Travel in Good Health – Part 3 of 3

26 07 2014

Babies and small children are less able to fight off foodborne and waterborne infections. Little ones who are crawling or walking around and putting things in their mouths increase their exposure risk.

What comes from those infections? Yes, you knew we had to get there. We’re talking poo. The kind that makes you want to pay strangers good money to change an oozing diaper.

But, there are a few things we can do to help prevent the big D.

Breastfeeding helps eliminate foodborne and waterborne transmission to infants.

Use purified water for drinking, ice cubes, formula, brushing teeth, washing food if eating food raw, or just anytime you’d use water. Purify the water, unless you know the water source is safe.

Wash hands with soap and water frequently each day and certainly before eating anything and before preparing foods, after changing diapers, after going to the restroom, after coming in from outdoor activities (this includes shopping!), when you get up in the morning and before going to bed at night. Use soap and water if available and always when you can see any grime on the hands. Alcohol-based hand sanitizer can be used to help disinfect your hands.

Pacifiers and other items made to go into a baby’s mouth that you bring or buy on the trip need frequent cleaning.

Don’t eat food from street vendors. Make sure all your food is either cooked thoroughly or washed with purified water and, if applicable, peeled.

Dehydration due to diarrhea and vomiting

Infants and young children can easily become dehydrated due to diarrhea and vomiting. They need plenty of liquids each time they have a watery stool or vomit. If you’re unaware of the signs of dehydration, you should read up on it prior to departure. Prevention is the best thing, but just in case, there are commercial oral rehydration solutions, or you can make your own. Here are some suggestions from rehydration.org:

Make sure the rehydration drink has in it starches and/or sugars, a little sodium and some potassium. Breastmilk is great for those nursing, or watery cooked cereal, carrot soup, or rice water is fine as long as they’re made with purified water.

You can make a simple solution yourself by using salt and sugar (molasses, raw sugar or white sugar) and something like orange juice or mashed banana for potassium. Add one teaspoon of salt to eight teaspoons of sugar and stir into a liter of boiled and cooled water, stirring until everything is dissolved.

Fresh fruit juice, weak tea or even simply boiled and cooled water will help, if nothing else is available.

Parasites in the soil

There are parasites in sand and soil where children love to play. They should wear enclosed footwear and play on a tarp or covering. Don’t put clothing or towels on the ground to dry, and iron anything you hang out to dry before using. All of these precautions are dependent on your destination, of course.

Rabies

Children are more likely to be bitten by animals yet less likely to tell parents about the bite. Remind the children to stay away from animals and to report any wound immediately. If a child is bitten or wounded, wash the area with soap and water and take the child in for evaluation. If possible, bring the animal in as well.

Water and infectious agents

Children and adults can pick up illnesses or infections by swallowing or simply being in contact with contaminated water. If you don’t know the area, don’t swim in fresh, unchlorinated water and, depending on where you travel, be careful with washing in the bathtub.

Well, that’s about it. We’ve come to the end of our Travel in Good Health series. Hope you enjoyed it as much as we did and, hey, maybe we’ll meet you on the road somewhere and do some trading. Ten diapers for a barf bag?  Anybody?

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Travel in Good Health – Part 1 of 3

24 07 2014

[Editor’s note: We posted this a few years ago, but find the info timely, so what the heck, we’re running it again! Parts 2 and 3 run 25 and 26 July.]

Traveling with children, no matter their age, can be a joyful, tiring, exciting, and exhausting endeavor. Traveling with children who get sick on the trip is just plain exhausting and, sometimes, exciting in a way that we don’t want to experience.

Although dealing with illness in the midst of a family trip isn’t ideal, you can take steps to prevent illness before traveling and equip yourself with supplies to make the treatment of illness easier and more comforting.

Prevention is key, and no one does that better than the CDC. This article captures some tips for traveling families from CDC’s website, and a few other places.

If anyone in your travel group has an existing condition that may affect his or her health, it’s important to discuss travel health safety with a healthcare provider.

