Twitter Facebook RSS Feed Print
Daily Dose

Mumps Outbreak!

1:30 to read

The latest infectious disease outbreak is in the Boston area where several colleges have reported cases of mumps. Mumps is a viral illness that causes swelling of the salivary glands as well as other symptoms of fever, fatigue, muscle aches and headache.    Harvard University has been hit the hardest and has now documented over 40 cases this spring.  Boston is a city with numerous colleges all in close proximity, and there are documented mumps cases at Boston University, University of Massachusetts  and Tufts as well.  These Boston area colleges are all in close proximity and are merely a walk, bike or train ride away from one another, so these students, while attending different universities may all co-mingle at parties and athletic events.

Mumps is spread via saliva (think kissing), or from sharing food, as well as via respiratory droplets being spread after coughing or sneezing. It may also be spread via contaminated surfaces that will harbor the virus. People may already be spreading the virus for  2 days before symptoms appear and may be contagious for up to 5 days after their salivary glands appear swollen….so in other words there is a long period of contagion where the virus may inadvertently be spread. It may also take up to 2-3 weeks after exposure before you come down with mumps.

All of the students who have come down with mumps had been vaccinated with the MMR vaccine (mumps, measles, rubella).  Unfortunately, the mumps vaccine is only about 88% effective in preventing the disease. Despite the fact that children get two doses of vaccine at the age of 1 and again at 4 or 5 years….there may be some waning of protection over time. This  may also contribute to the virus’s predilection for young adults in close quarters on college campuses. Something like the perfect infectious disease storm!

In the meantime there are some studies being undertaken to see if adolescents should receive a 3rd dose of the vaccine, but the results of the study are over a year away.

In the meantime, be alert for symptoms compatible with mumps and make sure to isolate yourself from others if you are sick.  Harvard is isolating all of the patients with mumps for 5 days….which could mean that some students might even miss commencement.  Doctors at Harvard and other schools with cases of mumps are still on the watch for more cases …stay tuned.

 

 

 

 

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

How to Treat A Vomiting Child

We are definitely in the throes of "sick season" in our office and with that comes a lot of kids with vomiting. I remember the first time that one of my own children vomited.

We were in Target, he was about two and he had said he "was sick". Now, seeing that he was not very specific and did not elaborate, I just went on shopping. Several minutes later, as he sat in the cart (with seat belt fastened), he just looked at me wide eyed and suddenly vomited. This is the moment as a parent that you understand the difference between babies that "spit up", and true, projectile vomiting! Now what do you do once your child has vomited (besides rush out of Target as fast as you can)? Once a child has vomited it is important not to give them anything else to eat or drink, for at least 30 to 45 minutes. That means even if they are "begging" for a drink, as you will probably see it come right back at you if you do. After waiting, you want to begin re-hydrating with clear liquids. Not a good idea to pull out the milk or food yet. In an infant you can use Pedialyte, which is an oral electrolyte solution, and instead of breast milk or formula you can try feeding your infant about an ounce of Pedialyte every 10 to 15 minutes and see if they can keep Pedialyte down. In toddlers and older children I use Gatorade, as it is not quite as "salty" and kids seem to take it better. Again, frequent small sips of Gatorade while you wait to see if the vomiting is persistent. Don't go too quickly on giving them larger volumes. The key is small amounts, frequently, which are easier to handle. As your child keeps down the Pedialyte or Gatorade you can increase the volume that they are taking and decrease the frequency. The main thing you are trying to do with a child of any age is to keep them from getting dehydrated and their vomiting is typically due to a viral illness affecting their GI tract. Because it is typically a virus that is the culprit for nasty vomiting, it just takes time to get through the illness. There is no "miracle" cure, and watching your child vomit, or cleaning up the vomit that invariably is usually not in the toilet, is one of the worst parenting jobs. That being said, there are very few children who will not experience vomiting at least once or twice during their childhood, so you need to keep "clear liquids" on hand in the pantry. Having powdered Gatorade around is a lifesaver at 2 a.m when your four-year-old wakes up and throws up. If you are giving the clear liquids, and your child tolerates larger volumes, but then vomits again later on, you just back up and start all over with smaller amounts more frequently. It is somewhat like a "balancing act" to give enough that they are hydrated, but at the same time to not give too much at one time that they vomit again. Slow and steady is the mantra. You should always be looking for your child to have tears, a wet and moist mouth (put your finger in there, it should come out with some saliva on it), and urine. It is often hard to tell if a child in diapers has had a wet diaper as they will not be "soaking" the diaper and smaller amounts of urine are "wicked" with the new super absorbent diapers. Children will also be pitiful after vomiting and may seem "lethargic" to you, but if they are an infant and can smile and make good eye contact or they are an older child who can tell you they feel terribly and don't want to drink Gatorade or play with their blocks they are probably not dehydrated. If in doubt, give your doctor a call to discuss what is going on. After using Pedialyte and Gatorade, and your child has not vomited for six to eight hours you can try adding some formula or breast milk, or other liquids such as chicken soup or a Popsicle. I still would not start solid food until the child has kept down other liquids. We parents all worry if our children don't "eat" but the fluids are the important part, and as we all know, a day without out chicken nuggets or peanut butter will be okay. Keep up the fluids!! If your child continues to vomit despite your best efforts with "slow and steady" fluids you need to call the doctor. We have plenty of patients that we see everyday to make sure they are hydrated, and to even watch them while they take fluids in our office. Occasionally, when all else fails we will have to hospitalize a child for IV hydration. Oh yes, remember to wash your hands frequently as these nasty viruses are contagious and parents will often find themselves getting sick after their children. That’s your daily dose, we’ll chat again tomorrow.

