The Measles Epidemic of 2014-2015- UPDATE

The Measles Epidemic of 2014-2015- UPDATE

January 29, 2015

The United States is right now experiencing an epidemic of measles, a threat to children not seen in the US commonly since the 1950's.

The Current Epidemic

It appears all the current cases of measles erupted from one source, a child with measles in the Disneyland in California.   To date there are 70 people who have the disease measles from that one source, but many thousands exposed.

What is Measles?

Many think of measles as yet another pesky but harmless, colorful, childhood illness, like chickenpox.  And there are some similarities- both cause fever, and a very distinctive rash, highly contagious, and once occurred in most all children.

But the difference is that measles can cause a permanent and quite severe impairment of the brain, leaving the affected person forever disabled.   

Across the world, measles is blamed for about 5% of all childhood deaths.  

So, it is not a harmless childhood infection, despite the fact that most children who get it recover well.

The key symptom of measles is a unique rash- large red dots- and also usually causes a very intense pink eye, cough, runny nose, and high fever.   But you have to have the measles rash to be diagnosed with it.

The Broader Context 

This is not the first outbreak of measles in the United States since we came close to eradicating it in the 1960's.    But the difference this time is our reaction to the news that otherwise healthy children are now in harms way.

There is only one reason that countries experience measles epidemics:  if enough children are not immunized to allow the virus to spread.   One a population reaches a certain percentage of being immunized against measles, the disease disappears.  This fact has been demonstrated time and again.

In recent measles epidemics, there has been not so much concern, because the nation has been in the grip of a passionate worry that the measles immunization causes autism.  And so, for many years, when the word measles was raised, the word autism came to mind, and the fear of the disease paled in comparison to the threat of autism.

Now, however, the fact that the measles immunization has nothing to do with autism has actually taken hold across the nation.  Today, parents of young children are less and less concerned about the idea the measles immunization can cause harm, and so the very real threat to their child that measles poses is rising up, and rapidly.

This explains why this Disneyland outbreak has captured the headlines like no other in many years.  The image of children being put at risk of serious neurologic hazard from a visit to Disneyland has struck fear and concern across the US.

BOTTOM LINE

The measles outbreak from Disneyland is not very large, but is happening.  Time will tell if it grows or dissipates.  But the real lesson of this outbreak is that the era of worry about the measles immunization is drawing to a close, and families across the country are once more becoming united in having their children not risk the tragedies that a measles infection can cause.

A special note:  We can give the MMR to even young infants who are exposed.  Normally we wait to one year of age, because prior to that time mother's antibodies will clear the vaccine.  But if an exposure occurs, MMR can be given during infancy, it just won't count as a long-term MMR in the series.

To your health,
Dr. Arthur Lavin

---

*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.

From Norwalk Ohio to the world- the new stomach flu is here- and an influenza update

From Norwalk Ohio to the world-

The new stomach flu is here-

 and an influenza update

One thing is far from new- stomach flu in the winter.

Background on the stomach flu viruses

Every year for probably many hundreds or thousands of years, certain viruses appear across the country to cause vomiting, diarrhea, and fever, that is, stomach flu, every January, February, and March.

For most of our lives that virus was rotavirus, but rotavirus immunization in the United States has effectively cut down on the presence of rotavirus.

Sadly, a new virus has fully taken the place of rotavirus, that is the norovirus.  The norovirus is so widespread at exactly the same time as rotavirus once was, that the number of people who get stomach flu and the severity of it is essentially unchanged.

So this winter, like all others, a very large number of our children are suddenly starting to vomit heavily then develop diarrhea, staying sick for a week, and raising concerns about dehydration.

So what does the norovirus have to do with Norwalk, Ohio?  Well, it was first discovered there in 1968.  The virus was completely unknown across the world until this discovery, leading to it being named the Norwalk virus until more was known about it and a category of virus was created and the species name norovirus adopted fairly recently.

The norovirus is now the most prevalent cause of stomach flu in the winter across the US, and most cruise ships!   

What to do if your child gets the stomach flu

It turns out that stomach flu, although an entirely miserable experience, is typically quite harmless.  

The whole illness has to do with gut viruses landing in your stomach, causing the stomach, then the intestines, then the colon to get inflamed as it burns along the whole tube of the gut.

