Travel in Good Health – Part 2 of 3

25 07 2014

All the prep and stress of getting out your front door is over. Now it’s fun, sun, and bugs.

Wait. What?

Oh yes, wherever your journeys take you, you can be sure that pesky critters will be flying or crawling around, biting, stinging and more…so much more.

Some bugs carry certain diseases, such as West Nile virus, malaria, dengue and others. Whether you’re in Napa Valley, the Sahara or the Alps, there are steps you can take to avoid infection.

  • Use an insect repellent on exposed skin to repel mosquitoes, ticks, fleas and other arthropods. EPA-registered repellents include products containing DEET (N,N-diethylmetatoluamide) and picaridin (KBR 3023). DEET concentrations of 30% to 50% are effective for several hours. Picaridin, available at 7% and 15 % concentrations, needs more frequent application.
  • DEET formulations as high as 50% are recommended for both adults and children over 2 months of age. Protect infants less than 2 months of age by using a carrier draped with mosquito netting with an elastic edge for a tight fit. There are DEET-free solutions available, but check with the pediatrician for a final recommendation. Protection against mosquito bites is the goal.
  • When using sunscreen, apply sunscreen first and then repellent. Repellent should be washed off at the end of the day before going to bed. Put repellent only on exposed skin and/or clothing and don’t apply repellent to open or irritated skin. Don’t let children handle the repellent. Rather than spraying it directly on children, adults should apply it to their own hands then rub it on the children. Don’t get it near a child’s mouth, eyes or hands and don’t use much around a child’s ears.
  • Wear long-sleeved shirts which should be tucked in, long pants, and hats to cover exposed skin. When you visit areas with ticks and fleas, wear boots, not sandals, and tuck your pants into your socks.
  • Inspect your body and clothing for ticks during outdoor activity and at the end of the day. Wear light-colored or white clothing so ticks can be more easily seen. Removing ticks right away can prevent some infections.
  • Apply permethrin-containing (e.g., Permanone) or other insect repellents to clothing, shoes, tents, mosquito nets, and other gear for greater protection. Permethrin is not labeled for use directly on skin. Check label for use around children. Most repellent is generally removed from clothing and gear by a single washing, but permethrin-treated clothing is effective for up to 5 washings.
  • Be aware that mosquitoes that transmit malaria are most active during twilight periods (dawn and dusk or in the evening). Stay in air-conditioned or well-screened housing, and/ or sleep under an insecticide-treated bed net. Bed nets should be tucked under mattresses and can be sprayed with a repellent if not already treated with an insecticide.
  • Keep baby carriers covered with a mosquito net.
  • Daytime biters include mosquitoes that transmit dengue and chikungunya viruses, and sand flies that transmit leishmaniasis.

Don’t forget to come back for Part 3, where we talk about more fun times for traveling parents.

Share





What’s New With Flu?

26 09 2013

CDC released lots of data today on last year’s flu season. This will help to inform all of us as we look at the coming season and determine our health messaging targets.

Take a look . . .

Flu vaccination is the best protection available against influenza.  All persons 6 months and older should receive a flu vaccination every year to reduce the risk of illness, hospitalization, and even death.

The 2012-13 influenza season is a reminder of the unpredictability and severity of influenza.  The 2012-13 season began early, was moderately severe, and lasted longer than average.

More children than ever before received a seasonal flu vaccination during the 2012-13 season.

  • 45.0% of people in the United States 6 months and older were vaccinated during the 2012-13 season,  less than half of the U.S. population 6 months and older.
  • Among children, coverage was highest for children aged 6-23 months (76.9%) with large increases in vaccination for children 5-12 years old (4.4 percentage points higher for the 2012-13 season compared to the 2011-12 season) and teens 13-17 year old (8.8 percentage points higher for the 2012–13 season compared to the 2011–12 season).
  • Among adults, coverage was highest for adults aged 65 years and older (66.2%) and lowest among adults aged 18-49 years (31.1%).
  • Among children, coverage was highest among non-Hispanic Asian children (65.8%), Hispanic children (60.9%), non-Hispanic black children (56.7%), and non-Hispanic children of other or multiple races (58.5%). Coverage among non-Hispanic white children was lower at 53.8%.
  • Among adults, differences in coverage among racial/ethnic populations remain, with coverage among adult non-Hispanic blacks (35%) and Hispanics (34%) far lower than their non-Hispanic white counterparts (45%).

Coverage by Age:

Coverage for children 6 months through 17 years of age was 56.6% in the 2012-13 season, an increase of 5.1 percentage points from the 2011-12 season.  State-specific flu vaccination coverage for children 6 months through 17 years ranged from 44.0% to 81.6%.

