The recall also includes lot code numbers from 1274425 to 2140425 with “425” as the fifth, sixth and seventh numbers. These codes are included alongside best-if-used-by dates.  

There have been 14 reported illnesses and two hospitalizations over 12 states, according to the Centers for Disease Control and Prevention.

What are the symptoms of salmonella?

Salmonella is an organism that can cause serious and sometimes fatal infections in young children, frail or elderly people, and others with weakened immune systems. 

Healthy persons infected with Salmonella often experience fever, diarrhea (which may be bloody), nausea, vomiting and abdominal pain. In rare circumstances, infection with Salmonella can result in the organism getting into the bloodstream and producing more severe illnesses such as arterial infections (i.e., infected aneurysms), endocarditis and arthritis.

What to do

• Be sure to check any Jif brand peanut butter you have because it has a very long shelf life.
• Do not eat any recalled Jif brand peanut butter. Throw it away.
• Wash surfaces and containers that may have touched the recalled peanut butter using hot, soapy water.
• Call your healthcare provider if you have one or more of these symptoms after eating recalled peanut butter:
  • Diarrhea and a fever higher than 102°F
  • Diarrhea for more than 3 days that is not improving
  • Bloody diarrhea
  • So much vomiting that you cannot keep liquids down
  • Signs of dehydration, such as:
    • Not peeing much
    • Dry mouth and throat
    • Feeling dizzy when standing up

Consumers who have questions or would like to report adverse reactions should visit www.jif.com/contact-usExternal Link Disclaimer or call 800-828-9980 Monday through Friday, 8 AM to 5 PM ET.

It’s a good question and one that Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cook Children’s understands.

“It can be confusing because there are viruses that you can catch that trigger long-term immunity,” she said. “However, COVID-19 is not one of them.”

She explains it this way – COVID-19 is in the coronavirus family. We all get a coronavirus each year and it usually feels like a cold. Even though we catch a coronavirus, our immunity is temporary so we may catch it again the next year, and the year after that. COVID-19 is the same. Even though you’ve had it once doesn’t mean you won’t catch it again.

“It’s very different from, say, the measles where you probably won’t catch the measles twice in your lifetime. Coronaviruses are different,” said Dr. Whitworth.

So what about the COVID-19 vaccine? We don’t know how long immunity lasts with it either, but Dr. Whitworth says it does appear to provide protection for a longer period of time than getting COVID-19. She points to this study released by the Centers for Disease Control and Prevention (CDC) that examined two outbreaks at a nursing home in Kentucky. The first outbreak in July sickened 20 residents and killed five. Three months later in October, another outbreak hit the same nursing home. There were 12 residents who tested positive the first time who were still living at the facility. Five tested positive again.

“Three of those five had no symptoms during the first outbreak. This means those three were made worse by the second infection,” said Dr. Whitworth. “So, we know our immunity wears off after getting the virus.”

Another CDC study released in June shows people who had COVID-19, but didn’t get very sick, likely didn’t build up a strong antibody response, likely making them more susceptible to catching it again.

“The good news about this study is that it shows if you had COVID-19 and you got the vaccine, your protective antibodies will be even higher than someone who only got the vaccine,” she said. “The bottom line is that a lot of people who get COVID disease, but aren’t very sick, do not develop very good antibodies.”

Still, she knows a lot of people are worried about the potential side effects of the COVID-19 vaccine. It is a new vaccine, but scientists have been following the data and risks for seven months now. At this point, more than 155 million people in the U.S. have been fully vaccinated. That’s a lot of people. However, no vaccine is 100% effective. According to the CDC, 4,115 vaccinated people have been hospitalized or died with COVID-19 as of June 21. Of those “breakthrough infections,” 750 were asymptomatic.

“About 20% of the deaths in this group were not related to COVID-19. They were car wrecks, heart attacks, other things that people died from,” said Dr. Whitworth. “All of this is to say, it’s incredible how safe and effective this vaccine is. There’s not another one on earth like it. It’s as good of a vaccine as there has ever been.”

Recent reports about myocarditis, or inflammation of the heart, in young people have raised new concerns about the COVID-19 vaccine. Since April, there have been more than 1,000 reports of myocarditis in people who received one of the two COVID-19 mRNA vaccines (Pfizer and Moderna).

The CDC reports:

• Confirmed cases have occurred:
  • Mostly in male adolescents and young adults age 16 years or older
  • More often after getting the second dose than after the first dose of one of these two mRNA COVID-19 vaccines
  • Typically within several days after COVID-19 vaccination
• Patients can usually return to their normal daily activities after their symptoms improve. They should speak with their doctor about return to exercise or sports.
• CDC continues to recommend COVID-19 vaccination for everyone 12 years of age and older, given the risk of COVID-19 illness and related, possibly severe complications.

While this can sound scary, especially for parents trying to make the right decision for their child, Dr. Whitworth shares this:

• The number of vaccinated people who have contracted myocarditis is about one in 10,000 to 50,000.
• The NCAA tracked rates of myocarditis among its athletes who contracted COVID-19 before the vaccine was available. Thirty-seven, or 2.3%, of 1,597 Big Ten college athletes were found to have myocarditis through regular EKGs and MRIs.
• The risk of myocarditis from contracting COVID-19 infection is much higher than from the vaccine.

She adds that, like other coronaviruses, COVID-19 isn’t going anywhere anytime soon. She fully expects to see it circulating for years to come, making it even more important to get vaccinated. And if you think it’s easy to be the bearer of bad news day after day, it’s not. She’s going on 17 months of advising us about preventing COVID-19.

“It’s a lot of pressure sharing these opinions all the time, but I’m not scared of telling people to get the vaccine. I saw so much heartbreak watching the adult hospitals in Fort Worth have to call in morgue trucks because they ran out of places to keep the bodies. And we’ve held a lot of scared families’ hands here whose children required ICU care,” she said. “I got the Pfizer vaccine the week after it received emergency use authorization. My adult children got vaccinated. My parents were vaccinated. I firmly believe that it’s safe and it’s our best protection.”

A recent Seton Hall Sports Poll shows 25% of Americans say they will hold or attend a party for the big game. According to Mary Suzanne Whitworth, M.D., medical director of infectious diseases at Cook Children's, it is important to avoid large gatherings, even if you’re vaccinated.

“The COVID-19 vaccine is not a green light to get together with people,” Dr. Whitworth said. “If you’ve had the immunization, you can still get an asymptomatic infection and transmit it to others.”

Cook Children’s Medical Center is finally seeing lower numbers of COVID-19 patients after record hospitalizations and positive test numbers in December and January. The percentage of COVID-19 tests administered by Cook Children’s that are coming back positive is under 10%, which is a great improvement.

Dr. Whitworth says more good news is on the horizon. Vaccine rates are going up, and community spread of the disease is declining.

“The more people do their part, the sooner everyone can have large gatherings and celebrate with loved ones,” she said.

COVID-19 can spread from people who are symptomatic or asymptomatic by secretions coming from the nose and mouth. As you exhale, talk, yell, etc., those secretions fall within six feet of you. This is why it’s so important to stay six feet apart from others, wash your hands and wear a mask. When people are yelling at the TV or taking a break to eat or drink, there is always a possibility of spreading COVID-19. Dr. Whitworth reminds everyone, “Cloth, paper or N95 masks keep secretions in so you don't share germs with others around you.”

Although we can’t celebrate like years past, there are alternatives for large indoor gatherings, such as hosting a virtual party or starting a group text thread. These options allow us to enjoy the action with other fans while keeping distance and remaining safe.

As more COVID-19 vaccinations become available, health officials urge everyone to take the same precautions whether fully vaccinated or not. Dr. Whitworth says if everyone gathering is vaccinated, it’s safer, however, the vaccine is only about 95% effective. There’s still a chance someone could get sick.

While some may argue having a gathering in their home is safer than going out in public, Dr. Whitworth says any gathering comes with risks.

“A public place could have an influx of people with no masks and closed doors, and that is a high-risk environment,” she said.

The best way to protect yourself is to celebrate with those you live with.

It is also important to understand COVID-19 testing does not predict the future. If everyone gets tested before a gathering, the risk is lower because you can exclude those who test positive. However, you can test negative one day and transmit the virus the next day. While taking a COVID-19 test could lower the risk, it’s not the best indicator for a gathering.

