EV-D68

7 10 2014

We were writing an update on EV-D68 when this email arrived from CDC. We think the points are important for parents to know, so we’re going to share this with you and will provide future updates as warranted.

As parents, we’re all concerned about this virus which isn’t really new, but has captured the nation’s attention. If you have questions, please ask them in the comments and we’ll get answers for you.

[This information is current as of 23 October, 2014 and has been slightly edited for length (believe it or not). The bold text includes the latest updates]:

The United States is currently experiencing a nationwide outbreak of enterovirus D68 (EV-D68) associated with severe respiratory illness.

From mid-August to October 23, 2014, CDC or state public health laboratories have confirmed a total of 973* people in 47 states and the District of Columbia with respiratory illness caused by EV-D68.** This indicates that at least one case has been detected in each of those states but does not indicate how widespread infections are in each state.

In the United States, people are more likely to get infected with enteroviruses in the summer and fall. We are currently in the middle of the enterovirus season. EV-D68 infections are likely to decline later in fall.

For the week of October 8-12, 34 states reported to CDC that EV-D68-like illness activity is low or declining; 8 still have elevated activity, and only 1 has increasing activity.

Many state health departments are currently investigating reported increases in cases of severe respiratory illness in children. This increase could be caused by many different viruses that are common during this time of year. EV-D68 appears to be the predominant type of enterovirus this year and is likely contributing to the increases in severe respiratory illnesses.

Due to increasing knowledge about the nationwide EV-D68 outbreak, there has been a very large increase in the number of specimens tested from patients with severe respiratory illness. Awareness of these initial results is also contributing to increased recognition of new cases.

CDC is prioritizing testing of specimens from children with severe respiratory illness. There are likely many children affected with milder forms of illness.

Of the more than 1,700 specimens tested by the CDC lab, about half have tested positive for EV-D68. About one third have tested positive for an enterovirus or rhinovirus other than EV-D68. Almost all of the CDC-confirmed cases this year of EV-D68 infection have been among children. Many of the children had asthma or a history of wheezing.

CDC has developed, and started using on October 14, a new, faster lab test for detecting EV-D68, allowing CDC to rapidly process in about seven to 10 days the more than 1,000 remaining specimens received since mid-September. As a result, the number of confirmed EV-D68 cases will likely increase substantially in the coming days. These increases will not reflect changes in real time or mean the situation is getting worse.

As a result, confirmed cases increased today and will likely continue to increase in coming days. This does not mean the situation is getting worse.

Faster testing will help to better show the trends of this outbreak since August and to monitor changes occurring in real time.

EV-D68 has been detected in specimens from eight*** patients who died and had samples submitted for testing.

CDC is reporting the test results to state health departments as we obtain them. State and local officials have the authority to determine the cause of death, the appropriate information to release, and the time to release it. CDC will defer to states to provide this information.

So far, state and local officials have reported that two of these deaths were caused by EV-D68.

CDC will post updated data to the website every Thursday.

CDC understands that Americans may be concerned about these severe respiratory illnesses and the new reports of neurological illness. Severe illness is always a concern to us, especially when infants and children are affected. We will share information as soon as we have it, and post updates on our website (http://www.cdc.gov/non-polio-enterovirus/outbreaks/EV-D68-outbreaks.html).

Clinicians should consider EV-D68 as a possible cause of severe respiratory illness, particularly in children, and report unusual increases in the number of patients with severe respiratory illness to their health department.

The general public can help protect themselves from respiratory illnesses by washing hands with soap and water, avoiding close contact with sick people, and disinfecting frequently touched surfaces. Anyone with respiratory illness should contact their doctor if they are having difficulty breathing, or if their symptoms are getting worse.

*Total confirmed case count includes results from State Public Health Laboratories that can do testing to determine type of enterovirus.
**The primary reason for current increases in cases is that a backlog of specimens is being processed from several states that are investigating clusters of people with severe respiratory illness. It can take a while to test specimens and obtain lab results because the testing is complex and slow, and can only be done by CDC and a small number of state public health laboratories. These increases will not necessarily reflect changes in real time, or mean that the situation is getting worse.
***Investigations are ongoing; CDC will review and update available data every Wednesday.

 

BACKGROUND

Enteroviruses are very common viruses; there are more than 100 types.

It is estimated that 10 to 15 million enterovirus infections occur in the United States each year. Tens of thousands of people are hospitalized each year for illnesses caused by enteroviruses.

