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. 
   

“It takes planning,” explained Suzanne Whitworth, M.D., Division Chief of Pediatric Infectious Diseases.

The unit has six beds and dedicated areas for visitors and staff to put on and take off personal protective equipment (PPE). The rooms also provide a bed for family members and have specialized air ventilation systems. In the negative-air-pressure rooms, air is pulled inward, preventing recirculation.

“We are so grateful to have this unit here primarily because these children will be able to stay with their parents and keep our staff safe,” Dr. Whitworth said.

The unit focuses on keeping children with their parents and avoiding exposure to others. The rooms provide space for two parents or guardians to sleep and a bathroom with a shower.

Dr. Whitworth adds that any medical personnel in the unit will don PPE similar to that used during the pandemic.

“They would wear a gown with long sleeves, gloves, an N95 mask, and eye protections,” said Dr. Whitworth.

Currently, Cook Children’s Medical Centers in Fort Worth and Prosper have not had a measles case.

Dr. Whitworth explains the unit is not new. In 2022, the unit opened although Cook Children’s had discussed the need long before, and the need became more pronounced during the COVID-19 pandemic.

“This unit allows us to have a space where we are always ready for the next thing that comes along,” said Dr. Whitworth.

The unit provides staff with an area for them to shower and change before going home.

System-Wide Solutions

Dr. Whitworth said a meeting was held with Cook Children’s Health Care system stakeholders to ensure a synchronized response in case of a measles outbreak. This includes the medical center in Prosper, primary care and urgent care offices.

The medical center in Prosper also has negative-pressure rooms, which would be used if a child were diagnosed with measles.

Clinics have adopted updated policies for testing, identifying people with measles, and caring for those patients.

“Everything is really full-court press right now for preparation in case we have to do that here, and hopefully we won’t,” Dr. Whitworth said. 

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. 
   

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Measles FAQs: What Parents Need to Know
Measles and Community Health

 Julee Morrow, M.D., a pediatrician at Cook Children’s Harris Parkway, is one of the few current doctors at Cook Children’s who treated patients during that time.

“A majority of the kids that I took care of had to get admitted to the hospital,” Dr. Morrow recalls. “We needed a way to keep them hydrated. We needed a way to keep their oxygen levels up.”

More than 30 years later, Dr. Morrow did not expect to see another outbreak, especially with the availability of the measles, mumps, and rubella (MMR) vaccine.

Cook Children’s has tested patients for the measles; there have been no confirmed cases at its  Fort Worth and Prosper medical centers.

“We are in such a good place from a standpoint of the science and the technology we have now, it can be prevented, ” Dr. Morrow said.

According to the Center for Disease Control and Prevention (CDC), measles was declared eradicated in the United States in 2000.

“We were the only country that didn't have a travel advisory for measles, because our rates were so low, because we had such good vaccination rates,” said Alice Phillips, M.D., Director of Ambulatory Quality and Safety.

The Texas Health and Human Services reported the first measles death on Feb. 26, A school-aged child who was not vaccinated died. The child had been hospitalized in Lubbock and tested positive for measles.

“I feel sad because measles is so easily prevented,” Dr. Morrow explained. “One dose of measles vaccine gives 93%. Two doses give people 97 to 99% immunity.”

As of Feb. 28, the state reported 146 measles cases, mostly in children. Rockwall County reported its first measles case on Feb. 25. Cook Children’s Medical Centers in Fort Worth and Prosper are prepared to treat patients.

Cook Children’s Health Care System is prepared

To prevent potential spread, Cook Children’s Medical Centers, primary care, and urgent care offices ask families to call ahead and inform staff if they believe their child may have measles.

“We will likely be donning all of our personal protective equipment (PPE) to go to the family’s car to screen children before bringing them into the waiting room, so as not to expose any other susceptible patients,” said Dr. Morrow.

If the child is taken into an exam room, the room will be closed for two hours afterward. Families will be provided with a handout on quarantine and measles information. 

Cook Children’s continues to monitor the cases in the state and will revise protocols as necessary.

Thirty-eight years ago, there was no rapid test. Doctors diagnosed patients based on symptoms.

“We now have better testing,” explained Dr. Morrow.

Now, patients are given a nasal or throat swab, similar to the tests used during the COVID-19 pandemic. The sample is sent to a lab. While patients await results, Dr. Morrow said families must quarantine.

“Measles virus is one of the most contagious germs on the planet,” said Dr. Morrow. “It would be very easy to spread it to someone whose immune system is not very strong, like a person who has finished chemotherapy, or has heart or lung problems. It would be very dangerous for a premature baby.”

Dr. Phillips understands that parents may have concerns about the science of vaccines and encourages them to discuss these concerns with their pediatricians.

The CDC recommends children get two doses of MMR vaccine, starting with the first dose at 12 - 15 months of age, and the second dose at 4 through 6 years of age.

“We are here to help them, for them to understand the science and to give them the vaccines that their children need,” Dr. Phillips said.

A native Texan, Dr. Morrow urges people to care for one another. The MMR vaccine provides 93% to 95% protection with one dose and 97% effectiveness with two doses.

She encourages families to have a plan in place if they are unable or reluctant to get the vaccine.

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. 
 

It’s a dose of antibodies that works right away to help fight off severe RSV infection for at least five months. Getting the shot in October – just before RSV season -- provides an infant with extra antibodies to build their immunity during the fall and winter months.  

In November 2023, Cook Children’s saw a spike in RSV at our Urgent Care centers and Emergency Departments, the highest volume of cases in recent years.   

“RSV is one of the most common winter viruses. All of us catch RSV in the first couple of years of life," said Mary Suzanne Whitworth, M.D., Medical Director of Pediatric Infectious Diseases at Cook Children’s.

In older children, RSV typically causes cold-like symptoms such as cough and runny nose. But babies under 12 months don’t have fully developed immune systems, Dr. Whitworth said. They tend to get sicker with RSV, a leading cause for wintertime hospitalization in infants.

Severe RSV in infants tends to impact the lungs. Infants should be seen by a doctor if they’re struggling to breathe. If your baby is sick, Dr. Whitworth said, watch for rapid breathing, flared nostrils, airway congestion, wheezing or a rattle you can hear or feel in their chest. Other concerning signs are excessive sleepiness, lack of appetite and trouble feeding.

The Food and Drug Administration (FDA) approved the preventive medication, called nirsevimab, in 2023 after clinical trials showed it reduces the risk of hospitalization for RSV by 75%.

Every infant under age 1 needs the medication ahead of RSV season, Dr. Whitworth said. Some older babies need the shot too if they have certain underlying health conditions. Here’s the breakdown. 

Stopping RSV Two Ways

The first option Pfizer's Abrysvo, given during weeks 32-36 of pregnancy.  Maternal antibodies are passed to your baby and protect against RSV for about six months after birth.   

Infants who don’t have maternal antibodies should get a dose of nirsevimab shortly before the RSV season. Infants born from October to March should receive the medication within one week of birth, according to the U.S. Centers for Disease Control and Prevention (CDC).

The CDC also recommends nirsevimab for certain young children shortly before their second RSV season. This higher-risk group includes children who were preemies, or those with chronic lung disease, compromised immune systems or cystic fibrosis.

The injection delivers safe and effective antibodies, Dr. Whitworth said, and the most common side effect is soreness from the needle stick. She encourages parents to ask their baby’s pediatrician for the shot in October, before hospitalizations for RSV start climbing in infants.

“They are going to be exposed to RSV. It is a virus we are exposed to regularly all winter long.” she said. “The immediate benefits of the shot are huge.”

Cook Children’s has the RSV shot available at our seven Neighborhood Health Centers in the Fort Worth area and more than 40 pediatric offices from Aledo to Willow Park.

Additionally, the Tarrant County Health Department is offering this product to infants ages 2 – 8 months with state-funded insurance or no insurance and infants 8 – 19 months with a qualifying diagnosis.   

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A case of measles was confirmed in a pediatric patient last week in Texas, according to Texas Health and Human Services. The last confirmed measles case in Texas was in 2019. Cook Children’s is sharing what parents and caregivers should know.

