Childhood Diseases Reaching Out to Adults

16 12 2014

Angelina Jolie has chickenpox, and a passel of NHL players suffers at home with mumps. What’s going on?

Adults are getting knocked sideways by childhood illnesses because (1) when they were children, they missed one or more recommended vaccines, (2) there were no vaccines for certain diseases when they were young, or (3) the protection they received as children from vaccines is waning.

It’s also possible that a vaccine simply didn’t work for this or that person. It happens.

I was already an adult when the chickenpox vaccine first became available. A couple of years prior to the release of that vaccine, my little nephew became infected. He was miserable, and as his parents were out of town, I was the go-to person.

I bathed him in cool water to help bring down his temperature (does that really work?). I cuddled with him, and generally took care of him until his parents came home.

A couple of weeks later, my face erupted in what I thought were spectacularly huge pimples. They flattered my shiny new adult braces and first-ever pair of glasses.

I could not understand why I was breaking out, and then I remembered. My nephew.

I called my mom to see if I’d had chickenpox as a kid, and you already know the answer.

Well, that was a long time ago, and I can happily report my nephew and I had complete recoveries.

All this is to say that diseases lurk. It doesn’t matter how old or young we are, if we’re not protected, we’re open to infection. And, diseases from our childhood pose just as much risk to us as adults.

It takes one phone call or email to the healthcare provider’s office. Ask about all vaccine-preventable diseases, and where you are in your level of protection.

 

 

by Trish Parnell





Oops Not Acceptable!

5 08 2013

One of the many reasons our family likes to stay out of hospitals is to avoid nosocomial infections.  Those are infections you get while you’re in the hospital (not what sent you to the hospital in the first place).

And there are other reasons to steer clear of hospitals.  Do you recall the study in the April 2008 issue of Pediatrics that tells us one out of 15 hospitalized kids are harmed by hospital errors, including mix-ups of medicines, bad drug reactions and overdoses?

As parents, we ask of no one in particular and everyone in general:  What are we supposed to do?  We want to take our sick or hurt children to a place that will, at the bare minimum, do no harm, and in theory, do some good.  But the risks associated with a hospital stay are pretty serious.

The National Initiative for Children’s Healthcare Quality worked on a tool that helped investigators get a more accurate count of numbers of children harmed while in the hospital.  Prior to the use of this tool, the count of children harmed by hospital error was much lower because errors were supposed to be voluntarily reported, and we now know that wasn’t happening.

I can accept the fact that no one is perfect, but the bar for standard of care is pretty low.  As our children’s advocates, we have the responsibility to insist that bar be raised.

Hospital staff: please worry less about political fall-out and more about doing what you have to do to stop mistakes from occurring, or worse, reoccurring.  And strive for transparency – it will relieve unnecessary suspicion and mistrust on the part of patients and their families and will serve to keep everyone working toward an error-free environment.  Ask questions, involve the family in patient care, stay focused on the tasks at hand, and communicate thoroughly with those taking over your patients when shifts change.

Families: as much as possible, stay with your loved one in the hospital and ask questions about everything that is being done. If something doesn’t seem right, don’t be afraid to ask about it. If someone’s feathers get ruffled because you ask questions about what they’re doing, just remember: better that than a mistake.

 

By Trish Parnell





Sports and Infectious Diseases – Part 2 of 3

10 04 2013

bloodborneWhat risk does an athlete with a bloodborne pathogen pose?

The American Academy of Pediatrics tackled this difficult issue in December, 1999, with a policy statement on HIV and Other Bloodborne Viral Pathogens in the Athletic Setting.  In it, the Academy made clear, “Because of the low probability of transmission of their infection to other athletes, athletes infected with HIV, hepatitis B or hepatitis C should be allowed to participate in all sports.”

That participation, however, assumes all athletes and coaches will follow standard precautions to prevent and minimize exposure to bloodborne viruses.  The Academy tackled each infectious disease individually:

HIV: The risk of HIV infection via skin or mucous membrane exposure to blood or other infectious bodily fluids during sports participation is very low . . . such transmission appears to require, in addition to a portal of entry, prolonged exposure to large quantities of blood.  Transmission through intact skin has not been documented: no HIV infections occurred after 2,712 such exposures in 1 large prospective study.  Transmission of HIV in sports has not been documented.  One unsubstantiated report describes possible transmission during a collision between professional soccer players.

Hepatitis B: HBV [hepatitis B virus] is more easily transmitted via exposure to infected blood than is HIV . . . the risk of infection [is] greater if the blood [is] positive for HBV e antigen . . . transmission of infection by contamination of mucous membranes or broken skin with infected blood has been documented, but the magnitude of risk has not been quantified.