Different enteroviruses can cause different illnesses, such as respiratory, febrile rash, and neurologic [e.g., aseptic meningitis (swelling of the tissue covering the brain and spinal cord) and encephalitis (swelling of the brain)].

In general, the spread of enteroviruses is often quite unpredictable. A mix of enteroviruses circulates every year, and different types of enteroviruses can be common in different years.

In the United States, people are more likely to get infected with enteroviruses in the summer and fall.

 

Enterovirus D68

EV-D68 was first recognized in California in 1962. Small numbers of EV-D68 have been reported regularly to CDC since 1987. However, this year the number of people with confirmed EV-D68 infections is much greater than that reported in previous years.

The strains of EV-D68 circulating this year are not new.

CDC, working with state health departments, has identified at least three separate strains of EV-D68 that are causing infections in the United States this year; the most prominent strain is related to the strains of EV-D68 that were detected in the United States in 2012 and 2013.

There is no evidence that unaccompanied children brought EV-D68 to the United States; we are not aware of any of these children testing positive for the virus.

It is common for multiple strains of the same enterovirus type to be co-circulating in the same year.

Respiratory illnesses can be caused by many different viruses and have similar symptoms. Not all respiratory illnesses occurring now are due to EV-D68.

EV-D68 has been previously referred to as human enterovirus 68 (or HEV-68) and human rhinovirus 87 (or HRV-87). They are all the same virus. The D stands for enterovirus species D.

 

SYMPTOMS

EV-D68 infections can cause mild to severe respiratory illness, or no symptoms at all.

Mild symptoms may include fever, runny nose, sneezing, cough, and body and muscle aches.

Severe symptoms may include wheezing and difficulty breathing.
Anyone with respiratory illness should contact their doctor if they are having difficulty breathing, or if their symptoms are getting worse.

Enteroviruses are known to be one of the causes of acute neurologic disease in children. They most commonly cause aseptic meningitis, less commonly encephalitis, and rarely, acute myelitis and paralysis.

CDC is aware of two published reports of children with neurologic illnesses confirmed as EV-D68 infection from cerebrospinal fluid (CSF) testing.

 

PEOPLE AT RISK

In general, infants, children, and teenagers are most likely to get infected with enteroviruses and become sick. That’s because they do not yet have immunity (protection) from previous exposures to these viruses. We believe this is also true for EV-D68. Adults can get infected with enteroviruses, but they are more likely to have no symptoms or mild symptoms.

Children with asthma may have a higher risk for severe respiratory illness caused by EV-D68 infection.

 

TRANSMISSION

Since EV-D68 causes respiratory illness, the virus can be found in an infected person’s respiratory secretions, such as saliva, nasal mucus, or sputum.

The virus likely spreads from person to person when an infected person coughs, sneezes, or touches a surface that is then touched by others.

Diagnosis

EV-D68 can only be diagnosed by doing specific lab tests on specimens from a person’s nose and throat.

Many hospitals and some doctor’s offices can test sick patients to see if they have enterovirus infection. However, most cannot do specific testing to determine the type of enterovirus, like EV-D68. CDC and some state health departments can do this sort of testing.

CDC recommends that clinicians only consider EV-D68 testing for patients with severe respiratory illness and when the cause is unclear.

 

TREATMENT

There is no specific treatment for people with respiratory illness caused by EV-D68 infection.

For mild respiratory illness, you can help relieve symptoms by taking over-the-counter medications for pain and fever. Aspirin should not be given to children.

Some people with severe respiratory illness caused by EV-D68 may need to be hospitalized and receive intensive supportive therapy.

There are no antiviral medications are currently available for people who become infected with EV-D68.

 

PREVENTION

You can help protect yourself from getting and spreading EV-D68 by following these steps:

  • Wash hands often with soap and water for 20 seconds
  • Avoid touching eyes, nose and mouth with unwashed hands
  • Avoid close contact such as kissing, hugging, and sharing cups or eating utensils with people who are sick, or when you are sick
  • Cover your coughs and sneezes with a tissue or shirt sleeve, not your hands
  • Clean and disinfect frequently touched surfaces, such as toys and doorknobs, especially if someone is sick
  • Stay home when you are sick
  • There are no vaccines for preventing EV-D68 infections.

Children with asthma are at risk for severe symptoms from EV-D68 and other respiratory illnesses. They should follow CDC’s guidance to maintain control of their illness during this time:

  • Discuss and update your asthma action plan with your primary care provider.
  • Take your prescribed asthma medications as directed, especially long term control medication(s).
  • Be sure to keep your reliever medication with you.
  • Get a flu vaccine when available.
  • If you develop new or worsening asthma symptoms, follow the steps of your asthma action plan. If your symptoms do not go away, call your doctor right away.
  • Parents should make sure the child’s caregiver and/or teacher is aware of his/her condition, and that they know how to help if the child experiences any symptoms related to asthma.

