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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

HPV Vaccine

1:30 to read

I don’t think I have posted the latest good news about vaccines. As you know I am a huge proponent of vaccinating children (and ourselves), and remind patients that there continue to be ongoing studies regarding vaccine safety, as well as efficacy.  The CDC and ACIP recently announced that the HPV vaccine may be protective and effective after just 2 doses of vaccine rather than the previous recommendation of a series of 3 vaccines.  That is good news for teens, especially those that are “needle phobic”!  

 

The ACIP (Advisory Committee on Immunization Practices  recommended  a 2 dose HPV vaccine series for young adolescents, those that begin the vaccine series between 11 and 14 years.  For adolescents who begin the HPV vaccine series at the age 15 or older, the 3 dose series is still recommended.

 

This recommendation was based upon data presented to the ACIP and CDC from clinical trials which showed that two doses of HPV vaccine in younger adolescents (11-14 years old) produced an immune response similar or higher than the response in older adolescents (15 yrs or older). 

 

The HPV vaccine, which prevents many different types of cancer caused by human papilloma virus, has been routinely recommended beginning at age 11 years  approved to use as young as 9 years), but unfortunately only about 42% of girls and 28% of teenage boys has completed the 3 dose series.  

 

By showing that a 2 dose series (when started at younger ages) is effective and protective the hope is that more and more young adolescents will complete the series.  The two doses now must be spaced at least 6 months apart and may even be given at the 11 year and then 12 year check up which would not require as many visit to the pediatrician.

 

According to the CDC more HPV - related cancers have been diagnosed in recent years, and reported more than 31,000 new cases of cancer each year (from 2008 - 2012) were attributable to HPV, and that routine vaccination could potentially prevent about 29,000 cases of those cancers from occurring.  But, in order to see these numbers shrink, more and more adolescents need to be immunized…before they are ever exposed to the virus. Remember, the HPV vaccine is protective against certain strains of HPV, but does not treat HPV disease.

 

So..once again a good example of using science based evidence to provide the best protection against a serious disease…with less shots too!! Win - Win!!

 

 

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 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.  

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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!

Daily Dose

War On Zika Virus

1:30 to read

There seem to be updates everyday on the latest cases of Zika virus both in the U.S. (to date all of which have been imported) and in more and more countries in the Caribbean. At the same time, there is more information being released  by the CDC and the World Health Organization on the virus, its effects, how to diagnose it, who should be tested and prevention.  There are also many scientists around the world who continue to work on diagnosing, treating, and preventing the Zika virus. Despite all of this there is still a lot to learn and many questions still remain about this rapidly spreading virus.

The CDC has just documented the first case of the Zika virus being transmitted sexually in this country.  The case was actually confirmed in Dallas after the patient had returned from a trip to Venezuela and was diagnosed with Zika virus. Subsequently his partner, who had had unprotected intercourse within 2 weeks of the initial patient’s return, was diagnosed with Zika virus. Fortunately, there was not a fetus involved in this case and both of the patients have recovered. Because of this the CDC has now issued new guidelines stating “men who live in or travel to areas of active Zika infections and who have a pregnant sexual partner should use latex condoms correctly, or refrain from sex until the pregnancy has come to term”.  Questions still remain about possible viral transmission from saliva and urine and further information will be forthcoming. 

The CDC also changed the guidelines for pregnant women who have traveled to areas with known Zika virus and are concerned about possible exposure.  While they had previously recommended that only those with at least 2 symptoms of the virus (which include rash, fever, joint pain or conjunctivitis) be tested, they now have more data on the accuracy of the tests and the new guidance states “pregnant women without symptoms can be offered testing between two to 12 weeks after travel.” So if you are concerned consult your Ob-Gyn. 

I am also getting questions from young woman who have been “trying to get pregnant” or who are even “thinking about getting pregnant” and they want to know if they should “delay getting pregnant”?  While I am concerned about the spread of the Zika virus, I do not think that women in the U.S. should alter their plans to become pregnant.  But, at the same time, I am advising these women to change their plans and to cancel any and all travel to the Caribbean, Central and South American countries with known Zika virus until after they have conceived and given birth…so in other words for at least 9 -12 months and maybe more. Why risk an exposure when not necessary? 

While this virus is expected to spread to the U.S. this summer there is some thought that it may be our southern states with hotter and more humid weather who will have the greatest likelihood of seeing significant Zika virus. Again, this is based on historical as well as ongoing research.  What is known, is that the Aedes mosquito (the type that carries Zika) has previously been found in most states in the United States. I have had one mother who is pregnant call and ask if I thought she should leave the state of Texas this summer, and move north to a cooler climate!  While that seems a bit extreme,  no one knows what impact Zika will have here until the temperatures warm up. In the meantime I advised her to start wearing insect repellant that contains DEET or picardin, as well as to wear long sleeves and pants and to try and stay inside during peak mosquito hours (dawn and dusk), as we still have mosquitos in Texas even at this time of year.  Might as well get in the routine now.

