Cold and Flu Season Update 2010-2011

Each flu season seems to have some kind of surprise in store for parents and pediatricians.

Last year, the big surprise was that there wasn't a shortage of flu shots. And of course, there was the emergence the swine flu pandemic.

So far, the big surprise this year is the early, widespread availability of flu shots and the expectation that there will be over 155 million doses of seasonal flu vaccine.

Reports of a novel influenza A virus that has been reported, a swine origin influenza A (H3N2) virus, are thought to be cases where a few people got sick from contact with pigs. There is no evidence of human-to-human transmission of this swine flu virus, as we saw in the 2009 H1N1 pandemic, so there is no big surprise with this flu virus.

Flu Season

Flu season got a very early start last year, but concerns that there might have been another wave of flu activity at some point over the summer faded from most parent's minds, well before the World Heath Organization declared an official end to the 2009 H1N1 pandemic on August 10, 2010.

Whether you are concerned about seasonal flu or swine flu, parents should take steps to avoid the flu to keep their family from getting sick. In addition to getting the seasonal flu vaccine include frequent handing washing, voiding close contact with people who are sick with the flu, disinfecting contaminated surfaces, including toys and kitchen counter-tops.

Fortunately, this year's seasonal flu vaccine provides coverage against the 2009 H1N1 swine flu virus and two other flu viruses, an H3N2 virus and an influenza B virus. And so far, although it is very early in this year's flu season, this seems to be a good match for the flu virus strains that are being found on flu tests.

Flu Season Activity Reports

As of mid-December, the CDC states that flu activity 'remained relatively low in most of the United States, however certain key flu indicators are increasing.'

No states are reporting widespread flu activity.

Four states, Georgia, Kentucky, Mississippi, and Nevada, and Puerto Rico, are now reporting regional flu activity.

Twenty states, Alabama, Arizona, Connecticut, Florida, Hawaii, Illinois, Iowa, Louisiana, Maryland, Massachusetts, Minnesota, New Jersey, New York, Oklahoma, Pennsylvania, South Carolina, Tennessee, Texas, Utah, and Virginia, are now reporting local flu activity.

Twenty-one states, Alaska, Arkansas, California, Colorado, Idaho, Indiana, Kansas, Michigan, Missouri, Montana, New Hampshire, New Mexico, North Carolina, North Dakota, Ohio, Rhode Island, South Dakota, Washington, West Virginia, Wisconsin, and Wyoming, the District of Columbia and the U.S. Virgin Islands, are now reporting sporadic flu activity.

Only five states, Delaware, Maine, Nebraska, Oregon, and Vermont, and Guam, are still reporting no flu activity.

Remember that when it comes to flu activity reports, widespread > regional > local > sporadic > no activity.

Google's Flu Trends, which relates flu searches in an area to how many people are actually sick with the flu, now reports a low level of flu activity in the United States, which has increased from the previous minimal level over the summer. Remember that Google Flu Trends is supposed to 'estimate flu activity faster than traditional systems,' like the CDC and based on their scale, flu activity has declined to its lowest level in the past few months.

Knowing where there is flu activity can be helpful, because if you have classic flu symptoms in an area where there are a lot of flu infections, especially widespread or intense flu infections, then you likely have the flu and should see your doctor right away to see if you are a candidate for one of the flu medications, such as Tamiflu or Relenza.

Flu Deaths

Each year, the flu is reported to be responsible for almost 36,000 deaths, including about 46 to 74 deaths in children. Last year (2009-10 flu season), 281 deaths in children were reported to the National Notifiable Diseases Surveillance System.

There has been one pediatric death from flu during the 2010-2010 flu season.

Kids Safe Toys & Gifts Month

It likely doesn't come as a surprise to anyone that December is Safe Toys and Gifts Month.

Each year, Prevent Blindness America, encourages people to make toy safety priority as they do their holiday shopping, including that they:

Buy age appropriate toys.

Look for toys and other gifts that meet American Society for Testing and Materials (ASTM) standards.

Review warnings on the toy's box.

Avoid shooting toys and toys that have pieces that shoot or fly off.

Remember that BB guns and air guns are not really toys.