Although transmission of HBV is apparently rare in sports, 2 reports document such transmission.  An asymptomatic high school sumo wrestler who had a chronic infection transmitted HBV to other members of his team.  An epidemic of HBV infection occurred through unknown means among Swedish athletes participating in track finding (orienteering).  The epidemiologists concluded that the most likely route of infection was the use of water contaminated with infected blood to clean wounds caused by branches and thorns.

An effective way of preventing HBV transmission in the athletic setting is through immunization of athletes.  The American Academy of Pediatrics (AAP) recommends that all children and adolescents be immunized.  Clinicians and the staff of athletic programs should aggressively promote immunization.

Hepatitis C: Although the transmission risks of HCV infection are not completely understood, the risk of infection from percutaneous [through the skin] exposure to infected blood is estimated to be 10 times greater than that of HIV but lower than that of HBV.  Transmission via contamination of mucous membranes or broken skin also probably has a risk intermediate between that for blood infected with HIV and HBV.

“There is clearly no basis for excluding any student from sports if they are infected,” said Dr. Steven J. Anderson, who was chair of the Academy’s Committee on Sports Medicine and Fitness when it drafted the Academy’s policy, “and we should also try to protect the confidentiality of each athlete.”

Dr. Anderson, a pediatrics professor at the University of Washington and a team doctor for many high school athletic teams, ballet companies and the U.S. Olympic Diving Team, suggests students should have access to any sport, except boxing, which the Academy opposes for all youths because of its physical risks.

“I personally feel parents have no obligation to disclose the infectious status of their children to anyone,” said Dr. Anderson.  Strict compliance with standard precautions is critical for this open-embrace of all athletes, regardless of their infectious status.  Coaches and teachers must have a plan in place to handle blood spills, said Dr. Anderson, including latex [or non-permeable] gloves, occlusive dressings, appropriate sterilizing solutions, disposal bags and even a printed protocol for coaches, athletes and officials.

The following is an excerpt of a sample school policy, used by numerous public school districts and in compliance with ADA that addresses HIV infection:

“The privilege of participating in physical education classes, programs, competitive sports and recess is not conditional on a person’s HIV status.  School authorities will make reasonable accommodations to allow students living with HIV infection to participate in school-sponsored physical activities.

“All employees must consistently adhere to infection control guidelines in locker rooms and all play and athletic settings.  Rulebooks will reflect these guidelines.  First aid kits and standard precautions equipment must be on hand at every athletic event.

“All physical education teachers and athletic program staff will complete an approved first aid and injury prevention course that includes implementation of infection control guidelines.  Student orientation about safety on the playing field will include guidelines for avoiding HIV infection.”

In addition to the Academy, several sports and other health organizations have also weighed in on this issue.  According to the NCAA, National Football League (NFL) and World Health Organization, athletes with HIV should be permitted to participate in all competitive sports at all levels.

These organizations all endorse immunization against hepatitis B for all athletes.

The National Athletic Trainers’ Association (NATA) echoes Dr. Anderson’s suggestion that coaches, trainers, athletic directors, school officials and others take the lead in educating themselves, their teams, parents and their communities about the importance of effective disease prevention.

Trainers and coaches, they suggest, should provide the following information in age-appropriate terms to all participants before or during any competition :

  • The risk of transmission or infection during competition.
  • The risk of transmission or infection generally.
  • The availability of HIV testing (for teens and adults).
  • The availability of hepatitis B vaccination and testing (for parents, teens and adults).

“Athletic trainers who have educational program responsibility should extend educational efforts to include those, such as the athletes’ families and communities, who are directly or indirectly affected by the presence of bloodborne pathogens in athletic competitions,” the NATA stated in a position paper.

See PKIDs’ Infectious Disease Workshop for more information.

Photo courtesy of Lolie Smith





Airplane Cabins and Your Health

30 08 2012

Do you remember SARS (Severe Acute Respiratory Syndrome)? It popped up in China in 2002 and spread to more than 25 countries before we could blink.

PKIDs landed a group of disease prevention educators in China just as the world became aware of this outbreak that would rapidly become an epidemic. It was coincidence, of course. The trip had been planned for months.

But, our proximity to the SARS outbreak was a reminder to us of how efficient air travel is at spreading germs.

In 2009, there were 2.5 billion airline passengers and that number is expected to increase to 3.3 billion by 2014. That’s a lot of sneezing, coughing, and just plain touching of armrests, overheads, and other surfaces going on in small spaces.

Dr. Alexandra Mangili and Dr. Mark Gendreau wrote a piece for the Lancet in 2005 that talks about the mechanics of disease transmission in an airplane. It’s very good, if you have a few minutes to read it.

They explain air flow patterns and how much air is recirculated (50% and that’s through filters). Turns out, air does not flow the length of the plane, but rather in sections or pockets along the width of the plane. Still an efficient method of disease transmission for airborne and large droplet transmission, but not the only way germs are spread onboard.