Dr. Whitworth urges everyone to remain hopeful and to remember that we are getting closer to celebrations like Super Bowl parties, holidays, and birthday celebrations.

“As I've heard one of our scientists say, ‘The months ahead look a lot better than the weeks ahead and vaccine rates are going up everywhere,’” Dr. Whitworth said.

For more information on safer ways to enjoy the Super Bowl, visit the CDC’s website.

At some point, we all fell down and probably scraped a knee or an elbow. But what happened next determined how well we handled our next fall and eventually how successful we were at riding a bike.

"Likewise, life can be tough sometimes. We don't always realize our day-to-day struggles as parents can have lifelong effects on our children?," said Anu Partap, M.D., director for the Center for Prevention of Child Abuse and Neglect at Cook Children's. "It can be a hard fall if we don't actively protect and nurture our children through those tough times."

What kind of tough times can have such a long-standing impact?

The Centers for Disease Control and Prevention (CDC) released a new report Tuesday that found that people who experienced abuse or neglect as a child were at higher risk of dying from five of the top 10 leading causes of death.

Such traumas are called Adverse Childhood Experiences, or ACEs. They can include:

• Sexual abuse
• Physical abuse
• Emotional abuse
• Physical neglect
• Emotional neglect
• Domestic violence
• Divorce
• Community violence
• Having a parent with substance abuse or mental health issues.
• Having a parent incarcerated.

Trauma, and more specifically, the toxic stress connected to trauma, is the link between not only chronic health issues (asthma, cancer, kidney disease, diabetes, obesity, and heart disease), but also mental health issues and risky health behaviors. These issues can include depression, anxiety, alcoholism, smoking, substance abuse and suicidal attempts or ideation.

How people are affected by ACEs?

The CDC's recent report gives the first estimate of how many American citizens are impacted by adverse childhood experiences and stresses the importance of preventing these traumas. The report, based on a survey of more than 144,000 adults from 25 states, found that almost 60% of Americans faced at least one adverse experience during childhood, with 15.6% experiencing four or more different types.

"A stressful home can leave children feeling scared or alone, and that stress can trigger pathways to disease," Dr. Partap said. "What stresses one child dramatically may be less stressful for another. Part of that is our personality, but a large part may also be how nurtured and protected a child feels. So when life is tough, the child who feels alone will respond much worse than a child who knows loving people protect them."

Jamye Coffman, M.D., medical director of the Cook Children's Center for Prevention of Child Abuse and Neglect and the CARE Team, knows a report on trauma can be overwhelming, even depressing. But she offers hope for anyone who has gone through trauma as a child.

"Childhood trauma impacts how you parent and your mental health," Dr. Coffman said. "It impacts how you respond to stress and even how you bond with your child. Trauma impacts all of those things. But it doesn't mean you can't become a loving, caring adult. It is about your own introspective as an adult and receiving the counseling or parenting coaching you need to become a productive grownup. It's never too late for any of us. But you have to identify the issue; then you can fix it and have a better, more productive life."

Another positive takeaway from this information is that the effects of trauma are reversible. Communities that promote resiliency within the family, schools and the community can alleviate the debilitating effects of toxic stress and help children and families bounce back from adversity.

"It is critical to continue to study the link between adverse childhood experiences and serious chronic health issues," said Denise Coover, LCSW, trauma-informed care specialist at Cook Children's. "The more we understand this link, the better that public and mental health programs can plan and provide interventions and resiliency strategies to curb the onset of later costly health issues."

The experts interviewed for this article agree that parents and adults are the mitigating factor between toxic stress and resiliency. What makes the trauma experience so toxic, is many times children are left to manage high levels of stress on their own. If parents or other adults in a child’s life can provide a low-stress, loving environment, then the child is more likely to build the resiliency they will need to thrive.

"My recommendation is always that it is not about what you can buy for your child, but the quality of the love, listening and attention that is important," Coover said.

Dr. Partap wants this study to draw attention to ACEs. She hopes people in the health care community who can make a difference will be able to connect the dots from adult concerns back to the trauma many youth experience.

"Childhood is such a precious time," Dr. Partap said. "This connection that what happens in childhood matters forever is powerful for everyone to embrace. It affects me as a mom every day. Sometimes life gives us challenges we didn't ask for, and it may be depression or a loved one who struggles with addiction. Some folks lose their homes, but we have to know the strongest prevention act is asking for help.”

Dr. Partap continues, “That's how we prevent or help reduce the impact of these tough times on our child's life-long health. Sometimes help is a neighbor, a relative and sometimes it's a service like therapy, addiction treatment, or a shelter. Anything that helps parents be more present for their child prevents the impact of toxic stress on a child's health."

Resources Available

We all need help and there are many resources available. You shouldn't feel alone when you're raising children. Tarrant Cares and Aunt Bertha are web-based resources anyone can check out. Visit the website 211texas.org, which even has a staffed phone line. Try not to feel alone through difficult experiences, especially when you're raising children.

Last week, eight children tested positive the flu at the medical center, according to Laboratory results from Cook Children’s. What’s interesting is that seven children tested positive for influenza B and only one for the A strain.

Morgan Pence, Ph.D., a clinical microbiologist at Cook Children’s, says this occurrence is a bit odd because the A strain usually precedes B. Pence adds that the majority of flu cases reported nationwide have been influenza B.

Since Sept. 29, 2019, the Centers for Disease Control and Prevention (CDC), found that 68.1% (289) of positive tests gathered from clinical laboratories nationwide were for influenza B.

The good news is Flu B is usually less severe than Flu A. The bad news is the flu season is just beginning. And while it remains to be seen what the flu season holds in store for the area, one thing is for sure: it’s time to get your flu shot.

“It’s important for people to take care of themselves and others to prevent the spread of the flu as much as possible,” said Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases. “The flu vaccine continues to be recommended for everyone 6 months of age and older. Make sure to practice washing your hands and please keep your children home if they are sick.”

Speaking about the early flu season, the CDC reports:

• Nationally, flu activity is low and similar to what has been observed during recent previous seasons at the same time, but Louisiana and Puerto Rico are experiencing high levels of influenza-like-illness.
• Severe flu outcomes have been reported, including the first two pediatric deaths of the 2019-2020 season.
• Flu vaccination is always the best way to prevent flu and its potentially serious complications. Most flu vaccines protect against 4 different flu viruses. Get vaccinated now.

Other flu prevention tips include:

• Try to avoid close contact with sick people.
• While sick, limit contact with others as much as possible to keep from infecting them.
• If you are sick with flu-like illness, the CDC recommends staying home for at least 24 hours after your fever is gone except to get medical care for other necessities. Your fever should be gone for 24 hours without the use of fever-reducing medicine.
• 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 with soap and water. If soap and water aren’t available, use an alcohol-based hand rub.
• Avoid touching your eyes, nose and mouth. Germs spread this way.
• Clean and disinfect surfaces and objects that may be contaminated with germs like the flu.

The ACEs Task Force, chaired by Cook Children’s, aims to reduce adversities for children starting before they are even born. Their work is based on a study conducted between 1995 and 1997 by Kaiser Permanente and the CDC. The study, which involves 10 questions about what a person experienced before the age of 18, shows ACEs are associated with high risk behaviors, chronic disease and reduced quality of life in adulthood. The task force is focusing their efforts on the signs of stress or difficulties that show up in early childhood.

Cook Children's medical staff saw its own cluster of patients in 2016 and has seen sporadic cases since then, as have other hospitals across the nation.

Acute flaccid myelitis (AFM) presents similar to polio in that it causes an abrupt onset of limb weakness an decreased muscle tone, which can have associated problems with urination and, in the worst cases, cause respiratory failure if the muscles involved in the breathing become weak.

“This is a very rare illness and we’re still not sure what causes AFM,” said Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cook Children’s. “It is mostly like caused by a virus or a genetic disorder. At this point, we must treat each child on a case-by-case basis, but the earlier a diagnosis is made, the quicker a plan of action can take place.”