The American Academy of Pediatrics also provides tips for choosing a safe toy, including that you look for a toy that is sturdy, made with nontoxic materials, not too loud, and if it is an electric toy, that it is UL approved.

In addition to general toy safety guidelines, the Consumer Product Safety Commission and other experts have highlighted hazardous toys the last few years, including:

Toys with small magnets, which can be swallowed and lead to serious medical problems if two or more magnets are swallowed.

Toys with lithium button batteries that can be easily removed without a screwdriver and can be a hazard if swallowed.

Lead paint on recalled toys.

Metals in children's jewelry, which can include lead, cadmium, and other toxic metals.

Unfortunately, most of these toys weren't found to be hazardous until they were recalled after having been on the market for some time. That makes it important to inspect toys before you buy them to make they are well made and don't have any hidden hazards.

What you need to know about this flu season

There's no worldwide flu pandemic this year, no shuttered schools, no crisis atmosphere. But doctors, health officials and especially private pharmacies are ready to needle us again, anyway.

The 2010-2011 influenza season will be different in several ways. First, the H1N1 ``swine flu'' that disrupted our lives last year is still around, but without its old punch. And it'll be joined by two other flu viruses more typical of seasons past.

Second, last season's flu struck children and pregnant women hardest. This year's more typical season could be tougher for senior citizens. Drug makers have even created a stronger vaccine for them.

Also unlike last year, vaccine shortages are not expected. Federal officials, criticized for issuing swine flu vaccine very late last year, opened this year's pipeline in August. Pharmaceutical companies plan to pump out 165 million doses, a 40 percent increase.

And this year, due to a new law, it'll be easier than ever to get flu vaccine from private pharmacies.

Still, health officials can't say whether it will be a hard flu season or an easy one.

``Flu seasons are unpredictable,'' says the U.S. Centers for Disease Prevention and Control on its website.

Here are some questions and answers about the coming flu season:

Q: How bad a season should we expect?

A: There's no way of knowing. ``Although epidemics of flu happen every year, the timing, severity and length depends on many factors, including what influenza viruses are spreading and whether they match the viruses in the vaccine,'' the CDC says. Last year, nearly 100 percent of all influenza was of the H1N1 ``swine flu'' strain. This year, experts predict a return to older patterns with at least three strains of flu circulating.

Q: What difference will that make?

A: Last year's swine flu was hard on kids, easier on seniors. Only 10 percent of last year's swine flu fatalities were 65 and older. In a typical year, 90 percent of influenza victims are seniors. This flu season is expected to be more like a typical year.

Q: What can seniors do?

A: For the first time, the CDC has approved a new High-Dose Fluzone vaccine for seniors made by Sanofi Pasteur containing four times the amount of antigen (the active ingredient) of a regular flu shot. That's because aging makes a body less able to generate a robust immune response when vaccinated.

Q: Last year, there were two flu shots. This year, there's only one. Why?

A: Every year, health experts get together in February, try to determine what strains of flu are going around and devise a seasonal vaccine against the three most prevalent. Last year, H1N1 influenza showed up after the seasonal flu vaccine was formulated, so the CDC quickly added a second shot for H1N1 swine flu.

Q: What will be in this year's vaccine?

A: This year's vaccine will counter last year's H1N1 virus, the Perth H3N2 virus and the B Brisbane virus.

Q: What are these viruses like?

A: The H1N1 is like last year's swine flu virus. The Perth virus was first identified last year but didn't circulate widely. Those who got last year's seasonal flu shot will not be protected against it, the CDC says. A few cases of Perth cropped up in Iowa in June and July of this year, it says. The Brisbane virus circulated in some areas in 2008. Last year's seasonal flu shot contained antigens for the Brisbane virus, so those who got the shot might have some protection.

Q: Last year, some age groups were asked to wait to get their shots until high-risk groups were vaccinated. Will that be the case this year?

A: No. This year there's plenty of vaccine, and everyone over 6 months of age is urged to be vaccinated unless they have contraindications. People allergic to eggs should avoid the vaccine because eggs are used to make it.

Q: Where can I get the vaccine?

