Flu Shot Already?

29 08 2011

It’s so easy to get flu vaccinations these days. My daughters and I were grocery shopping and we were immunized between the bacon and the frozen pizza aisles.

OK, I confess I didn’t tell my 12-year-old what we were going to do. I lured her to the store with promises of cantaloupe and pepperoni sticks (don’t judge) and slipped in the visit to the pharmacy mid-store. My 15-year-old was happy to get her shot because she had H1N1 last year and is determined never to get the flu again as long as she lives.

Does it seem weird to anyone else to get a flu shot in August? The upside is, there are no lines, and the shot takes a couple of weeks to kick in, so getting it sooner rather than later is a good idea.

Obviously, influenza is on my mind. I was browsing YouTube for flu vaccination videos and came across this one from Australia. What do you think? We need to mix it up a bit. Does this do the trick?

By Trish Parnell

Video courtesy Government of South Australia

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

Donuts to Broccoli

18 08 2011

When my brothers and I were children (lo these many years ago), our mom went into the kitchen every night and cooked dinner for the family. We had beef, pork or chicken, potatoes, two kinds of colorful vegetables and, once a week or so, a homemade dessert.

Occasionally, noodles would take the place of the potatoes, but pasta never graced our table. We were Midwesterners, for crying out loud.

There was one obese kid in our school and we knew just a handful of obese adults. We didn’t know anyone who was undernourished, except as abstract beings brought into play when we didn’t want to eat black-eyed peas: “Don’t you know there are starving kids in (fill in the blank)? Eat your peas!”

It feels ridiculously self-indulgent to talk about obesity when families in Somalia and those escaping that land are starving, but there you are. Today I am thinking and acting locally.

Millions of obese Americans face health risks that could be eliminated or reduced by weight loss. Obesity impairs immune function and causes a host of other ailments. It’s time to step away from the donuts and embrace broccoli.

I used to cook a lot—experimenting in the kitchen was therapeutic. Then I became a parent. Between work and homework, the activities of two kids, and one incredibly annoying picky eater, I gradually found little time and less inclination to do anything in the kitchen besides microwave leftover take-out or “cook” a prepackaged dinner in the oven.

My weight has nearly doubled in the last 15 years and my kids are lethargic slugs.

When we were young, my brothers and I spent hours outside running and playing and were never tired. Long car trips were what exhausted us. Almost the opposite is true today—my kids can sit and text or surf the web or listen to their iPods for hours.

I physically feel the effects of obesity, and the guilt of not providing a healthier daily diet for my kids gnaws at me. Are any of you going through the same thing? Or maybe you were and you’ve found a way out? What did you do?

I bought some melon. And broccoli. And for once we’re going to eat them before they go bad, hiding in the back of the refrigerator.

Obesity is preventable. It’s time I got off my considerable rear end to do something about it for me and for my kids. And like it or not, they’re unplugging and getting off of the couch and out into the world.

If you have any suggestions, I’d love to hear them!

By Trish Parnell

Image courtesy of franςois @ edito.qc.ca

End Polio Now

15 08 2011

What do Donald Sutherland, Joni Mitchell, Robert McNamara, and Arthur C. Clarke have in common?

Polio. They all survived polio.

This disease, which may be thousands of years old, was clinically described in the 18th century as a “debility of the lower extremities.” Later, in the U.S., it was labeled infantile paralysis.

Fast-forward a couple of centuries to the 1950s, when Dr. Jonas Salk developed the first polio vaccine and right on his heels was Dr. Albert Sabin, with another vaccine that became widely used. Cases of polio plummeted in most countries, but each year there were still hundreds of thousands of kids infected.

Fresh from the success of smallpox eradication, an opportunity to do the same to polio was envisioned and energies were renewed in 1988, when the World Health Assembly launched the Global Polio Eradication Initiative.

Twenty years later, the World Health Organization reports on the success of the Initiative:

“Polio cases have decreased by over 99% since 1988, from an estimated 350,000 cases in more than 125 endemic countries then, to 1604 reported cases in 2009 . . .”

That’s pretty good. But, polio keeps flaring up. Areas and countries that were once polio-free have seen the virus imported by those not protected through vaccination. In 2009-2010, 23 countries saw such activity. Seems we’re moving in the wrong direction.

Dr. Bruce Aylward explains how we’ll stop polio—for good.

We’re on a fine edge. Tilt one way and we eradicate polio from the world. Tilt the other, and we’ll never see the end of it.

Help spread the word. Blog about it. Tweet about it. Every kid deserves to grow up free of this disease.

By Trish Parnell

TB Marches On

11 08 2011

It has killed millions in its march through the human population, including the famous—Chopin, Emily and Anne Brontë, Eleanor Roosevelt—and more abundantly, the not-so-famous. It currently infects about one-third of the world’s population, able to linger without symptoms in people who may never be aware that they’re carrying it. What is it?

