Category: Infection

Measles Outbreaks 2025: What Parents Must Know Now!

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Measles Outbreak 2025: What Parents Must Know Now!

Measles Outbreaks 2025

As of March 7, 2025, per the CDC’s weekly update, there have been 222 cases of measles in the United States with 17% of those with measles hospitalized and one (1) unvaccinated child that died in Texas. That’s approximately 78% of last year’s 285 measles cases in just the first two (2) months of this year.  The last child who died of measles in the U.S. was 10 years ago in 2015. This is the worst measles outbreak Texas has had in 30 years. The 12 states that have had measles cases this year include: Alaska, California, Florida, Georgia, Kentucky, New Jersey, New Mexico, New York, Pennsylvania, Rhode Island, Texas, and Washington.

Measles in Florida

As of March 6, 2025, there is one (1) student at Miami Palmetto Senior High School that was diagnosed with measles. The good news is that the school has a 99.7% vaccination rate. Hence, the chance of it spreading in the school is extremely low. No other cases of measles have occurred at the school.

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What is Measles?

Measles is a highly contagious viral infectious disease. It spreads when a person breathes, coughs, or sneezes.

How Contagious is Measles?

Very! It spreads when an infected person breathes, coughs, or sneezes.  Measles virus can survive in the air for up to two (2) hours! Any exposure can occur up to two (2) hours after a person left the area where they were located. Measles symptoms can begin 7 to 21 days after exposure, so unvaccinated children, adults, and immunocompromised people need to monitor themselves for symptoms. If symptoms occur, get tested.

Measles Impact Before the Measles Vaccine?

Before the Measles Vaccination Program in 1963 in the U.S., there were:

  • 500,000 reported cases of measles each year,
  • 48,000 hospitalizations each year, and
  • 1,000 developed encephalitis (brain swelling) from measles each year, and
  • 400 to 500 deaths from measles each year.

Why Are There Measles Outbreaks?

In 2000, measles was declared Eliminated in the U.S. The official designation of “Eliminated” is defined as no continuous disease spread for more than 12 months. Herd (community) immunity occurs when vaccination rates are 95% or higher. Unfortunately, the anti-vaccination movement and the COVID-19 pandemic resulted in measles vaccination rates dropping. Illness spreads easily in communities with unvaccinated people, allowing measles outbreaks to occur. Kindergartners Measles, Mumps, Rubella (MMR) vaccination rate across the U.S. decreased to 92.7% in the 2023-2024 school year. This year, Gaines County, Texas has a MMR vaccination rate of 82% in its kindergartners. Hence, the outbreak found a home. As of March 4, 2025, Gaines County reported 107 cases of measles, up 12 from the prior week.   

When Do Measles Symptoms Start?

Measles symptoms begin to show between 7-21 days after exposure.

Measles symptom in mouth - Koplik spots
Measles symptom in mouth – Koplik spots

Early Symptoms (First Four Days of Illness)

  • high fever
  • cough
  • runny nose
  • red, watery eyes
  • white spots inside the cheeks

 

 

 

Measles Rash
Measles Rash

Later Symptoms (3-4 Days After Illness Starts)

  • rash that starts on the face and neck
  • rash spreads to lower body (over a period of 3 days)
  • rash fades (after approximately 5-7 days)

 

Who’s at Greatest Risk From Measles?

  • children less than 5 years old
  • adults older than 20 years old
  • pregnant women
  • people with weakened immune systems

Common Measles Complications

Ear infections and diarrhea are common complications with measles.

  • ear infections – 1 in every 10 children with measles
  • diarrhea – 1 in every 10 people with measles

Severe Measles Complications

Hospitalization, pneumonia, encephalitis, and death are some of the severe complications that occur with measles disease. Encephalitis is brain swelling that occurs due to the measles infection. It can lead to potential brain damage which may include blindness, deafness, and developmental disabilities. In addition, pregnant women may deliver prematurely, have a miscarriage, a stillbirth, a baby with low birth weight, or a newborn with birth defects including brain damage.

  • hospitalization – 1 in every 5 unvaccinated people with measles
  • pneumonia – 1 in every 20 children with measles.
  • encephalitis (brain swelling) – 1 in every 1,000 children with measles.
  • death – 1-3 in every 1,000 children with measles die from neurological, pneumonia, or respiratory complications

What is Subacute Sclerosing Panecephalitis (SSPE)?

This is a slow ongoing measles brain infection. It is rare. It occurs in about 2 per 100,000 cases of natural measles.  It occurs 7 to 10 years after the initial measles infection.  It always results in brain damage and always ends in death.

How to Prevent Measles?

Make sure you and your children are fully vaccinated. According to the CDC vaccination schedule, full vaccination is defined as measles vaccine should receive two (2) doses of the vaccine. The first vaccine is given between 12-15 months old. The second vaccine is given between 4-6 years old.

How Efective is the Measles Vaccine?

The measles vaccine is 93% effective after the first dose.  It is 97% effective after the second dose. The vaccine is safe, effective, and generally lasts lifelong. 

Who Should Not Get the Measles Vaccine?

It is important to know that it is a live vaccine. As a result, there are certain situations where someone should not be vaccinated with a live vaccine such as the measles vaccine.  Pregnant women should not get the vaccine. Children and adults with weakened immune systems due to a condition (HIV, AIDS, etc.) or due to a specific medical treatment (chemotherapy, radiation, high-dose steroids, etc.) should not receive the vaccine. In addition, they need to stay away from those who recently received the vaccine to protect themselves. Discuss with your doctor all the details specific to your child’s or your condition so that you know how long to proceed.