Measles is highly contagious. It causes severe pneumonia and can cause a progressive form of encephalitis or inflammation of the brain.

Measles spreads through the air when an infected person coughs or sneezes. You can get measles by being in a room where a person with measles has been, even up to two hours after the person has left. An infected person can spread measles to others even before knowing he/she has the disease.

Some of the more common measles symptoms include:

• high fever (may spike to more than 104° F),
• cough
• runny nose
• red, watery eyes (conjunctivitis)
• rash (3-5 days after symptoms begin)

If you think you have measles or may have been exposed, isolate yourself and immediately call your health care provider and your county health department. It is recommended to wear a face mask.

Even children who recover from measles, especially those younger than 2 years old, are still at risk for developing SSPE – delayed brain inflammation – seven to 10 years later.

Two doses of MMR vaccine provide the best protection against measles for your child. The Centers for Disease Control and Prevention recommends that all children receive two doses of the measles-mumps-rubella (MMR) vaccine – one at 12 to 15 months old and another at 4 to 6 years old. One dose is 95% effective against measles and two doses are 97% effective.

People at high risk for severe illness and complications from measles include:

• Infants and children aged <5 years
• Adults aged >20 years
• Pregnant women
• People with compromised immune systems, such as from leukemia and HIV infection

According to the Centers for Disease Control and Prevention, 16 cases of measles have been reported this year as of June 8, 2023. The CDC warned in November 2022 that a record of nearly 40 million children missed a measles vaccine dose, leaving them susceptible to infection.

Protection

The best protection against measles is MMR vaccine. MMR vaccine provides long-lasting protection against all strains of measles.

Here at Cook Children's, we follow the same guidelines that we recommend to our patients and their families.

• Vaccines save lives
• Vaccines are safe
• Vaccines protect those that cannot be vaccinated
• We vaccinate our own children

Nicholas Rister, M.D., of the Cook Children's Infectious Disease team, answers questions about measles and shares what parents and caregivers need to know.

What should I do if my child has only received one dose of the MMR vaccine so far?

If your child has received only a single dose of the MMR vaccine and is >4 years of age, then they are due for a second dose which can help boost their immunity.

In the meantime, the single dose they have gotten should provide substantial protection from severe disease. This is great for their safety but can make how they may present more subtle. While they may still have a fever, cough, red eyes, and a rash, these may be much more subtle or absent. However, they will still be contagious and can infect other children and adults who are non-immune.

If your child is only partially immunized and has some of these symptoms, especially a red rash that starts on the head and spreads downwards, be sure to ask your pediatrician about measles to review if testing is indicated.

How do I know if my child has been exposed to measles?

In many cases, you will not unless you are contacted by the health department. Sometimes an outbreak will occur through schools or daycares, and you will be alerted through these contacts as well. However, if your child or close contacts develop the constellation of symptoms above, be sure to discuss with your physician about the need for monitoring and testing.

How does measles transmission occur?

Measles transmission occurs via person-to-person contact as well as airborne spread. Infectious droplets from the respiratory secretions of a patient with measles can remain airborne for up to two hours. Therefore, the illness may be transmitted in public spaces, even in the absence of person-to-person contact.

Additionally, if someone is exposed to measles and is not immunized, they have a 90% chance of contracting the disease. It is highly contagious without vaccination.

What are the physical signs of measles in children?

The classic findings of measles in addition to fever and rash are cough, pink eye, and a runny nose. These are often prominent. The rash is also unique in that it starts on the head and spreads downward over the body. While other viruses can cause some or all of these symptoms, the constellation should raise the question of measles if there has been a known exposure or if a patient is unimmunized.

Where do measles come from?

Humans are the only natural source of the measles virus. While it could be spread in a laboratory setting, virtually all disease we see is from natural infection between person-to-person and airborne contact.

Information from Cook Children’s and the Centers for Disease Control and Prevention:

• CDC: Top 4 Things Parents Need to Know About Measles
• CDC: Measles
• Go here to view photos of measles from the CDC.
• What to know about vaccines and immunizations | Vaccine fact and fiction | Cook Children’s

Related content on CheckupNewsroom.com:

• Infectious Diseases Doctor Shares Why Measles Vaccination is So Important (checkupnewsroom.com)
• Infant Immunization Week Encourages Babies' First Shots (checkupnewsroom.com)
• Get Immunized for a Healthy School Year (checkupnewsroom.com)

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.

Story by Eline deBruijn Wiggins. Video by Tom Riehm.

Hispanic Heritage Month creates an additional opportunity for us to celebrate the culture and contributions of people who are Hispanic or Latino/a. At Cook Children’s, we see the world through the eyes of children and families, of all races, ethnicities and languages. Let’s hear from a few Latino/a and Hispanic pediatricians and specialists at Cook Children's.

Celina Cepeda, M.D.; Ana Rios, M.D.; Javier Gelvez, M.D.; Roberto Caballero, M.D.; Victoria Talamo, M.D. and Bianka Soria-Olmos, D.O. sat down with us to share their journeys to becoming doctors and to hear their perspectives as Hispanic and Latino/a doctors and specialists.

Did you know?

• In the U.S., Hispanics and Latinos are an underrepresented population in medical and health care professions. Only 5.8% of active physicians are Hispanic or Latino/a in the United States.
• The Hispanic and Latino population is growing and currently makes up approximately 19% of the U.S. population.
• In Tarrant County, 30.2% of the population identified as Hispanic or Latino, according to the 2021 Census.
• National Latino/a Physician Day is Oct. 1, a day to raise awareness about the need for more Latino/a doctors.

Meet 6 of our doctors and specialists

Celina Cepeda, M.D., is a pediatric nephrologist at Cook Children's Prosper. She's from Brownsville, Texas and is bilingual in Spanish and English. She enjoys teaching her patients about the kidneys and staying healthy.

“It really makes me happy when patients are Spanish-speaking only and I can help take care of them and they are appreciative of that,” Dr. Cepeda said. “Because otherwise, it's difficult for them to communicate their needs and what they're hoping to achieve for their children health-wise.”

Ana Rios, M.D., of the Cook Children's Infectious Disease team, grew up in Colombia. She says both of her parents were physicians so she always grew up listening to them talking about how passionate they were about their jobs.

“My older brother was diagnosed with leukemia and my parents were the ones who made the diagnosis,” Dr. Rios said. “That made me feel more passionate about becoming a doctor and pediatrician and helping kids like my brother. Eventually, that's what I did.”

Bianka Soria-Olmos, D.O., serves as our Medical Advisor for Digital Health and a Cook Children's pediatrician in Haslet. She has lived in Fort Worth for most of her life and as a child, she went to Cook Children's as her brother received care here.

“I always said I wanted to become a doctor and that one day I wanted to work at Cook Children's,” Dr. Soria-Olmos said. “I love that I was able to fulfill my childhood dream here. I like that we continue to strive to serve this community in the way it has been changing and do the best for the children.”

Javier Gelvez, M.D., of the Cook Children's Pediatric Intensive Care Unit, is from Colombia and was the youngest of eight children. He has been at Cook Children's for 21 years.

“We can inspire other people to be physicians and as my kids grow up I say this is an opportunity to serve,” Dr. Gelvez said. “This is the beauty of a job where you can serve other people and make a living.”

Roberto Caballero, M.D., of the Cook Children's Pediatric Intensive Care Unit, grew up in Mercedes in the Rio Grande Valley of Texas. At the time, his father was the only doctor in town. People came to their house after hours and on weekends needing help. Dr. Caballero is bilingual and said not many days go by that he doesn't have to communicate with patients in Spanish.

“That inspired me to help others and to value what it means to be available to people in need,” Dr. Caballero said.

Victoria Talamo, M.D., of the Cook Children's Pulmonology team, is from Venezuela. She says she enjoys helping people and was inspired to become a physician just like her dad.

“He was like my hero and he was everything to me,” Dr. Talamo said. “I wanted to grow up and be like him. He would come home late at night and share these amazing stories about his day.”

The global outbreak of monkeypox has raised concern now that at least two children in the United States have been diagnosed with the rare contagious disease.