It’s tuberculosis (TB), caused by the bacterium Mycobacterium tuberculosis. TB can lurk in a latent form, causing no symptoms at all, or it can cause active disease. People with latent TB usually don’t even know they have it unless they’ve had a skin test. Luckily, they also are not infectious to others. But people with active disease—and latent infections often turn active—are infectious. Highly so.

But not so infectious that a single contact will give another person TB. TB typically transmits in close quarters—prisons can be hotbeds of infection—requiring a person to cough up or sneeze the infectious bacteria into the air close to another person. You can’t get TB by shaking hands with someone or even by kissing them, but you can get it simply by living with them.

Latent or active infections both require treatment because even latent infections carry a risk of becoming active. While medical science has successfully attacked TB with antibiotics, misuse and abuse of these antimicrobial agents has led to a rise in multi–drug-resistant TB.

People with these highly resistant infections must often be quarantined for weeks and weeks while health professionals throw the kitchen sink of antibiotic treatments at the disease. Up to two years of chemotherapy may even be necessary.

What does an active TB infection look like? While it can infect tissues other than the lungs, including the brain or spine, in the lungs, it looks like this:

  • a bad cough that persists three weeks or more that can include coughing up blood or mucus
  • weight loss
  • weakness
  • fatigue
  • fever, chills, night sweats

Twenty years ago, health experts thought TB had been defeated, at least in areas of the world where antibiotics seemed to have wiped it out. But today, the resistant strains of TB have made an alarming comeback, sometimes traveling the world in the form of unwitting—or in at least one instance, witting (PDF)—infected people.

Particularly alarming is the combination of TB together with HIV. The two infections often occur together, as HIV-infected people may be less able to fight a TB infection. In addition to being especially lethal, this combination also interferes with efforts to prevent the spread of resistant TB to other populations.

How can you avoid acquiring a TB infection? A vaccine is available, but is not completely effective and not widely used in the United States. Your best bet is to take precautions when traveling to parts of the world where TB is common—which includes Latin America, the Caribbean, Africa, Asia, and Eastern Europe—staying away from crowded populations at particular risk.

TB is most common in prisons, drug-treatment centers, homeless shelters, and healthcare clinics. If you are going to be in a place where TB rates are high, consult a healthcare professional about steps you might take against acquiring it. If you think you may have been exposed, get a skin test.

Awareness of a latent infection—and treating it—is one step in the successful advance against the renewed uprising of TB.

By Emily Willingham

Image courtesy of mjagbayani

It’s August – Get Immunized!

8 08 2011

Are you aware of immunizations? You may think that as someone who has passed the childhood years, you’re finished with immunizations. August is National Immunization Awareness Month, and here at PKIDs, we thought you should be aware that immunizations aren’t only for kids anymore. Here is a handy guide to immunizations for specific populations, from children to tweens and teens to those who are more mature in years.


Immunization starts in childhood, with the standard shots against measles, mumps and rubella, chickenpox, polio, hib, hepatitis, diphtheria, pneumococcal, rotavirus, tetanus and whooping cough for children ages six and under. These vaccination programs have been extraordinarily successful at saving lives and permanent negative effects from these diseases. For example:

  • Vaccines have successfully wiped smallpox from the face of the planet. This horrific disease could kill as many as 25% of those infected and left survivors with permanent disfigurement. Scientists declared it globally eradicated—thanks to vaccines—in 1980.
  • Polio used to hit about 50,000 people every year in the United States. Between 13,000 and 20,000 of those cases were paralytic polio that left thousands of children disabled, some in iron lungs, unable to breathe on their own. Thanks to immunization, polio is a thing of the past in the Western Hemisphere but is resurging in areas where immunization programs have been suspended, including Nigeria.
  • The United States is currently experiencing measles outbreaks, primarily among unvaccinated groups. These outbreaks have resulted in high hospitalization rates. Vaccines against measles prevent infection—which also means preventing the death and disability that this highly infectious disease causes. In areas of the world where vaccines are lacking, hundreds of thousands of children die every year from measles.
  • Have you ever known anyone who has died of diphtheria? If not, that’s because of vaccines. About 13,000 people died each year in the United States before the vaccine. In 2002, there was a single case of diphtheria in the US.
  • And take chickenpox. You may not consider chickenpox to be deadly, but before the vaccine, the death rate was about 0.41 per million cases. The death rate has dropped 97% among children and teens since the advent of the varicella vaccine.

