Ask Emily

23 02 2012

Why does our skin break out in a rash with some viral infections like measles or Fifth disease?

These sorts of rashes are technically known as viral exanthems (the word derives from the Greek word “exanthema,” meaning “breaking out”).

The skin responds to infection with a rash for one of three reasons: the infectious agent releases a toxin that causes the rash, the infectious agent damages the skin and causes a rash, or the immune response results in the skin outbreak.

The skin responds in only a few ways to these challenges, although the pattern of the response can vary from virus to virus (bacteria and some other infectious organisms can also trigger a rash).

The response is the body’s attempt to deal with the presence of viral particles that find their way to the epidermis, or skin. In general, the upshot of the immune response is an area of inflammation. Because viruses cause a systemic or body-wide infection, viral rashes often cover much of the body.

Although the basic pathway to the rash is similar among viruses, the specific pattern of the rash can help distinguish the virus involved. For example, Fifth disease, so-named because it was the fifth virus in a series to be identified as causing a rash, produces a “slapped-cheek” ruddy appearance on the face and may cause a lacy, rather flat rash elsewhere on the body.

A measles rash, on the other hand, starts as an eruption of raised or flat spots behind the ears and around the hairline before spreading body-wide.

One thing to recognize is that not every rash is a viral rash or a benign viral rash, although most viral rashes will resolve on their own. Usually, a fever accompanies a viral rash. If a rash develops, you should be aware of the following warning signs that signal a call to your doctor:

  • If you suspect you have shingles. This highly uncomfortable rash tends to trace along the nerve routes under the skin but can spread out from those, as well. Starting antivirals within the first 24 hours may ward off a more intense recurrence or a permanent pain syndrome called postherpetic neuralgia.
  • If you suspect measles. Infection with this highly contagious virus should be reported immediately.
  • What you think is a rash from a severe allergic reaction or a rash that arises coincident with taking a new medication.
  • The rash accompanies a high fever, spreads rapidly, and starts to look like purple bruising. This pattern is indicative of meningitis.
  • Any rash involving a very high fever, pain, dizziness or fainting, difficulty breathing, or a very young child or that is painful.
  • Any rash that you find worrisome, including for reasons of persistence or timing with something such as exposure to infection, a new medication, or new food.

Do you have a question for Emily? Send it to: pkids@pkids.org

By Emily Willingham

Image courtesy of HowStuffWorks


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Ask Emily

26 01 2012

I’ve just read that there’s a kind of tuberculosis making a comeback that doesn’t respond to any known TB drugs. How does that happen and can anything be done to treat it or stop its spread?

Tuberculosis (TB) is a bacterial infection, usually of the lungs, although it can invade other tissues.

A healthy person may be infected but not show symptoms, but someone with an active infection may have a cough with blood in the sputum, night sweats, weight loss, and fever. The bacteria spread through coughs or sneezes.

As with seemingly all infections we treat with antibiotics, the TB bacterium has evolved to evade the arsenal of medications we throw at it.

While many cases still resolve after the long-term antibiotic treatment required (6 months or more), often people with the infection begin to feel better or get tired of the unpleasant side effects and will cease the therapy.

As with other similar situations with antibiotics, this premature cessation of therapy can give resistant bacteria the upper hand. The outcome is different grades of TB infection, based on the level of resistance. TB that resists most but not all drugs is multidrug-resistant. TB that resists all but drugs of last resort is extensively drug-resistant, and TB that responds to no antibiotics at all is totally drug-resistant (TDR).

That last form of TB strikes fear into the hearts of epidemiologists and public health officials because it is an infectious disease nightmare.

For a series of reasons ranging from an inability of low-resource countries to test for and detect TB to a lapse in treatment adherence because of poor healthcare management and patient follow-up, the most resistant forms of TB often emerge in areas poorly equipped to control it. Thus, when a report surfaced in January 2012 that a research team had identified 12 cases of TDR TB in India, on the heels of 15 identified cases in Iran in 2006, the worldwide response was, essentially, anxiety and fear.

The fear is that if this TDR form of TB gains a stronger foothold in overcrowded conditions where people walk ill and undiagnosed, it would be a plane flight away from toeholds anywhere else in the world. While humanity dealt with incurable and fatal TB for millennia before antibiotics started to fight back in the 1940s, this resurgence at a time when technology can take a disease around the world in a matter of hours adds a whole new dimension to the threat.

