Back to School Basics -- July 28, 2008 -- Dr. Titus Daniels - | Nashville News, Weather & Sports

Back to School Basics -- July 28, 2008 -- Dr. Titus Daniels


Medical Mondays  


Why Immunizations?

Immunization has been called the most important public health intervention in history, after safe drinking water. It has saved millions of lives over the years and prevented hundreds of millions of cases of disease. We all know that getting our children immunized can protect them from some very serious diseases. But did you know that it can also...

  • Protect their friends, schoolmates and others from those same diseases? Some children can't get certain vaccines for medical reasons, or some children are not able to respond to certain vaccines. For these children, the immunity of people around them is their only protection.
  • Protect your grandchildren, their grandchildren and future generations from diseases? If we stopped vaccinating, diseases that are under control would eventually come back to cause epidemics. This has happened in several countries.
  • Help rid the world of diseases that have been crippling and killing children for centuries? Immunization allowed us to eradicate smallpox. Today polio is nearly gone, and in the future measles and other diseases will follow.

Vaccines have a remarkable track record. For example...

  • Diphtheria used to be one of the most dreaded of childhood diseases, killing more than 10,000 people a year in the United States. After we started vaccinating children in the 1930s and 1940s, the disease began to disappear. Today most doctors will never see a case of diphtheria, much less have a patient die from it.
  • In 1962, the year before measles vaccine was introduced, almost 500,000 cases of measles were reported in the United States, and many more cases went unreported. Ten years later there were about 32,000 cases and 10 years after that fewer than 2,000. As of the end of 2005, there have been only 405 cases in this century.
  • Parents in the 1950s were terrified as polio paralyzed children by the thousands. Then we learned how to prevent polio using vaccines. There has not been a case of wild virus polio in the United States since 1979.
  • Smallpox was one of the most devastating diseases the world has ever known. It killed millions of people every year. In 1967 the World Health Organization undertook an intensive, worldwide vaccination campaign. Twelve years later the disease had been wiped out, and there hasn't been a single case since. Smallpox is the first, and so far the only, disease we have ever eradicated; and it was thanks to vaccination.

How Vaccines Work

What is Immunity?

When disease germs enter your body, they start to reproduce. Your immune system recognizes these germs as foreign invaders and responds by making proteins called antibodies. These antibodies' first job is to help destroy the germs that are making you sick. They can't act fast enough to prevent you from becoming sick, but by eliminating the attacking germs, antibodies help you to get well. The antibodies' second job is to protect you from future infections. They remain in your bloodstream, and if the same germs ever try to infect you again - even after many years - they will come to your defense. Only now that they are experienced at fighting these particular germs, they can destroy them before they have a chance to make you sick. This is immunity. It is why most people get diseases like measles or chickenpox only once, even though they might be exposed many times during their lifetime. This is a good system for preventing disease. The only drawback is obvious - you have to get sick before you become immune.

Immunity from Vaccines

Vaccines solve this problem. They help develop immunity without getting sick first.

Vaccines are made from the same germs (or parts of them) that cause disease. But the germs in vaccines are either killed or weakened so they won't make you sick. Vaccines containing these weakened or killed germs are introduced into your body, usually by injection. Your immune system reacts to the vaccine the same as it would if it were being

invaded by the disease - by making antibodies. The antibodies destroy the vaccine germs just as they would the disease germs - like a training exercise. Then they stay in your body, giving you immunity. If you are ever exposed to the real disease, the antibodies are there to protect you.

Immunizations help your child's immune system do its work. The child develops protection against future infections, the same as if he or she had been exposed to the natural disease. Except with vaccines your child doesn't have to get sick first to get that protection.

Vaccine Side Effects

While vaccines are very safe, but like any medicine they do sometimes cause reactions. Mostly, these are mild "local" reactions (soreness or redness where the shot is given) or a low-grade fever. They last a day or two and then go away. Sometimes more serious reactions are associated with vaccines. These are much less common. Some of them are clearly caused by the vaccine; some have been reported after vaccination but are so rare that it is impossible to tell if they were caused by the vaccine or would have happened anyway. Some children also have allergies, and occasionally a child will have a severe allergy to a substance that is component of a vaccine. There is a very small risk (estimated at around one in a million) that a vaccine could trigger a severe reaction in a child who has such an allergy. Should one of these allergic reactions occur, it would

usually happen within several minutes to several hours after the vaccination, and would be characterized by hives, difficulty breathing, paleness, weakness, hoarseness or wheezing, a rapid heart beat and dizziness. Doctors' offices are equipped to deal with

these reactions. Always tell your provider if your child has any allergies that you know of.