Some real-life examples include a parent who is on high-dose steroids due to a transplant or a grandparent who is undergoing chemotherapy or radiation treatment who has a one (1) year old who is due to be vaccinated.

Is It Safe To Travel with Measles Outbreaks?

For the most part yes. However, if you are traveling to an area or near an area where there has been an outbreak, then check your vaccination status before or after you’ve been to or near the affected outbreak area. Make sure to watch for any signs and symptoms for the following 21 days. Contact your doctor to have a specific plan for you and/or your child’s exposure.

What To Do If Exposed To Measles?

Call your doctor. They will review your/your child’s vaccination status. In most cases, if you and your child have received two (2) doses of the MMR vaccine, you are considered immune from measles.

If you or your child haven’t received two (2) MMR doses, then call your doctor.  Your doctor will help guide you as to what to do next. Each case is managed differently. For example, if you have a one (1) year old child who was exposed to measles and had received the MMR vaccine more than 28 days prior to measles exposure, then a repeat MMR vaccine may be given to boost immunity. In another example, you have a seven (7) month old child who was exposed to measles that couldn’t be vaccinated yet because he/she wasn’t yet one (1) year old.  Your doctor will likely recommend that your unvaccinated infant receive the measles vaccine early in order to reduce the risk of contracting measles.

Again, if exposed, call your doctor. If you or your child are not vaccinated, you may need to receive a measles vaccine or measles immunoglobulin. And since measles is highly contagious, you will need to be evaluated in a manner that is safe and not around others.

What’s Next?

Stay tuned the nest blog post, “Autism & Genetic Testing: Why & When?”  Don’t forget to check out the video for more in-depth information on today’s topic! Watch the full video on my YouTube channel!

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Picture Credits:

  1. Kolik Spots – Attribution: Hariadhi, CC BY-SA 4.0 <https://creativecommons.org/licenses/by-sa/4.0>, via Wikimedia Commons
  2. Measles – Attribution: Greene, Charles Lyman, 1862-, No restrictions, via Wikimedia Commons

Foreskin Care for Circumcised & Uncircumcised Boys

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foreskin care for circumcised and uncircumcised boys

Why is Foreskin Care Necessary?

Foreskin care is necessary to prevent foreskin infection and/or irritation. The penile foreskin produces a secretion called smegma. Smegma is produced by the sebaceous glands on the inner surface of the foreskin.  There is smegma buildup whether or not your son has been circumcised.  Smegma acts like glue if left uncleaned.  The foreskin always wants to re-adhere to the penile head.  This is also true for the uncircumcised penile head. As the foreskin naturally lowers, it’s important to maintain good hygiene.  The smegma will slowly be exposed as the foreskin slowly retracts. At that point, if the smegma is not cleaned away, the loosened foreskin will also want to re-adhere to the penile head.  It’s good hygiene to clean the penile head daily regardless of circumcision or not.

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Foreskin Care for Circumcised Boys

Many parents believe that since the foreskin has been removed, there’s not much else to do.  Even though your son’s foreskin was circumcised, there is some that intentionally remains at the time of the surgery.  The purpose behind this is to allow for skin stretching due to growth and erections over time as your son grows.  Much of the foreskin is removed during circumcision.  However, it can’t all be removed.  Otherwise, there would be much pain whenever there is penile growth or an erection. If the foreskin is not gently lowered and cleaned well, smegma will build up and the foreskin will naturally re-adhere to the penile head. This would lead to an increased risk of infection.  If the foreskin becomes completely re-adhered, it also leads to a potential need for another circumcision.

It’s important to thoroughly clean the penile head daily. This involves gently lowering the foreskin to beyond the base of the penile head. I often tell parents that when it’s lowered correctly to clean it, this should look like a mushroom cap with a stalk. Notice I’m saying gently lower. Do not force the foreskin down ever. The area should be cleaned once daily with either a wet wipe, plain soap and water, or a washcloth with soap and water. Wyou see smegma, make sure to clean it off.

If the foreskin becomes re-adhered, get an evaluation from your son’s pediatrician. If it is safe to do so, the pediatrician may reduce the adhesions. Then, there will be a discussion regarding follow-up care and prevention. It is important to know that there is a limited age by which your pediatrician can reduce the adhesions. Typically, somewhere between 12-18 months, the adhesions can no longer be manually reduced. At that point, you will need to have a discussion about whether or not your son needs to or can have another circumcision.  This is truly a case-by-case basis. Medical decision making and personal choice may be involved.

Foreskin Care for Uncircumcised Boys

It’s important to thoroughly clean the penile head daily. You should lower the foreskin to the point where you feel natural resistance. Notice I’m saying gently lower. Do not force the foreskin down ever.

The important difference from a circumcised penis, is that with the uncircumcised penis, you will most likely barely be able to lower the foreskin.  Typically, you may be able to gently lower it by about one millimeter. You will most likely only see the urethral opening.  That’s perfectly normal.  Over time, as your son’s penis grows and has erections, the opening will continue to expand. And you will be able to lower the foreskin gently more and more. The area should be cleaned once daily with either a wet wipe, plain soap and water, or a washcloth with soap and water. When you see smegma, make sure to clean it off.

You will most likely see the smegma trapped under the foreskin.  Again, do not force the foreskin to remove the smegma. While this can be done, there will be a lot of pain and some bleeding. It’s even possible that the foreskin may get stuck at the base of the penile head which would be an emergency. So, just don’t do it. Your pediatrician will let you know if anything needs to be done with trapped smegma.

