Marc Mazade, M.D., Cook Children’s medical director of Infection Prevention and Control, encourages anyone who has not received the vaccine to do so. Vaccinations not only protect you, but also help limit the spread to others.

As of March 14, the Texas Department of State Health Services reported 259 cases of measles in Texas.

“I'm worried. It's a real dangerous situation right now,” Dr. Mazade said.  “There are lots of people who are eligible to receive the vaccine and haven't. There are areas where vaccine uptake has been really poor and it is likely to rip through these communities like wildfire, like it did in West Texas.”

The best way to prevent getting and spreading the virus is to get the measles, mumps and rubella (MMR) vaccine. We talked with Dr. Mazade about what makes this vaccine effective, who can get it and why vaccination is important.

Measles is one of the most contagious diseases humans have faced. Descriptions of the disease date back to at least the 9th century, according to the World Health Organization (WHO), and became more widespread in the 16th century. Prior to the vaccine, the Centers for Disease Control and Prevention (CDC) estimates three to four million people became infected per year, and 400 to 500 died.

Before the measles vaccine, which became available in its current form in 1968, most everyone got measles, Dr. Mazade said. While measles can be mild, it is “pretty miserable.” The virus can cause a fever from 104 to 106 degrees, congestion, cough and a red rash that spreads across the body. Complications from the measles are not uncommon, including ear infections and pneumonia. As of March 14, one child has died from the current measles outbreak.

“People don’t understand how dangerous it is and how dangerous vaccine preventable diseases are,” Dr. Mazade said. “It can be really serious for people who are pregnant, people with immunodeficiencies and people who are on immunosuppressants that would make them more susceptible.”

Herd Immunity

The current measles outbreak shows just how contagious it is.

In general, measles has not been transmitted within the U.S. for years due to herd immunity.

Herd immunity is the idea that when enough people are vaccinated against a disease, it is much harder for the disease to spread. Herd immunity for measles is reached when 90% of a population is vaccinated, Dr. Mazade said.

Imagine a group of 100 people spread out across a room. Ninety of them have been vaccinated and cannot get or give anyone else measles. One person in the room brings in the virus.

Perhaps the people nearby are all vaccinated; the virus will likely not spread or will only spread to a few people.  But if only half of the people are vaccinated, the infected person is likely standing near at least one other unvaccinated person. The disease can spread through the community, and can do so at an increasing rate.

With measles, face-to-face contact is not required to contract the disease, Dr. Mazade said. The infectious aerosol that is created when someone with measles coughs or sneezes fills the entire air space and even lingers in the air for up to two hours after a person with measles leaves the area. To go off of the room metaphor, measles can spread throughout a space quickly and endanger more people.

For years, the U.S. was like the first room. Sometimes, an unvaccinated person would travel abroad and bring back measles, but it was not able to spread due to herd immunity. In 2000, the U.S. documented zero cases of measles, and the virus was declared eliminated from the United States.

About 92 to 94% of a population needs to be vaccinated in order to achieve herd immunity for measles, according to the American Academy of Pediatrics. The current outbreak is due to that vaccination percentage dropping, Dr. Mazade said. Over the past few years, fewer and fewer people received the MMR vaccine.

Misinformation about vaccines has contributed to that decrease. Mazade encouraged people to seek direct sources for accurate vaccine information. The CDC, WHO and Cook Children’s vaccine resource page are good places to find accurate information.

Asking your doctor directly may be the best way to get information on your vaccine questions.

 “Trust your doctor,” Dr. Mazade said. “He or she is the best source of information about vaccines and vaccine safety.”

Getting Vaccinated

Fortunately, future measles outbreaks are preventable.

The MMR vaccine is safe and available for unvaccinated adults to receive -- and it is extremely effective. The first dose grants about 93% immunity and the second, and final, dose grants 97% immunity. This means that 97 out of 100 vaccinated people exposed to measles will not become sick.

The measles vaccine can be administered to children who are 12 months old and is part of the recommended vaccine schedule that the CDC recommends. If you did not get the vaccine as a child -- or are not sure if you did -- talk to your doctor.

Some people may want their children to get the vaccine early due to the outbreak. As of now, this is not recommended by our local health department. Babies who are younger than six months will likely not respond to the vaccine and not achieve immunity, Dr. Mazade said. Even if the baby has been exposed to measles, the vaccine is not recommended at this age. Dr. Mazade recommends talking to your doctor if you have concerns about measles exposure.

Even if this outbreak slows down, it is still important to get vaccinated.

