My Blog

Posts for: October, 2017

By contactus@priority-pe
October 12, 2017
Category: Infectious Disease
Tags: repellents   mosquito   DEET   Pecaridin   Eucalyptus  

Don't stop as temps drop!

As summer turns to fall, mosquitoes are still around. Don't forget to protect yourself against bites.

 

Protect yourself and your family from mosquito bites

Use Insect Repellent

Use Environmental Protection Agency (EPA)-registered insect repellents with one of the active ingredients below. When used as directed, EPA-registered insect repellents are proven safe and effective, even for pregnant and breastfeeding women.

 

 

*See EPA’s search tool here.

Tips for Everyone

  • Always follow the product label instructions.
  • Reapply insect repellent as directed.
    • Do not spray repellent on the skin under clothing.
    • If you are also using sunscreen, apply sunscreen first and insect repellent second.

Tips for Babies & Children

  • Always follow instructions when applying insect repellent to children.
  • Do not use insect repellent on babies younger than 2 months old.
  • Do not apply insect repellent onto a child’s hands, eyes, mouth, and cut or irritated skin.
    • Adults: Spray insect repellent onto your hands and then apply to a child’s face.
  • Do not use products containing oil of lemon eucalyptus (OLE) or para-menthane-diol (PMD) on children under 3 years old.

Natural insect repellents (repellents not registered with EPA)

  • We do not know the effectiveness of non-EPA registered insect repellents, including some natural repellents.
  • To protect yourself against diseases spread by mosquitoes, CDC and EPA recommend using an EPA-registered insect repellent.
  • Choosing an EPA-registered repellent ensures the EPA has evaluated the product for effectiveness.
  • Visit the EPA website to learn more.

Protect your baby or child

  • Dress your child in clothing that covers arms and legs.
  • Cover crib, stroller, and baby carrier with mosquito netting.

Wear long-sleeved shirts and long pants

  • Treat items, such as boots, pants, socks, and tents, with permethrin* or buy permethrin-treated clothing and gear.
    • Permethrin-treated clothing will protect you after multiple washings. See product information to find out how long the protection will last.
    • If treating items yourself, follow the product instructions.
    • Do not use permethrin products directly on skin.

*In some places, such as Puerto Rico, where permethrin products have been used for years in mosquito control efforts, mosquitoes have become resistant to it. In areas with high levels of resistance, use of permethrin is not likely to be effective.

Take steps to control mosquitoes inside and outside your home

  • Use screens on windows and doors. Repair holes in screens to keep mosquitoes outside.
  • Use air conditioning when available.
    • Sleep under a mosquito bed net if air conditioned or screened rooms are not available or if sleeping outdoors.
  • Once a week, empty and scrub, turn over, cover, or throw out items that hold water, such as tires, buckets, planters, toys, pools, birdbaths, flowerpots, or trash containers. Check inside and outside your home. Mosquitoes lay eggs near water.

Control mosquitoes outside your home

Remove standing water where mosquitoes could lay eggs

  • Once a week, empty and scrub, turn over, cover, or throw out any items that hold water like tires, buckets, planters, toys, pools, birdbaths, flowerpot saucers, or trash containers. Mosquitoes lay eggs near water.
  • Tightly cover water storage containers (buckets, cisterns, rain barrels) so that mosquitoes cannot get inside to lay eggs.
  • For containers without lids, use wire mesh with holes smaller than an adult mosquito.
  • Use larvicides to treat large containers of water that will not be used for drinking and cannot be covered or dumped out.
  • If you have a septic tank, repair cracks or gaps. Cover open vent or plumbing pipes. Use wire mesh with holes smaller than an adult mosquito.

Kill mosquitoes outside your home

  • Use an outdoor insect spray made to kill mosquitoes in areas where they rest.
  • Mosquitoes rest in dark, humid areas like under patio furniture, or under the carport or garage. When using insecticides, always follow label instructions.

Control mosquitoes inside your home

Keep mosquitoes out

  • Install or repair and use window and door screens. Do not leave doors propped open.
  • Use air conditioning when possible.

Remove standing water where mosquitoes could lay eggs

  • Once a week, empty and scrub, turn over, cover, or throw out any items that hold water like vases and flowerpot saucers. Mosquitoes lay eggs near water.

