Zika Virus In The US

29 07 2016

We are all familiar with the word “Zika” because of the infections in Brazil.

The Florida Health Department and state officials have announced that they have identified four cases of Zika virus infection that were most likely transmitted locally. These cases are in Wynwood, an area just north of Miami

This is probably the first time that mosquito-borne transmission of Zika virus has happened in the continental US.mosquito

The CDC and Florida are saying “likely” and “probably” because, although they cannot yet prove these individuals were bitten by infected mosquitoes, there seems to be no other method of transmission in these cases, and the mosquito that carries the virus does live in the area.

However, this does not mean that the Zika virus will become widespread in the US.

The Zika virus is transmitted a few ways. The most common way for people to get the Zika virus is to be bitten by an infected Aedes species mosquito (Ae. aegypti and Ae. Albopictus).

This mosquito doesn’t like the climate in all parts of the US. Much of the northern area will not be at risk from this mode of transmission.

Also, this mosquito never travels more than 150 meters its entire life. That’s less than 1/10th of a mile. It usually travels far less than that distance.

The West Nile virus, on the other hand, was able to pretty much cover the US because the virus can be transmitted from an infected mosquito to a bird, which then flies off quite a distance before landing and getting bitten by a different mosquito, which then becomes infected. That mosquito, in turn, bites another bird. This cycle hopscotches its way across the US, spreading disease from bird to mosquito to bird to mosquito.

The mosquitoes also infect humans and other mammals with West Nile virus.

The mosquitoes that carry the Zika virus don’t work that way. They prefer to only bite humans.

Another reason the Zika virus will probably not explode across the US is because where the mosquito lives, people use screens across their windows and doorways, and they use air conditioning. It’s more difficult for the mosquito to get into the houses.

There are other ways for the Zika virus to be transmitted.

An infected pregnant woman can pass it to her fetus during pregnancy or around the time of birth.

An infected individual can pass the virus through sex with their partner. An infected person may or may not be symptomatic—they can still transmit the virus. It appears that four out of five infections are asymptomatic. One cannot assume that a person is virus-free just because they don’t seem to be sick.

An infected person may donate blood and the virus can then be passed through blood transfusions.

This virus is under a lot of scrutiny. New methods of transmission may be identified, but these are the primary methods at this time.

Now we have an idea of how it’s transmitted. What can we do about it?

Where pockets of infection have occurred, the state and local authorities have started aggressive mosquito control, including spraying and going door to door to alert residents to standing water. Mosquitoes love to lay eggs in standing water—making sure there is none helps to control the mosquito population.

We all need to prevent mosquito bites by using insect repellent containing DEET, wearing long sleeves and pants, and staying indoors unless covered and protected. This is particularly true for pregnant women, and for those living in areas where these mosquitoes are common.

For up-to-date info on Zika virus, visit http://www.cdc.gov/zika/





Flu And Pregnant You

21 07 2016

Pregnant women are harder hit by flu than women of the same age who are not pregnant. Their symptoms are usually more severe, there are more hospitalizations, and they’re at higher risk of premature delivery or even death.

Although the infection doesn’t travel from the woman to her fetus, if the mom-to-be is infected, her infection may indirectly hurt the fetus. pixabaybelly

A premature delivery may mean the baby is too small, or underdeveloped. It can even mean death for the baby. If fever is present, mom’s infection can also lead to an assortment of abnormalities in the baby.

Why is this? Well, we can’t say for sure.

Part of a pregnant woman’s immune system is changed, or weakened, during pregnancy. This happens so that the woman’s body won’t attack the fetus as a foreign invader.

This altered immune state may allow a flu virus to attack, causing harm to the pregnant woman.

It’s also possible that part of the immune response is actually boosted during pregnancy, causing an increase in inflammation in the lungs when a pregnant woman is infected with a flu virus.

This in turn may be causing the increase in death and illness found in some flu-infected pregnant women.

The fact that pregnant women’s organs are squished may also increase the risk of pneumonia or other problems. Also, because of the increased blood volume, a pregnant woman’s lungs are a little “wetter” and less capable of resisting a severe infection.

Could be, may, might — that’s not what we want to hear. We want definite reasons so that we can use definite means to prevent all of this.

Unfortunately, it’s just not that simple.

If you’re pregnant, be extra cautious when it comes to flu. Call your provider as soon as you have symptoms — early treatment makes a big difference.

