With the news in Boston recently of two co-eds at a local college getting diagnosed with bacterial meningitis, many people are alarmed. While a very contagious illness if you have contact with an infected person, this is not contagious like the flu. So, there is little concern for wide-spread community spread. But, meningitis can be tricky to diagnose and can be a very serious and sometimes deadly illness. Knowing what symptoms to look for in your child can help you catch it early and get your child to medical attention should there be contact you are unaware of.

Technical Names: Meningitis or Spinal Meningitis

What it is: an infection of the tissue that lines the outside of our brain called the meninges.

Typical Ages for Illness: any age

Typical Symptoms: fever, headache, stiff neck. light bothering eyes.

Etiology: Bacteria and viruses. The bacteria we hear about in the news that the vaccine covers is Meningococcus.

Seasonal Issues: Any season. Can occur in epidemics.

How’s It Spread? Close contact from saliva – kissing, sharing straws, sharing utensils, sharing cups.

Contagiousness: Bacterial meningitis is very contagious so it is important to not just treat the patient but the people the patient has had close contact with to contain the spread of illness.

Diagnosis:

• the definitive diagnosis is a spinal tap or lumbar puncture but sometimes for mild illness the diagnosis can be made clinically.

Symptom Duration: symptoms develop over a few hours to a few days before becoming severe enough for a person to be seen by a physician for a diagnosis to be made.

Treatment:

• antibiotics – possibly in the hospital if bacterial meningitis
• fluids
• other treatments depending on severity of illness
• pain control for headache
• treatment of contacts including immunization
• viral meningitis is usually like a bad flu and resolves within 7-1o days with only symptomatic treatment.

Call Your Pediatrician if your child has:

• high fever
• severe headache
• stiff neck causing worsening of headache or inability to actually bend at neck
• mental status changes

Prevention:

• Immunization! The links below have great descriptions of the history of meningitis vaccinations but immunization has drastically reduced the amount of childhood meningitis from bacterial that used to be big problems such as Haemophilus Influenza type b.

School and After school Activity Issues: As with other illnesses, fever needs to be cleared for 24 hours before returning to school if the illness is viral. If a child has bacterial meningitis, an infectious disease expert will help you figure out when your child is no longer contagious. Usually this is within a couple days of starting antibiotics.

Internet Resources For Parents

CDC Resource Sheet on Meningitis
Meningitis by KidsHealth

Internet Resources For Teens

What is meningitis? (KidsHealth)

Internet Resources For Kids

What is meningitis? (KidsHealth)

With all the press about MRSA, the “superbug”, it is important to have the facts and know what to do if you find a skin infection on you or a family member that concerns you. Keep in mind that there are still many antibiotics available to treat MRSA so don’t let the hype scare you. It can be serious but more often then not it is very, very treatable.

Technical Names: Methicillin Resistant Staphylococcus Aureus

NickNames: “the superbug”, resistant Staph., Staph.

What it is: a bacterial infection that is resistant to a group of antibiotics.

Typical Ages for Illness: Any

Typical Symptoms: MRSA typically causes a skin infection akin to a very painful pimple or boil but can cause more serious infections sometimes such as bone infections, blood infections or pneumonia, all of which are very rare in otherwise healthy people.

Seasonal Issues: Can occur year roun.

How’s It Spread? By contaminated objects and person to person. The CDC sites “the 5 C’s” as risk factors:  Crowding, skin-to-skin Contact, Compromised skin (i.e., cuts or abrasions), Contaminated items and surfaces, and lack of Cleanliness. (see MRSA in schools link below).

