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Daily Dose

More Confusion Surrounding Swine Flu Recommendations

There seems to be little consistency about how we are going to handle swine flu this fall and winter.I woke up today for my regular early a.m. exercise, jumped on the treadmill and put on my headphones. I then began channel surfing flipping between various local and national TV stations. On every station there were stories on H1N1 influenza (swine flu), and the symptoms, possibility of vaccine release dates, number of people who might be infected, and the report just released by the President’s task force on pandemic flu.

There were also stories about schools, specifically colleges in our area with cases of “swine flu” already being reported, and school just started yesterday. It is going to be a long winter! The only problem is there seems to be little consistency about how we are going to handle swine flu this fall and winter. Despite specific guidelines outlined by the CDC, it does not seem that there is anyone really in charge. We don’t even have a Surgeon General to weigh in. State and local health departments seem to be offering different advice about testing and treating possible swine flu cases. Colleges are already treating some students with tamiflu when the specific recommendations have been to only treat patients who are extremely ill, have underlying diseases that make them more at risk for complications or that are hospitalized. I have patients in the same family, who attend two different colleges, whose parents received different information from their colleges. One child is on tamiflu while the other is not. No wonder they are confused and so am I. Many of my friends and patients have reported possible exposures to swine flu and some have called their doctors and are being put on tamiflu over the phone. I have continued to reiterate to them that we are all going to have continuous exposures that we are not even aware of as more and more people become ill and you can’t take tamiflu every time you go to the grocery store, school, cleaners, etc. There are also some not so nice side effects from tamiflu, which no one really wants if not necessary. At the same time, I am wondering if I should just start taking tamiflu for the next six months, as I am sure that doctors are being constantly exposed and no one is recommending that doctors take tamiflu either. Maybe it is time to bring out the masks? I am only kidding. So.. amid all of the confusion I guess I will just keep washing my hands and practicing good hand hygiene. Maybe some of these inconsistencies will be resolved before we start seeing large numbers of cases? One can only hope! That’s your daily dose, we’ll chat again tomorrow.

Daily Dose

Infant Immunization Week

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April 20-27 is National Infant Immunization Week.  Although there are infants and children in this country being immunized every day, this is the week to remind parents, caregivers and health care professionals of the importance of vaccines.  

Infants are immunized against 14 vaccine preventable diseases.  Vaccines are now given to prevent not only “older” diseases like diphtheria, tetanus and polio but for diseases like bacterial meningitis, chicken pox and a viral diarrheal disease. Vaccines are one of the greatest public health achievements of the past century, and more vaccines are in the pipelines to continue to save lives.

Although some parents have been concerned and even misinformed that vaccines cause autism, study after study, including one published last month, have shown that there is NOT a link between vaccines and autism.  What we do know is that vaccines save lives, lots of lives.

Before the meningitis vaccines for both pneumococcal and H. flu bacterial infections were available there were hundreds of children who died each year.  I can remember taking care of some very sick children, and even doing spinal taps in my office to rule out meningitis. Some of the spinal taps       were positive and a few of my young patients were fortunate to survive bacterial meningitis, but they are now adults with deafness.  We had a few children in our practice during the 1980‘s who died from meningitis.  

During my early years of practice bacterial infections of the blood were also more common and we hospitalized a lot more infants and children than we do now.  I will also never forget a previously healthy 2 year old little boy who died from chickenpox and a bacterial infection of his blood stream.     This occurred almost 20 years ago, before the chickenpox (varicella) vaccine was available.  He would have been protected just a year later when the vaccine was introduced.  My youngest son received one of the first doses of varivax vaccine after it was approved as I knew that children did die from chickenpox and I could not give him that vaccine fast enough!

We all owe a great deal of gratitude to the brilliant scientists who study diseases and develop vaccines to prevent those diseases.  There are years  and years of work that go into not only developing a vaccine, but study after study to prove their efficacy and safety.  We are all healthier for this dedication.

So, if your child is not up to date on their immunizations, this is the week to start to play catch up. If you have a new baby, plan on starting immunizations at their 2 month check up. Big shout out for vaccines!

Your Child

It’s Official; CDC Says Flu is Epidemic


The flu has reached epidemic levels in the United States, with 15 children dead so far this season, the federal Centers for Disease Control and Prevention (CDC) reported at the end of December 2014.

Every year, the U.S. reaches a point where the number of flu cases enters the epidemic stage.  There’s no way to tell right now if this year’s flu season will end up being more or less severe than previous ones. Those statistics won’t be available till later in the year.