  • Coverage for children decreased with age:
    • 76.9% for children 6-23 months
    • 65.8% for children 2-4 years
    • 58.6% for children 5-12 years
    • 42.5% for children 13-17 years

• Coverage increased in the 2012-13 season:

    • Children 5-12 years: an increase of 4.4 percentage points from the 2011-12 season
    • Children 13-17 years: an increase of 8.8 percentage points from the 2011–12 season
    • Changes in coverage were not significant for other age groups

Coverage for adults aged 18 years and older was 41.5% in the 2012-13 season, an increase of 2.7 percentage points from the 2011-12 season.  State-specific coverage ranged from 30.8% to 53.4%.

  • Coverage for adults increased with increasing age:
    • 31.1% for adults 18-49 years
    • 45.1% for adults 50-64 years
    • 66.2% for adults 65 years and older
  • Coverage increased in the 2012-13 season:
    • Adults 18-49 years: an increase of 2.5 percentage points from the 2011-12 season
    • Adults 50-64 years: an increase of 2.4 percentage points from the 2011–12 season
    • Adults 65 years and older: an increase of 1.3 percentage points from the 2011–12 season
  • Among adults 18-49 years of age with at least one high-risk medical condition (asthma, diabetes, or heart disease), coverage for the 2012-13 season was 39.8%, an increase of 3 percentage points from the 2011-12 season coverage estimate of 36.8%  State-specific coverage ranged from 17.9% to 58.8%.

Coverage by Sex:

Children (6 months-17 years)

  • There were no differences in coverage for male and female children.

Adults (18 years and older)

  • Coverage was higher for females (44.5%) than for males (38.3%).

Coverage by Race/Ethnicity:

Children (6 months-17 years)

Coverage for Asian children (65.8%) was significantly higher than all other racial/ethnic groups.

  • Coverage for non-Hispanic Asian children (65.8%), Hispanic children (60.9%), non-Hispanic black children (56.7%), and non-Hispanic children of other or multiple races (58.5%) was significantly higher than for non-Hispanic white children (53.8%).
  • Coverage for non-Hispanic American Indian/Alaska Native children (52.5%) was similar to that for non-Hispanic white children (53.8%).
  • There were significant increases in coverage from the 2011-12 season for non-Hispanic white children (6.2 percentage points), non-Hispanic Asian children (7.6 percentage points), and non-Hispanic children of other or multiple races (8.5 percentage points).
  • Coverage for non-Hispanic black, Hispanic, and non-Hispanic American Indian/Alaska Native children did not change from the 2011-12 season.

Adults (18 years and older)

Coverage among adults aged 18 years and older increased across all racial/ethnic groups except for American Indian/Alaska Native adults and adults of other or multiple races in which coverage did not change.

  • Among adults, coverage for non-Hispanic Asians (44.8%), non-Hispanic whites (44.6%), and non-Hispanic American Indians/Alaska Natives (41.1%) was higher than coverage for non-Hispanic adults of other or multiple races (38.0%), non-Hispanic blacks (35.6%), and Hispanics (33.8%).

There is an opportunity to raise awareness of the important benefits that can be gained by increased vaccination among children and adults.

  • Continued efforts are needed to ensure those at higher risk of flu complications (i.e. elderly, young children, and persons with chronic health conditions) are vaccinated each year.
  • Access to vaccination should be expanded in non-traditional settings such as pharmacies, workplaces, and schools.
  • Health care providers should make a strong recommendation for and offer of vaccination to their patients and improve their use of evidence-based practices such as vaccination programs in schools and WIC settings and client reminder/recall systems.
  • Immunization information systems, also known as registries, should be used at the point of care and at the population level to guide clinical and public health vaccination decisions.

Pregnant women and healthcare workers

During the period of October 2012-January 2013, 50.5% of pregnant women reported they received the influenza vaccination before or during their pregnancy.

Overall, 72.0% of health care workers reported having had a flu vaccine for the 2012-13 season, an increase from 66.9% vaccination coverage during the 2011-12 season.





Here Come the Germs!

24 09 2013

I love my kids. I do. But, may I just say, entre nous, that my heartbeat slows and I’m immersed in a narcotic sense of freedom when they toddle off to school each September.

That euphoric bliss lasts about two weeks. Maybe. Then come the colds, the aches, the lethargy, the sniffles, the who-knows-what.