There is, of course, already the threat on the ground in India, where one of the cases is a 13-year-old girl and another of the people in the cohort has died from the disease. But lest anyone think that in their comfortable home in the West they are sheltered from threat, the news the day I wrote this contained reports of a student with TB in Fort Wayne, Indiana, which precipitated notification to 100 students who may have come in contact with their classmate. Another student in Westlake, Ohio, also had been diagnosed with TB, precipitating community action to make people aware of symptoms and prevention of spread.

The communities in these cases benefited from a public health surveillance program that moved into action once each diagnosis was made. But in India, the result has led to public health chaos, with officials arguing over whether or not some of the cases truly were TDR TB. That does not change the fact that TDR TB has already been identified in Iran, or the economic and healthcare gaps that will only continue to contribute to the likelihood of its spread.

Do you have a question for Emily? Send it to: pkids@pkids.org

By Emily Willingham

Video courtesy of IBNLive


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Pink Eye!

12 01 2012

Evening time. Your little moppet is fed, bathed, and snuggled ‘neath her blanket. You bend to kiss her nose and then, because your mother did the same, you gently press your cheek against your child’s and exchange butterfly kisses.

This is also known as giving (or getting) the gift of pink eye.

In case you haven’t yet experienced it, pink eye is when your eye becomes pink or red because it’s irritated or inflamed.

We all have a thin membrane that covers the inside of our eyelids and the whites of our eyes – it’s called the conjunctiva. When it becomes inflamed or irritated, we have a case of conjunctivitis. Also known as pink eye.

Lots of non-infectious agents can irritate the conjunctiva and cause our eye to get pink. If we’re allergic to pollen or pet dander, that can give us pink eye. Sometimes the chlorine in pools will do the same.

We can also pick up a bacterial or viral infection that results in pink eye and is infectious, easily spreading person to person. That’s the one that is the gift of the butterfly kiss, should one of the eyes doing the kissing be infected.

Prevention is easy, mostly it’s about not touching your eyes with unclean hands and not sharing any items that have been near an infected person’s eye, such as pillowcases, towels, makeup. You get the idea.

If you have pink eye, do all of the above, and don’t use the same eye dropper or bottle on infected and uninfected eyes, as it’s a good way to ensure both of your eyes become infected. And, CDC says to stay out of swimming pools.

Treatment of conjunctivitis depends entirely on the cause of the irritation. If it’s viral, the symptoms are treated and antivirals may be used for severe cases.

Bacterial infections will probably receive antibiotics and treatment to alleviate the discomfort.

It’s best to check with your provider for specifics, and to make sure and revisit the clinic under these circumstances noted by CDC:

  • Conjunctivitis is accompanied by moderate to severe pain in the eye(s).
  • Conjunctivitis is accompanied by vision problems, such as sensitivity to light or blurred vision, that does not improve when any discharge that is present is wiped from the eye(s).
  • Conjunctivitis is accompanied by intense redness in the eye(s).
  • Conjunctivitis symptoms become worse or persist when a patient is suspected of having a severe form of viral conjunctivitis—for example, a type caused by herpes simplex virus or varicella-zoster virus (the cause of chickenpox and shingles).
  • Conjunctivitis occurs in a patient who is immunocompromised (has a weakened immune system) from HIV infection, cancer treatment, or other medical conditions or treatments.
  • Bacterial conjunctivitis is being treated with antibiotics and does not begin to improve after 24 hours of treatment.

One of the best methods of disease prevention (and not just pink eye) is to keep our hands clean and not touch our noses, eyes, or mouth.

I have to confess that, although my teenager no longer tolerates butterfly kisses, my tweener loves them. As long as the whites of her eyes remain, well, white, we will share that bedtime ritual. But, I do perform a quick inspection as I’m leaning in, just in case.

By Trish Parnell

Image courtesy of littlenelly


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Antibiotics – Not Always Invited

17 11 2011

George Armelagos is an anthropologist (kind of like Apolo Ohno is a skater).

A few years ago, one of George’s students detected an antibiotic called tetracycline in the bone of an ancient Nubian. Both the student and George thought this was odd, since tetracycline had not come into common use until the 1950s.

George and his student, along with some of their colleagues, got busy and discovered that lots of Nubians, Egyptians, and others from the early years of the second period of the Gregorian calendar had detectable tetracycline in their bones.

Turns out, the antibiotic was consumed in the beer of the day.

George wrote up this find in Natural History Magazine. As for the beer . . .

