Summer + Mosquitoes = Dengue Fever?

13 05 2014

The dengue fever virus is the most common virus that mosquitoes transmit and infects about 100 million people worldwide every year, killing about 25,000. In spite of this frequency, though, the United States, with the exception of Puerto Rico, has been mostly dengue-free for decades—until 2009.

image by infidelic

That year, a woman in New York turned up with a dengue infection, having just returned from a trip to the Florida Keys. Her case was the first of a handful that led public officials to conduct a survey of the Key West population. To their shock, they found that about 5% of residents, or about 1000 people, showed evidence of dengue exposure in 2009.

The mosquito that carries the virus occurs in warm areas of the country, including Florida and Texas, and indeed, isolated cases of dengue have cropped up a few times since the 1980s along the Texas–Mexico border. But the cases in 2009 and more in 2010 have authorities concerned that dengue now has achieved an intractable foothold on the continental United States.

Work on a vaccine against dengue is ongoing, but in the meantime, the only preventive is to avoid the bug that carries the virus: the mosquito.

Wearing repellent when in areas where they occur is one tactic. Another is removing breeding places, such as any containers with standing water. The precautions apply wherever you’re going, whether to areas where dengue is already endemic or where it is emerging. The CDC provides regular updates for travelers, including a page specific to the Florida cases.

Dengue fever can hit hard or harder, depending on the symptom severity. The “mild” version of the disease can involve a high fever, a rash, severe headache and pain behind the eyes, and nausea and vomiting.  Given that these symptoms are largely nonspecific, if you see your doctor about them and have traveled in a place where dengue fever occurs, be sure to mention it. A more severe form of dengue fever is dengue hemorrhagic fever, which begins much like the “mild” form but then progresses to symptoms that can include nosebleed and signs of bleeding under the skin, known as petechiae.  This form of dengue can be fatal.

The most severe manifestation of the disease, dengue shock syndrome, includes the symptoms of the milder forms along with severe abdominal pain, disorientation, heavy bleeding, and the sudden drop in blood pressure that signals deadly shock.  Onset is typically four to seven days after exposure, and the mild form usually lasts only a week, while the more severe forms can involve either a progressive worsening or a sudden worsening following an apparent improvement.

Oddly enough, having dengue fever once does not mean you’re safe from it. Indeed, some studies indicate that a second bout of dengue fever often can be worse than the first, with a greater risk of progressing to the hemorrhagic form.





One Day, on the Way to the Army

24 04 2014

Today is World Meningitis Day, and the start of World Immunization Week. Are you young and healthy? Stay that way! It’s Your Choice, so choose to get immunized and get on with what life has in store for you.

Abby Blanco-Wold was a young woman on her way to the Army when she was attacked by meningitis. This is Abby’s story, as written by her.

 

TWO DAYS TO GO

Two days to go, and I would have been gone, off to the ARMY . . . Tuesday at dawn.

Out to the gun range my dad and I went, I did really well, to our amazement!

I wanted to shoot a gun once before basic training, the old men that were there found it quite entertaining.

Abby before meningitis changed her life

I had this slight headache throughout the day—didn’t recognize the faint scent of death’s bouquet.

Later that night, out with friends one last time, I threw up by a building, but then I felt fine.

We went home anyway, but stopped for a treat. I didn’t even feel bad enough not to eat.

I awoke in the night, throwing up once again . . . except this time throwing up took forever to end.

So I went back to sleep, but when I arose, intense pain was all over, from my head to my toes.

We need to go now, something’s not right. Upon changing my shirt, came the real fright.

Fever, throwing up, aches and pains, purple spots. The familiarity is chilling. Meningitis, I thought!

To the hospital my friends and I immediately rushed. Oh my God, if it’s true, my family’s going to be crushed!

Meningitis it was, but I already knew. I deteriorate quickly—my feet are both blue.

My parents arrive, “Mom, I have to go pee,” but not a drop would come from my failing kidneys.

I said to the doctor, “I know I might die, but can I have some pain medicine so I don’t have to cry?”

So, here I am in this bed instead, more worried about being AWOL than being dead.

In a war against nature, my body will try to fight off these enemies, so that I don’t die.

