Clean Those Hands!

11 08 2016

My older daughter started preschool when she was three.

That autumn, our lives changed — our healthy little family became a sick, exhausted mess.

Every three to four weeks for the next several years, at least one of us would be felled by some illness.

I remember commenting on it to the preschool director. She laughed and explained that it happened to every teacher and family new to preschool or daycare.

A perfectly healthy family or individual would, soon after their first exposure to school, dissolve into a puddle of sickly goo and stay that way for years.

It was due to the teeming mass of sneezing, coughing, nose-picking, walking petri dishes we called children, who cheerfully plastered germs on each other and on every surface in the building.

preschool

We were all immunized against the diseases for which there were vaccines. But, that didn’t account for those germs running free with nothing to stop them but a pair of clean hands.

We had to up our hand cleaning game, big time.

And here’s the thing about clean hands — one could almost say the conundrum of public health — when we use soap and water on our hands, we wash off most of the germs, but as soon as our clean hands touch an unsterilized surface (a.k.a. pretty much anything or anyone in the world outside of instruments in an operating room), germs hop right back on our hands.

The same is true with hand sanitizer. As soon as it’s dry and our hands touch a germy surface, we’re loaded for bear, as my grandma used to say.

One could ask, why bother to clean our hands?

It’s a fair question. The answer is simple — by cleaning our hands numerous times a day, we continually get rid of the hitchhiker germs.

If we add cleanliness to the habit of keeping our hands away from our eyes, nose, and mouth, then we have a good shot at avoiding lots and lots of infections.

Cleaning our hands frequently throughout the day is not a guarantee of good health, but not cleaning them is a sure way to spend a lot of time feeling lousy.

 

 

by Trish Parnell

Image courtesy Pixabay





New Year, New Immunization Schedule

18 02 2016

Immunizations are good for grams and gramps, moms and pops, and little ‘uns of all ages. But, wow it’s hard to keep up with who’s supposed to get what, and when they’re supposed to get it.

Every year about this time, the CDC puts out a revised immunization schedule. I’m not sure how many people wait on the edge of their seats for the schedule to come out. I think it’s one of those things that we should care about, that some of us actually do care about, but that’s not as exciting as waiting for the next Star Wars movie to come out.

Exciting or not, immunizations do help keep us healthy. They’re important! So, let’s briefly go over the changes for this year.

For all of us, the usual vaccines are on the schedule, plus there are a few vaccines that need particular attention.

In addition to the existing meningitis vaccines, there are currently two vaccines that protect against meningitis B. The ACIP (Advisory Committee on Immunization Practices) approved the recommendation that kids 10 years of age and older who are at higher risk for infection should get vaccinated against this strain of meningitis.

Young people ages 16-23 years who are not at higher risk for infection may get vaccinated, and should check with their providers to see about doing so.

We strongly encourage young people to protect themselves against meningitis B through immunization, unless their providers determine there are medical reasons not to do so.

There is a vaccine that protects against nine strains of the human papillomavirus. There are also vaccines available that protect against fewer strains of HPV, but we believe it’s important to protect kids as thoroughly as possible. We suggest you talk to your provider to see which HPV vaccine you or those you love should get. This vaccine is typically given between ages 11 and 12, but as with all vaccines, you can usually follow a catch-up schedule if you miss some immunizations.

There are more vaccines on the schedule. What you should get depends on many factors—check with your healthcare provider about what you need to stay up-to-date on your immunizations.

For a complete list of current recommendations, click here.

 

 

by Trish Parnell





What Is Meningitis, Anyway?

27 01 2015

At PKIDs, we help families affected by infectious diseases, and we work to educate ourselves and others about these diseases. Our goal is to prevent infections.

In 2015, we’re turning the spotlight on meningitis, or more accurately, meningococcal disease.

Meningitis is scary—and confusing. For instance, if I say that I have meningitis, it sounds like I’m saying I’m infected with a No More Meningitisgerm called meningitis. But, there is no germ called “meningitis.”

Adding to the confusion is the fact that we tend to use that term loosely for what should be called “meningococcal disease.”