Teaching Self-Cleaning Takes Time

Boys are well known for taking years until they learn how to clean themselves. I have long heard many parents sharing stories with me about their little boys being fine with poop smears in their underwear and an itchy butt. This also holds true for cleaning their penis. This means you will have to do this for them for many years.

Typically, they are not ready until after they have been fully potty trained. Boys should be potty trained by 4 years old. At that point, I’d recommend starting to teach them by talking to them as you clean their penis. Boys will start showing they are capable of self-cleaning between 5 and 6 years old.

Independent Self-Cleaning Takes More Time

However, in my personal and professional experience, it takes them about until they are 8 years old until they can truly self-clean well. And then, come the teenage years! This is when many boys revert to a lack of self-cleaning.  You will need to repeatedly check with them. It’s important to prevent foreskin infection. Common questions to ask your teens are, “Did you wash your hair? Did you scrub your back?  Did you clean your penis?”  They will get annoyed that you will repeatedly ask this. However, that’s your role as the parent.  Rinse and repeat, literally.

What’s Next?

Stay tuned the nest blog post, “Autism & Genetic Testing: Why & When?”  Don’t forget to check out the video for more in-depth information on today’s topic! Watch the full video on my YouTube channel!

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Featured Photo by Christian Bowen on Unsplash

Flu Levels Are High! Prevent Getting the Flu!

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flu high

U.S Flu Levels Very High & Surging!

Our office has been hit by Flu and other respiratory illness & across the U.S. So, it’s time to review some important facts.  The CDC’s U.S. Surveillance Report for the week ending January 25, 2025 revealed alarming data.  As an update, since this post was originally written, the CDC’s U.S. Surveillance Report for the week ending February 1, 2025, reveals the Flu has worsened.  It is surging ahead! 

  • There was an 31.6% increase in cases positive for Flu across the country (Prior week = 29.4%).
  • There was an increase of respiratory illness by 7.8% (prior week = 6.9% increase). 
  • 45 states were categorized as having High or Very High Flu levels (prior week = 44).
  • There was an upward trend of an additional 48,661 patient hospitalizations due to Flu for that week alone (prior week = 38,255)!
  • Sadly, there were an additional 10 child deaths that week alone due to Flu (prior week = 16)!
  • This makes the running total 57 child deaths due to Flu this season thus far. 

Flu Symptoms

  • Fever and chills
  • Nasal congestion
  • Cough
  • Sore throat
  • Body aches
  • Fatigue
  • Nausea and vomiting

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Prevention

  • Handwashing is important as always. As humans, we’re always touching our face, nose, mouth, etc.  If we keep our hands clean, this can help minimize catching and spreading the Flu.                                                                                                                                                                                         
  • Avoid sick people. This may sound simple.  However, you’d be amazed at how many people will say they just have a cold.  Or they are “over it.” The simplest thing to do is stay away from anyone with the sniffles or a cough.  They may indeed have “just a cold.” They may also not be aware that they have a mild case of the Flu.  And one person’s mild Flu can be another person’s Flu with a pneumonia or worse.                                                                                                                                                                                                                             
  • Get the Flu Vaccine. It’s especially important to get the vaccine when Flu levels are high! These are available at your doctors’ offices, urgent care clinics, and pharmacies everywhere. Babies as young as 6 months old can be vaccinated.  Pregnant women can be vaccinated.  It protects their baby as well. Anyone caring for your child, including grandparents can be vaccinated. While it is true that the Flu vaccine does not prevent the Flu 100%, it is also true that it prevents severity and hospitalization. In my experience as a Pediatrician, those children and adults who received the Flu vaccine and became ill with the Flu, had milder cases of the Flu.  And it prevented severity, hospitalization, and secondary bacterial infections, such as ear infections, sinusitis, hospitalizations, and death.

Treatment

Tamiflu is an anti-viral specifically against the Flu.  If you test positive for Flu, treatment with Tamiflu helps, IF taken within the first 48 hours of your illness. Tamiflu also is available in liquid form with weight-based dosage for children as well.

What’s Next?

Stay tuned the nest blog post, “Autism & Genetic Testing: Why & When?”  Don’t forget to check out the video for more in-depth information on today’s topic! Watch the full video on my YouTube channel!

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Fully Vaccinated? No Mask Needed with Exceptions

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Fully Vaccinated - No Masks with Exceptions
Photo by Ani Kolleshi on Unsplash

CDC’s Updated Mask Guidance for Fully Vaccinated People

On May 13, 2021, the CDC updated their Interim Public Health Recommendations for Fully Vaccinated People.  The CDC states the science shows that breakthrough COVID-19 illness in fully vaccinated individuals is limited and most breakthrough infections resulting in asymptomatic or mild disease. Hence, fully vaccinated individuals do not need to wear a mask indoors and do not need to socially distance, “except where required by federal, state, local, tribal, or territorial laws, rules, and regulations, including local business and workplace guidance.”
 

What is the Definition of Fully Vaccinated?

Full vaccination occurs ≥2 weeks after a person has received the 2nd dose of the Pfizer or Moderna vaccine or ≥2 weeks after a person has received the Johnson & Johnson vaccine.
 

What Can Fully Vaccinated People Stop Doing?