Landing in the stomach leads to stomach inflammation, and therefore, vomiting.  That usually starts the illness and lasts 1-3 days.  Once the virus passes to the intestine and colon, diarrhea appears and lasts until the whole intestine is healed, which usually takes 5-14 days.  Fever may or may not be present.

The inflammation of stomach flu tends to be relatively minor.  It causes all this trouble, but does no lasting damage to the gut or stomach.

So the key risk your child with stomach flu is really not the germ, but the risk of dehydration.  This does not actually happen in the vast majority of cases, but it can.  The greatest risk is during the heavy vomiting period.  If there is not much vomiting, diarrhea tends not to cause dehydration since your child can simply drink to keep from getting dry.  Heavy vomiting however can keep drinking from working.

One way around  this is to use the strategy of limiting drinking to small sips that get absorbed before they can hit the stomach and be vomited.  This works if you limit drinking to one teaspoon every 5 minutes.  Eight hours of this provides 16 ounces of fluid with no vomiting of what is swallowed.

Of course, sometimes the vomiting and diarrhea is so intense that no strategy can keep up, and dehydration occurs.  How do you know if this has happened?  Here are the signs:

• No or little urination
• Dry cracked lips
• Sunken eyes
• And, wilted lack of energy.

The good news is that no matter what, it is easy to reverse dehydration- it just involves adding water by drinking or by IV.  If drinking fails we turn to the ER for IV hydration.

FOOTNOTE ON INFLUENZA

The latest data from the CDC show that the influenza virus epidemic of 2014-2015 is following the track of the epidemic of 2012-2013 to a remarkable degree, making it a very typical epidemic.   As such it is waning as spring approaches, and we anticipate influenza infections will become infrequent as February arrives and proceeds.

Also, thankfully, the number of childhood deaths is much smaller than in prior epidemics of influenza virus.

All in all, despite all the excitement in the news, this appears to be a very average, typical winter of influenza caused colds and flus and is on the wane.

To your health,

Dr. Arthur Lavin

---

*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.

Influenza Winter 2015 UPDATE: Saturday, January 10, 1PM

Influenza Winter 2015 UPDATE:  
Saturday, January 10, 1PM

The CDC has recently released the latest data on this year's influenza virus epidemic, and the news is very good.

Every week the CDC reports a comprehensive set of data on how many people are infected with the flu virus that week, how many are getting hospitalized ,and how many deaths this virus is causing, especially in children.

As we share this week's information with you, it is once again very important to keep in mind that only a minority of a winter's colds and flus are caused by the influenza virus, in fact about 25-30%.  All the other colds and flus we have are caused by all sorts of viruses, like the rhinovirus, adenovirus, RSV, etc.  So all the news reports and all this data concern only the influenza virus.

The good news is that this winter's influenza epidemic is giving an early sign of weakening, of being past its peak.

Even more striking, the pattern of this year's influenza virus epidemic is matching the pattern of the epidemic of 2012-2013 almost exactly!  This epidemic appeared in December and peaked around New Year's.  The rise and fall of 2012-2013 is so far almost an exact match to this year's epidemic.

That means the worst of this year's influenza epidemic may be over and it is very reasonable to hope that the intensity is already fading.

Here is more good news:  there are far fewer of the most frightening outcomes this year than in years past.  The number of childhood deaths from influenza virus infection by this time of year in the 2012-2013 epidemic (which matches this year so closely) was about 50-60 deaths.  This year that number has dropped to 26, across the whole country.  To put that into further context, influenza virus infection typically kills about 20,000 people in the US every year, and this year that may only include <100 children.="" i="">

These data are especially important to know as the news and reporting on this year's influenza epidemic are giving a needlessly frightening message.  If you read the paper, watch TV, or listen to the radio, the impression is that the United States is under the assault of a historically dangerous influenza outbreak with unprecedented levels of illness, risk of dying, and failure of flu vaccination.

None of these impressions are true.   This year is very much like most others, lots of colds and flus circulating in the winter.  The actual numbers are about the same as in 2012-2013 which was a year the generated almost no comment of worry, and the number of deaths in children is actually much lower than that year.

