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Crypto in Swimming Pools Doubles in 2 Years

2:00

Many kids and adults won’t be waiting till the first official day of summer before cooling off in a waterpark or pool. Unfortunately, the chance of getting a pool-linked infection has doubled in the last year.

At least 32 outbreaks of cryptosporidiosis were reported in 2016, compared with 16 outbreaks in 2014, according to a new report from the U.S. Centers for Disease Control and Prevention.

Cryptosporidium is a microscopic parasite that causes the diarrheal disease cryptosporidiosis. Both the parasite and the disease are commonly known as "Crypto."

While this parasite can be spread in several different ways, water (drinking water and recreational water) is the most common way to spread the parasite.

Crypto is spread when people come in contact with the feces of an infected person, the CDC says. Not a pleasant thought.

Otherwise healthy people can be sick for up to three weeks with watery diarrhea, stomach cramps, nausea or vomiting, the CDC warns. The infection can become life-threatening in people with compromised immune systems.

The cause? Adults or children sick with crypto-caused diarrhea are swimming in public pools despite their illness and further spreading the parasite, said Michele Hlavsa, chief of the CDC's Healthy Swimming Program.

Not only do humans spread the parasite, but also infected animals. Swimming in ponds or “swimming holes,” or anywhere animals have access, is not a good idea.

You can become infected after accidentally swallowing the parasite. Crypto may be found in soil, food, water, or surfaces that have been contaminated with the feces from infected humans or animals. Crypto is not spread by contact with blood.

Once infected, people with decreased immunity are most at risk for severe disease. 

People also can contaminate pool water with crypto through just physical contact, said Lilly Kan, senior director of infectious disease and informatics with the National Association of County & City Health Officials (NACCHO).

For example, parents might spread the parasite if they change a child's crypto-contaminated diaper and then hop in the water without properly washing their hands, Kan said.

Hlavsa explained that crypto is resistant to chlorine, and can survive up to 10 days in even properly chlorinated pool water.

Parents should take kids on bathroom breaks often, and shouldn't count on swim diapers protecting other swimmers from exposure to a child's diarrhea, Hlavsa added.

"Swim diapers do not contain diarrhea," she said. "If water is getting into that diaper, then water is getting out."

To protect themselves, swimmers should avoid swallowing any pool water, and make sure that kids don't have pool toys that encourage swallowing the water, Hlavsa said.

While home pools are safer, because of the fewer number of people sharing the water, they are not fool proof. Make sure that no one with diarrhea or a stomach illness has been in the pool before you allow your kids to jump in a friend or family member’s pool. And it goes without saying, make sure your own kids stay out of your pool if they’ve had or have diarrhea. Crypto can easily spread to family and friends.

Good hygiene and common sense should help make this summer’s pool party a special one - where everyone just has a good time and no one goes home with an unwelcomed guest inside them.

Story sources: Dennis Thompson, https://consumer.healthday.com/gastrointestinal-information-15/diarrhea-health-news-186/the-water-s-not-fine-u-s-pool-linked-infection-doubles-in-2-years-722869.html

Https://www.cdc.gov/parasites/crypto/infection-sources.html

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

Swollen Lymph Nodes

1:30 to read

A parent’s concern over finding a swollen lymph node, which is known as lymphadenopathy, is quite common during childhood.  The most common place to notice your child’s lymph nodes are in the head and neck area.

Lymph nodes are easy to feel  around the jaw line, behind the ears and also at the base of the neck, and parents will often feel them when they are bathing their children.  Because young children get frequent viral upper respiratory infections (especially in the fall and winter months), the lymph nodes in the neck often enlarge as they send out white cells to help fight the infection. In most cases these nodes are the size of nickels, dimes or quarters and are freely mobile. The skin overlying the nodes should not appear to be red or warm to the touch. There are often several nodes of various sizes that may be noticed at the same time on either side of the neck.   It is not uncommon for the node to be more visible when a child turns their head to one side which makes the node “stick out” even more.

Besides the nodes in the head and neck area there are many other areas where a parent might notice lymph nodes.  They are sometimes noticed beneath the armpit (axilla) and also in the groin area.  It your child has a bug bite on their arm or a rash on their leg or even acne on their face the lymph nodes in that area might become slightly swollen as they provide an inflammatory response. In most cases if the lymph nodes are not growing in size and are not warm and red and your child does not appear to be ill you can watch the node or nodes for awhile.  The most typical scenario is that the node will decrease in size as your child gets over their cold or their bug bite.  If the node is getting larger or more tender you should see your pediatrician. 