  • Stop wearing masks and social distancing, except as “required by federal, state, local, tribal, or territorial laws, rules, and regulations, including local business and workplace guidance.”
  • Stop testing before or after travel or self-quarantine after domestic travel
  • Stop testing before leaving the U.S. for international travel (unless required by the destination)
  • Stop self-quarantining after arriving back in the U.S.
  • Stop testing following a known exposure, if asymptomatic, with some exceptions for specific settings
  • Stop quarantining following a known exposure, if asymptomatic
  • Stop routine screening testing, if feasible

Where Are Masks Still Required for All?

Please keep in mind these CDC Guidelines do not apply in medical offices yet. Medical offices are places of higher risk. 
Other locations where mask use is still required are hospitals, other medical facilities, nursing homes, prisons, homeless shelters, and public travel.  In addition, it is still recommended that masks be worn in environments where there is a dense population, for example, at concerts.
 

What about Travel?

“All travelers are required to wear a mask on all planes, buses, trains, and other forms of public transportation traveling into, within, or out of the United States and in U.S. transportation hubs such as airports and stations.”
 

What about International Travel?

  • Fully vaccinated travelers do not need to get tested before leaving the U.S. unless required by their destination.
  • Fully vaccinated air travelers coming to the United States from abroad, including U.S. citizens, are still required to have a negative COVID-19 test result or documentation of recovery from COVID-19 before they fly to the U.S.
  • International travelers arriving in the U.S. are still recommended to get a COVID-19 test 3-5 days after travel regardless of vaccination status.
  • Fully vaccinated travelers don’t need to self-quarantine in the U.S. after international travel.

What If I’m Fully Vaccinated, Symptomatic, & I Get COVID-19?

The risk of breakthrough infection is very low for fully vaccinated people.  However, if this occurs, the fully vaccinated person who has COVID-19 symptoms should:
  • isolate themselves from others
  • be medically evaluated for a COVID-19 infection
  • get tested for COVID-19 infection
  • inform their doctor that they are fully vaccinated

What If I’m Fully Vaccinated, Asymptomatic, & Am Exposed to Someone Who Has/Might Have COVID-19?

The risk of breakthrough infection is very low for fully vaccinated people.  Isolation, quarantining, work restrictions, and COVID-19 testing are not required after exposure to someone who either has or is suspected of having COVID-19.  However, it is still necessary for them to self-monitor for 14 days after the exposure.
 

What If I’m Fully Vaccinated, Asymptomatic, Am Exposed to Someone Who Has/Might Have COVID-19, & I Work in a Prison or Homeless Shelter?

COVID-19 testing is required.  However, isolation, quarantining, work restrictions are not required after exposure to someone who either has or is suspected of having COVID-19.
 

What If I’m Fully Vaccinated, Asymptomatic, & Not Exposed to Someone Who Has/Might Have COVID-19?

Fully vaccinated people without COVID-19 symptoms, without known COVID-19 exposure “should be exempted from routine screening testing programs, if feasible.”
 

What If I’m Not Fully Vaccinated?  

The CDC recommends continued mask use and social distancing for anyone who is not fully vaccinated.  Masks are recommended for those children and adults, ages 2-years-old and up who are not fully vaccinated. Discuss your concerns about the vaccine with your doctor. Please consider getting a COVID-19 vaccine.  It is life-saving for the person vaccinated and the people around them.
 

When Will Fully Vaccinated People Be Able to Stop Wearing Masks in Your Office?

We will be able to relax some of our office’s mask requirements for fully vaccinated individuals, once the Overall New Percent Positivity is consistently (at least 2 weeks) <5% in BOTH Pasco & Hillsborough counties, as we serve both of these counties in Florida. New Percent Positivity refers to the percent of the population that has tested positive for COVID-19 for the first time in the past two weeks.  
 
Currently, as of 05/12/21, Pasco County’s Overall New Percent Positivity has been below 5% for two days. Hillsborough County’s Overall New Percent Positivity is 6.26%.  In addition, Pediatric Overall Percent Positivity has continued to increase through May 2021. Pasco’s Pediatric Overall Percent Positivity is 13.4% and Hillsborough’s is 14.7%. The Florida Department of Health does not release Pediatric New Percent Positivity. As always, we are watching these numbers very closely.
 

Do Children Still Need to Wear a Mask in Your Office?

Children ages 2-years-old and up and their parents who are not fully vaccinated against COVID-19 need to wear a mask throughout their office visit.  COVID-19 vaccine is not available for children 2 to 11-years-old at this point.  Trials are ongoing for children ages 6 months to 11-years-old.  The trials are expected to yield results in September 2021.  Please stay tuned.  We will keep you posted as updates occur.
 

How Can I Request to Not Wear a Mask in Your Office?

Fully vaccinated individuals that show their COVID-19 vaccination status as fully vaccinated will not need to use a mask in our office. For those who are uncomfortable sharing their vaccine information, mask use will be necessary throughout the visit.
 

How Can I Get More COVID-19 Updates?

Please feel free to search this blog for general non-COVID-19 health updates like car seat safety.  COVID-19 information changes daily.  We are happy to serve our community and others in this rapidly changing world we currently live in.  Please consider following us on our Small World Pediatrics Facebook page for frequent updates.  We also have weekly Facebook Live Videos on Sundays at Noon focusing on COVID-19 discussions where this week we discuss many updates and answer questions, including but not limited to the CDC’s mask guidance for fully vaccinated individuals.

Coming Out To Your Doctor

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Coming Out To Your Doctor

Coming Out To Your Doctor – Difficult & Private

Coming out to your doctor may be difficult, especially for if you are a teen.  Often, a teenager comes out with a million thoughts running

Coming Out To Your Doctor
Coming Out To Your Doctor – Photo by Sharon McCutcheon

through their head.  Will my doctor accept me?  Will my doctor help me?  Does my doctor understand me?  Will my doctor tell my parents/keep my secret?  According to poll conducted by NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health, 18% of all LGBTQ Americans refrain from seeing a physician for fear of discrimination. 