A: From your doctor, county clinics, retail pharmacies and some supermarkets. The Miami-Dade County Health Department is offering flu shots at its Downtown Clinic, 1350 NW 14th St., Miami; its Little Haiti Clinic, 300 NE 80th Ter., Miami; and its West Perrine Clinic, 18255 Homestead Ave. Call 786-845-0550. Shots are free to those younger than 18 and older than 64. Others pay $25. The Broward Health Department urges residents to contact their private physicians. Both departments will work with schools to vaccinate children.

Q: Will pharmacies have the vaccine?

A: In spades. Encouraged by last year's boom in vaccinations, pharmacies are competing to provide the shots. They're dueling on price, charging $20 to $30 for the shots. The enthusiasm stems from a new law allowing pharmacists with special training to give the shots to adults. Until the 2008-2009 flu season, only pharmacies with walk-in clinics staffed by nurse practitioners or physicians' assistants were permitted to give flu shots. Now, pharmacists who take a 20-hour state course in giving shots, handling allergic reactions and administering CPR may give them.

Q: With no dire predictions and no pandemic, will people line up this year to get their shots?

A: ``It's a difficult situation,'' says Samir Elmir, director of environmental health for the Miami-Dade Health Department. ``We will try to educate the public as well as possible about the need to vaccinate.''

By Fred Tasker.

Turnoff Week

TURNOFF WEEK - The American Academy of Pediatrics encourages everyone to participate in Turnoff Week this week and 'go for a week without screen time.'

A report this earlier this year by the Kaiser Family Foundation found that the average child in the United States between the ages of 8 and 18 years old spends just over 10 1/2 hours a day (10:45) using some type of entertainment media (screen time), including watching TV, listening to music, playing video games, and surfing the internet, etc.

Considering those statistics, it is easy to see why the American Academy of Pediatrics encourages everyone to participate in Turnoff Week and 'go for a week without screen time.

Many people probably think that really going a week without any screen time is unrealistic for the average family, and if you are one of those people, keep in mind that kids who get too much screen time are more likely to get poor grades, less likely to get along well with their parents, and are more likely to report being sad or unhappy.

My kids probably get too much screen time, as they do like to watch TV and play games on their iPods and PlayStation. On the plus side, they would rather play outside, they are very active in at least one sport each season, and they do well in school and like to read. Instead of cartoons or other shows, they have also gotten to where they mainly like to watch sports on TV. So I'm not sure I really need to limit their screen time very much at this point.

One thing I would like to do during Turnoff Week is break their habit of automatically turning the TV on when they get home. Having a TV on in the background when you aren't really watching a show and are doing something else is a bad habit that many kids and adults have.

A report by the Kaiser Family Foundation has found that the average child in the United States between the ages of 8 and 18 years old spends just over 10 1/2 hours a day (10:45) using some type of entertainment media (screen time), including:

• 4:29 watching TV shows, either on a TV, cell phone, or iPod, etc.

• 2:39 listening to music

• 1:29 on a computer (online and offline)

• 1:13 playing video games

• :25 watching movies in a movie theater

Use of all of these types of media has been increasing over the past 10 years. The only thing that they found that had decreased was the amount of time kids spent reading each day, which is down to just 38 minutes a day.

Screen Time

Keep in mind that these times are in addition to the average half-hour a day (:33) they spend talking on their cell phones and 1 1/2 hours they spend texting.

Even when you consider that kids do many of these things together, the Kaiser Family Foundation found that the average child was spending about seven hours and 38 minutes watching TV or using their computer, cell phone, and iPod, etc.

Although that clearly sounds like too much time using these devices, that is even easier to see when you consider that kids who are heavy users of these types of entertainment media are:

• more likely to get poor grades

• less likely to get along well with their parents

• more often bored

• more likely to get into trouble a lot

• more likely to report being sad or unhappy

Schedules and Activities for Kids

If your child shouldn't be in front of the TV or computer or on his cell phone all of the time, what should he be doing?