Kill mosquitoes inside your home

  • Kill mosquitoes inside your home. Use an indoor insect fogger* or indoor insect spray* to kill mosquitoes and treat areas where they rest. These products work immediately, and may need to be reapplied. When using insecticides, always follow label directions. Only using insecticide will not keep your home free of mosquitoes.
  • Mosquitoes rest in dark, humid places like under the sink, in closets, under furniture, or in the laundry room.

 


By contactus@priority-pediatrics.com
October 07, 2017
Category: Infectious Disease
Tags: Cough   Facts   Bronchiolitis   RSV   Rhinovirus   Metapneumovirus  

According to a Decision Support in Medicine article published in Pediatric News, reinfections with RSV occur throughout life but generally are limited to the upper airway in healthy individuals.

The younger the child in whom RSV infection occurs, the more likely the disease will be severe, requiring hospitalization or intensive care. In a 2009 study, Hall et al., noted that 1.7% of infants less than 6 months of age in the United States were hospitalized for RSV infection, with considerable variation among communities throughout the country. Despite this high hospitalization rate, only approximately 40 children in the United States die each year from complications of bronchiolitis. Bronchiolitis tends to be more severe when associated with RSV than with other viral causes, such as influenza, parainfluenza, human metapneumovirus, and rhinovirus. Although many older children and young adults are infected with RSV, those infections tend to occur primarily in the upper respiratory tract. RSV becomes a problem again in old age: it is estimated that some 14,000 elderly Americans die of RSV-associated infections each year.

Lance Chilton, MD, FAAP

Professor of Pediatrics

University of New Mexico

 

In children with bronchiolitis, the duration of symptoms has been estimated at 2-3 weeks.

Explanation

According to a Decision Support in Medicine article published in Pediatric News, “[r]ecovery from bronchiolitis can require weeks; the median duration of symptoms has been estimated at 12 days, but up to 20% of children continued to have intermittent cough at 3 weeks after onset of illness. A long-term association with increased risk for asthma in later childhood has been demonstrated for infants with severe bronchiolitis requiring hospitalization, although it is unclear if this is a complication of bronchiolitis or an underlying characteristic of the child.”

Knowing the prolonged course of RSV infection is helpful to those caring for young children who have suffered the disease in helping everyone understand the persistence of symptoms and the likelihood of eventual recovery from them. Counseling on the expected course and the lack of available therapy to avoid or treat prolonged cough, increased nasal secretions, and respiratory distress will avoid impossibly optimistic predictions of quick relief.  Those caring for children—parents and health care providers alike—should be aware that cough medications have severely limited effectiveness; codeine-containing preparations should be avoided in children.

Lance Chilton, MD, FAAP

Professor of Pediatrics

University of New Mexico

RSV spreads by large droplet transmission directly from patient to patient or by contact with viral particles on surfaces, which remain infectious for several hours

 

The clinical course of human metapneumovirus (HMPV) and RSV appear to be similar. HMPV is “another paramyxovirus that has infectious characteristics similar to those of RSV in regard to seasonal characteristics and mode of infection. HMPV was relatively recently described, but studies of banked specimens show it consistently has accounted for 3% to 19% of bronchiolitis cases,” according to a Decision Support in Medicine article published in Pediatric News.

 
Rhinovirus is a common coinfecting agent with RSV or human metapneumovirus.
Rhinovirus, a cause of the common cold, is a common coinfecting agent with RSV or human metapneumovirus. “Rhinovirus has an emerging role as a cause of bronchiolitis and is more common in children older than 6 months of age. Rhinovirus is known as a common trigger of wheezing in older children with chronic lung disease and asthma,” according to a Decision Support in Medicine article published in Pediatric News.
 
 

By contactus@priority-pediatrics.com
October 07, 2017
Category: Immunizations

Correcting Robert F. Kennedy Jr.’S Vaccine ‘Facts’

 

September 22, 2017Original Article  By Paul A Offit

When people misrepresent facts on the record, journalists are in a tough spot — especially when that information can be harmful.

Which brings me to STAT’s recent interview with Robert F. Kennedy Jr., conducted by Helen Branswell. STAT wanted to interview Kennedy about his claim in January 2017 that Donald Trump would soon appoint him to head a commission on vaccine safety and scientific integrity. Seven months had passed since Kennedy had made the claim and no announcement had been made. STAT wanted to find out where things stood.

Branswell began her interview by asking Kennedy eight different times and in eight different ways where things stood on his commission. Each time, he failed to confirm or deny whether the White House was about to appoint him.