Increasing cases of the rare monkeypox virus, which causes a rash and flu-like symptoms, prompted the World Health Organization on July 23 to declare monkeypox a public health emergency of international concern. Most reported cases are in males who have sexual contact with other males, according to the Centers for Disease Control and Prevention.

The monkeypox virus spreads when someone touches an infected person or items, including clothing, contaminated with the virus. Transmission primarily occurs through direct contact with lesions, scabs, or body fluids. Prolonged exposure to an infected person’s respiratory secretions can also transmit the virus. 

As of July 26, there were 231 cases reported by the Texas Department of Health and Human Services. The North Texas region accounted for almost half of the statewide total.

The CDC says that there have been 408 cases nationwide in the 16 to 20-year-old range, as of Oct. 5.  In Texas, there have been 16 cases in people under 18 years old.

“At this time, data suggest that gay, bisexual, and other men who have sex with men make up the majority of cases in the current monkeypox outbreak," the CDC said. "However, anyone, regardless of sexual orientation or gender identity, who has been in close, personal contact with someone who has monkeypox is at risk.”

However, young children are still at risk. The two known positive cases in children in the United States involve a toddler in California and an infant in Washington, D.C. Children under age 8 are among those most at risk for serious illness or death from monkeypox, according to the CDC. 

The CDC says monkeypox rash can be confused with other rash illnesses commonly considered in children, including chickenpox; hand, foot, and mouth disease; measles; scabies; allergy rashes; and adverse reactions to medication.

“Most cases of monkeypox resolve spontaneously and both adults and children can be safely quarantined at home," said Nicholas Rister, M.D., of the Cook Children's Infectious Disease team. "However, if you are concerned that your child may have come into contact with a monkeypox case or is developing symptoms, be sure to discuss this with your child’s provider to determine if additional testing or treatment is indicated.”

Frequently Asked Questions 

What is monkeypox?

Monkeypox is an infectious zoonotic disease caused by a virus related to smallpox. Symptoms are similar to smallpox symptoms, but usually milder and lasting two to four weeks.

How does it spread?

• Direct contact with the infectious rash, scabs or body fluids
• Contact with clothing, linens, eating utensils or items that previously touched the infectious rash
• Respiratory secretions from prolonged up-close contact with an infected person
• Eating the meat of an infected animal or being scratched or bitten
• In pregnancy, to the fetus through the placenta 

What are the key symptoms?

Fever, malaise, headache, chills, sore throat and cough, and swelling of the lymph nodes are typical initial symptoms. A rash then appears inside the mouth or on the body. The lesions are painful and fill with fluid before eventually scabbing over.  Once all the scabs fall off, a person is no longer contagious. Go here to view CDC photos of the monkeypox rash.

What happens next in suspected cases?

Monkeypox should be considered as a possible diagnosis if doctors identify a rash in patients who recently traveled to central or west African countries or other areas reporting a monkeypox outbreak. Testing can confirm the diagnosis.

The patient should isolate at home to limit transmission. Treatment is rarely necessary.

For more information:

Monkeypox | Poxvirus | CDC

Prevention | Monkeypox | Poxvirus | CDC

Monkeypox | Home (texas.gov)

“It started as a normal sickness. It was a fever, she looked pale and she was very tired and all she wanted to do was sleep,” Salazar said.

Natalie had gone to her pediatrician twice and was sent home with the diagnosis of “something viral.” Knowing the little girl was not getting better, Salazar’s family urged her to take Natalie back to the emergency room. That’s where they learned she was severely ill.

The hospital knew Natalie needed a higher level of care, so they called Teddy Bear Transport, which took her via ambulance to Cook Children’s Medical Center. From that point on, her mother knew it would be a long road ahead.

“One of the doctors turned to me and told me, your daughter is very sick and we see inflammation in her heart and she may need to be placed on the heart transplant list,” Salazar said.

Little did Alyssa know, her daughter was suffering from a rare, but serious condition. At Cook Children’s, Natalie tested positive for COVID-19 and her family later learned she had multisystem inflammatory syndrome (MIS-C). Her doctor, infectious diseases pediatrician Marc Mazade, M.D., says he is happy Natalie got to Cook Children’s when she did.

“MIS-C stands for multi inflammatory syndrome associated with COVID-19 and it is a hyper immune response to the COVID-19 virus infection. It usually happens sometime between two and four weeks after the infection and the infection doesn’t have to be symptomatic,” Dr. Mazade said.

Natalie had been exposed to COVID-19 a month before she started showing any symptoms. When Natalie got to Cook Children’s, her blood pressure was low. Her care team gave her fluids and could tell she needed to be admitted to the intensive care unit (ICU). Because Natalie had MIS-C, advanced treatment was required by a team of specialists familiar with the newly-described condition.

After five days at Cook Children’s, Natalie was sent home to recover. Thankfully, she didn’t need a heart transplant, however, her mom says COVID-19 is real and impacts everyone differently. She and her family are living proof.

“It could have ended differently if we didn’t take her in that third time. I feel like she probably could have died. I would have brought her home thinking I was going to be helping her, and the whole time I was going to be watching her die,” Salazar said.

Dr. Mazade hopes this is a teachable moment for all parents.

“If parents see those things developing or they know also know there is a history of COVID-19 infection within a close contact or a family member, then they should be highly suspicious of MIS-C,” Dr. Mazade said.

As Cook Children’s pediatricians, we are getting the forms daily. And the questions that come along with it.

“Can my kids go to summer camp this year?”

“Are we putting ourselves at risk by letting them go?”

While CLEARING your child for summer camp may be straight-forward for us, deciding whether or not they should attend camp this year can be a much more difficult question for families.

“Over time we will know more about the amount of disease in each community and the risk of being in a group setting at camp. At a minimum, camps have to maintain social distancing, wipe surfaces, enforce hand washing frequently, etcetera - and no high-risk children should attend,“ says Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cook Children’s.

Some camps nationwide are choosing to hold smaller sessions, with fewer kids. Many are imposing daily temperature checks. Some are even requiring a camper be tested for the virus before starting. The American Camp Association has recently put out a lengthy guide for camps to help them comply with CDC recommendations.

Obviously, there’s no easy answer here. But here are some things to think about in making your decision (developed in part by the thoughtful physicians at Cook Children's Southwest Harris Parkway office):

1. How healthy is your child? Do they have any chronic health conditions that would put them at an increased risk of significant illness from coronavirus, such as diabetes, asthma or immune deficiency?

2. How healthy are your other household members? Is there anyone who your child has frequent contact with who is elderly or at increased risk of severe illness from coronavirus?

3. How important is this camp to your child? If it is something they feel ambivalent about, it is probably not worth the exposure. If they have been looking forward to it since last year, it may deserve a serious family discussion.

4. What safety measures is the camp taking? Is there a screening process? Are there attempts at some degree of distancing? What happens if someone gets sick during camp? It is very possible, if someone gets sick at the camp, everyone will be sent home. It’s for this reason if you do send your child, it’s best that your family plan to be available for an unexpected pick-up.

5. If your child gets sick at camp, it could potentially mean the child or family would need to be on home quarantine for two weeks. What impact would this have on your household?

As for my family? My kids are young, 4 and 6. We had plans to attend four daytime camps in Fort Worth, for 1-2 weeks each. We canceled those plans. My kids aren’t emotionally tied to the idea of camp, and while they’ll be a little disappointed, we will find other ways to get outdoors, plan some fun projects, and interact with other kids virtually (if you haven’t tried a Zoom dinner date with another chicken-nugget-eating family once a awhile…try it!).

Stay Safe,

Dr. Diane

1. The Centers for Disease Control and Prevention (CDC) is closely monitoring the current outbreak caused by a novel (new) coronavirus first identified in Wuhan, Hubei Province, China.
2. Coronaviruses are a highly contagious type of respiratory virus that will sometimes cause outbreaks in regional areas (if you remember SARS, think along those terms).
3. Human coronaviruses are common throughout the world. The CDC states there are seven different coronaviruses that scientists know of, that can make infect people and make them sick.
4. A current strain of the coronavirus caused hundreds of cases in China. Symptoms typically are runny nose, cough, sore throat and fever.
5. Because the virus replicates and causes high levels of infection in the lungs, it can spread rapidly to a large number of people.
6. Because it’s so new, there’s no specific treatment for coronavirus, but exposed individuals should be monitored for upper respiratory symptoms and worsening breathing problems.
7. For now, most of us in the U.S. are at low risk for coronavirus, but care should be exercised for anyone traveling to or from the impacted areas of China.