If you’re traveling outside the United States and you love detail, download a copy of CDC’s Yellow Book . It’s written for healthcare providers, but many people find it useful. Wherever you’re traveling, these suggestions may help you and yours avoid infectious diseases on the road.

There are steps you can take prior to departure that will protect you and your kids, and many things you can do while traveling. First, the pre-departure list:

Time Zones and Rest

If you’re changing time zones, spend a few days just before travel adjusting your sleep/wake periods to match the destination’s time zones. When you arrive, get out during the sunny periods so that you body realizes it’s time to be awake. Good sleep is critical to good health. Make sure everyone gets lots of rest a few days before and then during the trip.

Vaccinations

You and your kids should be up-to-date on currently recommended vaccines in the U.S.

If you’re traveling outside the United States, you need to check the destination country for recommended vaccines for you and your children, and if you have special health concerns, you need to determine which vaccines to get and which you should not have. Not all vaccines recommended for international travel are licensed for children.

Health Notices

If you’re traveling outside the U.S., read the CDC’s Health Notices first to get the latest updates on infectious diseases in various areas of the world. What you learn may affect your travel plans.

First Aid Kits

Prepare a first aid kit for the trip or purchase one from a commercial vendor. This is a sample list, as not all destinations require the same things.

  • 1% hydrocortisone cream
  • Ace wrap
  • Acetaminophen, aspirin, ibuprofen, or other medication for pain or fever
  • Address and phone numbers of area hospitals or clinics
  • Adhesive bandages
  • Aloe gel for sunburns
  • Antacid
  • Anti-anxiety medication
  • Antibacterial hand wipes (including child-safe) or alcohol-based hand sanitizer containing at least 60% alcohol
  • Antibacterial soap
  • Antibiotic for general use or travelers’ diarrhea (azithromycin, cefixime)
  • Antidiarrheal medication (e.g., bismuth subsalicylate, loperamide)
  • Antifungal and antibacterial ointments or creams
  • Antihistamine (such as Benadryl)
  • Antimalarial medications, if applicable
  • Anti-motion sickness medication
  • Commercial suture/syringe kits (to be used by local health-care provider with a letter from your prescribing physician on letterhead stationery)
  • Cotton-tipped applicators (such as Q-tips)
  • Cough suppressant/expectorant
  • Decongestant, alone or in combination with antihistamine
  • Diaper rash ointment
  • Digital thermometer
  • Epinephrine auto-injector (e.g., EpiPen), especially if anyone has a history of severe allergic reaction. Also available in smaller-dose package for children.
  • First aid quick reference card
  • Gauze
  • Ground sheet (water- and insect-proof)
  • High-altitude preventive medication
  • Insect repellent containing DEET (up to 50%)
  • Latex condoms
  • Laxative (mild)
  • Lice treatment (topical)
  • Lubricating eye drops
  • Malaria prophylaxis and standby treatment, as required by itinerary
  • Medications that the child has used in the past year
  • Moleskin for blisters
  • Mosquito netting, if applicable
  • Oral rehydration solution (ORS) packets
  • Personal prescription medications in their original containers (carry copies of all prescriptions, including the generic names for medications, and a note from the prescribing physician on letterhead stationery for controlled substances and injectable medications)
  • Safe water
  • Scabies topical ointment
  • Sedative (mild) or other sleep aid
  • Snacks
  • Sunscreen (preferably SPF 15 or greater)
  • Throat lozenges
  • Tweezers
  • Water purification tablets

Discuss with your family’s pediatrician any special needs your children might have that require you to prepare beyond this basic list. Also, your pediatrician may be able to give you sample sizes of antibiotics and other meds that may be useful for your kit.

Health Insurance

Before traveling, check your health insurance policy to see what it pays for. It will probable reimburse you for most of the cost of emergency medical care abroad, excluding any deductible or co-payment. For non-emergency care overseas, you may be covered, but check with your health plan about this before you leave home. Failure to get authorization may mean denial of reimbursement.

Travel Regulations

Check travel regulations and carry what you can onboard the plane, particularly prescription medication. Put the rest in your checked baggage. Put your first aid kit in a fanny pack or backpack that you take with you everywhere you go. There’s no sense bringing the kit if you don’t have it when you need it.