Meningococcal disease causes meningitis, and it may also cause blood poisoning (septicemia).

WHAT IS MENINGITIS?

Our brains and spinal cords are protected by three layers of tissues, one on top of the other, along with a thin river of fluid that runs between the middle and bottom layers. That river, the cerebrospinal fluid, helps the tissues cushion the brain and spinal cord. It also brings in food and takes out trash from the brain.

These tissues that protect our brains and spinal cords are called membranes, or meninges. The whole setup reminds me of a hand in a baseball glove; the hand and wrist are the brain and spinal cord, and the layers of the glove are the meninges.

When I say that I have meningitis, I’m saying my meninges, those tissues layered over my brain and spinal cord, are swollen or inflamed.

This swelling usually causes symptoms that are typical and a tip-off that a person is suffering from meningitis. Those symptoms include fever, a stiff neck, and a severe headache.

There are other symptoms that may be happening, but those three are the most common.

Lots of things can cause meningitis, and they’re not all germs. But the cause of most concern is bacteria.

When certain bacteria, such as Neisseria meningitidis, cause meningitis, it’s called bacterial meningitis.

The bacteria can get into the bloodstream, cross the blood-brain barrier, and cause meningitis, as described above. They get into the river, the cerebrospinal fluid, and multiply like crazy, spitting out poison. The tissues react to the poison by becoming swollen and inflamed. If it gets bad enough, the swelling may cause seizures, or even brain damage.

WHAT IS BLOOD POISONING?

When bacteria such as Neisseria meningitidis get into the bloodstream, they can cause septicemia, or blood poisoning.

The poison released by the bacteria into the bloodstream makes the immune system wake up and start fighting. This war between the bacteria and the immune system can cause inflammation, or sepsis, which in turn can cause blood clots, and it may stop oxygen from getting to the organs. If this happens, the infected person may lose limbs, organs, and sometimes, his or her life. This can happen within hours of initial infection.

HOW TO PREVENT MENINGOCOCCAL DISEASE

The bacteria that cause meningitis, and possibly septicemia, can spread in many ways, including through a kiss or a cough, a sneeze or a sip on a shared straw.

To avoid infection, we do the same things we do when we’re trying to avoid influenza.

  • Wash our hands.
  • Keep our hands off of our nose, mouth, and eyes.
  • Don’t share items like food, forks, lipstick—anything that can transfer germs from another person’s mouth to our own.
  • Get immunized. There are several germs that cause meningococcal disease, and luckily, there are several vaccines to protect us. Ask your provider which vaccines are appropriate for your age and immunization history.
  • Keep our immune system strong by doing all those things we hear about: exercise, eat healthy, and get plenty of sleep.
  • Be responsible and cover our coughs and sneezes. We don’t want to spread infections that we may have.

There are certain groups that are at greater risk of becoming infected with meningococcal disease: those living in close quarters with large groups of people, such as youth campers, dorm residents, or military barrack inhabitants; individuals whose immune systems are compromised; travelers to regions where meningococcal disease is common; or people exposed to others who are currently infected and infectious.

The harm that can come from this infection is so great, it’s simply not worth the risk. We all need to get ourselves and our loved ones in to see our provider for vaccination against this truly horrible disease.

by Trish Parnell





Back To School!

15 08 2014

Dr. Mary Beth Koslap-Petraco, PNP, shares her tips for getting kids off to a healthy start this school year.

 

 

Share your ideas for a healthy school year in the comments!

 





Why We Talk About Immunizations

25 04 2014

There are so many ways to prevent infections, I sometimes wonder why we spend the vast majority of our time talking about immunizations.

Well, yesterday the CDC came out with data that are so astounding, all I could think when I listened was: That’s why!

The CDC looked back at children born between 1994 and 2013, and estimated that vaccination will prevent:

  • about 322 million illnesses
  • 21 million hospitalizations
  • and 732,000 deaths over the children’s lifetime

And, of less importance than a child’s life but good to know, the prevention of illnesses, hospitalizations, and deaths nets a savings of $295 billion in direct costs and $1.4 trillion in total societal costs. That ain’t hay, as my dad used to say.