Daily Dose

Viral Skin Rashes

We often see in kids are viral rashes (exanthems) that seem to appear as the other viral symptoms are resolving.While on the topic of skin, let's talk about viral rashes in kids. As every parent knows, your child will get several 100 or is it 1,000 viruses during their 18 years at home with you. Most of these viral infections present with typical fever, runny nose, cough and are more common during the winter months, and more frequent in the younger child. We are in the thick of these now.

What we also often see in kids are viral rashes (exanthems) that seem to appear as the other viral symptoms are resolving. It is not unusual to see a child who has had several days of fever develop a blotchy, red, flat rash on their body (not purple or bruise like) which doesn't seem to bother the child at all. The rash is not itchy, and may even come and go. This is often concerning to a parent as people say, "maybe it is the measles or chickenpox." The biggest distinguishing factor with a post viral rash is just that, it is later in the course of the illness and is actually appearing as you child is improving, all the more confusing for a parent. Measles and chickenpox are still present in the U.S. and worldwide. Unfortunately, due to decreasing immunization rates in some areas, outbreaks of chickenpox and measles have recently been reported. But in the case of these illnesses the rash occurs early in the course of the illness, along with the other symptoms. Children with both measles and chickenpox appear ill and the rash starts early and continues throughout. If your child has a fever and a rash at the beginning of an illness give your doctor a call to discuss the symptoms and appearance of the rash and whether they should be seen. But a rash that occurs late in the illness is often just the tale end of the virus and by then your child should be feeling better, not worse. In most cases of a post viral rash, the rash will disappear over the next several days and the child is good to go (until the next virus finds their prey!) That's your daily dose, we'll chat again tomorrow.

Tags: 
Daily Dose

Homemade Cure for Coxsackie?

1:30 to read

Desperate times call for desperate measures…or so it seems according to several of my patient’s mothers who have resorted to all sorts of “cra-cra” stuff to “treat” their child’s “HFM” - hand foot and mouth infection.  Remember, HFM is a viral infection that most children get in the first several years of life. It may cause all sorts of symptoms but in a classic case the child develops a macular-papular (flat and/or raised) vesicular rash on the palms, soles and buttocks. In some children the rash is fairly mild and in others it can look pretty disgusting and uncomfortable…but it has to fade away on its own…with time.

 

There has been a lot of HFM in our area and much anxiety among parents about this infection….fueled a lot by social media identifying who has HFM and where they go to school and how many cases there are. (too much information!!). Parents are even posting…places to “stay away from”. So, some of my patient’s parents are scouring their child looking to see if there might be a bump..and could this be HFM and if so, what do I do to “stop” it!  That would be “nothing” besides good hand washing..as this is a viral infection and you may be exposed to it almost anywhere.