Symptoms may include:
•    Fever
•    Chills
•    Fatigue
•    Cough or sore throat
•    Runny or stuffy nose
•    Muscle or body aches, headaches
•    Vomiting and diarrhea (although this is more common in children)

CDC recommends that if you are pregnant and have any of these signs, you should call 911 right away:
•    Difficulty breathing or shortness of breath
•    Pain or pressure in the chest or abdomen
•    Sudden dizziness
•    Confusion
•    Severe or persistent vomiting
•    High fever that is not responding to Tylenol® (or store brand equivalent)
•    Decreased or no movement of your baby

CDC recommends that individuals six months of age and older be immunized each year against flu.

Immunization and clean hands are the two best tools to prevent infection. Check with your healthcare provider to see about staying up-to-date on your immunizations.





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.





A Thoughtful Choice

17 04 2014

I remember lining up at school in the ‘60s to get vaccinated against smallpox and a few other diseases for which there were vaccines.

I also remember the years when my brothers and I took turns at getting measles, mumps and other diseases for which there were no vaccines.

In the end, we three were fortunate—no permanent harm from our maladies.

Fast-forward 30 years. My daughter was four months old when she was diagnosed with hepatitis B. She had not been vaccinated and subsequently developed a chronic infection.

It all sounds mundane when read as words on a screen. But in those early years, the heartache and anger I felt at having my daughter’s life so affected by something that was preventable . . . well, it was almost more than I could bear.

But again, we were fortunate. After years of infection, her body turned around and got control of the disease. Although we have bloodwork done every year to keep an eye on things, she has a good chance of living the rest of her life free of complications from this infection.

Over the years, I’ve met other parents whose children were affected by vaccine-preventable diseases. Some, like Kelly and Shannon, chose not to vaccinate their kids and ended up with horrible consequences. Kelly’s son Matthew was hospitalized for Hib and they came within a breath of losing him. Shannon did lose her daughter Abigale to pneumococcal disease, and almost lost her son. He recovered and was released from the hospital, at which time they had a funeral for their daughter.

Because of my job, I talk to and hear from many families with similar stories. Some children have died, some remain permanently affected, and some have managed to recover.

Also because of my job, I hear from parents who believe vaccines are not safe, and that natural infections are the safer choice. I understand and have experienced the emotions we as parents feel when something happens to our children. In a way, I was lucky. I knew exactly what caused my daughter’s problems. A simple test provided a definite diagnosis.

If we can’t identify the cause of our children’s pain or suffering, we feel like we can’t fix it and we can’t rest until we know the truth. When the cause can’t be found, we latch onto if onlys. What could we have done differently to keep our kids safe? If only we hadn’t taken her to grandpa’s when she didn’t feel good. If only we hadn’t vaccinated him on that particular day. If only. The problem is, the if onlys are guesses and no more reliable routes to the facts than playing Eenie Meenie Miney Mo.

The deeper I go into the world of infections and disease prevention, the more obvious it is to me that the only way to find the facts is to follow the science. Now granted, one study will pop up that refutes another, but I’ve learned that when multiple, replicable studies all reach the same conclusion, then I can safely say I’ve found the facts.

In our family, we vaccinate because for us, it is the thoughtful choice.

By Trish Parnell

Originally posted on Parents Who Protect





Pneumo – It’s All About the Numbers

3 03 2014

DDWhen we are immunized, we usually have to get several shots, or doses, before we’re protected against a disease.

Nearly all vaccine-preventable diseases require more than one dose of vaccine to provide us with a strong immune response. It’s not fun, but it’s better than fighting all those infections.

Last summer, an article in Pediatrics described a study which looked at the cost-effectiveness of removing a primary dose of 13-valent pneumococcal conjugate vaccine (PCV13).

This vaccine helps to prevent pneumococcal infections, which can mean anything from an ear infection to pneumonia to meningitis. It can be a dangerous and deadly infection.

Right now, this vaccine is a four-dose series. The first three doses are primary doses, and the fourth dose is a booster.

A primary dose “primes” the immune system, allowing our bodies to develop stronger immunity with each primary dose we receive. The booster dose is the last shove to get us over the top, helping our bodies to develop long-lasting immunity against a particular disease.

The study in Pediatrics was the topic of conversation at PKIDs for several weeks, and, while we were surprised that removing a dose was up for consideration (and you’ll see why in a minute), we thought it was probably more of an intellectual exercise than a course of action that our public health leaders in the US would take.