 

WHAT IS CDC DOING

CDC continues to collect information from states and assess the situation to better understand  EV-D68 and the illness caused by this virus and how widespread EV-D68 infections may be within states and the populations affected.

CDC is helping states with diagnostic and molecular typing for EV-D68.

We are working with state and local health departments and clinical and state laboratories to enhance their capacity to identify and investigate outbreaks, and perform diagnostic and molecular typing tests to improve detection of enteroviruses and enhance surveillance.

CDC has developed, and started using on October 14, a new, faster lab test for detecting EV-D68 in specimens from people in the United States with respiratory illness. CDC will provide protocols to state public health labs and explore options for providing test kits.

CDC’s new lab test is a “real-time” reverse transcription polymerase chain reaction, or rRT-PCR, and it identifies all strains of EV-D68 that we have been seeing this summer and fall. The new test has fewer and shorter steps than the test that CDC and some states were using previously during this EV-D68 outbreak. This will allow CDC to test and report results for new specimens within a few days of receiving them.

The previous test, which CDC used for about nine years,  is very sensitive and can be used to detect and identify almost all enteroviruses; however, it requires multiple, labor-intensive processing steps and cannot be easily scaled up to support testing of large numbers of specimens in real time that is needed for the current EV-D68 outbreak.

We are providing information to healthcare professionals, policymakers, general public, and partners in numerous formats, including Morbidity and Mortality Weekly Reports (MMWRs), health alerts, websites, social media, podcasts, infographics, and presentations.

CDC has obtained one complete genomic sequence and six partial genomic sequences from viruses, representing the three known strains of EV-D68 that are causing infection at this time.

Comparison of these sequences to sequences from previous years shows they are genetically related to strains of EV-D68 that were detected in previous years in the United States, Europe, and Asia.

CDC has submitted the sequences to GenBank to make them available to the scientific community for further testing and analysis.

 

GUIDANCE FOR CLINICIANS

Clinicians should:

  • consider EV-D68 as a possible cause of acute, unexplained severe respiratory illness, even if the patient does not have fever.
  • report suspected clusters of severe respiratory illness to local and state health departments. EV-D68 is not nationally notifiable, but state and local health departments may have additional guidance on reporting.
  • consider laboratory testing of respiratory specimens for enteroviruses when the cause of respiratory illness in severely ill patients is unclear.
  • consider testing to confirm the presence of EV-D68. State health departments can be approached for diagnostic and molecular typing for enteroviruses.
  • contact your state or local health department before sending specimens for diagnostic and molecular typing.
  • follow standard, contact, and droplet infection control measures

The antiviral drugs pleconaril, pocapavir, and vapendavir, have significant activity against a wide range of enteroviruses and rhinoviruses. CDC has tested these drugs for activity against currently circulating strains of enterovirus D68 (EV-D68), and none of them has activity against EV-D68 at clinically relevant concentrations.

 

SURVEILLANCE

U.S. healthcare professionals are not required to report known or suspected cases of EV-D68 infection to health departments because it is not a nationally notifiable disease in the United States. Also, CDC does not have a surveillance system that specifically collects information on EV-D68 infections.

No data is currently available regarding the overall burden of morbidity or mortality from EV-D68 in the United States. Any data CDC receives about EV-D68 infections or outbreaks are voluntarily provided by labs to CDC’s National Enterovirus Surveillance System (NESS). NESS collects limited data, focusing on circulating types of enteroviruses and parechoviruses.

For a large image and details of EV-D68-like illness activity in states, see http://www.cdc.gov/non-polio-enterovirus/outbreaks/EV-D68-activity.html.