According to the article, the most common infections on aircraft have been via the fecal-oral route through contaminated food, although that has diminished in the last few years, possibly due to prepackaged food products and more care in the prepping and handling of food.

Mosquitos, a common vector for diseases such as dengue and malaria, often hitch rides on airplanes. Mangili and Gendreau point out that, “Many cases of malaria occurring in and around airports all over the world in people who had not travelled to endemic areas, known as airport malaria, is evidence that malaria-carrying mosquitoes can be imported on aircraft.”

The cabins of airplanes cannot be thoroughly disinfected between flights. Many times, a plane lands, passengers disembark, and more passengers are seated within 30 minutes. Think of all the droplets of goo left behind that the cleaning crew cannot remove, and the many surfaces that can’t be disinfected.

Keeping one’s hands clean throughout the flight will go a long way toward preventing transmission, and staying up-to-date on your vaccinations for your home country and your destination. As for masks, the authors say, “Although masks play a crucial part in infection control in health care settings, their use is unproven in disease control within the aircraft cabin.” But they do recommend masking and isolating someone suspected of having SARS.

The CDC has quite a bit more to say about air travel and travelers’ health in general, if you’re looking for more details.

How do you prevent infections during air travel? What do you do to protect yourself? We’d love to hear! Please share your tips in the comment section.

By Trish Parnell
Image courtesy of WHO





Infected Kids and Sports

23 07 2012

While soccer, softball and gymnastics are a joyful rite of passage for many young children, athletic events carry a risk for all children, given the increased chance for mishaps, accidents and blood spills.

For parents of children with viral infectious diseases, including hepatitis B, hepatitis C and HIV/AIDS, these games often present a number of stressful issues.

  • What if my child is hurt and another child is exposed to his or her blood?
  • Should I tell the coach about my child’s infectious disease if it will spur him or her to practice standard (universal) precautions?
  • What if the coach or athletic director doesn’t know or practice standard precautions?
  • Should I attend every game in case there is an accident?
  • Should my child even be playing this sport?

The American Academy of Pediatrics tackled this difficult issue in December, 1999, with a policy statement on HIV and Other BloodBorne Viral Pathogens in the Athletic Setting. (This policy was reaffirmed in 2008.) In it, the Academy made clear, “Because of the low probability of transmission of their infection to other athletes, athletes infected with HIV, hepatitis B or hepatitis C should be allowed to participate in all sports.”

That participation, however, assumes all athletes and coaches will follow standard precautions to prevent and minimize exposure to bloodborne viruses.

The Academy tackled each infectious disease individually.

HIV/AIDS: The risk of HIV infection through skin or mucous membrane exposure to infected blood or other infectious bodily fluids during sports events is very low. The Academy found the risk from damaged skin or mucous membrane exposure was one in 1,007 exposures or 0.1 percent.

Hepatitis B: While hepatitis B is more easily transmitted through exposure to infected blood than HIV, the Academy found only two documented sports transmission. A high school sumo wrestler with chronic hepatitis B was found to have transmitted the infection to a team member. Wrestling is the only sport that raised concern because herpes, impetigo and measles have been transmitted through skin-to-skin contact. However, there is no risk of bloodborne pathogens being contracted through wrestling, the Academy found.

An outbreak of hepatitis B occurred within an outdoor orienteering team in Sweden. Doctors believe the team members used a common cup of warm water to clean wounds caused by branches and thorns.

Hepatitis C: The risk of transmission is greater than for HIV but less than with hepatitis B. The Academy reported no documented cases of transmission in sports.

“There is clearly no basis for excluding any student from sports if they are infected,” said Dr. Steven J. Anderson, who was chair of the Academy’s Committee on Sports Medicine and Fitness when it drafted the Academy’s policy, “and we should also try to protect the confidentiality of each athlete.”

Dr. Anderson, a pediatrics professor at the University of Washington and a team doctor for many high school athletic teams, ballet companies and the U.S. Olympic Diving Team, suggests children should have access to any sport, except boxing, which the Academy opposes for all youths because of its physical risks.

Pediatricians can avoid reporting a student’s infection, the Academy noted, by making it clear on any participation forms that they support the Academy’s position that all students can participate in all sports and that pediatricians must respect an athlete’s right to confidentiality.

“I personally feel parents have no obligation to disclose the infectious status of their children to anyone,” said Dr. Anderson, “that includes their own physicians! While that may seem wrong, it is felt that if standard precautions are used for blood contact or contamination, the risk of contagion is adequately reduced.”

But strict compliance with standard precautions is critical for this open-embrace of all athletes, regardless of their infectious status. “As a parent, I would make sure that there is a plan in place to handle blood spills,” said Dr. Anderson, “including latex gloves, occlusive dressings, appropriate sterilizing solutions, disposal bags and event a printed protocol for coaches, athletes and officials.

