1666 Mound Street
Phone: (941) 365-5898
Fax: (941) 366-5728

Dr. Ted’s Blog

Swine Flu Mist is now in!

Hi,

If you are interested in getting the Swine Flu Mist for your child, it is now in. Please remember that the children have to be 2 years old or more and have no chronic illnesses such as asthma or serious egg allergies. Also, if your child has recently had the the Seasonal Flu Mist, you must wait 28 days or more before getting the swine flu mist.

Also, please remember that this is a live virus vaccine, which is what makes it a more effective vaccine than the shot. We do not yet have any confirmation from the Sarasota Health Department about the availability of the Swine Flu shot (killed virus).

Please call the office for an appointment for the nasal mist vaccine. We are making every effort to give as many vaccines as quickly as the demand dictates, including Saturday mornings. We have been allotted 300 doses, so supply is not infinite. Call 365-5898 and ask to be scheduled for the Swine Flu Mist if you would like to get this done. Thanks,

Dr Ted, Nancy, Jen, Kay and all of us at Meyer Pediatrics

Things to Know About MRSA Infections

Recognize and Prevent MRSA Infections

photo: A mother holding her child. As kids head back to classrooms and sports venues, parents are encouraged to learn how to recognize and prevent skin infections caused by methicillin-resistant Staphylococcus aureus (MRSA), a type of staph bacteria that is resistant to certain antibiotics.

It is estimated that Americans of all ages visit the doctor more than 12 million times per year for skin infections that are typical of staph, more than half of which are MRSA. The good news is that a few simple steps can help parents protect their families.

Learn about MRSA

Visit www.cdc.gov/MRSA for posters, fact sheets, e-cards, graphics and more.

MRSA is methicillin-resistant Staphylococcus aureus, a potentially dangerous type of staph bacteria that is resistant to certain antibiotics and may cause skin and other infections. As with regular staph infections, recognizing the signs and receiving treatment for MRSA skin infections in the early stages reduces the chances of the infection becoming severe. MRSA is spread by:

  • Having direct contact with another person’s infection
  • Sharing personal items, such as towels or razors, that have touched infected skin
  • Touching surfaces or items, such as used bandages, contaminated with MRSA

Recognize the Signs and Symptoms of Infections

Most staph skin infections, including MRSA, appear as a bump or infected area on the skin that may be:

  • Red
  • Swollen
  • Painful
  • Warm to the touch
  • Full of pus or other drainage
  • Accompanied by a fever

Poster: A child's first line of defense against MRSA: A well-informed mom.
A series of educational posters contain prevention and control messages related to infectious diseases such as MRSA.

Take Action if You Suspect an MRSA Skin Infection

Cover the area with a bandage and contact your healthcare professional. It’s especially important to contact your healthcare professional if signs and symptoms of an MRSA skin infection are accompanied by a fever.

Protect Yourself and Your Family from MRSA Skin Infections

  • Know the signs of MRSA skin infections and get treated early
  • Keep cuts and scrapes clean and covered
  • Encourage good hygiene such as cleaning hands regularly
  • Discourage sharing of personal items such as towels and razors

National MRSA Education Initiative

The National MRSA Education Initiative is a comprehensive public education campaign to help parents and healthcare providers recognize, treat, and prevent MRSA skin infections in their families and patients. Through the Initiative, parents, healthcare providers and organizations have access to education materials – including printed posters, fact sheets, brochures and flyers, and Web-based e-cards, content and graphics. To access materials, visit www.cdc.gov/MRSA.

More Information

Did You Hear About Tim Tebow’s Concussion?

Learn to Prevent & Recognize Concussions

Photo: A coach talking to her young athletesCDC’s youth sports tool kit teaches coaches, athletes, and parents to play it safe when it comes to concussions.

A concussion is a brain injury caused by a bump or blow to the head that can change the way your brain normally works. Even what seems to be a mild bump or blow to the head can be serious.

