger children. The leading cause of death for young adults is unintentional injuries, which killed 40/100,000 young adults in 2005. These injuries are often traffic fatalities, many associated with drinking and driving and even under age drinking and driving. There are over 1,700 deaths per year due to binge drinking. The list of injuries is extensive as these are years for risk taking behaviors. Teens and young adults feel invincible, and the party line is usually, "this won't happen to me!" These topics should be discussed over and over again with our children beginning at young ages. The more they hear the better. Obesity was also on the list. As we all know obesity is skyrocketing in this country. The statistics are daunting and the obesity rates for young adults tripled between the 1970's and 2005-2006. With the economic problems we are all facing, more families may be making less healthy choices due to the cost of food. A box of macaroni and cheese is far less expensive than grilled chicken breasts, but the long-term consequences may be far more lasting. The statistics for younger children are not encouraging either. We the parents must make better food choices for ourselves and our children in order to combat an epidemic of obesity and health related issues such as diabetes, high blood pressure and heart disease. Exercise is also necessary for overall good health and only 36% of young adults get regular exercise, and only 26% report strength training at least twice/week. Our older school age children are also not meeting goals for exercise, as many schools no longer require P.E. credits or daily gym class. How many kids "pick" gym class if it is not required, especially if they are already having weight problems and therefore may be embarrassed to exercise while at school? Lastly, smoking!! In 2006, 29% of men and 21% of women ages 18 - 29 were smokers. Most of them report that they began smoking at a much younger age. The conversation about smoking in adolescence needs to be reinforced with our children. Nicotine is addictive and the media continues to show smoking without showing any of the horrible consequences of smoking: cancer, emphysema and death. So, happy spring, we can all get out and exercise and enjoy cookouts during the nice spring weather. The family as a whole will benefit. That's your daily dose, we'll chat again soon. More Information: Centers for Disease Control and Prevention

Daily Dose

Changes in Flu Immunizations for Children

Flu season is fast approaching and that means it is time to get your flu vaccine. Recently the Centers for Disease Control and Prevention and the American Academy of Pediatrics expanded the recommendation for flu vaccination to include all children ages six months to 18 years.

The previous recommended age group was 6 months to 5 years. "Children under nine years of age who have never received a flu vaccine need to have two doses of vaccine separated by at least four weeks, and all other children receive a single dose," says pediatrician Dr. Sue Hubbard. That means the time is now for you to call and schedule a flu shot with your doctor and your child's pediatrician. Many offices block off certain times during the day in which they have "flu shot clinics." According to Dr. William Schaffner, president-elect of the National Foundation for Infectious Diseases there is an ample supply of the flu vaccine this year. He encourages people to start taking it now as there is no reason to wait. "There are two options for children older than two: the injectable flu vaccine or the live attenuated flumist intranasal vaccine. There are some restrictions to intranasal vaccine (children with asthma, immuno-suppressed children) but for many children the idea of sniffing a vaccine is far better than a SHOT. The upside of the nasal vaccine is also that it seems to be more effective," says Dr. Hubbard. "Either way, start thinking about getting on your doctors schedule to get vaccinated before the winter and influenza hits." Dr. Hubbard also recommends that you teach your child to practice good hand and cough hygiene to help prevent the spread of germs. More Information: The American Academy of Pediatrics More Information: Centers for Disease Control and Prevention

Parenting

Health Official: Zika Outbreaks Likely in U.S.

2:00

The United States can expect to see outbreaks of the Zika virus says Dr.Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases.

While the U.S. has already seen more than 350 cases of people who were infected abroad and returned to the country, there haven’t been any recorded cases of someone infected within its borders. But those days may be limited, said Fauci.

"It is likely we will have what is called a local outbreak," he said on Fox News Sunday with Chris Wallace.

Since being detected in Brazil last year, the virus has spread through the Americas. It has been linked to thousands of cases of microcephaly, a typically rare birth defect marked by unusually small head size, which often indicates poor brain development. The World Health Organization declared a global health emergency in February.

Zika, which is spread by mosquitoes and through sexual contact, can give adults the paralyzing Guillain-Barre syndrome. The Aedes aegypti mosquito, which primarily transmits disease, is already present in about 30 U.S. states.

While Fauci does expect someone to be bitten by the mosquito here in the States, he does not expect a large number of people to become ill.

"It would not be surprising at all - if not likely - that we're going to see a bit of that," he said. "We're talking about scores of cases, dozens of cases, at most."

He also raised the prospect that other neurological ailments could be eventually linked to Zika, which he called "disturbing."

"There are only individual case reports of significant neurological damage to people not just the fetuses but an adult that would get infected. Things that they call meningoencephalitis, which is an inflammation of the brain and the covering around the brain, spinal cord damage due to what we call myelitis," he said. "So far they look unusual, but at least we've seen them and that's concerning."

Fauci has pressed the administration’s case for budgeting $1.9 billion dollars in emergency funds to fight the virus.

"We have to act now," he said. "I can't wait to start developing a vaccine."

Still, Fauci refrained from recommending that U.S. women avoid becoming pregnant because of fear of giving birth to a baby with microcephaly.

"Right now in the United States they should not be that concerned. We do not have local outbreaks," he said.

According to the Centers for Disease Control and Prevention (CDC), no vaccine currently exists to prevent Zika virus disease. The mosquito that carries the Zika virus mostly bites in the daytime.

The CDC recommends following typical mosquito bite preventions such as:

•       Wear long-sleeved shirts and long pants.

•       Stay in places with air conditioning and window and door screens to keep mosquitoes outside.

•       Sleep under a mosquito bed net if you are overseas or outside and are not able to protect yourself from mosquito bites.

•       Use Environmental Protection Agency (EPA)-registered insect repellents with one of the following active ingredients: DEET, picaridin, IR3535, oil of lemon eucalyptus, or para-menthane-diol. Choosing an EPA-registered repellent ensures the EPA has evaluated the product for effectiveness. When used as directed, EPA-registered insect repellents are proven safe and effective, even for pregnant and breast-feeding women.

◦       Always follow the product label instructions.

◦       Reapply insect repellent as directed.

◦       Do not spray repellent on the skin under clothing.

◦       If you are also using sunscreen, apply sunscreen before applying insect repellent.

•       To protect your child from mosquito bites:

◦       Do not use insect repellent on babies younger than 2 months old.

◦       Do not use products containing oil of lemon eucalyptus or para-menthane-diol on children younger than 3 years old.

◦       Dress your child in clothing that covers arms and legs.

◦       Cover crib, stroller, and baby carrier with mosquito netting.

◦       Do not apply insect repellent onto a child’s hands, eyes, mouth, and cut or irritated skin.

◦       Adults: Spray insect repellent onto your hands and then apply to a child’s face.

•       Treat clothing and gear with permethrin or purchase permethrin-treated items.

◦       Treated clothing remains protective after multiple washings. See product information to learn how long the protection will last.

◦       If treating items yourself, follow the product instructions carefully.

◦        Do NOT use permethrin products directly on skin. They are intended to treat clothing.

Story sources: Diane Bartz, http://www.reuters.com/article/us-health-zika-usa-idUSKCN0XE0UV

http://www.cdc.gov/zika/prevention/

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