Does your family experience the same thing? Here’s what’s going on:

  • In the US, kids under 17 years of age experience over 50 million colds each year. M-m-million!
  • Kids miss almost 22 million (there’s that “m” word again) days of school due to colds.
  • Diarrhea is no slouch when it comes to affecting the health of our kids—it’s a big contributor to missed school days.
  • Bacteria and viruses can survive on desktops, doorknobs, walls, water spigots, cafeteria trays, shoes, backpacks, purses, and other surfaces for minutes or even hours. A few even longer, depending on the environment. The germs lurk on surfaces, waiting for unsuspecting hands to slide by and pick them up.
  • Some kids and teachers don’t cover their coughs and sneezes, and they don’t clean their hands when it’s important to do so. Depending on the germ, it may float in the air and wait to be inhaled, or drop on a surface and wait to be picked up, or transfer from germy hands to surfaces or the waiting hands of others.

What can we do? We can’t completely protect our kids from the germs in the world (and there’s no way I’m homeschooling), so we teach them how to protect themselves and live with the fact that they’re occasionally going to pick up germs. Picking up germs is not a bad thing. That exposure helps strengthen the immune system and does other good things for the body that are best left to another blog post.

To keep illness down to a manageable level, share these tips with your family:

  • Wash hands with soap and water after coughing, sneezing, playing inside or outside, going to the bathroom, or touching animals, and before preparing or eating food and at any time that the hands look dirty. And, wash those hands as soon as you come home from school or, well, anywhere.
  • Use hand sanitizer in place of soap and water if no soap/water is available, but soap and water are preferred. Remember that hand sanitizer kills many germs, but only while it’s being rubbed onto the hands. Once it’s dry and the hand touches something germy even two seconds later, germs will live on the hands again.
  • Cough and sneeze into the crook of the elbow. Coughing and sneezing into tissues is OK, but not ideal. The tissues are thin and the germs blast right through onto the hands, requiring an immediate hand cleaning. Plus, the germs are more likely to escape the tissue and float around waiting to be inhaled, or drop onto surfaces, waiting to be touched.
  • Don’t share with others anything your mouth touches. This means don’t share forks, spoons, water bottles, food, drinking glasses, straws, lipstick or any other makeup, come to think of it, and don’t use anything that’s touched another person’s mouth, such as their pen or pencil or any item already listed. This is not a complete list, just one to get you thinking about how germs can be passed from one person to another.
  • Keep your hands away from your eyes, nose, and mouth, as these are entryways for germs.
  • Walk around your home with a disinfecting wipe and clean doorknobs (interior and exterior), light switches and the wall area around them if the wall surface will hold up to the moisture, keyboards, remote controls—anything around the house that gets touched a lot.
  • Call your provider and your child’s provider and make sure the entire family is up-to-date on immunizations.

Share your tips in the comment section. Let’s try to have a healthy school year!

 

By Trish Parnell

 

 





Hep B Clinical Trial

16 01 2013

When babies are infected with hepatitis B, chances are they’ll stay infected for life. It becomes a chronic condition.

Some live long lives and their deaths are unrelated to their hep B infection.

Others develop cancer or their liver gives out. And then there are those who have minor symptoms, such as jaundice or fatigue.

You never know what or when or if something’s going to happen.

There’s no wonder drug for this disease. The available treatments are anemic at best, and few get favorable results.

My daughter, who was infected as an infant, has lived with hep B for 13 years. We’ve waited a long time for drugs that might work for her stage of the disease.

Hope has just peeked over the horizon.

NIH is running a clinical trial through a few centers in the US and Canada on children whose hep B infection is at a certain stage.

They’re using a combination of entecavir and pegylated interferon. They’re not looking for a cure, but rather hoping to slow it down. Even the best results wouldn’t remove the hep b virus from the cells. It’s integrated now, and there’s no work being done that’s close to getting it out of the cells it’s infected.

But, if the stars align and results are better than expected, it could be that those who respond to this treatment can relax, knowing hep B needn’t remain on their worry list.

That’s what we want. We all want our kids to live long, happy, healthy lives.

We flew to San Francisco yesterday for blood work and to sign forms. Lots of forms. Dr. Phil Rosenthal is running the trial and Shannon Fleck, the clinical research coordinator at UCSF Benioff Children’s Hospital, is assisting. I’ve known Phil for nearly 20 years and was delighted to see how optimistic he is about this drug combo.

This first step is to determine if my daughter is eligible for participation in the study. Her lab results have to match the criteria set for the trial.

If she is eligible, we fly back down within 30 days and her name goes into a computer, which then spits back out her placement. She’ll either be in the control group (no treatment) or the treatment group.

If she’s in the control group and the study is proving successful, she’ll be allowed compassionate use of the drugs, but that won’t be for two or three years.

That’s where we are—not even past the first hurdle.

I know people who’ve been infected with hep B in their adult years and have died from the disease. And I know people who’ve had cancer or liver transplants, or both—all because of this infection.

There are lots of ways to become infected. The easiest way to prevent infection is to get vaccinated. You, your siblings, your parents, your kids . . . ask your healthcare provider about it.

You can’t fix this with an aspirin.