To help ensure the health and safety of young athletes, CDC developed the Heads Up: Concussion in Youth Sports initiative to offer information about concussions—a type of traumatic brain injury—to coaches, parents, and athletes involved in youth sports. The “Heads Up” initiative provides important information on preventing, recognizing, and responding to a concussion.

CDC wants to equip coaches, parents, and young athletes across the country with the “Heads Up: Concussion in Youth Sports” tool kit, which contains a:

  • Fact sheet for coaches on concussion
  • Fact sheet for athletes on concussion
  • Fact sheet for parents on concussion
  • Clipboard with concussion facts for coaches
  • Magnet with concussion facts for coaches and parents
  • Poster with concussion facts for coaches and sports administrators
  • Quiz for coaches, athletes, and parents to test their concussion knowledge

You can download the materials or request a free tool kit online.

More Information

When Do I Need Antibiotics, from the CDC

Get Smart: Know When Antibiotics Work

Photo: Pill bottle Antibiotics do not fight infections caused by viruses, like colds, flu, most sore throats and bronchitis, and some ear infections. Rest, fluids, and over-the-counter products may be your or your child’s best treatment option.

Dangers of Antibiotic Resistance

Photo: A pharmacist assisting a customerIf antibiotics are used too often for things they can’t treat—like colds, flu, or other viral infections—they can stop working effectively against bacteria when you or your child really needs them. Antibiotic resistance—when antibiotics can no longer cure bacterial infections—has been a concern for years and is considered one of the world’s most pressing public health problems. Widespread overuse of antibiotics is fueling an increase in antibiotic-resistant bacteria. So the next time you or your child really needs an antibiotic for a bacterial infection, it may not work.

If You Have a Cold or Flu, Antibiotics Won’t Work for You!

Colds and flu are caused by viruses, not bacteria. Taking antibiotics when you or your child has a virus may do more harm than good. Get smart about when antibiotics are appropriate—to fight bacterial infections. Taking them for viral infections, such as a cold, most sore throats, the flu, or acute bronchitis:

  • Will not cure the infection;
  • Will not keep other people from getting sick;
  • Will not help you or your child feel better; and
  • May cause unnecessary and harmful side effects.

What Not to Do

  • Photo: A doctor consulting a father and child.Do not demand antibiotics when a healthcare provider says they are not needed.
  • Do not take an antibiotic for a viral infection like a cold or most sore throats.
  • Do not take antibiotics prescribed for someone else. The antibiotic may not be appropriate for your or your child’s illness. Taking the wrong medicine may delay correct treatment and allow bacteria to multiply.

If your healthcare provider prescribes an antibiotic for you or your child:

  • Do not skip doses.
  • Do not save any of the antibiotics for the next time you or your child gets sick.

What to Do

Snort, Sniffle, Sneeze.
View or download “Snort. Sniffle. Sneeze: No Antibiotics Please!” (video 3:47 mins)

Learn about appropriate antibiotic use and how to feel better when you or your child has a sore throat, ear or sinus pain, fever, cough, or runny nose.

Adults and kids should clean their hands often, especially before meals and after touching pets. And make sure both you and your child are up-to-date on recommended immunizations.

Talk with your healthcare provider about the best treatment for your or your child’s illness. To feel better when you or your child has an upper respiratory infection:

  • Increase fluid intake;
  • Get plenty of rest;
  • Use a cool-mist vaporizer or saline nasal spray to relieve congestion; and
  • Soothe a throat with ice chips, sore throat spray, or lozenges (do not give lozenges to young children).

Video: Snort. Sniffle. Sneeze. No Antibiotics Please!

CDC created a video to help you learn more about appropriate antibiotic use and how to feel better when you or your child has a sore throat, ear or sinus pain, fever, cough, or runny nose. This video features a doctor, who is also a concerned mom. You can download the video at CDC-TV, download the podcast, or access on your mobile phone.