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What If I’m Scared of Coming Out to My Doctor?

Coming out to you doctor may feel very scary and unsafe.  Consider asking your doctor if their office is a safe office where acceptance is commonplace.  Whenever the LGBTQ child is suffering, the most important thing I can say to them is, “You are safe.  You are safe here.”  Because every child is special.  After all, one of the best gifts a pediatrician can give to any child, especially the LGBTQ child/teen is letting them know they are special and wonderful just as they are.  It is not my job to help the child/teen figure out their sexual orientation.  It is my job to make them feel comfortable enough so that I can help them with any health issues they may have to date. 

 

Come Out When You Are Ready

Coming out to your doctor can help you in many ways.  However, given the difficulty that this may involve, you may want to consider calling your/any doctor’s office first to ask if they care for any LGBTQ patients.  Remember, you don’t have to give your name out at the first call.  Ultimately, this may help you feel more comfortable and ready.  

 

How To Come Out To Your Doctor

There are many conversation starters you can use, such as “There’s a conversation I need to have with you” or “How do you handle patient confidentiality?”  Consider telling the doctor in a matter-of-fact way.  Chances are, you are not the first LGBTQ patient they have ever had.  Follow up with a prepared list of questions that you have for your appointment.  There is a “Do Ask, Do Tell” brochure that may help answer questions about coming out to your doctor.  It is also important to know that there are laws that protect you and your doctor, so that your information is kept private.  Ask about confidentiality will make you feel safe as well.  In addition, you may consider bringing a friend, partner, or family member for support.

 

Doctors Can Offer Support in Many Ways

I’ve had teens come out to me as their doctor, some have been painful to witness.  Painful for me, because it incredibly hard to see someone suffer and be in such tremendous emotional turmoil and/or physical pain) for simply saying their sexual orientation and/or gender identity.  In the past, I reassured a transgender child in the midst of an immediate, intense, and severe panic attack by continually repeating, “You are safe.  It’s okay.  You are safe here.  You don’t have to talk about it, but if you do, I’m here for you.”  I have had patients who became successful adults with great careers who thanked me for accepting them because I was the first person they came out to or that I cared for them and their issues with compassion and maybe even some tough love.  Most recently, I held and rocked a child that I cared for over 15 years until they stopped their uncontrollable shaking because they couldn’t face themselves and their sexual orientation.   That child motivated me to write this blog.  I want to help other LGBTQ youths know that they don’t have to suffer, that their doctor can help them.  Chances are your doctor cares and wants to help you in your journey to physical and mental health and peace.  

 

Do I Have to Tell My Doctor I’m LGBTQ?

It’s best if you do tell your doctor.  Your doctor can’t give you the best medical care if he/she doesn’t know that you are a LBGTQ person.  A doctor needs to know a patient’s sexual orientation, gender identity, and sexual activity history, to best help that patient and their medical and psychological needs. 

 

Medical Help & Disease Prevention Available

Sexual history will help me test for, diagnose and treat STDs.  Also, a pediatrician or internist will be able to teach you how to prevent HPV and offer the HPV vaccine to prevent this cancer and wart causing disease.  In addition, if you are HIV negative, but at high risk for developing HIV, then your doctor may start PrEP medication.  What is PrEP?  Pre-Exposure Prophylaxis (PrEP) is Truvada, which is a daily pill that when taken helps prevent HIV in people who are high-risk by up to 92%.  Your doctor may start this medication, if you agree to take it every day and follow-up with appointments every three (3) months.  Consider bringing a List of Top Ten Issues LGBTQ People Can Discuss with Their Doctor with you to your appointment.  In addition, if you are a transgender youth or adult, your doctor, yes, even your pediatrician, can refer you to a specialist for hormonal treatment.

 

Psychological Help Available

A doctor will also be able to make some psychological recommendations, if needed.  LGBTQ teens are more likely to suffer from anxiety, depression, have increased risk of suicide, abuse, may need referral to a psychologist, a psychiatrist, and/or a support group, like the Gay Straight Alliance (GSA), and GSA Network.  GSA is a student-led or community based organization.  GSA is an important resource on social media on Twitter (@GLSEN)  and Facebook.  GSA Network is also a resource available on Twitter (@GSANetwork) and Facebook.  Local support groups area usual available for GSA and GSA Network on social media and in as clubs many schools.  Lastly, your doctor is a source of support, simply be accepting you and caring for you.

 

Doctors Willing to Learn LGBTQ Issues & Needs

Your doctor may be comfortable with caring for you as a LGBTQ patient.  However, we are not classically trained to care for LGBTQ patients, so there usually is a learning curve.  However, if your doctor says, “I don’t know how to care for that issue, but let me do my research; I’ll get back with you on that particular issue,” then you have a great doctor indeed.  A doctor that’s willing to learn, cares for you, and is honest is the best kind of doctor.

 

Additional Resources for LGBTQ Teens & Parents

• Coming Out: Information for Parents of LGBTQ Teens is a helpful resource from the American Academy of Pediatrics. 

 

• How To Support Your Child Who is Questioning Their Sexual Orientation by Everyday Feminism which includes definitions of many LGBTQ+ terms.

 

• Transgender Children & Youth: Understanding the Basics by the Human Rights Campaign.

 

• Teens & Gender from an NPR interview which includes many gender terms, such as gender questioning, gender queer, gender fluid, agender, etc.