Now that you’ve done your pre-departure prep, stay tuned for Part 2 for some tips on problems you may encounter on the road.

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Oops Not Acceptable!

5 08 2013

One of the many reasons our family likes to stay out of hospitals is to avoid nosocomial infections.  Those are infections you get while you’re in the hospital (not what sent you to the hospital in the first place).

And there are other reasons to steer clear of hospitals.  Do you recall the study in the April 2008 issue of Pediatrics that tells us one out of 15 hospitalized kids are harmed by hospital errors, including mix-ups of medicines, bad drug reactions and overdoses?

As parents, we ask of no one in particular and everyone in general:  What are we supposed to do?  We want to take our sick or hurt children to a place that will, at the bare minimum, do no harm, and in theory, do some good.  But the risks associated with a hospital stay are pretty serious.

The National Initiative for Children’s Healthcare Quality worked on a tool that helped investigators get a more accurate count of numbers of children harmed while in the hospital.  Prior to the use of this tool, the count of children harmed by hospital error was much lower because errors were supposed to be voluntarily reported, and we now know that wasn’t happening.

I can accept the fact that no one is perfect, but the bar for standard of care is pretty low.  As our children’s advocates, we have the responsibility to insist that bar be raised.

Hospital staff: please worry less about political fall-out and more about doing what you have to do to stop mistakes from occurring, or worse, reoccurring.  And strive for transparency – it will relieve unnecessary suspicion and mistrust on the part of patients and their families and will serve to keep everyone working toward an error-free environment.  Ask questions, involve the family in patient care, stay focused on the tasks at hand, and communicate thoroughly with those taking over your patients when shifts change.

Families: as much as possible, stay with your loved one in the hospital and ask questions about everything that is being done. If something doesn’t seem right, don’t be afraid to ask about it. If someone’s feathers get ruffled because you ask questions about what they’re doing, just remember: better that than a mistake.

 

By Trish Parnell





TB

15 06 2013

Tuberculosis is in the air, so to speak.  After U.S. health officials carefully tracked down TB Andy in Rome and told him not, repeat not, to travel by air, young TB Andy cheerfully boarded a plane, flew to Canada and drove across the border into the United States.

He says that he didn’t want to get stuck in a hospital in Rome, as he was convinced that he would die if he didn’t get to Denver for treatment.  Apparently fear of his own death did little to prevent TB Andy from exposing hundreds of people to his particularly dangerous form of TB.

In all fairness, he is currently claiming that he was told he was not infectious.

So, what’s the brouhaha and should everyone be this excited?

It seems the critical question would be: does TB Andy have latent or active TB?

Here’s some info from the CDC on TB:

Tuberculosis (TB) is a disease caused by bacteria called Mycobacterium tuberculosis. The bacteria usually attack the lungs. But, TB bacteria can attack any part of the body such as the kidney, spine, and brain. If not treated properly, TB disease can be fatal. TB disease was once the leading cause of death in the United States.

TB is spread through the air from one person to another. The bacteria are put into the air when a person with active TB disease of the lungs or throat coughs or sneezes or, sometimes, just talks. People nearby may breathe in these bacteria and become infected. However, not everyone infected with TB bacteria becomes sick. People who are not sick have what is called latent TB infection. People who have latent TB infection do not feel sick, do not have any symptoms, and cannot spread TB to others.

But, some people with latent TB infection go on to get TB disease. People with active TB disease can be treated and cured if they seek medical help. Even better, people with latent TB infection can take medicine so that they will not develop active TB disease.

Why is TB a problem today?

Starting in the 1940s, scientists discovered the first of several medicines now used to treat TB. As a result, TB slowly began to decrease in the United States. But in the 1970s and early 1980s, the country let its guard down and TB control efforts were neglected. As a result, between 1985 and 1992, the number of TB cases increased. However, with increased funding and attention to the TB problem, we have had a steady decline in the number of persons with TB since 1992. But TB is still a problem; more than 14,000 cases were reported in 2003 in the United States.

