Measles- not gone, not forgotten

After the measles vaccine was introduced in 1963 the number of reported cases was reduced by 99%. In 2000 measles was declared no longer endemic ( occurring routinely) in the United States. U.S. public health officials consider an outbreak a major setback in the control of infectious disease.

A “RASH” OF MEASLES CASES

Measles in the U.S. has climbed to its highest level in 25 years, closing in on 700 cases this year in a resurgence largely attributed to misinformation that is turning parents against vaccines.

“This is alarming,” said Dr. William Schaffner, a Vanderbilt University vaccine expert. Not only is measles dangerous in itself, but its return could mean other vaccine-preventable diseases seemingly consigned to the past may be coming back as well, he said.

APNEWS.COM, APRIL 24, 2019

The rash of measles, also known as rubeola, starts on the head and spreads to the trunk (chest and upper back) , arms, and legs over a few days .

What is measles?

At one time, measles was one of the “usual childhood diseases” that most of us over age 55 years contracted as children, prior to the use of the vaccine. It is caused by a virus in the Paramyxoviridae family and spread by person to person contact.

The other childhood diseases were

  • Rubella, or  German measles
  • Chicken pox, or  varicella
  • Roseola
  • Fifth Disease, or erythema infectiosum

These all cause a rash, called an exanthem.

Mumps was also a common childhood disease but does not usually cause a rash.

Symptoms of measles include cough, nasal drainage, reddened, inflamed eyes, and a rash as pictured below.

the rash of measles
image courtesy of the CDC- Centers for Disease Control , U.S. government

There is no specific treatment and it runs its course in about 1-2 weeks. Antibiotics are not effective .

Most of those infected recover uneventfully but there can be serious complications including pneumonia and encephalitis (inflammation of the brain).

Preventing measles and other exanthems

After the measles vaccine was introduced in 1963 the number of reported cases was reduced by 99%. In 2000 measles was declared no longer endemic ( occurring routinely) in the United States. U.S. public health officials consider an outbreak a major setback in the control of infectious disease.

Measles vaccine is usually administered as a “3 in 1” vaccine- the MMR, which has been vilified as a possible cause of autism, although that has been thoroughly discredited.

The other two letters in the mix stand for mumps and rubella (also known as German measles) both of which are also caused by viruses and for which no treatment exists.

No vaccine exists for roseola or Fifth Disease, but we have an effective vaccine for varicella, commonly called chickenpox.

MEASLES OUTBREAK ELSEWHERE

According to the World Health Organization, WHO, Europeans are also contracting the most measles cases in 30 years.

The WHO European Region comprises 53 countries, from Andorra to Ukraine. According to data from the WHO, 41,000 measles cases were reported from January to June 2018 across those countries, including 37 deaths — a record-high number of fatalities since the 1990s.

CBSNEWS.COM, JUNE 17, 2019

sharing the HEART of health

My family receives vaccines and believe any potential risk is worth the benefit. I urge you to think carefully and talk to a trusted physician before you decide to forgo vaccination for yourself and especially for your children.

Thanks for visiting this blog and considering this vital information as we explore the HEART of health together.

To start following Watercress Words , use this form to get an email notification of new posts . Please find and follow me on Facebook, Pinterest and LinkedIn, links are on the left side bar here and the Home page. Thanks so much.

Dr. Aletha 

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Reconsidering vaccination- a book review

In 1961,  my mother and I went to my school on a Sunday afternoon to receive the newly released oral polio vaccine. She along with other parents eagerly sought a way to prevent a dreaded disease that had the potential to cripple or even kill their children.

In medical school I learned about diphtheria, a painful throat infection due to a bacteria, Corynebacterium diphtheriae. . Once a common cause of severe illness and death, a vaccine had rendered it rare. I saw no cases of diphtheria in medical school, nor have I since.

As a young physician I welcomed the introduction of the H.Flu vaccine (Haemophilus influenzae bacteria, not the virus) in 1985. At that time, any infant or toddler with a fever was a potential victim  of  meningitis due to H.Flu, which could be deadly or leave the child with neurological damage.

Similarly, the Hepatitis B vaccine made healthcare a less risky occupation; Hepatitis B is a blood borne infection contracted from contact with infected blood.

VACCINE-PREVENTABLE DISEASES
FROM THE CDC, UPDATED JANUARY 2016– follow link for detail

 

 

 

 

 

So, I was  first surprised, then puzzled, then alarmed , now resigned to the number of parents who reject vaccination for their children, and   adults who decline immunizations for themselves. Some people now fear the vaccines more than the diseases they prevent and we physicians must consider this to help people stay well instead of treating them when sick.