In this ICU, my family will weep, counting the moments that I am asleep.

Many of my doctors will quickly be stunned, watching my body grow increasingly rotund.

One by one my organs start to shut down; my urine is now coming out blackish- brown.

Covered all over in dark purple spots, as my vessels are littered with millions of clots.

Soon I can no longer breathe on my own, and more IVs into my body are sewn.

A ventilator’s my new buddy, I guess. How much longer can my body handle this stress?

This struggle is one that I simply must win, but things are so bad, more family flies in.

My priest comes to the hospital to say a prayer. My parents and brother are so numb they just stare.

He gives me just one last sacrament, as my body revolts, to my detriment.

Are they right, my last rites? Will tonight be my forever goodnight?

Suddenly, my blood pressure drops so low and so fast, my heart almost stops.

I am so, so very tired of this fighting, but I won’t give up—sorry that it’s so frightening.

Today, things aren’t good, the attending can’t lie, twenty percent chance to live, and that’s high.

Both my insides and outsides are going crazy. Now I’m in a coma, and my adrenals are lazy.

My prognosis looks so terribly bleak. How strong will my family be? Or how weak?

Am I allowed to die? Will you all fall apart? Will you succumb to the pain of your breaking hearts?

A few days later, it comes, a faint beacon of light. Can a miracle save me from this morbid plight?

Slowly but surely from the ventilator I’m withdrawn, and most of my organs start to turn back on!

I lay in this bed, comatose still. Reality sets in, but survive, yes I will!

I hesitantly, emerge from my sleep to hallucinations, pain, a machine’s constant beep.

I wonder, what could have happened to me? I was out for two weeks—how could that be?

I’m hurriedly transported to a new room, but I cannot sit up or hold on to a spoon.

Surrounded by so many balloons, gifts, and flowers, and cards that I read for hours and hours.

Everyone is here rejoicing my life, while knowing my future holds plenty of strife.

Just lying here the pain is so bad, it seems unbearable for my mom and my dad.

My body’s covered with open wounds that need care. An open bed in pediatrics? I’ll be right there.

My first ambulance ride reveals my yellow streak, and I need lots of help, because I’m so weak.

In my new room, tons of doctors I meet, their topic of interest—my gangrenous feet.

I finally see them completely unwrapped, “please be careful, and don’t touch them,” I snapped.

After surgery I’m left with no toes, heels, or skin, so I stayed alive—but did I really win?

Two months with surgery every other day, please let my parents and my brother be ok.

Eventually the big decision day comes—bilateral below knee amputee? Now I’m one.

abby2

So my life goes on and prosthetics I wear, but my family will never get over the scare.

There in that room . . . I was just 22, but oh how through the experience I grew!

Meningitis information I soon eagerly sought. I discovered that there’s a vaccine—what a thought!

The knowledge of inner beauty did finally come, and I realize, somehow, the battle I won!

But in my head, I know some will die, and many families will forever cry.

And in my heart, I am in disbelief that a shot could have prevented all of this grief!





A Thoughtful Choice

17 04 2014

I remember lining up at school in the ‘60s to get vaccinated against smallpox and a few other diseases for which there were vaccines.

I also remember the years when my brothers and I took turns at getting measles, mumps and other diseases for which there were no vaccines.

In the end, we three were fortunate—no permanent harm from our maladies.

Fast-forward 30 years. My daughter was four months old when she was diagnosed with hepatitis B. She had not been vaccinated and subsequently developed a chronic infection.

It all sounds mundane when read as words on a screen. But in those early years, the heartache and anger I felt at having my daughter’s life so affected by something that was preventable . . . well, it was almost more than I could bear.

But again, we were fortunate. After years of infection, her body turned around and got control of the disease. Although we have bloodwork done every year to keep an eye on things, she has a good chance of living the rest of her life free of complications from this infection.

Over the years, I’ve met other parents whose children were affected by vaccine-preventable diseases. Some, like Kelly and Shannon, chose not to vaccinate their kids and ended up with horrible consequences. Kelly’s son Matthew was hospitalized for Hib and they came within a breath of losing him. Shannon did lose her daughter Abigale to pneumococcal disease, and almost lost her son. He recovered and was released from the hospital, at which time they had a funeral for their daughter.