Vaccine Q & A

Why do children need so many shots?

Some of us may have gotten only three vaccines as children: DTP, polio and smallpox. There were no vaccines for measles, chickenpox, mumps and other diseases - which meant that many of us also got those diseases! Over the years scientists have developed vaccines against more diseases, and we give them to our children to protect them. Children don't get smallpox vaccine any more because we have eradicated the disease. Within our lifetimes, we may also eradicate polio, and then that vaccine too will no longer be needed. More combination vaccines also may reduce the number of shots children will need. At the same time, vaccines may be developed to protect us against even more diseases.

Why are vaccines given at such an early age?

Vaccines are given at an early age because the diseases they prevent can strike at an early age. Some diseases are far more serious or common among infants or young children. Of children under 6 months of age who get pertussis, 72 percent must be hospitalized, and 84 percent of all deaths from pertussis are among children less than 6 months of age. The ages at which vaccines are recommended are not arbitrary. They are chosen to give children the earliest and best protection against disease.

What if my child misses a dose of vaccine?

They can continue the series where they left off. Vaccinations do not have to be repeated when there is a longer-than-recommended interval between doses.

Do vaccines always work?

Vaccines work most of the time, but not always. Most childhood vaccinations work between 90 and 100 percent of the time. Sometimes, though, a child may not respond to certain vaccines. This is one reason why it is important for all children to be immunized. A child who does not respond to a vaccine has to depend on the immunity of others around her for protection.

What will happen if my child doesn't get his vaccinations?

One of two things could happen:

  1. If your child goes through life without ever being exposed to any of these     diseases, nothing will happen.
  2. If your child is exposed to one of these diseases, there is a good chance he will get it. What happens then depends on the child and the disease. Most likely he would get ill and have to stay in bed for a few days up to one to two weeks. But he could also get very sick and have to go to the hospital. At the very worst, he could die. In addition, he could also spread the disease to other children or adults who are not immune.

What are my child's chances of being exposed to one of these diseases?

Overall, quite low. Some of these diseases have become very rare in the United States (thanks to immunizations), so the chances of exposure are small. Others, such as varicella and pertussis, are still relatively common. Some are rare in the U.S. but common elsewhere in the world, so there is risk not only to travelers, but to anyone exposed to travelers from other countries visiting here.

If my child's risk of exposure to disease is so low, why should I bother getting him immunized?

This is a good question. One answer, of course, is that even if the risk of getting these diseases is low, it is not zero. If only one child in the whole country gets diphtheria this year, that child has a 1 in 10 chance of dying. Vaccination would have protected him.

But there is also another answer. Even if disease rates are low now, if we stopped vaccinating they wouldn't remain low for very long. We know this because it has already happened in several countries, including Great Britain and Japan. For instance, in 1974, about 80 percent of Japanese children were being vaccinated against pertussis. That year Japan had only 393 pertussis cases and no deaths. But then there was a national scare about the safety of pertussis vaccine, and over the next few years the vaccination rate dropped to about 10 percent. In 1979 the country suffered a major pertussis epidemic with more than 13,000 cases and 41 deaths. When routine vaccination was reinstated, disease rates dropped again. Without the protection afforded by a highly immunized population, diseases could make a comeback here too.

-Centers for Disease Control. For more information, visit


For students, preparing for the upcoming school year often means participating in organized sports. Parents may be concerned about staph infections.


What is Staph?

Staphylococcus aureus, often referred to simply as "staph," are bacteria commonly carried on the skin or in the nose of healthy people. Approximately 25 to 30 percent of the population has staph bacteria in the nose. Sometimes, staph can cause an infection. Staph bacteria are one of the most common causes of skin infections in the United States. Most of these skin infections are minor (such as pimples and boils) and can be treated without antibiotics. However, staph bacteria also can cause serious infections (such as surgical wound infections, bloodstream infections, and pneumonia).


What is MRSA (Methicillin-resistant Staphylococcus aureus)?