 

Since coxsackie virus has been around for years, this means that most adults had the virus when they were young.  But, several moms and dads whose children have HFM have also shown me a rash on their palms and soles, that I presume may be HFM? They are kind of freaked out and may be uncomfortable too…but this is not life threatening.  Even so,  several parents are resorting to THE GOOGLE to get their medical information… and one young mother kindly brought me all of the stuff that she had gotten to treat her son’s HFM as well as hers.  She was earnest in hoping that this was the “cure”…and did I know about all of these remedies?

 

Here we go, her potions!  Epsom salts for baths as this is an “antiviral”, turmeric and ginger in veggie juice, crushed garlic which she was mixing with small amounts of orange juice and squirting into her toddlers mouth with a syringe, lavender essential oil and lastly “virgin” coconut oil massages.   

 

I was most impressed that her sweet toddler was eating, drinking and bathing in all of this!!! Unfortunately, despite her best efforts it took about 2 weeks for his rash to totally disappear and she kept him under house arrest for most of that time!!  He really could have gone out long before that as he was over his acute illness, but she wanted every “mark” to have faded. She was most chagrined to hear that he might get HFM again. I am not sure the her “voo-doo” did any good, except in her mind. 

 

Lastly, if you do resort to “internet medicine” remember the oath, “first do no harm” and check with your pediatrician about some of the advice you might find online, not everything may be safe.

 

Daily Dose

More on Ear Infections

1:30 to read

It is winter and fortunately while there is not much flu to date, there are certainly colds and coughs throughout the country.  It seems that every child I see has a runny nose.  Remember, a toddler will get anywhere from 5-10 colds a year for a couple of years as they start to have playmates and pass those pesky viral upper respiratory infections back and forth.  But for some young children, (especially those in daycare) those frequent colds may lead to recurrent ear infections (otitis).

Otitis media is an infection of the middle ear. In children, an ear infection typically follows a common cold, which may be caused by a plethora of viral illnesses. It seems that the virus changes how the middle ear “functions” (lots of complicated science about cilia, and mucous and eustachian tube function) which then leads to secondary bacterial infection and an acute ear infection.  It typically takes a few days to weeks of a cold, before developing an ear infection. I tell my patients, “you don’t usually see an ear infection in a young child on day 1 or 2 of a cold”.  If everything else seems okay, you might want to watch your child for a few days before having their ears checked.

The guidelines for treating acute otitis media (AOM) changed several years ago after studies showed that not all ear infections were caused by bacteria, especially in older children, and that with “watchful waiting” many ear infections would improve on their own.  So, for children between the ages of 6 -23 months of age with bilateral or unilateral ear infections and signs and symptoms of pain (tugging on the ear, rubbing the ear, irritability and sleep interruption) and fever the recommendation is to treat the infection with antibiotics.  The recommendations get a bit trickier for children who do not have bilateral infections and who are considered to have “non-severe” AOM, in which case the doctor and parent may discuss the pros and cons of antibiotic therapy and in some cases may decide to defer the use of antibiotics for 48-72 hours and observe the child for worsening of symptoms or failure to improve at which time an antibiotic may be started.  “Watchful waiting” has helped to decrease the number of antibiotics prescribed for children.

For the younger children 6 - 23 months who are more likely to be “sicker” than an older child with AOM,  the first line antibiotic to be prescribed is still Amoxicillin (unless the child is known to be penicillin allergic). Amoxicillin is the gold standard , “pink medicine” that many parents remember from their childhood…..tastes like bubble gum and needs to be refrigerated.  For children who have had recurrent ear infections other antibiotics know as “second line” drugs may be used.  Again, there are pros and cons to many antibiotics as well in terms of taste, how often they need to be given and side effects….so discuss this with your own pediatrician.   

