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Daily Dose

Cold & Flu Season

1:30 to read

Despite the fact that the weather is beautiful in most parts of the country, it is Fall which means more viral upper respiratory infections. This is especially true of the 12-15 month old children who are now getting their “first of many” colds.  Many of their parents are concerned as to why they are suddenly getting sick…as they have not been sick before?

 

Well, here is the deal. Last fall and winter these children were babies in arms, and were not crawling and walking which also means they were not exploring their environment and all of the germs that go with touching EVERYTHING!  During that first winter season (if a child is not not  in day care or school) and does not have siblings (to get them sick) they may luck out for the first 2 - 12 months without a runny nose or cough. 

 

But….those days come to an end once they become toddlers. This is not alarming at all, but just a fact of life.  Toddlers will catch a little bit of everything once they hit one. That means they may have a cold, cough or even a fever every month…for the next fall/winter/early spring months, (which is about the next 5-6 months).  As a parent of a new toddler this is really difficult to fathom!

 

Every parent wants to know how they can “avoid” these illnesses….short answer is it is impossible and you should actually look at each viral illness as a victory which primes the immune system, and helps develop antibodies to some of the viruses we are all exposed to every day.  With each viral illness your child’s immune system is actually getting stronger…and you will notice that around the age of three your child will not catch as many colds and coughs as they did when they were younger. I know that seems like such a long time!! Unfortunately, parents of toddlers also catch a few more illnesses as they too are “over exposed” by their child. 

 

Remember to always watch your child for any difficulty breathing by looking at their chest with their shirts off - you do not want to see them look like they are “working with their ribs to breathe”. You also need to make sure they are well oxygenated and should turn red with cough and never a dusky blue color…especially important in young infants. Any concerns call your doctor.

 

So…gear up for winter as peak upper respiratory season is not even here yet!!  Get those flu vaccines too. 

Daily Dose

Flu is Here!

1:30 to read

Well, I knew that it would happen sooner or later…that is when would I see my first case of Influenza 2017-2018?  Unfortunately, it is it happening sooner than later as I am seeing more than a handful of children with classic flu like symptoms that come on quickly including high fever, body aches, chills, sore throat and cough. The few children that I have seen have looked like “flu victims” as they are laying down on exam table with a coat or blanket over them despite having a fever and say “they feel terrible”. Their flu tests have been positive for influenza!

 

To remind you there are two types of influenza: A and B. The patients that I have been seeing have had Influenza A which is typically the more “severe”  illness than Influenza B.  The flu vaccine (all of which is injectable this year) is a quadrivalent vaccine, which means it contains 2 influenza A viruses and influenza B virus.  The vaccine components are selected each season based on the worldwide surveillance of flu activity and specifically what have been the prevalent viruses in the southern hemisphere in the months prior to our flu season.

 

The CDC tracts flu activity around the country every year, and they are currently reporting very little flu based on tests from surveillance sites throughout the U.S (only about 2.9% of tests are positive for flu this week)  The Dallas County Health Department also tracts influenza activity and are reporting that 4.7% of their tests were positive for influenza, most of which is influenza A. 

 

The CDC is predicating that is may be a “tough” flu season based on the most recent data from Australia.  They are just wrapping up their flu season as it is early spring there now. Australia has had one of their worst flu seasons in recent years with the predominant strain being an influenza A - H3N2 virus, which typically causes more severe illness. Fortunately, this years flu vaccine contains the H3N2 virus.

 

Many people (including my patients and their parents) ask “why get the vaccine if it is not 100% effective?” The vaccine typically is between 40 - 60 % effective in preventing flu and if you are unlucky enough to get the flu after being vaccinated you typically have a less serious illness, are less likely to have complications and to require hospitalization. Seems like an easy choice to me. 

 

So….it is really important to get that vaccine now…if indeed we are gong to have an early and severe fu season you don’t want to wait. It takes about 2 weeks post vaccine to develop antibodies and protection too…it is not immediate.

 

Parents with babies under 6 month of age also need to make sure they are immunized as well as anyone that cares for the baby.  Babies under 6 month of age cannot get flu vaccine, so they need to be protected by having everyone around them vaccinated. 