Some staph bacteria are resistant to antibiotics. MRSA is a type of staph that is resistant to certain antibiotics. While 25 to 30 percent of the population is colonized with staph, approximately 1 percent is colonized with MRSA.


Who gets staph or MRSA infections?

Staph infections, including MRSA, occur most frequently among persons in hospitals and healthcare facilities (such as nursing homes and dialysis centers) who have weakened immune systems. These healthcare-associated staph infections include surgical wound infections, urinary tract infections, bloodstream infections, and pneumonia.


What is community-associated MRSA?

Staph and MRSA can also cause illness in persons outside of hospitals and healthcare facilities. MRSA infections that are acquired by persons who have not been recently (within the past year) hospitalized or had a medical procedure (such as dialysis, surgery, catheters) are know as CA-MRSA infections. Staph or MRSA infections in the community are usually manifested as skin infections, such as pimples and boils, and occur in otherwise healthy people.


How common are staph and MRSA infections?

Staph bacteria are one of the most common causes of skin infection in the United States and are a common cause of pneumonia, surgical wound infections, and bloodstream infections. The majority of MRSA infections occur among patients in hospitals or other healthcare settings; however, it is becoming more common in the community setting.


What does a staph or MRSA infection look like?

Staph bacteria, including MRSA, can cause skin infections that may look like a pimple or boil and can be red, swollen, painful, or have pus or other drainage. More serious infections may cause pneumonia, bloodstream infections, or surgical wound infections.


Are certain people at increased risk for community-associated staph or MRSA infections?

CDC has investigated clusters of CA-MRSA skin infections among athletes, military recruits, children, Pacific Islanders, Alaskan Natives, Native Americans and prisoners.
Factors that have been associated with the spread of MRSA skin infections include: close skin-to-skin contact, openings in the skin such as cuts or abrasions, contaminated items and surfaces, crowded living conditions and poor hygiene.


How can I prevent staph or MRSA skin infections?

Practice good hygiene:

  • 1. Keep your hands clean by washing thoroughly with soap and water or using an alcohol-based hand sanitizer.
  • 2. Keep cuts and scrapes clean and covered with a bandage until healed.
  • 3. Avoid contact with other people's wounds or bandages.
  • 4. Avoid sharing personal items such as towels or razors.


Are people who are positive for the human immune deficiency virus (HIV) at increased risk for MRSA? Should they be taking special precautions?

People with weakened immune systems, which include some patients with HIV infection, may be at risk for more severe illness if they get infected with MRSA. People with HIV should follow the same prevention measures as those without HIV to prevent staph infections, including practicing good hygiene, covering wounds (e.g., cuts or abrasions) with clean dry bandages, avoiding sharing personal items such as towels and razors, and contacting their doctor if they think they have an infection.


Can I get a staph or MRSA infection at my health club?

In the outbreaks of MRSA, the environment has not played a significant role in the transmission of MRSA. MRSA is transmitted most frequently by direct skin-to-skin contact. You can protect yourself from infections by practicing good hygiene (e.g., keeping your hands clean by washing with soap and water or using an alcohol-based hand rub and showering after working out); covering any open skin area such as abrasions or cuts with a clean dry bandage; avoiding sharing personal items such as towels or razors; using a barrier (e.g., clothing or a towel) between your skin and shared equipment; and wiping surfaces of equipment before and after use.


What should I do if I think I have a staph or MRSA infection?

See your healthcare provider.


Are staph and MRSA infections treatable?

Yes. Most staph and MRSA infections are treatable with antibiotics. If you are given an antibiotic, take all of the doses, even if the infection is getting better, unless your doctor tells you to stop taking it. Do not share antibiotics with other people or save unfinished antibiotics to use at another time.

However, many staph skin infections may be treated by draining the abscess or boil and may not require antibiotics. Drainage of skin boils or abscesses should only be done by a healthcare provider.

If after visiting your healthcare provider the infection is not getting better after a few days, contact them again. If other people you know or live with get the same infection tell them to go to their healthcare provider.


Is it possible that my staph or MRSA skin infection will come back after it is cured?

Yes. It is possible to have a staph or MRSA skin infection come back after it is cured. To prevent this from happening, follow your healthcare provider's directions while you have the infection, and follow the prevention steps after the infection is gone.


If I have a staph, or MRSA skin infection, what can I do to prevent others from getting infected?