Stay tuned…

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

Spring Viruses

1.30 to read

While it is warming up here in Dallas, many parts of the country are still seeing freezing temperatures and even snow! Even so, I am beginning to see typical spring illnesses like Fifth’s disease. 

Fifth disease is a common viral illness seen in children, often in the late winter and spring. Many of these children look like they have gotten a little sun burn on their faces (just as your child starts playing outside) as they often show up in my office with the typical slapped cheek rash on their faces.  At the same time they may also have a lacy red rash on their arms and legs, and occasionally even their trunks.

Fifth’s is also called erythema infectiosum and is so named as it is the fifth of the six rash associated illnesses of childhood. Fifth disease is caused by Parvovirus B19, which is a virus that infects humans. It is NOT the same parvovirus that infects your pet dog or cat, so do not fear your child will not give it to their pet or vice a versa.  In most cases a child may have very few symptoms of illness, other than the rash.  In some cases a child may have had a low-grade fever, or runny nose or just a few days of not feeling well and then the rash may develop several days later. The rash may also be so insignificant as to not be noticed. When I see a child with Fifth disease it is usually an easy diagnosis based on their few symptoms and the typical rash.

Although children with Fifth are probably contagious at some time during their illness, it is thought that by the time the rash occurs the contagious period has passed. This is why you never know where you got this virus. (the incubation period is somewhere between 4-20 days after exposure).  Parvovirus B19 may be found in respiratory secretions and is probably spread by person to person contact.  During outbreaks it has been reported that somewhere between 10-60% of students in a class may become infected.

Most adults have had Fifth disease and may not even have remembered it, as up to 20% of those infected with parvovirus B19 do not develop symptoms, so it is often not a memorable event during childhood.

Fifth disease is another one of those wonderful viruses that resolves on its own. I like to refer to the treatment as “benign neglect” as there is nothing to do!  The rash may take anywhere from 7–10 days to resolve. I do tell parents that the rash may seem to come and go for a few days and seems to be exacerbated by sunlight and heat. So, it is not uncommon to see a child come in from playing on a hot sunny day and the rash is more obvious on those sun exposed areas. 

Occasionally a child will complain of itching, and you can use a soothing lotion such as Sarna or even Benadryl to relieve problematic itching. A cool shower or bath at the end of a warm spring day may work just as well too. Children who are immunocompromised, have sickle cell disease, or have leukemia or cancer may not handle the virus as well and they should be seen by their pediatrician. But in most cases there is no need to worry about Fifth disease, so it is business as usual with school, spring days at the park and Easter parties.

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

Daily Dose

Vomiting Kids

1:30 to read

Pick a virus ….and it is probably circulating in your area!  Seems we are at the peak of upper respiratory season, influenza like illness season and also vomiting and diarrhea season. In other words, lots of sick kids right now.

 

I just started seeing a lot of vomiting again!!  It is the worst for both the child and the doctor’s office where it seems many a child has vomited either in the car, coming up the elevator or in the exam room.  YUCK for all.

 

Remember, norovirus is the most common virus that causes vomiting and diarrhea and it is VERY contagious. Not only via “dirty hands” but it is also airborne…so in other words, those standing near by a child who is vomiting (parents, other sibs) are probably being exposed as well. That is the main reason you probably see an entire family who gets sick almost simultaneously.  

 

If your child vomits….DO NOT give them anything to eat or drink for at least 30 min. I know that is hard as they are asking for a drink,  but you need to give their tummy a minute to “recover” before challenging them with a few sips of Pedialyte or Gatorade.  A SIP is the key word too….tiny amount to start in hopes that they do not vomit again.  

 

I just saw a 6 year old little boy who had been vomiting several times during the night.  His Dad said that he had given him Zofran to help stop the vomiting (this is a prescription).  I use a lot of Zofran in children who are vomiting as it can go under the tongue.  But after the Zofran his son felt better….so he gave him strawberries and a waffle!! Surprise? He vomited again!!

 

Don’t be fooled and start trying to feed your child too quickly after they are vomiting. I know parents worry that “their child is not eating”, but fluids are the important part of staying hydrated. As one little boy told me, “ it feels like there are grasshoppers in my tummy”!! So well put. I grumbling tummy needs time to heal and frequent sips of clear liquids (no dairy) are the best way to prevent dehydration. As your child tolerates a small volume you can go up a bit and gradually increase the amount that they take.  I usually wait a good 4-6 hours after a child has successfully tolerated fluids before I even consider giving them food. Then I start with crackers, noodles or something bland (that I also don’t mind cleaning up) in case they vomit again.  

 

You are just wanting to make sure your child stays hydrated…tears, saliva and urine!  Keep washing those hands. 

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