The beer produced in ancient times, according to Barry Kemp, author of Ancient Egypt: Anatomy of a Civilization, was quite different from the modern commercial product: “It was probably an opaque liquid looking like a gruel or soup, not necessarily very alcoholic but highly nutritious. Its prominence in the Egyptian diet reflects its food value as much as the mildly pleasurable sensation that went with drinking it.”

Spores that produce tetracycline were inadvertently captured during the beer-brewing process and before they knew it, the ancients were slinging back antibiotics with their brewskies.

The old-timers might not have known how their beer came to be medicinal, but know it they did. George went on to write:

Given that the ancient Nubians and Egyptians were getting doses of tetracycline, another question is whether this afforded them any medical benefits. In Food: The Girl of Osiris, William J. Darby and coauthors provide archaeological, historical, and ethnographic accounts of beer’s use as a mouthwash to treat the gums, as an enema, as a vaginal douche, as a dressing for wounds, and as a fumigant to treat diseases of the anus (the dried remains of grains used in brewing are burned to produce a therapeutic smoke). This shows that even in the distant past, Egyptians and their neighbors appreciated beer’s medicinal qualities.

This sounds like a classic case of antibiotic overuse to me, and who knows? Maybe it was.

Overuse or misuse is certainly a concern these days. CDC is in the middle of Get Smart About Antibiotics Week, which is an international collaboration with the European Antibiotic Awareness Day and Canada′s Antibiotic Awareness Week.

Antibiotics are effective “against bacterial infections, certain fungal infections and some kinds of parasites.” They don’t do squat against viruses.

Misuse of antibiotics is a pervasive problem. For instance, if I take an antibiotic against a bacterial infection but I don’t take it long enough, the bacteria that survive become resistant to the antibiotic and can infect other people. The bacteria also reproduce and their offspring or clones are resistant.

When someone is infected with the resistant bacteria and he or she takes the same antibiotic I took (but didn’t finish), it may not work.

If this happens often enough, and it has, then we end up with a plethora of germs against which we have little or no defense.

It’s not a theory. It’s reality. It’s happening right now.

What can be done?

Healthcare professionals can stop giving antibiotics against viral infections and in other circumstances where the drug is not helpful.

We can stop asking for antibiotics. The healthcare professionals will know when we need them and when we don’t. Also, we must comply with the dosing instructions. We need to take the drug as directed and for as long as directed.

That’s about it. Pretty simple. But here’s hoping it’s not too late for scientists to come up with a new class of antibiotics that will allow us to have a do-over.

By Trish Parnell

Image courtesy of National Health Service


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Holiday Poisoning (oops) Cooking

7 11 2011

Do you cook? Most people do, and some people cook every day. I know of only one person who doesn’t cook—ever. The rest of us crank the oven on or prepare salads or treats at some point during the year, even if it’s just for the holidays.

We also manage to poison each other when we handle food with unclean hands, undercook the bird, or let hot foods get cool and cold foods get warm.

CDC says that “each year roughly one out of six Americans (or 48 million people) get sick, 128,000 are hospitalized, and 3,000 die from foodborne diseases.”

Hence this rather long (but we hope useful) post on how not to poison Grandma this year.

Foodsafety.gov says to follow these four steps (edited a little for length):

CLEAN hands and surfaces often—wash your hands for 20 seconds with soap and running water. Here’s a visual that shows how.

And when to do it:

  • Before eating food.
  • Before, during, and after preparing food.
  • Before and after treating a cut or wound.
  • Before and after caring for someone who is sick.
  • After handling uncooked eggs, or raw meat, poultry, seafood, or their juices.
  • After blowing your nose, coughing, or sneezing.
  • After touching an animal or animal waste.
  • After touching garbage.
  • After using the toilet.

Wash surfaces and utensils after each use:

  • Use paper towels or clean cloths to wipe up kitchen surfaces or spills, then toss or wash.
  • Wash cutting boards, dishes, utensils, and counter tops with hot, soapy water after preparing each food item and before you go on to the next item.
  • As an extra precaution, you can use a solution of 1 tablespoon of unscented, liquid chlorine bleach in 1 gallon of water to sanitize washed surfaces and utensils.

Wash fruits and veggies:

  1. Cut away any damaged or bruised areas.
  2. Rinse produce under running water. Don’t use soap, detergent, bleach, or commercial produce washes.
  3. Scrub firm produce—like melons or cucumbers—with a clean produce brush.
  4. Dry produce with a paper towel or clean cloth towel and you’re done.
  5. Bagged produce marked “pre-washed” is safe to use without further washing.