How is TB spread?

TB is spread through the air from one person to another. The bacteria are put into the air when a person with active TB disease of the lungs or throat coughs or sneezes. People nearby may breathe in these bacteria and become infected. When a person breathes in TB bacteria, the bacteria can settle in the lungs and begin to grow. From there, they can move through the blood to other parts of the body, such as the kidney, spine, and brain.

TB in the lungs or throat can be infectious. This means that the bacteria can be spread to other people. TB in other parts of the body, such as the kidney or spine, is usually not infectious.

People with active TB disease are most likely to spread it to people they spend time with every day. This includes family members, friends, and coworkers.

What is latent TB infection?

In most people who breathe in TB bacteria and become infected, the body is able to fight the bacteria to stop them from growing. The bacteria become inactive, but they remain alive in the body and can become active later. This is called latent TB infection. People with latent TB infection
• have no symptoms
• don’t feel sick
• can’t spread TB to others
• usually have a positive skin test reaction
• can develop active TB disease if they do not receive treatment for latent TB infection.

Many people who have latent TB infection never develop active TB disease. In these people, the TB bacteria remain inactive for a lifetime without causing disease. But in other people, especially people who have weak immune systems, the bacteria become active and cause TB disease.

What is active TB disease?

TB bacteria become active if the immune system can’t stop them from growing. The active bacteria begin to multiply in the body and cause active TB disease. The bacteria attack the body and destroy tissue. If this occurs in the lungs, the bacteria can actually create a hole in the lung. Some people develop active TB disease soon after becoming infected, before their immune system can fight the TB bacteria. Other people may get sick later, when their immune system becomes weak for another reason.

Babies and young children often have weak immune systems. People infected with HIV, the virus that causes AIDS, have very weak immune systems. Other people can have weak immune systems, too, especially people with any of these conditions:
• substance abuse
• diabetes mellitus
• silicosis
• cancer of the head or neck
• leukemia or Hodgkin’s disease
• severe kidney disease
• low body weight
• certain medical treatments (such as corticosteroid treatment or organ transplants)
• specialized treatment for rheumatoid arthritis or Crohn’s disease.

Symptoms of TB depend on where in the body the TB bacteria are growing. TB bacteria usually grow in the lungs. TB in the lungs may cause symptoms such as:
• a bad cough that lasts 3 weeks or longer
• pain in the chest
• coughing up blood or sputum (phlegm from deep inside the lungs).

Other symptoms of active TB disease are:
• weakness or fatigue
• weight loss
• no appetite
• chills
• fever
• sweating at night .

The Difference Between Latent TB Infection and Active TB Disease

A person with latent TB infection:
• Has no symptoms
• Does not feel sick
• Cannot spread TB to others
• Usually has a positive skin test or QuantiFERON-TB® Gold test
• Has a normal chest x-ray and sputum test

A person with active TB disease:
• Has symptoms that may include:
o a bad cough that lasts 3 weeks or longer
o pain in the chest
o coughing up blood or sputum
o weakness or fatigue
o weight loss
o no appetite
o chills
o fever
o sweating at night
• May spread TB to others
• Usually has a positive skin test or QuantiFERON-TB® Gold test
• May have an abnormal chest x-ray, or positive sputum smear or culture

What if I have a positive test for TB?

If you have a positive reaction to the TB skin test, your doctor or nurse may do other tests to see if you have active TB disease. These tests usually include a chest x-ray and a test of the phlegm you cough up. Because the TB bacteria may be found somewhere other than your lungs, your doctor or nurse may check your blood or urine, or do other tests. If you have active TB disease, you will need to take medicine to cure the disease.

What if I have been vaccinated with BCG?

BCG is a vaccine for TB. This vaccine is not widely used in the United States, but it is often given to infants and small children in other countries where TB is common. BCG vaccine does not always protect people from getting TB.