For children 2 and older I am a big believer in “watchful waiting” and pain control.  So many of these children will do well with over the counter acetaminophen and ibuprofen as well as topical ear drops for analgesia.  I would guess that in my practice (not a valid scientific study) about 80% of my older patients do not fill a prescription for antibiotics….which as you know is a good thing (no one wants to be on an unnecessary antibiotic).  

Unfortunately, there seems to be a “group” of children (typically the younger ones) who get recurrent AOM and spend many of their winter months in the pediatricians office.  More about those infections in another post.

Daily Dose

RSV

1:30 to read

Flu season seems to be winding down but RSV (respiratory synctial virus) season is still here and actually arrived a bit later than usual this year. RSV is a common upper respiratory infection that causes cold symptoms with cough, runny nose, congestion and in some cases wheezing.  

But when new parents hear that there is RSV in their day care or school they often “freak out”. While RSV may cause cough, wheezing and respiratory distress in some young children (more commonly in those with underlying lung or cardiac disorders), thankfully for most it is just a really bad cold!

Statistically, 2% of infants less than 12 months of age are hospitalized for RSV each year.  But, that also means that 98% of infants do not require hospitalization!!  Much better odds that your child will be okay than if you play the lottery, right?

It really doesn’t make much of a difference as to which virus causes your child’s (or your) cold.  What is more important is how your child is breathing!!  Because a baby’s nostrils and airways are smaller, it is not uncommon for parents to be concerned that their child sounds noisy when they are breathing. I think it is more important to look at how your child is breathing rather than listening to their stuffy nose and coughing. This means that you need to take off their t-shirt or jammies and actually look at their chest, and make sure that you cannot see their ribs pulling in and out, or see their abdominal muscles doing work of breathing. You should also not see your baby’s nostrils flaring or see any change in their color...always pink, never dusky or blue!  The cough with RSV is horrendous and sounds terrible as well, but look at how they are breathing and their color when coughing.

It is also important that your child stays hydrated, even though they may not take their bottle or fluids as well as usual. You should always see “spit” in their mouths and tears when they cry and wet diapers (may not be sopping, but wet).  Remember, you probably don’t want to eat as much when you are sick yourself. Offer more frequent feedings. No schedules when your child is sick.

Best treatment, suck the mucous out of your baby’s nose and turn on a cool mist humidifier. They may also feel better when more upright, that is probably why there are many nights with a baby spent rocking on your shoulder when they are sick.

If you have any concerns about how your child is breathing you should always contact your doctor...better be safe. 

Daily Dose

Home From School

1:30 to watch

I continue to talk about it being  the “sick season” and thankfully it is now February!  Parents are all tired of having sick children and I can now at least assure them that we are halfway to the end of upper respiratory and flu season.

 

But, with that being said that means I am still seeing children with RSV, Flu and every other virus I can think of. Remember, the majority of the illness I see every day in my office is VIRAL.  It really doesn’t matter if you can put a name to the virus, as the treatment is the same. Rest, fluids, fever control and watch for any respiratory distress or symptoms of dehydration. As I told one young mother who said that her other child had been tested for RSV (by another doctor), testing the child I was now seeing will not make any difference in how we treat the illness. So, why make the child uncomfortable when doing the swab and also drive up health care costs, for no change in treatment recommendations.  I think people are confused about what the test actually does….it does not change how a child is treated, and it also causes a lot of “alarm” as the mother of one patient goes home to tell her friends that her child has RSV and then the school starts sending out emails and parents become more anxious and alarmed that they may have been exposed….as they are every day all over our city.

 

So…when do you know it is time to keep your child home from day care or school as we all know these viruses are spread at home, school and work as well.  

 

If your child has a fever over 100.5 degrees (by any method of taking their temperature) they should not go to day care or school for at least 24 hours after becoming fever free (without fever lowering medication).

 

If your child is vomiting, 2 or more times in the last 24 hours, they should stay home. Some young children may vomit after coughing as well, but if infrequent they may attend school. 

 

Diarrhea as defined by two or more loose, watery stools that are “out of the ordinary stool pattern” for your child. Any child having diarrhea that does not stay contained within a diaper should stay home. A child who has blood in their stool should not attend day care or school (and should see the doctor).

