8
Oct

Enterovirus D68 (EV-D68)

enterovirus - 2014-1008 -imageedit_7_9044717870What is Enterovirus D68?

Enterovirus is a non-polio virus that was first discovered in California in 1962. (http://1.usa.gov/1rVzPYU) It typically exists during the Summer and Fall, with frequency of the virus decreasing in late Fall.  

 

Where is Enterovirus D68 in the United States in 2014?

This year, Enterovirus D68 is documented with severe respiratory illness in the United States. Currently, the Centers for Disease control (CDC) or state labs have confirmed 628 people infected with this virus in 44 states and the District of Columbia.  Yesterday, the Florida Department of Health confirmed Florida's first Enterovirus D68 infection in a 10 year old girl from Polk county who was treated in Hillsborough County at Tampa General Hospital one (1) month ago for six (6) days. (http://on.wtsp.com/ZQzSw3)  The reality is that Enterovirus D68 is everywhere.

 

Enterovirus D68 Updates:

Update 10/8/14: Enterovirus D68 appears to be winding down.  Fewer severe respiratory illnesses reported last week.  Peak was three (3) weeks ago. (http://usat./1vUOJPz)

Update 10/16/14: CDC new rRT-PCR test for Enterovirus D68 allows more rapid test for the more than 1,000 remaining specimens from since mid-Sept. (http://bit.ly/ZC9JzW).  This will result in an increased number of positive results.  However, this will be for past infections, not recent ones.  Enterovirus D68 still appears to be winding down.  

 

What Are the Symptoms of Enterovirus D68?

Enterovirus is typically misdiagnosed as a common cold, rhinovirus, RSV, or the flu. Typical symptoms include those of cold symptoms, runny nose, cough, sneezing, and achiness.  In more severe cases, wheezing and difficulty breathing has occurred. There have been four (4) deaths associated with Enterovirus. (http://1.usa.gov/1yLuo52)  In addition, the Colorado Health Department reports that partial paralysis has occurred in 12 Colorado children infected with Enterovirus D68. (http://dpo.st/1CTtJgp)  The CDC is investigating the deaths and the potential paralysis link. 

 

Who's at Highest Risk for Contracting Enterovirus D68?

Infants, children, and teenagers are at highest risk for contracting the disease as they have not had sufficient exposure and therefore immunity against this virus.  Those who have asthma and reactive airway disease are at higher risk to have more severe symptoms and illness from the virus.

 

How Do I Prevent Enterovirus D68?

•Hand washing, hand washing, and hand washing! Hand sanitizers are not effective in prevention.  This virus spreads by cough, sneeze, or touching an infected surface.  

•Non-alcohol disinfectants are effective. However, hand washing is still the best.

•Keep your sick child home.  This is very important to prevent the spread of this virus. Remember, in some, this virus acts like the common cold.  However, if your child spreads it to someone else, the child may develop more severe symptoms.

•Cough and sneeze into your elbow.

•Clean commonly used surfaces (countertops, door knobs, toys, etc) with bleach water.

 

When Should I See a Doctor?

If you or your child have asthma or reactive airway disease, develop cold symptoms, fever, wheezing or shortness of breath, then go see a doctor.  

 

What is the Treatment for Enterovirus D68?

There is no cure for this virus.  There is supportive care.  The sooner you or your child receive supportive care, the better the outcome. That being said, it doesn't mean that the moment you or your child gets sick, you should run to the pediatrician.  However, if you or your child has asthma or reactive airway disease, become ill with fever, cold symptoms, is wheezing or short of breath, your pediatrician should examine your child.

Enterovirus D68 is most commonly a mild disease.  However, this year, it has become a scary one.  Knowing your child's health, closely observing them if they are ill, and follow-up care with your pediatrician will help in the treatment of Enteovirus D68, so it won't terrify you.