Don’t wash meat, poultry, and eggs. Washing raw meat and poultry can actually help bacteria spread, because their juices may splash onto (and contaminate!) your sink and countertops. All commercial eggs are washed before sale. Any extra handling of the eggs, such as washing, may actually increase the risk of cross-contamination, especially if the shell becomes cracked.

SEPARATE Don’t cross-contaminate

Even after you’ve cleaned hands and surfaces, raw meat, poultry, seafood, and eggs can still spread illness-causing bacteria to ready-to-eat foods—unless you keep them separate. Use separate cutting boards and plates for produce and for meat, poultry, seafood, and eggs.

  • Use one cutting board for fresh produce, and one for raw meat, poultry, or seafood.
  • Use separate plates and utensils for cooked and raw foods.
  • Before using them again, thoroughly wash plates, utensils, and cutting boards that held raw meat, poultry, seafood, or eggs.
  • Once a cutting board gets excessively worn or develops hard-to-clean grooves, consider replacing it.

Keep meat, poultry, seafood, and eggs separate from all other foods at the grocery.

  • Separate raw meat, poultry, seafood, and eggs from other foods in your shopping cart.
  • At the checkout, place raw meat, poultry, and seafood in plastic bags to keep their juices from dripping on other foods.

Keep meat, poultry, seafood, and eggs separate from all other foods in the fridge.

  • Place raw meat, poultry, and seafood in containers or sealed plastic bags to prevent their juices from dripping or leaking onto other foods. If you’re not planning to use these foods within a few days, freeze them instead.
  • Keep eggs in their original carton and store them in the main compartment of the refrigerator—not in the door.

COOK

Did you know that the bacteria that cause food poisoning multiply quickest in the “Danger Zone” between 40˚ and 140˚ Fahrenheit? Cooked food is safe only after it’s been heated to a high enough temperature to kill harmful bacteria. Color and texture alone won’t tell you whether your food is done. Instead, use a food thermometer to be sure.

  • If you don’t already have one, consider buying a food thermometer.
  • When you think your food is done, place the food thermometer in the thickest part of the food, making sure not to touch bone, fat, or gristle.
  • Wait the amount of time recommended for your type of thermometer.
  • Compare your thermometer reading to our Minimum Cooking Temperatures Chart to be sure it’s reached a safe temperature.
  • Some foods need 3 minutes of rest time after cooking to make sure that harmful germs are killed. Check the Minimum Cooking Temperatures Chart for details.
  • Clean your food thermometer with hot, soapy water after each use.

Keep food hot after cooking (at 140 ˚F or above). The possibility of bacterial growth actually increases as food cools after cooking because the drop in temperature allows bacteria to thrive. But you can keep your food above the safe temperature of 140˚F by using a heat source like a chafing dish, warming tray, or slow cooker.

Microwave food thoroughly (to 165 ˚F). To make sure harmful bacteria have been killed in your foods, it’s important to microwave them to 165˚ or higher. Here’s how:

  • When you microwave, stir your food in the middle of heating.
  • If the food label says, “Let stand for x minutes after cooking,” don’t skimp on the standing time. Letting your microwaved food sit for a few minutes actually helps your food cook more completely by allowing colder areas of food time to absorb heat from hotter areas of food. That extra minute or two could mean the difference between a delicious meal and food poisoning.
  • After waiting a few minutes, check the food with a food thermometer to make sure it is 165˚F or above.

CHILL

Did you know that illness-causing bacteria can grow in perishable foods within two hours unless you refrigerate them? (And if the temperature is 90 ˚F or higher during the summer, cut that time down to one hour!) But by refrigerating foods promptly and properly, you can help keep your family safe from food poisoning at home.

Cold temperatures slow the growth of illness-causing bacteria. So it’s important to chill food promptly and properly. Here’s how:

  • Make sure your fridge and freezer are cooled to the right temperature. Your fridge should be between 40 ˚F and 32 ˚F, and your freezer should be 0 ˚F or below.
  • Pack your refrigerator with care. To properly chill food (and slow bacteria growth), cold air must be allowed to circulate in your fridge. For this reason, it’s important not to over-stuff your fridge.
  • Get perishable foods into the fridge or freezer within two hours. In the summer months, cut this time down to one hour.
  • Remember to store leftovers within two hours as well. By dividing leftovers into several clean, shallow containers, you’ll allow them to chill faster.