 

Children with strep throat may return to school after 24 hours if they are fever free and have received the appropriate antibiotic therapy.  (Newer article suggests 12 hours if they are feeling well).

 

Your child does not need to stay home due to a cold, cough, runny nose (of any color) or scratchy throat if they do not appear ill and do not have a fever. Look at how your child is behaving…some times a day of rest may be needed (even when you get sick, right?) 

 

Most importantly, it is not necessary to name the virus that your child might have, but to follow the guidelines for keeping them home (as well as out of stores, church, and after school activities) until they are feeling better. Wash hands, cover coughs and yes….still get the flu vaccine. It is not too late…the ground hog even said we still have a lot of winter left.

 

 

 

Daily Dose

More Zika News

1:30 to read

There continues to be more and more information being published about Zika and the continued concerns over side effects of the viral infection. So there are several new key facts that every parent needs to know.

Based on more research the CDC and WHO have now confirmed the link between Zika virus infection and birth defects. Two interesting studies were just published further substantiating the link. The first was in the journal Stem Cell in which researchers found that the Zika virus selectively infects cells in the brain’s outer layer which makes “ those cells more likely to die and less likely to divide normally and make new brain cells.” In other words, Zika preferentially affects tissues in the brain and brain stem of the fetus.  While this does not prove that Zika causes microcephaly it certainly points to the fact that brain cells are very susceptible to the virus and if the cells don’t divide to make new cells….one would think the brain would be smaller as would the head (microcephaly).

Another article in the New England Journal of Medicine reported on research that had been done on 88 pregnant women in Rio. The article stated, “infection during pregnancy has grave outcomes including fetal death, placental insufficiency, fetal growth restriction and central nervous system involvement.”  They also stated that “major fetal abnormalities were found in nearly a third of the women who had been infected and had undergone ultrasounds.” This virus seems to act like some other viruses (rubella) that have caused congenital infections and brith defects as well. The study also showed that the Zika virus may affect the placenta as well, which could cause miscarriages and/or still births.

While much of the Zika virus news has focused on pregnant women and associated birth defects, countries with high rates of Zika infections have also seen an increase in the number of cases of Guillian Barre Syndrome (GBS), a neurological disorder which causes muscle weakness and varying degrees of paralysis.  A study published in The Lancet reviewed results of blood tests from patients who had Zika and GBS in French Polynesia, which was the site of an earlier Zika outbreak. Of the 42 patients that had been diagnosed with GBS, 41 had antibodies to Zika, which is more evidence that Zika may be the cause of the serious neurological condition. While GBS has been seen in children and adolescents post Zika, it tends to be seen more frequently in older adults and is actually a bit more common in men.

Although it seems that the virus affects pregnant women and older adults in different ways, the severe side effects of Zika are in both cases related to the nervous system. There is still much research to be done to elucidate the how and the why, before any type of cure or vaccine is available, but all of these studies are getting scientists one step closer.

Another issue that scientists continue to work on is how to best test for Zika virus.  It is still not clear how long the incubation period is after being exposed to Zika virus, and remember about 80% of people will not even realize they were infected. With that being said, one of the tests ( called a PCR test)  requires that the patient’s blood be drawn within 4 - 7 days after being bitten by the infected mosquito. Another test ( Zika MAC-ELISA) , may be the better test as it may be used for a longer period of time after being bitten. Both of these tests are being used for diagnosis and are now being sent to qualified labs to help speed up the diagnosis of Zika. 

In the meantime as warmer, humid weather is approaching the United States, we all need to be pro-active about using insect repellant, reduce standing water (it has been raining in TX for days), and wear long sleeved clothes and pants when possible. Stay tuned for further updates as the CDC expects to see cases of Zika in the U.S. over the coming months. To date all of the Zika cases that have been diagnosed in the U.S. have been imported and not acquired here.  

Tags: 

Pages

Please fill in your e-mail address to be included in our newsletter.
You may opt out at any time.

 

DR SUE'S DAILY DOSE

Are vaccines safe for pregnant moms?

Please fill in your e-mail address to be included in our newsletter.
You may opt out at any time.

 

Please fill in your e-mail address to be included in our newsletter.
You may opt out at any time.