 

Our son and his wife just had their first baby a few weeks ago…a BOY!! So I assure you everyone in our family has already been vaccinated to protect that precious new grandson of ours. Welcome Stewart Wilson! 

 

  

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Daily Dose

More Flu Cases

1:30 to read

If you read this blog often you know I have been writing about the upcoming flu season since the vaccine was released this summer.  The predictions were that it might be a “bad” flu season due to the fact that Australia had had a severe flu season, and the United States often sees the same influenza strains that were previously in the southern hemisphere.

 

The predominant strain in Australia was an influenza A virus (H3N2 strain) which seemed to have caused outbreaks with more serious illness. The H3N2 strain was also the one that was included in this years (2017-2018) influenza vaccine currently being given.

 

Preliminary studies from Australian data analyzed the effectiveness of the influenza vaccine against H3N2 and found that it was only about 10% effective in preventing this type of flu. This is not great news for the impending flu season in the U.S.

 

At the same time we are already seeing early flu cases in several states including Oklahoma and Louisiana as well as increasing activity in several other states. As I noted in an earlier post, Dallas has been seeing some early flu activity as well. I have already seen two doctors who were immunized succumb to influenza A with classic symptoms of fever, body aches, chills, sore throat and cough….and indeed sick enough to be home from work for several days, where I assure you they were missed! 

 

If indeed flu season continues to increase in the next weeks it could potentially be a busy Christmas season….and not just for Santa. The more we “gather together”, whether at a party, church, on an airplane or in a mall shopping, the more likely you are to be exposed to the flu and to infect others. 

 

So, the best way to try and prevent getting the flu is to still go ahead and get vaccinated, despite the question of how effective the vaccine may be. Any protection is certainly better than none. Other ways to ward off the flu?  Continue good hand washing and observe respiratory and cough hygiene. When possible stay away from large groups of people and this is especially important for very young children, under 6 months of age who cannot receive a flu vaccine and who also have more complications with the flu.

 

Lastly, if you are sick and have flu like symptoms, stay home!  Do not send your child to day care or school. If you the parent get sick you also need to stay home and not go to work, or host the Christmas cookie exchange etc. etc…..and risk exposing others as well. 

 

i am working over the Christmas holidays and continue to pray that all of the above predictions are WRONG!! Stay tuned for further updates.

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Daily Dose

Do Essential Oils Boost Immune System?

1.30 to read

Although it is still hot and officially summer, soon everyone will be heading back to school  and coughs and colds (and eventually flu, another topic) will be just around the corner. I had a patient ask me about the use of essential oils. Her 2 1/2 year old daughter is heading to preschool for the first time and she “had heard from her friends that essential oils help a child’s immunity during cold season”.

Unfortunately, there is very little data at all to confirm that statement. I only wish that rubbing a bit of lavender oil on would help prevent the common cold. While it may smell great and be relaxing....there is no data that I can find to show that there is any reproducible science to the claims that essential oils boost the immune system.  

While I was researching I found many sites stating that “eucalyptus oil is an anti-viral” and “peppermint oil is an anti-pyretic (fever reducer)”.  Tea tree oil is touted as being “both anti -bacterial and anti-fungal” (I don’t know of other drugs that can claim both!).  But, I just don’t see any data to support all of this. 

The word essential refers to the essence of the plant the oil is derived from, rather than being “essential” to your health. While in most cases essential oils (which are highly concentrated) used as aromatherapy are not harmful for adults, it may be a different story in children, especially those under the age of 6. While labels may say  “natural” it may not always mean safe.  Many oils are poisonous if ingested and there have been reports of accidental overdoses in children with several different oils. In one report tea tree oil and lavender oil applied topically have been shown to cause breast enlargement in boys.  Oil of eucalyptus and peppermint are high in menthol and cineole.  These substances may cause children to become drowsy have decreased respirations.  While there are articles stating that the use of menthol (Vicks) on a child’s feet may be helpful during a cold for reducing a cough, do not use this if child is young enough to put their feet in their mouths. 

I must say that I sometime use a few drops of eucalyptus oil in the shower when I have a cold as I think it smells great and seems to help “open up” my head. Whether this is in “my mind” or a response from my olfactory centers which sends calming messages to respiratory center is not clear. But, I am not ingesting it or using it topically. 