Diagnosis:

• There is often a high index of suspicion based on the appearance
• Culture of the wound/area is the gold standard to diagnosis

Treatment:

• incision and drainage of the skin lesion is curative much of the time
• antibiotics: orally or intravenous depending on severity and location

Call Your Pediatrician if your child has:

• a skin infection that worries you
• a skin pimple, red area on skin, or pustule that is large and painful

Prevention:

• good hand washing
• do not share personal objects such as towels, razors, bandaids
• good cleaning of public places such as gyms and hospitals where MRSA tends to live and get spread easily
• only use antibioitcs when you absolutely need to

School and After school Activity Issues

• no restrictions are needed if the area is undergoing treatment and is covered

Internet Resources:

For Parents

• CDC Podcast on MRSA
• CDC information on MRSA in schools
• CDC Community Acquired MRSA Page

For Kids and Teens:

KidsHealth Information on MRSA

Norovirus is a virus that causes the stomach flu and food poisoning. It is one of the 24 hour stomach bugs that spreads like wildfire through communities, daycare centers, schools and college campuses. Because there are many strains, people can get this illness more than once in a lifetime. It can effect any age.

Main Symptoms: Nausea, Vomiting, Diarrhea, Stomach Cramps

Spread: person to person

Incubation Period:12-48 hours

Duration of Illness: 1-2 days

Treatment Considerations: See The Stomach Flu

Internet Resources

CDC FAQ Norovirus Information

The Update:

Pertussis out breaks(i.e. whooping cough) have been occuring more frequently over the past few years prompting changes in our immunization booster recommendations for pertussies. Because this is a major publich health issue, it is important to have an understanding about why pertussis is on the rise and why it is so important we all get immunized against pertussis – as kids and adults.

Understanding Pertussis Recommendations Based on History

Pertussis is one of the vaccine preventable illnesses. Before the wide-spread vaccination against pertussis, the illness claimed the lives of 5000-10,000 people annually. Vaccination reduced that number to 30! However, in recent years, we’ve begun to see a rise in Pertussis cases reaching 25,000 in 2005. This is thought to be the result of waning immunity to the primary series of Pertussis immunizations given in infancy and early childhood and due to the rising number of people not opting to immunize their children. Another factor is that because immunity wanes over time, adults once vaccinated are becoming unprotected and contracting Pertussis if exposed.

To avoid a public health disaster, the CDC altered the Pertussis immunization recommendations to add a booster in the form of TdaP for teens instead of the traditional Td and to do the same for adults when their next Td would be due. The hope would be to re-booster vulnerable people and get everyone protected again thereby haulting this rise we are seeing.

Pertussis Information:

Technical Names: Pertussis

Nicknames: Whooping Cough

What it is: respiratory illness caused by Bordetella Pertussis

Typical Ages for Illness: Any!! Most severe in infants less than 1 year of age

Typical Symptoms:

Starts as a cold then quickly progresses to the “whoops” which come is spurts or spasms.

Seasonal Issues: none

How’s It Spread? Person to Person by respiratory droplets

Contagiousness: People are contagious for the first 2 weeks of the cough without antibiotics or until on antibiotics for a full 5 days.

Incubation Period: usually 7-10 days from exposure but can be up to 3 weeks

Diagnosis: nasal swab for culture

Symptom Duration:

Cold symptoms for 1-2 weeks then 2-4 weeks of cough followed by a recovery phase that can last for months.

Treatment:

Antibiotics shorten the “whoop” phase as well as stop the spread to other people.

Supportive care with fluids and respiratory treatments if needed

Some kids do need to be cared for in the hospital

Complications: pneumonia (1 in 10), seizures (1 in 50), encephalopathy (1 in 250), fatal in 10-20 cases a year

Call Your Pediatrician if your child has: High fever, difficulty breathing, not eating or drinking, not acting right, seizures, productive cough

Prevention: VACCINATION

Primary DTaP series at 2, 4 and 6 and 15-18 mo of age with a booster going into Kindergarten (4-6 years of age)

TdaP for at the 11-12 year old well child visit, and for adults when their next Td would be due for one dose.

Return to School and Activities:

This is a tough call as each child’s case of Pertussis is unique. Like with other illnesses, children need to be fever free for 24 hours. In the case of Pertussis, they need to be on antibiotics for 5 full days before returning to school, as opposed to the standard 24 hours for other illnesses requiring antibiotic treatment.

To return to school, children should also be able to move well without coughing too much and be able to eat and drink normally.