Any node that continues to increase in size, or becomes more firm and fixed needs to be examined. As Adrienne noted in her iPhone App email, her child has had a prominent node for 7 months. Some children, especially if they are thin, have prominent and easily visible nodes.  They may remain that way for years and should not be of concern if your doctor has felt it before and it continues to remain the same size and is freely mobile.  Thankfully, benign lymphadenopathy is a frequent reason for an office visit to the pediatrician, and a parent can be easily reassured.

That's your daily dose.  We'll chat again tomorrow.

Daily Dose

Ear Infections Can Develop Quickly

1:15 to read

One of the things that I sometimes see in my practice, which is interesting to me as a pediatrician, and was equally interesting when I had young kids, is how quickly a child's ear exam can change.

You are taught that in medical school, but when you really see it happen it with your patients or your own child you become a real believer. As the saying goes, seeing is believing. I can remember checking one of my boy's ears for an ear infection early in the morning before heading out to work, and declaring, "his ears are perfectly clear". How could it be, my husband would inquire, "that they seem worse after we have been at work all day" and lo and behold, I would re-check their ears and a normal morning ear is an abnormal evening ear. What a difference 12 hours can make! Not a very good warranty on ears and infections.

I was reminded of this yesterday when a patient called and said that her little boy had developed "disgusting" eye drainage which was worsening since I had seen them in the office a few days ago. They had just returned from taking both of their young children to Disney World, and she "couldn't believe they came home sick!" That's a whole 'nother column. At any rate, seeing that they lived fairly close I told them to swing on by and let me look at him again. I think she was just hoping I would call in eye drops. The two precious boys arrived at my doorstep on Saturday night and lo and behold after looking in the youngest child's ears, both of his ears were so infected. So, once again I was a believer in ears changing, and he did not need eye drops he needed to have oral antibiotics to clear up his ears (and subsequently his eyes). There are several lessons from all of this. Ears can change quickly, eye drainage in a toddler with a cold may often really indicate that their ears are infected, and house calls are a good thing.

That's your daily dose, we'll chat again tomorrow.

Daily Dose

Migraines in Children

1.15 to read

I received an email via our iPhone App inquiring about migraines in children. Headaches are a common complaint throughout childhood, but pediatricians have recognized that children have many different types of headaches which include migraine headaches. 

Migraine headaches are best diagnosed by obtaining a detailed history and then a thorough neurological exam. There are several characteristics of childhood migraines that are quite different than adult migraines. While adult females have a higher incidence of migraine headaches, males predominate in the childhood population. 

Childhood migraines often are shorter in duration than an adult migraine and are less often unilateral (one sided) than in adults. Only 25-60% of children will describe a unilateral headache while 75-90% of adults have unilateral pain.  Children do not typically have visual auras like adults, but may have a behavioral change with irritability, pallor, malaise or loss of appetite proceeding the headache.  About 18% of children describe migraine with an aura and another 13% may have migraines with and without auras at different times. When taking a history it is also important to ask about family history of migraines as migraine headaches seem to “run in families”. 

Children who develop migraines were also often noted to be “fussy” infants, and they also have an increased incidence of sleep disorders including night terrors and nightmares. Many parents and children also report a history of motion sickness. When children discuss their headaches they will often complain of feeling dizzy (but actually sounds more like being light headed than vertigo on further questioning). 

They may also complain of associated blurred vision, abdominal pain, nausea and vomiting, chills, sweating or even feeling feverish. A child with a migraine appears ill, uncomfortable and pale and will often have dark circles around their eyes. It seems that migraine headaches in childhood may be precipitated by hunger, lack of sleep as wells as stress. But stress for a child may be positive like being excited as well as typical negative stressors. 

Children will also tell you that their headaches are aggravated by physical activity (including going up and down stairs, carrying their backpack, or even just bending over). They also complain of photophobia (light sensitivity) and phonophobia (sensitive to noises) and typically a parent will report that their child goes to bed in a dark room or goes to sleep when experiencing these symptoms. 

Children with migraines do not watch TV or play video games during their headaches. They are quiet, and may not want to eat, and may just want to rest.  Nothing active typically “sounds” like fun. To meet the diagnostic criteria for childhood migraine, a child needs to have at least 5 of these “attacks” and a headache log is helpful as these headaches may occur randomly and it is difficult to remember what the headache was like or how long it lasted, without keeping a log. 