Experts recommend that school age children and teens:

· 9 (teens) to 10 (8-12 year olds) hours a night

· Excersise for at least one hour every day, including moderate-intensity aerobic physical activity each day (bike riding, brisk walking, skateboarding, etc.), muscle-strengthening physical activity (push-ups, sit-ups, swinging on playground equipment, etc.), bone-strengthening physical activity (hopping, jumping, running, etc.), and more vigorous-intensity physical activity (running, playing soccer or basketball, jumping rope, etc.) at least three days a week.

· Eat a meal together with their family each night

· Limit screen time (which should include time watching TV, using a computer, playing video games, or using an iPod, cell phone, or other media device) to no more than one or two hours a day

Limiting Screen Time

To help decrease your child's use of all of the different types of entertainment media (screen time), it can help to:

• remove most media devices from your child's bedroom, including their television or computer, especially if it has internet access

• take away your child' cell phone and other mobile media devices (iPod, Nintendo DS, etc.) around an age-appropriate bedtime

• make sure your kids are getting a good night's sleep and aren't staying up late talking on the phone, texting, or listening to music, etc.

• use parental controls on your TV and computer to limit when they can be turned on and used

• encourage active free play after-school with friends.

• encourage your child to participate in an organized sport, hobby, or other extracurricular activities

• turn the TV off during meals and when your kids aren't watching a specific show so that the TV isn't on in the background all of the time

• set a good example by being active and limiting your own use of screen time

• avoid using extra screen time as a reward

Most importantly, don't use your child's media devices as a babysitter. Spending more time with your kids is probably the best way to get them off their computer or away from the TV.

Back to School Health Primer

Back to School Health Primer

The start of a new school year is always exciting with new challenges and new expectations. Everything that occurs during the school year from September through June will impact our children’s health – mostly in positive ways but there are always a few speed bumps along the way at unexpected times. Here’s a snapshot of the most important issues nuts and bolts to consider as you march through a new school year with your kids.



The Annual Well Child Examination

Most public school systems require an official physical examination, or well child examination, on record entering Kindergarten, Middle School and High School, and for sports participation. The American Academy of Pediatrics, however, actually advises a checkup annually from 3 to 21 years of age. This is really the only way to be sure your child’s health and well being is stable year to year and to catch subtle issues that need attention. During those visits, the entire child’s health is looked at, not just the physical exam. A year’s overview of a child’s emotional, developmental and academic ups and downs is what gives ups a picture of a child’s health. We can tell you a great deal about your child based on what has changed, or not changed, from one year to the next and help you prepare for what changes are anticipated next.

Finally, keep in mind that since the point of the visit is to get a sense of your child’s health, it is important for your child to weigh in on issues. Most pediatricians and nurse practitioners work hard to help a child learn to talk about themselves during these visits as they get older. What helps is if the child is given an opportunity to answer the questions first with you filling in the blanks later. In some offices, the parent talks with the pediatrician separately and during the actual physical is more of a fly on the wall.

When A Child Is Sick

Kids can and do get sick during the school year. During cold and flu season, many illnesses are hard to avoid. Given that kids get 6-12 illnesses a year, it is not surprising that most of these illnesses occur during the school year when kids are in close proximity of one another. Luckily, most illnesses are minor and self-limited but that doesn’t mean they won’t impact your child’s school attendance and your ability to go to work. What can create great peace of mind is having some basic information, including return to school guidelines. Your school will have specific guidelines in place created by your public health department but these are the general rules of thumb we follow in pediatrics:

Most illnesses are viral and take time to resolve.

A simple cold last 3-5 days but a stronger virus up to 2 weeks. That can seem like forever sometimes!

Fever and even a rash can be part of many viral illnesses but some due require medical attention so you’d want to notify your doctor if sick symptoms develop with BOTH a fever and a rash.

Fever alone is not a concern if your child looks well and is acting well.

More important than the height of the fever is how your child looks with any degree of fever.

Your child is contagious with fever needs to stay home from school until fever free for a full 24 hours.

It is important to remember that even minor illnesses take time to recover from. Kids don’t learn well when they are worn down. It is lousy enough to be sick and get behind in school, it is even more upsetting for a child to be back in school before the illness has cleared enough to really function well. Time really does cure most ails so be patient and don’t push your child back to school until you are sure your child is really ready. Your pediatrician can help guide you if you are uncertain.