 

 

Daily Dose

Protecting Your New Bundle of Joy

When I see newborns in my office this fall I am already thinking into the winter season ahead.

As I see new parents in my office this fall, bringing in that most precious newborn for their first pediatric visit, I am already thinking into the winter season ahead. Infants born during fall and winter are exposed to more upper respiratory viruses and flu in their first six months of life. Infants under six months of age are at more risk of complications from viruses like RSV and flu. Unfortunately, infants under six months cannot receive flu vaccine.

But a recent study showed that mothers who received a flu vaccine during pregnancy reduced influenza illness in their newborns. That study is important in reminding pregnant mothers of the importance of receiving flu vaccine during their pregnancy. Unfortunately, in my practice, I do not see this information being given to pregnant mothers while they are in for their OB visits. It is also important that new parents are vaccinated against whooping cough with a newer vaccine which is given to adults called a TDaP. If you are pregnant or thinking about becoming pregnant this winter discuss these vaccines with your obstetrician. If they do not have the vaccines in their office, your local health department has them. The best way to protect that new bundle of joy is by immunizing those around them. This would also apply to grandparents, aunts, uncles and cousins. Spread the word about flu vaccine and TDaP and not the germs. That's your daily dose, we'll chat tomorrow!

Daily Dose

Airborne & Your Kids

1.45 to read

It’s cold & flu season and I have already been receiving emails from parents asking what works/doesn’t work.  I reviewed a recent note from a well-meaning dad asking if he could give his 3 year old son Airborne to help “offset colds”. 

I myself have just recovered from my first cold of the “season” and have looked high and low for ANYTHING that might prevent or treat the common cold. As I tell my own patients on a daily basis, if I had the “magic pill” I would certainly not only manufacture it to distribute to everyone, but I would also be getting ready to accept Nobel Prize in medicine for solving the mystery of preventing the common cold!!  Airborne is NOT the magic potion and I see no reason to use it period.

I recently did an extensive review of complementary and alternative medicine for the common cold (selfishly trying to cure myself) and once again came up empty handed for any proven remedies. There are still a lot of ongoing studies (someone will win the Nobel Prize one day), but nothing so far has really proven to be the panacea.

Many people “swear” by Airborne.  I am just not sure what they are thinking it does. If you read their website it states, “there are scientific studies that the ingredients in Airborne have been shown to support the immune system”. I can’t find those studies anywhere. 

In 2008 a class action suit against Airborne resulted in a $23 million dollar fine for “misleading consumers and making false claims”, when Airborne claimed to “ward off colds”. They have now changed their advertising to the wording, “boosting the immune system” which also seems like deceptive advertising to me. Regardless, they continue to make millions (despite that huge fine).  My mother even called to say she thought she might take some before flying to visit at Thanksgiving asking, “did I think that would help her from getting sick?” OMG!

The ingredients in Airborne include Zinc, ginger, Echinacea, vitamins, minerals, and herbs.  This is what I commonly call “hocus pocus”.  Many of the ingredients in Airborne have been studied for use during a cold, without a lot of success.  Zinc is still being studied with varying outcomes, but there are still no definitive guidelines on using Zinc for a cold. Stay tuned for more as more studies are completed.

In the meantime, the answer to the email is NO; I would not give a 3 year old Airborne. What I would do is make sure that your child is getting nutritious meals, adequate sleep and that they learn to wash their hands and cover their mouths when they cough (hand hygiene). I would put the money you would spend on Airborne in their piggy bank for future college expenses.   I would also make sure to get your child their Flu vaccine. We do have data that vaccines work!

That’s’ your daily dose for today.  We’ll chat again tomorrow.

Daily Dose

Get Your Flu Shot!

1:30 to read

I just had my flu vaccine!  Guess what - my arm didn’t even hurt this year.  I have also been reminding all of the pregnant mothers that I see to get their flu vaccines as well.  The current recommendation is that pregnant women receive influenza vaccine as soon as possible beginning after their 28th week of pregnancy (3rd trimester). 