The Centers for Disease Control and Prevention (CDC) says most patients will have a sudden onset of limb weakness and loss of muscle tone and reflexes. Some patients will also experience:

• Facial droop/weakness
• Difficulty moving the eyes
• Drooping eyelids
• Difficulty with swallowing or slurred speech

If you notice any of these symptoms, please notify your doctor immediately. Through thorough testing of the nervous system, doctors will be able to diagnose AFM.

The CDC recommends the following as means of prevention:

• Up to date on all recommended vaccinations, including the poliovirus.
• Protect yourself from mosquito-borne viruses such as West Nile by using mosquito repellent and staying indoors at dusk and dawn.
• Remove standing or stagnant water from properties to minimize the number of mosquitoes in your area.
• Wash hands with soap and water.
• Avoid close contact with sick people.
• Clean surfaces with a disinfectant, especially those that a sick person has touched.

According to data released Thursday, suicide rates doubled among girls and increased more than 30 percent among teen boys between 2007 and 2015.

At Cook Children’s, this news comes as no surprise to the behavioral health care workers who see the young adults struggling with depression and other mental health challenges each day.

“It’s not surprising. It’s absolutely heartbreaking, but not surprising,” said Lisa Elliott, Ph.D., a licensed psychologist and manager of Cook Children’s Behavioral Health in Denton.

Since 2015, the number of children and teens admitted to Cook Children’s Medical Center after trying to kill themselves has increased significantly. There’s no data available yet to say for certain how many more of these cases there have been, but it’s safe to say the percentage is in the double digits.

“We see the increase in the numbers of calls we receive from parents looking for help whether it’s for therapy or hospitalization,” said Elliott. “Not only is this a real problem across the country, but it’s affecting families right here in North Texas.”

Elliott says one big mistake parents make is believing that stories like this don’t apply to their children. She says when suicide is in the news, parents should use those stories as an opportunity to talk to their kids and teens.

“Ask them why they think this is happening and if they find themselves wishing they weren’t here,” said Elliott. “You can find out a lot about how they are feeling, and how their friends are feeling.”

Also know that kids may not tell you the truth, even if you ask.

“I think it’s important for parents to be mindful and recognize warning signs of suicide, even if their child denies having suicidal thoughts,” Elliott said.

Warning signs of teen suicide include:

1. Increased use of alcohol/drugs
2. Preoccupied with death (writing, drawings)
3. Talking about feelings of hopelessness
4. Talking about being a burden to others
5. Telling loved ones goodbye
6. Decline in performance
7. Giving prized possessions away
8. Isolating and withdrawing
9. Acting highly anxious or agitated
10. Acting reckless and taking risks
11. Rages
12. Changes in sleeping and/or eating
13. Dramatic changes in personality and/or appearance

Bottom line, Elliott says kids need to understand that problems are temporary, but suicide is permanent.

If you feel your child needs help, please click here to find a Cook Children's Behavioral Health location near you. You can also address your concerns with your child’s pediatrician, psychologist or therapist.

Cook Children's Behavioral Health Center

Growing up in today's world is hard and many children or teens may go through life experiences that cause them to feel anxious, depressed or even suicidal. As a parent or a caregiver, it can be hard to know when to ask for help. The Behavioral Health Center brings all services together in an expanded space that will provide a talented, dedicated team of caregivers, physicians and professionals with the facilities, resources, tools and programs they need to ensure that these most vulnerable children receive the high quality treatment they need and deserve. Click here to learn more about an appointment or referral.

From Jan. 15  to Jan. 21, 427 patients were tested for the flu, with 100 testing positive for Influenza A and five for Influenza B.

The CDC says influenza activity is slowly and steadily increasing. The CDC continues to encourage flu vaccines for everyone 6 months and older to help prevent influenza illness, as well as prompt treatment with flu antiviral drugs for people at high risk of serious flu complications who develop flu symptoms.

The good news is if you and your children received the flu vaccine you stand a good chance of being protected.

“The flu viruses isolated so far are covered in this year’s vaccine well over 95 percent of the time,” Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases said. “So, this is a good year to have gotten the vaccine. And if you have not gotten the vaccine yet, the season is starting late enough that you should go ahead and make sure your entire family is vaccinated.”

The flu season began with the announcement that the nasal spray flu mist vaccine wouldn’t be administered this year because the Centers for Disease Control and Prevention said it wasn’t effective. Then in North Texas, and around the country, the flu has been late in arriving.

About the source

Mary Suzanne Whitworth, M.D. is the medical director of Infectious Diseases at Cook Children’s, which offers care for children and teens with diseases caused by bacteria, parasites, fungi or viruses. Our team provides a broad range of services including diagnosis, inpatient and outpatient consultations, immune deficiency evaluations and treatment of recurring infections.

The patient lives in Cameron County in the Rio Grande Valley and was confirmed last week by a lab test to be infected. She is not pregnant and reported no recent travel to Mexico or anywhere else with ongoing Zika virus transmission and no other risk factors.

“This is not surprising. We knew this would happen eventually because Texas is so close to Mexico,” said Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cook Children’s. “Mosquitoes don’t have borders. The good news is at this time of the year, we should get our first freeze soon and the mosquitoes in the Fort Worth/Dallas area should die out for the winter."

For more information:

• Texas Announces Local Zika Virus Case in Rio Grande Valley
• The deets on DEET from a pediatrician
• Should we be afraid of Zika?
• 11 facts about the Zika virus

About the source

Mary Suzanne Whitworth, M.D. is the medical director of Infectious Diseases at Cook Children’s, which offers care for children and teens with diseases caused by bacteria, parasites, fungi or viruses. Our team provides a broad range of services including diagnosis, inpatient and outpatient consultations, immune deficiency evaluations and treatment of recurring infections.

New recommendations from the Centers for Disease Control and Prevention (CDC) requires only two doses of the vaccine spread over six months for younger teens 11-14 years of age. The Advisory Committee on Immunization Practices (ACIP), the body that formulates recommendations on how the vaccines which are licensed by the FDA should be used in this country, voted for the change.

The ACIP says older teens and young adults, ages 15 to 26, will still need three doses because they don’t have as robust a response as younger teens.

“This is good news because it will mean that more younger teens can be considered fully vaccinated if they complete their series of two doses over six months prior to their 15th birthday,” said Jason V. Terk, a Cook Children’s pediatrician in Keller and someone who has been at the forefront of HPV vaccination efforts. “Fewer doses means better compliance with this important cancer-preventing vaccine.”

Under the new schedule, the first of two doses of the HPV vaccine should be administered at 11 or 12, although it could be given as early as 9, as under the previous guidance. The second dose would be administered six to 12 months after the first dose.

According to the CDC, about 80 million Americans are infected with HPV; in most cases, the immune system clears the infection. Still, more than 38,000 cases of HPV-associated cancers occur in the United States every year.

Related Articles

• Early evidence HPV vaccine is working
• HPV Raises Risk of Head and Neck Cancer Sevenfold
• 'Epic fail
• Cook Children's Keller Clinic
• What is unique about pediatric leadership?

About the Source

Jason Terk, M.D., is a Cook Children's pediatrician in Keller. He earned his medical degree from University of Texas Medical Branch in Galveston, Texas. He completed his residency in pediatrics at Mayo Graduate School of Medicine (Mayo Clinic) in Rochester, Minnesota. His interests include public policy advocacy for children's health issues, focusing primarily on vaccines. Dr. Terk is board-certified in pediatrics.

Facing these devastating complications, parents are desperately seeking a treatment for their children. Imagine the relief of being part of a life-changing study using an experimental combination of ledipasvir and sofosbuvir, Harvoni, that has resulted in undetectable levels of the virus in these children.

“This is the most rewarding thing I’ve done in the last 20 years. Hands down,” said Dr. Whitworth, who came to Cook Children’s in 1995 and is the medical director of Infectious Diseases at Cook Children’s. “We have helped these kids. These children who had this infection will now, hopefully, be cured. Ten years ago, we did not think this could happen.”

The research comes at a crucial time. The Centers for Disease Control and Prevention released data last week that states that hepatitis C related deaths reached an all-time high in 2014, more than doubling from 2010. More people have died (2,194 cases reported in 2014) from hepatitis C than 60 other infectious diseases including HIV, pneumococcal disease and tuberculosis.

The CDC says the increase in deaths is frustrating because of the advancement in medications to treat the disease. The increase in deaths includes lack of testing and diagnosis, especially for those using injectable drugs.