MORE INFORMATION

CDC Enterovirus D68 in the United States, 2014 website: http://www.cdc.gov/non-polio-enterovirus/outbreaks/EV-D68-outbreaks.html

CDC Enterovirus D68 general website: http://www.cdc.gov/non-polio-enterovirus/about/EV-D68.html

CDC Enterovirus D68 for Health Care Professionals website: http://www.cdc.gov/non-polio-enterovirus/hcp/EV-D68-hcp.html

CDC Activity of Enterovirus D68-like Illness in States website: http://www.cdc.gov/non-polio-enterovirus/outbreaks/EV-D68-activity.html  

CDC What Parents Need to Know about Enterovirus D68 webpage: http://www.cdc.gov/features/evd68/

Enterovirus D68 in the United States: Epidemiology, Diagnosis & Treatment, COCA Call, September 16, 2014 (http://www.bt.cdc.gov/coca/calls/2014/callinfo_091614.asp)

Severe Respiratory Illness Associated with Enterovirus D68 – Multiple States, 2014, Health Alert Network, September 12, 2014 (http://emergency.cdc.gov/han/han00369.asp)

Severe Respiratory Illness Associated with Enterovirus D68 – Missouri and Illinois, 2014, MMWR, September 8, 2014 (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6336a4.htm?s_cid=mm6336a4_w)

Clusters of Acute Respiratory Illness Associated with Human Enterovirus 68 — Asia, Europe, and United States, 2008–2010, MMWR, September 30, 2011 (http://www.cdc.gov/mmwR/preview/mmwrhtml/mm6038a1.htm)





Reporters – Follow The Science (Please!)

12 12 2012

Immunizations are a perpetually hot topic. We’ve been getting questions from reporters for over a decade about the need for vaccines, the efficacy of vaccines, and invariably the safety of vaccines.

Reporters have been doing stories on vaccines for a lot longer than a decade, but I remember 1999 as the year that things kicked off on the national scene. The television program ‘20/20′ ran shows featuring parents who claimed that various vaccines caused SIDS, multiple sclerosis, autism, and a variety of other illnesses in themselves or their children.

All these years later, when study after study after hundreds of studies have proven the safety of vaccines, many reporters still insist on representing the “other” side of the story when the subject is vaccine safety.

When I get a call from a reporter asking to speak to a parent whose child has been affected by a vaccine-preventable disease, I ask if they are also speaking to parents who believe their child has been adversely affected by a vaccine.

The answer is always yes.

The reporter will say that he or she just wants to present a balanced story.

After all of these years, and after all of these studies, I can’t help but wonder what their definition of balanced may be.

When I read a story about the importance of wearing a helmet when riding a bicycle or a motorcycle, there is often included in the story an anecdote about someone not wearing a helmet while riding who was consequently harmed by the lack of said helmet.

Never, in the same story, do I read about riders who were saved from harm by not wearing helmets, although I’m sure there are people in this world who believe it is safer to ride without helmets. For some reason, reporters don’t feel the need to present the anti-helmet point of view in order to have a balanced story.

The use of seat belts in cars has been mandatory in all states since the 1980s. When writing about car accidents, reporters frequently include stories about the injuries sustained when so-and-so was not wearing a seat belt.

I don’t believe I’ve ever read such a story where the reporter also highlighted incidents of those saved from harm by not wearing seat belts. I know of at least one person who firmly believes that not wearing a seat belt is safer than wearing one, but I have not yet seen her anti-seat belt view used to provide balance in a car accident story.

Reporters who include opinions from parents who believe their children were adversely affected by vaccines, and who include junk science from those pretending to be scientists, all in the name of having a “balanced” piece on vaccines, simply haven’t done their homework.

They are behind on the science, and the stories they write end up creating fear and confusion on the part of parents.

If a reporter feels that it is important to present views not substantiated by science, they should do an opinion piece rather than a news story.

At PKIDs, we sincerely appreciate those writers who look for and use the facts. As parents of children affected by disease, it’s easy for us to have lab work done and determine by the results that our child is infected with a particular disease.

If there is a vaccine to prevent that particular disease, we can say that it’s probable that, had our child been vaccinated, he or she would not have become infected. But, since not all vaccines work for everyone, we cannot say for certain. We can only talk about what vaccine-preventable diseases have done to our families.

We’re not painting all reporters with the same brush. Many reporters follow the science and come back with a fact-based story.

For those who do not, we ask that you make clear in your next story which parts are unsubstantiated, and which are based on fact.

Let’s stop the unnecessary scaremongering of the public.

 
By Trish Parnell





Vaccine Conversations

30 01 2012

Parents have questions about the health and care of their children. It’s normal!

They want to know (for instance) what to give a child who has a high fever, when a multivitamin is appropriate, and if vaccines are safe and necessary.

It’s that last bit that has many of us searching for the words that parents want to hear. When a parent asks if vaccines are safe and necessary, it’s not enough to simply say yes. Parents want more information, and here are a few resources that will help you provide answers.