 

• Sexual Attraction & Orientation by Kids Health.

 

• This blog also has information on Children & Affirmations and Daily Affirmations & Quotes that are helpful in general.

 

 

Flu Season Severe 2017-2018

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fight the flu, severe flu, vaccine prevention, vaccine, vaccine, prevention, symptomsFlu Season Today?

As of the end of December 2017, the flu season is officially moderately severe.  The flu is widespread in 46 states.  This is up from 36 states in the previous week.  The U.S Centers for Disease Control and Prevention (CDC) research reveals that flu hospitalization is about 3 times higher than it was in the same time period in 2016.  In addition, the flu season started earlier this year than it did in 2016.  During the same time period in 2016, only 12 states had reported widespread activity, as compared to 46 states this flu season.  This pretty much matches what I’ve been seeing in our office in Florida.  About 3 weeks ago, we began to diagnose multiple children with the flu every day.

Why is this Flu Season Severe?

This season’s dominate flu strain is an Influenza A strain, H3N2, which is a particularly severe and causes more symptoms than other strains typically do.

What Are Flu Symptoms?

Flu symptoms typically include a fever and nasal congestion at a minimum. Other symptoms may include weakness, nausea, vomiting, diarrhea, headache, body aches, and more.

What To Do If I Think I Have the Flu?

If you are feeling sick with flu-like symptoms, you may want to consider going to see a doctor, especially within the first 48 hours of your illness.  Your doctor may be able to prescribe an anti-viral medication against the flu, Tamiflu, which is effective in preventing worsening symptoms of the flu by stopping its replication.  However, if you’ve been sick with the flu for more than 48 hours, Tamiflu is not effective.

I Have the Flu.  Now What?

Follow your doctor’s instructions.  Drink plenty of fluids.  Rest.  Stay home.  Do not go to work, school, religious gatherings, or other community gatherings or events.  By going out, you increase the risk of spreading the flu.  In addition, as the flu weakens the immune system, if you go out, you place yourself at risk for contracting a secondary bacterial infection, such as pneumonia, sinusitis, or an ear infection.

How Do I Prevent Myself From Getting the Flu?

Good old-fashioned hand washing is helpful, as flu droplets may linger on countertops and other objects. Hand washing prevents many other common infections as well (https://drsilvatotstweensandteens.com/2013/01/new-norovirus-highly-contagious-virus.html).

The good news is that the CDC reports that this season’s flu vaccine strains are a good match to the live flu virus strains that are circulating (http://bit.ly/2CLWaCZ).  That means the flu vaccine is providing good protection against the flu by preventing the flu so far.

The best course of action is to make sure you and your children get the flu vaccine.  It’s not too late.  No one knows exactly when the flu season ends.  From the looks of it, it will probably continue for another few months.  There is still time to protect yourself.  Get the flu vaccine at your doctor’s office, health department, school, or pharmacy today.

Zika Virus | Health Information

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zika virus symptoms
  1. zika virus symptomsZika Virus | International Public Health Emergency

 

Zika Virus is a global health scare, especially for pregnant women.  Due to the October 2015 cluster of 524 cases of newborns in Brazil diagnosed with microcephaly and other neurological disorders reported in Brazil, World Health Organization (WHO) has stated that it is as a Public Health Emergency of International Concern. (bit.ly/1PYrRKs)

 

Update as of 9/16/19: The CDC states, “There is no current local transmission of Zika virus in the continental United States, including Florida and Texas, which reported local transmission of Zika virus by mosquitoes in 2016-17. No Zika virus transmission by mosquitoes has ever been reported in Alaska and Hawaii.  If you are traveling outside of the continental United States, please see the Zika Travel Information page.

 

What are the symptoms of the Zika Virus?

zika virus microcephalyWhen humans become infected, they may develop symptoms which include fever, itchy rash, headache, red eyes, joint pain, muscle pain, and temporary paralysis.  Typically, symptoms last for 2 to 7 days.  Incubation period is unknown, but ranges from a few days to a week.

There has also been an increase in incidence of Guillain-Barré syndrome that has coincided with increased incidence of Zika Virus. (bit.ly/22Tg8mx)

Pregnant women infected with the virus have had newborns with microcephaly and brain damage.  It is believed that the virus has spread from the infected mother to baby in utero and during delivery.  Zika virus has been found in the brain tissue of these infected babies.

Where Did Zika Virus Start?

zika_americas_03-18-2016_webAccording to WHO, it was originally detected in a rhesus monkey in Zika Forest, Uganda in 1947 and in humans in Nigeria in 1954 (bit.ly/1QeAEcO).  Before 2015, the virus was found in Africa, Southeast Asia, and the Pacific Islands.  Currently, there are many countries around the world with local mosquito-borne Zika virus disease cases as noted on the CDC website at 1.usa.gov/1Mv4zhb  Currently, countries affected by local transmission include Aruba, Barbados, Bolivia, Bonaire, Brazil, Colombia, Puerto Rico, Costa Rica, Cuba, Curacao, Dominica, Dominican Republic, Ecuador, El Salvador, French Guiana, Guadeloupe, Guatemala, Guyana, Haiti, Honduras, Jamaica, Martinique, Mexico, Nicaragua, Panama, Paraguay, Saint Martin, Saint Vincent and the Grenadines, Sint Maarten, Suriname, Trinidad & Tobago, U.S. Virgin Islands, and Venezuela).

