Saturday, April 19, 2014
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Stephen Aronoff

POSTED: Monday, March 24, 2014, 10:16 AM
Allen Smith, 21, from West Hollywood, Calif., gets a free vaccine against bacterial meningitis at the AIDS Healthcare Foundation in West Hollywood, Calif., Monday, April 15, 2013. (AP Photo/Damian Dovarganes)

Bacterial meningitis is a contagious and potentially lethal infection. Recent cases at Princeton and Drexel universities and the infection of an 8-year-old Collegeville elementary school student have raised concerns about the disease across the area. I hope to provide anxious parents with some understanding of the nature of this disease and its spread.

Historically, three species of bacteria accounted for the vast majority of cases of childhood bacterial meningitis: Hemophilus influenzae type b, Streptococcus pneumoniae, and Neisseria meningitides.  The advent of modern vaccines has eliminated the disease caused by the first two bacteria for the most part.  Neisseria meningitides remains as the most common cause of disease among healthy children and adolescents in the United States.

The disease is spread by respiratory secretions. While the disease is contagious, the attack rate is relatively low. Among household contacts of individuals with meningococcal disease, secondary cases appear at a rate of 2 to 4 in 1,000 household contacts. Children under 5, adolescents and young adults, and the elderly are the groups at highest risk for infection. Most cases occur as single instances, but outbreaks of the disease do occur, often on college campuses or in military barracks.

POSTED: Thursday, February 13, 2014, 5:30 AM
Filed Under: Stephen Aronoff | Tips
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A child with fever is one of the most complex problems in the field of pediatrics. Unlike adults, children will respond to simple viral infections with spectacular elevations in temperature.  The approach to the febrile child varies depending on the child’s age, state of health, and associated symptoms. 

While a myriad of studies have been published on the subject, there is surprisingly little evidence that provides definitive guidance so I will try to focus on several myths and facts when it comes to children with fevers.

Myth #1:  Any temperature over 98.6 F is a fever.

POSTED: Monday, February 3, 2014, 6:00 AM
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Pregnant teens should receive the Tdap vaccine for each pregnancy to protect themselves and their babies against tetanus, diphtheria and pertussis, preferably during week 27 through week 36 of gestation, regardless of time since previous Td or Tdap vaccine, according to new vaccine recommendations released last week.

Each year, the American Academy of Pediatrics, the American Academy of Family Medicine and the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention, and the American College of Obstetricians and Gynecologists release up dated recommendations and schedules for routine vaccinations of children aged 0 to 18 years of age. 

The combined recommendations this year cover 14 separate vaccine preparations that provide protection for 17 separate diseases. Some of these immunizations, such as the diphtheria, tetanus and polio, have been available for decades. Other vaccines such as those for human papillomavirus (HPV) and rotavirus are relatively new to the vaccine schedules. The recommended changes vary from year to year. 

POSTED: Monday, November 18, 2013, 12:05 AM
Filed Under: Stephen Aronoff | Viruses
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Today, one in five visits to a pediatric healthcare provider results in a prescription for an antibiotic – this accounts for nearly 50 million antibiotic prescriptions each year in the United States.

However, most upper respiratory tract infections – those in the nose, sinuses and throat -- are caused by viruses and require no antibiotics.  As many as 10 million antibiotic prescriptions annually are directed toward respiratory conditions for which they are unlikely to provide benefit. Over prescribing these medications can cause avoidable drug-related side effects, contribute to antibiotic resistance, and add unnecessary medical costs.

To reduce the indiscriminate use of antibiotics for these common infections, the American Academy of Pediatrics released today three principles for the judicious use of antibiotics for pediatric upper respiratory infections. 

POSTED: Monday, October 28, 2013, 12:05 AM
Filed Under: Stephen Aronoff | Viruses
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It’s generally thought that young children and those with high-risk medical conditions are at a higher risk of flu-related complications – which can include pneumonia, encephalitis, and even death. Although it’s not common, the flu can also be fatal in healthy children with no underlying diseases or chronic conditions, found an analysis from the CDC released online today from Pediatrics.

Beginning in 2004, the Centers for Disease Control and Prevention mandated the reporting of all pediatric deaths due to influenza virus infection.  Today, the CDC released this information for the period October 1, 2004 through September 30, 2012.  To summarize:

  • 830 children between 6 months and 17 years of age died of influenza virus infection or its complications during the study period.
  • The seasonal pediatric mortality rate from influenza varied from 0.5 to 3.8 deaths per million children.
  • The seasonal median age of pediatric deaths ranged from 3 to 8.5 years with an overall median age of 7 years.
  • Almost half of the children who died from influenza virus were previously healthy children with NO underlying diseases or chronic conditions.
  • Of those children with chronic illnesses, asthma and cerebral palsy accounted for almost a quarter of the deaths.
  • For those victims whose vaccination status was known, 80% were not vaccinated or were inadequately vaccinated.