More Information

Description of Swine Flu from the CDC

Clinical Features of H1N1 Influenza

Typical Signs and Symptoms

The incubation period for H1N1 influenza is 1-4 days, possibly as long as 7 days. The clinical features of influenza are well known and include:

  • Sudden onset of fever (usually high);
  • Headache;
  • Extreme tiredness;
  • Dry cough;
  • Sore throat;
  • Runny nose; and
  • Muscle aches and stomach symptoms — more common in children.

(CDC. Interim guidance for clinicians on identifying and caring for patients with swine-origin influenza A (H1N1) virus infection. June 2009. Available at: http://www.cdc.gov/h1n1flu/identifyingpatients.htm Accessed September 16, 2009.)

The symptoms of pandemic H1N1 influenza of 2009 are essentially the same as the seasonal flu, although some have noted an increased frequency of gastrointestinal symptoms, including vomiting and diarrhea, and others have noted the absence of fever in a significant number with virologically proven cases.

The CDC defines cases as influenza-like illness (ILI) if there is fever of ≥100° F (37.8° C) plus cough and/or sore throat in the absence of a known cause other than influenza. Another category is acute respiratory illness (ARI), defined by the presence of 2 of the following 4 symptoms: fever, cough, sore throat, or rhinorrhea. In the outbreak of pandemic influenza in New York City, 95% of virologically proven cases satisfied the ILI definition. (CDC. Swine-origin influenza A (H1N1) virus infections in a school — New York City, April 2009. MMWR Morb Mortal Wkly Rep Dispatch. 2009;58:1-3. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm58d0430a1.htm Accessed September 25, 2009.)

Patients with 2009 influenza A H1N1 infections have higher rates of gastrointestinal symptoms and lack of fever compared with those who have seasonal flu. Most patients have mild symptoms, but a small subset of previously healthy young adults have severe pulmonary disease that progresses to acute respiratory distress syndrome (ARDS); this may occur with or without underlying conditions.

Symptoms in virologically confirmed cases. During an outbreak of H1N1 in a New York City high school, a sample of New York City school students (median age, 15 years) with virologically confirmed cases were interviewed about their symptoms by telephone. They reported:

  • Cough (98%);
  • Subjective fever (96%);
  • Fatigue (89%);
  • Headache (82%);
  • Sore throat (82%);
  • Abdominal pain (50%);
  • Diarrhea (48%);
  • Dyspnea (48%); and
  • Joint pain (46%).

The measured mean peak fever in this group was 102.2° F. (CDC. Swine-origin influenza A (H1N1) virus infections in a school — New York City, April 2009. MMWR Morb Mortal Wkly Rep Dispatch. 2009;58:1-3. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm58d0430a1.htm Accessed September 25, 2009.)

Case Definitions for H1N1 Influenza

(CDC. Interim guidance for clinicians on identifying and caring for patients with swine-origin influenza A (H1N1) virus infection. June 2009. Available at: http://www.cdc.gov/h1n1flu/identifyingpatients.htm Accessed September 16, 2009.)

  • Confirmed case: Patient with ILI plus laboratory evidence confirmed by real-time RT-PCR or viral culture;
  • Probable case: ILI plus laboratory test positive for influenza A and negative for human H1 and H3 by RT-PCR; and
  • Optional: ILI without negative H1N1 test and (1) previously healthy person > 65 years hospitalized for ILI; (2) epidemiologic link to confirmed or probable case in past 7 days; or (3) ILI plus travel to a state or country with confirmed or probable cases.

Complications of H1N1 Influenza

  • Exacerbation of underlying chronic disease;
  • Complications related to the upper airways, including sinusitis or otitis;
  • Pulmonary complications, including bronchitis, asthma (sometimes with status asthmaticus), and acute exacerbations of chronic bronchitis; and
  • Miscellaneous conditions, including cardiac (myocarditis and pericarditis), myositis, rhabdomyolysis, central nervous system complications (encephalopathy, encephalitis, seizures), toxic shock syndrome, and secondary bacterial pneumonia.