By Hep B Mom





Fevers – Not Always a Cause for Alarm

26 07 2012

Few symptoms cause as much confusion and concern as fevers do. Dr. Katherine Vaughn, PKIDs’ medical director, answers questions about this worrisome symptom (check with your child’s doctor to determine what course of action is best for your child):

Why do Fevers Occur?

A fever is a resetting of the body’s thermostat to a higher temperature. This usually occurs in response to an infection, although other conditions can cause fever as well. Fever is an indicator that the immune system is working.

What is a Fever?

We all tend to think of 98.6 as a “normal” temperature, and anything above as a fever. In fact, temperature varies from person to person, and will also fluctuate by about a degree in any given person over the course of a day. We typically run about a degree lower in the morning compared to the evening. A temperature of over 100.4 is considered a fever.

How should a Temperature Be Taken?

Rectal temperature is considered the “gold standard”, and it’s most important to obtain in this way in an infant under 3 months of age. An axillary or ear (tympanic) temperature can be obtained in older infants and children. Forehead and pacifier thermometers are not as reliable a measure of temperature.

When Do I Worry About a Fever?

Always notify your doctor if an infant 3 months of age or younger has a rectal temp of over 100.4. The fever itself isn’t harmful, but babies this age can be quite ill without showing other signs, and will likely need to be seen.

For children over 3 months of age, it’s less likely they will be seriously ill and not have other signs and symptoms. A child’s behavior and activity level are more important clues to the severity of illness. A 6 month old who is playing and happy with a temperature of 103 would be less concerning than a 9 month old with a 101 temp who is listless and lethargic. A fever has to be quite high (generally felt to be greater than 106) for the fever itself to be harmful.

Other symptoms, such as rash, trouble breathing, lethargy, or other indications of a sick-looking child should prompt a call to your physician or visit to the ER. Fevers over 104 degrees, or any fever lasting more than 3 days should prompt a call to your physician to help assess for the need for a visit.

When Should a Fever Be Treated?

The main reason to treat a fever is for comfort. A happy child with a fever does not have to be treated. However, as temperatures rise over 101, many children become uncomfortable, with headache, body aches, increased heart rate, etc.

Treatment can be with acetominophen or ibuprofen at the appropriate doses. Never give your child aspirin for fever. It has been linked to a condition called Reyes’ syndrome.

Lukewarm sponge baths can also be used, as well as offering plenty of fluids. Don’t worry if your child doesn’t want to eat much for a few days, as long as they’re drinking.

Avoid alcohol sponging (it will raise the temperature) or cold water baths (increases discomfort).

Fever Myths

  1. “The temperature came down a few degrees and my child feels better, but the temperature still isn’t normal. My child must be really sick.” A child’s response to acetominophen or ibuprofen (in terms of degrees a fever decreases) is not an indicator of severity of illness. We don’t expect the temperature to come down to normal. Remember, treating the fever is done mainly for the child’s comfort, but it doesn’t make the illness get better any sooner.
  2. “Fever can cause brain damage.” A temperature probably has to be over 106 to cause problems like this, and in a normally healthy person, that doesn’t happen.
  3. “What about febrile (fever) seizures? They can occur at temperatures less than 106.” True. Febrile seizures are frightening. They occur in 3-4 percent of children, usually between 6 months and 5 years of age. They are typically brief and don’t cause any lasting problems. Always notify your child’s doctor if they have a febrile seizure.

Take Home Message

Fevers are rarely harmful. In a child under 3 months of age, call your doctor for any temperature over 100.4 . In older children, you can feel more comfortable evaluating the child, giving medicine to bring the fever down if they are uncomfortable, and calling the doctor if you’re concerned about how they are looking or acting.





Phoenix

17 05 2012

(Years ago, we at PKIDs had a lengthy argument/discussion with a few public health officials about the need to recommend that young kids be vaccinated against meningitis. We didn’t win. This post, reprinted from Parents Who Protect, illustrates why it’s important that someday, all young children be protected.)

Guest post by Clare from Parents Who Protect

It has taken me several weeks to pull myself together, to sit down and take a breath. I don’t imagine this will ever get easier or hurt any less. But I have to tell this story and hope that because of it, one less child will die from meningitis, meningococcemia, or any meningococcal disease.

I have always thought this saying to be true, “An ounce of prevention is worth a pound of cure.” Therefore, on the one-month anniversary of Phoenix’s death, the time has come to tell his story.

Phoenix is my beautiful, intelligent and amazing son. I want every parent to know that he was a precious child who was loved, cherished and cared for by his parents and his twin brother. In just a few days, I went from being a happy mother of two playful little boys to a grief-stricken mother trying to find meaning in such a tragic death.