Common School Year Illnesses

Your child will likely not get all of these but here’s a list of the typical sick and urgent complaints kids in general are prone to each September to June:

Mono

Strep Throat

sniffles: common cold or allergy

injuries

chicken pox – even if having had the shot

vomiting and/or diarrhea

headaches

“not feeling well”

starting an antibiotic: no school for 24 hours or until fever free for 24 hour

needing medications at school

asthma

rash

fever

flu symptoms

Your school nurse’s office usually sends around notices if any of these illnesses are in your child’s school or building. What is important is to be sure your child is diagnosed properly and not to push your child back to school until your child is ready. Your pediatrician is the best guide for both of these important decisions.

Medication Use In School

With the school year starting, take a minute to think about the types of medications your child may need at school, both prescription and nonprescription. This is particularly important for conditions that could be live threatening, such as allergies to food or stings and asthma. Make sure the school has necessary inhalers, benadryl and epipens. If your child has an asthma action plan, the school should have a copy.

For acute illnesses, usually all you need is a note from the doctor and the prescription medication. Luckily many antibiotics can now be given only once or twice a day but there are still a few that are 3-4 times a day so will need to be given during the school day.

Just in case medications are sometimes needed at school. Migraines are a great example of this. So, make sure your school has what your child needs should a headache begin.

Finally, if your child gets diagnosed with a major condition, talk to the school nurse so she is aware of the treatment plan and medications.

Immunizations

School is a special situation for health care because of the group setting created by the close proximity of teachers and students. For this reason, all States have State mandated immunization laws in place for school entry that are based on the current CDC 2010 Childhood Immunization Schedules.

In most states, parents must provide proof of immunizations when kids are entering Kindergarten, when moving into the school system, and in middle school or high school, depending on the district. Typical immunization requirements for those grades include:

By Kindergarten, students must have proof of:

3 doses of Hep B
5 doses of DTaP/DTP
4 doses of Polio
2 doses of MMR
1 dose of Varicella

By 7th Grade, students must have proof of:

3 doses of Hep B
1 booster dose of Td
3 doses of Polio
2 doses of MMR
1 dose of Varicella if under 13 years of age; 2 doses if over 13 years of age

You can find the school entry immunization requirements for your State here.

Special Vaccines for Special Situations

There are two times special vaccines are needed: travel to other countries and during the flu season. If you are planning a trip over seas, check the CDC.Gov website to see if your family will need pre-travel vaccinations.

For the upcoming flu season, all kids now need an annual flu shot. The risk to kids from the flu is just too high and anti-flu medications ineffective and dangerous. Annual vaccination against the flu is the only way to protect kids from the flu.

If you have an infant under 6 months at home, it is crucial that both parents and all siblings over 6months get the flu shot. This is the only way to protect that very vulnerable infant.

Here's some valuable new information from the CDC on the seasonal flu, including H1N1.

Unexpected Problems

Finally, just like with a check-up on your car, the annual physical examination only is a touch point at that time. And, while your pediatrician can talk to you about issues expected for each age, that doesn’t mean those issues will come up for your child or others won’t occur. Just be open to whatever comes your way and call your pediatrician at the first sign of concern, in you or your child. Better to call and have something be nothing than to find out an issue is brewing your pediatrician can help with. A child’s body is very dynamic and changing all the time. And, a school year has a way to molt our children in new an unexpected ways. While most of those changes are wonderful, some can be a bit rough and we don’t want you to face those alone.

August 2010 by Dr Gwenn

Sun Safety 101: Prevent Skin Cancer by Following These Simple Tips

Excessive exposure to the sun and other sources of ultraviolet (UV) radiation is clearly associated with a higher risk of multiple forms of skin cancer. Since skin cancer is diagnosed in over one million Americans every year (and rising), experts from the American Cancer Society, the National Cancer Institute, the American Academy of Dermatology, the National Comprehensive Cancer Network, and many other organizations are unanimous in strongly recommending that you should reduce your time in the sun.

That sounds simple, but how much sun is too much? Who is most at risk? What are the most effective ways to protect yourself? Here are answers to frequently asked questions about sun safety.