Tweens and Teens

Don’t leave out children over age six when it comes to immunizations. Kids ages 11 and 12 need boosters for tetanus, diphtheria, and whooping cough (pertussis), and everyone needs protection against meningococcal with a booster after a few years. Further, current recommendations are also for girls to get the HPV vaccine, which protects against the viruses that most commonly cause cervical cancer. Remember that your daughter’s sexual behavior or history is not the only determinant of whether or not she will be exposed to the virus; her partner’s past matters, too. The HPV vaccine is also licensed for boys—talk to your son’s provider about vaccination.


If you’re grown, you still need to get a tetanus booster every decade, or TDaP if you haven’t received at least one booster for whooping cough. If you’re age 60 or older, get your shingles vaccine to avoid a painful viral attack on your nervous system. Adults age 65 or better also should get a one-time pneumonia shot.


Everyone should get vaccinated against flu each year, either with a shot or a nasal spray. The nasal spray contains live, weakened viruses and is approved for healthy people ages 2 to 49 who are not pregnant. The flu shot is approved for people ages 6 months and over, either healthy or with chronic health conditions. Children younger than 2 years, pregnant women, and people over age 50 are especially vulnerable and a specifically targeted population for flu shots. If you have a fever, egg allergy, or a history of reaction or Guillain-Barré following a flu shot, you should not get the vaccine.

Speaking of people who can’t get vaccines for medical reasons, one final thing to be aware of during National Immunization Awareness Month and beyond: Vaccinations as preventive healthcare don’t prevent disease only in you or your child. They also protect those who can’t receive vaccine protection because of allergy or medical conditions. It’s protection for all of us.

By Emily Willingham

Image courtesy of CDC

Ramadan – Healthy Fasting!

4 08 2011

Ramadan is a holy month for those who follow Islam. During this time, many are expected to fast from sunrise to sunset and by doing so, learn self-discipline, patience, and empathy for those less fortunate.

Years ago, I lived in a tiny country in North Africa where most of the citizens were practicing Muslims. At that time, Ramadan was in the summer, as it is this year. It was HOT. We’re talking Sahara hot.

I remember wandering around a small town one boiling afternoon, searching for an open shop—anyplace to buy water and maybe one of those buttery croissants with a thin stick of dark chocolate wrapped inside. I’d heard of Ramadan, but was in my 20s and not used to inconveniencing myself for religion.

There was one bakery open. I can only assume it was because there was a large group of individuals with various religious beliefs staying in town for a few weeks.

I got my water and croissant and continued my wanderings. While I was busily licking the delicious crumbs off of my fingers, I noticed that the few townspeople on the road were politely and pointedly looking away from me.

Boy, did I feel dumb. And crass. And ignorant. It’s OK to skip Ramadan observances if you’re not a Muslim, but it’s not OK to walk around gorging yourself when others are fasting. In my defense, pitiful as it is, I’d been there about a week and was clueless to the reality of Ramadan. My experience with religion up to that time was that of a child, watching as adults got dressed up for an hour of Bible talk each Sunday, and then spoke no more of it the rest of the week.

It’s another hot summer and Ramadan is here. I wonder what fasting each day for a month does to one’s health? The fasting isn’t meant to be a health benefit or punishment, it’s meant to be a holy act. But, the potential for side effects to one’s health is a common concern.

Ramadan requires fasting from sunrise to sunset, and then eating and drinking is allowed. The body is not as stressed as it would be if the fast lasted 24 hours a day for several days.

If you are sick, or traveling, or of a certain age, fasting is not a requirement. But, for those who are fasting, it is terribly hard to perform manual labor. The body loses sodium and potassium through sweat, so working shorter hours and consuming a balanced diet in the evening and early morning hours is critical to maintaining good health.

Foods to avoid when breaking the fast are the same as at any other time—deep-fried foods, sugary and fatty foods. Caffeine is a diuretic. The last thing you want during Ramadan is consuming anything that increases urination (water loss).

Foods that are good for you when breaking the fast are also the same as at any other time—whole grains, fruits, vegetables, some protein and dairy.

The Ramadan Health Guide discusses possible health problems related to fasting, as well as solutions:

  • Thinking of food can increase the acid in one’s stomach, creating heartburn. The guide suggests continuing any heartburn medication you’re on and avoiding foods that increase stomach acid. Sleeping with your head higher than the rest of your body may help.
  • Those who are ill shouldn’t be fasting, so check with your doctor if you’re living with diabetes or any condition or infection.  You may or may not be able to fast, but if you do, there will be precautions you’ll want to take to do so safely.
  • Seems like everyone gets headaches when they’re hungry.  Take painkillers with your morning meal (check with your HCP first), wear a hat in the sun, get lots of sleep and know that, no  matter what, you’re going to hurt if you’re a caffeine lover and you’ve given it up for Ramadan.
  • Dehydration is an obvious problem. Stay hydrated when not fasting, and take in plenty of sugar and salt.
  • Some people gain weight during Ramadan. They consume too many calories when not fasting, to make up for the loss during the day. Everything in moderation!
  • Constipation can be a side effect of daily fasting. Keep hydrated and eat lots of fruits and veggies when you break your fast. If all else fails, there are over-the-counter options.