Twenty years ago, because of the focus on adults taking injectable drugs, the diagnosis of hepatitis C in children was relatively new. Over the next five years, Dr. Whitworth and staff began to see more and more children diagnosed with the infection. Unfortunately, users of injectable drugs can pass the disease on to their children at birth.

The only way to acquire hepatitis C as a child is at birth or through bloodborne transmission. In the early 2000s, a treatment protocol with two different drugs to try and cure this infection was established.

Over the course of time, the success rate of this regimen was nearly 60 percent but it was associated with numerous side effects.

Then in March 2014, Cook Children’s began participating in a new study. There is great hope that this study will be permanently successful for all of these children.

Because our Infectious Diseases team was proactive, Cook Children’s enrolled two of the 10 teens in the world to participate in the initial trial. Later, they were able to enroll five more patients to fill in available slots.

The trend continued as the study moved to treating younger children, getting three out of the 10 worldwide slots for kids 6 to 11 years. In total, Cook Children’s had more than 15 kids participating in the trial, ranging from age 6 to 17. And so far, the results have been successful.

“I’ve never seen the kind of results to a drug as we’ve seen so far for this infection,” Dr. Whitworth said. “These children, if they are permanently cured, will now have a normal quality of life and be healthy. They can go to school and play sports. When you have cancer, you can brag to the world that you are cured. That’s not the case with hepatitis C because many of these kids don’t want others to know about their diagnosis. Their friends often don’t know. Fortunately, now they may never need to know. “The emotional part for the families is that their viral load is now undetectable. When families hear this, they just break down because they have carried the weight of this infection for so long. They have often been anxious since the child was born and now they don’t have to feel that way anymore.”

In a study that was released early online from the journal Pediatrics, researchers looked at the percentage of girls aged 14-19 years were infected with the types of human papillomavirus (HPV) contained in the HPV vaccine in the years 2003-2006 and compared that to the percentage of 14-19 year old girls infected with the types of human papillomavirus (HPV) contained in the HPV vaccine in the years 2009-2012.

They found that the rate of infection in the years prior to routine vaccination in this group of girls was 11.5 percent. That percentage dropped to 4.3 percent in the years following routine recommendation of a vaccine. This is a rather remarkable finding given the relatively small numbers of girls who had received the full 3-dose series of the HPV vaccine.

It further illustrates how well this vaccine protects against such an important infection that can cause cancer in later years. This evidence of early success will likely lead to even more important measures of success with decreased numbers of women having abnormal pap smears that indicate cervical dysplasia and ultimately decreased numbers of cancers.

Imagine how much better it will be when we improve the numbers of teens getting this important vaccine!

Jason V. Terk, M.D.

Leaders from the Who called Zika a “public health emergency of international concern,” earlier in the week, because how fast the virus is spreading and the continued investigation into its link to babies born with abnormally small heads (microcephaly). Experts are also looking into the possible connection between Zika and a neurological condition called Guillain-Barré syndrome, which can cause paralysis.

No vaccine exists to prevent Zika virus. Mosquitoes that spread Zika virus bit mostly during daytime.

Click here for prevention information from the CDC.

Here's what we know from about the Zika virus from the Centers from Disease Control and Prevention:

1. The Zika virus is spread to people primarily through the bite of an infected Aedes species mosquito, the same mosqutoes that spread dengue and chikungunya.
2. The mosquitoes are aggressive daytime biters, prefer to bite people and live indoors and outdoors near people. Mosquitoes become infected when they feed on a person already infected with the virus. Infected mosquitoes then spread the virus to other people through bites.
3. A mother already infected with the Zika virus can pass on the virus to her newborn around the time of birth, but this is rare.
4. The CDC has not found any reports of the Zika virus spread through breastfeeding.
5. The CDC believes the virus could spread through blood transfusion. At this time, there have been no reports of this happening.
6. There has been one case of the virus spread through sexual contact.
7. The most common symptoms of Zika virus disease are fever, rash, joint pain and conjunctivitis (red eyes). The illness is usually mild with symptoms lasting from several days to a week and severe disease requiring hospitalization is uncommon.
8. However, the Zika virus can be dangerous, especially to babies. Doctors are studying the link to the virus and microcephaly, a birth defect that causes abnormally small heads and brains.
9. There is no vaccine to prevent or medicine to treat Zika.
10. The CDC recommends “that all people, especially pregnant women, who are traveling to Brazil and other areas in Latin America, should take precautions to avoid mosquito bites to reduce their risk of infection with Zika virus and other mosquito-borne viruses such as dengue and chikungunya.”
11. The CDC asks that travelers protect themselves from mosquitoes by using insect repellent, wear long sleeves and pants, and stay in places with air conditioning or that use window and door screens.

“There is still a lot to learn about Zika virus and the potential risk to cause this particular birth defect,” said Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cook Children’s. “However, because it could spread to the United States, it is important that doctors and patients are aware of it. Like other diseases that were once thought to be isolated to tropical areas like chikungunya, many patients and doctors forget to think about them.”

About the source

Mary Suzanne Whitworth, M.D. is the medical director of Infectious Diseases at Cook Children’s, which offers care for children and teens with diseases caused by bacteria, parasites, fungi or viruses. Our team provides a broad range of services including diagnosis, inpatient and outpatient consultations, immune deficiency evaluations and treatment of recurring infections.

I have to start with an apology.

It’s not that I didn’t care, or wasn’t concerned.

I asked about feedings and dirty diapers. I asked about sleep positioning. I asked about your plans for vaccination. I educated on how to take a temperature and what a fever is, whom you should call when you are concerned.

I know a lot about your baby from our little time together.

But, I often forgot to ask about you.

Sometimes, if you looked particularly tearful, concerned … I don’t know, maybe distraught, I asked how you were doing. You might have said “fine” and I probably left it that.

Recent news reports reminded me that I should be doing better.

Depression affects about 30 percent of women between 18 and 44 years of age. I don’t want to get bogged down with more stats, but about 15 percent of women in their reproductive years take antidepressants. Most experts agree that untreated depression carries much more risk to babies than medications for depression. Studies have shown mixed results with most indicating that they are safe and others indicating a slight increase in risk for birth defects.

A special US Preventative Service Task Force report stated that all adults should be screened for depression but placed particular emphasis on the importance of screening pregnant and new moms. They conclude that screening should be implemented “with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up.”

If new moms should be screened for depression, who is going to do it if I don’t? Many don’t go back to their obstetricians until six weeks. What doctor are they seeing in the mean time? Who is going to screen them for postpartum depression? It has to be me.

Many pediatricians do this very well. They have built a system in place and screening has been part of their process for years.

Those of us who didn’t have many reasons…

Other priorities took over.

Checkup times are too short.

We’re not sure what we would do when we identified someone with postpartum depression.

But none of those are good excuses.

Because of this, I promise to work to develop a system that works.

I have to.

For you and for your baby.

I will report back with more soon.

Sincerely,

PS. Symptoms of postpartum depression can include:

• Increased irritability
• Loss of patience
• Quick mood changes
• Excessive energy or extreme fatigue
• A sense of feeling hopeless or overwhelmed

If you are someone you know is suffering from these symptoms, please ask for help from someone. Start with a friend or a doctor but do not suffer in silence. There are resources available.

The CDC says more public health research is urgently needed to find out why the dramatic increase in what the CDC describes as a "serious birth defect of the abdominal wall."

Patrick Thomas, M.D., FACS, a pediatric surgeon at Cook Children’s says gastroschisis results from a defect in the abdominal wall with herniation of the abdominal contents (such as intestines, stomach and often the gonads). The hernia is always to the right of the bellybutton.

Treatment includes starting immediate IV fluids and placing the infant in an organ bag below the chest to prevent heat loss and to protect the bowel. Surgical options can include immediate repair by placing the organs back in the abdomen and closing the abdominal wall defect. For cases not responsive to immediate closure, a protective bandage (called a silo) is placed and the bowel gradually reduced until closure of the defect can be performed about a week later.

Dr. Thomas said ongoing studies are needed to identify the causes of gastroschisis, but the current treatment through surgery has produced “great outcomes.”

Candace Gamble, M.D., a medical geneticist at Cook Children’s, calls the report from the CDC on the increasing prevalence of gastroschisis, significant.