“If standard precautions are not followed, I would recommend that the coaches or instructors are queried as to their familiarity with the precautions,” he added. “If they are not familiar with or following procedures, a higher up source needs to be consulted, such as a league office or school administrator.”

Parents should also contact the school or athletic league’s physician so he or she can also act as an advocate to ensure the coaches comply with the department or organization’s safety procedures.

But the Academy’s policy may not lessen the stress some parents feel when their very young children approach a soccer field for the first time. “When children are young, parents should educate their children about the dangers of blood contact,” said Dr. Anderson. “Despite the trauma that can accompany free play, I don’t hear of too many cases where two or more bleeding children mix their blood. I would also hope that an adult would be present when children are playing and would be consulted if there were an injury.”

Dr. Anderson feels it is not necessary to disclose a child’s infectious status to a coach. “Given the low risk of infecting other children, and the high risk of being shunned or ostracized. However, I think a responsible parent would be adamant about standard precautions being in place and followed. I supposed an astute coach might make inferences if a particular parent was a zealot about blood contamination. I would read that as a message that their child was infected and that they wanted their child to participate without creating a risk for others.”

Even when a child has an HIV infection, disclosure is not a requirement, explained Dr. Anderson, stating his personal opinion. “However, if a coach is educated about the risks, the necessary precautions and can be trusted to maintain confidentiality, disclosure may be appropriate. Unfortunately, most youth sports coaches are parent volunteers, non-professionals and are unlikely to have a long-term relationship with the athlete. In such cases, I recommend that standard precautions be followed.”

Dr. Anderson contends active contact sports, such as football, are also not off limits to athletes with infectious viral hepatitis. “However, students with infectious hepatitis A (spread through close physical contact with contaminated food, water or skin) or with liver or spleen enlargement should be restricted from contact or collision sports until the liver or spleen has returned to normal size,” he added, “and the person is no longer contagious.”

One mother whose son has hepatitis B commented, “I used to worry about my son infecting other children, but eventually I decided to make sports decisions based on what my kids risked catching from others.”

This post originates from PKIDs’ website.

Image courtesy of Rugby Pioneers





The end in sight – eliminating seven diseases plaguing half a billion kids

5 04 2012

(Welcome to End7. Thank you for sharing information about your work through this guest post!)

Moms and Dads from every country want one thing; healthy kids.  That’s why groups like PKIDs form—to help educate parents and the general public about specific diseases and to provide families with the support they need.

While the languages, food and clothes may be quite different for some of the kids we work with, we have a lot in common with PKIDs. Unfortunately, for families living in the poorest communities in the world, there is little in the way of support networks or treatment programs for children and adults who have neglected tropical diseases—or NTDs.

NTDs are a group of parasitic and bacterial diseases that infect half a billion kids around the world, most coming from families living on less than a $1.25 a day. These kids don’t always have shoes or clean water, which is a problem since they can get NTDs just by doing the things that kids love to do—playing, swimming and other daily activities.

When kids get sick with NTDs like hookworm, whipworm and roundworm, parasitic worms grow in their stomachs, robbing them of food and energy and making them too weak to pay attention in school. For those who live near water sources, flies may carry a disease called River Blindness, which causes rashes and severe itching and can eventually lead to blindness. These NTDs disable and debilitate their victims, keeping children out of school and preventing parents from working. They take away any chance that families have of lifting themselves out of poverty.

But this is a major global health issue that actually has a simple, cost-effective solution.  It costs just 50 cents for a packet of pills that treats and protects a child for a year. Since the drugs are donated by major pharmaceutical companies, we just need the funds to get them to the people that need them most and set up treatment and education programs that communities can run themselves.  Even better, the medicine is so easy to administer that communities don’t even need medical professionals—who are often in very short supply in developing countries—to administer them to sick kids.  The medicine can be dispensed right in schools or community centers.

The END7 campaign is working to raise awareness and donations in order to actually eliminate seven of these NTDs by 2020—the WHO said it could be done and we accepted the challenge.

To learn more about NTDs and to join the movement to eliminate them, visit our campaign on  Facebook and tell your friends to do the same. We need help in taking the “neglected” out of NTDs and that starts with you.

Together we can see the end.

By Mara Veraar, Social Media Officer at Sabin

Image courtesy of Esther Havens





Contact Sports and Skin Infections

6 02 2012

(Welcome to guest blogger Rebecca Kreston, MSPH and thanks, Rebecca, for sharing this post from your blog: bodyhorrors!)

In honor of one of the most lucrative American events that happened just yesterday, I thought I’d explore sports and infectious diseases. Specifically, contact sports and skin infections!

Since starting this blog, I’ve gathered that readers just love reading about transmissible skin infections, so what could be better than watching the Super Bowl and knowing just exactly what kind of diseases could possibly be smeared between the players of the Patriots and Giants?