After all, our tradition in the US is to use all of the tools we have to protect our citizens and prevent infections.

Come to find out, this is more than an exercise in “what if.”

In February, I attended the Advisory Committee on Immunization Practices (ACIP) meeting in Atlanta.

(As noted on their website, the ACIP “is a group of medical and public health experts that develops recommendations on how to use vaccines to control diseases in the United States. The recommendations stand as public health advice that will lead to a reduction in the incidence of vaccine preventable diseases and an increase in the safe use of vaccines and related biological products.”)

Based on that meeting, it sounds like they’re looking at removing a primary dose as a real option.

This may give us an opportunity to save money—$400 to $500 million—but it’s not a risk-free deal. In order to save that money, we have to be willing to see harm come to a lot of people.

This flies in the face of what we, as health advocates, say every day to the folks we meet, which is: Get immunized! Use the safe and effective prevention tools available to protect yourself and your family from unnecessary infections.

It’s easier to make this kind of money-saving decision if the conversation is all about the numbers: the dollar amount saved, the numbers of increased cases of disease, the numbers of hospitalizations and deaths.

Numbers are easy to talk about because they’re not personal.

But this decision to remove a primary dose of vaccine is personal. The consequences will be felt by our people, our loved ones, our friends, and our neighbors. We can’t dehumanize this process by just talking about the numbers.

If the third primary dose is removed, an average of 2.5 more people will die each year. Who are those people? One could be my niece, Millie, who’s just learning to crawl. Another could be your grandson, who loves cheerios and bananas.

Forty-four more people will get invasive pneumococcal disease. My daughter could get meningitis, and your son could get a bloodstream infection.

Fifteen hundred more people will be hospitalized for pneumonia. When my oldest was a toddler, she was hospitalized for pneumonia. It’s a terrifying experience and one that I would not have anyone else go through, if possible.

An additional 10,000 of our friends and neighbors and loved ones will have to be treated for pneumonia as outpatients.

Twenty-three hundred more ear tubes will have to be inserted into the tiny ears of children that we know.

A staggering 261,000 more children will get earaches, fevers, and possibly ruptured eardrums.

All of this happens if we decide to save money and remove a primary dose of PCV13.

It’s all about the numbers. We just have to decide which numbers are more important to us as a nation—the dollar amounts or our people?

by Trish Parnell





Meningitis Outbreaks This Holiday Season

25 11 2013

What’s going on with meningitis at Princeton and UC Santa Barbara?

Both universities are experiencing an outbreak of meningitis—specifically, serogroup B (that’s the genetic fingerprint of the particular strain of meningitis).

In the US, we don’t have an approved vaccine against this serogroup or strain, but we do have vaccines that fight other strains of meningitis, such as C and Y. Those vaccines are working great!

We’re seeing more serogroup B infection right now because there’s no vaccine available in the US to control transmission. And, we’re seeing an outbreak because that just happens sometimes, particularly when there’s no vaccine to prevent it.

As of 25 November, there have been seven cases identified at Princeton, with a probable eighth case not yet formally identified. Three cases have been identified so far at UC Santa Barbara.

Some of the cases have been serious, but to date there are no deaths. Dr. Amanda Cohn, a pediatrician and expert in meningitis with the CDC, talked about these outbreaks today in a teleconference.

She said that while health departments and healthcare providers should be aware of symptoms and think about meningitis should they see indications, it is safe for the college kids to come home for the holidays.

CDC is not expecting transmission in the home. It tends to occur with very close contact (“french” kissing, sharing a room and coughing all over a roommate). Generally, you might get either meningococcal meningitis or meningococcal septicemia from a meningococcal infection.

Symptoms of meningococcal meningitis as noted by CDC include:

  • Sudden onset of fever
  • Headache (severe)
  • Stiff neck (hurts to move it)

Other symptoms might include:

  • Nausea
  • Vomiting
  • Photophobia (increased sensitivity to light)
  • Altered mental status (confusion)

The symptoms of meningococcal meningitis can appear quickly or over several days. Typically they develop within 3-7 days after exposure. This infection can be serious with long-term consequences such as hearing loss or brain damage, and it is at times fatal.

Symptoms of meningococcal septicemia may include:

  • Fatigue
  • Vomiting
  • Cold hands and feet
  • Cold chills
  • Severe aches or pain in the muscles, joints, chest or abdomen (belly)
  • Rapid breathing
  • Diarrhea
  • In the later stages, a dark purple rash

These symptoms can come on in a matter of hours and the infection is very dangerous.