 Is Zika Virus in the United States?

zika-by-state-report_03-23-2016_webYes.  However, only travel associated cases have been reported in the United States.  However, “local mosquito-borne transmission of Zika virus has been reported in the Commonwealth of Puerto Rico, the US Virgin Islands, and America Samoa.”  As of March 28, there have been 273 travel associated cases have been found in the U.S., including in Hawaii.  There have been 258 locally acquired cases in Puerto Rico, 10 in the U.S. Virgin Islands & 14 cases in the American Samoas.  

 

How is Zika Virus Transmitted?

It is most commonly transmitted by a mosquito bite.  It can also be sexually transmitted and via blood transfusion. It is unknown how common sexual or blood transmission is among humans.

Can Zika Virus Be Sexually Transmitted?

Yes.  The CDC recently reported on February 2, that this virus was sexually transmitted in Texas, USA (cnn.it/1WSuiRd).  In addition, Florida confirmed on March 9 & California confirmed on March 25, that they too have had their first case of sexually transmitted Zika Virus. As a result of confirmed sexual transmission of the virus, the CDC now recommends that if you are a pregnant women whose “male sexual partner has traveled to or lives in an area with active Zika virus transmission, you should abstain from sex or use condoms the right way every time you have vaginal, anal, and oral sex for the duration of the pregnancy.”  The case in Texas did not involve pregnancy.  However, keep in mind that this illness can infect anyone.

Other countries, confirmed that they too have had their first case of sexually transmitted Zika Virus.  France confirmed this occurred on February 27.  Chile confirmed firmed this on March 27.  Be aware that more cases and countries are confirming sexual transmission of the virus.

What Can I Do to Prevent Zika Virus?

Use insect repellent, especially when outdoors.  Avoid travel to areas with active Zika Virus transmission.  If you cannot avoid travel to an area with active transmission, then practice abstinence or use birth control while traveling in that area.  Abstain from sex if your partner has traveled to an area with active transmission.  

What Insect Repellent is Best to Zika Virus Infection?

The CDC recommends the use of insect repellents with active ingredients registered with the U.S. Environmental Protection Agency (EPA) for use to be applied to skin and clothing.  EPA registered insect repellents contain DEET, picaridin, IR3535, and some oil of lemon eucalyptus and para-menthane-diol.  Insect repellents with these active ingredients products offer longer-lasting protection.  Insect repellents containing oil of lemon eucalyptus should not to be used on children under the age of three years.  Insect repellents can be used by pregnant and nursing women.  The CDC has many details about use, efficacy, and safety of insect repellents available at https://www.cdc.gov/zika/prevention/prevent-mosquito-bites.html.

I’m Worried Myself or My Child Might Have Zika Virus.  What Should I Do?

First, know the symptoms.  Typically, at a minimum, an infected person may have a low grade fever which is frequently accompanied by and a rash.  Next, contact your doctor.  If your doctor is concerned that you or your child might be infected with Zika Virus, they will advise you to schedule an appointment for a more detailed evaluation.  Lastly, if your doctor thinks that you may need to be tested for Zika Virus, then your doctor will refer you to your local health department.  Currently, only local health departments have testing for the Zika Virus. 

Is There a Travel Advisory Due to Zika Virus? 

Yes. This is mostly for pregnant women and their partners.  However, advisories also differ by region you travel.  The CDC provide specific Zika Travel Information & Zika Travel Recommendations by Traveler Type and Country Category.

I’m Not Pregnant & Plan to Travel to an Area with Zika Virus.  Is There Anything I Should Do?

It is advised to not travel to areas with the Zika Virus.  However, if you do travel to an area where Zika Virus is present, then use insect repellent at all times, especially when outdoors.  It is also recommended that if you are a women that is not currently pregnant, that you take birth control as it is estimated that 50% of all pregnancies are estimated to be unplanned.

I’m Pregnant and I’ve Traveled to an Area with Zika Virus.  What Should I Do?

Talk to your OB/GYN doctor before any travel, especially if you are traveling to an area with active Zika Virus transmission. Follow up with a phone call with your doctor immediately upon return.  Depending upon your experience or exposure, they may have additional recommendations for you and your unborn baby.

Is a Vaccine for Zika Virus Available?

Not yet.  However, there is work on a vaccine.  As of February, the National Institutes for Health (NIH) has stated that Zika Virus Vaccine trials will begin this summer (wapo.st/1pTCPZO).  They have built upon research on similar viruses, Dengue and West Nile.  They are likely to be able to do a small scale trial of about 20 to 30 people in Summer 2016 with large scale trials likely to occur in 2017.  Until a Zika Virus Vaccine is available, use insect repellent, travel with caution, if pregnant prevent exposure in your travel and with your sexual partner. 

 

Ebola Virus

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ebola - imageedit_14_3363191172

What is Ebola? 

Ebola is a virus that was first discovered in 1976 near the Ebola River in Africa. Sporadic outbreaks have occurred in Africa since then. There are five (5) strains of Ebola that infect animals in Africa. Four of the strains infect humans.

 

What are the Signs & Symptoms of Ebola?

Symptoms include fever, headache, muscle aches, vomiting, diarrhea, abdominal pain, unexplained bleeding or bruising.  Ebola can only be spread when symptoms begin. Symptoms typically occur between 8 to 10 days after infection.  However, symptoms may occur as late as 21 days after exposure to Ebola. 

 

How is Ebola Spread?

