BREAKING NEWS ON URINARY TRACT INFECTIONS

---

BREAKING NEWS ON URINARY TRACT INFECTIONS (UTI)

On July 1, the official journal of the American Academy of Pediatrics just published an important study on

urinary tract infections.

Many of you may not realize it, but there are actually two reasons we like to diagnose and treat urinary tract infections

(UTI's):

1. To help your child feel better. Curing the illness ends the symptoms
2. Prevent kidney damage. Some UTI's spread to the kidney and cause scarring.

For many, many years, the teaching has been that UTI's are more likely to spread to the kidney if you are an infant

and if you have reflux.

Reflux is a condition in the urinary system in which urine goes up to the kidney as well as out into the toilet when you

urinate. Reflux is a physical property of your urinary system and is not caused by infection. You either have it

or you do not. With time those with reflux tends to stop having reflux as they get older.

The New Findings

Now comes a very important study of many hundreds of children with first time UTI's, from age 1 month to age 14 years.

Everyone with such a UTI had fever measured, some blood tests, and two radiology studies that proved if the

person had reflux and if the person had actual kidney infection with their UTI. Six months later they repeated a study

to see if any scars developed in the kidney.

This is the first time anyone has actually directly measured whether a child's UTI caused kidney infection and later kidney scarring

What they found was that the our prior understandings were quite wrong.

If you have a UTI, you are much more likely to have kidney infection as you get older, infants are actually less likely to

have kidney infection when they have a UTI.

Further, there appears to be no connection between reflux and getting a kidney infection or later kidney scarring from

an infection.

How This Changes How UTI's Should be Managed

Prior to this study, the question of whether you had reflux to your kidneys seemed critically important to protecting the

kidneys in future UTI's. This no longer appears to be the case.

Prior to this study, it was clear that doing a study to find out if you have reflux, now this intervention seems no longer

important to do.

At this time, the state-of-the-art approach to managing UTI's will be to:

1. Obtain a urine sample to see if there is an infection
2. Only if there is a bacterial infection, treat with antibiotics
3. Make sure you get better.

This appears the best way to make your child feel better and to protect the kidneys.

*Disclaimer*
The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

SWINE FLU UPDATE: As of June 20, 2009

---

SWINE FLU UPDATE: As of June 20, 2009

Every Friday the CDC posts the actual numbers of cases of all influenza infections in the US. We will be commenting

on this posting from time to time.

This note reviews the posting of June 20, 2009, posted on June 27, 2009.

EPIDEMIC GROWS, BUT CASES REMAIN QUITE MILD

The epidemic of H1N1 Influenza (swine flu) virus continues to grow. The good news is that it is still true that although

spreading rapidl, this is still a quite mild illness.

As of June, the numbers of cases of influenza jumped higher in the US. This week actually saw fewer deaths from this

infection than previously, further proof that, as of now, this is indeed a mild illness.

THE ADVANCED PEDIATRICS RECOMMENDED APPROACH AT THIS TIME

As noted in our overview, we at Advanced Pediatrics will have a different approach to a mild illness than a severe

illness. As long as this remains a mild illness, there is little or no advantage to diagnosis, treatment, or isolation.

While this remains a mild illness the treatment with Tamiflu offers little relief for the risk of taking the medication.

Isolation has been attempted very aggressively with whole schools and camps closing, aggressive exclusion of

diagnosed individuals from schools and camps. The result has been a complete failure to stop the spread of the virus.

Since we generally do not recommend policies that do not work, Advanced Pediatrics, at this time, is not recommending

closing camps, schools, or keeping well-feeling but diagnosed individuals excluded from program activities.

At this time the H1N1 influenza (swine flu) virus causes an illness very much like a mild flu, and should be treated as

such, since that is what it is for now.

WHAT IF THE H1N1 ILLNESS GETS MORE SEVERE

If the H1N1 influenza (swine flu) virus starts causing more severe illness, the recommendations from the CDC, Boards

of Health, and Advanced Pediatrics will change accordingly.

STAY INFORMED: CHECK OUT OUR WEBSITE, FACEBOOK, AND TWITTER PRESENCE

ON THE H1N1 PANDEMIC

Please see our overview of H1N1 Influenza (swine flu) on our website (www.advancedped.com) and facebook page for

details on what is a pandemic, an epidemic, what to do about this illness, and other details.