7
Nov

CDC Report | Kids Not Receiving Pneumonia Vaccine

Only 37% of children between the ages 14 and 59 months have received the 13-valent pneumococcal conjugate vaccine (PCV13).  This alarming statistic was released on November 4, 2011 in the U.S. Centers for Disease Control's Morbidity & Mortality Weekly Report.
PCV13 replaces the 7-valent pneumococcal conjugate vaccine (PCV7).  Current recommendations include that: 1) children receive a primary series of PCV13 and 2) children between ages 14 and 59 months who have previously received the PCV7 as their primary series, receive a supplemental dose of PCV13, in order to prevent invasive pneumococcal disease (IPD).  Essentially, PCV13 protects children against an additional 6 strains of pneumococcus infection.
Pneumococcus is a bacterial infection that can cause invasive disease, such as pneumonia, sepsis, and/or meningitis, which can result in severe illness and/or death.  Parents are usually familiar with & doctors typically refer to this vaccine as one of the "pneumonia" vaccines.
If your child is less than 5 years old, please ask your kids' doctor if they are due for PCV13.  It could prevent illness & even save their lives.  For more information regarding kids and this pneumonia vaccine, PCV13, please go to http://www.cdc.gov/vaccines/vpd-vac/pneumo/default.htm#vacc.
24
Feb

Whooping Cough (Pertussis) on the Rise in the U.S.

According to the Centers for Disease Control (CDC), last year, more than 21,000 people in the U.S. were diagnosed with whooping cough. This is the highest rate of whooping cough that the U.S. has seen in approximately 50 years. Currently, there is a whooping cough epidemic in California. Last year, in California, there were 8,300 cases of whooping cough and 10 babies died. Nationally, there were 26 deaths attributable to whooping cough.

Whooping cough, also known as Pertussis, is a highly contagious bacterial infection. Once infected, it starts with symptoms that seem to be consistent with the common cold. However, within 10 to 12 days, it progresses. It can lead to weeks or months of coughing. It can also result in many devastating complications, such as pneumonia, dehydration, blindness, hearing loss, brain damage, seizures, or death. Infants have the highest risk of dying from this disease.

Those at highest risk, generally are those who have not yet be able to receive a high level of protection after receiving 3 doses of the pertussis vaccine. These include, but are not limited to:

* children who have not been vaccinated,

* children with delayed immunizations,
* children who are less than 6 months old

It is recommended that all children receive that whooping cough vaccine. This is offered as part of the Diphtheria-Tetanus-acellular Pertussis (DTaP) combination vaccine for children at ages 2, 4, 6, and 12-18 months old, with a booster at 4 to 5 years old. Additional recommendations are for children’s primary caregivers (moms, dads, grandparents, etc.) to receive the Tetanus-diphtheria-acellular pertussis (Tdap) vaccine.
I recommend this for all of my patients, their parents, and the older kids (teenagers) at home. Funny enough, dads hate the idea of receiving any vaccines. I never thought I would hear so many grown men cry, “But doc, do you know I hate shots? Do you know the last time I got shots?” My usual reply is, “Yes, I understand. No one likes them. Since, it’s been so long, you are probably not protected against pertussis. Just remember, you’re not doing this for yourself; you’re doing this for your baby.”

An excellent resource for more information is http://www.soundsofpertussis.com/. Jeff Gordon, of NASCAR, is their latest supporter. Past supporters have included actress, Jennifer Lopez. Watch her touching public service announcement on You Tube at http://www.youtube.com/watch?v=3LsuJi33B2U (see right). Also, watch one family’s story on You Tube at http://www.youtube.com/watch?v=3akJVesMdvs&NR=1.

As always, consult your doctor with any questions you have about this disease and/or its prevention.

23
Feb

Supreme Court Protects Vaccine Injury Compensation Program (VICP)

The VICP was established as part of the National Childhood Vaccine Injury Compensation Act in 1986.  In essence, this provides families with financial compensation for injury proven to be caused by a vaccine.  It also protects vaccine manufacturers from lawsuits due to injuries caused by childhood vaccines, as long as every step in the manufacturing process was executed in the manner best known at the time.