If you were vaccinated with BCG, you may have a positive reaction to a TB skin test. This reaction may be due to the BCG vaccine itself or due to infection with the TB bacteria. Your positive reaction probably means you have been infected with TB bacteria if:
• You recently spent time with a person who has active TB disease; or
• You are from an area of the world where active TB disease is very common (such as most countries in Latin America and the Caribbean, Africa, Asia, Eastern Europe, and Russia); or
• You spend time where TB disease is common (homeless shelters, migrant farm camps, drug-treatment centers, health care clinics, jails, prisons).

If I have latent TB infection, how can I keep from developing active TB disease?

Many people who have latent TB infection never develop active TB disease. But some people who have latent TB infection are more likely to develop active TB disease than others. These people are at high risk for active TB disease. They include:
• people with HIV infection
• people who became infected with TB bacteria in the last 2 years
• babies and young children
• people who inject illegal drugs
• people who are sick with other diseases that weaken the immune system
• elderly people
• people who were not treated correctly for TB in the past .

If you have latent TB infection (a positive TB skin test reaction or positive QFT) and you are in one of these high-risk groups, you need to take medicine to keep from developing active TB disease. This is called treatment for latent TB infection. There are several treatment options.You and your health care provider must decide which treatment is best for you.

The medicine usually taken for the treatment of latent TB infection is called isoniazid (INH). INH kills the TB bacteria that are in the body. If you take your medicine as instructed by your doctor or nurse, it can keep you from developing active TB disease. Children and people with HIV infection may need to take INH for a longer time.

Because there are less bacteria in a person with latent TB infection, treatment is much easier. Usually, only one drug is needed to treat latent TB infection. A person with active TB disease has a large amount of TB bacteria in the body. Several drugs are needed to treat active TB disease.

Sometimes people are given treatment for latent TB infection even if their skin test reaction is not positive. This is often done with infants, children, and HIV-infected people who have recently spent time with someone with active TB disease. This is because they are at very high risk of developing active TB disease soon after they become infected with TB bacteria.

It is important that you take all the pills as prescribed. If you start taking INH, you will need to see your doctor or nurse on a regular schedule. He or she will check on how you are doing. Some people have serious side effects from INH. If you have any of the following side effects, call your doctor or nurse right away:
• no appetite
• nausea
• vomiting
• yellowish skin or eyes
• fever for 3 or more days
• abdominal pain
• tingling in the fingers and toes.

Warning: Drinking alcoholic beverages (wine, beer, and liquor) while taking INH can be dangerous. Check with your doctor or nurse for more information.

People who have latent TB infection need to know the symptoms of active TB disease. If they develop symptoms of active TB disease, they should see a doctor right away.

How is active TB disease treated?

There is good news for people with active TB disease. It can almost always be cured with medicine. But the medicine must be taken as the doctor or nurse tells you.

If you have active TB disease, you will need to take several different medicines. This is because there are many bacteria to be killed. Taking several medicines will do a better job of killing all of the bacteria and preventing them from becoming resistant to the medicines.

If you have active TB disease of the lungs or throat, you are probably infectious. You need to stay home from work or school so that you don’t spread TB bacteria to other people. After taking your medicine for a few weeks, you will feel better and you may no longer be infectious to others. Your doctor or nurse will tell you when you can return to work or school or visit with friends.

Having active TB disease should not stop you from leading a normal life. When you are no longer infectious or feeling sick, you can do the same things you did before you had active TB disease. The medicine that you are taking should not affect your strength, sexual function, or ability to work. If you take your medicine as your doctor or nurse tells you, the medicine will kill all the TB bacteria. This will keep you from becoming sick again.

Why do I need to take TB medicine regularly?

TB bacteria die very slowly. It takes at least 6 months for the medicine to kill all the TB bacteria. You will probably start feeling well after only a few weeks of treatment. But beware! The TB bacteria are still alive in your body. You must continue to take your medicine until all the TB bacteria are dead, even though you may feel better and have no more symptoms of active TB disease.

If you don’t continue taking your medicine or you aren’t taking your medicine regularly, this can be very dangerous. The TB bacteria will grow again and you will remain sick for a longer time. The bacteria may also become resistant to the medicines you are taking. You may need new, different medicines to kill the TB bacteria if the old medicines no longer work. These new medicines must be taken for a longer time and usually have more serious side effects.