I’m happily highlighting these numbers because it’s World Immunization Week, and because the Vaccines for Children (VFC) program celebrates its 20th anniversary this year. Thanks to the VFC, vaccines are provided at no cost to uninsured kids in our country.

20-year-infographicAbout 25 years ago, there was a big measles outbreak in the US. We saw approximately 55,000 cases of measles and more than 100 deaths. Come to find out, this outbreak was primarily due to uninsured children not being vaccinated.

Shortly after the outbreak, the VFC program was established with the hope that such an event would never be repeated.

We are currently seeing small outbreaks of measles cases in the US. Unlike 25 years ago, these outbreaks are primarily due to a small number of parents choosing not to vaccinate their children.

Measles was eliminated from the US in 2000, but not from the world. It’s estimated that 20 million people on this planet get measles each year, and 122,000 die from the disease. When unvaccinated individuals in this country travel to other countries, or interact with visitors from other lands, they are at risk for measles.

The symptoms of measles include the typical rash, fever, cough, runny nose, tiredness, red and watery eyes, and sometimes little white spots in the mouth. The symptoms stay for several days before gradually disappearing. However, complications are not uncommon. According to the CDC: About 30% of measles cases develop one or more complications, including:

  • Pneumonia, which is the complication that is most often the cause of death in young children.
  • Ear infections occur in about 1 in 10 measles cases and permanent loss of hearing can result.
  • Diarrhea is reported in about 8% of cases.

These complications are more common among children under 5 years of age and adults over 20 years old.

Even in previously healthy children, measles can be a serious illness requiring hospitalization. As many as 1 out of every 20 children with measles gets pneumonia, and about 1 child in every 1,000 who get measles will develop encephalitis. (This is an inflammation of the brain that can lead to convulsions, and can leave the child deaf or mentally retarded.) For every 1,000 children who get measles, 1 or 2 will die from it. Measles also can make a pregnant woman have a miscarriage, give birth prematurely, or have a low-birth-weight baby.

In developing countries, where malnutrition and vitamin A deficiency are common, measles has been known to kill as many as one out of four people. It is the leading cause of blindness among African children.

I look at these statistics and I think: Oh yes, this is the other reason we spend so much time talking about immunizations.

If I may appropriate and paraphrase something I heard the other day: Mom and dad, choosing not to vaccinate or to delay vaccination of your children is like choosing to put them in their car seats only on Thursdays when the sun is shining.

Don’t be a part of that small minority of parents who are afraid to proactively protect their children. Call your child’s healthcare provider today and make sure he or she is current on all immunizations.

Oh, and happy World Immunization Week.

 

by Trish Parnell

(Thanks to Liz Szabo for the thing I heard the other day.)





NIIW 2013 – Resources for Vax Educators

23 04 2013

It’s National Infant Immunization Week!

We put out the call for infant vaccination resources that groups were prepared to share, and this is what we received. If you have any tools or resources you can share with others, either hard copies or downloadables, just add them to the comments section.

Vaccinate Your Baby has a nice section on their website of video FAQs, featuring Dr. Paul Offit, Dr. Mark Sawyer, Alison Singer, and Dr. Mary Beth Koslap-Petraco. The videos are very short, and they each ask and answer a question about vaccines. Plus, they have the full transcripts available for download. Nice way to hear how other healthcare professionals answer questions, and something you can show patients.

AAP has a multitude of resources, as you would imagine.

Here’s the Childhood Immunization Support Program Best Practices Summary. Clinicians answer several questions, and their answers are compared to best practices for each question. Sample question: “How does your practice ensure that, whenever possible, immunization appointments are scheduled along with other appointments, to prevent missed opportunities?” Good opportunity to find out how others are overcoming issues related to best practices.

AAP also has a nice page with several provider resources listed for those wanting to communicate with parents of infants, or children of any age.

The Alliance for Immunization in Michigan has a toolkit available for download that addresses infant immunization, as well as immunization in other age groups.

The Illinois Maternal & Child Health Coalition has a Community Immunization Education Guide Toolkit available in English and Spanish. It provides background information that the trainee can use as they train fellow community workers and/or educate the public about immunizations. Key topics include: What is a vaccine preventable disease, what are the five key immunization messages, what do vaccine preventable diseases look like, how to give an excellent presentation.