There is a glut of infectious diseases that one can acquire from dabbling in combat or contact sports such as American or Aussie-style football, rugby, wrestling, and sumo. In fact, skin infections are the most common injury associated with all sports (1). All that body bashing and face-to-face smearing in contact sports does wonders for spreading skin or cutaneous infections. A number of these ailments are common to us non-athletic mortals—athlete’s foot, jock rash and ringworm (or tinea corporis). Two diseases in particular, with the marvelous potential to initiate larger epidemics within and beyond the locker room, form the focus of this article.

Herpes gladiatorum is a wonderfully evocative name used to describe an athlete’s infection with herpes simplex virus 1 (HVS-1), a terribly contagious virus that many have the misfortune of being acquainted with; it’s estimated that 65% of people will become infected with the virus by the time they reach their 40s (2). Symptoms can include painful, blistery cold sores on the face and neck, along with a sore throat, infected lymph nodes and malaise.

It’s a tricky little bugger of a virus. It can remain dormant, hiding away in nerve cells known as sensory ganglia, only to spring out on one’s face or genitals during periods of physical or emotional stress or, say, when you’re sunbathing in tropical locales on vacation. It has an uncanny sense of knowing when to erupt at the most inappropriate of times, though I’ve been unable to track down any research examining the molecular basis of how it goes about conducting this remarkable mechanism.

Most people rightfully assume that HSV-1 infection is a rather personal, intimate matter: we hear about transmission between a mother and her child, between romancing couples and so on. This makes sense considering that it’s spread by respiratory droplets or direct contact with infected lesions; you’ve really got to get up close and personal in someone’s face if you want to get a sense of what HSV-1 infection feels like (2). But given social situations with a generous amount of skin-to-skin contact with many individuals—sports, for instance—the virus will happily engage in a bit of unplanned host-hopping. As such, it has a frustrating tendency to erupt into outbreaks in sports team and during competitions.

Many athletes may sport micro-abrasions and skin breaks stemming from turf burns, powerful body-to-body collisions, facial stubble or beard burn, and shaving. Depending upon the level of protective clothing and gear, these athletes can experience substantial exposure with their opponent’s infected HSV-1 lesions, not to mention the respiratory droplets, spit and mucus that may transmit other types of infections. Charming! Among teammates, a grab-bag of infections can also be spread by sharing towels, water bottles, clothing, equipment, and hygiene and cosmetic products.

HSV-1 is considered to be particularly endemic in rugby players due to the style of the sport and the lack of protective gear (3). Its rampant presence in rugby leagues has earned it the moniker “herpes rugbiorum” or “scrum pox” (“scrum strep”, caused by the bacterium Streptococcus pyogenes, can also plague rugby players).

In rugby, the “scrum” is a type of huddle maneuver used to return the ball into play. It is a sensational way to spread HSV-1: players in the forward position interlock their heads with their opponents in facing rows before the ball is launched between them. These forwards are the most likely of their teammates to contract scrum pox due to their prominent role in scrums and the increased prospect of serious face-to-face contact. The fact that rugby players do not use protective gear, including helmets, exposes a greater part of their body to physical contact and further increases their risk.

HSV-1 regularly rears its ulcerous face on wrestlers as well. A research group checking serum samples from wrestlers to determine previous HSV 1 exposure found that 29.8% of college wrestlers had reported previous HSV infection (4).

The level of intimacy required in grappling almost makes it inevitable that something is going to be transmitted between two athletes, whether that be sweat, saliva or HSV-1. Indeed, in a 1989 outbreak in high-school wrestling camp for boys, 34% of participants were diagnosed with HSV-1 (5). Lesions commonly appeared on regions of the body most likely to encounter direct skin-to-skin contact with their opponents – 73% on the head, 42% on the extremities and 28% on the trunk of the body.

How do you tell if a wrestler is right or left-handed? Check which side of their face, head, neck and arms has the greatest amount of lesions. Athletes will tend to prominently use the most powerful sides of their body, regardless of which sport, and it will be this side that can receive the greatest amount of skin-to-skin contact with opponents.

Getting a touch of HSV-1 and sharing it with your teammates may be the least of an athlete’s problems. In 2003, a ghastly outbreak of methicillin-resistant Staphylococcus aureus (MRSA) emerged during a college football camp in Connecticut (6). Ten players were infected, of whom two required hospitalization. The infection was discovered to have spread due to the combination of body shaving and turf burns from the artificial grass. Infections were most commonly located at the elbow, thigh, hip, chin, forearm and knee, parts of the body most likely to incur abrasions on the turf. Those players with turf burns had a seven-fold risk of acquiring MRSA infection than those who emerged from scrimmage and active play unscathed (6). Cornerbacks and wide receivers were particularly susceptible due to their frequent body contact during drills and scrimmage play.