You can prevent spreading staph or MRSA skin infections to others by following these steps:

  • Cover your wound. Keep wounds that are draining or have pus covered with clean, dry bandages. Follow your healthcare provider's instructions on proper care of the wound. Pus from infected wounds can contain staph and MRSA, so keeping the infection covered will help prevent the spread to others. Bandages or tape can be discarded with the regular trash.
  • Clean your hands. You, your family, and others in close contact should wash their hands frequently with soap and warm water or use an alcohol-based hand sanitizer, especially after changing the bandage or touching the infected wound.
  • Do not share personal items. Avoid sharing personal items such as towels, washcloths, razors, clothing, or uniforms that may have had contact with the infected wound or bandage. Wash sheets, towels, and clothes that become soiled with water and laundry detergent. Drying clothes in a hot dryer, rather than air-drying, also helps kill bacteria in clothes.
  • Talk to your doctor. Tell any healthcare providers who treat you that you have or had a staph or MRSA skin infection.


Parents of smaller children may be concerned about the spread of lice in schools.

What are head lice?

The head louse is a parasitic insect that can be found on the head, eyebrows and eyelashes of people. Head lice feed on human blood several time a day and live close to the human scalp. Head lice are not known to spread disease.


Who is at risk for getting head lice?

Infestation with head lice is most common among preschool children attending child care, elementary school children and the household members of infested children. Although reliable data on how many people in the United States get head lice each year are not available, an estimated 6 million to 12 million infestations occur each year in the United States among children 3 to 11 years of age. In the United States, infestation with head lice is much less common among African-Americans than among persons of other races. Head lice move by crawling; they cannot hop or fly. Head lice are spread by direct contact with the hair of an infested person. Anyone who comes in head-to-head contact with someone who already has head lice is at greatest risk. Spread by contact with clothing (such as hats, scarves, coats) or other personal items (such as combs, brushes, or towels) used by an infested person is uncommon. Personal hygiene or cleanliness in the home or school has nothing to do with getting head lice.

What are the signs and symptoms of head lice infestation?

  • Tickling feeling of something moving in the hair.
  • Itching, caused by an allergic reaction to the bites of the head louse.
  • Irritability and difficulty sleeping; head lice are most active in the dark.
  • Sores on the head caused by scratching. These sores can sometimes become infected with bacteria found on the person's skin.


How did my child get head lice?

Head-to-head contact with an already infested person is the most common way to get head lice. Head-to-head contact is common during play at school, at home and elsewhere (sports activities, playground, slumber parties, camp). Uncommonly, head lice may be spread by sharing clothing or belongings onto which lice or nits may have crawled or fallen. The risk of getting an infestation by a louse or nit that has fallen onto a carpet or furniture is very small. Dogs, cats, and other pets do not play a role in the spread of human lice.


How is head lice infestation diagnosed?

The diagnosis of a head lice infestation is best made by finding a live nymph or adult louse on the scalp or hair of a person. Because nymphs and adult lice are very small, move quickly, and avoid light, they can be difficult to find. Use of a magnifying lens and a fine-toothed comb may be helpful to find live lice. If crawling lice are not seen, finding nits firmly attached within a 1/4 inch of base of the hair shafts strongly suggests, but does not confirm, that a person is infested and should be treated. Nits that are attached more than 1/4 inch from the base of the hair shaft are almost always dead or already hatched. Nits are often confused with other things found in the hair such as dandruff, hair spray droplets and dirt particles. If you are not sure if a person has head lice, the diagnosis should be made by their health care provider, local health department, or other person trained to identify live head lice.


Treatment for head lice is recommended for persons diagnosed with an active infestation. All household members and other close contacts should be checked; those persons with evidence of an active infestation should be treated. Some experts believe prophylactic treatment is prudent for persons who share the same bed with actively-infested individuals. All infested persons (household members and close contacts) and their bedmates should be treated at the same time.

When treating head lice, supplemental measures can be combined with recommended medicine. For example, hats, scarves, pillow cases, bedding, clothing and towels worn or used by the infested person in the two-day period just before treatment is started can be machine washed and dried using the hot water and hot air. Items that cannot be laundered may be dry-cleaned or sealed in a plastic bag for two weeks. Items such as hats, grooming aids, and towels that come in contact with the hair of an infested person should not be shared. Vacuuming furniture and floors can remove an infested person's hairs that might have viable nits attached.


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