If you become infectious again, you could give TB bacteria to your family, friends, or anyone else who spends time with you. It is very important to take your medicine the way your doctor or nurse tells you.

How can I keep from spreading TB?

The most important way to keep from spreading TB is to take all your medicine, exactly as directed by your doctor or nurse.
You also need to keep all of your clinic appointments! Your doctor or nurse needs to see how you are doing. You may need another chest x-ray or a test of the phlegm you may cough up. These tests will show whether the medicine is working. They will also show whether you can still give TB bacteria to others. Be sure to tell the doctor about anything you think is wrong.

If you are sick enough with active TB disease to go to a hospital, you may be put in a special room. These rooms use air vents that keep TB bacteria from spreading to other rooms. People who work in these special rooms must wear a special face mask to protect themselves from TB bacteria. You must stay in the room so that you will not spread TB bacteria to other people. Ask a nurse for anything you need that is not in your room.

If you are infectious while you are at home, there are certain things you can do to protect yourself and others near you. Your doctor may tell you to follow these guidelines to protect yourself and others:
• The most important thing is to take your medicine.
• Always cover your mouth with a tissue when you cough, sneeze, or laugh. Put the tissue in a closed bag and throw it away.
• Do not go to work or school. Separate yourself from others and avoid close contact with anyone. Sleep in a bedroom away from other family members.
• Air out your room often to the outside of the building (if it is not too cold outside). TB spreads in small closed spaces where air doesn’t move. Put a fan in your window to blow out (exhaust) air that may be filled with TB bacteria. If you open other windows in the room, the fan also will pull in fresh air. This will reduce the chances that TB bacteria will stay in the room and infect someone who breathes the air.

Remember, TB is spread through the air. People cannot get infected with TB bacteria through handshakes, sitting on toilet seats, or sharing dishes and utensils with someone who has TB.

After you take medicine for about 2 or 3 weeks, you may no longer be able to spread TB bacteria to others. If your doctor or nurse agrees, you will be able to go back to your daily routine. Remember, you will get well only if you take your medicine exactly as your doctor or nurse tells you.

Think about people who may have spent time with you, such as family members, close friends, and coworkers. The local health department may need to test them for latent TB infection. TB is especially dangerous for children and people with HIV infection. If infected with TB bacteria, these people need medicine right away to keep from developing active TB disease.

What is multidrug-resistant TB (MDR TB)?

If you do not take your medicine as your doctor or nurse tells you, the TB bacteria may become resistant to a certain medicine. This means that the medicine can no longer kill the bacteria.

Drug resistance is more common in people who:
• have spent time with someone with drug-resistant active TB disease
• do not take their medicine regularly
• do not take all of their medicine as told by their doctor or nurse
• develop active TB disease again, after having taken TB medicine in the past
• come from areas where drug-resistant TB is common

Sometimes the bacteria become resistant to two or more of the most important medicines: INH and RIF. This is called multidrug-resistant TB, or MDR TB. This is a very serious problem. People with MDR TB disease must be treated with special medicines. These medicines are not as good as the usual medicines for TB and they may cause more side effects. Also, most people with MDR TB disease must see a TB expert who can closely observe their treatment to make sure it is working.

People who have spent time with someone sick with MDR TB disease can become infected with these multidrug-resistant bacteria. If they have a positive skin test reaction, they may be given medicine to keep them from developing MDR TB disease. This is very important for people who are at high risk of developing MDR TB disease, such as children and HIV-infected people.

What is extensively drug-resistant tuberculosis, or XDR TB?

XDR TB is a subtype of multiple-drug resistant tuberculosis.

People with XDR TB are resistant to first- and second-line drugs; their treatment options are limited and the disease often proves fatal, although cure is possible for up to 30 percent of cases.





The Dangers of Spring Cleaning

13 03 2013

spring-cleaning1Spring is nearly here. Does your yard beckon, displaying fast-growing weeds and frumpy foliage?