There are many new drugs that are available for treating child hood migraines and we will discuss that in another daily dose.  Stay tuned! 

Daily Dose

Zika Virus

1:30 to read

If you are pregnant or planning on becoming pregnant in the near future you need to be aware of the Zika virus.  This virus is spread via the Aedes mosquito (as is West Nile Virus, Dengue fever and Chikunguyna), and has been found in Africa, Southeast Asia, the Pacific Islands , South America and Mexico.  The Zika virus was also just confirmed in Puerto Rico and the Caribbean in December.  There are new countries confirming cases of Zika virus almost every day, as the Aedes mosquito is found throughout the world.  

When bitten by a mosquito that has the Zika virus, only about 1 in 5 people actually become ill.  The most common symptoms are similar to many other viral infections including fever, rash, joint pain and conjunctivitis.  For most people the illness is usually mild and lasts for several days to a week and their life returns to normal.  Many people may not even realize that they are infected. 

Unfortunately, if a pregnant mother is infected with the Zika virus, the virus may be transmitted to the baby.  It seems that babies who have been born to mothers who have been infected with the Zika virus may have serious birth defects including microcephaly (small head) and abnormal brain development. There have been more than 3,500 babies born with microcephaly in Brazil alone…and just recently a baby was born in Hawaii with microcephaly and confirmed Zika virus. In this case the mother had previously lived in Brazil and had relocated to Hawaii during her pregnancy.  The virus to date has not been confirmed in mosquitos in the United States.

Because of the association of the Zika virus and the possibility of serious birth defects, the CDC has announced a travel advisory stating, “until more is known and out of an abundance of caution, pregnant women in any trimester, or women trying to become pregnant, should consider postponing travel to the areas where Zika virus transmission is ongoing”.  

Should pregnant women have to travel to these area they should follow steps to prevent getting mosquito bites during their trip. This includes wearing long sleeves, staying indoors as much as possible, and using insect repellents that contain DEET.

Researchers are continuing to study the link between Zika virus and birth defects in hopes of understanding the full spectrum of outcomes that might be associated with infection during pregnancy. There will be more data forthcoming.

At this point the safest way to avoid being bitten is to stay away from the countries who have had confirmed cases of the Zika virus.  But as the weather warms up in the United States and mosquitos become more abundant there is concern for Zika virus to be found here.  It only takes one infected mosquito to bite one person who then contracts the virus….should that person be bitten by another mosquito, that mosquito may acquire the infection and so it spreads.  There is not known to be human to human transmission of the virus.

Daily Dose

The Difference Between A Viral Sore Throat & Strep Throat

It only takes getting the kids back in school for the pediatrician’s office to see an upswing in illness. But this year it came on particularly early and we are definitely seeing more illness in the first week of fall than is typical.

Most of the illness being reported around the country is due to Influenza A, H1N1 (swine flu) and the majority of cases seem to be occurring in the five to 24 year old age group, in other words the school aged, elementary through college aged kids. To review again, flu like symptoms for all influenza strains are typically similar with fever, sore throat, cough, congestion, headaches and body aches. Occasionally there may be some nausea or vomiting but that is not seen as often. Flu like symptoms seem to begin with general malaise and then develop over the next 12 – 24 hours and you just feel miserable. Some of the confusion now is about sore throats and the difference between a sore throat with the flu, which is due to a viral infection, and strep throat, which is a bacterial infection. As for most things in life, nothing is 100 percent and the same goes for viral and bacterial sore throats. But, with that being said, there are certain things that might make a parent think more about a viral sore throat than strep throat and vice versa. Viral sore throats, which we are seeing a ton of with the flu right now, are typically associated with other viral symptoms which include cough, and upper respiratory symptoms like congestion or runny nose. A viral sore throat may or may not be accompanied by a fever. In the case of flu, there is usually a fever over 100 degrees. With a viral sore throat you often do not see swollen lymph nodes in the neck (feel along the jaw line) and it doesn’t hurt to palpate the neck. If you can get your child to open their mouth and say “AHHH” you can see the back of their throat and their tonsils, and despite your child having pain, the tonsils do not really look red, inflamed or “pussy”. Even though it hurts every time you swallow, to look at the throat really is not very impressive. Strep throat on the other hand, typically occurs in winter and spring (that is when we see widespread strep), but there are always some strep throats lurking in the community, so it is not unusual to hear that “so and so” has strep, but you don’t hear a lot of that right now. As we get into winter there will be a lot more strep throat. Strep throat most often affects the school-aged child from five to 15 years. Children get a sudden sore throat, usually have fever, and do not typically have other upper respiratory symptoms (cough, congestion). This is another opportunity to feel your child’s neck and see if their lymph nodes are swollen, as strep usually gives you large tender nodes along the jaw line. When you look at the throats of kids with strep they usually have big, red, beefy tonsils (looks like raw meat) and may have red dots (called petechia) on the roof of the mouth. The throat just looks “angry”. Sometimes a child will complain of headache and abdominal pain with strep throat. Some children vomit with strep throat. The only way to confirm strep throat, again, a bacterial infection, is to do a swab of the back of the throat to detect the presence of the bacteria. There are both rapid strep tests and overnight cultures for strep. Most doctors use the rapid strep test in their offices. If your child is found to have strep throat they will be treated with an antibiotic that they will take for 10 days. Again, antibiotics are not useful for a viral sore throat and that is why strep tests are performed. I’m sure we’ll talk more about sore throats as we get into winter. But in the meantime, get those flashlights out and start looking at throats. That’s your daily dose, we’ll chat again tomorrow.