So, the optimal time to return to school will be determined not just by when a child starts the antibiotics but when other symptoms are controlled enough so that the child can attend school comfortably. Your pediatrician will be able to guide you best for this.

Internet Resources For Parents

CDC: why vaccinate for pertussis

CDC: Pertussis Vaccine Information

American Academy of Pediatrics: Pertussis Information

KidsHealth: Whooping Cough

Technical Names: Pneumonitis

NickNames: Pneumonia, Lung Infection

What it is: infection of the lung

Typical Ages for Illness: Any

Typical Symptoms: cough, fever, vomiting, abdominal pain, fatigue, decreased activity level and appetite, respiratory symptoms including shortness of breath, difficulty breathing, grunting or wheezing sound, breathing fast. Chest pain common when coughing a lot. Some children with more serious signs of respiratory distress will look gray or blue around the mouth.

Etiology: Many different germs can cause this including viruses, bacteria, fungus. Viruses are the most common pathogen for all ages.

Seasonal Issues: Can occur year round but more common in winter months

How’s It Spread? Person to person by direction contact with respiratory secretions – getting coughed or sneezed on, touching an object that was coughed or sneezed on.

Incubation Period: Develops 1 to 6 days after the onset of a viral infection like a cold or flu.

Diagnosis: Some cases of pneumonia can be diagnosed by the physical exam and others require a X-ray.

Symptom Duration:Before treatment, pneumonias are preceded by a bad cold or flu-like illness.  Once treatment starts, the cough can take 1-2 weeks to improve.

Treatment:

• antibiotics may be needed
• +/- breathing treatments such as inhalers or nebulizers
• fluids
• rest
• tylenol or motrin for fever and discomfort
• in cases of severe pneumonia, some kids do need to be hospitalized

Call Your Pediatrician if your child has:

• high fever, or fever not gone in 2-3 days
• vomiting or diarrhea and can’t hydrate well
• lethargy
• sick appearance
• trouble breathing despite treatment
• blue or gray color to lips or fingernail beds

Prevention:

• stay home if sick
• good hand washing
• having the child cover his or her mouth when coughing, if possible
• cleaning toys and objects likely contaminated by respiratory droplets

School and After school Activity Issues

• may return to school when fever free for 24hours and able to eat and drink normally
• avoid large groups of kids if cough is not controlled to prevent further spread
• if on antibiotics, needs to be on them for 24 hours before returning to school
• activities should be curtailed until the child has the energy to participate without becoming winded or fatigued.

Internet Resources:

For Parents

KIDS Health Info on pneumonia

For Kids and Teens

KidsHealth Pneumonia Info for kids

KidsHealth Pneumonia Info For Teens

Technical Names: RSV Bronchiolitis

NickNames: RSV, wheezing virus

What it is: viral infection of the small airways of the lung; can cause a true viral pneumoniaas well.

Typical Ages for Illness: All ages; most severe in young and premature infants and children with heart and lung problems including congenital heart disease and asthma. Interesting fact: all kids become infected by RSV by the age of 2 and many of us get it multiple times throughout our lives.

Typical Symptoms:

adults: bad cold symptoms

older infants and children: similar to a bad cold

young infants: lethargy, trouble eating, fast breathing, cough, wheeze.

Etiology: Respiratory Syncytial Virus

Seasonal Issues: occurs predictably between November to March

How’s It Spread? Direct contact with secretions – person to person or on objects.

Incubation Period: 4-6 days but can range from 2 to 8 days

Diagnosis: Usually clinical – based on symptoms and high index of suspicion given out breaks in community. Rapid assay test available in many offices and emergency rooms – most useful if a child needs to be hospitalized to control infection.

Symptom Duration: 7-14 days, as with most viral illnesses with the most intense symptoms early in the illness.

Treatment:

• cold treatment: saline nose spray and bulb syringe, humidifier
• +/- breathing treatments such as inhalers or nebulizers
• fluids
• tylenol or motrin for fever and discomfort
• some children do need to be hospitalized due to severe respiratory symptoms such as trouble breathing and needing oxygen, or due to underlying heart and lung problems.