Mine calls to me, along with the garage, all of the windows, the closets, and every surface that is bespeckled with dust.

If you can’t fight the urge to clean, beware of the risks (you knew this was coming). If, however, you can resist the urge, feel free to use this list in your defense, should your SO wave a rake or sponge your way.

I can’t clean or do yard work . . .

—until I get my tetanus shot. Rusty nails, hoes, and rakes that are pokey and dirty, debris blown onto the yard from winter storms—they’re just waiting for me. (Swap out this Td shot for a one-time Tdap shot, get protected against tetanus, diphtheria, and pertussis.)

—because I saw mouse poop in the garage and I don’t want to get hantavirus by sweeping up those virus-laden bits. I have delicate airways. (There are safe ways to clean up mouse droppings, but the SO doesn’t need to know that.)

—as long as there are mosquitoes in this world. West Nile virus is everywhere! And I can’t wear mosquito repellent while doing yard work because it smells funny, although that’s not the case when I’m kayaking. Strange.

—while ticks live in this world. Lyme disease, Rocky Mountain spotted fever, Colorado tick fever—these are all insidious infections brought on by ticks. I believe I saw a tick on the bathroom wall last week. Possibly it hitched a ride on the dog, which shook it off while in the bathroom. I really have no other explanation.

These excuses are reasonable and clear. If your SO is having trouble swallowing understanding them, feel free to share our contact info.

By Trish Parnell





Telling the School About Your Child’s Infection

12 03 2012

[Ed. note: One of our parents hired an attorney to write a letter to the preschool her daughter will be attending. She chose to inform the school of her daughter’s illness, but wanted to do so in a way that would best protect her daughter’s rights. She kindly offered to share the letter in case others would like to use it. We’ve edited it to make it generic, but PKIDs does not take responsibility for the contents of this letter or any person’s use of this letter, nor does the mom who provided it. Consider it a form letter for your adaptation. Please contact an attorney to review any documents you prepare.]

Please be advised that this firm has been retained by Mr. and Mrs. Smith. Mr. and Mrs. Smith are the parents of Jane Smith, a (number) year old girl who was recently enrolled in the ABC School.

The purpose of this correspondence is to address a situation that is of great concern to Mr. and Mrs. Smith, that is, the health and well-being of their daughter and those who care for her. The Smith’s daughter is a carrier of the hepatitis [B or C, whatever is true for you] virus.

Although there is no legal or ethical duty for my clients to inform you or the school of the specific health status of their daughter, the Smiths, in their personal discretion and out of an abundance of caution, have chosen to share this very private and confidential fact with you. In fact, the Centers for Disease Control do not advocate that parents of children with hepatitis [B or C] routinely inform day care providers of the hepatitis [B or C] status of their children.

Under normal conditions, a child with hepatitis [B or C] poses no threat to other children or to day care staff. Please bear in mind that the hepatitis [B or C] virus (hereinafter “HBV or HCV”) is not transmitted casually: it can be, for example, transmitted through blood, sexual relations, needles and mothers who carry [HBV or HCV] to their newborn child.

There is no data to demonstrate that hepatitis [B or C] is transmitted through feces or urine, nor is it transmitted by stool contamination of food or beverages, or casual contact. Changing diapers or helping children with “accidents” associated with potty-training generally do not place one at risk of contracting [HBV or HCV].

[This next paragraph is only for HBV kids in some states:] In addition, since the State of [your state] requires children to have a series of immunizations against HBV, it is highly likely that Jane’s classmates are already protected from any potential transmission of HBV. The medical information record required of children admitted to the ABC school indicates that such inoculations are mandatory for enrollees. I assume your day care staff have had such vaccinations and are similarly protected.

Regardless of any minimal risk a carrier of [HBV or HCV] pose to others, my clients and I assume that proper, standard precautions are taken when dealing with the bodily fluids of any child in the ABC school. You have been made aware of Jane’s condition, but you may not be aware of other children who may carry blood-borne pathogens as well, not just [HBV or HCV].