“If people who are fully eligible are not fully vaccinated, we will be in the spot time and time again,” Dr. Mazade said. “Until we have a huge outbreak with lots of sick people."

Vaccinations and immunizations

Here are a few resources and tips for finding a place to take your child for immunizations. 

• Check with your child’s doctor. Ask which vaccines are due and make an appointment. If your child needs a doctor, see our locations or call 211 for help. 
• Visit a public health vaccine clinic. Anyone from any county can call Tarrant County Public Health at 817-248-6299 to make an appointment or to find a walk-in clinic. 
• Check with your local school district for vaccine events. 
• Enter your zip code at Vaccines.gov to find other options. 
   

This is an ever-evolving situation. As information changes, we will update you here and on our website at cookchildrens.org.

For a downloadable flyer, click here. 

The measles outbreak in Texas has reached nearly 150 cases, according to the state health department. Twenty of those patients have been hospitalized, and one school-aged child has died. 

There have been no confirmed cases across Cook Children’s Medical Centers in Fort Worth and Prosper. 

We know questions about measles are at the top of every parent’s mind. To provide the most up-to-date information, we’ve compiled and answered some of our most frequently asked questions (FAQs). 

1. What is measles? 
Measles is a viral infection caused by rubeola virus (which is not the same as rubella), that causes a fever, rash, cough, runny nose, and red eyes. Ear infection, diarrhea, pneumonia and—in rare cases—brain damage, and even death can occur.

The virus is very small, which makes it more contagious. It is in the air in a room with an infected patient and remains in the air for another two hours after that patient leaves.

2. How contagious is it? 
Measles has a contagiousness rate of 90%, making it one of the world’s most contagious diseases for the unvaccinated. This means that if ten unvaccinated children are in a room and one of them has measles, nine out of ten of them will likely catch the virus. 

3. How long after exposure will someone get sick if they have measles? 
Measles has an incubation period (the amount of time between exposure and symptoms) of seven to 21 days.

4. When can a person spread the measles virus? 
A person with measles can spread the virus to others for nine days, starting four days before the rash appears, the day the rash appears and ending after the rash has been present for four days.

5. What are the symptoms? 
Measles symptoms typically appear seven to 14 days after infection. They can include: 

• Fever, sometimes over 104º Fahrenheit or 40 º Celsius 
• Runny nose 
• Cough 
• Red, watery eyes 
• Sore throat 
• Tiredness

Typically, ten days after exposure is when a person will develop a fever, cough and runny nose. Some people may have conjunctivitis (eye infection) that looks like pink eye and develop a sensitivity to light. Tiny white spots known as Koplik spots may appear inside the mouth two to three days after symptoms begin. After about four days, the fever may go down, but the second phase of measles will likely begin.

The red rash is the most well-known sign of measles. A measles rash typically starts three to five days after symptoms first begin. It usually begins on the scalp behind the ears or at the hairline. The rash can spread down the face, body and all the way to the feet. It is not itchy but is uncomfortable and painful. Once the rash sets in, the fever might come back.

Gastrointestinal symptoms, vomiting, diarrhea and severe abdominal pain are also possible.

While rare, internal issues can start at this point. As coughing and respiratory symptoms pick up, about 1 in 20 children with measles may develop pneumonia. This can lead to inflammation in the lungs that can only be treated with oxygen.

6. What do I do if I think my child has measles? 
Call your child's pediatrician or your primary care physician or medical provider if you or your child have been exposed to measles or are showing symptoms. Follow your providers’ instructions.

Consider making an appointment instead of seeking emergency care unless your child is in respiratory distress (wheezing, severe breathing problems), is unresponsive or showing other acute signs of distress.

Parents or guardians should call the primary care doctor before arriving at a doctor’s office so arrangements can be made to minimize potential exposure in the waiting room.

If you make an appointment at a Cook Children’s facility, do not come into the waiting room. A medical provider will meet you to take you to a room. This is to mitigate the spread of the virus. The facility will do a nasal or throat swab test. They may also do a blood test.

7. Where have people tested positive for measles? 
As of Feb. 28, the Texas Department of State Health Services said cases have been confirmed in the South Plains and Panhandles regions of Texas in the following counties: Dallam, Dawson, Ector, Gaines, Lubbock, Lynn, Terry, Martin and Yoakum. On Feb. 26, Rockwall County officials said they also had a confirmed measles case. 

As of Feb. 28, 146 cases have been identified since late January. Forty-six cases are in children zero to four years old, 70 are in children five to seventeen and 25 cases are in people over the age of 18. Five cases do not have the age confirmed yet. Five of the cases are vaccinated. The rest are unvaccinated, or their vaccination status is unknown. 