The Hepatitis B Foundation has a downloadable flyer promoting hep B vaccination.

CDC has an entire infant/toddler immunization section on its website.

Stanford’s Asian Liver Center has a flyer available in multiple languages that addresses HBV and Moms-to-be

CHOP’s Vaccine Education Center has several resources available:

Print materials: – Vaccines and Your Baby booklet; Q and A sheets about related vaccines: rotavirus, hep A, chickenpox, influenza, pertussis; Vaccine safety q and a sheets – facts about childhood vaccines, aluminum, recommended immunization schedule, thimerosal, too many vaccines, vaccine ingredients, vaccines and autism; Clings of the immunization schedule.

Videos: – Vaccines and your baby (for new or expectant parents), Vaccines: Separating Fact from Fear (for parents concerned about vaccine safety)

Parents PACK program – website and monthly e-newsletter (sample)

IAC has several resources for those working with infants:

FOR PARENTS:

Immunizations for Babies  (also available in 8 translations)

Vaccinations for Infants and Children, Age 0–10 Years

Clear Answers & Smart Advice About Your Baby’s Shots by Dr. Ari Brown, MD, FAAP

Cocooning Protects Babies

Personal belief exemptions for vaccination put people at risk. Examine the evidence for yourself.

Questions Parents Ask about Baby Shots   (also available in 8 translations)

Reliable Sources of Immunization Information: Where to go to find answers!

What if you don’t immunize your child?

FOR PROVIDERS:

Vaccine Administration Record for Children and Teens

Summary of Recommendations for Child/Teen Immunization

Recommendations for Pneumococcal Vaccine Use in Children and Teens

Meningococcal Vaccination Recommendations by Age and/or Risk Factor

Screening Checklist for Contraindications to Vaccines for Children and Teens   (also available in 9 translations)

Decision to Not Vaccinate My Child (declination form)

Standing orders for all routine childhood vaccines

PKIDs has several infant-specific resources that anyone may use. There’s a nice section on pertussis with video and audio PSAs, , and other materials for use by providers and parents. For the Make On-Time Vaccination Easy program, there are radio PSAs available for download . There are also videos covering a variety of vaccine-preventable diseases that may be used by anyone as PSAs, or there are longer versions for showing in waiting rooms .





You’re An Adult, So Get Vaccinated!

29 01 2013

adults onlyOnce we leave our family home and go off to college or the military or the workforce, how healthy we are is up to us.

For our first couple of decades, mom and dad do all the work. They get us in for our immunizations, tell us to wash our hands, nag us to eat our greens—well, the nagging about our health never ends. But the point is, we don’t worry about that stuff because we know someone else is doing that for us.

Then, in our 20s, 30s, and 40s, we’re hauling our own kids to the clinic for shots and sniffles, or nagging them to eat their greens. We haven’t the time for a long shower; forget finding time to take care of our own health.

In our 50s, we’re working hard and at the peak of our careers, or getting laid off and stressing about that. Plus, we’re watching out for our parents’ health. We have no time for check-ups or even basic immunizations. Even if we have the time, we have no idea what we’re supposed to take care of and might not have a “medical home,” a physician we see when we need to see one.

Our 60s and 70s are when we wake up to the fact that we have to take care of our bodies. Most of the time, we do that by reacting to health issues that pop up rather than working to prevent problems.

After 80, we’re bossed around by our middle-aged children who can find us a specialist in 10 minutes, but have no idea that we need a Tdap vaccine.

Adults 19 and older in the US are not taking advantage of vaccines, and that’s an easy place to start taking care of ourselves. Each of us should check in with a healthcare provider and find out what vaccines we need. Nobody has time to do it, so just do it anyway.