We will continue to monitor the CDC and other health organizations. If there’s something new to report, we will be sure to let you know.

*Image Credit: NIAID

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.

Tarrant County Public Health has confirmed a traveler passing through DFW Airport on a May 15, 2019

TCPH wants the traveling public to be aware that exposures may have occurred at DFW Airport on May 15 in the following areas:

• Terminal D customs area from 5:15 to 7:45 p.m.
• The Skylink (i.e., tram between terminals) from 5:45 to 8 p.m.
• Terminal A in the area of gate 8 from 6 to 10:50 p.m.

People who were in the areas listed above are asked to watch for any symptoms until June 5, 2019. Measles is an airborne disease spread by coughing and sneezing. It causes a reddish rash, high fever, cough, runny nose and watery eyes. It usually lasts one to two weeks. The rash begins on the face and head and then proceeds downward and outward to the hands and feet. It fades in the same order it began, from head to feet.

Travelers who are flying internationally or to sites of active outbreaks are advised to follow these guidelines:

• Infants 6 months through 11 months of age should receive one dose of MMR vaccine.
• Children 12 months of age and older should receive two doses of MMR vaccine separated by at least 28 days.
• Adults should be sure they have had at least two doses of MMR vaccine.

Most people born in 1957 or after should have documentation of at least one dose of MMR (Measles, Mumps and Rubella) vaccine or other evidence of immunity to measles. The U.S. Centers for Disease Control and Prevention recommends two doses of the vaccine.

For children, the first dose should be given at 12 months of age and the second between the ages of 4 to 6 years.

“Vaccination is still the most important thing you can do to protect your child against measles. If you have concerns you, or your child, may have the measles or been exposed to the measles, please call your doctor immediately and try not to come in contact with others,” said Justin Smith, a Cook Children’s pediatrician. “The MMR vaccine is safe and very effective at preventing measles. If you or your child has not had the vaccination, please call your doctor to arrange this as soon as possible.”

Click here to read the release from Tarrant County Public Health.

More Resources:

• What Is Measles?
• Vaccines and Immunizations
• Common Questions About Immunizations
• MMR Vaccine
• When It Comes To Your Kids, It's Never Just a Virus

Flu A usually arrives prior to the B strain and is usually more severe than Flu B.

Of the 1,141 children tested last week, 484 tested positive for Flu A, 165 had RSV and none had Flu B.

The good news is that this flu season is currently lower than in previous years.

By this date in 2014-2015, more than 2,100 kids had tested positive at the medical center. By the end of last season, there were more than 3,000 kids who had tested positive.

To date this season, there have been a total of 1,395 positive tests.

Morgan Pence, Ph.D., a clinical microbiologist at Cook Children’s, says we are most likely to have a flu season similar to 2014-2015.

“It’s not clear if this flu season has peaked, but if it hasn’t yet, my guess is that it will peak in the next week or two,” Pence said.

Although the numbers are a bit lower than previously, Cook Children’s pediatricians are prepared to be busy over the next couple of weeks once the holiday break is over and kids return back to the classroom to share their germs with one another.

“We typically see an uptick in flu A a couple of weeks after kids go back to school following the winter break,” said Jason Terk, M.D., a pediatrician at Cook Children’s in Keller.

Dr. Terk stresses that the lower numbers right now may not mean an increase in flu cases in the near future.

"This isn't a guarantee that the total numbers will be lower," Dr. Terk said. "We could still have a later arriving season than we've had in the past and right now we don't know how long the season will last."

Flu Prevention Tips

Along with the vaccine and flu antiviral drugs if prescribed by a doctor, the CDC recommends these everyday preventive actions to stop the spread of germs:

• 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, CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. (Your fever should be gone for 24 hours without the use of a 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 often with soap and water. If soap and water are not 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.

“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 Disease. “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.”

I tell you that not to freak you out, but to let you know how common it is. Most cases are typically mild. When we see sever disease, it's often in immunocompromised patients and those cases are uncommon.

What's important to remember is the children who died in New Jersey were all medically fragile and had weakened immune systems.

I know this kind of news can be scary, so I thought I would take some time to answer a few questions you may have.

What is adenovirus?

For most children, adenovirus causes mild symptoms. Sore throat, pink eye, fever and common cold symptoms are the most frequent. The symptoms are typically similar to but much less severe than influenza and can also be mistaken for strep throat. Like most viruses, the initial symptoms go away on their own in a few days but upper respiratory symptoms such as cough and congestion can last up to two weeks.

There are multiple different types of adenovirus, some cause more severe disease than others. They are all spread by close personal contact and by droplets spread by coughing and sneezing. In addition, adenovirus is pretty resilient and can live on surfaces. It can also continue to be spread by people with weakened immune systems, even after the symptoms have resolved.

Should you be worried?

Because adenovirus is usually a mild illness, most parents don't have to worry about the virus. The situation in New Jersey is a tragic combination of factors that led to this terrible outcome. Multiple children who are medically fragile living in close quarters. In addition the type of adenovirus which affected the children is known to be one that causes more serious disease.

So, what if my child is medically fragile?

If your child lives or will spend time in a group rehabilitation home investigate their cleaning practices. There is little evidence to suggest that this rehabilitation center has made significant mistakes that caused the outbreak, but you can never be too careful.

Otherwise, keep you child away from illness as much as possible. If they are sick with upper respiratory symptoms, monitor them closely for sign of difficulty breathing and seek help quickly

For the rest of us, it's important to remember to keep our kids home when they are sick so that we do not put other children at risk.

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.

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.

For most of the first 20 years of his life, Michael Jankowiak never played ball or even owned a toy. His debilitating cerebral palsy wadded his fingers into a tight fist. He barely moved his hands, except to drive his electric wheel chair.

Then, during a visit to his neurologist, every changed. During a BOTOX® session at Cook Children’s, Fernando Acosta Jr., M.D., a neurologist at the Jane and John Justin Neurosciences Center, told Michael's mother, Lynn, that a surgeon on staff could possibly make a big difference in her son’s life.

Lynn was told Pamela Sherman, M.D., performed surgeries on children with disabilities. 

The original intent of the surgery was to help children clean the palms of their hand and aimed at improving hygiene for patient with significant contractures (the permanent tightening of muscles, tendons ligament or skin that results in a loss of motion in the affected joints).

But the sides effects were, as Lynn puts it, “pretty remarkable.”

Patients who need this surgery often demonstrate limited function with the contracted limb preoperatively. Things such as the ability to trim finger nails, avoid skin breakdown in the palm or elbow and the ease of nursing care with dressing, bathing and transferring to the wheel chair are the focus of surgical intervention. 

"Placing the upper extremity in a more functional position and releasing contractures often has a wonderful added benefit of improving use,” Dr. Sherman said. “Suddenly, the patient with previously limited spontaneous use of their limb has a hand that they are able to use to push a wheelchair control, use a communication board or hold an object.  A little goes a very long way for them.”

For the first time since he was a baby, Michael, who is now 24, opened up his left hand and played with a toy. Michael even held his own glass and brought it to his mouth to take a drink.

“This surgery has given him something new with his life,” Lynn said. “He has never been able to find a toy that he could play with. We took a golf-sized rubber ball. It’s elastic and put a rubber band on it. It looks like it came out of a gum ball machine. But when he’s playing with it, he grins from ear to ear. He can now even hold the ball and drops it for the dogs to play with him.”

After receiving a second surgery on his right hand that summer, Michael could now play on his iPad. He can swipe and select different videos to watch on YouTube.

What may have seemed so routine to most families has been nothing short of a miracle to Lynn because of how far her son has come.

Lynn described her first few months after she learned Michael had cerebral palsy as “fuzzy.” She lived in a terrified blur of emotions and cried for the first year after learning of his diagnosis.