As for the impact of immunization, it is true that the most widespread subtype of the influenza virus circulating right now is not the exact form of the one in the vaccine, but even so, those vaccinated have a 50% of being protected from that strain.

Finally, to repeat our perspective on Tamiflu.  There are three reasons to be cautious in its use:

1. It is not free of side effects.  Children especially are at risk for developing seizures, and it can cause serious behavioral disturbances.
2. It does not deliver dramatic improvements consistently.
3. If millions of relatively healthy people use it for most colds and flus, we hasten the day when even its limited efficacy is available.

Of course, if a person does develop a dangerous influenza infection, defined as one impairing the ability to get air in and out of your chest, or in some other way impaired in function, the use of Tamiflu is clearly worth the risk of its use despite its impact being limited.

Bottom Lines:

1.  This year's influenza epidemic is actually a rather typical winter flu season.  Its magnitude and timing, so far, nearly exactly match the 2012-2013 epidemic which caused almost no comment at the time.

2.  This year's influenza epidemic is giving early signs of being on the wane.  If this turns out to hold up, we won't have much to talk about influenza in a few weeks.

3.  The scary news reports on this year's influenza virus epidemic are highly misleading.   These infections are overwhelmingly harmless to healthy children, the frightening reports of deadly infections in children fail to discuss just how rare this is.  And, so far this year, fatal illness in children is quite a bit lower.

4.   The flu immunizations have worked, those who got them, even this year, turned out to be less likely to get sick, and when ill had milder illness.

5.  As with any illness, if you have serious troubles such as struggling to breath, severe pain, a stiff neck, dehydration, call for help.

We hope you and your family get through this winter in good health, and that any colds or flus you get- although unpleasant- remain harmless.

Happy and Healthy New Year,

Dr. Arthur Lavin

---

*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.

Influenza Winter 2015 UPDATE

Influenza Winter 2015 UPDATE

The rates of infection with the influenza virus in the United States continue to climb, as expected at this time of year.

Before going further, we should repeat that there are many viruses that cause viral respiratory infections, and in fact, so far this year the number of such colds and flus due to the influenza virus has reached 30%, so over 2/3 of all colds and flus still are not from the influenza virus.

Now, on to the latest on the influenza virus.

We have talked before about how the influenza virus changes every spring as it leaves the human community, and every late fall when it returns to us. Sometimes the influenza virus that actually appears completely matches the subtypes in that winter's vaccine, sometimes not so much.

The current data suggest that the dominant strain appearing in the US is indeed the H3N2 strain, and it is different than the H3N2 in the flu spray and flu shot, that is, the flu vaccines for the winter of 2015.

We now know the following details on how well this year's flu vaccines protect against the H3N2 out there:

• About 50% of the H3N2 circulating do match what's in the flu vaccine, and those vaccinated are protected very well against it.
• About 50% of the H3N2 circulating do not fully match what's in the flu vaccine, but match well enough to blunt the severity of the infection.

And, a word on the terribly frightening reports on childhood deaths from the influenza virus of the winter of 2015.  The total across the entire United States is 15 deaths.  Each are horrifying losses, but the fact remains that across a nation of 100 million children, this number actually demonstrates that this terrible outcome is extremely unlikely.

Bottom Lines

1.  If you got or get this year's influenza vaccine, by spray or shot, you will almost certainly reduce the severity of the dominant influenza virus out there, the H3N2.

2.  If you got or get this year's influenza vaccine, by spray or shot, you have a 50% chance of full protection against the main influenza virus circulating right now.

3.   If you got or get this year's influenza vaccine, by spray or shot, you have a 50% chance of only partial, but still significant protection against the full severity of the main influenza virus circulating right now.

4.  If you haven't gotten a flu vaccine for the winter of 2015, it is not too late, we anticipate another month or two of lots of influenza virus causing lots of illness.  The flu vaccine only takes 2 weeks to provide its protection.

5.  Viral respiratory illnesses are a true misery.  And this year's influenza virus is causing very high fevers and much suffering.  But they are not dangerous infections for 99.999 (really)% of our children.   This means that very nearly all children who get these infections will do what very nearly all children do when they get colds and flus- recover without hazard or complication.  This year is still really not much different than others in that regard.

A Happy and Healthy New Year to all,

Dr. Lavin

---

*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.