If you’re fasting for Ramadan or for any other reason, the guide is worth reading. There’s also a section for healthcare professionals that will be useful if your patients are observing Ramadan.

And finally, happy Eid-ul-Fitr on 31 August, the end of Ramadan!

By Trish Parnell 

Image courtesy of Vit Hassan

Antibiotics Aren’t for Everyone

1 08 2011

The boy who lost interest in the Velveteen Rabbit—what archaic malady did he have again? Scarlet fever, that’s what it was. One of those things, like consumption or ague, that you only read about in old books . . . until recently, when it hit the headlines by killing two children in Hong Kong.

Unless you live there or have connections to there, you might not have thought too much about it, but it’s actually the latest harbinger of a dead-scary public health menace coming our way. Unlike most global menaces, there’s actually a lot we can do about this one.

Scarlet fever is a bacterial infection caused by group A Streptococcus, the same germ that causes strep throat.  It’s not vaccine-preventable, but it’s pretty easily treated with antibiotics, so since those have been around, nobody’s been too afraid of scarlet fever.

The recent deaths were caused by a strep strain that has mutated to be simultaneously more contagious and more antibiotic-resistant than the ones we were used to dealing with.

It’s still vulnerable to good old penicillin, but given how many other types of bacteria have become resistant to penicillin, it could just be a matter of time before we lose our last treatment option. Then, it’d be down to a battle between the bacteria and the infectee’s innate defenses.

How does antibiotic resistance happen, anyway? Say you have an infected ear, teeming with all manner of bacteria. You take your first dose of erythromycin (or whatever) and, bam, a whole bunch of the least-hardy bacteria go squealing off into the Great Petri Dish in the Sky. Your second dose takes out the next-wimpiest ones, and so on for four or five days. By then, you’re feeling much better, because there aren’t too many bacteria left to inflame your poor eardrum. So you stop taking the erythromycin, because, hey, why take medicine you don’t need?

Here’s why—those few bacteria left puttering around in your eardrum were the cream of the crop, hardy enough to withstand several days’ worth of antibiotics, and now they’re left with no competition for your delectable ear tissue. They multiply unchecked, and you can bet they’re not going to be content to populate just your ears.

You’ve done a little bit of genetic engineering right there inside your own skull, creating an antibiotic-resistant strain of bacteria that’s going to be a headache (or earache) for anybody who happens to pick it up from you, because throwing erythromycin at these bad boys will just make them snarl and chitter like Gremlins.

Naturally, since creating antibiotic-resistant bacteria is so simple even a child can (and often does) do it, you never know when your next infection will be with somebody else’s home-brewed nasties. Or even those of some random pig! That’s right—livestock get antibiotics too, mostly as a sort of general-purpose illness-preventing measure to grow them as big as they can possibly get.

In fact, 80% of all antibiotics in the U.S. are fed to animals that will themselves become food. It’s not well-documented yet, but researchers suspect resistant bacteria may be carried in the critters we eat.

We owe it to ourselves and those around us to understand how this works and how big a deal it is. Patients still end up getting antibiotics for colds and flu-like illnesses—viral infections which antibiotics cannot cure—possibly because their doctors aren’t current on when it’s appropriate to prescribe them.

Probably the biggest example of the pickle this has put us in is the emergence of methicillin-resistant Staphylococcus aureus—better known as MRSA—vividly described in the book Superbug.

It’s a tremendous problem in hospitals, which are just now figuring out how to get a handle on it, but is easy to catch in ordinary community settings too.

Science isn’t sitting back waiting to see what happens with this. There is research going on to develop new types of antibiotics, although it may just be a matter of time before these, too, are easily evaded by our tiny attackers.

Other projects are working on using things like nanostructures to kill bugs that antibiotics can’t touch, or creating new compounds specifically to defeat resistance mechanisms.

But antibiotic-resistant bacteria are in the here and now, so for today, here’s what each of us can do to minimize risks:

  • Get smart about antibiotics. Don’t pressure doctors to prescribe them. If they’re really necessary, take the whole course as prescribed.
  • Consider putting our purchasing power behind meat from animals raised without antibiotics.
  • When in the hospital, we must be that persnickety patient who insists everyone wash his or her hands before touching us.

Bacteria may outnumber us and reproduce faster, but we may yet outsmart them for good.

By Ms. Health Department

Image courtesy of perpetualplum