I was intrigued when I heard of a book, by a physician,that seems to promote a compromise-

The Vaccine-Friendly Plan

 

The Vaccine-Friendly Plan is published by Ballantine Books,  2016

 

 

The Vaccine-Friendly Plan by Paul Thomas, M.D., a pediatrician  and Jennifer Margulis, Ph.D.a science journalist.

It is based on his pediatric practice, Integrative Pediatrics,  as well as their extensively noted references. The book’s subtitle summarizes the contents accurately-

“Dr. Paul’s Safe and Effective Approach to Immunity and Health- from Pregnancy through your Child’s Teen Years.”

The book discusses pregnancy, infant and  child care in general, not just vaccination, although that is a major emphasis.There is a chapter about pregnancy and for each stage of child development through adolescence.

The first chapter discusses a popular health topic now- toxins. (As an aside, I don’t know when we started calling poisons  “toxins”) . This should grab your attention-

“Toxins, Toxins, Toxins: Raising Healthy Children in a Poisoned World”.

Anything can be “toxic” if misused, overused,or abused  but they concentrate on these toxins in particular- acetaminophen, aluminum, aspartame, fluoride, methanol, mercury, and what they call endocrine disruptors(this includes pesticides).  They state “environmental toxins are likely contributing to the autism epidemic” as well as other neurodevelopmental and mental disorders in children.  They base their conclusion on an extensive list of review articles from the medical and scientific that support their view (obviously) and also from Dr. Paul’s medical practice of 11,000 children who he calls “among the healthiest in the world.” While I suspect  families who are already health conscious tend to select a physician who is health oriented, this claim sounds impressive.

I agree with some of the advice the authors offer. For example this advice for pregnancy is hard to argue with-

  • Eat a whole foods, organic, non-GMO diet 
  • Skip the soda
  • Drink filtered water
  • Minimize stress
  • Get treatment for addiction
  • Join a support group

But in addition, they recommend declining all vaccinations during pregnancy, certainly not mainstream medicine advice.

 

A later chapter also offers sound advice:

“ The Best Ways to Support your Child’s Immune System” 

  • Breast feed
  • Enjoy cuddling
  • Laugh a lot
  • Relax often
  • Rock your body
  • Stay hydrated
  • Eat a variety of foods
  • Maintain social connection
  • Read
  • Get Dirty
  • Be cautious but not afraid
  • Choose vaccines based on real science, your family’s needs and common sense
  • Sleep enough
  • Trust your children
  • Trust yourself

 

He offers an interesting list  Ten Questions to Ask When Looking for a Pediatrician (which I assume would apply if you use a family physician for your child’s care).

As a physician, I have never liked the idea of being “interviewed” by a potential patient; I  want a relationship with patients, not a job. But I think pediatricians routinely offer “get acquainted” visits so you may find it helpful. Some of the questions seem more appropriate to explore  in a long term relationship with a physician, not quick answers in a short visit, like “What would you like me to know in order to keep my family healthy?”

An appendix compares the CDC immunization schedule of 1983 to the current 2016 version, illustrating  many more vaccines and doses are now recommended.

Of course the list is longer since several new vaccines have been developed in the past 30 years and the CDC recommends those considered necessary for the public health. Most areas of medical care have changed dramatically in the past 30 years, we have a lot more of everything-drugs, procedures, etc- so this should not be a surprise.

vaccines
CDC Immunization Schedule– follow link for detail

 

 

Also in the appendix is Dr. Paul’s Vaccine Plan at a Glance, which is a much abbreviated version of the CDC recommendations. The plan is offered free at his web site drpaulapproved.com by signing up to receive his newsletter. (There is also a “store” on the web site offering an assortment of vitamins, minerals, probiotics and melatonin.)

The authors describe themselves as “pro-vaccine”, have received vaccines themselves and vaccinated their children. But they also believe that physicians and parents should have a choice and make informed decisions about immunization and other procedures. 

Universal vaccination is recommended , but there are individual circumstances where the routine schedule might need to be altered due to a child’s particular medical circumstance, but not for some vague concern that vaccination might not b e “safe”. Neither is infectious disease.

If  you are a parent who has  rejected vaccination for your children,  please read this book soon.

Also, read another review of this book by  Vincent Iannelli, MD is a pediatrician and Fellow of the American Academy of Pediatrics.

 

 

 

 

Sonia Shah, a science journalist, also wrote about vaccination in her book

Pandemic – Tracking contagions from cholera, to Ebola, and beyond

Read my review at this link Pandemic- a book review

 

Pandemic by Sonia Shah

 

Previous posts about vaccination on this blog include

Vaccination prevents disease – Part 1 and Part 2

 

Explore the Category “books, literature, writing” for more book reviews.