When a pregnant woman receives her flu vaccine she is not only protecting herself, but also her baby.  Infants cannot receive a flu vaccine until they are 6 months of age…and for babies born during the fall and winter season, that means they will not be vaccinated until the following year. But when a mother has received a flu vaccine the infant is also getting protection via antibody that the mother passes to her baby across the placenta. 

In a 2014 study, the authors reported that “immunization of pregnant women with trivalent inactivated influenza vaccine (IIV3) was safe, immunogenic, and partially protected the women with a vaccine efficacy of 50% and their infants with a vaccine efficacy of 49% against laboratory-confirmed influenza illness during a 6-month follow-up post delivery ”. In other words, the infants in the study had just as much protection as the mother.

In a more recent study the authors now looked at how long the immunity lasted in the infants born to the flu vaccinated mothers. Surprisingly, the immunity was not as long lived as had been thought. The infants involved in the study were born an average of 81 days after their mothers were vaccinated with flu vaccine, and were monitored for influenza infection for about 172 days after birth.

Infants born to mothers who had a longer interval between vaccination and delivery had higher antibody titers. The infants’ antibody levels did drop off after birth and by 8 weeks of age the babies did not have significant antibody. Ideally, In order for babies to have better protection a mother would be vaccinated even earlier in her pregnancy, and studies are being done to look at this possibility.

Infants are especially susceptible to influenza and have a higher rate of complications as well as hospitalizations.  While the current recommendations for vaccinating pregnant women may not confer as much immunity to the newborn as was previously thought , there is very high protection for the first 8 weeks after birth. Any protection is preferable to none!.

Get your flu vaccine and if you are pregnant ask your doctor to give it to you as soon as you are in your 28th week.  The longer the baby is getting placental antibody the better!!

 

 

 

 

 

Daily Dose

National Flu Immunization Week

This week is National Influenza Immunization week, so I thought it would be a good time to remind everyone about the need to continue to get vaccinated for both seasonal and H1N1 flu.

We were all fortunate that flu did not “rear its angry head” over the holidays (flu is currently widespread in only several states) and therefore it seems that many people have become “complacent” (verbiage from CDC) about getting vaccinated. The one thing that we doctors know for sure is that flu comes every winter, so we don’t think 2010 will be any different. The difference will be whether it is H1N1 having another resurgence, or will it be seasonal influenza or both? Seeing that none of us has that proverbial crystal ball, I would continue to recommend vaccinations against both. It seems there are many people who wanted to be vaccinated against H1N1 (swine flu) while there was a vaccine shortage, and the lines were long and there were restrictions being placed on who could get vaccinated. Now there is a plethora of vaccine and it is available for all comers. Suddenly, interest wanes, just like the Zhu Zhu pet after the holidays. It is especially important that infants and children continue to be vaccinated as well as the adolescent and young adult population. As you can recall from previous posts, this population seems to have a higher than expected rate of complications and deaths than has been seen with seasonal flu. There have even been recent reports of more pediatric deaths from H1N1, despite the fact that the disease seems to be waning for now. As I continue to see infants who have turned six months of age for their routine check-ups I am giving them their first doses of both seasonal and H1N1 flu vaccine. I am also reminding parents that they will need to bring their infants back in four weeks to receive their second doses. My hope is that we will have plenty of vaccine available to continue to immunize into early spring. The H1N1 vaccine availability does not seem to be problematic at this point, but the seasonal flu vaccine used for children between six months and two years is in short supply. In any event, one dose of vaccine is preferable to none. I have been telling the parents to call us in month and come in and we will give their children second doses of what we have available. Remember too that all children under the age of 10 require two doses of H1N1 vaccine; so many children should be due to get their second doses of vaccine if they were vaccinated in the fall. Take advantage of the availability of H1N1 vaccine and get you and your family vaccinated. The vaccine is the same whether you get it at your doctor’s office, at the health department or at your local pharmacy or grocery store. The continued post marketing surveillance has not shown any problem with side effects or safety related to the H1N1 vaccine. The more people that are vaccinated the better chance we have of preventing widespread disease. Pick up the phone and call your pediatrician this week! That’s your daily dose, we’ll chat again tomorrow.

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