Twenty of the patients have been hospitalized. One child has died from measles in Lubbock. 

8. Am I and my child safe from measles if we have been vaccinated? 
You are very likely protected.

Vaccinations provide the strongest available protection against measles. The first MMR vaccine is typically given to kids at 12 months, with a booster at 4 years old. People who receive MMR vaccination according to the U.S. vaccination schedule are usually considered protected for life against measles and rubella with 97% immunity, according to the Centers for Disease Control and Prevention (CDC).

However, if you were vaccinated before 1968, you may need a booster because vaccines during that time period were less effective, according to the CDC. A small number of vaccinated people can occasionally develop measles. In these cases, the symptoms are generally milder, and they are less likely to spread the disease to other people.

9. Can my child receive the vaccine early? 
The first MMR vaccine is typically given to kids at 12 months, with a booster at 4 years old. Reach out to your doctor with questions about early vaccination. Children traveling outside the country may be able to receive the vaccine earlier than 12 months.

10. If I or my child hasn’t been vaccinated, can we still get the vaccination? 
Yes. Children over the age of 12 months can receive their first vaccination. People who were not vaccinated as children can be vaccinated any time unless you are pregnant.

11. How long does the vaccine take to be effective? 
Detectable antibodies generally appear within just a few days after vaccination. People are usually fully protected after about two or three weeks.

12. Should I also have my child tested, or should I get tested?
Contact your child's pediatrician or your primary care physician to determine if you need testing. 

13. Can I order a test myself? 
Tests have to be ordered from the Texas Department of Health and Human Services. Go to the website for more information or contact their lab via email at labinfo@dshs.texas.gov or Phone at 512-776-7318. 

We anticipate updates regarding community testing options from our local public health departments in the near future. Stay tuned.

14. What is the test? 
Tests come in various forms; nasopharyngeal swabs, throat swabs and oral swabs. There are also blood tests for some patients. 

15. How long do test results take? 
Test results typically take anywhere from two to seven days. 

16. What is the treatment for measles? 
There is no specific treatment for measles, just like most other viruses. Supportive care and close observation is very important including: 

• Making sure your child is drinking plenty of water to stay hydrated 
• Controlling fever with Tylenol or Motrin (Do not use Motrin in children less than 6 months of age).
   

17. Should we quarantine while awaiting test results? 
Yes. All exposed members of the household should stay home and away from others while waiting for the results of the measles test. If your child tests positive, they should stay home and have no outside contact. If you have been fully vaccinated, your likelihood of spreading measles is low, but consider limiting your exposure to others as well. If you are not vaccinated, you should stay away from settings where there are susceptible people (such as schools, hospitals, or childcare) until your healthcare provider says it's okay to return. This will help ensure that you do not spread it to others.

18. What do I do if I or my child tests positive for measles? 
Continue isolation at home for four days after the rash appears or until directed by your physician.

If you think your child needs to be seen, please call ahead so we can prepare and see your child safely.

19. What are possible complications from measles? 
Measles can be serious in all age groups. However, there are several groups that are more likely to suffer from measles complications: 

• Children younger than 5 years of age 
• Adults older than 20 years of age 
• Pregnant women 
• People with weakened immune systems, such as from leukemia or HIV infection 
   

Ear infections: 1 out of every 10 kids develops an ear infection. Call your doctor if your child complains of ear pain 

Diarrhea: 1 out of every 10 has diarrhea. Make sure your child is getting plenty of fluids. 

Pneumonia: 1 out of every 20 will develop pneumonia. Watch for cough or rapid breathing 

Brain swelling: Very rarely children with measles can develop acute disseminated encephalitis, where the virus gets into the brain tissue and spinal fluid and causes brain swelling. This can cause seizures, paralysis, hearing damage, comas or death. 

20. How does measles spread? 
Measles lives in the nose and throat mucus of an infected person. It can spread to other through coughing and sneezing.

Measles can be spread through air droplets when an infected person coughs or sneezes. You can get measles just by being in a room where a person with measles has been for up to 2 hours after that person has left.

Measles can also spread through infected surfaces.

21. What can we do to prevent the spread of measles? 
The most effective prevention against measles is vaccination.

Aside from getting vaccinated, the spread of measles can be mitigated by proper handwashing, covering your mouth and nose when you cough or sneeze, avoid sharing drinks or eating utensils and disinfect frequently touched surfaces.

