Adults and Measles

Although vaccination discussions are typically most focused around children due to the dramatic lifelong benefits of childhood immunization, I have had many recent inquiries from adults about Measles vaccination due to the recent outbreaks. Below is some information that should be most helpful for my adult patients based on these inquiries. The majority of this information is directly from the Centers for Disease Control (CDC) as they have the experts dedicated to continually researching and updating the information. If you want further detail you can access much more at CDC.gov.

Up to 90% of unvaccinated individuals exposed to measles will get it compared to only about 3% of those who have had the standard 2 dose vaccination.

Recent Data:
From January 1 to April 19, 2019, 626** individual cases of measles have been confirmed in 22 states. This is the second-greatest number of cases reported in the U.S. since measles was eliminated in 2000, second only to the 667 cases reported during all of 2014. In the coming weeks, 2019 confirmed case numbers will likely surpass 2014 levels.

am

*Cases as of December 29, 2018. Case count is preliminary and subject to change.
**Cases as of April 19, 2019. Case count is preliminary and subject to change. Data are updated every Monday.

Recent areas of Measles outbreaks in the US include New York State, Rockland County, New York City, Washington, New Jersey, California, Butte County, and Michigan. These are linked to travelers who brought measles back from other countries where large measles outbreaks are occurring. A significant outbreak can occur when a traveler bringing measles into the country then exposes a pocket of unvaccinated people.

Complications of Measles:
It is important to consider the potentially severe complications of measles infection. Awareness has faded due to successful immunization campaigns over the years leading to most people fortunately not having to experience themselves or a loved one suffering or dying from this.
● Ear infections,
● Permanent hearing loss,
● Pneumonia,
● Encephalitis (brain swelling),
● Brain damage,
● Death.

What Adults Can Do:
1. Make sure your children obtain immunizations at the optimal recommended schedule.
2. Generally if you received your childhood immunizations appropriately you would NOT need additional immunization or testing for immunity. But, there are a couple of special considerations:
a. Birth before 1957 provides only presumptive evidence for measles, mumps, and rubella. Before vaccines were available, nearly everyone was infected with measles, mumps, and rubella viruses during childhood. The majority of people born before 1957 are likely to have been infected naturally and therefore are presumed to be protected against measles, mumps, and rubella. Healthcare personnel born before 1957 without laboratory evidence of immunity or disease should consider getting two doses of MMR vaccine.
b. If you were vaccinated between 1963 and 1968 you may have received a “killed measles vaccine” which was an earlier formulation that is no longer used and was not as effective as the current MMR vaccine. Fortunately, this involves a relatively small number of people.
c. If you have direct, close contact (sharing sport equipment, drinks, kissing, living in close quarters) with someone diagnosed with measles.
d. International travelers without evidence of measles immunity.
3. If you have concern for any of the above circumstances or otherwise then you can schedule an appointment with us to discuss the best preventive measures for you. If appropriate you can have a blood test to determine if you are immune or to get a dose of the MMR vaccination. There is no specific additional harm in getting another dose of the MMR vaccine if you may already be immune to measles, mumps, or rubella. You should check with your insurance to understand your coverage for testing or immunization so there is no surprise if insurance passes the cost directly to you.
4. If you do not have immunity and are exposed to measles you may get some protection if you get the MMR vaccine within 72 hours of your exposure. Clearly this is a last resort.
5. There are some individuals who should not get the MMR vaccine and it is important to discuss preventive measures with your doctor.
6. If you think you have the measles then contact your doctor’s office with your concern PRIOR to going to the office. Most offices have extremely cautious protocols to minimize risk of spreading this highly contagious infection while still evaluating and treating you appropriately.
7. For more information: https://www.cdc.gov/vaccines/vpd/mmr/public/index.html

Advertisements

Zika Prevention in Children

zika_mosquito-335x189Everywhere you turn these days, the spread of the Zika virus is talked about in the media.  Recently it has even been identified in Texas, primarily in the Rio Grande Valley region. With it encroaching so close to home, we thought it wise to review how it spreads, what the symptoms are and what can be done to prevent it.

As most of you probably know, Zika is contracted when humans are infected by mosquitoes. Humans can then spread it from person to person through blood transfusion, mother to baby in utero and sexual contact.

Symptoms associated with a Zika viral infection are relatively mild, and in fact, many experience no symptoms at all. For those that do show signs, the illness may entail a fever, rash, joint pain and red eyes which lasts approximately 3-7 days. The scare associated with Zika stems around an increase of newborn microcephaly believed to be associated with a Zika virus outbreak in Brazil starting in 2015.