Never thaw or marinate foods on the counter. Many people are surprised at this tip. But since bacteria can multiply rapidly at room temperature, thawing or marinating foods on the counter is one of the riskiest things you can do when preparing food for your family. To thaw food safely, choose one of these options:

  • Thaw in the refrigerator. This is the safest way to thaw meat, poultry, and seafood. Simply take the food out of the freezer and place it on a plate or pan that can catch any juices that may leak. Normally, it should be ready to use the next day.
  • Thaw in cold water. For faster thawing, you can put the frozen package in a watertight plastic bag and submerge it in cold water. Be sure to change the water every 30 minutes. Note: If you thaw this way, be sure to cook the food immediately.
  • Thaw in the microwave. Faster thawing can also be accomplished in the microwave. Simply follow instructions in your owner’s manual for thawing. As with thawing in cold water, food thawed in the microwave should be cooked immediately.
  • Cook without thawing. If you don’t have enough time to thaw food, just remember, it is safe to cook foods from a frozen state—but your cooking time will be approximately 50% longer than fully thawed meat or poultry.

To marinate food safely, always marinate it in the refrigerator.

Know when to throw food out. You can’t tell just by looking or smelling whether harmful bacteria has started growing in your leftovers or refrigerated foods. Be sure you throw food out before harmful bacteria grow by checking our Safe Storage Times chart.

And finally, CDC has some reminders for Turkey Day:

Food safety is especially important as you prepare a holiday meal. Within the last couple of years, CDC has investigated outbreaks of foodborne illness that were caused by bacteria in jalapeños, spinach, peanut butter, frozen pizza, frozen pot pies, and frozen beef patties. Many consumers are now more aware of the ongoing importance of food safety.

CDC is a food safety partner with the United States Department of Agriculture (USDA), Food Safety and Inspection Service (FSIS), which is responsible for the safety of meat and poultry. The FSIS has assembled preparation tips intended to serve as safety reminders to those who are already familiar with meat and poultry preparation safety and as guidelines for the first-time chef.

Turkey Basics: Safely Thaw, Prepare, Stuff, and Cook

When preparing a turkey, be aware of the four main safety issues: thawing, preparing, stuffing, and cooking to adequate temperature.

Safe Thawing
Thawing turkeys must be kept at a safe temperature. The “danger zone” is between 40 and 140°F — the temperature range where foodborne bacteria multiply rapidly. While frozen, a turkey is safe indefinitely, but as soon as it begins to thaw, bacteria that may have been present before freezing can begin to grow again, if it is in the “danger zone.”
There are three safe ways to thaw food: in the refrigerator, in cold water, and in a microwave oven. Instructions are also available in Spanish .

Safe Preparation
Bacteria present on raw poultry can contaminate your hands, utensils, and work surfaces as you prepare the turkey. If these areas are not cleaned thoroughly before working with other foods, bacteria from the raw poultry can then be transferred to other foods. After working with raw poultry, always wash your hands, utensils, and work surfaces before they touch other foods.

Safe Stuffing
For optimal safety and uniform doneness, cook the stuffing outside the turkey in a casserole dish. However, if you place stuffing inside the turkey, do so just before cooking, and use a food thermometer. Make sure the center of the stuffing reaches a safe minimum internal temperature of 165°F. Bacteria can survive in stuffing that has not reached 165°F, possibly resulting in foodborne illness. Follow the FSIS’ steps to safely prepare, cook, remove, and refrigerate stuffing. Spanish language instructions  are available.

Safe Cooking
Set the oven temperature no lower than 325°F and be sure the turkey is completely thawed. Place turkey breast-side up on a flat wire rack in a shallow roasting pan 2 to 2-1/2 inches deep. Check the internal temperature at the center of the stuffing and meaty portion of the breast, thigh, and wing joint using a food thermometer. Cooking times will vary. The food thermometer must reach a safe minimum internal temperature of 165°F. Let the turkey stand 20 minutes before removing all stuffing from the cavity and carving the meat. For more information on safe internal temperatures, visit FoodSafety.gov’s Safe Minimum Cooking Temperatures.

By CDC, mostly!


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Vaccine Fears: What You Can Do

22 08 2011

What’s not to fear directly about vaccines? There’s a needle that someone pokes into your child. Your child screams. You tense up. What’s in there? you wonder. Viral or bacterial bits that, in ways that are mysterious to a non-immunologist, will keep your child well when intuition seems to say they ought to make your child sick.

Needles, screaming, microbial bits…these naturally would make any parent blanch. The number of vaccines has added to the fear for at least a decade, leading to non–evidence-based calls to “spread out” the schedule or reduce the number of vaccinations.

In fact, the evidence supports the schedule as it’s recommended.