The case in which the U.S. Supreme Court ruled was Bruesewitz v. Wyeth, Inc. (No. 09-152, S. Ct.).  The Bruesewitz family’s daughter suffered from seizures and has permanent developmental delay, after receiving a third DTP vaccine when she was 6 months old.  After losing their case in “vaccine court” (under the VICP), the Bruesewitz family sued Wyeth siting a 1998 DTP vaccine design flaw.  They claimed that Wyeth had prior knowledge about the design flaw, but decided to place it on the market regardless.  The Bruesewitz family filed a lawsuit against Wyeth directly with the claim that design-flaw was not protected by the VICP.  Of note, 65 other children were injured by the vaccine in the same vaccine lot that their daughter received.  Subsequently, the lot was pulled from the market.

In a 6-2 ruling yesterday, the U.S. Supreme Court upheld a ruling by the Third Circuit Court.  Justice Antonin Scalia wrote, “Provided that there was proper manufacture and warning, any remaining side effects, including those resulting from design defects, are deemed to have been unavoidable. State law design-defect claims are therefore preempted.” In other words, the Supreme Court decided that the VICP is still the only way in which families can receive compensation for any vaccine injury their child may experience; they cannot sue the vaccine manufacturer directly.

It is important to note that this ruling does not make claims that vaccines do not ever cause harm.  It merely offers protection so that lawsuits will not bankrupt the vaccine manufacturers causing them to pull out of the market.  If a withdrawal from the vaccine market would occur, it would be considered a public health issue with devastating consequences.

For example, prior to the existence of the Haemophilus influenza (Hib) type b vaccine in 1987, approximately 20,000 U.S.  children became infected with Hib meningitis, pneumonia, epiglottitis, or other invasive Hib disease.  Approximately 1,000 U.S. children died per year as a result of invasive Hib disease.  Per the Centers for disease Control (CDC), “the incidence of Hib disease in infants and young children has decreased by 99% to fewer than 1 case per 100,000 children under 5 years of age. In the United States, Hib disease occurs primarily in underimmunized children and among infants too young to have completed the primary immunization series.”

Of note, here are a few excellent sources regarding vaccine information:
http://www.cdc.gov/vaccinesafety/index.html

16
Nov

Get Smart About Antibiotics Week

November 15-21, 2010 is Get Smart about Antibiotics Week.  This is a campaign set forth by Centers for Disease Control (CDC).  The American Academy of Pediatrics (AAP) is a partner in this campaign.  
The goal this week is to help educate the public about the use of antibiotics, how they work, when they are  needed, and their side effects.
Antibiotics are used to treat bacterial infections, such as ear infections, strep throat, sinusitis, and pneumonia.  It is important to know that antibiotics don't "work for everything."  Antibiotics do not treat viral infections.  Viruses cause the common, the flu, and many cases of upper respiratory infections.  You may wonder why your doctor does not prescribe an antibiotic each time your child is evaluated for his/her sore throat, cough, and stuffy nose.  That is because there is no cure for most viral infections. 
In fact, taking antibiotics unnecessarily may do more harm than good.  Your child may feel worse than he/she already does.  Antibiotics change the normal gut flora.  As a result, diarrhea is a common side effect as is nausea as well.  In addition, judicious use of antibiotics is imperative so as to prevent antibiotic resistance.  Over the decades, antibiotic resistance has increased.  This means that some antibiotics are no longer effective in their fight against infectious certain bacteria.  This occurred as a result of overuse of antibiotics in the past.  Lastly, it is important to make sure you follow your doctors directions in regards to how your child takes his/her anitbiotics.  Unless your child cannot tolerate his/her medication, please always make sure that he/she finishes the medication as directed.  In addition, do not save "left over" antibiotics and do not give "left over" antibiotics.  If you do, this leads to increased bacterial resistance.  In other words, this antibiotic is less likely to have killed the bacteria the first time, rendering it less susceptible to that same bacteria the next time.  As a result, your child will need to be placed on an additional course of antibiotics.  And no one wants that.
As always, the best resource you can have for all your questions regarding bacterial and viral infections and the treatment of your child(ren)'s illness is your doctor.  For more information, please check out the follow webpages from the CDC  (www.cdc.gov/getsmart/antibiotic-use/URI/index.html) and the AAP (www.healthychildren.org/English/News/pages/Get-Smart-About-Antibiotics.aspx).
4
Oct