To prevent the contraction of Zika virus, the CDC recommendations taking steps to prevent mosquito bites by following these recommendations:

  • Wear protective clothing including long sleeve shirts, pants, socks and hats to create a physical barrier from mosquitoes.
  • Use mosquito-repellent clothing treated with permethrin which lasts for 6 washes.
  • Avoid being outside during sunrise and sunset when the insects are most active.
  • The current AAP and CDC recommendation for children older than 2 months of age is to use 10% to 30% DEET. DEET should not be used on children younger than 2 months of age.
  • The effectiveness is similar for 10% DEET and 30% DEET but the duration of effect varies. Ten percent DEET provides protection for about 2 hours, and 30% protects for about 5 hours. Choose the lowest concentration that will provide the required length of coverage.
  • The concentration of DEET varies significantly from product to product, so read the label of any product you purchase.
  • As an alternative to DEET, Picaridin has become available in the U.S. in concentrations of 7% to 20%. Concentration of 7% Picardin provides protection for about 1-2 hours and 20% Picaridin provides 4-5 hours of protection. Picaridin is a synthetic compound developed from a plant extract from the genus Piper, the same genus that produces table pepper. Picaridin has been available since 1998 in Europe but was approved for sale in the U.S.A. only in 2005. AS with DEET, the EPA has concluded that the normal use of picaridin does not present a health concern. Picaridin is sometimes preferred over DEET because it is odorless, non-greasy, and does not dissolve plastics or other synthetics. Repellents that include picaridin include Cutter Advanced, Sawyer Premium and Repel Smart Spray.
  • With any type of insect repellent, remember not to apply to a child’s hands, eyes, mouth, or cut or irritated skin.
  • And finally, children should wash off repellents when they return indoors.

For further questions/concerns regarding Zika and its prevention, please do not hesitate to consult your pediatrician.

 

What’s that rash? Have you had your shingles vaccine?

shingles vaccineHerpes zoster, or more commonly known as “Shingles” affects almost 1 in every 3 people in the United States in their lifetime.  Anyone who has ever recovered from the chickenpox may develop shingles, even children. However, the risk of shingles increases with age.  Almost half of cases are seen in individuals 60 years and older.  Shingles is caused by the varicella zoster virus (VZV), the same virus that causes chickenpox. After a person recovers from VZV the virus stays inactive or dormant in the body and the virus can reactivate years later.

Symptoms of shingles include a very painful rash that develops on one side of the face or body. The rash forms blisters which may burst, and scab over in 7-10 days and clears up within 4 weeks. Before the rash develops you may have pain, itching, burning, or tingling to the area. This can happen anywhere between 1-5 days prior to the rash occurring. Most commonly, the rash occurs in a stripe pattern on one side of the body. It can also cause fever, headaches, chills, upset stomach, and fatigue.

Shingles cannot be passed on from one person to another. HOWEVER – the virus that causes shingles, VZV, can spread to another person with active shingles who has never had chickenpox. In this case, the person may develop chickenpox, but not shingles. The virus is spread through direct contact with fluid from the blisters. A person with active shingles can spread the virus when the rash is in the blister-phase. A person is not infectious before the blisters appear and once the rash has developed crusts. Shingles is less contagious than chickenpox and the risk of a person with shingles spreading the virus is low if the rash is covered.

  • Avoid touching or scratching the rash
  • Wash your hands often to prevent the spread of VZV
  • Until the rash has developed crusts, avoid contact with those who:
    • Are pregnant who have never had chickenpox or the vaccine,
    • Premature or low birth weight infants,
    • Have weakened immune systems (chemotherapy, immunosuppressant medications, HIV)

Treatment for shingles includes antiviral medications, which shorten the length and severity of the illness. Medication must be started as soon as possible after the rash appears. If you, or someone you know thinks they have shingles, contact our office for an evaluation appointment as soon as possible.

You can reduce your risk for developing shingles and long term pain from shingles by vaccination. The Center for Disease Control recommends that individuals age 60 and over get one dose of the shingles vaccination. If you, or someone you know is interested in the shingles vaccination contact our office at 512-336-2777 to schedule a wellness visit so we can discuss the vaccine, along with other vaccinations and screening measures for your age.  Here is more information on the vaccination. (http://www.cdc.gov/vaccines/hcp/adults/downloads/fs-shingles.pdf)

Center for Disease Control. Shingles (Herpes Zoster). http://www.cdc.gov/shingles/index.html (2016).

National Foundation for Infectious Diseases. Shingles (Herpes Zoster). http://www.nfid.org/idinfo/shingles.aspx. (2016)

 

 

What you need to know about Zika virus:

Zika virus is spread to people primarily through mosquito bites. The most common symptoms of Zika virus disease are:zika

  • Fever
  • Rash
  • Joint pain
  • Conjunctivitis (red eyes)

The illness is usually mild with symptoms lasting from several days to a week and can generally be managed at home with symptomatic treatment alone, similar to the common cold.  Antibiotics do not treat Zika.  Severe disease requiring hospitalization is uncommon.  If you feel your symptoms are severe, we are available with same day appointments to see you and provide guidance.  For an appointment with one of our Family Medicine providers, call 512-336-2777, option 1.

