Telling the School About Your Child’s Infection

12 03 2012

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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





Ask Emily

23 02 2012

Why does our skin break out in a rash with some viral infections like measles or Fifth disease?

These sorts of rashes are technically known as viral exanthems (the word derives from the Greek word “exanthema,” meaning “breaking out”).

The skin responds to infection with a rash for one of three reasons: the infectious agent releases a toxin that causes the rash, the infectious agent damages the skin and causes a rash, or the immune response results in the skin outbreak.

The skin responds in only a few ways to these challenges, although the pattern of the response can vary from virus to virus (bacteria and some other infectious organisms can also trigger a rash).

The response is the body’s attempt to deal with the presence of viral particles that find their way to the epidermis, or skin. In general, the upshot of the immune response is an area of inflammation. Because viruses cause a systemic or body-wide infection, viral rashes often cover much of the body.

Although the basic pathway to the rash is similar among viruses, the specific pattern of the rash can help distinguish the virus involved. For example, Fifth disease, so-named because it was the fifth virus in a series to be identified as causing a rash, produces a “slapped-cheek” ruddy appearance on the face and may cause a lacy, rather flat rash elsewhere on the body.

A measles rash, on the other hand, starts as an eruption of raised or flat spots behind the ears and around the hairline before spreading body-wide.

One thing to recognize is that not every rash is a viral rash or a benign viral rash, although most viral rashes will resolve on their own. Usually, a fever accompanies a viral rash. If a rash develops, you should be aware of the following warning signs that signal a call to your doctor:

  • If you suspect you have shingles. This highly uncomfortable rash tends to trace along the nerve routes under the skin but can spread out from those, as well. Starting antivirals within the first 24 hours may ward off a more intense recurrence or a permanent pain syndrome called postherpetic neuralgia.
  • If you suspect measles. Infection with this highly contagious virus should be reported immediately.
  • What you think is a rash from a severe allergic reaction or a rash that arises coincident with taking a new medication.
  • The rash accompanies a high fever, spreads rapidly, and starts to look like purple bruising. This pattern is indicative of meningitis.
  • Any rash involving a very high fever, pain, dizziness or fainting, difficulty breathing, or a very young child or that is painful.
  • Any rash that you find worrisome, including for reasons of persistence or timing with something such as exposure to infection, a new medication, or new food.

Do you have a question for Emily? Send it to: pkids@pkids.org

By Emily Willingham

Image courtesy of HowStuffWorks





Telling Our Kids They’re Infected With Hepatitis or HIV

16 01 2012

If hearing your child is infected with HIV or hepatitis B or C is the worst that can happen to a parent, telling your child about the infection runs a close second.

When should a parent disclose? How should they tell them? What will a child ask? Will they ever forgive the parents who infected them? Are silence and secrecy justified to protect a child from a painful diagnosis?

Two pioneers who have peered into the disclosure cauldron are Lori W. Wiener, coordinator of the Pediatric HIV Psycho-Social Support and Research Program at the National Institutes of Health, and Heidi Haiken, coordinator of Social Work at the Francois Xavier Bagnoud Center in Newark, N.J., an innovative program that works with parents and children with HIV.

For more than 10 years, Haiken and Wiener have worked with hundreds of families infected with and affected by HIV on the emotional and social issues related to the disease. Wiener, who has a PhD, has researched and written about the impact of disclosure on family members.

Their combined experiences have produced two cardinal rules for parents of children infected with chronic, viral infectious diseases:

  1. Never lie. You don’t have to name the disease if children are very young, but never, never lie. The damage to the parent-child relationship will surpass any short-lived benefits gained by deceit.
  2. Disclose as early as you can, especially once kids start asking questions. The longer you wait, the harder it gets and the greater your chance of undermining your child’s trust in you.

“We even tell parents who come to the center that if they don’t tell the kids by the time they reach sexual maturity, we will,” Haiken said. “But of course it’s much, much healthier to have this information come from the parents.”

Both women acknowledge that disclosing is very traumatic for parents. “For some parents, it’s just devastating,” said Haiken. “They feel guilt because they infected the child because of their past sexual behavior or drug use. They feel guilt that the child has to suffer. Even for parents of children who contracted it from transfusions or are adopted, disclosure is extremely difficult.”