But through her tears Lynn kept her resolve, beginning with one decision – Michael would be transferred from the family home in Abilene to Fort Worth to be treated by Cook Children’s. They then moved to Fort Worth to stay closer to Cook Children’s.

“To see your baby crawling, trying to learn to walk and then all of a sudden he’s not moving, was horrible,” Lynn said. “We insisted he be transferred. If he had not gotten transferred Michael would not be alive. I believe that with all my heart. I would not go anywhere else.”

The first month he stayed in the Pediatric ICU. Since then Michael has been seen by a plethora of specialties at Cook Children’s including Infectious Disease, Neurosciences, the Heart Center, Radiology, Surgery and Rehabilitation Services for issues ranging from pneumonia to cerebral palsy.

Michael stopped moving his extremities at 18 months and was diagnosed at that time.

Mark Shelton, M.D., was the physician on-call the day Michael first arrived at Cook Children’s. Dr. Shelton, a member of the Cook Children’s Physician Network, continues to be Michael’s primary care physician.

“Dr. Shelton, even though he is a specialist, I want him involved in everything,” Lynn said. “I trust him completely. I honestly think Dr. Shelton saved Michael’s life. He’s wonderful and so is his entire staff. He has such wonderful nurses. But all of Cook Children’s has such great nurses.”

Medical Director of Orthopedic Services David Gray, M.D., has also been there for Michael through multiple operative procedures associated with cerebral palsy.

“Dr. Gray is amazing. I remember him when he joined the Cook Children’s staff,” Lynn said. “A few years ago Michael broke his femur. When the ambulance came I told them I wasn’t going anywhere but Cook Children’s. Dr. Gray wasn’t on call that day, but somehow they got in touch with him and Dr. Gray managed to be there when we needed him.”

And now even today, after all this time, Lynn believes Cook Children’s works miracles for her son.

“It’s really the entire system,” Lynn said. “Everybody works so well together. It’s one of those places. I remember how I felt from the first time I walked in at 2 in the morning. It’s just comforting. You knew you were going to be treated well and your child was going to be taken care of by everyone.”

Alani Murrieta, a 20-year-old mother, died only two days after she began feeling ill from the flu, according to the Washington Post. Her young children and other family members had become sick during a long Thanksgiving holiday. While the other family members got better, Murrieta became progressively worse.

She went to a nearby urgent care center where she was prescribed Tamiflu. By the next day, she was coughing uncontrollably and, at one point, she coughed up blood. She was admitted to Banner Estrella Medical Center, where she was diagnosed with pneumonia. Two days after she became ill, Murrieta died.

Her family told CBS News that Murrieta did not get a flu shot, but doctors couldn’t say for sure whether it would have made a difference.

Murrieta was the eighth flu death in the United States this season, according to a Fox News report. Five deaths were reported in North Carolina, two in Oklahoma and then the latest in Arizona. CBS News, citing data from the Centers for Disease Control and Prevention, reports that 7,000 cases of influenza have been confirmed in the U.S., more than double the number this time last year.

“What we do know is the flu vaccine is still the best form of protection we have to fight off getting sick,” said Justin Smith, M.D., a pediatrician at Cook Children’s in Trophy Club. “Even if you do get the flu, people who are vaccinated generally get a milder and less dangerous form of the illness.”

The flu has arrived in Fort Worth. Last week, 33 kids tested positive for the flu at Cook Children’s and 28 of those cases were Flu A, the more severe and dominant strain.

Some experts are predicting a potentially severe influenza season based on what has been seen in other parts of the world. This year, Australia saw record-high amounts of flu cases. The flu vaccine, which is the same one used in the U.S., was only 10 percent effective in preventing Flu A.

“The concern is when people hear that news, they wonder if they should even bother getting the flu vaccine for themselves and for their children,” Dr. Smith said. “We saw some of those comments posted on Cook Children’s Facebook page. The answer is without question, ‘Yes!’ Parents, should take every precaution to protect their children during this time of year and that begins with the flu vaccine.”

Another concern often voiced by parents is the risk of contracting the flu from the vaccine itself.

Mary Suzanne Whitworth, M.D., medical director of Infectious Disease, stresses a person cannot get the flu from the flu shot. They may feel achy for a day or two but that is very different from being in bed with a high fever for a week from a true influenza infection.

“We do know that thousands of deaths nationally are prevented every year by vaccination against the flu,” Mary Suzanne Whitworth, M.D., medical director of Infectious Disease said earlier this week. “It is important to note that although the vaccine has known side effects that are similar to all vaccines given, side effects are mild and uncommon. Serious side effects are very rare.”

Along with getting the flu shot, parents should take the following steps to protect their kids from the illness:

1. Teach your kids to cover their coughs. Remember to cough into the crook of your elbow and not into your hands. And throw away the tissues.
2. Wash your hands. Other than a vaccine, this is the most important thing you can do to protect yourself and your kids from the flu. Teach kids to use soap and wash their hands for at least 20 second or long enough to sing “Happy Birthday.
3.  Kids with the flu are usually sick 3-5 days and then start to improve. If you or your child’s symptoms are worse than you expect or last longer, please call your doctor to discuss.

WHO says the list is an effort to “guide and promote research and development of new antibiotics.”

Antibiotic resistance is growing, according to WHO, which means “we are fast running out of treatment options.”

Mary Suzanne Whitworth, M.D., medical director of Infectious Disease at Cook Children’s, says the best way both the medical community and parents can prevent the spread of these dangerous bacteria is the judicious use of antibiotics.

Some infections in kids require antibiotics for improvement. Some strep throat, urinary tract infections and skin infections will need antibiotics to treat and prevent worsening of the symptoms.

Ear infections don’t always need antibiotics. In older children with less severe disease, a period of waiting can allow the infection to go away without treatment.

Many infections in children are caused by viruses. Colds and sore throats that aren’t strep and many other infections in children simply need a little time and TLC.

“Most viral upper respiratory tract infections start with clear runny nose, maybe fever, and maybe a cough. After a few days the nose drainage is green and then after a few more days it goes away on its own. Antibiotics are not needed for these viral illnesses. The child might have bacterial sinusitis and need antibiotics if the green runny nose lasts for over 7 to 10 or if symptoms worsen after a few days.”

Children can have severe, even life threatening, allergic reactions (even if they have taken that antibiotic before and been fine). Because these are rare, they are not a reason to avoid antibiotics when necessary but they are a reason to use caution when antibiotics are not the right treatment in the first place.

Antibiotics can also cause other side effects, most commonly diarrhea. This diarrhea can last weeks and can be quite severe. If the diarrhea is severe (especially if blood or mucous is present) your doctor might have to consider testing for C. difficile which is a potentially serious infection that can be the result of antibiotic use.

Physicians say they are seeing an increase in the number of infections caused by bacteria that do not respond to the antibiotics we have traditionally used for them.

“This requires us to use stronger antibiotics which can often cause more side effects,” said Justin Smith, M.D., a pediatrician at Cook Children’s. “You can see why people are concerned if we continue along the same path but fast-forward 25 or 50 years. What types of bacteria would emerge? This is why we must use extreme caution.”

Dr. Whitworth adds, “Antibiotics are important and often life-saving. But each time they are used there needs to be a conscious decision made about exactly why they are indicated, what the best choice is for patient compliance, and what the risks and benefits are. They should not be used just because they are expected or requested.”

The problem is these apps simply aren’t for children under any circumstance and can lead to tragic consequences.

On Feb. 11, a 44-year-old Arlington man was arrested of sexually assaulting four students in the Keller ISD.

Reports say the man met the girls through a website called Seeking/Arrangement.com. Other sites parents should be concerned about include Grindr, Tinder and KIK.

“The problem with these message apps is that it’s really hard to find the perpetrators after they use them,” said Jamye Coffman, M.D., pediatrician and medical director for Cook Children’s Advocacy Resource and Evaluation. “That information is difficult to find. So it can be very anonymous. It’s very dangerous for teenagers because they don’t really know who is on the other side.”

With the GPS devices on the apps of these sites, your teenage kid could give a complete stranger the location of your home. They may come into mom and dad’s home without you even knowing it. 

Coffman said that the reason for the bad judgment can be directly related to basic science.