Here’s a list from the CDC, although it’ll be much simpler to ask a physician. But, if you love the details (full recommendations for each vaccine can be found here):

  • Pneumococcal Vaccine Information
    • Pneumococcal polysaccharide vaccine is recommended for all adults aged 65 years and older.
    • In addition, certain adults younger than 65 years should be vaccinated if they have certain high-risk conditions such as cardiovascular disease, pulmonary disease, diabetes, alcoholism, cirrhosis, cerebrospinal fluid leak, or a cochlear implant, or if they have a suppressed immune system.
    • Adults aged 19 years and older should also get a pneumococcal polysaccharide vaccine if they have asthma or smoke cigarettes.
    • Preliminary data report approximately 37,000 cases of invasive pneumococcal disease in 2011. Of those cases, there were about 4,000 deaths.
    • The majority of cases and deaths occur among adults 50 years or older, with the highest rates among those 65 years or older. Almost everyone who gets invasive pneumococcal disease needs treatment in the hospital.
    • Overall, pneumococcal polysaccharide vaccine (PPSV23) is 30% to 70% effective in preventing invasive pneumococcal disease, such as meningitis and bloodstream infections.
      • Effectiveness is highest among otherwise healthy adults.
      • Effectiveness is lowest among adults with significant underlying illness.
    • There is not consensus regarding the effectiveness of PPSV23 against non-invasive pneumococcal pneumonia.
    • Certain adults with significant underlying illness should also get the pneumococcal conjugate vaccine (PCV13), which has proven highly effective among children.
      • A large clinical trial is underway in the Netherlands that is studying the effectiveness of PCV13 against pneumococcal pneumonia among adults.
    • Adults at high risk for pneumococcal disease who haven’t gotten the vaccine yet should talk with their doctor about getting it now.
  • Tetanus and Tdap Vaccine Information
    • Tdap vaccine is recommended for adults aged 19 years and older to protect against tetanus, diphtheria, and pertussis (whooping cough).
    • Tdap vaccine is especially important for adults who will have close contact with infants less than 1 year old.
    • In addition, pregnant women are recommended Tdap vaccination during each pregnancy, preferably at 27 through 36 weeks’ gestation, to help protect their newborns from whooping cough.
      • Tdap vaccine can be safely given at any time during pregnancy, but is recommended during the third trimester to pass the most amount of protection to the baby.
    • Tetanus, diphtheria, and pertussis are all caused by bacteria.
      • Both diphtheria and pertussis are spread from person to person.
      • Tetanus enters the body through cuts, scratches, or wounds. • Provisional data report nearly 42,000 cases of pertussis during 2012, a nearly 60-year high.
    • Our current estimate is that Tdap vaccination protects 7 out of 10 people who receive it.
    • Since Tdap vaccines were only licensed in 2005, we don’t yet have results on long-term vaccine protection.  We’re still working to understand how that protection declines over time.
    • CDC is conducting an evaluation in collaboration with health departments in Washington and California to better understand how long Tdap vaccines protect from pertussis.  The data from these evaluations will help guide discussions on how best to use vaccines to control pertussis.
    • Adults who haven’t gotten a Tdap shot yet should talk to their doctor about getting it as soon as possible, no matter when they last got a tetanus (Td) booster.
    • After receiving the Tdap shot, adults should continue to get a Td booster every 10 years.
    • Adults need to get Tdap even if they were vaccinated as a child or have been sick with pertussis in the past; neither provides lifelong protection.
  • Hepatitis A Vaccine Information
    • Hepatitis A vaccine is recommended for adults who are working in or traveling to any area of the world outside of Canada, Western Europe and Scandinavia, Japan, New Zealand, and Australia.
    • Other adults that should get the vaccine include men who have sex with men, people who use illegal drugs, people who have clotting factor disorders, people with chronic liver disease, and people who might be exposed to hepatitis A on the job (such as those who work with hepatitis A virus in laboratory settings or with hepatitis A-infected primates).
    • Hepatitis A is caused by a virus and spreads primarily by oral contact with fecal matter, either through person-to-person or by contaminated food or water.
    • More than 95% of adults will develop immunity within one month of a single dose of hepatitis A vaccine, and nearly 100% will develop immunity after receiving two doses.
  • Hepatitis B Vaccine Information