Other online resources on Zika virus:

Author: Cameron T. King, MD

 

It’s National Men’s Health Week – Make YOUR health a priority!

three-generationsNational Men’s Health Week is celebrated the week leading up to Father’s Day. We are urging individuals, families, and others to work on raising awareness to promote healthy living and encourage early detection and treatment of diseases among men and boys.

Ladies, this means that you can help too. Encourage everyday actions to promote good physical and mental health. Be a role model on how to live healthy as well.

Health week isn’t only to remind you to have your wellness exam, but to remind you to lead by example….

  • Eat healthy
  • Be physically active
  • Have annual wellness visits
  • Get vaccinated
  • Be smoke-free
  • Prevent injuries
  • Sleep well
  • Manage stress

Remember to exercise – Adults need at least 2.5 hours of moderate intensity aerobic activity such as brisk walking every week, and muscle strengthening two or more days a week. Remember, you don’t have to do it all at once, spread your activity out during the week, or break it into smaller chunks during the day. If you have questions about exercising then ask your primary care provider how you should start. Always remember to listen to your body, and don’t overwork yourself if you are just starting out.

Eat Healthy Eating a variety of fruits and vegetables gives you energy, and are great sources for vitamins, minerals, and other natural substances that help protect you from diseases. Limit the amount of food and drink that are high in calories, sugar, salt, fat, and alcohol. Choose healthier snacks – nuts, apples, grapes, or snacks high in protein.

how-to-manage-stress

Tame your stress Sometimes stress can be good (sometimes!). However, it can also be harmful to your health. It can make you feel overwhelmed and out of control. Avoid drugs and alcohol, which can worsen stress. Take charge of your health, and find an outlet that is best for you – running, kickboxing, swimming, yoga, meditating. Take 15 minutes out of each day for yourself – Sit in a quiet room with no TV, cellphone, or children and take a few deep breaths. RELAX!

Wellness Checklist for Men

  1. Cholesterol – High cholesterol is one of the major risk factors for heart disease. Have you had your cholesterol checked this year?
  2. Blood pressure – High blood pressure increases your chance of developing heart or kidney disease, and increases your risk for stroke. If you have high blood pressure, you may need medication to control it.
  3. Colorectal Cancer – Beginning at age 50, through age 75 (depending on other risk factors present that your primary care provider will determine) you need to get tested for colorectal cancer. It is a great primary screening tool.
  4. Prostate Cancer – Starting at the age of 50 (depending on other risk factors present) you may want to talk to your provider about a prostate cancer screening, and if it is the right choice for you.
  5. Sexually Transmitted Diseases – Talk to your provider to see if you are at risk for developing sexually transmitted diseases, and ask about testing.
  6. Diabetes – If you have a family history of diabetes, or are overweight you may be at risk for developing diabetes. Ask your provider about screening tools, and ways to prevent and decrease your risk for diabetes. Diabetes can affect your heart, eyes, feet, nerves, and other body parts.
  7. Tobacco use – If you smoke or use tobacco, talk to your provider about quitting.
  8. Vaccinations – Get up to date on your vaccinations to protect you, your loved ones, and the community. Ask your provider which vaccinations you may need to stay healthy.
  9. Testosterone screening – May be indicated for some, but not all men.

Scheduling an Annual Wellness Visit with your family medicine provider is the best way to start these conversations and starting taking control of your health and wellness.

 

Sun Safety – Protecting your family in the Texas sun

As wsunburn cartoone enjoy more bright and sunny days, the risk of sunburns and skin damage rises for everyone.   Take these steps now and your skin will thank you in the long-run.

Ultraviolet (UV) rays from the sun or indoor tanning damage the skin. Even a tan is a response to injury, not an indication of good health, as some may perceive. There are many risk factors that can contribute to sunburns, and skin cancer including: family history of skin cancer, sun exposure sun through work and play, history of sunburns (especially early in life), history of indoor tanning, freckles, skin reddens easily or becomes painful in the sun, if you have blue or green eyes, blonde or red hair, and certain types of moles and/or a large number of specific types of moles.

Now that you know your risk factors for UV damage the next step is reducing your risk.sunscreen

Protection from UV rays is important all year round, not just during the summer months. UV rays from the sun can reach the Earth on a cloudy, hazy day as well as bright and sunny days. UV rays also reflect off of surfaces such as water, cement, sand, and snow. The hours between 10:00am and 4:00pm during late Spring and Summer are the most hazardous for UV exposure outdoors in North America.