CDC has a section on their website that addresses the question of how to talk to parents and others about vaccines. There are materials for talking to specific groups, such as college-age students, healthcare workers, or pregnant women. There are materials to share with parents who are choosing not to vaccinate or who have questions about immunization schedules. There’s a one-pager for providers that’s handy to have. Basically, this site has gobs of resources—more than we have room for here—and is worth a long look.

The Colorado Foundation for Medical Care and Every Child by Two have a CE for nurses that offers “practical knowledge and skills on vaccine safety and patient communication.” It’s provided in webinar format and wraps up on 29 November, 2012. Try to get it on your calendars before then.

The Vaccine Education Center at CHOP has an excellent menu of articles written in palatable form for non-scientists. Few explain the facts behind vaccines better than Dr. Paul Offit, the Center’s director. This site is one of our favorites.

Immunization Action Coalition keeps a list of resources for those who speak with parents about vaccines. It’s a good page to bookmark.

We found a nice slideset by a nurse from GSK that provides answers to parents’ questions. It may be something you would want to share with your staff.

At PKIDs, we have several videos of parents sharing their children’s stories. Sometimes it helps to connect parent-to-parent. In addition to PKIDs, there’s ShotByShot, National Meningitis Association, and Families Fighting Flu—all of whom have videos to share.

While poking around, we found many more helpful sites, but when they were boiled down to their essences, the resources provided could be found in one of the sites listed above.

If you know of a site that has materials useful to the vaccine conversation, we’d love to hear from you in the comments.

By Trish Parnell

Image courtesy of Norman Rockwell Museum





PubMed: Obtaining Full-Text Journal Articles

23 04 2010

In our previous PubMed articles, we discussed finding free articles online and conducting more effective searches. In this PubMed post, we discuss ways to get full text articles that are not free online.

Visit Your Libraries

Local Library

Check with your local library to see if they have the journal in question, or if they can get it in for you. This may be your only recourse for getting full articles at no cost, even if you have to wait awhile to get the journal.

Nearest Medical Library

If your local library doesn’t have or cannot get the journal or article you want, contact your nearest medical library. Call the National Network of Libraries of Medicine at 800-338-7657 or visit their website to locate your nearest library. (You can’t call this number to get help finding information, but they can help you locate a library.)

Order Online Through PubMed

Loansome Doc

PubMed is primarily for medical students and professionals, which is why it provides a service called Loansome Doc that enables you to 1) find medical libraries in your state serving the general public, and 2) easily and conveniently order journal articles through PubMed.

When viewing an article’s abstract, clicking on the “Send To” link opens a box from which you can select “Order.” Clicking the “Order articles” button will direct you to enter your Loansome Doc login information.

PubMed Loansome Doc

Ordering option for Loansome Doc

Registration for Loansome Doc is free; you only pay when you order an article. To sign up for Loansome Doc, visit the Loansome Doc signup page.  The first step will help you locate a medical library near you. You will need to contact the medical library of your choice to get signed up with them.

If you are not a healthcare provider or student, the medical library will consider you an “unaffiliated user.” Each library will have different criteria regarding unaffiliated users, pricing, and document delivery formats (hardcopy vs. electronic, e.g.).

LinkOut

If you click on an article’s title in your PubMed search results, you can click “LinkOut” at the bottom of the abstract to see online sources providing full text. You do not need a Loansome Doc account for these, but you may have to set up an account on the website of the online source to place an order.

PubMed - LinkOut

Viewing options for ordering under LinkOut

So to sum up:

  • Try your local library or visit a medical library (if you have one close to you).
  • If you are planning to order articles on a relatively frequent basis, sign up for Loansome Doc so you can place all your orders from within PubMed.
  • If you are planning to order articles relatively infrequently, try ordering from a LinkOut service.




Meningitis: A College Memory You Don’t Want

21 04 2010

Going away to school is a lifechanging experience. For many students, four years disappear into a haze of studying, working, and partying with their classmates. It’s a chaotic time where everything is shared: space, feelings, clothes, cars, and germs.

When a meningitis outbreak shows up in the news, it’s a good bet that it showed up at a school. Any shared spaces like schools, dorms, or barracks where crowds of young adults converge are favorite territories for bacteria and viruses to spread.

Meningitis, a serious but rare infection, is an inflammation of the membranes covering the brain and spinal cord. It affects about 1,500 Americans each year.

Meningitis is commonly mistaken for the flu in its early stages, and therefore left untreated. When this happens, it can do a lot of damage within hours, sometimes causing confusion, seizures, and brain damage. Survivors are often left with amputated limbs—permanent reminders of their experience.