Because of my job, I talk to and hear from many families with similar stories. Some children have died, some remain permanently affected, and some have managed to recover.

Also because of my job, I hear from parents who believe vaccines are not safe, and that natural infections are the safer choice. I understand and have experienced the emotions we as parents feel when something happens to our children. In a way, I was lucky. I knew exactly what caused my daughter’s problems. A simple test provided a definite diagnosis.

If we can’t identify the cause of our children’s pain or suffering, we feel like we can’t fix it and we can’t rest until we know the truth. When the cause can’t be found, we latch onto if onlys. What could we have done differently to keep our kids safe? If only we hadn’t taken her to grandpa’s when she didn’t feel good. If only we hadn’t vaccinated him on that particular day. If only. The problem is, the if onlys are guesses and no more reliable routes to the facts than playing Eenie Meenie Miney Mo.

The deeper I go into the world of infections and disease prevention, the more obvious it is to me that the only way to find the facts is to follow the science. Now granted, one study will pop up that refutes another, but I’ve learned that when multiple, replicable studies all reach the same conclusion, then I can safely say I’ve found the facts.

In our family, we vaccinate because for us, it is the thoughtful choice.

By Trish Parnell

Originally posted on Parents Who Protect





TB Today

24 03 2014

Tuberculosis. Sounds old-timey to me, a disease not of this century.

My 87-year-old uncle had TB when he was a teenager. He was sent to a sanatorium and came back about a year later, more or less healthy.

In those days, TB was the leading cause of death for teens and young adults. He was lucky to survive it.

Today, TB hasn’t dropped down the list much. It’s still a killer, and holds the number two spot in the world for leading cause of death from infectious disease.

One million kids get sick from TB each year. The World Health Organization says that in 2012, about 8.6 million people developed TB and 1.3 million died from the disease.

We talked about the details of TB on this blog last June. Today, let’s watch a story unfold. This is Chapter One of EXPOSED – four short films by Aeras TB.

 

 

 

By Trish Parnell

 





A Brother’s Love

14 03 2014

My older brother, Evan, and I were 12 1/2 months apart.  We were the “twins” who weren’t really twins, but who shared a bond so close, that I still can’t believe he is gone.

I never needed to worry about having friends around, because I always had Evan.  We both loved sports, and I have the greatest memories of growing up playing baseball, soccer, and basketball together.  It was a great family time, and one I hope to impart to my children.

Evan wanted to be a pitcher on a college baseball team, and my dad took him around to different colleges in Georgia.  After tryouts at Georgia Southwestern University, Evan was asked to join the team as a walk-on player.

Me and Evan

Me and Evan

He was at a small university, but he loved it and loved his team.  I was attending the University of Georgia, and I was so proud of my brother for following his dream.  Both of us had plans to become orthopedic sports physicians and practice medicine together.  We would get married, our children would not only be cousins but best friends—everything was planned out, everything was in motion.

Then, Evan came down with a violent migraine, so we thought.

The ER physicians diagnosed him as having a “little virus,” but it wasn’t a “little virus.”  It was bacterial meningitis, or more specifically, “meningococcal disease.” My parents were told he had a 5% chance of survival.

I can only imagine, now that I am a parent myself, what horror they must have felt hearing that their son might die.  I was on spring break with some friends in Florida, and my parents couldn’t reach me until much later that night.  I immediately left to drive to the hospital where Evan was being treated.

In a spirit of youthful optimism, I felt that if Evan knew I was by his bedside, he would rally, just as each of us could always get the other one to rally.

But this horrible disease was stronger than all of the prayers and love being sent to Evan.  My parents and I watched the disease ravage Evan’s body,  as gangrene set in on his arms and legs.  We watched the machines monitoring Evan, willing the numbers to be stable, for some sign of improvement.

As Evan was transferred to a third hospital, a burn unit, we were told that Evan had a 1% chance of survival.  I remember asking my mom about life after death.  I didn’t understand how my brother could be so sick.  Evan went in for surgery to try to save his life, and both arms and legs were amputated.

That still wasn’t enough.