A quick browse through the research literature pulls up dozens of MRSA outbreaks like this. In 2002, two college football players in Los Angeles were hospitalized due to MRSA infection (7). A one-year surveillance of a football team at an unnamed major university in the southeastern United States found that 19% of the players showed evidence of nasal colonization of the bacteria at the end of the football season; though the high prevalence of MRSA among these men did not yield any active skin and soft tissue infections, it goes to show how endemic of a problem this really is (8). In 2007, six football players on a Brooklyn high school football team showed evidence of MRSA skin and soft tissue infection; the players had just recently returned from a preseason training camp (9). The infections were serious enough that they generated abscesses requiring surgical incision and drainage.

MRSA colonization of football players is apparently becoming so commonplace that some researchers have suggested using them as human sentinels for public health surveillance of outbreaks within the surrounding community (10). It is regrettably becoming a rather conventional type of emerging infection in athletes.

These infections aren’t just unseemly looking but can be disfiguring, have long-lasting effects within the body and can temporarily disqualify an athlete from practice and competition to prevent localized outbreaks. Hell, some of them can kill ya! These outbreaks can ruin seasons for the team while for salaried athletes, these kinds of infections have serious economic, professional and personal repercussions. Medical professionals recommend that players abstain from play until they’ve started antiviral medications or antibiotics, they are free of systemic symptoms – fever, malaise and lymph node swelling – and until any moist lesions have subsided. Seems reasonable, no?

Infectious diseases are always context specific and spread through particular practices. In the case of contact sports, there are several variables at play that help to spread some nasty infections. While there isn’t a lot we can do about changing how a sport is played (or can we?), coaches and referees can keep an eye out for athletes who seem ill or are showing visible evidence of infection. Fighting against poor hygiene practices and ensuring that wounds are cleaned and dressed immediately can also keep these kinds of sticky situations in line. Game on!

RESOURCES
A mission statement and guidelines on how to deal with herpes gladiatorum from the Sports Medicine Advisory Committee at the National Federation of State High School Associations.
Wrestlers filed a “herpes lawsuit” in 2008 against their coach and trainer holding them responsible for a localized HSV-1 outbreak.
In 2008, researchers discovered a unique herpes strain that only affects sumo wrestlers.

REFERENCES
1. BB Adams. (2010) Skin Infections in Athletes. Expert Rev Dermatol. 5(5): 567-577
2. R Sharma et al. (2011) Herpes Simplex in Emergency Medicine. Accessed online on Feb 2, 2012. Link.
3. BB Adams. (2000) Transmission of cutaneous infections in athletes. Br J Sports Med. 34(6): 413–414
4. B.J. Anderson (2008) Managing Herpes Gladiatorum Outbreaks in Competitive Wrestling: The 2007 Minnesota Experience. Curr Sports Med Rep. 7(6): 323-7
5. Belongia EA, Goodman JL, Holland EJ, et al. (1991) An outbreak of herpes gladiatorum at a high-school wrestling camp. N Engl J Med. 325(13): 906-10
6. EM Begier et al. (2004) A High-Morbidity Outbreak of Methicillin-Resistant Staphylococcus aureus among Players on a College Football Team, Facilitated by Cosmetic Body Shaving and Turf Burns. Clin Infect Dis. 39(10): 1446-1453
7. DM Nguyen et al. (2005) Recurring Methicillin-resistant Staphylococcus aureus Infections in a Football Team Emerg Infect Dis. 11(4): 526-32
8. CB Creech (2010) One-year surveillance of methicillin-resistant Staphylococcus aureus nasal colonization and skin and soft tissue infections in collegiate athletes. Arch Pediatr Adolesc Med. 164(7): 615-20
9. Centers for Disease Control & Prevention (CDC). (2009) Methicillin-resistant Staphylococcus aureus among players on a high school football team–New York City, 2007. MMWR Morb Mortal Wkly Rep. 58(3): 52-5
10. B Barr, M Felkner & PM Diamond. (2006) High school athletic departments as sentinel surveillance sites for community-associated methicillin-resistant staphylococcal infections. Tex Med. 102(4):56-61





Safer Sex (We Hope)

19 01 2012

Warning: This article contains explicit sexual information. It has been adapted from a piece written for PKIDs’ Pediatric Hepatitis Report. We encourage young people to talk with their parents and healthcare providers about safer sex and abstinence before becoming sexually active. The methods of disease prevention described in this post are not guaranteed to work. You may practice safer sex and still acquire an STD.

Anyone can become infected with a sexually transmitted disease (STD). CDC estimates that 19 million new infections occur each year, almost half of them among young people ages 15 to 24.

Many people are unaware they have an infection. Some diseases that can be transmitted sexually may also be transmitted during the birthing process, or through a blood transfusion. You may be living with hepatitis B or herpes or human papilloma virus (HPV) and not know it.

For maximum prevention, teens and adults should either abstain from sex or always practice “safer sex,” although abstinence is the more sure method of STD prevention.

What Is Safer Sex?