22. Why is a measles outbreak happening? 
Measles was declared eliminated from the United States in 2000. However, measles immunization has been on the decline in recent years due to several factors like missed doctor visits during the pandemic, parental concerns about vaccines and vaccine misinformation. 

Measles is also still common in many parts of the world. Most recent cases of measles in the United States stemmed from travelers who are not vaccinated bringing measles back to the U.S. This, combined with a decline in immunization, can cause a disease resurgence. 
 

Cook Children’s Medical Center has completed its new infectious diseases critical care unit (CCU), meeting the need for a clinical facility dedicated to the treatment of patients with contagious illnesses.

The expansion ensures children with highly infectious diseases will be treated in the safest environment possible. The unit’s design and technology allow for the treatment of the sickest patients while also protecting Cook Children’s staff and the community from the spread of illness.

While the need for the unit first appeared on Cook Children’s radar several years ago when Ebola made its way to U.S. shores, the COVID-19 pandemic shined a light on its importance once again.

“COVID-19 overwhelmed us and we had a hospital full of kids with COVID during the Omicron surge,” said Marc Mazade, M.D., medical director of infection control and prevention at Cook Children’s. “But we only saw a modest number of kids with COVID-19 who really needed care in the pediatric intensive care unit (PICU), and most of them graduated out of the PICU pretty quickly in comparison to the much sicker adolescents with severe lung manifestations that we saw with the first two waves of COVID. We have to be prepared to deal with whatever comes and this new unit will help us to do that.”

The overall expansion for the preparedness of current and future pandemics includes the new six-bed infectious diseases CCU and a 24-hour solutions center with dedicated incident command space. In addition, a new 32-bed medical-surgical unit was added to expand Cook Children’s ability to meet the hospitalization needs of the growing communities it serves.

“I work for a system that pursues whatever is needed to improve a child’s health or save a child’s life,” said Mary Suzanne Whitworth, M.D., medical director of infectious diseases at Cook Children’s. “This new infectious diseases CCU is that next great opportunity and we are all thrilled to be a part of it.”

The pandemic showed us all how important it is to feel close to your family members, even if you can't be in the same room. In September 2020, a Cook Children's dad went viral for dancing in the parking lot during his son's cancer treatments. Due to the COVID-19 restrictions at the time, only one parent or caregiver could attend appointments with patients. 

These new infectious disease critical care units will make seeing family much easier with Virtual Connect – think FaceTime but for hospital rooms. Doctors and clinicians will also be able to visit with patients through Virtual Connect.

This will allow all “dancing dads” to connect with their child if they can't physically be at the Cook Children's Medical Center.

Family-Centered Safety

Since the start of the pandemic, much has been learned about how to maintain safety for staff and guests and expertly care for infectious disease patients now and in the future.

These best practices and protocols are standard design in the infectious diseases units, which feature specialized air ventilation systems, dedicated areas to put on and take off personal protective equipment (PPE), and technology that allows clinicians to closely monitor a patient without having to be directly at the bedside and other heightened protection measures to contain disease spread.

“These units will be used in an effort to place potentially contagious patients in one area,” Dr. Whitworth said. “The goal is to have everybody in one unit with every employee in that specific unit dedicated to being experts in proper PPE donning and doffing, patient and visitor flow and all of the aspects of interrupting the spread of an infectious disease.”

Maintaining a family-centered and supported environment also influenced the design of the new infectious diseases CCU. The decision to limit visitors to Cook Children’s Medical Center during the pandemic was a difficult one for everyone. While Cook Children’s patients have always been allowed at least one family member at their bedside during the outbreak, the spread of the virus demanded that administrators take steps to protect employees and vulnerable patients by restricting the visitation of others within the family unit.

“Segregating families is not who we are as an organization,” said Stan Davis, chief operating officer at Cook Children’s Medical Center. “We promote that when a child is sick and in our hospital, they need family at their bedside to help with treatment and healing. This unit allows our staff to feel comfortable that they’re in the right environment and have the right precautions to be comfortable treating patients, and it allows our community to understand that in addition to having the best nurses, therapists and support folks in the world, we have the right environment to keep families together.”

Each of the new infectious diseases CCU rooms will have a private bathroom, an accommodation not available in the previous critical care space used for contagious patients. This allows parents to stay in the room with their child as long as they would like and reduces the in and out traffic of a parent who may have the same illness as the child due to exposure. Dedicated entrances and exits to these units for staff and visitors will help protect the general hospital environment.