And please follow this blog for more articles to

inform, instruct, and inspire you to explore the

HEART of HEALTH.      

a stethoscope, a red heart and a heart ekg tracing
exploring the HEART of HEALTH

6 smart facts about antibiotics

6 smart facts about antibiotic use

We’ve already looked at how antibiotic resistance develops and why it’s important. Now let’s consider 6 more important facts about using antibiotics appropriately.

Antibiotics save lives.

“The discovery of penicillin in 1928 by Alexander Fleming was one of the greatest scientific achievements of the 20th century. It’s hard to imagine a world before the development of what many consider to be miracle drugs; however, just 90 years ago antibiotics weren’t available” (quote from the CDC website)

Prior to the discovery of penicillin, infectious diseases frequently caused death, probably the most common cause prior to the mid-20th century.  Now they have been surpassed by heart disease, cancer and trauma. We are less likely to contract and die from an infectious disease because of immunization, improved hygiene, sanitation, safe food and water, improved nutrition, and antibiotics. Unfortunately, in some parts of the world, and in any place devastated by war or a natural disaster, infectious diseases are still a major menace.

please wash your hands
common sight now in public restrooms

Antibiotics are used to treat infections caused by bacteria.

In a broad sense, the word antibiotic could refer to any drug that kills or stops germs, or in other words, organisms that cause disease. But we usually reserve it to refer to bacteria type organisms. There are many families of bacteria; two of the most common are the Streptococci, or Strep and the Staphylococci, or Staph (pronounced staff). There are different drugs that work on other infections caused by viruses, fungus, and parasites.

MRSA bacteria
MRSA- a staph bacteria photo from Public Health Image Library

Ear infections may or may not need treatment with an antibiotic.

Ten years ago we thought all ear infections must be treated with antibiotics. Now we know that some resolve spontaneously, so antibiotic prescribing is not automatic. In some circumstances, they are still recommended

  • Infants less than 6 months old
  • Toddlers under 2 years old with both ears infected
  • A ruptured ear drum (perforated tympanic membrane) with pus draining

In other cases, it is safe to wait 2-3 days before giving an antibiotic if symptoms have not resolved.

A sore throat usually gets better without an antibiotic.

Unless it is due to an infection with the Streptococcus bacteria, “Strep throat”. Greater than 90% of sore throats are caused by viruses, including those which cause colds and influenza. Mono, the “kissing disease”, (infectious mononucleosis) is also caused by a virus called Epstein-Barr. None of these are treatable with antibiotics, although influenza symptoms can be lessened with an anti-viral drug.

Strep throat is usually treated with penicillin but symptoms may not get better any faster than without. The goal in using an antibiotic is to prevent rheumatic fever, a complication of strep which is now rare in the United States.

Chart showing that the following illnesses are usually caused by viruses and don’t need antibiotic treatment: colds/runny nose, bronchitis/chest cold (in otherwise healthy adults), flu, sore throat (except strep), and fluid in the middle ear (otitis media with effusion). Chart also shows that the following illnesses are usually caused by bacteria and do need antibiotic treatment: whooping cough, strep throat, and urinary tract infection.
illness chart provided by the CDC

 The color of mucus, pus, or drainage does not determine the need for an antibiotic.

Some infections may cause characteristic colors or odors, but that alone is not used to diagnose or treat bacteria. If there is pus or other drainage, a sample may be collected and sent to a lab for a culture- attempting to grow any bacteria present. Sometimes this is misleading, since our bodies harbor lots of bacteria normally.

Like all drugs, antibiotics have potential risks.

You may think of antibiotics as safe, harmless drugs with no potential for serious effects.  Usually antibiotics are well tolerated and safe. But serious side effects are possible and dangerous, though rare.

Here are some of the potential serious risks of popular frequently used antibiotics

  • Penicillin- anemia (loss of red blood cells), injury to kidneys and nerves
  • Cephalexin- seizures, liver problems leading to yellow jaundice
  • Sulfa- increased sensitivity to sunlight, inflammation of the pancreas
  • Azithromycin (Z-Pak) irregular heart rhythm, injury to liver and pancreas
  • Ciprofloxacin- seizures, depression, rupture of tendons

In the last post of this series I’ll talk about when to use an antibiotic and when not to. In the meantime, you can explore further here.

Vaccination prevents disease- part 1

 

Prevention is a focus in healthcare now  and immunization has  been one of the most effective ways to prevent disease ever developed.

The list of diseases that are “vaccine preventable” is long and continues to grow.