The fear of vaccination is not new. Since Edward Jenner and his cowpox inoculation at the turn of the 19th century, people have latched onto the fear of the known—those needles!—and unknown—what’s in those things?

What might be considered the first anti-vaccine cartoon appeared in response to Jenner’s proposed inoculation of cowpox to combat smallpox.

The vision of cows growing out of arms is comical, but the reality of possible side effects from today’s vaccines can lead some parents to keep their children away from the doctor’s office. Indeed, this anxiety has done so since the days of the 19th century anti-vaccination leagues, aligned against the widespread use of Jenner’s smallpox vaccine.

The vaccine wars in those days were just as bitter and divisive as they are today, including an 1885 march in England in which anti-vaccination forces carried a child’s coffin and an effigy of Jenner himself. Today’s most fanatical crusaders against vaccines may not carry coffins or effigies, but death threats against those who promote vaccines for public health are not unknown.

The fact that the vast majority of parents overcame those fears and had their children vaccinated has led to some of the greatest public health successes of the 20th century. Thanks to the willingness of people to participate in vaccination programs, smallpox disappeared and polio became a thing of the past in much of the world. Indeed, people in those eras knew, often from personal experience, what these diseases could do—maim and kill—and the fear of those very real outcomes outweighed fears of the vaccinations.

But today, we’re different. In the United States, most of us under a certain age have never witnessed a death from diphtheria or tetanus or smallpox or measles. We haven’t seen a child drained of life as a rotavirus rapidly depletes the molecules she needs to live. Many of us have not witnessed the sounds of pertussis, the vomiting, the exploding lungs in an agony of infant death. Why? Because of vaccines.

This very success has, ironically, led to the resurgence of fear and misgiving about vaccines. No longer weighed against anxiety of death or disability from disease, the fear of vaccines now aligns against the bright picture of a nation of children largely free of life-threatening illness.

Without the collective memory of days when children played on the playground one day and died the next of vaccine-preventable disease, the calculus of parental fear pits only the side effects of vaccines against the healthy child. Vaccination requires intentional agency—parental agreement—to impose on that healthy child the very small risk that vaccines carry. Some parents simply are not comfortable either with that intentionality or that risk.

Feeding this reluctance is the explosion of Internet sites that warn against vaccines or disseminate incorrect information about them. The Centers for Disease Control and Prevention (CDC) has provided abundant information about vaccines, including a page devoted to countering erroneous information with facts.

This information will not move the fiercest anti-vaccine groups that lump the CDC in with pharmaceutical companies and others in an alleged conspiracy to harm millions via a money-making vaccine industry. However, it certainly helps concerned parents who simply seek to calm fears, weigh evidence, and make an informed decision about choosing vaccines over the life-threatening illness and compromised public health that result when people don’t vaccinate.

Indeed, these threats to public health have grown considerably with recent large outbreaks of measles and pertussis. The growing threat has led to calls for more stringent requirements for childhood vaccines, including dropping exemptions and requiring that all children be vaccinated over parental objections. This tactic likely would increase vaccination rates among children attending school.

But instead of strong-arming parents into having their children vaccinated, what we really need is a two-fold approach to education. First, we need sober, non-sensationalist reporting from the news media about vaccine-related stories, including stories about side effects, research, and court cases. These articles—and their sensational headlines—are in all likelihood among the prime drivers of the rumor mill against vaccines.

Second, when parents read these stories and turn to a medical professional for input, that input must come as part of a two-way communication between the health professional and the parent, not in lecture format or as patronizing. A little, “I understand your concerns because I’ve had them, too, but here’s what I know that gives me confidence in vaccines,” is considerably better than, “Your child has to be vaccinated, or you can get out of my office.”

As centuries of history attest, no efforts will completely eradicate vaccine fears. Motivations fueling anti-vaccine sentiment that go beyond information gaps range from personal economic benefit to a desire to out-expert the experts to the inertia of fear.

But a careful and persistent information campaign and outreach efforts from medical professionals in the trenches may help keep vaccination rates sufficiently high. To ensure adequate rates requires either these efforts or a resurgence of the deadly diseases that have graphically demonstrated the real balance of the threats at issue here.

Which one would we rather have?

By Emily Willingham

Image courtesy of ajc1


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Ask Emily

28 07 2011

What causes ear wax?

You do! Ear wax comes in two types. One is a thick, yellow wax, known as the “wet” type. The other is a greyish, flaky kind of wax, known as the “dry” type and most common among people of Asian origin and American Indians. Either way, its job is to clean, disinfect, and moisturize your ears, which makes it sound like a beauty product.

