Summer + Mosquitoes = Dengue Fever?

13 05 2014

The dengue fever virus is the most common virus that mosquitoes transmit and infects about 100 million people worldwide every year, killing about 25,000. In spite of this frequency, though, the United States, with the exception of Puerto Rico, has been mostly dengue-free for decades—until 2009.

image by infidelic

That year, a woman in New York turned up with a dengue infection, having just returned from a trip to the Florida Keys. Her case was the first of a handful that led public officials to conduct a survey of the Key West population. To their shock, they found that about 5% of residents, or about 1000 people, showed evidence of dengue exposure in 2009.

The mosquito that carries the virus occurs in warm areas of the country, including Florida and Texas, and indeed, isolated cases of dengue have cropped up a few times since the 1980s along the Texas–Mexico border. But the cases in 2009 and more in 2010 have authorities concerned that dengue now has achieved an intractable foothold on the continental United States.

Work on a vaccine against dengue is ongoing, but in the meantime, the only preventive is to avoid the bug that carries the virus: the mosquito.

Wearing repellent when in areas where they occur is one tactic. Another is removing breeding places, such as any containers with standing water. The precautions apply wherever you’re going, whether to areas where dengue is already endemic or where it is emerging. The CDC provides regular updates for travelers, including a page specific to the Florida cases.

Dengue fever can hit hard or harder, depending on the symptom severity. The “mild” version of the disease can involve a high fever, a rash, severe headache and pain behind the eyes, and nausea and vomiting.  Given that these symptoms are largely nonspecific, if you see your doctor about them and have traveled in a place where dengue fever occurs, be sure to mention it. A more severe form of dengue fever is dengue hemorrhagic fever, which begins much like the “mild” form but then progresses to symptoms that can include nosebleed and signs of bleeding under the skin, known as petechiae.  This form of dengue can be fatal.

The most severe manifestation of the disease, dengue shock syndrome, includes the symptoms of the milder forms along with severe abdominal pain, disorientation, heavy bleeding, and the sudden drop in blood pressure that signals deadly shock.  Onset is typically four to seven days after exposure, and the mild form usually lasts only a week, while the more severe forms can involve either a progressive worsening or a sudden worsening following an apparent improvement.

Oddly enough, having dengue fever once does not mean you’re safe from it. Indeed, some studies indicate that a second bout of dengue fever often can be worse than the first, with a greater risk of progressing to the hemorrhagic form.

Flu – The Last Push

18 02 2013

It ain’t over ‘til it’s over!

Following are some ‘in the home stretch’ flu tips and resources from the CDC.

This patient’s brochure is spot-on for this year’s (or next) flu season. And if you’re worried about getting the flu, take a look. It includes tips on prevention and what you can do to make it better, should you become infected.

If you’re a health educator and your message is getting a little tired, here are some free resources, including audio/video, badges, and widgets.

We hope you got a flu shot this season. If not, take this year as a lesson and do so next year and all the years after. The vaccine works for the majority of those who take it. Don’t miss out on this crucial first step in flu prevention.

The US flu season continues; flu-like illness has fallen in the East and risen sharply in the West, so take care for the next month or so.

The timing of flu is very unpredictable and can vary from season to season. Flu activity usually peaks in the US in January or February. However, seasonal flu activity can begin as early as October and continue to occur as late as May.

Symptoms of the flu may include fever, cough, sore throat, runny nose, body aches, headaches, and fatigue.

To find out what’s going on in the world of flu, get timely information at:

If you’re infected, get to your provider and start on antivirals.

And next year, as soon as you hear about flu vaccine being available, hightail it to your pharmacy or provider and get vaccinated!

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.

RSV – Not Always Simple

14 11 2011

Almost all kids in the United States are infected with RSV by the time they’re two years of age. In adults and older kids and teens, the symptoms resemble your basic cold, and for most babies and toddlers, it’s not a serious infection, but it’s capable of great nastiness.

Respiratory syncytial (sin-SISH-ul) virus, or RSV, was identified in 1956 and is the usual suspect in “lung and airway infections in infants and young children.”

It’s a contagious virus — spreads easily through droplets that infected people cough or sneeze into the air. Those droplets that aren’t inhaled by others land on surfaces, which are then touched by unsuspecting individuals. The germ gets on people’s hands and infects them when they touch their noses or mouths.

The virus is no lightweight. It can survive for at least 30 minutes on one’s hands, nearly five hours on surfaces, and even longer on contaminated tissues.

Symptoms are similar to cold symptoms, and may include:

  • Wheezing
  • Difficulty breathing
  • Cough
  • Stuffy or runny nose
  • Fever

There is a simple and quick test for RSV that clinics can run. Because it’s a virus, antibiotics don’t work against it, and most of the time, there is no treatment because the symptoms will be no worse than those of a mild cold.

But, more severe infections can lead to pneumonia, bronchiolitis, lung failure, and a host of related problems. If a baby or toddler (or anyone, really) has difficulty breathing, get them to a hospital. There they will be treated for their symptoms and treatment may include oxygen, IV, or even a ventilator.

To stop transmission of RSV, pertussis (whooping cough), colds, flu and many other infections, cover your coughs and sneezes, wash hands frequently and thoroughly, don’t swap spit with others, and don’t share forks, cups, straws, or anything else that’s been in your mouth.

There’s no vaccine for RSV, but there is a drug that can be given monthly to those kids at high risk of severe illness. Check with your provider about this preventive option, and if your young one has any symptoms that would lead you to suspect RSV or any other infection, it never hurts to take him in for a visit.

By Trish Parnell

Video courtesy of  TheDoctorsVideos

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

Ask Emily

28 07 2011

What causes ear wax?

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

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

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

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

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

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

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

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

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

Do you have a question for Emily? Send it to:

By Emily Willingham

Image courtesy of CuriousGeoff