Vaccine recommendations may be based on a person’s

  •  age,
  • gender,
  • ethnicity and
  • concurrent conditions, especially diabetes mellitus, chronic lung diseases, heart disease and  immune suppressing disorders.

Vaccine administration may vary by

  • the number of doses recommended,
  • how far apart the doses should be given, and
  • which vaccines can be administered at the same time.

 

Immunization protocols have  become so complex that even physicians have difficulty keeping it straight without the use of paper or digital checklists. This is one area where the Internet and EMRs (electronic medical records) can be useful.

Create an immunization schedule for your child from birth to 6 years of age

2016 recommended immunizations for children
2016 recommended immunizations for children (the 2017 schedule is available on the CDC website)

 

Vaccines for infections caused by bacteria

I use the name of the disease and/or the bacteria, rather than the vaccine name, since there are different brand names for the vaccines depending on the manufacturer.

So successful have these vaccines been that most young doctors have never seen a patient with these diseases (unless perhaps they specialize in infectious disease, immunology, emergency medicine or critical care). And even I, who graduated medical school in 1978, have only seen a few, and none in recent years.

Diphtheria-primarily a respiratory tract illness in young persons

Pertussis, better know as whooping cough, also a respiratory illness, which has made a comeback in recent years, apparently due to a waning of immunity

Tetanus, also called “lockjaw”– due to a toxin which may contaminate a dirty wound

Menigococcal disease, which is one of many causes of meningitis (inflammation of the brain lining), but one of the most deadly, even with treatment

Streptococcal pneumoniae disease; the vaccine is often referred to as the “pneumonia vaccine”, but the bacteria can also cause ear infections, sinusitis, meningitis and sepsis (bloodstream infection)

Haemophilus disease is similar to pneumococcal, but more of a concern in infants and children

 

Six Things YOU Need to Know about Vaccines

 

 

 Pneumococcal Vaccination from JAMA

infections caused by Streptococcus pneumoniae

 

 

 Pandemic- a book review

Infection is still a major health issue worldwide

and epidemics are still a threat. This book explains why.                 Pandemic by Sonia Shah

Vaccination prevents disease, part 2

Should your family receive vaccinations?

This post is being updated with the current CDC vaccination recommendations. With a few exceptions for medical reasons I believe all adults should discuss vaccination with their physician and be immunized for any diseases for which they are at risk.

Current vaccination recommendations, 2019

This post is being updated with the current CDC vaccination recommendations. With a few exceptions for medical reasons I believe all adults should discuss vaccination with their physician and be immunized for any diseases for which they are at risk.

And I recommend that parents do the same for their children and adolescents.

RECOMMENDED ADULT IMMUNIZATIONS 2019
RECOMMENDED CHILD AND ADOLESCENT IMMUNIZATIONS 2019

Some questions to ask about vaccines and the immunization process include.

  • What contagious diseases is a person likely to be exposed to?
  • What are the risks of those diseases?
  • What are the risks of a particular vaccine for that person?
  • What are the risks versus benefits to other people?
  • What else can we do to prevent an infection?

Infectious disease control methods

The  developed countries  have eliminated or controlled many of the environmental sources of contagious disease by manipulating our environment.

  • indoor plumbing
  • water treatment facilities
  • screens on windows
  • air purification
  • wear gloves to prepare food
  • inspect restaurants
  • signs in many public restrooms reminding us to wash our hands.
Hand hygiene saves lives.
Hygiene remains vital to infection prevention even when immunizations are given.

However, we have not eliminated another source of infectious disease- and that is other humans.

Rarely do we isolate or quarantine people with infections. Most of us have gone to work, school or social events with symptoms suggestive of infection- a cough, runny nose, upset stomach- putting our friends and colleagues at risk.

Please review these excellent resources on vaccine use

A basic review of  Childhood vaccines  and Adult vaccines from UpToDate, a researched, non- commercial medical publication for doctors and patients

The Science Behind Vaccination from The New York Times

 7 things about vaccines from The Washington Post

Reconsidering vaccination a blog post review of the book The Vaccine Friendly Plan

Voices for Vaccines – a parent-led organization that supports and advocates for on-time vaccination and the reduction of vaccine-preventable disease.

Thanks for reading and sharing this important information about protecting the HEART of health.

I appreciate all of you who follow this blog; there are numerous other blogs to choose from so I am honored you chose to spend some time here. A special welcome to all my new followers from this past month.

To start following Watercress Words , use this form to get an email notification of new posts . Please find and follow me on Facebook, Pinterest and LinkedIn, links are on the left side bar here and the Home page. Thanks so much.

Dr.  Aletha