Call Your Pediatrician if your child has:

• high fever, or fever not gone in 2-3 days
• vomiting or diarrhea and can’t hydrate well
• lethargy
• sick appearance
• trouble breathing despite treatment
• blue or gray color to lips or fingernail beds

Prevention:

• stay home if sick
• good hand washing
• having the child cover his or her mouth when coughing, if possible
• cleaning toys and objects likely contaminated by respiratory droplets
• a medication called Synagis before RSV season is available for kids under 2 years of age that are high risk – premature babies younger than 35 weeks and congenital heart disease children. This is usually given starting in November as RSV season begins. Your pediatrician will alert you if your child falls into this group.

School and After school Activity Issues

• may return to daycare when fever free for 24hours and able to eat and drink normally, and breathing normally
• avoid large groups of kids if cough is not controlled to prevent further spread
• if on antibiotics, needs to be on them for 24 hours before returning to school
• activities should be curtailed until the child has the energy to participate without becoming winded or fatigued.

Internet Resources For Parents

General Info on RSV (KidsHealth)

General Info on Bronchiolitis (Kids Health)

How Lungs Work (KidsHealth)

It never fails. One of your children gets sick when your spouse is away on business and you have a full schedule. The domino effect for a family with a sick child is enormous – home, work and school lives are all impacted and often at the least convenient times! To complicate matters, it can be difficult deciding when to keep a child home and when to forge ahead business as usual.

Sickness is a part of childhood, whether it’s a fever, sore throat, cough or just not feeling well. According to the Centers for Disease Control and Prevention, the typical child has 6 to 12 illnesses a year ranging from mild to severe. Illness can occur throughout the year, but tends to cluster in the winter due to flu season. These illnesses can seem to spread like wild fire affecting other students, teachers, and family members. Families and schools need to balance the child’s school attendance with the risk of spreading the illness to others in the school. Sometimes even minor illnesses require the child to stay home just to prevent the further spread of a contagious disease. Continue Reading

Technical Names: Streptococcal Pharyngitis

NickNames: Scarlet Fever, Strep Throat

What is it: infection of the throat involving the pharynx, tonsils or both

Typical Ages for Illness: school age kids and teens are the biggest population; can occur in adults; rare in children under 2 years of age.

Typical Symptoms:

sore throat and pain with swallowing; swollen neck glands

+/- abdominal pain and headache, common in school-aged kids

+/- fever

+/- sandpaper-like rash: when present, the illness is termed Scarlet Fever

+/-swollen tonsils with pus covering them

Etiology: Group A beta-hemolytic streptococci (Streptococcus pyogenes)

Seasonal Issues: outbreaks can occur year round but are more common from Fall to early Spring when people are more in doors and in close contact.

How’s It Spread? Person to person usually through direct contact or respiratory secretions (cough, sneeze)

Incubation Period: 2-5 days

Diagnosis: rapid strep test or throat culture at a doctor’s office

Symptom Duration: symptoms can go away without treatment in a few days; with treatment, improvement typically occurs within 24-48 hours of starting antibiotics.

Treatment:

• antibiotics once diagnosis is confirmed
• fluids
• rest
• tylenol or motrin for fever and discomfort
• popcicles, throat lozengers
• other medications as determined by your child’s doctor

Call Your Pediatrician if your child has:

• high fever, or fever not gone in 2-3 days
• vomiting or diarrhea and can’t hydrate well
• lethargy
• sick appearance

Prevention:

• stay home if sick
• good hand washing
• having the child cover his or her mouth when coughing, if possible
• cleaning toys and objects likely contaminated by respiratory droplets

School and After school Activity Issues

• may return to school when fever free for 24hours and able to eat and drink normally
• needs to be on antibiotics for 24 hours before returning to school
• avoid large groups of kids if cough is not controlled to prevent further spread

Internet Resources:

For Parents From KidsHealth

Strep Throat Information

Scarlet Fever Info

For Kids and Teens From KidsHealth

The Scoop on Strep

Teen Info on Strep