Wiener, who has written several research papers on this topic, found the longer parents withheld the diagnosis, the more embedded the lies became and the harder it became to disclose the truth. “Parents often fear that once they disclose new and different information, that their child will no longer trust them,” she said. “Following disclosure, many of these children feel embarrassed that other people in their family have been aware of the diagnosis before they had been informed. Once disclosure takes place, these issues and feelings can be successfully dealt with in individual and group counseling sessions with parents and children.”

Haiken and other social workers at the center work hard to help parents work through their guilt, or at least face it without flinching, before they disclose.

“I tell them you didn’t mean for this to happen, it’s clear you never wanted to hurt your child, look at all the wonderful things you’ve done for your child,” said Haiken. “After a while they get there, they see it, but it’s still very difficult. No parent ever wants to infect her child. It’s something they felt they had no control over.”

In terms of disclosure, parents who are themselves living with HIV have additional challenges to face. They fear disclosing their own life-threatening disease to their children. But generally, says Wiener, by the time children reach ages 6 to 10, they realize the consequence and finality of death. It is useless to shield children this age from the knowledge that their parents have a serious or terminal illness.

The disclosure process, timetable and style are often dictated by the parents’ health. Can they focus on their kids and execute disclosure, or are their own health problems overwhelming? Are they getting the support and time they need or are their own medications, insurance forms and other factors too overwhelming?

“Foster or adoptive parents have the luxury of not having to worry about their own illnesses, so the emotional and financial stress on the entire family may not be as intense,” noted Haiken.

The journey to disclosure begins early, says Wiener. “The child and parent should first have a sense of trust—that is the highest priority.” Disclosure occurs little by little in age-appropriate ways as soon as a child can communicate. Just like talking about adoption, it’s always on the table, though not all the details or medical terms may be exposed just yet.

Ideally, when the parent discloses the conversation should go something like this, suggests Wiener.

“Do you remember when I told you that you had a germ in your blood? That’s why we have blood work done every year. (And) Do you remember I told you that you got the germ from blood? Well, that germ is a virus that is called HIV or hepatitis….”

“You see, the disclosure dialogue is a constant building process,” she said. “If the child asks why the parent didn’t tell them earlier, the parent needs to be able to say, ‘I never lied to you, I told you what was wrong, I just hadn’t told you name of the virus.”

It may take a child weeks, months or years to absorb the diagnosis. “Try to be where the child is at when they ask questions,” wrote Wiener. “Let the child know that no matter how difficult the subject matter, he or she can always ask questions or share feelings. Be careful, however, not to provide more information than the child wants or is prepared for. They may not be ready for a virology discussion.

“You never want to be in the position of telling a 12 year-old about his or her disease that you have never even referred to before,” she added. “That is my main concern in the disclosure process. We’ve interviewed a lot of children who have been disclosed to. Most felt they had been told at the right age and by the right person except those whose parents had a doctor tell them. Those were the only kids who remained upset about the disclosure process.”

At NIH, counselors work intensely with parents of HIV-infected children to prepare them for the disclosure discussion. Social workers even have parents write out what they will tell their children and then play the part of the child in role-play situations. Generally, parents should be prepared to answer the following questions, depending on the child’s age and development. (Some questions apply if the parent is infected also.)

Why did this happen to you?

Where did you get it from?

Are you going to die?

Am I the reason you got sick?

Who else in the family has it?

Why do I have it?

Why don’t (siblings) have it?

Am I going to die?

Will this hurt?

Who else knows I have this?

Who can I tell?

What will happen to me and (siblings)?

Can I get married?

Can I have children?

Here are some general guidelines Wiener has identified for parents to consider as they prepare for the disclosure discussion.

Where do you want to make the disclosure and who should be part of the discussion?  

“You don’t want to have a ton of people there, just those whom the child trusts and feels most comfortable with,” cautioned Wiener. “Try to anticipate the child’s response based on his or her emotional age and maturity. Be careful never to disclose when you’re angry, or during an argument. Have the discussion in a safe, comfortable environment.”

What is the most important message you want your child to walk away with from this discussion?  

Possibilities include: Nothing is going to change… I am just now giving you the name of the virus… We will always be there for you… I will never lie to you… Nothing you did caused this disease.

How exactly will you disclose the actual diagnosis?  