If a person is ill with Ebola virus, they can spread it by blood, body fluids (urine, saliva, sweat, feces, vomit, breast milk, and semen).  It can also be transmitted via objects contaminated with the virus (like needles and syringes). Lastly, it can spread via infected bats, apes, gorillas, and monkeys. (https://www.cdc.gov/vhf/ebola/about.html)

 

Where is the Ebola Outbreak? Where Has Ebola Spread?

This year is the largest Ebola outbreak in history.  It has taken place largely in West Africa.  Currently, areas designated by the U.S. Centers for Disease Control and Prevention (CDC) as having widespread transmission of Ebola are in West Africa, specifically Guinea, Liberia, and Sierra Leone.  Countries that have had travel associated transmission and local transmission are (Port Harcourt and Lagos) Nigeria, (Madrid) Spain, and (Dallas and New York City), New York.  Countries that have had travel associated transmission are (Kayes) Mali and (Dakar) Senegal.

 

Are there are recent updates in Florida?

As of October 26, 2014, Florida Governor Scott issued an order mandating the Department of Health to have a 21 day monitoring of anyone who has returned from areas where individuals have been infected by Ebola virus, as designated by the CDC. (http://bit.ly/1wH4o6M) New York, New Jersey, Illinois and now Florida have instituted a 21 day health evaluation plan. Twice daily monitoring is to include measuring temperature twice daily.  Gov. Scott also stated that if individuals monitored are assessed to be high-risk, then a mandatory quarantine will be required.

 

Are There U.S. Guidelines for Healthcare Workers Caring for Patients with Ebola?

The CDC has issued guidelines for healthcare workers and healthcare settings for those caring for patients infected with, suspected to be infected with, or having died of Ebola. (https://www.cdc.gov/niosh/topics/ebola/healthcare.html#us) There are also CDC Ebola waste management guidelines. On October 14, 2014, the CDC admitted that they were unprepared for Ebola in the U.S. (http://bit.ly/1E4V6F4)  Since then, the CDC has formed the previously mentioned guidelines.  

 

Are there flight Restrictions from Africa?

As of October 21, 2014, the U.S. Homeland security Department announced that travelers from Guinea, Liberia, and Sierra Leone have limited airport entry into the U.S.  They are limited to five (5)  international airports in New York, New Jersey, Atlanta, Chicago, and Washington, DC.  These airports will have extra screening of passengers for possible Ebola exposure, which include taking temperatures and other assessments as well.  All U.S. airports are screen for possible Ebola exposure. (http://www.cdc.gov/vhf/ebola/pdf/ebola-algorithm.pdf)  Currently, there is no travel ban from or to Guinea, Liberia, and Sierra Leone to U.S. due to Ebola.

 

It is highly unlikely that Ebola will spread in the U.S. as it has in endemic West Africa. However, we must keep a vigilant eye on developments, travel screenings are necessary, and healthcare workers must follow CDC guidelines to prevent spread of this disease.

 

Flu Deaths | Prevention with Vaccine

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Flu Deaths | Prevention with Vaccine

The 2012-2013 Flu season started & peaked earlier than it typically does with cases documented as early as September  2012 and peaking in December 2012.  In addition, The past Flu season brought had a higher death rate for both seniors and children.   149 documented children’s death occurred due to Flu.  This is about 3 times higher than the average season.  In addition, seniors over the age of 65 were hit hard as evidence that they accounted for more than half of the hospitalization rates in the U.S.
 
While it is summertime, it is important to think about Flu shots now.  Typically, physicals are done in the summertime.  That is also the perfect time to receive the Flu vaccine.  Your child will be protected before the season & before they are exposed to other children when school restarts.
 
For more information about the recent Flu season, disease, and vaccine, please go to http://bit.ly/14sECUM and https://www.cdc.gov/flu/weekly/usmap.htm
 

New Norovirus: Highly Contagious Virus

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New Norovirus

A new highly contagious strain of Norovirus is prevelant throughout the U.S. This new strain is so contagious that it accounted for 58% of all U.S. reported cases of gastroenteritis last month.  It was first discovered in Sydney, Australia in March 2012. 

This illness has symptoms of vomiting, diarrhea, abdominal pain, and in many cases, fever as well.  Norovirus has peaked in the U.S. in January.  Unfortunately, Norovirus has peaked at the same time as Influenza has peaked.  This has led many people to incorrectly call this “the stomach flu.”  The Norovirus is a virus that causes gastrointestinal illness. The Flu is a respiratory illness caused by the Influenza virus which is unrelated to Norovirus.

Norovirus is highly contagious.  It remains in stools for approximately 2 weeks after the symptoms have resolved.

What can you do to prevent Norovirus infection?
1. Handwashing
2. Rise fruits & vegetables
3. Cook food thoroughly
4. Clean & disinfect surfaces

Handwashing with soap and water is the most important preventative measure one can take to prevent from getting gastroenteritis. Hand sanitizer simply will not be effective.  For little children, specifically toddlers, it is especially difficult for them to keep their fingers and objects out of their mouths.  So, make sure to wash their hands frequently.

Cooking food thoroughly is important because Norovirus can survive in temperatures up to 140°F.  Avoid eating raw foods during this time.

In addition, it is important to disinfect any contaminated surfaces.  The Center for Disease Control & Prevention (CDC) recommends bleach water of a combinations of 5-25 tablespoons of bleach per gallon of water.

What can you do once you have gastroenteritis?
Hydration is the key.  Depending on the age, Pedialyte or sports drinks are recommended to replace the fluids lost.  It’s important to contact your doctor if you or your loved one is unable to tolerate fluids.  Dehydration is serious and can lead to death.

For more information about Norovirus, please go to www.cdc.gov/norovirus.

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