That clearly wasn’t what Kennedy wanted to talk about. Instead, he wanted to talk about his belief that mercury in vaccines is poisoning America’s children and that no one in the federal government seems to care. By insisting that the interview be conducted in the question-and-answer format, Kennedy effectively tied STAT’s hands, which had to print what he said without editorial comment or opposing views.

I feel compelled to oppose Kennedy’s claims.

During the interview, Kennedy said that some babies were being injected with 25 micrograms of ethylmercury, which is part of a preservative called thimerosol that is used in multi-dose vials of influenza vaccine. He claimed that amount to be “100 times” greater than the amount considered to be safe.

As an environmentalist, Kennedy should know that mercury is a natural part of the Earth’s crust. As a consequence, methylmercury (environmental mercury) is contained in water and anything made from water, like breast milk and infant formula. The human body eliminates ethylmercury from vaccines far more efficiently than it eliminates naturally occurring methylmercury.

Babies typically ingest about 360 micrograms of methylmercury during the first 6 months of life, well before they will ever receive their first dose of influenza vaccine. If the 25 micrograms of ethylmercury in vaccines is 100 times greater than what Kennedy claimed is safe, then simply by living on Earth, by 6 months of age babies will have ingested an amount of mercury that is 1,440 times greater than Kennedy’s safety limit.

According to Kennedy’s calculations, all of us are massively intoxicated with mercury. The only way to avoid this would be to move to another planet.

Kennedy also said that he wanted to ensure “that vaccines are subject to the same kind of safety scrutiny and safety testing that other drugs are subject to.” In fact, vaccines are subjected to greater scrutiny than drugs. Much greater. For example, the CDC spends tens of millions of dollars every year on the Vaccine Safety Datalink, a system of linked computerized medical records from several major health maintenance organizations that represents about 7 million Americans, 500,000 of whom are children. Nothing like this exists on the drug side. Frankly, if a Drug Safety Datalink existed, the problem with Vioxx as a cause of heart attacks might have been picked up much sooner.

Kennedy said, “We need to, prior to licensing vaccines, do gold standard safety testing, like every other drug approval requires. We need to do double-blind placebo testing.” Branswell knew that the FDA does require placebo-controlled trials before licensure. So she pushed back. “Sir, that’s done all the time,” she said. “That is done all the time.”

Branswell was right. Here’s an example of the kind of testing that vaccines are put through. One of the currently licensed vaccines against rotavirus was tested in a placebo-controlled, prospective, 11-country, four-year trial of more than 70,000 infants before being approved. That’s fairly typical of most pre-licensure trials. But STAT was stuck having to report Kennedy’s remarks as is, even though Branswell knew they were false. That was the deal. The interview had to be printed without contradiction.

Perhaps most outrageous was Kennedy’s claim that “the hepatitis B vaccines that are currently approved had fewer than five days of safety testing. That means that if the child has a seizure on the sixth day, it’s never seen. If the child dies, it’s never seen.” Safety monitoring for the hepatitis B vaccine, like all vaccines tested before being licensed, involved determining side effects in the vaccinated and unvaccinated group for weeks after each dose. Indeed, some subsets of vaccinated individuals have been monitored for 30 years after hepatitis B vaccination.

Throughout the interview, Kennedy never adequately addressed the new commission. Creating such a commission doesn’t make sense to me for two main reasons.

First, a vaccine safety commission already exists. It’s called the Centers for Disease Control and Prevention. Staffed by epidemiologists, microbiologists, virologists, statisticians, molecular biologists, and clinicians, the CDC supervises the Vaccine Safety Datalink, which I described earlier. Whenever a new vaccine is licensed, this system quickly determines who’s been vaccinated and who hasn’t and detects any side effects that might be occurring more frequently in the vaccinated group.

Second, a commission for scientific integrity also already exists. Independent of the CDC, it’s called the Office for Research Integrity, and is housed in the Department of Health and Human Services.

It’s unfortunate that our culture, and our media, sometimes give celebrities a chance to comment without opposition on subjects about which they are often misinformed. It’s invariably the listener or reader who suffers this advice. Maybe journalists could at the very least add a cigarette-style caution to interviews like the one that STAT did with Robert F. Kennedy, Jr. Something like “CAUTION: Reading this article might be dangerous to your health.”

Paul A. Offit, M.D., is a professor of pediatrics and director of the Vaccine Education Center at the Children’s Hospital of Philadelphia. His most recent book is “Pandora’s Lab: Seven Stories of Science Gone Wrong” (National Geographic Press, April 2017).