LANCASTER PEDIATRICS



MRSA

Community acquired MRSA or “Superbugs” The background: There has been much talk in the media lately about so called superbugs, bacteria that are resistant to commonly used antibiotics. Although these bacteria began as hospital acquired infections, reports of community acquired infections began in 2000. The most commonly talked about infection is MRSA, methicillin resistant staphylococcus aureus. About 30% of healthy individuals carry staphylococcus bacteria on their skin or in their noses and it rarely causes any signs or symptoms. Some of these staphylococcus bacteria are the resistant strains and are immune to the effects of penicillin and cepalosporins, antibiotic commonly used in the past to treat skin infections. The disease: The most common staph infections are superficial skin infection although some may spread to the soft tissue and cause abscesses or boils. This may appear to be a “spider bite” or a wound that just won’t heal. True invasive infections are much less common than the superficial type, but can be more serious. Prompt medical evaluation and good local wound care are important to avoid this more serious type of infection. How Staph infections are spread: Staph infections are spread through direct contact with the bacteria, most often through damaged skin. It can also be spread by direct skin to skin contact as well as contact with contaminated surfaces, personal items, or equipment. Sharing personal items such as towels, soap, or razors should be avoided. Although staph infections are treatable, prevention remains the most effective intervention (see below) How staph infections are treated: There are treatments that are effective for all staph infections, including MRSA. This includes possible drainage of abscesses or boils and the use of topical and/or oral antibiotics-although the type varies on the location and severity of infection. There are still antibiotics available for the treatment of MRSA. Because the infections can be recurrent, it is important to talk with your health provider if you have had more that one infection as the treatment options for recurrent infections may be more aggressive. Prevention/Controlling spread: --Frequent hand washing with either soap and warm water or the use of alcohol based hand sanitizers should be encouraged. --Showering after every athletic event with soap and clean towels --All open wounds should remain covered through athletic events. If a wound cannot be kept covered the student should not participate in the event. --Skin cuts, breaks, and scrapes should be cleaned immediately with soap and warm water and should be kept dry and covered until healed. --Do not share personal items such as towels, razors, soap, or clothing. Athletic uniforms should be washed after each use. --Clean all cuts, scrapes, and abrasions twice per day and keep bandages on until healed. An antibiotic ointment may be applied as well. --If the injury begins to appear infected-tender, red, warm to touch, swollen, draining pus-see a medical provider right away. We have been treating these types of infections for several years and are happy to answer any questions that you may have. Further information may also be found on the American academy of Pediatrics (below).

NEWER SHOTS FOR CHILDREN

TdaP
What is this?? The incidence of Pertussis (P=Pertussis=Whooping cough) has been increasing over the last several years. The proposed solution is to increase children's immunity by adding this Booster at 10-12 year well exam. It is a safe vaccine comprised of Antigens already in use for many years. Lancaster Pediatric Associates will be offering and recommending this vaccine. Incidentally, what is the proper pronunciation of Whooping Cough? Answer: "Hooping" cough. Silent "W". Will insurance carriers pay for this? Most likely, but check.

Menactra
What is this?? Meningococial meningitis is a rare, but highly contagious and very dangerous form of bacterial meningitis. A vaccine has been available since the 1960's. Initially it was used only by our Armed Forces. More recently it has been recommended for students planning to live in dormitories, but not for younger students because the protection lasted only 2-3 years. The new vaccine is equally safe, but has a protective span of 4 plus years and thus can be used to protect high school age kids with the immunity lasting into their "dormitory" years. Lancaster Pediatric Associates is offering this vaccine to this age group. Will your insurance carrier pay for this? Maybe, by all means check.

Gardasil
Gardasil is a vaccine which protects against Human Papillomavirus (HPV). HPV causes squamous cell cervical cancer and genital warts. The virus affects about 20 million people in the United States and one person dies from cervical cancer every 10 minutes. HPV is spread via intimate contact with an infected person. Many people who have HPV do not show or feel any signs of infection. Gardasil is approved for girls and women ages 9 through 26. It is given in three doses and then provides life long immunity. It is not a live vaccine and is mercury free. The most common side effect is pain and or itching at the injection site. Overall it has been shown to be a very well tolerated vaccine. The most commonly asked question about Gardasil is: Why should I give my child this vaccine if she is not sexually active? To answer this concern: Much like the hepatitis B vaccine, it is the goal with Gardasil to give the vaccine prior to any possibility of sexual activity so that you eliminate all the risk of HPV contraction. Lancaster Pediatrics recommends that all girls ages 9-26 receive the three doses of Gardasil vaccine. The vaccine will soon be available in our office. Insurance coverage varies depending upon your company. For more information: www.cdc.gov/nip/vaccine/hpv/hpv-faqs.htm or click below.

Hepatitis A
The disease is self-limited, with fever, general discomfort (malaise), nausea, and loss of appetite. Jaundice is rare in young children but is present in up to 70% of older children and adults. In fact, most young children after exposure do not get sick and the first person to “get it” is often an adult. Typically the disease lasts several weeks but can drag out for six months. It is transmitted from person to person and is in bowel movements leading to rapid spreading through day cares. More rarely it has food or water sources. At times in the United States and in many places around the world there are highly infected (endemic) areas. The Hepatitis A Vaccine has been used since 1995 in the U.S. for travel to or exposure in endemic areas. This has effectively controlled infection within these groups but the majority of disease is actually outside them. Therefore, it is now recommended by the American Committee of Infection Control and the American Academy of Pediatrics that all patients greater than one year of age get immunized. The vaccine is prepared from dead virus particles. Some brands have preservatives and some do not. In our office we use a brand without preservatives and without Mercury. It is a two shot series with the first after the first birthday and the next one 6-18 months later. Common reactions include site tenderness, swelling, and redness. Occasionally, reactions can include fatigue, malaise, fever, and headaches. Rarely, nausea and decreased appetite may happen. We at Lancaster Pediatrics believe that all children are candidates for this vaccine and encourage all our patients to get this series but especially children in daycare, those who spend time with the elderly or immunocompromised, and of course those traveling to endemic areas. For more information on the topic, please see below:

Rotavirus Vaccine
Rotavirus is the leading cause of severe vomiting and diarrhea in infants and children in the USA. Over 90% of these children who require hospitalization for IV fluids due to dehydration have Rotavirus as the cause. The biggest group at risk are children 6 to 24 months. This age group will put their hands in their mouths frequently thus swallowing the virus. No human parents can wash their kids’ hands every 30 seconds. Crawling, walking increase exposure risks. Rota-Teq Vaccine was released in April 2006 for prevention of this disease. We at LPA have been carefully watching its adoption before recommending it to our patients. It is a vaccine given at 2, 4, and 6 months of age. 1st dose cannot be given to infants greater than 3 months of age and the last dose must be completed by 8 months of age.

Questions that should be addressed about this vaccine:
1) Is it safe? Yes, side effects are no higher then in the placebo control group of children.
2) Why not give it at an earlier or later age? Because that is the way FDA certified it. More liberal dosing guidelines may follow.
3) Does it work? It is 95.8% effective.
4) Should I get this for my child? Full time child in Day Care-Yes. Only child living on a farm? - No. In between these 2 extremes? Ask us at a visit, we’ll discuss.
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