“We have parents write out how they’d like it to happen, and they always start out with, ‘Do you remember?’ Weave in pertinent aspects of the child’s life and pick up the threads of your past discussions about infections,” suggested Wiener. “Rehearse the questions and answers, including ‘How did I get it? Can I get married? Can I have kids? Who else knows about it?’”

If the diagnosis is to be kept secret, who else can the child talk to?  

“If parents tell a child not to tell anyone, the first thing a child will do is go tell someone,” said Wiener. “They’ll feel resentful if they have no one to talk to. Parents need to find others in the community for the child to talk to. If there isn’t anyone nearby and the child wants to tell his or her best friend, I would tell them to talk with me, the parent, first. I would explain that not everyone is as educated as we are, and it’s important that we make a plan and educate the friend about this infection first. After all, we don’t want anyone to treat us badly.”

Give child a journal or diary or a way to express their feelings about the infection.  

Encourage the child to use art or writing to express feelings. “If HIV had a face, what would it look like? Or start a discussion with, ‘If I had a million dollars, I would get rid of this virus. What would you do with a million dollars?’ Keep those discussions going,” Wiener suggested.

“It is usually not until days or weeks after disclosure that the child has the courage to ask more questions,” she added. However, after finally making the disclosure, some parents feel so relieved and so exhausted from the ordeal that they may not have the emotional energy to talk about it again. This blocks open communication at a time when sharing concerns about the disease and its impact on the family is most important.

Red flags to look for in a child following disclosure.  

These include difficulty sleeping, changes in appetite, withdrawal, ticks, new fears, mood changes, difficulty concentrating or hoarding things.

If you see any such problems, talk to your child and if necessary, seek help from a social worker or psychotherapist. Remember, disclosure is not a one-time event and a child needs constant reassurance that they did not cause the disease.

Don’t forget siblings in the disclosure process.

Whether or not a sibling is told depends on age, said Wiener. “If the sibling is close in age, I don’t make it a choice, the sibling must be told. But, I do give them a choice of whether the infected child tells the sibling or if the parents tell the sibling. You need to give the child a sense of control. Living with secrets in the home does not promote a healthy emotional climate. I try to minimize the amount of secrets or lying that’s going on. However, if there’s a medical procedure or if they’re on interferon which makes them grouchy, it’s important that siblings know why.”

Even after disclosure is made, the full reality of the diagnosis may not come about for years. “It may not be until someone dies, or they get sick for the first time or they can’t go to a party and drink like everyone else that the reality really sinks in,” said Wiener. “At that point, it becomes an emotional reality, not just an intellectual reality.”

Wiener finds most parents do feel relief after making disclosure. The burden of secrecy is lifted, and children who already intuitively know something is wrong often feel better after they are told of their diagnosis. Siblings, especially if they are older, are also relieved when the veil of secrecy is lifted.

“The demands of keeping the family secret is a heavy burden for a young sibling and may threaten healthy development,” Wiener wrote in a study of siblings of HIV-infected children. “As inquisitive peers begin asking siblings why their brother or sister is sick, it becomes increasingly difficult not to tell the secret. One 9-year-old girl describes: ‘I want to tell people. Right when I almost say it, I remember in my head I’m not allowed to.’”

Resentment of the special treatment given to the sick sibling may cause the healthy sibling to feel less loved, Wiener explained, particularly if no explanation for the preferential treatment is provided.

Heidi Haiken, who has worked with more than 400 HIV-infected kids, has found disclosure to be beneficial to parents and kids alike. “By and large, the kids do well and are glad they’ve been told,” she said.

But disclosure is just a step in the journey. Parents must be prepared to ask, probe and continue the dialogue about health safety, standard precautions, medical treatments, good nutrition and the fundamentals of safer sex with their infected children.

“In our program, we start teaching safer sex at age 10 to 13,” said Haiken. “We give out condoms, talk about masturbation and how to keep yourself and your partner safe. We don’t deny they’re sexual beings, we focus on how to be safe with it, how drugs and alcohol can make you do things that aren’t safe.”

That safer sex discussion is just one more elaboration on the discussion that began when parents tell their infected toddlers never to touch anyone’s “boo-boos.”

Most parents of infected children and teens don’t have a Heidi Haiken or Lori Wiener in their hometowns. And, they can’t count on local schools to teach standard precautions or to delve into the nitty gritty of safer sex procedures. Most parents must be open and honest as they continue these discussions, no matter how painful or awkward, throughout their children’s lives.