Prevention means washing your hands and covering your coughs and sneezes. Get up-to-date on your immunizations (no matter your age) and know that, if a healthcare provider suspects someone in the home may have an infection, those in close contact will receive antibiotics to prevent the spread of the disease. There are some manufacturers working on vaccines that include serogroup B for approval in the US, but they are not yet at the final stages of development on those vaccines.





Sports and Infectious Diseases – Part 3 of 3

17 04 2013

Guidelines for Before, During and After Each Sports Event

The NCAA and NATA and other sports organizations carefully spell out the standards athletic organizers, including coaches, teachers and others, should follow before, during and after an 558354119_c856022b30athletic event.

Before the Event Begins

As part of the “pre-game” education program, NATA encourages trainers to:

  • Educate athletes about bloodborne pathogens.
  • Discuss the ethical and social issues related to bloodborne pathogens.
  • Review the importance of prevention programs, including standard precautions and immunizations.
  • Educate athletes about the signs and symptoms of hepatitis B [and hepatitis C] and HIV.

Make sure the athletes know the rules concerning standard precautions, including reporting all wounds immediately if and when they occur.  This is part of the coach or trainer’s critical pre-game education.

Before the opening whistle, cover all wounds, abrasions, cuts or weeping wounds that may serve as a source of bleeding or as a port of entry for bloodborne pathogens.  Remember, protection is a two-way street.  No one wants germs entering or exiting these wounds or abrasions. The “cover” or bandages should be able to withstand the demands of competition.

Wear protective equipment over high-risk areas where bruising commonly occurs, such as elbows or hands.

Make sure the necessary equipment and supplies needed to comply with standard precautions are available, including latex [or other non-permeable] gloves, biohazard containers, disinfectants, bleach solutions, antiseptics, containers for soiled equipment and uniforms and sharps containers.

During the Event

Underscore the importance of early recognition and control of any cuts or bruises that bleed.  Coaches and athletes alike should be prepared for appropriate cleaning and covering procedures and changing of blood-saturated clothes.

Require all athletes to report all wounds immediately.  Players with active bleeding should be removed from the event as soon as practical.  Return to play should be determined by appropriate staff.

All personnel involved with sports should be trained in basic first aid and infection control, including standard precautions:

  • They should use sterile latex [or other non-permeable] gloves for direct contact with blood or body fluids containing blood.
  • Gloves should be changed after treating each individual participant.  After glove removal, hands should be washed.
  • Any surface or equipment contaminated with spilled blood should be cleaned with gloves on.  The spill should be contained in as small an area as possible.  After the blood is removed, the surface should be cleaned with a disinfectant or decontaminant.
  • Proper disposal procedures should be practiced to prevent injuries caused by needles, scalpels and other sharp devices.
  • Any equipment or uniforms soiled with blood should be laundered in accordance with hygienic methods.

Any life-saving equipment should be maintained in accordance with infection control guidelines.

After the Event

When the game is over, any wounds, cuts, and abrasions should be tended to.

Coaches and athletic personnel should constantly review the level of knowledge and implementation of standard precautions policies and recommend revisions and retraining where necessary.

Appropriate policy development with legal and administrative assistance of existing OSHA (Occupational Safety and Health Administration) and other legal guidelines and conference or school rules and regulations should be considered on an as needed basis.

Medical Records and Confidentiality

While many experts feel an athlete should not have to “disclose” an infection to a coach, trainer or teacher, some athletes may decide personally to share information about a bloodborne viral infection.

The security, record-keeping and confidentiality requirements and concerns that relate to athletes’ medical records generally apply equally to those portions of athletes’ medical records.

Because social stigma is sometimes attached to individuals infected with HIV or viral hepatitis, athletic officials should pay particular care to the security, record-keeping and confidentiality requirements that govern the medical records for which they have a professional obligation to see, use, keep, interpret, record, update or otherwise handle.

An Infected Trainer, Teacher or Coach

A coach, teacher or trainer infected with a bloodborne pathogen should practice his or her profession while taking into account all professionally, medically and legally relevant issues raised by the infection.

Depending on individual circumstances, the infected coach, trainer or official must take reasonable steps to avoid potential and identifiable risks to his or her own health and the health of his or her team.

More information may be found at PKIDs’ Infectious Disease Workshop

Image courtesy of PShanks