In reality, it is a health product that your body makes as a line of defense against things that might harm you, from bacteria to fungi to, yes, insects. For this reason, unless your ear wax is causing a health problem, medical folk recommend that you just leave it alone. It will cycle through and out of your ear, renewing as it goes.

Which type you have—wet or dry—depends on a single mutation in a single gene. Researchers have noted that Asians, especially people from East Asia, have ear wax that is dry and whitish. People whose ancestors are from Europe and Africa almost invariably have ear wax that is sticky and brown or yellow. If a person doesn’t dump cholesterol and other smooth fatty things into their ear wax, then the wax will consist primarily of dead skin flakes, the dry type.

Whether or not you make one or the other traces back to a single change in a single gene. This gene encodes a protein that makes ear wax . . . wet. With the single change in the genetic alphabet, a person doesn’t make wet wax. Researchers have even used this single change to trace the course of human migration throughout the world. Who knew ear wax could be so informative and useful?

I know that a fever is when my body’s temp goes up, but why does it go up? Why is THAT the reaction to whatever is going on in my body?

Let’s start by talking about bedbugs. One of the potential treatments for a bedbug infestation is to turn up the heat in the house to a level that bedbugs can’t survive. Turns out, the little bloodsuckers aren’t too fond of high temperatures. Many things that invade your body are like those bedbugs. They’re pretty comfortable at your normal temperature, but high heat can disable the molecules that keep them functioning. That’s why, when your body’s defense system recognizes an invader, one response may be fever.

Cells that detect these invaders can send out chemical signals with a great name: pyrogens. Pyro, of course, refers to fire or flame, and these chemicals travel to the brain’s thermostat center. There, they signal the brain to readjust the body’s temperature . . . kicking it up a few notches.

To a point, this higher temperature is thought to make things uncomfortable for microbes while not harming you too much. When a strong fever response takes things too far, fever can be harmful, but you might be surprised at exactly how high a fever needs to be to cause harm to you. According to the experts, a fever won’t cause brain damage unless it exceeds a very specific 107.6 F (42 C).

This general defense—it doesn’t target the specific invader; instead, it just relies on wholesale heating—is one of your body’s first responses to infectious invaders like bacteria or viruses. Meanwhile, your body is likely also getting to work on more specific tactics to deal with the unwanted intruders.

Do you have a question for Emily? Send it to: pkids@pkids.org

By Emily Willingham

Image courtesy of CuriousGeoff


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Bacteria and Viruses-How They Work

19 05 2011

Bacteria
There are thousands of types of bacteria and most are harmless or even beneficial.  However, even “good” bacteria, if they find their way to the wrong place, can cause harm.  For example, bacteria that live in our mouth can cause illness if they find their way to the middle ear and cause an ear infection.  Also, some bacteria that ordinarily do not cause disease in persons with a working immune system, may do so in people with a weakened immune defense system.

Most bacterial diseases occur when bacteria multiply rapidly in tissue, damaging or killing it.  Boils result from the multiplication of bacteria in the skin.  Other bacteria cause disease by producing toxins or poisons.  Tetanus is a disease that begins after bacteria that normally live in soil enter the body through a wound.  The bacteria produce a poison that affects muscles and nerves far away from the wound.

To cause illness in humans, bacteria need to be able to gain access to the human body, reach their unique place within the body and multiply there.  The human body has developed several strategies to make life as difficult as possible for disease-causing or pathogenic bacteria, but bacteria have also learned how to break down our defenses.

An infection by pathogenic bacteria can be seen as a miniature battle between bacteria and host.  Bacteria try to survive and feed and multiply, while the human body’s immune system tries to prevent this.  The resulting infection is a process with three possible outcomes:

  • The immune system wins and the bacteria are removed, possibly with the help of medications.
  • The bacteria win the ultimate battle and kill their host (bacterial infections are a major cause of death, especially for children and elderly people).
  • An equilibrium is reached in which host and bacteria live in relationship together and damage is minimized.

Viruses
All viruses live to make more viruses, and they usually make more viruses by invading a host’s cell (for instance, one of the cells in our bodies) and using the host cell’s “machinery” to churn out more of themselves.

Once the viruses mature, they leave the host cell and go find many more host cells to set up shop in so that they can start churning out more of themselves.

Sometimes, there is a hitch in the churning process.  During viral replication, mutations can occur.

The mutation can be bad enough to interfere with the virus’s ability to duplicate itself.  Or, it might just create a new strain of the virus.  The influenza virus does this, which is why every year, each new strain of flu virus must be identified in order to make a vaccine that is effective against it.