*Disclaimer*
The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

MMR No Longer Made Separately

---

MMR No Longer Made Separately

Despite a growing interest in giving the measles, mumps, and rubella (German measles) vaccines separately, the company that makes these vaccines recently stopped making them separately.

The only company that makes measles, mumps, and rubella in the United States is Merck. They once made a separate form of measles, mumps, and rubella vaccine, but for reasons we are not aware of, stopped doing so recently.

So at this time, the only way to get immunized for measles, mumps, and rubella is to get the combination of all three, the MMR.

Advanced Pediatrics is monitoring the manufacturer’s decision. Clearly, as long as separate measles, mumps, and rubella vaccine does not exist, we will not be able to order or obtain any. If the manufacturer starts making them separately we will let you know.

*Disclaimer*
The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

The H1N1 influenza (swine flu) Pandemic of 2009: Is it a problem for your family?

---

THE SITUATION

An unusual outbreak of influenza virus infection is occurring in several nations, up to 70 nations so far through mid-June. Several features of this outbreak that are generating large media attention. But the real question for you and your family is whether any harm threatens.

At this time, this infection looks no more harmful than the usual winter flu we see every year. Because this could change, we will keep this web page updated as new information becomes available.

Meanwhile, here are a few things to keep in mind.

FLU, INFLUENZA, EPIDEMICS, and PANDEMICS

1. There is a difference between the illness we call flu, and the germ we call the influenza virus.

THE ILLNESS, FLU, is a slang term for a viral illness that makes you feel very lousy. It can be a stomach flu or a respiratory flu. It is very seldom fatal in generally healthy people.

THE INFLUENZA VIRUS is a particular species of virus that typically causes infection of the airways. This includes eyes, ears, nose, sinuses, throat, voice box, and lungs. It can cause troubles with which we are all familiar: pink eye, ear infections, earache, runny nose, blocked sinuses, croup, hoarse voice, sore throat, coughs, bronchitis, and pneumonias. The influenza virus usually causes about one third of all winter respiratory flus, but not many stomach flus. It causes about 30,000 deaths a year, mostly in aged or generally unhealthy people.

2. Illness with influenza, flu epidemic, flu pandemic: What is the difference?

An illness with influenza happens when one person gets one of the illnesses mentioned above from the influenza virus. So an illness is one case in one person.

The influenza virus is quite unusual in its ability to change every year. Chickenpox virus is an example of a far more typical virus, it only infects humans, and hardly changes at all across many centuries. That is why once you get chickenpox, you generally never get it again.

But influenza is very odd in that it infects humans in the winter and animals (mainly birds and barnyard animals) every spring and summer. As it shifts from species to species, the virus changes. This means every year, a new influenza virus shows up in the late fall.

As a result all of humanity can catch the influenza virus every late fall and winter. This leads to worldwide flu epidemics every year.

The key features of the annual flu epidemic are:

• Everyone in the world can catch it every year.
• The virus is not too different year to year.
• The illnesses occur in one season, same time of year, every year.
• Severity varies, but roughly 20-40,000 deaths occur in the US every year.

A pandemic, like a flu epidemic, is worldwide and is very contagious, but has these important differences:

• A pandemic virus looks quite different from the year-to-year more typical influenza virus.
• It causes illness at any time of the year, not just flu season.
• As time goes on, it can continue to change, sometimes getting more dangerous, sometimes less dangerous.
• The regular epidemic flu virus might kill 20-40,000 people a year in the US, a pandemic virus might cause millions of deaths or might just cause a few dozen deaths in the US in one year.

3. What about this virus, the H1N1 (swine flu) influenza virus of 2009 now? If I get the illness or are exposed, how worried should I be?

This virus was recently declared by the World Health Organization (WHO) and the US Centers for Disease Control and Prevention (CDC) to be a true pandemic influenza virus.

What was the basis of this determination, and what does it mean?

WHO and CDC now classify the H1N1 influenza (swine flu) virus as a pandemic for two reasons and two reasons only:

1. This virus looks quite different in its genes and chemistry from the usual annual winter influenza virus.
2. It spreads very easily (as noted it is now in 70 countries).

As a pandemic virus it can continue to change as time goes on, but right now, this virus causes very, very mild illness in nearly everyone who gets infected.