On the morning of February 9, 2012, Phoenix woke with a mild fever. He played with his brother, ate his breakfast, and then played some more. After eating lunch he laid down for his nap and around 2:00 p.m., woke up with vomiting and with diarrhea. Being the mother of twins, I am used to having both boys sick at the same time, so I thought it was a bit odd that Gryphon showed no signs of being sick at all. After getting Phoenix all cleaned up and settled down, I decided to check his temperature again. When I saw that it was now 104 degrees, I strapped him in the car and headed to the emergency room.

As we arrived at the ER, I noticed a small spot on his arm. I couldn’t linger on this thought because things started moving pretty fast with the doctors and nurses checking his vital signs and asking me a lot of questions. I couldn’t keep my eyes off of Phoenix. I started to realize he was now acting very strange; it was like he was hallucinating. He seemed at peace and started to sing to me.

Nobody, not even the doctor, recognized his symptoms. The hospital staff had decided to just keep an eye on him and monitor his temperature. Phoenix asked me to take him to the bathroom, and while he was sitting on the toilet, he kept losing his balance and falling off. Immediately I knew something was wrong, so I started screaming for help. Several nurses came into the room, and at this time, the doctor decided to do a spinal tap. Even though it is such a painful procedure, my precious Phoenix didn’t move at all.

The doctor and staff called for the helicopter to transport him to Oakland Children’s Hospital. In the meantime, the results came back positive for meningitis. When my husband came into the room, Phoenix’s face lit up and he asked his baba for milk and cookies. He appeared to be responsive and cheerful and started to sing E-I-E-I-O. The anesthesiologist suggested we put him under to help eliminate any pain that he may be feeling. That was the last time we heard his sweet voice.

When the helicopter arrived, I demanded to be transported with him. As we were walking out to get in, the hospital chaplain walked with me. We stopped to pray for a miracle. It was at that moment I knew my baby was dying.

After a 50 minute helicopter ride, we arrived at the hospital. While they were getting him out, I could see that his tiny body was covered in purple splotches called petechiae; his legs, his arms, and his torso. Phoenix was raced to the ICU. Coming into the room, I could see at least four doctors and ten nurses scrubbed in and ready to go. I was asked by the head nurse to stay in the waiting room and was told they would brief me on his condition.

Those were the longest two hours of my life. When she came back and told me Phoenix was the sickest boy in that hospital, I felt sick to my stomach. My husband had not yet made it to the hospital, so I stood there alone and in shock, trying to make sense of all that I was being told. As soon as my husband arrived with Phoenix’s twin brother, Gryphon, we were taken straight into the ER to make sure that Gryphon didn’t have the same thing as Phoenix. The decision was made to keep Gryphon under observation for the night until we could get a better grasp on what was happening with our baby son. The nurses came in periodically and updated us on Phoenix’s condition. I couldn’t bear being separated from either one of my boys.

I was so worn down that I couldn’t possibly process all the information that was being given to me. At times, I didn’t understand it, or maybe I simply didn’t want to believe it. I cuddled up to Gryphon and tried to fall asleep with him. Around 2:00 a.m., Gryphon started laughing in his sleep, sat up, hugged the air, and said, “I love you.” Little did I know that, at around the same time, Phoenix’s heart had stopped for 15 minutes. I didn’t know it then, but I know now that Phoenix had come to say goodbye to Gryphon.

For the next three days, machines kept Phoenix’s little body alive. Then, we received the most devastating news we hoped never to hear: “Your son, at this moment, is the sickest boy in the whole world.” Phoenix was hooked up to countless IVs, lines, and machines, at least 15, going into his little body at one time. They also had him on an ECMO machine that was inserted into his arteries to help oxygenate the blood. He was so unstable to move that they could not do a CT scan on his brain because his heart had stopped, and his temperature had reached 106 degrees. They held off until Sunday evening to do the CT scans.

From Friday to Sunday evening, we heard from the doctors, “Your son possibly has severe brain damage due to his high fevers, he has pneumonia, looks like we will have to amputate some toes and fingers, looks like we will have to amputate all four limbs.” It was shocking and horrible; it was hell.

On Sunday evening, they were finally able to move him and did a CT scan. The scan confirmed there was no brain activity. Monday came, and the neurologist confirmed that he was, in fact, brain dead. Throughout this extremely long weekend, the chaplain of the hospital stayed close with us. Sister Breanice was an absolute saint, and through her words and kindness helped Bart and I become at peace with where Phoenix was about to go. She was right there as we watched the surgeon take the ECMO out of his body, and she was right there as Bart and I held his little hands and watched his strong heart slowly die. Our baby was pronounced dead around 1:00 p.m. on Monday, February 13.

