My Blog

Posts for category: Infectious Diseases

By Diji Vaughan, MD.FAAP
July 17, 2013
Tags: zinc   cold remedies   zinc lozenges  

 

The incredibly vast wonderful matrix of cells, tissues, organs and enzymes that make up the human body is much more complex that would be unraveled in our respective lifetimes. The role tiny elements called trace elements play in ensuring a smooth run of affairs from moment to moment cannot be overstated. Zinc, is one of the elite members in this league of trace elements. Many benefits have been touted to Zinc, and scientific testing has validated many of these. One of the more colloquially perceived strengths of Zinc is under review today, Does Zinc cure the common cold? The common cold is regarded as one of the most widespread illnesses and is a leading cause of visits to the doctor and absenteeism from school and work.

As the argument rages on, researchers pooled a number of randomized controlled trials designed to answer this question with very rigid selection criteria. This meta-analysis meets one of the highest pedigree of medical scrutiny and the study was published in the Cochrane Systemic Database Reviews in June 2013. Researchers, Das and Singh collectively had looked at the effects of Zinc if any and what optimal dosage it is likely to be beneficial in ameliorating symptoms or curing the cold symptoms in about 1900 study participants over a 5 day period.The study findings showed that Zinc when administered within 24 hours of onset of symptoms reduces the duration of common cold symptoms in healthy people but some caution is needed due to the heterogeneity of the data. As the zinc lozenges formulation that has been widely studied show, there is a significant reduction in the duration of cold at a dose of >/= 75 mg/day, for those considering using zinc it would be best to use it at this dose throughout the cold. Regarding prophylactic zinc supplementation, to keep the cold at bay for months at a time, currently no firm recommendation can be made because of insufficient data. When using zinc lozenges (not as syrup or tablets) the likely benefit has to be balanced against side effects, notably a bad taste and nausea.

Excess ingestion of trace elements can have its own problems and always discuss treatment options with your healthcare provider. 

 

Prevention is better than cure! This often told precept is widely accepted in many settings but it oddly doesn’t enjoy the same courtesy with childhood immunizations in our experience.

Since its antecedents in the days even before Edward Jenner (1749-1823), who’s widely credited for his pioneering work on immunizations and immunology by showing that small pox can be prevented through rather crude but effective vaccination methods. Louis Pasteur and others built on this and vaccinations rose to be the most significant public health achievement of the 20th century. This iconic success of vaccination programs around the world has bred an untoward side effect: many people no longer grow up in a time where childhood diseases like measles, pneumococcal bacterial infection, diphtheria etc. were almost always deadly. Some evolve in their understanding of vaccines and their role and view them with undue suspicion and anathema. This attitude led to the re-emergence of diseases like polio in western Africa and south East Asia after a nearly successful global eradication was within sight.

Many parents would gasp, when I tell them that barely a century ago measles claimed more than 500,000 children annually in the USA and that Diphtheria (immunized against with the DTaP vaccine) claimed 12, 230 lives in 1921 and only one case was documented by 1998.  The polio epidemic that ravaged the nation involved 60,000 cases in 1952 alone and more than 3,000 deaths. The work of Drs Jonas Salk and Albert Sabin during this period eliminated the specter of children who are wheel chair bound or crutches dependent for life from the eyes of the public and numbed us to the reality of polio. The success of the vaccination program that followed the epidemic eliminated polio from the USA by 1979 and the entire western hemisphere was rid of the disease by 1991.

The concern that vaccine refusal is spreading and may become so prevalent it may actually ebb away at the fragile protection conferred by “herd immunity” in the coming dispensation was reflected in this statement from one of the past presidents of the AAP, David Tayloe MD in 2009 when he stated: “Our citizens need to understand that the vaccine program has been extremely successful. It's the most effective public health program in the history of man, and we cannot let down our guard just because we’ve done such a good job. We must continue to protect our children and our population”.  After the now discredited report linking Autism and the MMR (Measles Mumps Rubella) vaccine was published in the medical journal Lancet, there was a sharp reduction in MMR vaccination rates between 2006 and 2007 and the number of cases of measles quickly rose to 971 in that time frame- A few dozen vaccination refusals can bring us to the tipping point of an epidemic depending on where we are as a community on the spectrum of disease control and prevention with, mother nature. Pertussis (whooping cough) is re-emerging as a key player because of an interval lapse in the immunity of the public to this infection. We now recommend adolescents get a booster and pregnant or new mothers do the same. Young infants have a more severe disease course if infected with pertussis, and adolescents and adults  have been shown to be the reservoir of this disease in the community, outbreaks of pertussis were reported in 2010 in California with pediatric fatalities.

Because we don’t see children suffering from vaccine preventable illnesses does not mean they don’t exist. Because many more people deciding to immunize their children inversely protect yours if you should choose not to immunize them doesn’t mean the risk of a chance exposure in an increasingly shrinking global village is moot. In 2008, an unvaccinated child from California travelled to Sweden and was exposed to measles while abroad, he promptly spread the infection to his friends and classmates upon his return and spawned the California measles outbreak that year. 