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

Viruses Linger During End of School Year

Viruses linger during end of school year and disrupt many events. Dr. Sue explains what parents can do to keep their kids healthy.Well, it seems all students, from preschoolers through those in high school and college, are in full end of the school year mode. Graduations are ahead, from kindergarten through college, and of course there also seem to be several spring/summer viruses lurking around that are disrupting students (and parents) end of year plans.

Just like we have influenza during the winter months (and over the Christmas and New Year’s holidays), we also see other viruses that cause fever, myalgias (muscle aches), cough, congestion and sore throat, that are equally bothersome at this time of year.  While it is not influenza, other viruses such as  adenovirus, enteroviruses and parainfluenza virus (just to name a few), can make you run fairly high fever, feel horribly, have a sore throat and congestion and eventually a cough. Most viruses last anywhere from 7 -14 days, and for the first 2-4 days it is not unusual to see kids running fever, which only makes them feel that much worse.  Something about having a 103 degree fever, while the weather is in the 70’s to 90’s around the country, just doesn’t seem right! Unfortunately, these viruses don’t really care what we all have happening in our lives, and so you may find your child trying to wrap up end of school activities, but really needing to stay home for a few days due to illness. I am writing this as I have seen dozens and dozens of sick kids in the last few weeks with a litany of things to “do” before school ends. Parents bringing their sons and daughters in to my office for “the cure” so that they may attend the end of preschool party, or the field trip, prom or graduation.  I only wish that I had “the cure”. As we have discussed so many times, viruses are bigger and brighter than the best minds, and they cannot be cured in 12 hours with a magic shot of penicillin (although I must say some doc in the boxes still do this).  Despite my best efforts as a physician (and a mother too), the only thing that really cures a viral illness is “tincture of time”, which no one seems to have any more. I am not pointing fingers, because I am guilty of feeling like that too.  I only wish that I could get everyone, including my own children, better in time to attend all of these important functions!!  Viruses always occur at the most inconvenient times. One mother has brought her son to see me both in my office and by my house in hopes of finding “something” that we can treat. She has thrown out options like “antibiotics, inhalers, vitamins and steroids” in hopes of getting him better faster. Now throughout this illness, he like many others has “drug” his sick body out of bed to attend “special” events, all the while running fever and coughing. So, he is indeed contagious and might spread the virus to others. Whether intentional or not, viruses are spread very easily, especially in the close contact that our adolescents all have. I LOL when a parent says “my child has not been around anyone that is sick”!!  But of course they have.  The viruses are at  school, at  after school activities, while sharing water bottles on the sports field, or sandwiches at lunch, our children are exposed. Then throw in all of the parties going on now and it is perfect storm for germs to spread. So bottom line, if your child has a fever, they should stay home.  Rest, fluids, fever control and time are really the only cures.  But thankfully, I feel certain that one of these bright students will one day find the “CURE” for the viral illnesses that we all dread, and they will be a Nobel Prize winner. Not only that, they will be loved by all parents who want to figure out how to  “fix” their child in time for  the next party or event! That's your daily dose for today.  We'll chat again tomorrow. Send your question or comment to Dr. Sue now!

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