Mr. and Mrs. Smith wish to convey to you their desire to keep the lines of communication open and fully cooperate with the ABC School and its staff regarding this situation. Mrs. Smith has provided me with written materials that she has collected about [HBV or HCV]. If you would like copies of this literature to help educate staff members about [HBV or HCV], please contact me and I will provide you copies of this material. If you have further concerns, my clients are also willing to participate in any meetings you may wish to have with them, or you may discuss this situation with a health care professional of your choice.

Although Mr. and Mrs. Smith have chosen to disclose private, confidential information about their daughter to your organization, it is of the utmost importance that no one other than officials at the ABC school are to be informed about Jane’s health status. In fact, my clients would prefer that you limit disclosure of Jane’s [HBV or HCV] status to your staff members on a “need to know” basis and that as few people as possible be told this information.

Additionally, anyone so informed should be cautioned that this information is highly confidential and extremely private, it is not to be disclosed to other persons, particularly parents of other children in Jane’s class.
As you may imagine, my clients are very concerned that, should information be leaked to other parents, Jane may suffer retaliation, discrimination or be socially ostracized by other children or their parents.

There are a number of laws and statutes which protect the confidentiality of private information, including both health and educational records. For example, the Family Educational Rights and Privacy Act of 1974, 20 U.S.C.123g (the Buckley Amendment) mandates that any institution which receives federal funds is prohibited from releasing a student’s records to any one other than school officials who have been determined to have a legitimate interest in the child. There are also protections for privacy of a student’s medical records under the Americans with Disabilities Act, 42 U. S. C. 12101, et seq.

Mr. and Mrs. Smith have only sought my assistance because this subject is of such personal importance, they felt that a disinterested, objective person might be able to more effectively convey their concerns.

My clients and I trust that all of the parties involved in this situation will cooperate and work toward a positive solution to the concerns of my clients, as well as those of the school. Mr. and Mrs. Smith also hope that this fall is the first of many happy semesters Jane will spend at the ABC school.

If you have any comments or concerns, please feel free to contact me by 4:00 p.m. on (day/month/year), as Jane is scheduled to begin school the following day.

If I do not hear from you, I will assume that there will be no problem with her attending this school and/or you have encountered this situation before and are well-versed in issues of this nature. Thank you for your attention to this important matter.





Fifth Disease? What About Third or Fourth?

21 07 2011

Last summer, PKIDs’ advice nurse, Dr. Mary Beth, explained what fifth disease is: a viral rash that is tricky to contain because by the time you get the rash, you’re already through the contagious stage.

The rash itself is not painful and most children get through it without any problems, although adults may experience joint pain with this infection.

If a pregnant woman catches it, there is a small risk that the unborn baby will have severe anemia and the woman may have a miscarriage.

It’s also worse for people with sickle cell disease. Their red blood cells can get dangerously depleted during a bout with fifth disease.

Why is this condition known by a number instead of a real name? The vernacular term “slapped cheek syndrome” isn’t too endearing; neither is its scientific moniker, “erythema infectiosum,”  nor “parvovirus B19,” the name of the organism that causes it.

Even “variola” has a certain melodic ring to it, and that (smallpox) was the Chuck Norris of infectious disease.

It turns out that, by old tradition, several of the rashy illnesses of childhood were known by numbers:

  • First disease was measles
  • Second disease was scarlet fever, caused by the same bacterium that causes strep throat
  • Third disease was rubella
  • Fourth was Duke’s disease, which is not a defined disease today
  • Fifth, our friend erythema infectiosum
  • Sixth, roseola—which sounds a lot like rubella and rubeola—is actually caused by a couple of strains of herpes viruses

It seems that, just like squirrels are said to be rats with good PR, the names of the other diseases were relatively euphonious compared to “erythema infectiosum,” and so the rather anonymous “fifth disease” was the name that stuck.

Frankly, the whole rubella-rubeola-roseola conglomerate might be easier to keep straight if each of those diseases were still referred to by number. Maybe it’s time fifth disease got the charming name it’s never had. How about . . . slappacheeka? Rosella? Gwendolyn?

By Ms. Health Department

Image courtesy of http://healthpictures.in/