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





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





International Conference on Viral Hepatitis

9 05 2011

The International Conference on Viral Hepatitis was held in mid-April in Baltimore.  The conference description was as follows:

There exist significant challenges to diagnosing and linking to treatment large numbers of hepatitis B virus (HBV)- and hepatitis C virus (HCV)-infected patients who are unaware of their serostatus and thus are not on either anti-HBV or anti-HCV treatment. Additionally, bottlenecks preventing expanded access to HBV and HCV care must be addressed in light of shifting treatment paradigms, which requires an expanded number of clinicians from multiple disciplines to deliver HBV and HCV care.

Presentations will feature state-of-the-art information on HBV and HCV research, clinical perspectives, and medical treatment, both within the context of HBV and HCV monoinfection, as well as coinfection with HIV. The conference will feature 24 oral abstract presentations, poster sessions, plenary presentations, invited panel discussions, and clinical case study reviews.

A couple of findings from the conference that could interest parents of HCV+ kids include:

Forty percent of HCV+ patients are not adhering to their treatment. The key to this is identifying those patients who are depressed and treating the depression along with the disease. Those who were treated for their depression showed higher rates of adherence and, consequently, higher rates of viral suppression.

SPRINT-2 was a study of previously untreated HCV+ genotype 1 patients looking at boceprevir with peginterferon/ribavirin.  In this study, this combination of drugs increased sustained virologic response  significantly over standard therapy. Another study looked at patients who had been previously treated with standard therapy but either did not respond to treatment or relapsed.  For those patients, boceprevir was added in re-treatment and significantly higher rates of sustained virologic response were achieved.

These studies were not performed on children, but we know that what works in the adult population will eventually find its way to the pediatric population.

Please read the conference PDF for more abstract findings.

 





Monkeypox

2 07 2010

This blog is a long time coming. We heard about monkeypox a few years ago and wanted to write it up just so we could use the word “monkeypox.”

Turns out, monkeypox the disease isn’t as funny as the word. When infected, one gets a blistery rash similar to smallpox. In areas of Africa where the virus is endemic, one to 10 percent of human cases end in death.

Although the virus was first detected in monkeys, other animals can become infected, including humans

The first outbreak of monkeypox detected in the U.S. was in 1993 and probably started with animals imported from Africa infecting pet prairie dogs, who then infected humans.

Monkeypox can be transmitted in unusual ways, including through the consumption of bushmeat—legal (or illegal) wild animal meat imported to cities in Europe and the U.S.

There’s no specific treatment for monkeypox and prevention methods are the usual: handwashing, avoid sick animals, and practice standard, contact, and airborne precautions.

Turns out monkeypox just isn’t funny.





Dr. Mary Beth Explains Fifth Disease

16 06 2010

Dr. Mary Beth, PKIDs’ advice nurse, tells us what Fifth disease is and that we can’t really prevent it! But, we can manage symptoms.

Listen now!

Right-click here to download podcast (9min/4.5mb)








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