Showing posts with label infectious disease. Show all posts
Showing posts with label infectious disease. Show all posts

Wednesday, September 9, 2015

The Mystery of Who’s Giving Babies Pertussis? A New Suspect Emerges!

By: Lewis First, MD, MS; Editor-in-Chief 
  
Mamma Loves
          While no one wants to contract pertussis, we worry the most about infants coming down with this disease.  They tend to have the least reserve and highest morbidity and mortality from this illness—and sadly even in the setting of high infant pertussis vaccination coverage, the incidence of this disease in babies has been increasing.  This raises the question of who is spreading the disease to our youngest patients.   
     Prior to a study by Skoff et al. (doi: 10.1542/peds.2015-1120) being released this week, we certainly worried about mothers being the most common source of spreading this infection, but with the aggressive campaign to vaccinate pregnant mothers with Tdap vaccine, are there other “suspects?”  The authors reviewed cases of pertussis in infants less than 1 year old and interviewed parents regarding potential sources of infection in contact with a baby within 7 to 20 days before the onset of their cough.   
     Of more than 1300 cases identified, a source was found for almost half with that source being other family members—and most commonly siblings—with parents following behind. In fact siblings have taken over from mothers as the most common source of pertussis infection to the new babies in their families.  So how old were the siblings who tended to spread this infection, and what was their vaccination status in terms of needing or receiving a Tdap booster?  Inject some time into reading this interesting study and learn more, and in turn share the import of getting booster pertussis vaccine where warranted in older sibs and parents especially if a new baby is expected or has arrived into a family.  
    Have you seen siblings as the source of pertussis cases in your practice?  What if anything did you do about the spread of pertussis if you live in an area that has recently seen an uptick in cases?  Share your thoughts on preventive measures via a response to this blog, an e-letter, or posting on Facebook or Twitter.

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Tuesday, August 4, 2015

Mycoplasma pneumonia and Stevens-Johnson Syndrome: A Combination and Complication You Should Know About




       While we are all familiar with Stevens-Johnson Syndrome (SJS) as a somewhat uncommon dermatologic illness in our patients in which the epidermis separates from the dermis due to cell death, we may be less familiar with outbreaks of this disorder and their etiology.   
      This week, Olson et al. (doi: 10.1542/peds.2015-0278) report on an outbreak of 8 cases of SJS seen over a three month period at Children’s Hospital Colorado that was associated with mycoplasma pneumonia infection.  Just how the association was found and what was done about it make for an interesting read.   
       If you are looking for possible etiologies of a patient you care for with SJS, add mycoplasma to your list of “rash-ional” etiologies.

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Friday, June 5, 2015

Isoniazid-resistant Tuberculosis: A Problem More Common than You Might Have Thought


By: Lewis First, MD, MS; Editor-in-Chief

          Tuberculosis (TB) in children remains a global health problem and yet for decades we have relied on the use of isoniazid to help treat this devastating illness.  Sadly however, we have become more and more aware of isoniazid resistance in cases of TB in children.  But how prevalent is this resistance?  Yuen et al. (doi: 10.1542/peds.2015-0172) studied this question and estimated on the basis of their data that globally more than 120,000 children or 12.1% of all children with TB have isoniazid-resistant TB. Just where these cases are is well described in this study so please take a few minutes and read and learn more. 
      It appears, based on what the authors share in this study, that adults with resistance to isoniazid are transferring this resistance to children and raises new concerns as to whether we should continue to use this drug as first line in children with active or even latent disease.   
     The good news is that the AAP’s Committee on Infectious Diseases is also following this story and will keep us well informed of changes in treatment regimens as data like that shared in this important study continue to accumulate.  

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Tuesday, May 19, 2015

Two Strategies to Decrease Pertussis Transmission to Infants: Which One Is Preferred?


By: Lewis First, MD, MS; Editor-in-Chief     

     Given the reluctance to vaccinate children on the part of some parents, as well as issues with efficacy of the vaccine requiring boosters to maintain herd immunity, the burden of pertussis remains a global public health issue not just in this country but around the world, especially in young infants who have not yet been vaccinated fully.  To protect infants from pertussis transmission, two strategies have been proposed:  (1) vaccination of pregnant women with protection through passive passage of antibodies to an infant and (2) cocooning whereby parents, caregivers, and other close contacts are vaccinated to indirectly protect infant transmission by keeping the organism out of those in close proximity to the infant.   
     So which strategy is better?  You’ll have to read a special article by Forsyth et al. (doi: 10.1542/peds.2014-3925) who reviews the evidence for both and arrives at the conclusion that vaccination during pregnancy is the preferred way to protect infants with cocooning as the backup plan.  Doctor Mark Sawyer and Doctor Sarah Long offer their own infectious disease expertise in an accompanying commentary (doi: 10.1542/peds.2015-0770) to further stress the import of making sure Tdap is given to every pregnant mother-to-be. 
      Take a shot at reading both the special article and commentary and in turn, don’t forget to tell pregnant mothers in your practice to get their Tdap if they haven’t already.

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