Severe complications of H1N1 Influenza. In June 2009, the University of Michigan reported severe pulmonary complications of 2009 H1N1 influenza infection in 10 patients with a median age of 49 years. All 10 patients were referred for severe hypoxemia, ARDS, and inability to oxygenate with conventional ventilation methods. All had severe multilobar pneumonia on x-ray, none had evidence of bacterial pneumonia, and 4 had CT scan-confirmed pulmonary embolism. Lab findings included leukocytosis in 5 (median WBC 9500/mm3), elevated AST levels (41-109 IU/L) in all 10, and elevated CPK levels (51-6572 IU/L) in 6; none had evidence of disseminated intravascular coagulation. The major risk factor was obesity in 9 and morbid obesity (BMI > 40) in 7. All 10 required advanced mechanical ventilation with high-frequency oscillatory or bilevel ventilation with mean airway pressures of 32-55 cm H2O. Two required veno-venous extracorporeal membrane oxygenation (ECMO) support and 6 required dialysis. At the time of the report, 3 had died, 1 was still on ECMO, 1 was still on mechanical ventilation, and 5 had been transferred back to referring institutions. (CDC. Intensive care patients with severe novel influenza A (H1N1) virus infection — Michigan, June, 2009. MMWR Morb Mortal Wkly Rep. 2009;58:749-752.)

Neurologic complications. Neurologic complications were reported in 4 children ages 7-17 years with 2009 H1N1 influenza A. Findings included seizures in 2 children, encephalitis in 2, and ataxia in 1. All recovered without neurologic sequelae. The editorial comment in this report noted that the neurologic disease in these 4 patients was less severe than what has been described in previous reports of seasonal flu. (CDC. Neurological complications associated with novel influenza A (H1N1) infection in children — Dallas, Texas, May 2009. MMWR Morb Mortal Wkly Rep. 2009;58:773-778.; Maricich SM, Neuf JL, Lotze TE, et al. Neurologic complications association with influenza A in children during the 2003-2004 influenza season in Houston, Texas. Pediatrics. 2004;114:e626-e633.; Morishima T, Togashi T, Yokota S, et al. Encephalitis and encephalopathy associated with an influenza epidemic in Japan. Clin Infect Dis. 2002;35:512-517.)

Related Risk for Infection, Hospitalization, and Lethal Outcome

Age-related risk. These data are shown in Table 1.

Table 1. Rates for H1N1 for May-July 2009 by Age

Age Cases/100,000 Hospitalization/100,000 Death %
0-4 yrs 23 4.5 7 (2%)a
5-24 yrs 27 2.1 48 (16%)
25-49 yrs 7 1.1 124 (41%)
50-64 yrs 4 1.2 71 (24%)
> 65 yrs 1.3 1.7 26 (2%)

a % of total deaths. Age data not available for 15%.
Rate expressed /100,000 population

US age data

(Novel Swine-Origin Influenza A (H1N1) Virus Investigation Team; Dawood FS, Jain S, Finelli L, et al. Emergence of a novel swine-origin influenza A (H1N1) virus in humans. N Engl J Med. 2009;360:2605-2615.)

  • Median age of confirmed cases: 12 years
  • Median age of hospitalized cases: 20 years
  • Median age of lethal cases: 37 years

Additional Influenza Vaccine Information

Parents/Caregivers: If your child or adolescent has been diagnosed with Mononucleosis (Epstein-Barr Virus), Hepatitis or other serious viral illnesses within the past few months, please make sure our office is aware before obtaining the influenza vaccine (mist or shot). There may be some time constraints or contraindications. Contact us for any questions.

Update on combing H1N1 and seasonal flu vaccines

Hi

A live seasonal and a live H1N1 flu vaccine cannot be given at the same time. They need to be spaced at least 28 days apart. However, one live and one inactivated vaccine can be given at the same time. The H1N1 VIS is now available (at CDC.GOV) and it confirms that children age 9 and younger need two doses.

I am more than happy to answer any questions for you or anyone in the practice. Feel free to call or email me at any time. We are hoping to see the first shipment of H1N1 flu mist vaccine arrive by next week!