Please pardon my anger and sadness when I express how devastating it was to read the article regarding Phoenix in the local newspapers, a simply-put story regarding a nameless three year old who had contracted the meningococcal disease. There was no follow up to his condition, no call to action for parents to talk to their healthcare professionals, not even a note on what symptoms parents should look for in their own children.

No one knows where Phoenix contracted this disease. What I know, after doing my own research, is that this disease is only carried by humans and is passed along in close contact situations: crowded areas, high schools, dormitories and even preschools! I also know that this disease has a high fatality rate in children and adolescents, and many who are lucky enough to survive usually don’t escape its devastation without the loss of a limb, some form of brain damage, hearing loss, or kidney failure .

As a mother, I don’t understand how something like this can happen. That “something” being that any child in theUnited States could die from a disease that currently can be prevented by a vaccine. That is right: there are vaccines that help prevent the spread of disease and pointless deaths.

I am sure many of you have heard of polio, measles, mumps, and rubella, and how our society has done its best to eradicate these dangerous diseases. Every child that is born is required to get vaccinated at some point, and I am a parent who says, “That is great!” Why should our children die from a disease that can be prevented? How often do we hear of an outbreak of polio? Not often, or really ever. Thanks to vaccines.

I understand that there are many families who choose not to vaccinate. I respect your right to choose. However, I do vaccinate my children and expect to be given all of the necessary information to make an informed decision. Herein lies the problem: I was never made aware of the vaccinations available for meningitis. It is hard to believe that we currently have vaccines which protect against types A,C,Y and W135. One of the vaccines is approved for use in children as young as nine months of age.

There are five different strains of bacteria that can cause meningococcal disease, and we can currently vaccinate against four of the five. The vaccine is offered to teenagers, college students, military personnel and other selected groups. Although this disease is known to have a high mortality rate in young children, for some reason, this is the age group not offered the vaccine.

I am lost. No, I am more than lost. I am angry and saddened that this disease can take the life a child, and no one seems to care. Why aren’t the younger children protected with a vaccine recommendation? Without any kind of public outcry, pleas of parents who have lost their most valuable treasures are going unheard.

Our government needs to help protect our children and change the way our medical system works. Something has to be done but won’t be until we raise our voices loud enough to be heard. I didn’t want to be an advocate. I would much rather be holding my precious son in my arms, watching him play with his brother, tucking him in at night.

I have to say that without the love and support from our friends and family, I am not sure my husband and I would have gotten through this. So, I must ask you, from one parent to another: wasn’t Phoenix’s life worth that ounce of prevention?





Shot at Life

23 04 2012

Remember SARS? That virus popped up in China in 2003 and quickly coughed and sneezed its way to dozens of other countries. And the 2009 H1N1 virus made its introductory appearance in Mexico, when a pig infected a human. It then traveled the globe with a speed that shocked us.

The world is enormous, but nowadays it’s also quite small.

Long ago, when people were mostly nomadic in nature, diseases were not easily spread, at least not outside of one’s group or tribe.

Then we formed societies, lived closer together, traded wheat and pelts, and passed germs like nobody’s business. But it still took months and sometimes years for diseases to become widespread.

Today, with air travel, diseases can spread from country to country in a matter of days, and sometimes, within a few hours.

These diseases are not all new; many are vaccine-preventable. But, when the immunity in a community is low due to reluctance to vaccinate or lack of access to vaccines, these diseases which science has bested scatter anew, bringing illness and sometimes death.

The United Nations Foundation’s Shot@Life campaign targets Americans with the hope that we will be inspired to advocate for those with little or no access to vaccines.

That inspiration isn’t too hard to find, if you’re a mom or dad. Once you’re a parent, you acquire a faint and nagging voice that compels you to “parent” all kids, anyone’s kids, every kid.

There are numerous self-serving reasons to ensure everyone is vaccinated, and that’s OK. Who wants to get sick? There are some of us for whom this or that vaccine simply doesn’t work, or we can’t use a vaccine due to allergies or for other reasons. We’re unprotected and we depend on those around us to not get sick and, so, not infect us.

There are also simple, human reasons for wanting everyone vaccinated. There are boys and girls in need who should grow up laughing and being naughty sometimes, who should go to school and raise families. This one will clean toilets for 30 years and then retire to enjoy his grandchildren. That one will discover life on another planet. Another will be the teacher who changes the lives of hundreds of students, who in turn go on to do wondrous deeds.

It’s a really small world, when you think about it. Protecting other children will protect our own children. And, it’s what we do for neighbors.

Check out Shot@Life. Do something this week to help your neighbors in Nigeria, Laos, Bangladesh, and elsewhere.

