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. 
   

 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.   

Related Stories

Physicians Say New Antibody Shot Could Be Game Changer
Medication to Prevent RSV

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.

As we continue to worry about the spread of COVID-19, now we hear that positive West Nile Virus mosquito activity is at record high levels in Tarrant County.

It seems 2020 is not quite ready to give us a break any time soon.

Tarrant County Public Health issued a warning to the general public at the end of last month. In its latest report (Aug. 2-Aug. 8, 2020), TCPH reported 302 positive tests in the region this year.

“We are continuing to see rapid increases in mosquito infection rates in Tarrant County, which means we have more human risk for West Nile Virus,” said Tarrant County Public Health Director Vinny Taneja at the end of last month. “To prevent outbreaks of West Nile, it’s very important that people remember to always use an EPA-approved repellent and wear long sleeves and pants when they go outside,” he said.

Fox4 reports one death related to West Nile this summer and "recent tests of mosquito traps in the northeastern part of the county show a 60% positivity rate."

Adding to the anxiety are how similar the symptoms of the West Nile virus is to COVID-19. About 20% of infected people will develop a fever with other symptoms such as headache, body aches, joint pains, vomiting, diarrhea or rash.

These are symptoms common in many viruses including COVID-19 and the flu.

But there are differences in COVID-19 and West Nile, beginning with how you contract the viruses.

“COVID is a respiratory virus spread between people’s secretions,” said Nicholas Rister, M.D., an infectious disease pediatrician at Cook Children’s. “West Nile virus is a blood infection spread by mosquitos. People with COVID, have symptoms that are primarily respiratory symptoms. West Nile virus is more fever, rash and joint aches.”

Dr. Rister said less than 1% of West Nile virus cases can cause central nervous system infections (meningitis/encephalitis for example), which is a bit more common in adults than kids, but still rare.

West Nile virus can affect anyone, although people age 50 and older run a higher risk of developing a severe infection.

Most people with this type of the disease recover completely, but fatigue and weakness can last for weeks or months. Less than 1% of infected people develop inflammation of the brain or surrounding tissues. The symptoms of neurologic illness can include headache, high fever, neck stiffness, disorientation, coma, tremors, seizures or paralysis.

Most children who are infected with this virus do not develop symptoms. West Nile virus has been circulating in mosquitoes in the United States for many years and is not new.

With heightened concerns of mosquito-borne illness, Tarrant County Public Health and County officials are asking for help to protect their community from mosquitoes such as:

• Wearing long sleeves and pants
• Dumping standing water
• Using EPA-approved insect repellent
• Keeping vegetation trimmed

Here is a list of mosquito repellents endorsed by the FDA and CDC. Tarrant County Public Health also has more information about West Nile Virus and other preventive measures residents can take at Be Mosquito Free.

Burleson Mayor Ken Shetter's frustration speaks for many physicians, nurses and other health care providers too. 

Shetter spoke at a news conference announcing that face coverings will be required in all area Tarrant County businesses and outdoor gatherings of 100 people or more, as part of an executive order.

Tarrant County Judge Glen Whitley stated the  order goes into effect at 6 p.m. Friday and will stay in effect through 6 a.m. Aug. 3.

The executive order came as recent cases continue to surge, locally and throughout the state.

As of June 24, 2020, 215 people have died in Tarrant County from COVID-19, with a total of 9,846 positive cases and 460 new cases. More than 4,600 people have recovered after getting the virus.

The news across the state is not good either. The Texas Department of State Health Services reported on the same day that the state would surpass 5,000 new cases in a single day for the first time.

This recent surge in COVID-19 cases means doctors, nurses, and other health care providers won’t get what they hoped for: a chance to catch their breath before the flu season arrives.

The Centers for Disease Control and Prevention (CDC) estimates there were between 24,000 – 62,000 flu deaths from October 1, 2019, through April 4, 2020 (last flu season).

In contrast, the Johns Hopkins University & Medicine's Coronavirus Resource Center reports more than 122,000 COVID-19 related deaths in the United States as of June, 25, 2020.

“It appeared things were getting better in the latter half of May. However, throughout June, things began to climb,” Dr. Whitworth said. “We have to do a better job right now, taking care of one another, and returning to the basics.”

Those basics include staying home, social distancing, not touching your face, washing your hands frequently, and wearing masks.