Humans are able to fight off viruses in several ways:

  • Proteins called interferons help neighboring cells resist infection by the virus.
  • If interferons fail, the immune system kicks in and fights the infection by killing the virus floating around outside the host cells and killing infected host cells.  (HIV is the exception, because HIV infects cells of the immune system that are necessary to kill the infected cells.)
  • There are drugs that help the body fight certain viral infections.  They hinder or stop the replication of the virus and are known as antivirals/retrovirals.

This is one in a series of excerpts from PKIDs’ Infectious Disease Workshop.  We hope you find the materials useful – the instructor’s text and activities are all free downloads. 

Photo credit: measles – sanofi pasteur


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Categories : Infectious Diseases

What Comes With a Kiss?

14 02 2011

A kiss can be a greeting between friends, or it can mean so much more. We enjoy it either way, don’t we?

Health-wise, locking lips can be both a benefit and a burden.

Scientists don’t completely understand why we kiss, but humans are not the only lip smackers on the planet. Animals, including apes, also practice kissing-like behaviors.

The Good Kiss

We get a serious physical response from a good kiss. Kisses cause a brain fireworks show. Sensory neurons from our lips send signals to our brain and body, kicking off sensory sparks, intense emotions, and physical reactions.

Getting to first base can be a huge stress reliever, and holding hands and kissing has been known to lower blood pressure as well as boost our immune systems.

When we get a passionate kiss, our brain oozes a bit of dopamine in the ventral tegmental part of the brain, which is the same region that is tickled by addictive drugs like cocaine. Our body sure does like getting love pecks.

Swapping spit can also help keep your teeth pearly white. Saliva acts as a natural lubricant, slipping under plaque and washing it away. It can even protect teeth from decay by neutralizing harmful acids.

Finally, a good make-out session can benefit your heart. We burn 12 calories for every five seconds of vigorous kissing .

The Bad Kiss

While Scottish writer Thomas Carlyle said, “If you are ever in doubt as to whether to kiss a pretty girl, always give her the benefit of the doubt,” there are some good reasons to put a pause in your pucker.

Kisses can spread germs and infections. One milliliter of saliva contains about 100,000,000 bacteria. And, according to the Academy of General Dentistry (AGD), with just one kiss, couples can share more than 500 different types of disease-causing bacteria and viruses.

Not exactly romantic, huh?

Cold sores are caused by the herpes virus and spread by skin-on-skin contact. Flu and cold viruses can be shared lover-to-lover through necking. Also, mononucleosis, heralded as the kissing disease “mono” is easily spread through a good French kiss, as well as by sharing food, a cup, utensils or straws with an infected person.

With a sloppy kiss, we pass on the bacteria that cause cavities. This can also happen when a parent sucks on a child’s pacifier or eating utensil with their mouth.

We don’t need to get worked up about this, but it’s good to know that along with fireworks can come cavities.

As your thoughts turn to love on this Valentine’s Day, consider Shakespeare’s words: “I can express no kinder sign of love, than this kind kiss.”

Smooch on, dear readers, smooch on!


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Categories : Colds, Health Education, Infectious Diseases

Acne and Bacteria – Best of Friends

5 05 2010

Acne is a skin condition that causes pimples, zits, whiteheads, blackheads, cysts, pus-filled lesions and, oy, if you’ve ever struggled with it, you know that it’s physically and emotionally painful.

Dead skin cells and the oils on skin can plug up follicles, and this produces acne. When follicles get plugged up, skin bacteria, particularly Propionebacterium acnes (aka P. acnes), get trapped and start to grow, causing irritation.

Because we all have skin bacteria, the first thing we should not do is pick or squeeze pimples. This breaks our skin and allows more bacteria to invade an already inflamed area; then we’re in a world of hurt and spreading acne.

Our hands pick up all sorts of germs all day long. We need to keep them off of our faces because they only add to the problem by dumping even more bacteria on the skin. Keeping our fingernails as short as possible also helps reduce bacterial growth.

Bacteria play a part in the acne game, and that’s what keeps antibiotics in the lineup for acne treatments. We hear of people being on oral antibiotics for months, but what we don’t hear as much about are the topical treatments.

Instead of taking an antibiotic orally, we can apply a treatment directly to the affected area. Antibacterial washes have been effective for some people.

No one treatment works for everyone. If you’re at war with acne and you haven’t tried topical treatments, see your doctor and ask if they could work for you.

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Categories : Teenagers

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