“It is particularly important for health care providers in the prenatal and neonatal setting as we care for these babies,” Dr. Gamble said. “While expecting parents have cause for concern, the occurrence is still relatively rare considering there are well over 3 million babies born in the U.S. each year. However, it’s a reminder that every pregnancy has a 3-5 percent risk of some type of congenital birth defect. Thus good prenatal care is essential in detecting these defects early so that these babies can receive the proper management.”

Both Dr. Thomas and Dr. Gamble state that researchers and clinicians do not fully understand why this is happening. There is no known genetic mutation that causes gastroschisis. It is likely due to a number of genetic and environmental factors, which lead to an error in fetal development. Doctors do know that there are certain factors that increase the risk for having a baby with gastroschisis, including being a pregnant mother under the age of 20, smoking, and taking vasoconstrictive medications.

“Prenatal care is very important,” Dr. Gamble said. “A screening test where we measure the maternal serum alpha fetoprotein around 16 weeks gestation can be used to detect some babies with gastroschisis, other abdominal wall defects, and more specific defects. In addition, the anatomy ultrasound at 20 weeks gestation can also be useful to detect this and other congenital abnormalities. However, neither measure can completely rule out all birth defects. It is important for parents to discuss these risk and screening options with their health care provider.”

*Illustration courtesy of CDC.

Dr. Rogers explains that there’s really not a cure for a common cold and then lets them know why she’s not giving the child an antibiotic and why no one else should either.

“I understand this mindset,” Dr. Rogers said. “You come to the doctor and you want to be treated. Parents often want an antibiotic. That’s why they are there to see me. They can’t afford to take time off when their child is running a fever and sick. They think the antibiotic will make the illness go away faster.”

But if the cold is viral, it’s simply going to run its course. The antibiotics will not have any impact on the cold at all. With something like a cold, you just have to wait it out.

The American College of Physicians and the U.S. Centers for Disease Control and Prevention agree with Dr. Rogers. They have issued new guidelines for prescribing antibiotics for acute respiratory tract infections (ARTIs) in adults.

The two organizations advice to adults is similar to Dr. Rogers’ advice to children: Use antibiotics to treat bacteria that causes the likes of strep throat and food poisoning. For common viruses like the common cold and flu, the recommendation is drink extra water and juice, use a cool mist vaporizer or saline nasal spray to relieve congestion.

“It’s not that I’m against antibiotics, but for the right reasons,” Dr. Rogers said. “Pertussis starts with cold-like symptoms, just kind of a mild cough, and after 2 weeks the cough gets much worse. In those cases, not only the patient, but the entire family, will need antibiotics, but once the patient has been infected, expect him or her to have a prolonged cough.

Other times antibiotics may be necessary with illnesses including:

•  Sinusitis or secondary bacterial infections, related to a cold.
• Certain skin conditions caused by bacterial infections, such as impetigo.
• Strep throat
• A severe ear infection

“I really do try very hard to limit my prescriptions of antibiotics for bacterial infections,” Dr. Rogers said. “If your child has an ear infection and it’s red and bulging, as a parent I would want antibiotics to help ease my child’s suffering.”

However, other caregivers aren’t as careful with their prescriptions, Dr. Rogers warns. She said this can cause the medication to not be effective or even useless when a child actually needs antibiotics. The infectious organisms adapt to the antibiotics, leaving the patient immune to the antibiotic.

Antibiotics have played a vital role in treating patients with infectious disease for 70 years, Dr. Rogers said. When prescribed the right way, antibiotics can prevent illness and even death. But when antibiotics are prescribed carelessly, they lose their effect.

“We frequently see patients who have been prescribed antibiotics at the doc-in-the-box type clinics,” Dr. Rogers said. “It sometimes seems to me that they have a mandate that everyone must walk out with a prescription. They often prescribe an antibiotic, steroid or prescription cough medicine regardless if the patient needs it or not. None of that stuff works for a cold. In fact, studies have been done that say it makes your child worse. The antihistamine thickens the secretion, so you can’t get the yucky stuff out. That’s how you get better, by getting the mucus out and resting. When we’re sick, especially children, we need lots of rest.”

Dr. Rogers’ advice is to see your Cook Children’s pediatrician. Other options include a Cook Children’s Urgent Care Center or Neighborhood Clinic. If a doctor prescribes an antibiotic, she says it’s Ok to ask if it’s the right thing to do. If the doctor says it’s bacterial or to stop an infection, then proceed.

“There’s no magic cure for the common cold,” Dr. Rogers said. “And unfortunately, too many prescriptions of antibiotics are zapping the magic out of what was once a miracle drug."

About the source

Audrey Rogers, M.D., is located at 3200 Riverfront Drive, Ste. 103, Fort Worth, TX 76107. To make an appointment with her or one of her partners, call 817-336-3800. Like her on Facebook.Dr. Rogers received her undergraduate degree from Emory University in Atlanta, Ga., her medical degree at Southwestern Medical School in Dallas, and completed her pediatrics training at Children's Hospital of Oklahoma. Her special interests are behavioral pediatrics and adolescent medicine. She became board certified in 1989.

“Vaccinations are still the best answer to preventing the flu and protecting your children from the upcoming season,” Dr. Whitworth said.

The flu shot is recommended for children ages 6 months and older. However, the Centers for Disease Control says only 47 percent of the nation’s eligible population received a flu shot. The only age group that met the CDC’s coverage goal of at least 70 percent was children 6 months to 23 months of age with 75 percent getting their shot.

It’s important for babies to get their shots beginning at 6 months of age. Flu shots are not approved for younger infants,” Dr. Whitworth said. “Because these younger babies cannot be protected by getting flu shots, their caregivers and household contacts must get theirs. If those individuals who are around the baby don’t get infected with influenza, the baby is much less likely to be exposed. It’s especially important for pregnant women to get their vaccines in order to protect their newborns.”

Last year, a lot of talk focused on how ineffective the flu vaccine was, with the CDC saying it was less than 23 percent effective against the dominant strain. The CDC says the vaccine will be more effective this year based on data from early detected cases.

Dr. Whitworth says it’s too soon to predict what the flu season will bring as far as severity and it’s difficult to say how effective the vaccine will be because different strains circulate each year. But vaccines are still the most effective way to fight against the flu.

During the 2014-2015 flu season, 145 children died in the United States from influenza-related illness and the American Academy of Pediatrics says many of those children had no underlying medical condition. The AAP states that an estimated 90 percent of pediatric deaths have occurred in unvaccinated children.

Two types of influenza vaccines are available for children this year, according to the AAP:

• The inactivated influenza vaccine (IIV) is given by injection and is approved for children 6 months of age and older. It is available in two types, one which protects against three strains and one which protects against four strains of influenza.
• Also available is the live attenuated influenza vaccine (LAIV), which is given by intranasal spray. It is approved for healthy patients 2 through 49 years of age and protects against four strains of influenza.

 The AAP also recommends:

• Everyone who is 6 months of age and older should receive annual influenza vaccine.
• Children ages 6 months through 8 years need two doses this flu season, if they have had less than 2 doses of flu vaccine before July 2015.
• Special efforts should be made to vaccinate household contacts and out-of-home caregivers of children with high-risk conditions, and all children under the age of 5.
• Parents should not delay immunization in order to receive a specific vaccine formulation. It is more important to be vaccinated at the earliest opportunity.
• Pregnant women, who are at high risk of influenza complications, can safely receive influenza vaccine at any time during pregnancy. This also provides protection for their infants during their first 6 months of life.
• Mandatory influenza immunization programs for all health care personnel should be implemented nationwide.

About the source

Mary Suzanne Whitworth, M.D. is the medical director of Infectious Diseases at Cook Children’s, which offers care for children and teens with diseases caused by bacteria, parasites, fungi or viruses. Our team provides a broad range of services including diagnosis, inpatient and outpatient consultations, immune deficiency evaluations and treatment of recurring infections.

Three kids have been ejected total, with one child surviving. It probably doesn’t come as a surprise the cause of the tragedies – the children weren’t restrained properly or not at all in their car seat.

Since April 2015, Cook Children’s Trauma team has treated 13 children who were ejected from a car.