No state will be spared this season with more flu cases and deaths’ increasing in the next few weeks says Dr. Michael Jhung, a medical officer in CDC's influenza division. "We are in the middle of flu season," Jhung said. "It's a safe bet that we are going to see flu activity continue to increase for a few more weeks. We are going to see every state in the country affected by flu."

The number of children’s deaths from flu changes every year. The latest victim may be a 17 year-old-girl in Minnesota. She was diagnosed with the flu and sent home to recover. Shanna Zwanziger had the flu for about a week before she died says her family. Her mother said Shanna was given the choice of whether to get the vaccine or not, and she chose not to.

The South, Midwest and Western states have been especially hard hit this flu season. At least six children have died in Tennessee and four in Minnesota, according to published reports.

The predominant flu strain this season is the H3N2 virus, the CDC says. This virus is not well matched to this year's flu vaccine, but what part this mismatch is playing in flu deaths isn't known, Jhung said.

The CDC acknowledges that that this year’s flu vaccine is not a good match for the most dominant strain of the virus. That’s because there’s not just one type of flu and the virus can mutate. This year’s vaccine was created before one of the viruses mutated. However, experts say that getting this year’s vaccine can still help protect you and can help make symptoms less severe if you get the flu.

The CDC recommends that everyone 6 months and older get a flu shot. It's not too late to get vaccinated, Jhung said. More than one type of flu is circulating, and the vaccine protects against at least three strains of circulating virus, he added.

"If you encounter one of those viruses where there is a very good match, then you will be well-protected," he said. "Even if there isn't a great match, the vaccine still provides protection against the virus that's circulating."

Many people get the flu and recover at home. They spend anywhere from a few days to a couple of weeks feeling very bad and then start to feel better. But others face life-threatening complications – such as pneumonia- according to the CDC.

Jhung says parents should always take the flu seriously, and get medical help if their child is very sick.

Warning signs might include a cough that disrupts sleep, a fever that doesn't come down with treatment, or increased shortness of breath, according to the U.S. Food and Drug Administration.

There are treatments for the flu such as Tamiflu and Relenza. "Those work best when they are given very quickly. So if you do have signs and symptoms of flu, reach out to a health care provider and get evaluated," Jhung said.

The flu season moves into its later stage in January and February, with different flu types taking the lead. It’s not too late to get your family the flu shot. They are still available at physician’s offices as well as at many pharmacies and health care centers.

Sources: Steven Reinberg,

Liz Neporent,

Daily Dose

Booster Shots

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Under the heading “kids say the smartest things” comes one of the latest entries!! I was seeing a 4 year old for their check up...this is a great age as most kids are very conversational and engaged and most are over their fear of the doctor.  I think “Doc McStuffins” has helped this out as well. Thank you Doc!

So, if you didn’t know it, 4-5 year olds get immunized before they start kindergarten.  I give 4 year olds their DTaP, IPV, MMR and Varicella vaccine, all in preparation for school.After a wonderful chatty and interactive visit, I always find it hard to now tell this precious child that at the end of the visit they are going to get some “vaccinations”.  Many times, in fact most, the idea of shots does not go over well.

Last week I saw this 4 year old, had a great visit, talked all about school and his soccer team and his new bike and bike helmet, only to end with “you are going to get several shots to keep you healthy”.  Then you wait for the reaction, right?

So, this little boy looked me right in the eye and said, “I get shots to protect and help my immune system!”.  What a smart kid! I think he is going to be an immunologist one day and save the world. I couldn’t be happier that he already understands re-boosting immunity.  

Daily Dose

Why 'Herd Immunity' Does Not Work

With all of the recent anxiety surrounding Swine Flu and the possibility of epidemics, lets be pro active in protecting all of us from diseases that we can prevent with the current immunizations that are available.There is an article in the June issue of the journal Pediatrics, which looked at whether parental refusal of pertussis vaccination could be associated with increased risk of pertussis infection in those unimmunized children. The study was conducted between the years 1996 - 2007 and looked at case controlled studies which compared a child with documented pertussis (whooping cough) to 4 other randomly selected children who did not develop pertussis. This study is important as many parents believe that if they choose not to vaccinate their child, that their child is protected by herd immunity (in other words, by all of the rest of us that are immunized).