“It’s our responsibility to re-too in order to deal with situations and illnesses such as the re-emergence of SARS which resulted in lots of health care worker deaths in Canada, for COVID-19 variants already circulating, for Middle East respiratory syndrome (MERS), for avian flu, for new and old world hemorrhagic fever viruses, or for bioterrorism-related infections like anthrax,” Dr. Mazade said. “We’re excited to have the facility to do that better than ever.”

To open up space for the infectious diseases CCU, the Cook Children’s simulation lab was relocated. The simulation lab is an educational space where staff practice using new technologies, innovations and research. Last year, Cook Children’s was the first freestanding children’s hospital in the world to receive full accreditation through the Society for Simulation in Healthcare. The relocated lab allows for the future expansion and growth of this program.

System-Wide Solutions

The design of the new 24-hour solutions center was inspired by lessons learned about system-wide coordination and cooperation throughout the pandemic. Members of all 14 of Cook Children’s Health Care System’s entities worked together in the medical center’s incident command center to coordinate a consistent response to COVID-19 across the entire organization. This consolidation and cooperation allowed Cook Children’s to be nimble, flexible and quick to the ever-changing environment.

The new solutions center will operate year-round under the same premise of consolidation, coordination and consistency. It will be a one-stop shop for staff and guests of any one of Cook Children’s entities to report or request assistance with a facility or operations issue.

“The solutions center will be a single touch point for staff, patients and families, in terms of who they contact for assistance with an operations issue at one of our facilities,” Davis said. “The consolidation that will occur is that there will be a joint information system—a communication hub, if you will—that everyone in the system uses, and the issue will be triaged and assigned from there. It’s similar to what you see with a technology help desk.”

Inside the solutions center is a dedicated incident command center equipped with meeting space that accommodates proper social distancing protocols and communication technology that supports real-time global health updates for rapid, informed decision-making. This is a much-needed upgrade from the classroom that doubled as an incident command center during the height of the pandemic.

“We’ve learned with COVID-19 that hospitals can become overwhelmed rapidly,” Dr. Mazade said. “Planning for staff shortages, getting supplies, developing protocols, and getting our teams the most up-to-date information ASAP while combating misinformation is vital to everyone in the organization, to our community partners, and to our community. We need an up-to-date, world-class incident command station built for that.”

Cook Children’s Health Foundation’s Protecting your Tomorrows campaign helped make the expansion and improvements possible. Thanks to the generosity of donors, Cook Children’s is more equipped than ever before to care for children during a pandemic or outbreak of any infectious disease. For more ways to support our patients, staff and families, visit cookchildrenspromise.org. If you’d like to join the Protecting Your Tomorrows fundraising effort, contact Cook Children’s Health Foundation at 682-885-4105.

This campaign will help fund an expansion project that will ensure the precise combination of clinical facilities and operations are in place to treat the sickest children, while best protecting Cook Children’s staff and the community from the spread of infectious diseases.

The expansion will include the construction of a new 6-bed infectious diseases critical care unit (CCU) and a 24-hour solutions center with dedicated incident command space. An existing 20-bed unit will become a dedicated infectious diseases unit for the treatment of non-critical contagious patients such as those hospitalized for flu, COVID-19, respiratory syncytial virus (RSV) and other viruses. A 32-bed medical surgical unit will be added, and the hospital’s simulation lab will be relocated.

“I am beyond excited about the new infectious diseases critical care unit,” Mary Suzanne Whitworth, M.D., medical director of pediatric infectious diseases at Cook Children’s Medical Center, said. “It is humbling to work for a system like Cook Children’s that is always looking for the next thing needed to make pediatric health care better. After spending the last 25 years of my career here I must say, however, that I am not at all surprised that this is in the works. This is a system that never stops rising to the occasion.”

Family-Centered Safety

Since the start of the pandemic, much has been learned about how to maintain safety for staff and guests and expertly care for infectious disease patients now and in the future. These best practices and protocols will be standard design in the infectious diseases units, which will feature specialized air ventilation systems, dedicated areas to put on and take off personal protective equipment (PPE), technology that allows clinicians to closely monitor a patient without having to be directly at the bedside and other heightened protection measures to contain disease spread.

“These units will be used in an effort to place potentially contagious patients in one area,” said Dr. Whitworth. “The goal is to have everybody in one unit with every employee in that specific unit dedicated to being experts in proper PPE donning and doffing, patient and visitor flow and all of the aspects of interrupting the spread of an infectious disease.”