“Teenagers and younger-aged children just aren’t able from a developmental standpoint to really grasp the consequences of what they are doing,” Coffman said. “Their frontal lobe of their brain hasn’t finished developing. Their impulse control is not very good. It’s up to the parents to know what their kids are up to. They have to know what’s on their child’s phone. Parents need to look at their phones and see what apps they’re using and talk to them about it.”

And with kids becoming more tech savvy in elementary school, the need for conversations about predators and sex must begin at an earlier age than ever before.

“The goal is to get them to adulthood, right? Where they can learn and make their own decisions,” Coffman said. “They do have to have natural consequences. That’s the only way they are going to learn. So you do have to let them have some consequences but you don’t want it to be something that’s either life threatening or life altering. As a parent, you can’t allow that to happen. It’s hard as a parent to talk to your kid about sex and the dangers out there. It’s really hard to have those open, non-judgmental conversations. It may be your pediatrician, if you aren’t able to have that conversation. But someone has to talk to them. It’s too important to just ignore the issues facing our kids these days.”

Parents, want to keep your children away from predators? Then be a snoop.

That’s the advice of Dr. Coffman, who is not just talking as an expert in caring for and knowing the signs of abused children, she’s speaking as a mom.

“Parents need to be nosy,” Coffman said. “Your kids may say, ‘It’s my phone.” But you’re paying for it. It’s what I used to tell my kids growing up. If you live in my home, there is no supposition that you are going to have privacy. There is no privacy if I’m paying your bills. I have the right to go in your room. I have the right to look at your phone. I have the right to look in your backpack. I have the right to look in your mattress and in the ceiling tiles and anywhere else you might hide stuff because it’s my house. I think parents are hesitant to take that role. They are so conflicted in what’s Ok and what’s not Ok for their child’s privacy. It’s just a concern for safety. If it’s something that’s a safety issue, you have a right to know.”

Jody Hawkins, Information Security Officer at Cook Children’s, seconds Dr. Coffman’s sentiments regarding privacy of children. In presentations that he gives to parents, Hawkins cautions parents to lay down the rule early.

“This is my phone, on my plan, and I pay the bills,” he said. “If you do not follow my rules, then I stop paying for the phone you are borrowing from me. If I stop paying, the phone stops working. It’s as simple as that.

Hawkins encourages spyware to be installed on children’s phones by the parents. He asks parents, “Would you allow your child to take a stranger into the bathroom, lock the door and have no worries? They usually answer, ‘No.’ I then tell them that if they allow the child to take the phone into the bathroom with no monitoring, they could very well be doing it all the time.”

It’s the world we live in today. If you want to protect your children parents, be a snoop.

A letter was sent to Hebron High School and Hebron 9^th Grade Campus parents to let them know a student had been diagnosed with active tuberculosis. The note stated that “medical officials have informed us there is a very low probability of this student being contagious.”

In Houston, parents of Sugar Grove Academy Middle School were also sent a letter saying a student was suspected of TB, but was recovering. School officials told parents they were monitoring the situation, and would let parents know if their child needed to be tested by Feb. 1.

“Fortunately because the health departments are monitoring the situation, the risk to other students is very low,” said Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cook Children’s. “People in close contact with someone who is contagious for tuberculosis are at highest risk. If the health department determines a teenager at the school is contagious they will notify families and arrange testing of those who may have been exposed.”

When a person who is contagious for tuberculosis coughs, their bacteria is airborne. If another person inhales this bacteria it goes into their lungs. They are at that point considered officially infected with TB. They may or may not ever develop symptoms of TB, but their TB skin test is likely to be positive after this event for life. This doesn't mean they are contagious for life, just that they will always test positive. People who have a positive skin test have to get chest X-rays every year to make sure they don’t have an active disease.

Dr. Whitworth says there’s about a 10 percent chance that the person will become clinically ill sometime during their lifetime with tuberculosis. The risk of becoming ill is much higher and can occur quickly in children under the age of 5 years. This is why a person who has been exposed is tested.

“If the test is positive they are considered officially infected and placed on oral medications to prevent those few bacteria in their lungs from developing into pneumonia or other forms of illness sooner or later in their lifetimes,” Dr. Whitworth said. “It takes a long time for someone to become contagious for TB, typically many years. This is why young children are almost never considered contagious. Even if they are sick with tuberculosis, they do not have a large enough bacteria count in their lungs to spread this to others nearby. “

Tuberculosis typically causes pneumonia with cough, fever, weight loss, night sweats, and chills. It can also cause meningitis, bone infection, and other more rare forms of disease.

The treatment varies from one medication for a child who has infection but is not ill, to several medications for up to a year in others. These are almost always given by mouth. Treatment is monitored by the health department. For ill individuals of any age the medications are delivered directly to the patient every day at home by the health department to make sure every dose is taken.

“When a person is fully treated, they most often have a full recovery, and also very importantly, there is minimal risk that they will ever be contagious to others again,” Dr. Whitworth said. “This is why our country has much less tuberculosis than many others, because we have good health departments who take this seriously.”

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.

What will the new year bring?

Will I be able to keep that New Year's resolution?

And where in the world is the flu?

Ok, you may not be asking yourself that last question. Out of sight out of mind right? Well, not at Cook Children's. Our lab specialists have been diligently testing cases each week for influenza. And for the first time in at least 10 years, they haven't identified a single case so far. Since 2005, the closest we've seen to a season hitting this late was back in 2012 when the first positive case popped up on Dec. 26. But here we are, just two days from 2016 and nothing!

Depending on where you look, outlooks on the impending flu season vary. One model, developed by researchers at Los Alamos National Laboratory, shows the flu season will likely peak in February. WebMD is using data from its online Symptom Checker to predict a spike in cases in early January.

Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cook Children’s, said the flu is unpredictable and she’s not sure why it’s “late.”

“We don’t know when it will start or peak,” Dr. Whitworth said. “We just generally go into each flu season with a wait and see attitude.”

Dr. Whitworth said how severe the flu season will be depends partly on whether or not the flu shot given is a good match to this year’s strains. Previously, in years when the flu shot strains didn’t match, doctors relied more on treatment with antiviral drugs (prescription medication) that fight against the flu in your body.

“For now, we don’t know how serious the flu will be, but for now getting a flu vaccine is still the best way to prevent what can be a potentially serious disease,” Dr. Whitworth said. “By immunizing every year, that’s how we, as a society, build up a community that protect themselves for new strains.”

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 vaccine is only in the beginning stages and part of ongoing research, so it will not be available to the public any time soon. But if a vaccine does become available, it has the potential to be a lifesaver for children across the world.

NBC News reports that a team at the National Institutes of Health has genetically engineered a virus that should be safe and effective against RSV, which kills 200 U.S. children a year and hospitalizes 75,000 more. RSV can lead to several types of diseases, ranging from a cold to pneumonia.

So how big would this be? Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cook Children’s says a vaccine that can prevent RSV will be a difference maker for all of us.

“In terms of preventing hospitalizations, emergency room visits and outpatient clinic visits, it would be huge for infants and toddlers,” Dr. Whitworth said. “Everyone has RSV at least once in the first two years of life. It may just be a minor cold or it could progress to involve the lungs and cause wheezing. We then acquire it regularly throughout our lives as some of our winter colds. In older children and adults, who are generally healthy, it is just a mild respiratory tract infection. But we are all impacted in some way by RSV.”

A new vaccine for RSV is the latest in a line of vaccines that have helped fight against diseases such as the flu and the whooping cough. Dr. Whitworth hopes that this latest medical breakthrough serves as a reminder of the importance of vaccines and why the medical profession seeks them out.

“Scientists all over the world dedicate their lives and careers to developing vaccines because they feel passionate about preventing disease and death,” Dr. Whitworth said.

In the meantime, Dr. Whitworth says families can help prevent the spread of RSV through good handwashing, cough hygiene (covering your mouth with your elbow), using tissues, etc.

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.

Hepatitis A is an infection of the liver. It can be passed easily from contaminated food, water or close contact with an infected person.

"Hepatitis A can cause outbreaks in day care which infect many children and last for several months,” Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases. “Good hand washing techniques can prevent outbreaks and decrease the spread of the disease, but the best protection for your child is to have them vaccinated.”