So what does the study mean for your child?  First, the mortality rate for influenza virus infection among children is low, but not zero.  Because it is a rate, the higher the number of infected children, the greater the number of deaths in a given season.

POSTED: Monday, September 30, 2013, 9:44 AM
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Vaccine refusal played a role in the large whooping cough outbreak of 2010 in California, found a study released today online from Pediatrics. That year, 9,120 cases of whooping cough were reported in California, the most since 1947.

In March, I wrote a blog about whooping cough, also known as pertussis.  The impetus for that blog was new data that had emerged regarding that California outbreak. Evidence available then suggested that waning immunity associated with the new acellular pertussis vaccine may have contributed to the outbreak.

Unlike many states, California requires only a parent’s signature on a form to permit a child to enter school without vaccinations.  The state keeps a record of these non-medical vaccination exemptions (NMEs). In California, pertussis is a disease that must be reported to the state health department. The authors of this study examined geographic clusters of NMEs and geographic clusters of pertussis cases to see if the clusters overlapped. The authors found that:

  • The average rate of NMEs per census tract in California averaged 2 percent between 2005 and 2010
  • 39 census tracts within the state had NME rates that were significantly higher than the rates seen in the remainder of the state
  • The odds of finding a cluster of pertussis cases within one of these census tracks with high rates of NMEs were 2.5 times higher than the odds of finding a cluster of cases in the remaining census tracts; this difference remained after the results were adjusted for a number of demographic factors.
POSTED: Monday, September 2, 2013, 12:05 AM
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Once again, school has begun and our thoughts turn to one thing…the flu.  Every year, the world is treated to this wintertime malady and health policy officials along with pediatricians urge parents to protect their children through vaccination. This annual ritual raises a lot of questions. The Academy of Pediatrics released its flu vaccination recommendations online today for this year’s flu season.

Here are some commonly asked questions about the upcoming flu season and vaccination:

Most vaccines are given at infrequent intervals.  Why does my child have to receive a flu vaccine every year?

POSTED: Wednesday, July 24, 2013, 6:00 AM
Filed Under: Stephen Aronoff
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“To everything there is a season,” and this applies to viruses as well.  In the winter, children are confronted with viruses that cause respiratory disease, such as rhinovirus, and gastrointestinal disease, such as norovirus. 

In the summer, a group of viruses called enteroviruses appear, which like their wintertime brethren, cause mini-epidemics of disease among children. Enteroviruses begin with non-specific symptoms such as fever, loss of appetite and fatigue. The most notable enterovirus, polio, has thankfully been eliminated from the U.S. and majority of the world. A polio outbreak going on now in Somalia is causing concern in that region.

Since nature abhors a vacuum, two other enteroviruses, enterovirus 71 and coxsackievirus A, typically appear in the summertime.  Much of our understanding of the scope of disease caused by these viruses came from an epidemic in Taiwan in 1998.

About this blog
The Healthy Kids blog is your window into the latest news, research and advice around children's health. Learn more about our growing list of contributors here.

If you have questions about your child's health, ask them here.

Anna Nguyen Healthy Kids blog Editor
Stephen Aronoff, M.D., M.B.A. Temple University Hospital
Christopher C. Chang, M.D., Ph.D Nemours/Alfred I. duPont Hospital for Children, Jefferson Medical Colg
Mario Cruz, M.D St. Christopher’s Hospital for Children, Drexel University College of Medicine
Katherine K. Dahlsgaard, Ph.D. Lead Psychologist - The Anxiety Behaviors Clinic, CHOP
Gary A. Emmett, M.D. Director of Hospital Pediatrics at TJU Hospital & Pediatrics Professor at Thomas Jefferson Univ.
Lauren Falini Bariatric exercise physiologist, Nemours/Alfred I. duPont Hospital for Children
Hazel Guinto-Ocampo, M.D. Nemours duPont Pediatrics/Bryn Mawr Hospital
Rima Himelstein, M.D. Crozer-Keystone Health System
Anita Kulick President & CEO, Educating Communities for Parenting
Janet Rosenzweig, MS, PhD, MPA VP for Programs & Research for Prevent Child Abuse America
Beth Wallace Smith, RD Children's Hospital of Philadelphia
W. Douglas Tynan, Ph.D. Nemours/Alfred I. duPont Hospital for Children, Jefferson Medical Colg
Flaura Koplin Winston, MD, PhD Scientific Director of the Children’s Hospital of Philadelphia’s Center for Injury Research and Prevention
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