Am I at risk for skin cancer?

People of all races and skin colors can develop skin cancer, but some are more susceptible than others. If you have one or more of the following risk factors, you should be especially vigilant about reducing your UV exposure:

• Fair skin
• Blue, green, or hazel eyes
• Blond or red hair
• Freckles
• Moles (especially 50 or more)
• Family or personal history of skin cancer

When and where is the sun most dangerous?

UV radiation from the sun is especially damaging under certain conditions, including the following:

• from 10 a.m. to 4 p.m.
• from mid-Spring through mid-Fall
• at latitudes nearer the equator (for example, Florida)
• at higher altitudes
• when there is no thick cloud cover (and clouds only block 20% of UV rays)
• near water, snow, or other highly reflective surfaces

Sun damage accumulates over time, so if you find yourself in these conditions often, consistent protection is a must. Remember that besides skin cancer, the sun can also cause cataracts and other eye problems, a weakened immune system, unsightly skin spots, wrinkles, and "leathery" skin.

What is the most effective way to protect myself?

If you answered "sunscreen," you're wrong. The most effective way actually is to simply stay out of the summer sun in the middle of the day. If that's not possible, wearing dark, tightly-woven clothing and a wide-brimmed hat also works. Only then comes sunscreen, which isn't a panacea and shouldn't be exclusively relied upon. Here are some more tips to protect yourself:

• Wear sunglasses that include a warranty stating they provide 99-100% UVA and UVB (broad-spectrum) protection.
• Apply one ounce (a palm full) of sunscreen to all exposed skin 15 minutes before venturing outdoors. The sunscreen container should specify a sun protection factor (SPF) rating of 15 or above and should state that it provides broad-spectrum (UVA and UVB) protection. Lotion- or cream-based sunscreens tend to adhere to the skin longer, thus providing better protection.
• PABA-free sunscreens are recommended for persons with sensitive skin. Susceptible individuals may also want to avoid oxybenzone and dioxbenzone. Products that contain avobenzone (Parsol 1789), ecamsule, zinc oxide, or titanium dioxide are considered broad spectrum sunscreens and are thus offer protection against UVB and most UVA rays, as well as help reduce the development of wrinkles and skin aging.
• Depending on your activity (swimming, sweating), sunscreen should be re-applied at least every two hours.
• The SPF number on the sunscreen indicates how many times longer, under ideal conditions, a person can stay out in the sun without beginning to turn red in comparison with the amount of time totally unprotected skin would start to burn. Research indicates these numbers are sometimes overstated.
• Avoid tanning salons, beds, and sunlamps.

Do children need extra protection?

Yes. Up to 50% of an individual's lifetime contact with sunshine occurs before adulthood. Studies also show that the more incidents of sunburn kids have, the higher likelihood that they will develop skin cancer decades later. So it is especially critical to protect them from the sun. Here are a few tips:

Babies 6 months of age or younger should be kept completely out of the direct sun at all times. In addition, sunscreen shouldn't be applied to babies this age.

For children over 6 months, apply sunscreen every time they go outside.

Children's swimsuits made from sun-protective fabric and designed to cover the child from the neck to the knees are popular in Australia. They are now available in some areas of the United States.

Are tanning salons healthier than the sun?

No. Tanning lamps give out UVA and frequently UVB rays as well and so can cause serious long-term skin damage and contribute to skin cancer. Remember, tanning is a sign of skin damage and does nothing to protect the skin from further injury. Experts recommend that you prioritize your health over vanity and avoid tanning salons altogether.

The sun causes an estimated 90% of skin cancer cases. Reducing your exposure to UV radiation now is a simple, easy, and effective way to prevent a potentially devastating cancer later.

From Timothy DiChiara, Ph.D.

Sources:

"SunWise Program." Environmental Protection Agency. 15 September 2008.

"How Do I Protect Myself from UV Rays?" American Cancer Society. 15 September 2008.

"Facts about sunscreens." American Academy of Dermatology. 14 September 2008.

"Skin Cancer Prevention Program." California Department of Public Health. 14 September 2008.