I watched my brother, in a medically induced coma, lie in bed with stumps, his face and body bloated from kidney failure.  I cried, I prayed, I begged.  I would go listen to music in my car, to try to escape from the reality of what was happening.

Then, Evan suffered 10 hours of grand mal seizures, and that caused irreversible brain swelling, and a herniated brain stem.

My brother, who I loved so much, was brain dead.

We all watched as Evan was disconnected from life support, flat-lined, and carried away in a body bag.  Those are my last images of my brother.

I missed that quarter of school, because Evan had been in the hospital almost a month.  When I went back, it was with a renewed determination to be a doctor.  I did get admitted to medical school, and when I graduated, I fist-pumped my arm, and said to myself, “Evan, I did this for both of us.”

I still talk to Evan, I still miss him so much, and I carry his memory with me everywhere.  My daughter’s middle name is Evan. When I got married, I did not have a best man, because that spot was reserved for Evan.

When my parents and I found out that Evan’s death could have been prevented with a vaccine, that was being routinely used in the military, it just made no sense.  Why hadn’t any of us been told about the vaccine?

Needless to say, I am a staunch vaccine advocate, and as a primary care physician, I make sure that all of my patients are up-to-date on all CDC-recommended vaccinations.

It really is your choice, and your life. Take control and protect yourself against infections by getting immunized.

by Ryan Bozof





Baby Armor

6 03 2014

And now, a timely reminder from CDC:PSA-superbaby

It’s easy for parents to think of vaccine-preventable diseases like measles or whooping cough as issues of the past, but we know that most of these diseases still persist around the world.

Just last year a higher than normal number of measles cases were reported in the U.S., including an outbreak of 58 cases in New York City that was the largest reported outbreak of measles in the U.S. since 1996.

Making sure children get all of their vaccines is the most important thing parents can do to protect them from 14 serious childhood diseases before their second birthday. And CDC has created a series of print PSAs encouraging just that (including an adorable  super baby version).

CDC also has immunization schedules available for all ages and a handy scheduling tool that allows you to enter your child’s birth date and print out a custom copy of his or her personal immunization schedule.

As winter begins to fade and a new spring season starts creeping up, don’t forget to schedule your pediatrician’s visits and discuss vaccinations with your doctor. Let’s give our little super heroes the best protection we can.





Rotavirus, Vaccination, and Intussusception

15 01 2014

Rotavirus is a nasty little germ that targets our stomach and intestines, making them swollen, red, and sore.

The intestines help digest the food and liquid we take in, and they make poop out of what doesn’t get absorbed into our bodies.

When the rotavirus attacks, it can cause our poop to turn into watery diarrhea. Fever, vomiting, and pain are often part of the disease.

In younger kids and babies, the diarrhea and vomiting can be nonstop, causing a serious loss of body fluids (dehydration).

The CDC says that “Rotavirus is the leading cause of severe diarrhea in infants and young children worldwide. Globally, it causes more than a half a million deaths each year in children younger than 5 years of age.”

We have effective vaccines—hospitalization rates have dropped 96 percent in the US since the vaccines became available, and the overall number of infections has plummeted.

There’s something that can happen that’s a rare side effect of the rotavirus vaccine. It’s called intussusception. The important thing to know is that intussusception happens anyway in the infant population, but with the vaccine, there appears to be a tiny increase in numbers of those affected.

Intussusception is when one part of the intestine slides into another, similar to a telescope closing. This causes a blockage in the intestines which requires hospitalization and sometimes surgery.

In the US, there are about 34 intussusception-related hospitalizations per 100,000 babies in the first year of life.

These cases happen whether a baby has been vaccinated against rotavirus or not. It’s called the “background” rate.

There has been a slight uptick in cases of intussusception with vaccination against rotavirus. For those babies vaccinated, the increase in rates of intussusception appears to be 1 to 5 cases per 100,000 babies.

We’re talking about this because a couple of studies have been done and these are the findings. It’s important to know all that we can when making health decisions for our children.

We parents don’t want to expose our babies to anything that might harm them. In the case of rotavirus disease and vaccination, it’s clear that the greater risk by far is the disease.

Talk to your baby’s healthcare provider and make the informed decision to protect your young one against rotavirus. It can be a deadly disease.








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