In this case the study showed that 11% of all pertussis cases in this pediatric population were attributed to parental vaccine refusal. This study is important for several reasons. It is one of the first to document that herd immunity does not seem to completely protect unvaccinated children from pertussis. Children of parents who refuse pertussis immunizations are at high risk for pertussis infection relative to vaccinated children. One would assume, but further studies need to be done, that similar results would be found if you looked at diseases like measles, or H. flu meningitis. Herd immunity is important to the general health and well being of all of us, but it is not 100% at any time and risk of disease is still there. As we see increases in whooping cough in many communities across the country the need to educate parents about the importance of vaccines is paramount. Parents need to be protected too and we should all have a TdaP as an adult to provide pertussis protection for ourselves, as well as for those infants around us who are too young to be immunized. With all of the recent anxiety surrounding Swine Flu (H1N1) and the possibility of epidemics, lets be pro active in protecting all of us from diseases that we can prevent with the current immunizations that are available. That's your daily dose, we'll chat again tomorrow.

Your Teen

Acetaminophen, No Threat To Child's Liver

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With more than eight million American kids taking the drug every week, acetaminophen is the nation's most popular drug in children. It's toxic to the liver in high doses, and can be fatal if taken in excess. Very rarely, adults may also get liver damage at normal doses, so doctors had worried if the same was true for kids. Concerns about liver injuries in children who take the common painkiller acetaminophen, sold as Tylenol in the U.S. are unfounded, researchers said on Monday. "None of the 32,000 children in this study were reported to have symptoms of obvious liver disease," said Dr. Eric Lavonas of the Rocky Mountain Poison and Drug Center in Denver. "The only hint of harm we found was some lab abnormalities." With more than eight million American kids taking the drug every week, acetaminophen is the nation's most popular drug in children. It's toxic to the liver in high doses, and can be fatal if taken in excess. Very rarely, adults may also get liver damage at normal doses, so doctors had worried if the same was true for kids. "This drug is used so commonly that even a very rare safety concern is a big concern," said Lavonas, whose findings appear in the journal Pediatrics. Some researchers suspect there is a link between long-term use of acetaminophen and the global rise in asthma and allergies, but the evidence is far from clear at this point. For the new report, researchers pooled earlier studies that followed kids who had been given acetaminophen for at least 24 hours. There were no reports of liver injuries leading to symptoms such as stomachache, nausea or vomiting, in the 62 reports they found. Ten kids, or about three in 10,000, had high levels of liver enzymes in their blood, which usually means their livers have been damaged. In most cases, however, those elevations were unrelated to acetaminophen. And even if they were caused by the drug, they don't indicate lasting damage, according to Lavonas. "Acetaminophen is extremely safe for children when given correctly," he said. "Parents should not be afraid to give acetaminophen to their children when they need it, but they should be very careful about giving the right dose." "If you suspect that you have given a child an overdose, call your state's poison center," he added. The Rocky Mountain Poison and Drug Center receives funding from McNeil Consumer Healthcare, the Johnson & Johnson subsidiary that sells Tylenol, but the researchers said the company did not support this study.

Daily Dose

No Needle Shots?

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Over the last several months I have had a lot of patients (especially those that are old enough to talk) ask me about the new needless jet injectors for vaccinations. Of course anything that says “no needle” and “painless” has a lot of appeal for both doctor and patients, especially in pediatrics.  Our practice has not decided whether to try out the new jet injectors and we are still giving the standard shots, not always with smiling patients. How do jet injectors actually work? By using a thin high pressure of liquid to penetrate the skin with the vaccine.

Well, now that it is flu vaccine season, there has been a lot of advertising about needless injections for flu vaccine. Many drug stores and/or grocery stores had advertised that you could get your flu vaccine, “pain free”.  Sounds great, right?

Not so fast, the FDA recently announced that “all vaccines including flu vaccine be administered in accordance with their labeling.” This means that flu vaccine has not been studied when given by the new jet injectors. The FDA also stated that there “was no data to show the safety or efficacy of flu vaccine or other vaccines given by injectors”.  The only vaccine that has currently been approved to be given by the jet injectors is the MMR (measles, mumps, and rubella) vaccine.

The flu vaccine may be given by the traditional method with a needle, or as a nasal mist (for use in children 2 years of age and older). Most of our patients opt for a “flu mist” if they can talk and sniff. It is amazing that there are several children who really do prefer a shot, and they tell me that they would “never” sniff something up their nose. Different strokes for different children.

But in the meantime, I am not jumping on the jet injector bandwagon. The FDA is now stating that each vaccine needs to be evaluated for both safety and efficacy when given by a jet injector. I am sure that those studies will be forthcoming.

In the meantime, RUN to get your flu vaccine, it is time to get vaccinated as sick season is starting and who wants the flu!

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

Your Baby

Infant Ear Infections Declining


Ear infections in infants are very common and can be quite unsettling for parents. The good news is that ear infections among U.S. babies are declining according to a new study.