Thanks,

Anna Brereton-Hubbard, RN

Sarasota County Health Department
2200 Ringling Blvd.
Sarasota, FL 34237
941-861-2678
941-861-2676 (fax)

H1N1 Vaccine information sheets

Go to this CDC website for the vaccine information sheets for both types of H1N1 vaccines. We will update the website when we have the vaccines available.
http://www.cdc.gov/vaccines/pubs/vis/default.htm.

Swine Flu (H1N1) General Information

What is swine flu?

Swine Influenza (swine flu) is a respiratory disease of pigs caused by type A influenza viruses that

causes regular outbreaks in pigs. People do not normally get swine flu, but human infections can and

do happen. Swine flu viruses have been reported to spread from person-to-person, but in the past, this

transmission was limited and not sustained beyond three people.

Are there human infections with swine flu in the U.S.?

In late March and early April 2009, cases of human infection with swine influenza A (H1N1) viruses

were first reported in Southern California and near San Antonio, Texas. Other U.S. states have

reported cases of swine flu infection in humans and cases have been reported internationally as well.

An updated case count of confirmed swine flu infections in the United States is kept at

http://www.cdc.gov/swineflu/investigation.htm. CDC and local and state health agencies are

working together to investigate this situation.

Is this swine flu virus contagious?

CDC has determined that this swine influenza A (H1N1) virus is contagious and is spreading from

human to human. However, at this time, it not known how easily the virus spreads between people.

What are the signs and symptoms of swine flu in people?

The symptoms of swine flu in people are similar to the symptoms of regular human flu and include

fever, cough, sore throat, body aches, headache, chills, and fatigue. Some people have reported

diarrhea and vomiting associated with swine flu. In the past, severe illness (pneumonia and

respiratory failure) and deaths have been reported with swine flu infection in people. Like seasonal

flu, swine flu may cause a worsening of underlying chronic medical conditions.

How does swine flu spread?

Spread of this swine influenza A (H1N1) virus is thought to be happening in the same way that

seasonal flu spreads. Flu viruses are spread mainly from person to person through coughing or

sneezing of people with influenza. Sometimes people may become infected by touching something

with flu viruses on it and then touching their mouth or nose.

How can someone with the flu infect someone else?

Infected people may be able to infect others beginning 1 day before symptoms develop and up to 7 or

more days after becoming sick. That means that you may be able to pass on the flu to someone else

before you know you are sick, as well as while you are sick.

What should I do to keep from getting the flu?

First and most important: wash your hands. Try to stay in good general health. Get plenty of sleep, be

physically active, manage your stress, drink plenty of fluids, and eat nutritious food. Try not touch

surfaces that may be contaminated with the flu virus. Avoid close contact with people who are sick.

Are there medicines to treat swine flu?

Yes. CDC recommends the use of oseltamivir or zanamivir for the treatment and/or prevention of

infection with these swine influenza viruses. Antiviral drugs are prescription medicines (pills, liquid,

or an inhaler) that fight against the flu by keeping flu viruses from reproducing in your body. If you

get sick, antiviral drugs can make your illness milder and make you feel better faster. They may also

prevent serious flu complications. For treatment, antiviral drugs work best if started soon after

getting sick (within 2 days of symptoms).

Page – 2 –

Patient Handout provided to subscribers of Pharmacist’s Letter, Prescriber’s Letter, and Pharmacy Technician’s Letter for distribution

to patients. Updates available at www.pharmacistsletter.com, www.prescribersletter.com, www.pharmacytechniciansletter.com.

Content provided by CDC at www.cdc.gov. April 27, 2009.

How long can an infected person spread swine flu to others?

People with swine influenza virus infection should be considered potentially contagious as long as

they are symptomatic and possibly for up to 7 days following illness onset. Children, especially

younger children, might potentially be contagious for longer periods.

What surfaces are most likely to be sources of contamination?