Sharon Evans, Trauma/Injury Prevention outreach coordinator at Cook Children’s, says it’s so frustrating because she has seen wrecks where one child who was properly restrained live and the other child not buckled in dies.

“Honestly, it’s just so infuriating,” Evans said. “These accidents are totally preventable. It’s because the adults in the car aren’t doing something that could save their child’s life. I don’t think people think it can happen to them. But it can happen to anyone. It just breaks my heart because these are deaths that shouldn’t occur if people would just place their kid in the proper car seat and buckle them up with a seat belt.”

Statistics show this is especially a problem for Hispanics in the community. Ninety percent of the ejections that have occurred since April 2015 were Hispanic.

“I think a lot of it has to do with our culture,” said Magdalena Santillan, Trauma Injury Prevention specialist at Cook Children’s. “These are people who love their kids and they want to hold their baby. A lot don’t want to hear their baby cry and so it’s easier to hold their baby in the car. They are showing love, but the consequences are too high. This can be a deadly mistake.”

According to the Centers for Disease Control and Prevention, car crashes are a leading cause of death among children ages 3 to 14. From 2002 to 2011, about 9,000 children under the age of 12 died in car accidents, the agency’s statistics show. Correctly using a child safety seat can reduce the risk of death by as much as 71 percent.

“We know that car seats are working,” Evans said. “Research shows that a properly installed rear-facing car seat is five times safer and can dramatically reduce the risk of head, neck and spinal cord injury if your child is involved in a crash.”

Call 682-885-2634 to set up a FREE car seat checkup to ensure your seat is properly installed.

The DSHS has received reports of 205 cases of Cyclosporiasis in Texas. No cases have been reported at Cook Children's. In Cook Children's six-county service region, the following numbers have been reported:

The U.S. Food and Drug Administration's alert says cilantro from the Mexican state of Puebla may be the cause for the recent outbreaks.

Symptoms usually begin 2 to 14 days after ingestion of contaminated food or water.Mary Suzanne Whitworth, M.D.,medical director of Infectious Diseases at Cook Children’s, advises parents to contact their Cook Children’s pediatrician if they have a diarrhea-like illness lasting more than a few days or diarrhea accompanied by severe weight loss or fatigue. Those are symptoms of Cyclospora.

Symptoms include severe diarrhea that can last a week to months, and if not treated, the person may relapse. Additional symptoms may include fatigue, severe weight loss, abdominal cramps, bloating, increased gas, nausea, vomiting and low grade fever. If your child is experiencing these symptoms, do not wait. Contact your Cook Children’s pediatrician. If your child is diagnosed with Cyclospora, an antibiotic can be prescribed.

However, most cases of diarrhea or an upset stomach do not need treatment with an antibiotic. Usually, diarrhea is caused by viruses, so time, rest and diet will take care of the problem.

“Past outbreaks of Cyclospora in the U.S. have been caused from imported, fresh produce,” Dr. Whitworth said. “The best way to prevent Cyclospora in your household is to wash your fruits and vegetables as thoroughly as possible. Let fruits and vegetables soak for a few minutes in clean water in the sink, and then drain and spray them off with clean water before eating them. Thorough washing of fresh produce is highly recommended, but it may not remove the risk of someone in your family getting Cylospora entirely. If your child has these symptoms, it’s best to see a pediatrician and get treated as quickly as possible.”

Cyclospora is generally not transmitted directly from person-to-person, however children with diarrhea should always avoid swimming in pools to avoid the spread of infection.

The Centers for Disease Control and Prevention has more information about Cyclospora.

When should you call your pediatrician about diarrhea? Watch this video from Justin Smith, M.D., for more information.

Listeriosis is a bacterium that most commonly causes fever, body aches with diarrhea and other stomach issues in healthy persons. It is contracted by eating food that has been contaminated with the bacteria.

It can cause more severe illness in people with weakened immune systems, pregnant women, newborns and the elderly.

Three people have died and five others are ill in what is believed to be a result of a recent outbreak of Listeria following consumption of Blue Bell products. The Blue Bell press release said there have been several positive tests for listeria “in different plants.

Blue Bell has recalled all of its ice cream, frozen yogurt, sherbet and other frozen snacks. If you have any of the products do not eat them and throw them out. If your child does become ill, contact your doctor and let them know that they have been exposed to the contaminated products.

Symptoms of Listeriosis include:

Children/adults:

• Fever
• Muscle aches
• Diarrhea
• Nausea

Can progress to nervous system involvement (headache, stiff neck, confusion)

Newborns:

• Poor feeding
• Extreme fussiness
• Fever
• Vomiting

About the author

Justin Smith, M.D., is a Cook Children's pediatrician in Lewisville . View more from The Doc Smitty at his Facebook page. He attended University of Texas, Southwestern Medical School and did his pediatric training at Baylor College of Medicine. He joins Cook Children's after practicing in his hometown of Abilene for four years. He has a particular interest in development, behavior and care for children struggling with obesity. In his spare time, he enjoys playing with his 3 young children, exercising, reading and writing about parenting and pediatric health issues.

Because of the icy road conditions lately, you’ve probably kept your family indoors recently to make sure they were safe. But if you aren’t careful this winter, you risk new dangers inside your home.

Carbon monoxide is known as the ‘silent killer’ because it’s an odorless, colorless, tasteless gas. The Texas Department of State Health Services says, “Several household sources, such as gasoline-powered tools and generators, produce carbon monoxide. Anything that burns can produce carbon monoxide. The fumes are extremely hazardous and can cause sudden illness or death."

Carbon monoxide is especially dangerous to infants, women who are pregnant and their unborn children, the elderly and people with heart or breathing problems.

The Centers for Disease Control and Prevention (the CDC) recommends taking the following steps to prevent carbon monoxide exposure:

· Do have your heating system, water heater and any other gas, oil, or coal burning appliances serviced by a qualified technician every year.

· Do install a battery-operated or battery back-up CO detector in your home and check or replace the battery when you change the time on your clocks each spring and fall. If the detector sounds leave your home immediately and call 911.

· Do seek prompt medical attention if you suspect CO poisoning and are feeling dizzy, light-headed, or nauseous.

· Don’t use a generator, charcoal grill, camp stove, or other gasoline or charcoal-burning device inside your home, basement, or garage or near a window.

· Don’t run a car or truck inside a garage attached to your house, even if you leave the door open.

· Don’t burn anything in a stove or fireplace that isn’t vented.

· Don’t heat your house with a gas oven.

The CDC points out that commercial toddler foods and infant or toddler snacks, desserts, and juice drinks are of potential concern due to sodium or sugar content. 

But it doesn't end with toddler foods.

Food and drink companies are finding ways around the U.S. Food and Drug administration (FDA) regulations to mislead consumers into thinking their products are healthy. We highlight a few deceptive terms frequently used on food and drink labels that you should know about.

1. “All Natural”

The FDA currently has no definition for this claim. Foods and drinks that do not contain added color, artificial flavors or synthetic substances are allowed to write “All Natural” on their labels. This allows a lot of room for interpretation for the food companies.

2. “Reduced Fat/Sugar”

Beware of claims about reduced amounts of fat and sugar. According to the FDA definition for “reduced”, the item only needs to have 25 percent less of the claimed nutritional value than the original referenced item. Many times items that claim to be reduced are not necessarily healthier. Companies make up for ingredients taken out in other areas. For example, a reduced fat item might increase the amount of sugar in the product to keep the taste consumers prefer. Always check the nutrition label to see if the product is actually healthier.

3. “Zero Trans Fat”

In the U.S., if a product contains less than 0.5 grams of trans-fat per serving it can be advertised with “Zero Trans Fat.” In this case, the nutrition label will often read 0 grams of trans fat. The problem is once you eat more than one serving the product no longer has zero trans-fat. Make sure to check the ingredients for hydrogenated oils which indicate trans fat in the product.

4. “Organic”

There is a common misconception about the powers of the term organic. Organic refers to the way a product is produced. It has to be produced by an approved method sanctioned by the U.S. Department of Agriculture (USDA). People think buying organic is the key to weight loss, but buying organic items does not necessarily cut down the calories. Just remember to look at the nutrition and ingredients labels, even if the product is organic.