    • Hepatitis B vaccination is recommended for adults at high risk of infection by sexual or blood exposure to hepatitis B virus.
    • People at high risk of sexual exposure include sex partners of people who are positive for Hepatitis B, people who’ve had more than one sex partner in the last six months, people seeking evaluation or treatment for a sexually transmitted disease, and men who have sex with men.
    • People at risk of blood exposure include current or recent injection-drug users, household contacts of people who are positive for Hepatitis B, residents and staff of facilities for the developmentally disabled, people with end stage renal disease, and some health-care and public safety workers.
    • Other groups at risk include international travelers to regions with high or intermediate levels of Hepatitis B infection and people with HIV infection.
    • Hepatitis B is caused by a virus and is spread from person to person primarily through blood or semen. • In healthy adults, the vaccine is 80% to 95% effective in preventing infection or clinical hepatitis in those who complete a hepatitis B vaccine series (usually 3 doses).
  • Herpes Zoster Vaccine Information
    • Herpes zoster (shingles) vaccine is recommended for adults aged 60 years and older.
    • Shingles occurs when latent varicella zoster (chickenpox) virus reactivates later in life.
    • Pain from shingles lesions, called post-herpetic neuralgia, can be very severe and last a year or more.
    • 50% of people who live until age 85 will develop shingles.
    • In people 60 years of age and older, the shingles vaccine:
      • Reduces the risk of shingles by about half (51%)
      • Reduces the risk of post-herpetic neuralgia (prolonged pain at the rash site) by 67%
    • The shingles vaccine is effective for at least six years but may last longer; research is being done in this area.
  • HPV Vaccine Information
    • HPV vaccine is recommended for routine vaccination of females and males at age 11 or 12 years.  Vaccination is also recommended for females 13-26 years of age and for males 13-21 years of age, if not previously vaccinated.  Males aged 22-26 years may be vaccinated.
    • HPV2 or HPV4 is recommended for females; HPV4 is recommended for males.
    • Men who have sex with men (MSM) may especially benefit from vaccination to prevent condyloma and anal cancer.  HPV4 is recommended for MSM through age 26 years who did not get any or all doses when they were younger.
    • HPV is a common virus that is primarily spread through sexual contact.
    • There are approximately 40 types of genital HPV.
      • Some types can cause cervical cancer and other kinds of cancer in both men and women.
      • Other types of HPV can cause genital warts in both males and females.
    • About 6 million people become infected with HPV each year.
    • Studies found vaccine efficacy of over 93% against disease due to HPV vaccine types if a female had not already been infected with that type.
    • HPV vaccine is not therapeutic and does not treat existing infection or disease.
    • Prior infection with one HPV type did not lessen the effectiveness of the vaccine against other vaccine HPV types.
    • There are 2 vaccines licensed by the Food and Drug Administration (FDA) and recommended by CDC to protect against HPV-related illness; these vaccines are Cervarix (made by GlaxoSmithKline) and Gardasil (made by Merck).
      • Both vaccines are very effective against HPV types 16 and 18, which cause most cervical cancers, so both vaccines prevent cervical cancer in women.
      • Only Gardasil protects against HPV types 6 and 11 – the types that cause most genital warts in females and males.
      • Only Gardasil has been tested and shown to protect against cancers of the vulva, vagina, and anus.
      • Only Gardasil has been tested and licensed for use in males.
  • Vaccine Safety
    • All vaccines used in the United States are required to go through years of extensive safety testing before they are licensed by the U.S. Food and Drug Administration (FDA).
    • FDA and CDC work with health-care providers throughout the United States to monitor the safety of vaccines, including for any adverse events, especially rare events not identified in pre-licensure study trials.
    • There are three systems used to monitor the safety of vaccines after they are licensed and being used in the U.S.
      • These systems can monitor side effects already known to be caused by vaccines as well as detect rare side effects that were not identified during a vaccine’s clinical trials.
      • One of the three systems used to monitor the safety of vaccines after they are licensed and used in the U.S. is called the Vaccine Adverse Event Reporting System (VAERS).
      • VAERS accepts reports from health professionals, vaccine manufacturers, and the general public and receives about 28,000 U.S. reports per year, compared with millions of vaccine doses given to adults.

By Trish Parnell