Germs can be spread when a person touches something that is contaminated with germs and then

touches his or her eyes, nose, or mouth. Droplets from a cough or sneeze of an infected person move

through the air. Germs can be spread when a person touches respiratory droplets from another person

on a surface like a desk and then touches their own eyes, mouth, or nose before washing their hands.

How long can viruses live outside the body?

We know that some viruses and bacteria can live 2 hours or longer on surfaces like cafeteria tables,

doorknobs, and desks. Frequent handwashing will help you reduce the chance of getting

contamination from these common surfaces.

What can I do to protect myself from getting sick?

There is no vaccine available right now to protect against swine flu. There are everyday actions that

can help prevent the spread of germs that cause respiratory illnesses like influenza. Take these

everyday steps to protect your health:

Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the

trash after you use it.

Wash your hands often with soap and water, especially after you cough or sneeze. Alcoholbased

hand cleaners are also effective.

Avoid touching your eyes, nose, or mouth. Germs spread this way.

Try to avoid close contact with sick people.

If you get sick with influenza, CDC recommends that you stay home from work or school

and limit contact with others to keep from infecting them.

What is the best way to keep from spreading the virus through coughing or sneezing?

If you are sick, limit your contact with other people as much as possible. Do not go to work or school

if ill. Cover your mouth and nose with a tissue when coughing or sneezing. It may prevent those

around you from getting sick. Put your used tissue in the waste basket. Cover your cough or sneeze if

you do not have a tissue. Then, clean your hands, and do so every time you cough or sneeze.

What is the best technique for washing my hands to avoid getting the flu?

Washing your hands often will help protect you from germs. Wash with soap and water or clean with

alcohol-based hand cleaner. We recommend that when you wash your hands — with soap and warm

water — that you wash for 15 to 20 seconds. When soap and water are not available, alcohol-based

disposable hand wipes or gel sanitizers may be used. You can find them in most supermarkets and

drugstores. If using gel, rub your hands until the gel is dry. The gel doesn’t need water to work; the

alcohol in it kills the germs on your hands.

What should I do if I get sick?

If you live in areas where swine influenza cases have been identified and become ill with influenzalike

symptoms, including fever, body aches, runny nose, sore throat, nausea, or vomiting or diarrhea,

you may want to contact your health care provider, particularly if you are worried about your

symptoms. Your health care provider will determine whether influenza testing or treatment is needed.

Page – 3 –

Patient Handout provided to subscribers of Pharmacist’s Letter, Prescriber’s Letter, and Pharmacy Technician’s Letter for distribution

to patients. Updates available at www.pharmacistsletter.com, www.prescribersletter.com, www.pharmacytechniciansletter.com.

Content provided by CDC at www.cdc.gov. April 27, 2009.

If you are sick, you should stay home and avoid contact with other people as much as possible to

keep from spreading your illness to others.

If you become ill and experience any of the following warning signs, seek emergency medical care.

In children, emergency warning signs that need urgent medical attention include:

Fast breathing or trouble breathing

Bluish skin color

Not drinking enough fluids

Not waking up or not interacting

Being so irritable that the child does not want to be held

Flu-like symptoms improve but then return with fever and worse cough

Fever with a rash

In adults, emergency warning signs that need urgent medical attention include:

Difficulty breathing or shortness of breath

Pain or pressure in the chest or abdomen

Sudden dizziness

Confusion

Severe or persistent vomiting

How serious is swine flu infection?

Like seasonal flu, swine flu in humans can vary in severity from mild to severe. Between 2005 until

January 2009, 12 human cases of swine flu were detected in the U.S. with no deaths occurring.

However, swine flu infection can be serious. In September 1988, a previously healthy 32-year-old

pregnant woman in Wisconsin was hospitalized for pneumonia after being infected with swine flu

and died 8 days later. A swine flu outbreak in Fort Dix, New Jersey, occurred in 1976 that caused

more than 200 cases with serious illness in several people and one death.

Can I get swine influenza from eating or preparing pork?

No. Swine influenza viruses are not spread by food. You cannot get swine influenza from eating pork

or pork products. Eating properly handled and cooked pork products is safe.