5. “Cage-Free and Free-Range”

Most people read this claim and picture chickens running free in an open farm pasture. This is not the case. The term cage-free only implies that each hen is not locked in an individual cage, but in an open barn. Many times these hens are never given outside access. Similarly, the USDA only regulates that a free-range hen must have access to outdoors.

We spoke to Lisa Pegram, a registered dietitian at Cook Children’s, about how parents can decipher through marketing messages and know which foods are actually healthy. Pegram teaches her patients that “fresh is best.” The fresher the food, the more nutrients it will give you. Look for nutrient rich items in the grocery store. It is important to consume calories that give you nutrients which make you feel full. For example, eating a chocolate chip cookie gives you a lot of calories, but no nutritional benefits. It can leave you feeling hungry and unsatisfied.

Don’t rely solely on the wording on the front of the label. Pegram said, “I always tell parents to turn the food product around and look at the ingredients list to see what you are actually buying. If you see a chemical equation, you should probably do away with it.”

Pay attention to the order of ingredients listed on a label. The first few ingredients listed are the most used ingredients in the product. Pegram said that in most cases, the fewer ingredients, the better. The final thing to look at is the serving size because companies will often make it far less than a consumer would normally eat. Pegram warns that if you are going to eat double the serving size, you need to double the calories, fat, sugar, etc.

Parents have the most influence over what their child eats on a daily basis. Make a commitment to learn about these deceptive marketing tactics used by food companies to trick consumers. You and your family will feel better and live a healthier lifestyle.

For more information on food and drink regulations, visit the FDA and USDA websites at www.fda.gov and www.usda.gov.

The short answer is yes because your child is still more protected than without one.

Donald Murphey,M.D., medical director of Infectious Disease at Cook Children’s, was on a conference call with the CDC the morning of Thursday, Dec. 4, to discuss the advisory.

The dominant influenza strains at present in the US are influenza A, H3. There are two of these strains present this year:

• One is a good match for the vaccine currently in use.
• The second, accounting for about half of the samples tested, is a new flu A, H3 strain that was not seen until March 2014.

This new strain is not included in the current vaccine, but Dr. Murphey says it will likely be included in the vaccine for next year.

“This strain has drifted from other similar strains seen in the last few years. This new flu A could be associated with more severe influenza cases, and a more severe flu season in general, Dr. Murphey said.

But he stresses that parents and their children should still get a flu shot.

The CDC recommends:

• Treatment with antivirals for influenza more emphatically this season in hopes of preventing severe disease, hospitalization and death. Antiviral drugs are prescription medicines (pills, liquid or an inhaled powder) that fight against the flu in your body. Antiviral drugs are not sold over-the-counter. You can only get them if you have a prescription from your doctor or health care provider. Antiviral drugs are different from antibiotics, which fight against bacterial infections.

• Staying home if you have flu-like symptoms.

• Cover your cough.

• Frequent hand washing.

“We should still be using flu vaccine, as it is our best way to prevent this potentially serious illness,” Dr. Murphey said. “People's best chance of avoiding influenza and complications of influenza is to be immunized every year. That’s how we build up a community that can protect themselves from new strains, even when we did not have a vaccine for it yet.”

More resources:

• Six ways to protect your family from the flu
• The danger of the flu
• It's only the flu that killed her
• Fever, headaches and tummy aches: when you should be concerned
• Is your child afraid of shots?
• CDC's flu page
• What You Should Know for the 2014-2015 Influenza Season
• Seasonal Influenza Q&A

Paralysis

It may surprise you to know that there are more than 100 known varieties of non-polio enteroviruses in the world. All of these different types of enteroviruses can cause confusion and panic.

The non-polio enterovirus strains range from the common cold to meningitis. You may have noticed those strains are non-polio enteroviruses, which means that yes, an example of an enterovirus strain that can cause paralysis is polio.

Approximately 1 in 200 infections with polio will cause paralysis. Other enterovirus strains can cause similar symptoms, but do so much less frequently.

There have been a few reports stating that cases of EVD68 have possibly been associated with paralysis, most notably 10 cases in Colorado, 5 cases in California and now a case identified in Dallas. The most common locations for weakness have been the upper arms and hips.

But much work still needs to be done to decide what role EVD68 played in the paralysis. In a published Morbidity and Mortality Weekly Report last week, only four of the 10 children in Colorado tested positive for EVD68.

Investigation is ongoing to determine if these cases were actually caused by the virus. Those patients affected will be undergoing extensive physical therapy to regain function.

Death

The CDC released a report this week that announced there have been five deaths in which enterovirus D68 has been associated. We currently don't know the details of two of these cases. We do not know where the patients lived, their ages or if they had other medical conditions. These would all be important factors in determining the cause of death. The fourth patient was a 10-year old girl from Rhode Island who tested positive for enterovirus D68, but also for a bacteria in her blood stream called Staphylococcus aureus. Staph aureus infections are known to be dangerous, often progressing rapidly, and are resistant to many antibiotics.

Another case reported today described a boy who after an unexplained death was found to be positive for enterovirus D68. Prior to his death, he showed no signs or symptoms of upper respiratory infection, other than a case of pink eye which was proven not to be connected to EVD68. Because of these complicating factors, it is unclear what role EVD68 played in these deaths.

It is entirely possible that the others had similar stories with multiple infections or that they had other chronic health conditions which put them at risk for complications. At this point, I continue to believe that, in almost all children, enterovirus D68 causes mild runny nose and cough and that our biggest complication is the progression towards wheezing. Again, there are not many details out surrounding the deaths, but we felt it was important to update you on the situation given that we have stated all along that there had been no deaths clinically caused only by enterovirus D68. We will follow along and update you as soon as we know more.

Enterovirus D68 peaks in late summer and early fall so I expect that the number of cases to begin dropping soon (if it is not already on the way down). Other regions that experienced earlier outbreaks have already seen the end…they are doing what we will be doing soon, preparing for flu.

Our previous articles on Enterovirus D68:

• Health alert: What is Enterovirus D68?
• Enterovirus D68: What you need to know?

Get to know Justin Smith, M.D.

Justin Smith, M.D., is a pediatrician in Trophy Club  and the Medical Advisor for Digital Health for Cook Children's in Fort Worth, Texas. Dr. Smith is an experienced keynote speaker for a variety of topics including pediatric/parenting topics, healthcare social media and physician leadership. If you are interested in having Dr. Smith present to your conference or meeting, please contact him at thedocsmitty@cookchildrens.org.

He has an active community on both Facebook and Twitter as @TheDocSmitty and writes weekly for Cook Children's checkupnewsroom.com. He believes that strategic use of social media and technology by pediatricians to connect with families can deepen their relationship and provide a new level of convenience for both of their busy lifestyles. Dr. Smith’s innovative pediatric clinic, a pediatric clinic “designed by you,” open now. Click to learn more. To make an appointment, call 817-347-8100.

Back to school time has brought with it an unexpected and unwelcome virus to much of the United States. Center for Disease Control (CDC) officials are warning health care providers in affected states to be on the lookout for a respiratory illness that starts with symptoms similar to the common cold, but rapidly progresses to wheezing and difficulty breathing. The virus is suspected to be enterovirus D68. Once thought to be rare, we have seen increasing frequency of infection and outbreak in recent years.

The recent outbreak has been noted in several states, 10 of which have requested help from the CDC: Colorado, North Carolina, Georgia, Ohio, Iowa, Illinois, Missouri, Kansas, Oklahoma and Kentucky. It is of particular concern because of the number of children whose illness progresses to wheezing and difficulty breathing. Early estimates are that about 15 percent of children who contract the virus may require hospitalization and many have required care in the intensive care unit. As with other respiratory viruses, any child with asthma or other chronic illnesses are more susceptible. The virus has been reported to cause wheezing even in children who do not have asthma.

Enterovirus D68 is spread through contact with others (often via coughing and sneezing), so avoiding people who are sick and washing hands frequently are important steps to prevention. It is important for parents to be aware of the illness and seek medical care should their children develop wheezing.

There are currently no published reports of activity in Texas, but if you have recently traveled to any of the affected states, it is important to be aware and let your pediatrician know if your child develops respiratory symptoms. As always, we will continue to monitor the situation and provide updates when new information is available.

Marc Mazade, an Infectious Disease specialist at Cook Children’s, first heard about Middle East Respiratory Syndrome (MERS) at a presentation last year.