The Center for Disease Control and Prevention (CDC, 2014) recommends easy options for protection from UV radiation for adults and children.

  • Stay in the shade during peak hours (10:00am to 4:00pm) Plan indoor activities with children during this time unless you can be under an umbrella, seek shade under a tree, or under a pop up tent. An infant’s best defense is sun avoidance.Smiling-Sun-dreamstime_144972-440x372
  • Wear clothing that covers your arms and legs. Long sleeve shirts and pants may not always seem practical in the Texas summer, but a t-shirt, long shorts, a beach cover-up are good choices too. It is wise to double up on protection by applying sunscreen in the shade when possible.
  • Wear a hat that has a brim to protect your eyes, head, ears, and neck. Baseball caps do not protect ears and neck, so you must apply sunscreen in those exposed areas.
  • Wear sunglasses that wrap around and offer both UVA and UVB protection.
  • Use Sunscreen with sun protective factor (SPF) 15 or higher and UVA a/UVB protection. Plan ahead, keep a spare bottle of sunscreen in the car, in your purse, or a child’s backpack. For best protection apply sunscreen generously 30 minutes prior before going outdoors. Don’t forget to protect your ears, nose, lips, and the top of your feet! Always follow the directions on the package. All products do not have the same ingredients. If you or your child’s skin reacts to a product, call your primary care provider and avoid that product.
  • Reapply sunscreen.   Especially if outdoors swimming or exercising. This applies to both water resistant and waterproof products as well.
  • Avoid indoor tanning beds and booths.

Try combining sunscreen with other options such as hats, sunglasses, and shade options to prevent UV damage!

Managing Osteoarthritis

Osteoarthritis (OA) is the mosteoost common form of arthritis, affecting millions of people worldwide. It occurs when the protective cartilage on the ends of the bone wears down over time. It most commonly affects joints in your hands, knees, hips and spine.

Osteoarthritis can gradually worsen over time, and there is no current cure for it. It can cause chronic pain, reduce physical function, and diminish quality of life.

An increase in knee OA has been recently tied to an aging population and the prevalence of obesity. However, recent studies have shown that staying active, maintaining a healthy weight, and exercise therapy may slow progression of the disease and help improve pain and joint function.

Osteoarthritis symptoms often develop slowly and worsen over time. Signs and symptoms of osteoarthritis include joint pain, tenderness, stiffness, loss of flexibility, grating sensation and bone spurs (hard lumps around the affected joint)

OA is more prevalent in females, but other risk factors include old age, obesity, joint injuries (from sports, car accidents, etc), certain occupations (tasks that place repetitive stress on a particular joint), family history, and other chronic diseases such as diabetes, gout, and rheumatoid arthritis.

OA is diagnosed by a clinical exam, and or x-rays of the affected joint. An x-ray may show narrowing of the space between the bones in the affected joint. It may also show bone spurs around the affected joint. Specific blood tests may also be ordered to rule out other disorders such as rheumatoid arthritis or gout.

There’s no known cure for osteoarthritis, but treatments can help reduce pain and maintain joint movement. Exercising and achieving a healthy weight are the best and most important ways to treat osteoarthritis. This can include a multitude of therapies such as:

  • Physical therapy. A physical therapist can work with you to create an individualized exercise program that will strengthen the muscles around your joint, increase your range of motion and reduce pain.
  • Occupational therapy. An occupational therapist can help you discover ways to do everyday tasks or do your job without putting extra stress on your already painful joint. For instance, a toothbrush with a large grip could make brushing your teeth easier if you have finger osteoarthritis. A bench in your shower could help relieve the pain of standing if you have knee osteoarthritis.
  • A chronic pain class. The Arthritis Foundation and some medical centers have classes for people with osteoarthritis and chronic pain. Check with the Arthritis Foundation for classes available in your area. These classes teach skills that help you manage your osteoarthritis pain. And you’ll meet other people with osteoarthritis and learn tips and tricks for reducing and coping with joint pain.

Home remedies and at-home treatments:

Exercise and Stretching. Exercise can increase your endurance and strengthen the muscles around your joint, making your joint more stable. Try light walking, biking or swimming which is easier on the joints. You can also do home stretching, and or yoga exercises.

Weight Management. Being overweight or obese increases the stress on your weight-bearing joints, such as your knees and your hips. Even a small amount of weight loss can relieve some pressure and reduce pain. Most people combine changes in their diet with increased exercise.

Use heat and cold to manage pain. Both heat and cold can relieve pain in the joint. Heat also relieves stiffness, and cold can relieve muscle spasms and pain.

For more information on osteoarthritis, or if you and someone you know suffers from joint pain and discomfort, contact your provider for a more in-depth discussion on evaluation, treatment, and therapy. Remember, there are ways to cope and decrease your chronic joint pain and discomfort, and we are here to help.