The opportunities to naturally acquire illnesses like chicken pox and then acquire life-long immunity without being vaccinated is statistically negligible in most communities in the USA today; immunizations fill this void. There are other challenges in vaccine development for diseases like malaria and HIV which are scourges in parts of the world not far-flung from us and costs and better delivery methods are seismic challenges in primary care for pediatricians and primary care providers like myself. The state provides vaccines for free for qualifying residents including those that do not have insurance, your local public health office is available to provide information on vaccination dates etc. The AAP’s parenting website: www.healthychildren.org offers guidance on many topics including vaccinations. Don’t take your chances with vast technicians blessed with encyclopedic knowledge only like Dr. search engine.com, the signal-noise-ratio can be easily rigged against the discerning parent and only credible sources of information can provide you with the knowledge to make an informed health decision for your children and yours. www.springfieldpeds.com offers links to some of these resources. I’ll paraphrase, Maya Angelou: “ when you know better; you do better”

Vaccinations, save lives.

 

This information is for educational purposes only and not a substitute for professional medical care or advice. Always follow your healthcare provider’s instructions.

 

 

 

By Springfield Pediatrics
August 03, 2012
Tags: Measles  

 

July 30, 2012.

 

Confirmed Measles Case in Coconino County

A confirmed case of measles has been identified in a Flagstaff resident in Coconino County. The case is an unvaccinated child.  The case was confirmed by testing performed at Arizona State Public Health Laboratory. The child was likely contagious from July 4th through July 12th. The source of the infection in under investigation; the case has no recent travel history or interaction with anyone who has traveled or is foreign-born.

Measles is a viral disease of the upper respiratory system and is highly transmissible among unvaccinated or immunocompromised population. Both airborne and droplet transmission of measles can occur. Measles is not often seen in the US; however, cases in individuals who have travelled overseas to areas with endemic measles do sporadically occur. The best way to prevent measles is to receive two doses of MMR vaccine.

To report cases or for additional information please contact your local health department or the Arizona Department of Health Services at 602-364-3676.

Culled from the AZ Chapter of the American Academy of Pediatrics, bulletin.

By Springfield Pediatrics- Dr. Diji Vaughan
July 01, 2012

 

Parental anxiety rises and deservedly so whenever someone shares the discovery of an  illness, let alone a communicable one in their child with another parent. The words: hand-foot-and-mouth disease linked together in that sequence certainly evokes a suite of reactions from respect to bounding fear in the other parent listening. “Will my child catch it?”, “Oh! he had a fever last night too- he probably has caught it already!”. We want to address concerns like this in this post and share recent trends and disease patterns with this condition as we approach the fall season.

The town of Coxsackie NY will forever be embellished in the medical literature. This community of 9,000 people has the distinct recognition of being the discovery place of the family of viruses responsible for most forms of the hand-foot-and-mouth disease(HFAMD). These viruses are called Coxsackie viruses and have different numbers tethered to their names to reflect their many different types.

Humans are the only known reservoir for these viruses and their transmission from person to person is possible year round, but gets to epidemic proportions in the summer/fall seasons. Most of the transmission occurs through close contact through the respiratory airways, fecal-oral route, within families, daycare center, summer camps etc. The Coxsackie virus can survive outside a human host and this confers an advantage to the germ making environmental surfaces contamination and subsequent spread easy. Wet soil, swimming pools etc are possible sources of spread too although less common.

Children aged less than 5-years are more readily affected, though infection in all age groups is possible. The affected child develops fever (temp=100.4F or higher) usually, cases without a fever accompanying presentation are not uncommon. The mouth cavity has reddish shallow lesions on the tongue and lining of the mouth cavity, this is often accompanied with the apperance of fluid-filled or tiny pustule-like painful lesions on the back of the hands and feet. These lesions sometimes occur on the palm and soles too. Affected children often begin to eat less and less from the painful oral lesions and severe cases may tip them towards dehydration. Medical evaluation and assessment is recommended.These skin lesions resolve in about a week and the signs gradually fade away subsequently. Complications following hand-foot-and-mouth disease can occur though rarely and it is usually a self-limited condition where therapeutic efforts are largely supportive with comfort measures under the supervision of your medical provider.

Universal infection control precautions, especially with appropriate hand washing, and avoidance of overcrowded situations have been shown to reduce transmission and control outbreaks. The CDC reports in March 2012, the emergence of unusually severe cases of HFAMD caused by a different member of the Coxsackie virus family which has now been isolated from every geographic region of the USA. The vast majority of cases of HFAMD seen so far still follow the typical course described above. The CDC affirms, “HFMD is spread from person to person by contact with saliva, respiratory secretions, fluid in vesicles, and feces. Transmission of HFMD can be reduced by maintaining good hygiene, including handwashing and disinfection of surfaces in child care settings”.