By PKIDs staff





Ask Emily

29 12 2011

Do cold viruses mutate, or are we simply encountering new viruses with each new infection?

If you’re in situations that expose you to frequent cold viruses, I’ve got some bad news for you. First, what we collectively call the “common cold” is a non-medical way of saying “general upper respiratory infection.” Those sniffles and coughs don’t trace to a single virus or even to a single group of viruses. In fact, more than 200 different viruses can cause what we think of as a cold, and they fall into various classes. The most common is the rhinovirus (rhino refers to the nose). These cause up to 40% of colds. The other two types are coronaviruses and respiratory syncytial virus, which is fairly harmless in healthy people but can be dangerous, particularly for premature infants. Coronaviruses made the news when one turned up as the culprit in the SARS outbreak earlier this decade.

Every time we encounter and do battle with one of these viruses, we develop immunity to that specific microbe. But there are another couple of hundred of them out there, waiting to get into our nasal passages with someone else’s cough or sneeze. In addition, it doesn’t take a lot of viral particles to cause an infection, so trace exposures can still lead to illness.

That’s not even the bad news, though. While people probably muse aloud every time they get the sniffles, wondering why scientists have yet to come up with a cure or a vaccine for the common cold, the fact is, a single vaccine is unlikely. Rhinoviruses, for example, are quite complex and mutate fairly rapidly, evading any immunity we’ve built up to previously encountered strains. In that way, it’s like influenza viruses, which reassort around the globe each year and usually turn up as different strains in each new season.

One thing is certain: You won’t get a cold virus just from being cold. You might be more susceptible to infection if you’re stressed or tired or have allergies.

Some people may think they have the flu, but the difference between an influenza virus infection and a cold virus infection is usually quite stark: a flu infection hits hard and fast, often within hours, with a high fever, extreme fatigue, chills, and possibly gastrointestinal involvement. A cold builds up more slowly, peaking after a few days, and fever is relatively uncommon.

Is there anything you can do to at least ease the symptoms of this incurable but usually benign blight on humanity?  Washing hands is one way to avoid picking up a nasty cold virus, but once symptoms develop, your options are limited. Antibiotics are useless against any viral infection. Vaporizers, fluids, some TLC, and time are your best weapons against riding out infection with any of the viruses that cause the common cold.

And go ahead and resign yourself to the idea that even when you’re over this one, new versions linger out there, waiting to find their way up your nose.

Do you have a question for Emily? Send it to: pkids@pkids.org

By Emily Willingham 





Antibiotics – Not Always Invited

17 11 2011

George Armelagos is an anthropologist (kind of like Apolo Ohno is a skater).

A few years ago, one of George’s students detected an antibiotic called tetracycline in the bone of an ancient Nubian. Both the student and George thought this was odd, since tetracycline had not come into common use until the 1950s.

George and his student, along with some of their colleagues, got busy and discovered that lots of Nubians, Egyptians, and others from the early years of the second period of the Gregorian calendar had detectable tetracycline in their bones.

Turns out, the antibiotic was consumed in the beer of the day.

George wrote up this find in Natural History Magazine. As for the beer . . .

The beer produced in ancient times, according to Barry Kemp, author of Ancient Egypt: Anatomy of a Civilization, was quite different from the modern commercial product: “It was probably an opaque liquid looking like a gruel or soup, not necessarily very alcoholic but highly nutritious. Its prominence in the Egyptian diet reflects its food value as much as the mildly pleasurable sensation that went with drinking it.”

Spores that produce tetracycline were inadvertently captured during the beer-brewing process and before they knew it, the ancients were slinging back antibiotics with their brewskies.

The old-timers might not have known how their beer came to be medicinal, but know it they did. George went on to write:

Given that the ancient Nubians and Egyptians were getting doses of tetracycline, another question is whether this afforded them any medical benefits. In Food: The Girl of Osiris, William J. Darby and coauthors provide archaeological, historical, and ethnographic accounts of beer’s use as a mouthwash to treat the gums, as an enema, as a vaginal douche, as a dressing for wounds, and as a fumigant to treat diseases of the anus (the dried remains of grains used in brewing are burned to produce a therapeutic smoke). This shows that even in the distant past, Egyptians and their neighbors appreciated beer’s medicinal qualities.