By Trish Parnell

Image courtesy of Shot@Life





Annie’s Dad

17 10 2011

(This testimony was given on behalf of PKIDs to a U.S. House of Representatives’ committee a few years ago. It is so compelling—and, unfortunately, still relevant—that we wanted to share it with you now.)

My name is Dr. Keith Van Zandt, and as a practicing family physician, I appreciate the opportunity to address this committee regarding hepatitis B vaccines. I have degrees from Princeton and Wake Forest Universities, and completed residency training in family medicine here in Washington at Andrews AFB.

Today, however, I am here as a dad. I have five children, two of whom my wife Dede and I adopted from Romania. Our youngest, Adrianna, was nearly four years old when we adopted her from the orphanage, and was found to have chronic active hepatitis B when we performed blood work prior to bringing her home.

She had contracted this from her mother, who died when Annie was nine months old, from the effects of her liver disease as well as tuberculosis. We have been very fortunate to have had some excellent medical care for Annie, but her first year with us was an endless procession of liver biopsies, blood draws and over 150 painful interferon injections I gave to my new daughter at home. Interferon is a form of chemotherapy for hepatitis B that has many side effects and only a 25 to 40% success rate.

We know first-hand the pain and family disruption this completely preventable disease can bring.

You have already heard testimony from some of the world’s leading experts on hepatitis B and its vaccine, and I can add little new information to that. As a family doctor, though, I see patients every day whose lives have been significantly improved by the immunizations we now have available. My forebears in family medicine struggled in the pre-vaccination era with the ravages of horrible diseases that are now of only historical interest.

Preventive immunizations have so changed our world that I am afraid that we no longer remember how horrible some of these diseases were. My family and I have made multiple trips to Romania to work in the orphanages, and unfortunately I have seen the effects of many of these diseases there.

I am certainly aware of the potential for adverse reactions to our current vaccines, but we must maintain the perspective that these reactions are extremely rare. My partners and I in Winston-Salem care for over 40,000 patients, and I can honestly say that in over 20 years of practice we have never seen a serious adverse reaction to any vaccine. I believe that the vast majority of family physicians around the country can say the same. Certainly, I do not wish to minimize the suffering and losses of families who have experienced these problems, but we must remember that immunizations remain the most powerful and cost-effective means of preventing disease in the modern era.

Personally, it still sickens me to know that the disease my daughter has was completely preventable if hepatitis B vaccines had been available to Annie and her mother.

Whereas 90% of adults who contract hepatitis B get better, 90% of children under the age of one go on to have chronic disease, and 15 to 20% of them die prematurely of cirrhosis or liver cancer.

I know first-hand the gut-wrenching feeling of being told your child has a chronic disease that could shorter their life. I know first-hand the worry parents feel when their hepatitis B child falls on the playground, and you don’t know if her bleeding knee or bloody nose will infect her playmates or teachers. I know first-hand the concern for my other children’s health, with a 1 in 20 chance of household spread of hepatitis, and the thankfulness I feel that they have had the availability of successful vaccines. I know first-hand the pain a parent feels for their child as they undergo painful shots and procedures for their chronic disease with no guarantee of cure.

I am not the world’s leading expert on hepatitis B or the hep B vaccine, but I am an expert on delivering the best medical care I can to my patients in Winston-Salem, NC. I am also not the world’s leading expert on parenting children with chronic diseases, but I am the world’s best expert on parenting my five children.

I know professionally that immunizations in general have hugely improved the lives of those patients who have entrusted their medical care to me. I know personally that had the hepatitis B vaccine been available to my daughter, her life and mine would have been drastically different. I am also thankful that my other children have been spared Annie’s suffering by being successfully vaccinated.

Anecdotes of vaccine reactions are very moving, but they are no substitute for good science. Please allow me to continue to provide the best medical care I can with the best system of vaccinations in the world, and allow me to keep my own family safe.

Thank you very much for your time.

Keith Van Zandt, M.D.





Why are Vaccines Mandated?

26 05 2011

Why does the government mandate that millions of children and adolescents receive certain immunizations for school entry?

The more people in a community who are vaccinated, the healthier that community is.  Here is how Dr. Samuel Katz, a renowned vaccine expert and a member of PKIDs’ Medical Advisory Board, explained it before Congress in 1999.

“We know too well that the level of [immunization] protection that we have now established in our children and our communities is a fragile one that depends on what we refer to as community or ‘herd’ immunity.  From the standpoint of effectiveness, modern childhood vaccines are approximately 90 to 95 percent effective.  What that means is that for every 20 children who are vaccinated one or two may not develop a sufficient immune response [or antibodies to fight an infection].

“It cannot be assured that these children will be protected from the virus or bacteria should they encounter it at school, at a playground, at a shopping mall, or at their church daycare.  However, if sufficient numbers of children in a community are immunized, the vaccinated ones protect the unprotected by effectively stopping the chain of transmission in its tracks and drastically lowering the probability that the susceptible child will encounter the bacteria or virus,” said Katz.