Hepatitis A usually goes away on its own within two months. There are no lasting effects in most once the infection passes. Symptoms include:

• Tiredness
• Loss of appetite
• Fever
• Nausea and vomiting
• Abdominal pain or discomfort
• Yellowing of the eyes and skin—jaundice
• Darker colored urine
• Light or chalky colored stools
• Rash

Medical treatments that may help prevent infection include:

• Immune (Gamma) Globulin—temporary protection from hepatitis A. It can last about 3-6 months. It must be given before exposure to the virus or within 2 weeks after exposure.
• Hepatitis A vaccine—highly effective in preventing infection. It provides full protection 4 weeks after the first injection. A second injection provides long-term protection. The vaccine should be considered for:

• All children aged 12-23 months.
• Children aged 24 months or older who are at high risk and have not been previously vaccinated.
• People traveling to areas where hepatitis A is prevalent (The Centers for Disease Control and Prevention's http://wwwnc.cdc.gov/travel/ shows which areas have a high prevalence of hepatitis A).
• People with chronic liver disease.
• People with blood-clotting disorders, such as hemophilia. 
• People who desire immunity to hepatitis A.

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 statement from the city says "there is no reason to expect a widespread appearance of rabies, however it is extremely important that anyone exposed be identified and examined right away.If you know of a child who fits this description, please contact Ethel at Animal Services right away at 972.219.3478."

The staff at Cook Children's Infectious Diseases has treated its share of kids for rabies through the years, and bats are a frequent cause for rabies exposure. Infectious Diseases 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 by an animal, 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.

About the source

Cook Children's Infectious Disease is dedicated to providing excellent, patient-centered care, as well as access to the most up-to-date therapies and leading-edge clinical research.

Along with this goal of each child’s attendance, we have to balance the goal of keeping others safe from infectious diseases. Our contagious students need to stay home when they are sick to keep the rest of their classmates safe. (This is why I don’t really care for perfect attendance bike raffles. I prefer responsible attendance.)

Balancing these tensions is often hard for the parent, the school and the pediatrician because we often don’t know exactly when a child is no longer contagious. This is why I got so geeky excited last week to see a new study released in the Pediatric Infectious Disease Journal about the contagiousness of strep throat.

The study looked at 111 children with strep throat over two days.

Day 1: Children who tested positive for strep were given their first dose of amoxicillin before 5 p.m. (They also had cultures taken which allow to see if bacteria will grow from a swab of their throats.)

Day 2: Children were retested and cultured for strep in the morning to determine if they still carried the bacteria in their throats.

Here is what they found:

• 101 children tested negative for strep on the morning of day 2.
• 7 children had significantly decreased growth of bacteria from their throat cultures.
• 2 children continued to have high loads of bacteria.

The author’s conclusion: “all children treated with amoxicillin for streptococcal pharyngitis (strep throat) by 5 p.m. can, if afebrile (fever free) and improved, may be permitted to return to attend school on day 2.”

I’m pretty sure you’re not as excited as I am, but THIS IS HUGE!

Based on current guidelines, children must be treated for 24 hours before being allowed to return to school. If we treated according to the results of this study, it would allow for the child to be back in school and for the parent to be back at work a whole day earlier.

I feel like there is a lot of work to be done in this area and this type of study, along with other models of health care delivery, are good examples of the work that will be necessary.

Because I value education and our school districts so much, I want to be constantly thinking about ways we can do this better. As a general pediatrician, I can really boil down the goals of my job to these:

1.Keep kids growing and healthy.

2.Keep kids developing and learning.

Early in your baby’s life, this looks like frequent checkups for preventing illness, monitoring growth (and talking about diet) and teaching ways that parents can help their child with development. (Read: Everyone should homeschool.)

As your child gets older and starts school, my role changes a little bit. I don’t ask my elementary age patients about fractions or my high school students about “The Great Gatsby.” Instead, I might ask, “How is school going?” “Any problems I need to know about?” “Any way I can help?”

On a practical level, this means offering school aged children after school appointments when possible. It means getting sick kids in the same day so that we can start treatment and get them back in their desks as soon as possible.

In the future, this may mean totally different modes of delivering health care and working with the school and school nurses in order to decrease missed class time.

But I’m getting ahead of my geeky self again. I’ll save that discussion for later.

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.

Here are five surprising insights about the germs that breed on your phones:

1. Cell phones reflect the personal microbial world of their owners. Scientists have found that cell phones represent our microbiome—the trillions of micro-organisms that live in and on our bodies. Cell phones are an integral part of our daily lives, so our own germs regularly spread from our mouths and skin onto our phones.

2. Have you ever heard of streptococcus, staphylococcus and diphtheroids? If not, these are colonies of bacteria that thrive on your phones. A little bit of bacteria is ok, but too much of it can cause a problem. Our phones are overwhelmingly covered in bacteria and we need to worry about other people’s germs. Think about the next time you set your phone down in a public area or share your phone with someone else. Your phone accumulates the other person’s germs as well as the bacteria they’ve picked up.

3. A cell phone has 18 times more harmful bacteria than a public restroom. This statistic is a little scary, but think about it--we use our cell phones after we eat, work out, use the restroom, etc. Several of us are guilty of using our phones with filthy hands. We don’t think about the germs that are transferred every time our hands touch our phones.

4. Cell phones are breeding grounds for bacteria because of their warmth. Warmth breeds bacteria and phones are always warm from the battery and body heat. We also put our phones in germ-infested places like our purses and pockets.

5. Cell phones can intensify face acne. Pressing your phone onto your face allows bacteria to get trapped into your pores causing unwanted blemishes.

Chris Curtis, clinical coordinator of Infectious Disease at Cook Children's, recommends good hand washing and hygiene to prevent unwanted germs on cell phones. “It is imperative for individuals to continually wash their hands after activities. I tell parents to have their child sing “happy birthday” or the “ABCs” while hand washing,” Curtis said.

Screen protectors for cell phones can guard against the little monsters as well. Reiterate to your child to not only wash his or her hands, but to also keep the phone shiny and clean. Diminishing germs on cell phones can prevent illness and lead to a healthier lifestyle.

- Article written by Amanda Burmeister

Advocating for breastfeeding is a big part of a pediatrician’s job in the first few months of life. We state the benefits of breastfeeding. We encourage families who are struggling and provide help with troubleshooting issues. We point them towards lactation consultants and other resources that can help when things are not going well.

But, is there a point where “breast is not best?”

Does all the conversation about breastfeeding pressure moms to seek out breast milk from other sources when they choose not to breastfeed or when breastfeeding does not work for them?

The answer is: Yes.

Breast milk donation can be used to provide much needed breast milk to premature babies. Many of these babies would otherwise not receive breast milk. This provides an amazing service to a vulnerable population. I strongly encourage moms who are interested and have extra breast milk to look into donating their milk to one of these organizations.

There are other means of exchanging breast milk that I am not as excited about. Families can buy and sell breast milk online via websites that link buyers and sellers (often called “communities” or “societies”).

But, is this method of obtaining breast milk safe?

A recent study showed that out of 102 samples of breast milk bought online, 10 of those samples contained more than 10 percent cow’s milk. This shows that at least some sellers are mixing cow’s milk with their breast milk, most likely to increase volume and income from their breast milk sale.

Why is this dangerous?

It is dangerous because previous studies have shown that 20 percent of online breast milk buyers are buying milk because of a medical condition in their child - many of those are listed as formula intolerance. Introduction of cow’s milk into the breast milk increases the odds that these children could have a reaction or problem with the purchased milk especially if they have a true allergy to cow’s milk.

While this risk is not insignificant, I feel the danger is much greater. I believe that the real danger lies more in the motivation of the sellers. If they are willing to actively deceive buyers by adding cow’s milk, what else are they willing to lie about in order to find a buyer for their milk? Anyone ever thought of why we do not pay blood donors or allow for payment for organ donation? The motivations matter.

Here are some other potential issues with breast milk sold online that you should be aware of:

1. Storage and bacterial contamination

Safe storage of breast milk is not as simple as just throwing it into the freezer. Transportation of sold milk also creates another potential source for unsafe storage. The same group of researchers showed in a previous study that 74 percent of the milk they bought online contained enough bacteria to question their safety for infants.