Maintaining a family-centered and supported environment also influenced the design of the new infectious diseases CCU. The decision to limit visitors to Cook Children’s Medical Center during the pandemic was a difficult one for everyone. While Cook Children’s patients have always been allowed at least one family member at their bedside during the outbreak, the spread of the virus demanded that administrators take steps to protect employees and vulnerable patients by restricting the visitation of others within the family unit.

“Segregating families is not who we are as an organization,” said Stan Davis, chief operating officer at Cook Children’s Medical Center. “We promote that when a child is sick and in our hospital, they need family at their bedside to help with treatment and healing. This unit allows our staff to feel comfortable that they’re in the right environment and have the right precautions to be comfortable treating patients, and it allows for our community to understand that in addition to having the best nurses, therapists and support folks in the world, we have the right environment to keep families together.”

Each of the new infectious diseases CCU rooms will have a private bathroom, an accommodation not available in the current critical care space used for contagious patients. This allows parents to stay in the room with their child as long as they would like and reduces the in and out traffic of a parent who may have the same illness as the child due to exposure. Dedicated entrances and exits to these units for staff and visitors will help protect the general hospital environment.

“Re-tooling to deal with the re-emergence of SARS which resulted in lots of health care worker deaths in Canada, for COVID-19 variants already circulating, for Middle East respiratory syndrome (MERS), for avian flu, for new and old world hemorrhagic fever viruses, or for bioterrorism-related infections like anthrax, is our responsibility,” said Marc Mazade, M.D., medical director of Cook Children’s infection prevention and control. “We’re looking forward to having the facility to do that better than ever.”

To open up space for the infectious diseases CCU, the Cook Children’s simulation lab will be relocated. The simulation lab is an educational space where staff practice using new technologies, innovations and research. Last year, Cook Children’s was the first freestanding children’s hospital in the world to receive full accreditation through the Society for Simulation in Healthcare. The relocated lab will allow for future expansion and growth of this program.

A new 32-bed medical surgical unit will be built to gain back beds repurposed for the infectious diseases unit and to expand Cook Children’s ability to meet the hospitalization needs of the growing communities it serves.

System-Wide Solutions

The design of the new 24-hour solutions center was inspired by lessons learned about system-wide coordination and cooperation throughout the pandemic. Members of all 14 of Cook Children’s Health Care System’s entities worked together in the medical center’s incident command center to coordinate a consistent response to COVID-19 across the entire organization. This consolidation and cooperation allowed Cook Children’s to be nimble, flexible and quick to the ever-changing environment.

The new solutions center will operate year-round under the same premise of consolidation, coordination and consistency. It will be a one-stop-shop for staff and guests of any one of Cook Children’s entities to report or request assistance with a facility or operations issue.

“The solutions center will be a single touch point for staff, patients and families in terms of who they contact for assistance with an operations issue at one of our facilities,” Davis said. The consolidation that will occur is that there will be a joint information system—a communication hub, if you will—that everyone in the system uses, and the issue will be triaged and assigned from there. It’s similar to what you see with a technology help desk.”

Inside the solutions center will be a dedicated incident command center equipped with meeting space that accommodates proper social distancing protocols and communication technology that supports real-time global health updates for rapid, informed decision-making. This is a much needed upgrade from the classroom that doubled as an incident command center during the height of the pandemic.

“We’ve learned with COVID-19 that hospitals can become overwhelmed rapidly,” Dr. Mazade said. “Planning for staff shortages, getting supplies, developing protocols, and getting our teams the most up-to-date information ASAP while combating misinformation is vital to everyone in the organization, to our community partners, and to our community. We need an up-to-date, world-class incident command station built for that.”

Construction for this expansion is currently underway and slated to be complete in 12 months. If you’d like to join the Protecting Your Tomorrows fundraising effort, contact Cook Children’s Health Foundation at 682-885-4105.

The Centers for Disease Control and Prevention (CDC) is discouraging trick-or-treating nationwide, calling it a high-risk activity for spreading COVID-19. They’re also dissuading trunk-or-treat events (where treats are distributed from trunks of cars in parking lots), indoor parties and haunted houses.

So why are these Halloween favorites considered high-risk?

“We know outdoor activities are much safer than indoor activities,” said Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cook Children's. “The problem is coming in close contact with people you’re not around regularly, like family members.”

She says masks have been very beneficial in slowing the spread of COVID-19, but warns of a recent rise in cases in Fort Worth and surrounding areas.

“Tarrant County has had an increase in COVID-19 cases over the last couple of weeks, and our positivity rate is hanging around 10% or 11%, which is pretty high,” she said. “The State of Texas is several percentage points below that right now. So now is not a good time to increase face-to-face contact locally.”