So what does meningitis act like and why are colleges a prime environment for it?

Most meningitis patients complain of excruciating headaches, unyielding fevers, nausea, and vomiting. Sound like just a bad case of the flu? More telling are other symptoms, which include stiffness and pain in the neck (due to the swelling around the spinal cord and brain), sensitivity to light, numbness or loss of sensation in limbs, rashes, mental confusion, and convulsions and seizures.

Most at risk are college students. Busy, exhausted, and stressed students often have lowered immune systems. A wide variety of lifestyles and health choices create a melting pot of germs, especially when bathrooms and eating areas are shared. Meningitis is spread through contact with an infected person’s bodily fluid: a shared cigarette or drink, a kiss, a cough. It’s possible to carry a germ that causes meningitis and never be sick, while unknowingly passing it on to someone else. There are lots of ways to spread it.

Many such infections could be prevented with vaccination. Some schools are now requiring proof of vaccination; others only provide information about meningitis. Before heading off to college, make sure you’re protected and know what the warning signs are. Parents, if you’re reading this, make sure your son or daughter is protected before they leave you.  It could be the most important going-away gift you give your child.

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PubMed: Refining Searches with MeSH

5 04 2010

Our previous PubMed article described how you could search for journal articles using simple search terms, like you would on the Internet. However, if you want your search to be more targeted and effective, you should use MeSH search terms.

What’s MeSH? Sounds messy.

MeSH (Medical Subject Heading Terms) terms are medically-oriented keywords. Because PubMed is indexing medical journal articles, you will generate better search results if you use medical terms used by PubMed. Previously, our approach was:

  1. Enter keywords into PubMed
  2. Get results

Using MeSH terms, our approach will be:

  1. Enter keywords in MeSH to find MeSH terms
  2. Enter those MeSH terms into PubMed
  3. Get more targeted results

Great! How do I do this?

First, go to the MeSH homepage. Then enter a keyword in the search box, and click the “Go” button. In this example, we’ve entered “hepatitis” and the results are displayed below the term.

Finding MeSH terms

Click to enlarge

Every term or phrase listed here by number is a MeSH search term. Below each term is the definition for that term. Find the terms that most closely match what you have in mind, and check the box next to them. Then click the “Send to” drop-down box and choose “Search Box with AND.” A second search box appears above your search results with the MeSH term inside.

Sending MeSH terms to the new search box

Click to enlarge

Now you can add additional MeSH terms to further refine your search. Try entering “child” in the field at the top, and click “Go” to get MeSH terms related to “child.” Then click the box(es) next to your desired terms, and send them to the search box as you did in the step above.

If you want to exclude a term, choose “Search Box with NOT.”

If you want to search for articles that contain at least one of the terms you’ve sent to the search box, but not necessarily all of them, choose “Search Box with OR.”

Once you’ve sent your desired MeSH terms to the search box, click the “PubMed Search” button directly below it. You will then see a page of results, like the example below:

Getting results from your MeSH terms

Click to enlarge

You can now interact with the search results as we discussed in our previous PubMed article. Watch the blog for future articles on PubMed searching.





Searching Parents…Meet PubMed!

15 03 2010

When you’re a parent searching for information about your child’s medical condition, it doesn’t take long to exhaust the online resources most readily available. MedlinePlus…  Mayo Clinic…  WebMD…  But where do you go when you need more?

If you’re ready to dig deep, you can turn to journal articles for more information and research. One way to search journal articles is to visit NIH’s PubMed website.

You can enter keywords into the search box at the top of the page, and you will get results. But you’ll get a lot of them, and some won’t really be as targeted as you’d like. There are a number of ways to get better results, and we’ll be discussing these in upcoming posts, but today we’re going to show you the most economical: Filter by free text!

First, enter some keywords to search by and click the “Search” button. In our demo shots below, we use “chronic pediatric hepatitis.”

PubMed homepage

The next page will shows you some results. Depending on your personality, you’re either happy to see the 488 results returned by this search, or reeling with shock at the thought of sifting through 488 results! But for today’s purposes, we’re going to narrow our results the thrifty way, by clicking on “Free Full Text” on the right side of the screen.

Search results for "chronic pediatric hepatitis"

Below you can see the 61 free, full text articles available to you. Click on the “Free article” link under the citation.

Search results showing only those with free full text available

PubMed shows you services on the right that provide the article’s text free online. Choose one and start reading!

Links to free full text

Watch the blog for more posts on conducting targeted searches and finding full-text articles both on and offline.

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