While Dr. Mazade says the attack rate of MERS seems low compared to other respiratory illnesses, he does advise certain precautions if traveling overseas.

“Returning travelers who develop signs of illness should discuss with their healthcare provider their full travel itinerary, exposures they may have noted during travel, and activities in which they participated while traveling,” Dr. Mazade said. “For a physician, the key to a prompt diagnosis of any potentially serious disease like MERS is making the connection that a patient or family has traveled recently to the Arabian Peninsula or other area where an outbreak has been documented.”

The CDC reports “most MERS-CoV cases have been reported in adults (median age approximately 50 years, male predominance), although children and adults of all ages have been infected.” Pediatric Infectious Disease Journal said that severe disease can occur in children with underlying conditions.

First, Dr. Mazade suggests those who are traveling from the U.S. to other countries to always check the CDC website for health-related travel advisories before making travel plans. Six to eight weeks before visiting overseas, Dr. Mazade advises people to receive a travel clinic consultation from their physicians.For more information, read the CDC's tips on traveling smart.

Dr Mazade said a travel clinic consultation will help determine if travel vaccines or malaria prophylaxis are necessary, as well as provide:

• An opportunity to receive counselling about other health risks a traveler might face.
• Whether to buy travel insurance or not.
• How to register a travel itinerary with the State Department to get a replacement passport in the event that one is lost or stolen.
• What items to take and what to avoid. 

“We consider fever in a returning traveler to be a serious concern and encourage travelers to stay in touch with their physician about any health problems occurring after traveling,” Dr.  Mazade said. “Visiting other countries can be exciting. Staying healthy and being aware of risks when traveling will keep the memories pleasant.”

The Centers for Disease Control and Prevention has reported the first case in the United States of MERS to be transmitted from one person to another.

The CDC states, the first U.S. Case of MERS was confirmed on May 2, 2014, after someone traveled from Saudia Arabia to the U.S. On May 11, 2014, a second U.S. “imported case” occurred, again from Saudia Arabia. The third case came as a direct result of an Illinois resident who had contact with the first case.

According to the CDC, Middle East Respiratory Syndrome (MERS) is a viral respiratory illness first reported in Saudi Arabia in 2012. It is caused by a coronavirus called MERS-CoV. 

The CDC says MERS “represents a very low risk to the general public in this country,” but will continue to monitor the situation and provide recommendations as necessary. At this time, no vaccine against MERS exists.

Donald Murphey, M.D., medical director of Infectious Disease at Cook Children’s, worries over the fact that diseases like measles and pertussis are once again in the news.

“It’s alarming to see the rise in these diseases that were so common prior to the advent of effective vaccines, but largely disappeared with immunization,” Dr. Murphey said. “It’s frustrating too because we have safe vaccines that prevent these diseases. The solution is for kids, teens, and adults to get immunized.”

Measles is a highly, dangerous, but preventable disease with vaccinations.

The CDC report says that many of the cases are from people who visited other countries. Of the 129 cases reported by the CDC, 34 were “importations” from other countries. The Philippines has seen 20,000 confirmed or suspected cases of measles cases from Jan. 1 to Feb. 28 and 69 confirmed deaths.

But why is this happening? “The increase in importations from this outbreak and subsequent transmission in certain settings in the United States highlights the importance of ensuring age-appropriate vaccination for persons traveling to areas where measles is endemic and maintaining high vaccination coverage at the national and local level,” The CDC report states.

Parents can make an important step in preventing their children from catching measles through the use of two doses of the MMR vaccine.

“We thought we were on our way to eradicating these diseases,” Dr. Murphey said. “Our goal was that these diseases would be completely controlled by the year 2015. But misinformation and fear about immunization has prevented that from happening. It’s a very sad situation because children suffer, but it can be much worse if segments of the population refuse to receive their vaccines.

Measles is particularly contagious. Transmission is by coughing, sneezing or simply being next to someone laughing. It’s that easy.

Dr. Murphey said what’s particularly frustrating is that these diseases can be contained and even eliminated if we do our part. MMR vaccination remains the most effective way to prevent outbreaks. In children, the first MMR vaccine dose is usually administered at 12-15 months and the second at 4-6 years.  However, the MMR vaccine is recommended for children as young as 6 months old when they are traveling abroad. Children under 12 months of age and traveling internationally should receive 2 doses of MMR, separated by at least 28 days

All college students, international travelers, and health care personnel should receive two doses of MMR vaccine, unless they have other evidence of measles immunity.

“I can’t stress enough if you are traveling abroad, the importance of making sure you are updated on your immunization,” Dr. Murphey said. “This holds true for pregnant women, infants, kids, teens and adults. We all have to do our part and have our shots updated to keep each other healthy.”

But Aaron’s latest role is that of a young man whose weight has become such an issue, weighing in at 550 pounds, he was recently asked to leave a plane because he took up two seats.

“As I saw the seats, I’m literally hoping that no one had to sit next to me because I knew it wasn’t going to work if they did,” Aaron told NBC News.

The Centers for Disease Control and Prevention (CDC) report that Aaron’s struggles with his weight aren’t as unusual as you might expect. The CDC says that more than one third of kids and adolescents in the U.S. are overweight or obese. In addition to facing isolation and embarrassment, potentially continuing into adulthood, these children are at increased risk for numerous health ailments. Endowed Chair of Cardiovascular Health and Risk Prevention at Cook Children’s Don Wilson, M.D., warns, “most children with risk factors for cardiovascular disease will have them as an adult; being overweight or obese often results in weight related to health risks such as diabetes, high blood pressure, injury to bones and joints, disturbed sleep, fatty liver disease, abnormal blood fats and isolation and depression.”

To help children avoid problems caused by obesity in their adult life, parents have a responsibility to address concerns early. According to Wilson, “it is important to determine what, if any, cardiovascular risk factors your child may have, and begin working with your health care team in finding safe and effective long term solutions. Small changes at a young age can make a big difference in making sure your child has a healthy future.”

Becoming overweight or obese can happen to anyone; some factors can be controlled, while others are inevitable. One can’t control being predisposed to developing high blood pressure, having abnormal blood fats or family members with diabetes, for example, but there are always opportunities to improve one’s health, make lifestyle changes and develop a plan of action to reach a healthy weight.

Since children’s bodies are still growing, it can be difficult to identify when weight gain reaches a level of concern. Dr. Wilson suggests the following guidelines: “Is often difficult to simply look at a child and tell they are developing an unhealthy weight. That's why it's important that you calculate your child’s body mass index (BMI); there are several calculators available on-line. A BMI above the 85th percentile for age/sex is considered overweight, above the 95^th percentile is considered obese and over the 99^th percentile is regarded as morbidly obese.” The first step is to identify patterns that may indicate a problem; regardless of BMI, be sure your child is not gaining excessive amounts of weight each week or month and alert your doctor to any sudden changes. Bring up concerns during your child's health checkup and ask for guidance.

A common misconception is that poor diet and exercise is the only culprit for childhood obesity. These factors indeed have an impact in many cases, but an overweight child should never be blamed or labeled as “lazy,” as there are many other elements that can contribute to unhealthy weight gain. Be sure to rule out health-related causes while you are developing an appropriate weight-loss plan. Just as with adults, encouraging and motivating kids to lose weight can be a touchy issue. Parents often have the biggest influence to help their children become better informed about healthier food choices and the benefits of daily exercise. Wilson says, “As a concerned parent, you can help set realistic goals for weight, food and activities, talk about your child's food in terms of preference, preparation and portion size, increase physical activities for the entire family, discourage smoking and avoid smoking yourself and make healthy living a family affair.  Perhaps the most important thing you can do is to be a good role model for your child.

Aaron is using the uncomfortable experience of being kicked off his flight as motivation to speed up his weight loss plans. Remember, if you child’s BMI rises above the 85^th percentile or their weight gain is excessive (i.e. crossing percentiles on the CDC’s growth chart) be sure to discuss any underlying causes with your doctor and work with your family to develop healthy lifestyle patterns early on. Your child’s future depends on it.

For more information and to determine your child’s BMI, try using the American Academy of Pediatrics’ and Centers for Disease Control and Protection’s BMI calculators.