As of Oct. 5, 672 people had died of COVID-19 in Tarrant County, and nearly 45,000 others have recovered from the virus. With the current uptick, Dr. Whitworth says maintaining six feet of distance from other people is critically important, regardless of the activity.

“When you talk and exhale, you have droplets come out of your mouth and your nose that you don't see. There are a lot of them and they typically fall within three feet, but not always. You may talk louder or you may cough and they might travel farther. This is why the recommendation is to stay six feet apart” Dr. Whitworth explained. “It is less risky if you're outside because most of those droplets are diffused away and diluted outdoors. Of course, it’s even safer if you can wear a mask.”

In case you’re wondering, she isn’t talking about a Halloween mask. Dr. Whitworth says typical Halloween masks have openings for the mouth and nose, which defeats the purpose of stopping the spread of droplets.

But Halloween doesn’t have to lose all of its magic. Rayne Delgado, program coordinator for the Child Life Zone at Cook Children’s, has suggestions on how to make Halloween fun and safe for children this year.

“There are a lot of things families can do instead of trick-or-treating, like scavenger hunts in the house, family movie night and games.” Rayne said. “Pinterest also has a ton of craft ideas that meet all budgets.”

Here are some specific ideas Rayne shared with us:

Sensory fun

• Make Halloween slime and add googly eyes or critters in it
• Create sensory boxes filled with Halloween candy to find
• Build sensory bins with things like fake spider webbing, dyed-spaghetti noodles, soapy water, black beans, crushed graham crackers, un-popped popcorn, dyed rice, and Halloween trinkets (If age-appropriate)

Cooking activities

• Pumpkin face homemade pizza
• Dessert pizza using Halloween candy
• Carmel apples
• Ice cream cone witches hats
• Mummy hot dogs

Games

• Play Halloween-themed bingo
• Create a family mystery game with a play on Clue.
  • Using different rooms in your house, family members are the characters. Swap weapons for costumes.
  • Try to figure out which family member stole what piece of candy from what room, while wearing which costume. (This can also be done virtually with children and their friends. Switch rooms to each other’s houses.)
• Create an escape room in the house.
  • Start with one envelope that needs to be solved. That leads to another with another puzzle and so on until you find the bucket of trinkets/candy.
• Have a costume contest
  • Find things in the house to play dress up with. Who can be the most creative or silliest?

(We have provided templates in the 'Downloads' section of this article.)

The CDC says 121 cases of E. coli have been reported in 25 states, related to the outbreak tied to romaine lettuce. At the time of this writing, none of them were from Texas. The death occurred in California. No other details were released because of patient privacy laws. There have been 52 hospitalizations and 63 percent of ill people are female, with a median age of 29.

No recalls have taken place.

E. coli (Escherichia coli) are bacteria found in the environment, foods and intestines of people and animals, according to the CDC.

E. coli symptoms include stomach pain/cramps, vomiting and diarrhea (often bloody).

“Most people get better within a week, usually five to seven days,” said Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cook Children’s. “Some infections are very mild, but E. coli can become severe or even life-threatening. The most serious cases can lead to secondary complications with the kidneys that can result in kidney failure, called hemolytic uremic syndrome.”

For now, the CDC advices people to avoid romaine lettuce, unless you can confirm it is not from the Yuma, Ariz. growing region. “Product labels often do not identify growing regions, so, do not eat or buy romaine lettuce if you do not know where it was grown,” the CDC writes.

The warning for eating romaine lettuce includes whole heads and hearts of romaine, chopped romaine, baby romaine, organic romaine and salads and salad mixes containing romaine lettuce. If you do not know if the lettuce in the salad mix is romaine, do not eat it.

Other preventive tips include wash your hands, wash fruits and vegetables, cook meat thoroughly and don’t cook for others if you are feeling ill.

The mosquito was recently trapped in Benbrook, near the southwestern border of Fort Worth, and the test results were confirmed Wednesday Last year, TCPH reported its first WNV positive mosquito sample during the last week of June.

Most children with West Nile virus have only mild, flu-like symptoms that last a few days. Symptoms usually appear within three to 14 days of infection. If you expect your child has West Nile, it’s important to get the child seen by a pediatrician who can evaluate the child appropriately and if necessary refer the child to an Infectious Disease specialist or do the appropriate lab work.  

Parents can take care of themselves and their child by taking a few simple protective measures:

The majority of people (70-80%) who become infected with West Nile virus don’t develop any symptoms.