So if you get infected with the H1N1 influenza (swine flu) virus, you are very, very likely to simply experience a cold- with cough, runny nose, and fever- and about a 25% chance of having diarrhea, too. That's it, a mild cold. This is a mild illness for all but a tiny percentage of people.

As of today, this virus appears no more dangerous than the usual cold or flu.

There have been deaths from this virus, but there are also deaths from the cold and the other influenza viruses.

Again, so far this looks like very mild virus that causes almost only mild illness.

Why do we say so far? This is the real import of the designation of pandemic: over the next few months, this virus can get milder or can get more severe.

So who should worry?:

• As with any cold, people who have severe lung illnesses, the elderly, or anyone who starts really struggling to breathe should seek medical attention during this pandemic.
• The public health scientists at the WHO and CDC should be the most busy of us. They are monitoring sites in nearly every country of the world, testing and seeing if this H1N1 influenza (swine flu) virus changes for the worse. If it does, we will know very, very rapidly, and let you know.
• As long as this H1N1 influenza (swine flu) virus continues to be so mild, we do not think anyone exposed to someone with a cold, a flu, or even the H1N1 influenza (swine flu) illness itself has to be worried. At this point it really is like having a cold.
• And, as long as this H1N1 influenza (swine flu) virus continues to be so mild, we do not think anyone who actually has H1N1 influenza (swine flu) virus has to be worried, unless they get more ill than the usual cold, which for healthy people is very, very unlikely, so far.

PREVENTION AND CURES

Influenza viruses spread by sneezing and coughing. Influenza is not spread through skin-to-skin contact, per se. To become infected, the recipient must have the virus come in contact with their eyes, nose, or mouth. This can occur through breathing or touching a living virus on a surface and transferring it to a moist, mucus part of the body.

As a point of information, every breath a person inhales contains billions of viruses. Sneezing and coughing merely make them move quickly, rapidly, and in larger numbers. Covering ones mouth during sneezing and coughing is always a good idea to minimize the spread of viruses.

Masks are not particularly effective in prevention in the long run. At some point and often, humans touch their eyes, nose, and mouth with their hands, thus bypassing the mask. Taking off a mask after its use, results in touching it and the potential transfer of the virus it was intended to prevent!

While washing your hands frequently is always a good idea, given the number of viruses and other germs in our world, it will not prevent their spread, merely delay it for some time.

Keeping people home when they are sick, likewise, will not ultimately prevent the spread of an illness, merely delay it. Epidemics are epidemics because they spread widely and wildly. Not much can prevent them entirely. Reasonable, hygienic behavior is a good idea, but it never has prevented or stopped an epidemic.

The Swine Flu is not covered by the 2008 influenza vaccine. However, early indicators suggest that it is easily killed by two anti-viral antibiotics. The two drugs are Tamiflu and Relenza. Tamiflu comes in liquid and pill form and is available to be used for children older than one. Relenza is an inhaled medication that is available to prevent the flu only if a child is older than 5 years of age and to treat the flu only if a child is older than 7 years of age.

Both Tamiflu and Relenza have very limited benefits in the usual setting. They have no real impact a child has been infected for more than 48 hours. (Most people with the flu are sick for at least that amount of time before they get sick enough to seek medical attention.) Both drugs are associated with serious side effects. We do not recommend stockpiling these drugs, and in most instances these drugs will not help the colds and flus we will see this spring. The main setting in which these drugs are used is when someone gets very seriously ill within the first 48 hours of illness, and tested positive for being infected with an influenza virus.

THE BOTTOM LINE

1. The H1N1 influenza virus (swine flu) pandemic of 2009 in the US appears to be causing mild disease, very much like a mild flu or cold.
2. This pandemic could change from causing very mild illness to causing more severe illness over the next few months, so keep up to date.
3. As long as it is a mild illness, exposure to the swine flu, and even getting it, is not dangerous to healthy people.
4. We will post updates to this web page as information develops.
   
5. There is no reason for panic, or undue concern. If the situation fails to worsen, all serious worry now will quickly appear needless.
6. The web site at the American Academy of Pediatrics has ongoing updates athttp://www.aap.org/advocacy/releases/may09swineflu.htm

---

Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

*Disclaimer*
The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.