Researchers found that 46 percent of babies followed between 2008 and 2014 had a middle ear infection by the time they were 1 year old. While that percentage may seem high, it was lower when compared against U.S. studies from the 1980s and '90s, the researchers added. Back then, around 60 percent of babies had suffered an ear infection by their first birthday, the study authors said.

The decline is not surprising, according to lead researcher Dr. Tasnee Chonmaitree, a professor of pediatrics at the University of Texas Medical Branch, in Galveston.

"This is what we anticipated," she said.

That's in large part because of a vaccine that's been available in recent years: the pneumococcal conjugate vaccine, Chonmaitree said. The pneumococcal conjugate vaccine protects against several strains of pneumococcal bacteria, which can cause serious diseases like pneumonia, meningitis and bloodstream infections.

Those bacteria are also one of the major causes of children's middle ear infections, Chonmaitree said.

She added that flu shots, which are now recommended for children starting at 6 months, could be helping as well. Many times an ear infection will follow a viral infection such as the flu or a cold.

Vaccinations "could very well be one of the drivers" behind the decline in infant ear infections, agreed Dr. Joseph Bernstein, a pediatric otolaryngologist who wasn't involved in the study.

Other factors could be having a positive impact as well, such as rising rates of breast-feeding and a decrease in babies’ exposure to secondhand smoke.

"The data really do suggest that breast-feeding -- particularly exclusive breast-feeding in the first six months of life -- helps lower the risk of ear infections," said Bernstein, who is director of pediatric otolaryngology at the New York Eye and Ear Infirmary of Mount Sinai, in New York City.

There's also the fact that breast-fed babies are less likely to spend time drinking from a bottle while lying down, Bernstein noted. That position can make some infants more vulnerable to ear infections, he said.

The study findings were based on 367 babies followed during their first year of life. By the age of 3 months, 6 percent had been diagnosed with a middle ear infection; by the age of 12 months, that had risen 46 percent, researchers found.

Breast-fed babies had a lower ear infection risk, however. Those who'd been exclusively breast-fed for at least three months were 60 percent less likely to develop an ear infection in their first six months, the study showed.

But whether babies are breast-fed or not, they will benefit from routine vaccinations, Chonmaitree said. "Parents should make sure they're on schedule with the recommended vaccines," she said.

Parents can have a difficult time recognizing an ear infection in an infant or a child to young to tell them that their ear hurts.

Some symptoms to watch for are:

·      Tugging at the ear

·      Fever

·      Crying more than usual

·      Irritability

·      Child becomes more upset when lying down

·      Difficulty sleeping

·      Diminished appetite

·      Vomiting

·      Diarrhea

·      Pus or fluid draining from ear

Treatment for ear infections rarely requires medication, such as antibiotics, except when an infection is severe or in infants. 

According to the American Academy of Pediatrics (AAP), most children with middle ear infections get better without antibiotics, and doctors often recommend pain relievers -- like acetaminophen -- to start. But with babies, Bernstein said, antibiotics are often used right away.

The AAP recommends antibiotics for infants who are 6 months old or younger, and for older babies and toddlers who have moderate to severe ear pain.

The study was published online in the March edition of the journal Pediatrics.

Story source: Amy Norton,

Daily Dose

Another Case for Vaccinating Your Child

The American Academy of Pediatrics issued an alert last week that identified several more cases of invasive HIB disease in Pennsylvania and two deaths. One of the deaths occurred in an unimmunized child. Several months ago there were five cases of HIB disease in Minnesota, again resulting in one death, also in an unimmunized child. All of the cases involved unvaccinated or under-vaccinated children.

Prior to routine vaccination against HIB (H. flu) disease, which began in 1988, about 20,000 children developed infections each year, and 12,000 cases of HIB meningitis were diagnosed, with about five percent of children dying. Over the last 20 years the rates of HIB disease have decreased exponentially and deaths were no longer reported. The vaccine was a tremendous victory in preventing childhood meningitis and other serious infections. Over the last several years with parental anxiety related to vaccines, the number of unvaccinated children has been on the rise, especially in "pockets" throughout the country. At the same time, there has been a HIB vaccine shortage since December of 2007, which may have also resulted in children not completing their primary series at 2, 4, and 6 months of age. These two factors may have led to the cases of HIB disease and doctors are worried that we may see a recurrence of HIB disease and deaths. The community as a whole is often protected due to "herd immunity" and the herd must be immunized to provide maximum protection for everyone. This underscores the importance in vaccinating your children. If your child has missed any of their primary vaccine series, now is the time to update them. HIB disease is serious and unfortunately may be on the rise again. This is a vaccine preventable disease. That's your daily dose, we'll chat again soon.


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New moms have enough pressure and breast feeding is one of them.

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