2. Medications/drugs/alcohol

Many of the sellers’ listings make a point to say that the milk is free of substances or that the donor did not engage in risky behavior. In fact, sellers who made such claims (in addition to claims for clean handling and infectious disease screening) were 6 times more likely to sell their milk than those who did not make those claims. Does this encourage honesty?

3. Infectious diseases

You would hope that donors would be honest about their infectious disease history because many diseases can be transmitted via breast milk. Also, there are some transmitted diseases that the donor may not be aware of at the time they pumped the milk.

Of course, I advocate for breastfeeding for moms who can. But, let’s be real. Formulas have come a long way since the days where it was practically evaporated milk. So, let’s be realistic about the lengths we will go to in order to provide our child breast milk.

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

Fever, headaches, joint and muscle aches, weakness, fatigue, diarrhea, vomiting, stomach pain and lack of appetite.

Over the next few months, many children will have these symptoms and many parents will, and should, call their Cook Children’s pediatrician because of how their child’s feeling.

Unfortunately, many parents will assume the worst … Ebola. But the chances of that being a reality are extremely low. While knowing it’s not likely to be Ebola may be a relief, it’s important to remember that Ebola is not the only dangerous virus on the horizon for our children. The symptoms listed above are much more likely to be the flu.

Investigation of 25 outbreaks of Ebola over 38 years has shown that only direct contact with a person with Ebola would cause someone to become infected. Right now, there’s no approved vaccine to limit the epidemic in West Africa.

On the other hand, influenza can be deadly. The 2013-2014 flu season led to 108 pediatric deaths in this country. The flu is spread readily through the air by small droplets which can be infectious to someone near a person who is coughing and sneezing and is much more easily acquired and easily prevented through vaccination.

Please make sure to get your children the flu vaccine and parents should get them too! ASAP. Both injection and nasal mist vaccines are effective.

Unfortunately, the outbreak has hit a little bit closer to home as a traveler from Africa has died from Ebola in Dallas and a health care worker in the hospital has tested positive for the disease.

I wanted to take this opportunity to provide some thoughts on the situation:

1.Remember that the inital patient was a traveler from Africa and the second case was someone with close contact with the patient. No transmission has occurred through casual contact in the community.

2.Medical professionals across the country are aware of the concern of Ebola in returning travelers and should be asking about travel in patients with fever. If you know someone who has traveled to these areas who develops fever, encourage them to seek medical care and notify their provider or emergency room upon arrival (better yet, have them call ahead).

3.We have now treated multiple patients in the United States with success in helping them recover.

4.Remember to be cautious about how you talk about Ebola with your children. There is a significant amount of misinformation in our communities and especially on social media. What you tell your child matters as they will spread the message you send to their classmates. Widespread fear among the children in our area is unnecessary and could be harmful. If you want accurate information about the virus, check out our previous posts here and here.

We also spoke with Dr. Donald Murphey, medical director ofInfectious Disease at Cook Children’s, and he provided some wise perspective on the situation:

“Texas is a multinational country. We have new Texans coming from all over the US and all over the world … At Cook Children’s Medical Center and other large health care organizations, we are asked to care for patients with diseases that are not native to our area. We are asked to provide care for patients coming from West Africa that are ill. These patients often have fever and in most cases have malaria. They need high quality and prompt medical care. Now, we have had one case of Ebola in the US where a man was hospitalized in Dallas and later died. He, and others, can be cared for safely. We may go through a time when we are all concerned about Ebola in patients, even with minor illness, but Ebola will be contained in the United States."

About the author

Justin Smith, M.D., is a Cook Children's pediatrician in Lewisville . He attended University of Texas, Southwestern Medical School and did his pediatric training at Baylor College of Medicine. He joined 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.

Tarrant County Public Health (TCPH) confirmed the first imported case of chikungunya as a Mansfield, Texas, resident, who contracted the disease while in the Caribbean and was diagnosed by doctors upon returning home. Additional details are not being released to protect the identity of the patient.

This is the first imported case of chikungunya virus disease reported in Tarrant County – and the 13th in Texas. To date, local spread of the virus has been reported in Florida, but no other states.

Tarrant County Public Health stated that imported cases could make local spread possible because the Aedes mosquitoes that transmit the virus are found in Texas.

Aedes mosquitoes are active and bite during the day the TCPH said, so it’s important for people to protect themselves against mosquitoes at all times.

Because symptoms are similar, TCPH encourages physicians to consider both chikungunya and dengue infection in patients with acute onset of fever and joint pain - and patients who have recently visited areas where at least one of the viruses is present.

Donald Murphey, M.D., medical director of Infectious Disease at Cook Children's, stresses that all cases of chikungunya in the United States have been a result of people traveling outside of the country and returning home. No one has become infected by the virus without leaving U.S. The World Health Organization reports 350,580 suspected cases of the viral infection in the United States.

While infections are rarely fatal, chikungunya can be quite painful; especially for children. Children are impacted more severely.

• Children have a greater chance for rashes and joint pain can be quite painful.
• Babies’ only symptoms may be a rash and fever.
• Older children may complain of aching in their head or joints. Often times, nausea accompanies an infection.

If you notice these symptoms, please contact your pediatrician. A cure for chikungunya doesn’t exist, but a doctor may be help to ease the symptoms.

Symptoms usually begin three to seven days after being bitten by a mosquito. There is no vaccine or treatment for the virus. Most people feel better within a week, though some people may develop longer-term joint pain.

Chikungunya is not transmitted from direct person to person contact. Instead a person with the disease can be the source of the virus for mosquitoes to bite someone else and spread it. To prevent the spread of the disease, people with chikungunya illness should be especially careful to avoid exposure to mosquitoes during the first week of illness.

DSHS encourages people to protect themselves from mosquito bites at home and while traveling. The Aedes mosquitoes that transmit chikungunya are active and bite during the day. Precautions include:

• Use an approved insect repellent every time you go outside, and follow label instructions.
• Drain standing water where mosquitoes can breed.
• Wear long sleeves and pants when outside.
• Use air conditioning or make sure doors and windows are screened to keep mosquitoes outside.

According to the Centers for Disease Control and Prevention, with recent outbreaks in the Caribbean and the Pacific, the number of chikungunya cases among travelers visiting or returning to the United States from affected areas will likely increase. Cases have occurred in Africa, Southern Europe, Southeast Asia, and islands in the Indian and Pacific Oceans.

Measles is highly contagious and can easily spread by simply breathing, coughing, sneezing or coming in close contact with an infected person. If you or anyone you know develops symptoms of this disease, please contact your health care provider immediately.

Measles begins as a mild infection with fever, congestion, cough and some oral lesions. It then worsens to a severe respiratory infection, with very red eyes, lots of coughing and a rash all over the body with red, slightly raised, round spots. Measles can have complications such as pneumonia, dehydration and in rare occasions swelling of the brain (encephalitis). Measles is especially dangerous for people with weak immune systems.

Donald Murphey, M.D., medical director of Infectious Disease at Cook Children’s, and TCPH remind people that measles is a vaccine-preventable disease. Adults who have received a measles vaccine series are considered immune. Those who have not been immunized against measles, or have never had measles, should contact their health care provider to get vaccinated.

“If you think you, or your child, may have measles or have been exposed, call your doctor immediately and try not to come in contact with others,” Dr. Murphey said. “The measles, mumps and rubella (MMR) vaccine is safe and very effective at preventing measles.  If you are travelling with children, they can be immunized against measles to protect them as early as 6 months old. Children normally start the MMR vaccine at 1 year old. If you or your child has not had the vaccination, please call your doctor to arrange this ASAP.”

The Centers for Disease Control and Prevention recommends two doses of the vaccine. The first dose should be given at 12 months of age and the second between the ages of 4 to 6 years. But children can get the second dose at any age, as long as it is at least 28 days after the first dose.

You can find more information about Measles by clicking HERE.

The last recorded cases of Measles in Tarrant County were in 2013.

Click here to find a Cook Children's pediatrician in your area to get your child vaccinated.