Health Care Personnel & the Flu Vaccine

This September, the American Academy of Pediatrics (AAP) issued a statement that they support all healthcare personnel receiving a mandatory annual flu vaccination. The National Patient Safety Foundation (NPSF), the Infectious Diseases Society of America (IDSA) and The Society of Healthcare Epidemiology of America (SHEA) are other organizations that are also are in favor of such a measure.

Does your provider receive the Flu vaccine annually? You may be interested in knowing that bit of information. After all, if an unprotected health care provider becomes ill with the disease, that provider is now a source of the illness and can infect patients and other office staff members without having any intention of doing so.
Currently, the Flu vaccine is a voluntary vaccine for all health care personnel. However, the risks are different for the health care provider versus the patient. If a health care provider gets infected with the Flu, he/she will most likely infect many other patients before he/she is even aware that he/she has the illness. In my case, this could have devastating effects for the children I examine, especially those with chronic diseases such as asthma. Hence, very year I make sure to get the Flu vaccine. Getting vaccinated is the best way to protect myself, my patients, my family, and friends from contracting the Flu.
There is a Centers for Disease Control and Prevention (CDC) report that stated that last January, approximately 35% of health care workers get Flu vaccinations. Nurses have some of the lowest rates of Flu vaccination.
22
Sep

Eat Your Fruits & Veggies

A recent report from the U.S. Centers for Disease Control and Prevention (CDC) revealed that we are not eating enough of fruits and vegetables on a daily basis. The CDC report stated that in 2009, 67.5% of adults ate fruit less than two times daily and 73.7% ate vegetables less than three times per day.
 
How much fruit servings per day is recommended for my child?
Children 2-3 years old should have 1 cup per day, 4-8 years old should have 1 - 1½ cups per day.
Girls and boys 9-13 years old should have 1 ½ cups per day.
Girls 14-18 years old 1½ cups per day, whereas for boys it’s 2 cups per day.

How many veggie servings per day are recommended for my child?
Children 2-3 years old should have 1 cup per day, 4-8 years old should have 1 ½ cups per day.
Girls 9-13 years old should have 2 cups per day, whereas for boys it’s 2 ½ cups per day.
Girls 14-18 years old should have 2 ½ cups per day, whereas for boys it’s 3 cups per day.

What about for us parents?
You serve as the best role model for your children. Let them see you eat healthy every day.
Women 19-30 years old should have 2 cups of fruits per day & 2 ½ cups of vegetables per day.
Women 31-50 years old should have 1½ cups of fruits per day & 2 ½ cups of vegetables per day.
Men 19-50 years old should have 2 cups of fruits per day & 3 cups of vegetables per day.

In addition, eating enough fruits and veggies will help with your and your children’s overall health. It helps with weight control, prevention of chronic diseases and certain cancers, heart disease, diabetes, and several other illnesses.

What counts as a cup?
An 8 ounce cup of raw fruit, fruit juice or ½ cup of dried fruit counts as a cup of fruit. An 8 ounce cup of raw or cooked veggies, two cups of leafy green veggies, or a cup of pure vegetable juice counts as a cup of veggies.

Two excellent resources to utilize are www.fruitsandveggiesmatter.gov/index.html and www.supertracker.usda.gov/default.aspx. These websites have lots of examples, pictures and interactive tools to help you know how to make sure your family eats a healthy diet.

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