Community immunity also helps protect children and adults whose immune systems are compromised or weakened because of another illness or old age.

“As long as the great majority of children receive their vaccines, we will be able to maintain our current level of disease control,” Katz explained.  “However, should the level of community protection drop to the point where the viruses and bacteria travel unimpeded from person-to-person, from school-to-school, and from community-to-community, we instantly return to a past era when epidemics were an accepted part of life.”

America experienced such an outbreak in 1989-91 with the resurgence of measles.  There were 55,622 reported cases mainly in children less than 5 years of age, more than 11,000 hospitalizations and 125 deaths.  States do allow personal exemptions, so parents can choose not to vaccinate their children, but those exemptions carry risk to the child and the public’s health, emphasizing the importance of community immunity.

An article in the Journal of the American Medical Association found that, on average, those children who were exempted from immunizations ran a 35-fold greater risk of contracting measles compared to those who were nonexemptors.

Not only are these children at greater risk of disease, their infections can be the spark that ignites a disease outbreak in a community.

According to Dr. Katz, in the late 1960s and early 1970s, despite the availability of a safe and effective measles vaccine, the United States continued to experience regular epidemics of measles.  Left to individual choice (as opposed to government mandates), only 60 to 70 percent of the community was immunized.

That coverage failed to provide adequate community immunity to prevent an outbreak.

“States without school immunization requirements had incidence rates for measles significantly higher than states with these requirements,” noted Dr. Katz.  “Recognizing these data, other states (not the federal government), quickly adopted similar requirements.  These requirements are supported by the American Academy of Pediatrics.

“The results are striking,” he added.  “Before we had a measles vaccine, an estimated 500,000 cases of measles were reported each year.  In 1998, there were 89 cases of measles in the United States with no measles-associated deaths.  Most counties in the United States were free of measles.  However, we have learned that nearly all of the cases of measles that did occur in the United States were imported from other countries.  This would not have been possible without the “school exclusion” statutes that now exist in every state.  While we hear dramatic stories of exotic diseases that are just a plane ride away, the importation of vaccine preventable diseases into a susceptible population is much more frightening.  Should we allow our community immunity to wane, we will negate all the progress we have made and allow our communities to be at risk from threats that are easily prevented.”

Compulsory vaccination laws in the United States have repeatedly been upheld as a reasonable exercise of the state’s compelling interest even in the absence of an epidemic or a single case.  As the U.S. Supreme Court held in 1905 in the case Jacobson vs. Massachusetts:

“ …in every well-ordered society charged with the duty of conserving the safety of its members, the rights of the individuals in respect of his liberty may at times, under the pressure of great dangers, be subjected to such restraint, to be enforced by reasonable regulations as the safety of the general public may demand.”

The Supreme Court makes clear that “the liberty secured by the Constitution of the United States to every person within its jurisdiction does not import an absolute right in each person to be, at all times and in all circumstances, wholly freed from restraint.  There are manifold restraints to which every person is necessarily subject for the common good.   [Liberty] is only freedom from restraint under conditions essential to the equal enjoyment of the same right by others.”

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: lawtonjm





Sand, Surf, and What?!

25 04 2011

Kids love to dig in the sand and build castles. They’ll work for hours, crafting structures of dizzying heights, sculpting the turrets and drawbridges just so with their hands.

Oh, and getting buried in the sand? Even better.

Turns out, all that digging and getting buried can expose kids to lots of germs.  Researchers found “… evidence of gastrointestinal illnesses, upper respiratory illnesses, rash, eye ailments, earache and infected cuts. Diarrhea and other gastrointestinal illnesses were more common in about 13 percent of people who reported digging in sand, and in about 23 percent of those who reported being buried in sand.”

Just makes your skin crawl, doesn’t it?  Before you give up on the beach, know that there are things we can do to combat the germs.

Tell the kids they can play in the sand, but not to touch their faces with sandy hands, and make sure they clean their hands with soap or sanitizer when they’re done playing.  Also, send them to scrub down in a shower as soon as possible after play.  There’s no guarantee they’ll avoid an infection, but it’ll help.

Kids (and adults) love to swim in pools, lakes, and oceans. We’re usually swimming in urine,  garbage, or who knows what contaminants.  Due to the reality of raw sewage runoff, we could come down with all sorts of infections, including E. coli, after practicing the backstroke.

Blech, but hey, everything carries a risk. There’s no guarantee we’ll get sick or we won’t get sick from swimming.

So go. Swim. Enjoy and shower when you’re done.

Life is too short not to have fun on vaca!

(Photo from dMap Travel Guide)