Safer sex means taking action to make sure no one gets their partner’s blood, semen or vaginal fluids in their body. Similarly, safer sex means you make sure your own body fluids don’t enter your partner.

With safer sex, no body fluids enter a vagina, anus or mouth (during vaginal, anal or oral intercourse) or come into contact with mucous membranes, such as around the eyes, gums, or nostrils.

The best way to prevent body fluids from reaching someone during intercourse is to use a condom. A condom is a sheath that fits over the penis. It can be made of latex (the safest condom available), plastic or animal tissue. It is also called a rubber, safe or jimmy.

Today, nearly as many women as men buy and carry condoms. It catches a man’s semen before, during and after he ejaculates. Some condoms have a nipple-shaped tip to hold the semen so it does not spill out.

Experts consistently recommend latex because some animal tissue, such as lambskin, has pores small enough for sexually transmitted viruses or bacteria to pass through. Polyurethane condoms break more often than latex.

A study cited by Planned Parenthood observed heterosexual couples where one partner was HIV-infected and the other was not for an average of 20 months. It found:

  • None of the uninfected partners among the 124 couples who used condoms consistently and correctly for vaginal or anal intercourse became infected with HIV.
  • About 10 percent of the uninfected partners (12 of 121) became infected when condoms were used inconsistently for vaginal or anal intercourse.
  • Of the 121 couples that used condoms inconsistently, 61 used condoms for at least half of their sexual contacts and 60 rarely or never used condoms. The rate of infection was 10.3 percent for the couples using condoms inconsistently and 15 percent for couples not using condoms.

In short, nothing guards against STDs like a latex condom and other safer sex practices. Spermicidal foams and jellies, diaphragms, implants and other devices do not block body fluids and may not kill all of the harmful bacteria and viruses in your partner’s secretions.

The female condom fits inside the vagina like the diaphragm and also covers the vulva. It is a pouch with flexible rings that is inserted into the vagina. It has the advantage of not requiring a man to maintain an erection during use. Although it is not as effective as the male condom, the female condom is an option for women who want some protection against viral hepatitis, STDs and unintended pregnancies.

The birth control pill, IUDs, vasectomies, tubal sterilizations and other methods of birth control offer great protection against pregnancy, but no protection against STDs. Many people use latex condoms along with these birth control methods for the best protection against both pregnancy and sexually transmitted infections.

Even Oral Sex Requires a Condom

Oral sex may not get one pregnant, but it can still transmit disease.

It is safer to put a condom on the penis before beginning oral sex to guard against secretions that may carry infection. It is important not to get secretions or semen in the mouth. A sore throat or small cuts on the gums may serve as entryways for viruses.

Vaginal secretions can also carry viruses, especially if a woman is having her period. Latex condoms can be cut with a scissors up the middle for oral sex on the vulva or anus. Latex dams or squares, which are thicker than plastic wrap and more likely to resist tearing, may be used. Latex gloves also provide STD protection.

Proper Use of Condoms

A condom just might save a life, and should be treated like the valuable tool it is. Store condoms in a cool, dry place. Long exposure to air, heat or light makes them more breakable. Do not store them continually in a back pocket, wallet, purse or glove compartment.

Check the expiration date to make sure the condom is fresh and safe. Throw away condoms that have expired, been exposed to heat, carried around in a wallet, or washed in the washer or dried in the dryer. If they appear dry, stiff or sticky, toss them. If there are any doubts about a condom, buy a new one.

Condoms usually come rolled into a ring shape. They are individually sealed in aluminum foil or plastic. When opening the condom package, do it carefully to avoid tearing the condom.

To minimize mistakes, both partners should know how to put on and use a condom. Planned Parenthood Federation recommends learning in a safe place free of pressure or frustration. Practice on one’s own penis or on a penis-shaped object like a ketchup bottle, banana or cucumber.

To ensure maximum protection, never use a condom twice and always put a new condom on an erect penis before there’s any genital, anal or oral contact.

If intercourse has already begun, pulling out and putting on a condom right before ejaculation may be too late for protection against STDs and pregnancy.

The male should put on a condom as early as possible at the very beginning of sex play rather than waiting until his partner is ready for penetration. It’s also a good idea to have extra, new condoms around in case a condom is put on too soon or if he loses his erection.

A condom is like a sock, with a right and wrong side. First, unroll it about half an inch to see in which direction it is unrolling. Then put it on. If a male has not been circumcised, pull the foreskin back first. It should unroll easily down the penis. If it starts off on the wrong side, try again with a new condom. Don’t be afraid to practice ahead of time.

Hold the tip of the condom gently between the fingers as it rolls down. This keeps out air bubbles or pockets that can increase the chance of a condom breaking. It also leaves space at the end for the semen. Roll the condom down as far as it will go.

Anal intercourse increases the chance of STDs tremendously, because there can be small tears or bruises in the anus during sex, which makes one tremendously vulnerable to bloodborne infections like viral hepatitis and HIV.