About 1 in 5 infected people will develop a fever with other symptoms such as headache, body aches, joint pains, vomiting, diarrhea, or rash.  The majority of those with this type of West Nile virus disease recover completely, but fatigue and weakness can last for weeks or months.

Less than 1% of people who are infected will develop a serious neurologic illness such as encephalitis or meningitis (inflammation of the brain or surrounding tissues).

• The symptoms of neurologic illness can include headache, high fever, neck stiffness, disorientation, coma, tremors, seizures, or paralysis.
• People with certain medical conditions, such as cancer, diabetes, hypertension and kidney disease are also at greater risk for serious illness.
• Recovery from severe disease may take several weeks or months. Some of the neurologic effects may be permanent.
• About 10 percent of people who develop neurologic infection due to West Nile virus will die.The elderly are more likely to have complications of West Nile Virus.

Treatment:

• No vaccine or specific antiviral treatments for West Nile virus infection are available.
• Over-the-counter pain relievers can be used to reduce fever and relieve some symptoms
• In severe cases, patients often need to be hospitalized to receive supportive treatment, such as intravenous fluids, pain medication, and nursing care.

Already in 2014, 14 cases of rabies have been seen at Cook Children’s, with 11 dog cases and three skunk exposures. In the years from 2011 to 2013, 168 cases were treated at Cook Children’s, with animals including dogs, cats, bats, rats, cows, ferrets, raccoons, deer and squirrels.

Chris Curtis, clinical coordinator for Infectious Disease at Cook Children’s, has treated her share of kids for rabies through the years. As more kids head outside for the summer, Curtis offers these seven helpful tips to protect them:

1. Rabies is a deadly disease. Spread of the disease occurs when the saliva containing the rabies virus is introduced into an opening on the skin, usually via a bit (or possibly a scratch) of a rabid animal.
2. If you have a suspected animal, whether it’s a stray or a family pet, it should be taken to the vet or animal control for a confinement of 10 days. If the person who has been exposed to the animal is immediately treated with the vaccine and the animal does not show signs of rabies, it will not have to be euthanized.
3. Bats are extremely dangerous. Not all bats have rabies, but most human cases of rabies in the U.S. are caused by bat bites.
4. If you aren’t sure you’ve been bitten, go to the doctor immediately. Bats are tiny and can leave tiny bites or scratches that humans may not even notice, until it’s too late. If you come in close contact with a bat, go to the Emergency department immediately.
5. If bitten, wash the wound with soap and water and seek medical care immediately.
6. Protect your pets and farm animals from rabies by making sure they are vaccinated. Talk to your veterinarian for more information.
7. Cook Children’s is prepared and experienced when it comes to caring for children and rabies. Cook Children’s has been very invested in making sure that the vaccinations are in stock. The caregivers are specialized in treating children, including Child Life specialists who can help the child throughout the process. Adult hospitals may not be equipped to treat pediatric rabies cases.

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.”

"Salmonella infection can cause bloody diarrhea, severe stomach pain, cramping, vomiting and fever," said Mark M. Shelton, M.D., board certified physician with Cook Children's specializing in infectious disease. "It can be very dangerous in infants and toddlers whose immune systems are still developing, and salmonella requires hospitalization once symptoms become life-threatening."

Many parents are unaware of the harm associated with giving live animals as pets for Easter. Watching your child kiss, cuddle or hold an adorable baby chick or bunny makes for a picture-perfect moment, but it can be dangerous to the child and incredibly stressful for the animal, too. It's easy to forget these delightful, tiny creatures will mature in fewer than 90 days and require long-term care and attention.

Once Easter is over, thousands of rabbits are surrendered to animal shelters or rescues, while chickens and ducks are often turned into backyards or fields to tend for themselves. The Humane Society of the United States recommends buying children a toy stuffed animal or chocolate bunny in place of a live animal.

"Holidays such as Easter - along with petting zoos and farm-yard exhibits - expose children to a whole host of dangerous bacteria," Dr. Shelton said. "Children pet the animals then put their hands in their mouths, rub their nose and eyes, and can become infected on contact. There are hundreds of E. coli (Escherichia coli) strains and even potentially deadly bacteria and germs that can cause children severe illness or even permanent damage to the brain or kidneys."

Dr. Shelton recommends parents ensure children wash their hands thoroughly after touching and playing with any animal.

"We don't want to prevent children from enjoying and learning about animals," Dr. Shelton said. "But it is important they stay healthy by taking the proper hygienic measures."