This sounds like a classic case of antibiotic overuse to me, and who knows? Maybe it was.

Overuse or misuse is certainly a concern these days. CDC is in the middle of Get Smart About Antibiotics Week, which is an international collaboration with the European Antibiotic Awareness Day and Canada′s Antibiotic Awareness Week.

Antibiotics are effective “against bacterial infections, certain fungal infections and some kinds of parasites.” They don’t do squat against viruses.

Misuse of antibiotics is a pervasive problem. For instance, if I take an antibiotic against a bacterial infection but I don’t take it long enough, the bacteria that survive become resistant to the antibiotic and can infect other people. The bacteria also reproduce and their offspring or clones are resistant.

When someone is infected with the resistant bacteria and he or she takes the same antibiotic I took (but didn’t finish), it may not work.

If this happens often enough, and it has, then we end up with a plethora of germs against which we have little or no defense.

It’s not a theory. It’s reality. It’s happening right now.

What can be done?

Healthcare professionals can stop giving antibiotics against viral infections and in other circumstances where the drug is not helpful.

We can stop asking for antibiotics. The healthcare professionals will know when we need them and when we don’t. Also, we must comply with the dosing instructions. We need to take the drug as directed and for as long as directed.

That’s about it. Pretty simple. But here’s hoping it’s not too late for scientists to come up with a new class of antibiotics that will allow us to have a do-over.

By Trish Parnell

Image courtesy of National Health Service





World Rabies Day – 28 September

26 09 2011

Anyone who’s read Old Yeller knows (spoiler alert!) what happens to the title dog in the book. In this day of vaccinations against rabies, though, many people don’t give rabies more than the thought required to take their pets to the vet.

Yet rabies is still around, present in many mammals, including raccoons, skunks, bats, and foxes, and contact with any infected animal can mean infection for you or an unvaccinated furry pet.

In fact, about 55,000 people still die every year from rabies, which translates into a death every 10 minutes.

To make people more aware of the continued threat and precautions to take, national and international health organizations have designated September 28, 2011, as World Rabies Day.

Rabies is a viral disease. The virus attacks the central nervous system—the brain and spinal cord—and eventually is fatal (although there are extremely rare cases of survival). Symptoms, according the Centers for Disease Control and Prevention, are non-specific in the beginning—a fever, a headache, a general feeling of being unwell. But eventually, they progress to neurological symptoms, including hallucinations, confusion, paralysis, difficulty swallowing, and hydrophobia (as the disease is called in Old Yeller). Once these symptoms are present, death is only days away.

Usually, rabies is transmitted through a bite, transferred via the saliva of the infected animal, although rarely it transfers through other routes, such as via the air or transplantation of infected organs. The virus itself triggers no symptoms for up to 12 weeks even as it multiplies and invades the brain and spinal cord. When symptoms finally show up, an infected organism dies within about seven days.

Vaccines against rabies are available for animals, but worldwide, dogs remain the most common source of rabies infection in people, and children are at greatest risk. Vaccination could reduce or eliminate this risk, and a goal of the World Rabies Day campaign is to ensure more widespread vaccination of dogs. Since the campaign began in 2007, 4.6 million dogs have been vaccinated thanks to awareness events. This year’s goal is to grow that number even more.

Vaccinations also exist for people, especially post-exposure vaccinations. They once had a dire reputation as painful shots administered in the stomach, but now they’re shots in the arm and no more painful than other vaccinations. These shots include a shot given the day of exposure followed by more shots in an arm muscle on days 3, 7, and 14, according to the CDC. However, there is a short window of time for these vaccines to be effective; they must be administered preferably within a day of exposure. For people who have already had rabies vaccinations, a briefer round of further shots is required.

What should you do if you think you’ve come into contact with a rabies-infected animal? The CDC has a few guidelines:

  • Consider the situation urgent but not an emergency. Get medical help as soon as you can.
  • Wash a wound immediately with soap and water, which decreases the chance of infection.
  • Get immediate medical attention for acute trauma from a wound before worrying about rabies infection.
  • Once immediate considerations are addressed, your doctor and the relevant health department will determine if you need vaccination.

Remember, above all, keep your pets vaccinated against rabies, and stay away from wild animals, especially those known to carry the virus. For more information, see the World Rabies Day website.

By Emily Willingham

Image courtesy of secad.ie





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