For anal intercourse, lots of lubrication is helpful. Using a water-based lubricant is also helpful for vaginal intercourse. The lubricant goes on after the condom is put on, not before, or else it could allow the condom to slip off easily. Add more lubrication often. Dry condoms break more easily than properly-lubricated ones.

Using lubricant will make things go smoother and give added protection. Lubrication is especially helpful for women when they have intercourse for the first time, or if there is a tendency for soreness.

Always use a water-based lubricant (such as KY Jelly, Astroglide, Aqua Lube, Wet, Foreplay, or Probe) because oil breaks latex. Don’t use vaseline, hand creams or lotions as a lubricant. Also, treatments for yeast infections may contain oil and may break latex.

After ejaculation, hold the condom at the bottom of the penis so it doesn’t slip off. Try to pull out while still erect or hard. The condom comes off only after the penis is completely out of the partner.

Use a condom only once.

Never use the same condom for vaginal and anal intercourse.

Talk Contraception Before the Heat of the Moment

It may be embarrassing to talk to a partner about contraception and condoms, but it’s essential, and should be done before a sexual situation begins. Don’t wait until the heat of passion takes over. It can overwhelm good intentions.

Be honest about feelings and needs. Silence is not a virtue in this situation. Talking about condoms will make it easier for both partners. It can help create a relaxed mood and make sex even more enjoyable and safe.

Embarrassment should not become a health risk and increase chances of infection. It’s important for partners to be open and share health concerns and sexual health history.

By PKIDs staff





Fifth Disease? What About Third or Fourth?

21 07 2011

Last summer, PKIDs’ advice nurse, Dr. Mary Beth, explained what fifth disease is: a viral rash that is tricky to contain because by the time you get the rash, you’re already through the contagious stage.

The rash itself is not painful and most children get through it without any problems, although adults may experience joint pain with this infection.

If a pregnant woman catches it, there is a small risk that the unborn baby will have severe anemia and the woman may have a miscarriage.

It’s also worse for people with sickle cell disease. Their red blood cells can get dangerously depleted during a bout with fifth disease.

Why is this condition known by a number instead of a real name? The vernacular term “slapped cheek syndrome” isn’t too endearing; neither is its scientific moniker, “erythema infectiosum,”  nor “parvovirus B19,” the name of the organism that causes it.

Even “variola” has a certain melodic ring to it, and that (smallpox) was the Chuck Norris of infectious disease.

It turns out that, by old tradition, several of the rashy illnesses of childhood were known by numbers:

  • First disease was measles
  • Second disease was scarlet fever, caused by the same bacterium that causes strep throat
  • Third disease was rubella
  • Fourth was Duke’s disease, which is not a defined disease today
  • Fifth, our friend erythema infectiosum
  • Sixth, roseola—which sounds a lot like rubella and rubeola—is actually caused by a couple of strains of herpes viruses

It seems that, just like squirrels are said to be rats with good PR, the names of the other diseases were relatively euphonious compared to “erythema infectiosum,” and so the rather anonymous “fifth disease” was the name that stuck.

Frankly, the whole rubella-rubeola-roseola conglomerate might be easier to keep straight if each of those diseases were still referred to by number. Maybe it’s time fifth disease got the charming name it’s never had. How about . . . slappacheeka? Rosella? Gwendolyn?

By Ms. Health Department

Image courtesy of http://healthpictures.in/





Yuck, Gross, Ick

20 10 2008

Charles Gerba is the high priest of germ detection.  Until he came along with his environmental studies, we all thought eating at our desks had to be one of the most germ-free dining experiences we could have.  Turns out, we were very, very wrong.

The average office is teeming with germs and boasts hundreds of times more bacteria than (here it comes) a toilet seat.  And, if you think your area is safe because you’re a health nut and use hand sanitizers on everything, think again.  Gerba found that bacteria in one filthy office area will just multiply and crawl right over to its next-door neighbor.  Blech!

All the surfaces that are for common use, such as the elevator button, the enter and send buttons on the fax machine, and the restroom door handles are party central for germs.

All you teachers out there, your offices have the highest germ count per square inch and, good news for you lawyers, your offices have the lowest count. 

Well then, are we doomed?  Have we no options?  Oh, there’s hope.  We can fight back.  Simple things like washing hands (15-20 seconds, warm water, and use a paper towel to turn off the faucet and open the restroom door), either not shaking hands with walking cold factories or using sanitizer after, wiping keyboards and other equipment down with a sanitizer, and keeping your hands off your face.  Germs love to move from your hands to your mucous membranes, which are around the eyeballs and inside the mouth and nose.  Don’t do it! 

All these steps will help keep infections where they belong – somewhere else!

Finally, in the interest of public health, get the owner of the pigsty in your office, and there’s always one, to clean up.