Masks are a courtesy to others. They protect those who may be more vulnerable to the disease, such as the elderly or those with chronic illnesses such as cystic fibrosis or diabetes. Masks should cover the mouth and nose to keep others safe.

As the cases increase, the overall outlook for children with COVID-19 remains good.

At Cook Children’s, 125 kids have tested positive. Six of those patients are currently at the medical center, but that’s compared to more than 4,700 patients receiving negative results. The majority of children testing positive have not required medical intervention.

Up to this point, children make up a small percentage of hospitalizations and death in the United States as a result of COVID-19.

Nationally, children represent about 3.7% of all hospitalizations related to COVID-19 and only 0.7% of deaths. Data shows that infants, less than 1 year of age, have had the most severe disease in the pediatric age group.

“We’ve been very fortunate in pediatrics with the COVID-19 disease,” said Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cook Children’s. “One of the things we know about children is that they are less likely to be as ill as adults who contract COVID-19. It’s thought that 50% or less of children who have COVID have a fever. They may not show any symptoms of the disease, or may just have a cough.”

And while the risk to kids is lower, it’s not zero. So even if you don’t want to take precautions for yourself, do it for those around you that are high risk and for children who may be affected by the virus.

“We know now that people are contagious, probably for about two days before they develop symptoms. So, they don’t know they’re sick, and some people never get symptoms. And they still have this virus coming out when they are talking, or coughing or sneezing. That’s what this cloth mask does. It keeps it in. So even if you feel ambivalent and you’re not worried that you’re going to get COVID and you think I’m not going to wear a mask and if I get it, I get it, please remember, the reason you wear the cloth mask out in public is to protect others who are worried about catching it, to protect high-risk populations and to protect the public in general. That’s why it’s important to wear a mask.”

Important Links:

• Tarrant County Public Health COVID-19 (Coronavirus) Site
• Johns Hopkins University & Medicine's Coronavirus Resource Center 
• Checkup Newsroom COVID-19 Information
• COVID-19 Resources & Education (cookchildrens.org)
• Medical Director of Infectious Diseases Urges Us All To Wear Our Masks
• 'Because We Are All Taking an Amazing Handwashing Journey Together, Aren't We?'
• Why It's Important To See Your Pediatrician During a Pandemic and What To Expect During Your Visit
• Cook Children’s Pediatricians Welcome Patients Back to Clinic Visits. The Plan to Keep You Safe.

As Texas enters Phase 3 of Governor Gregg Abbott’s plans reopen the state amid the COVID-19 pandemic, bars, restaurants, amusement parks and sports venues are working to welcome back patrons.

But for many parents, their biggest concern remains what to do during the upcoming school year.

Medical Director of Infection Prevention at Cook Children’s Marc Mazade, M.D, hears questions about how to reopen school again on a daily basis from his patient families as well as his own colleagues.

“Everyone kept asking me, ‘Are kids even going back to school?’ I don’t really know what the plan is. I certainly hope schools reopen in the fall, but we have some work to do,” Dr. Mazade said.

Seeing a need for more guidance, Dr. Mazade worked with more than 50 Cook Children’s physicians to create “Recommendations for the Practical, Fair and Safe Reopening of Public Schools K-12 in the State of Texas.”

The doctors involved work in a variety of primary care offices as well as specialty clinics including Infectious Diseases, Emergency Services, Cardiology, ENT, Neurosciences and more. Dr. Mazade expects this to be a long-term plan, with elements in it that allow for looser restrictions based on current Centers for Disease Control and Prevention (CDC) guidelines for community transmission. He sent these recommendations to the governor and hopes to provide it to schools for the upcoming year.

Dr. Mazade admits to being cautious as kids return to the classroom, but he also believes a common-sense, careful approach will allow children the best opportunity to remain safe.

Students from kindergartners to high school seniors tend to tolerate infection better than adults, especially elderly people. Cook Children’s prescreening of asymptomatic children preparing for a medical procedure identified around 1% of children of all ages shedding the virus locally at the time of this writing.

“In order to put children safely to sleep, we have been testing children who are preparing for surgery for COVID-19 infection," Dr. Mazade said. "As feared, some children who have no symptoms are testing positive for COVID-19. That shows us that children with no symptoms have COVID-19 in our community and infection can spread unknowingly from person to person. We are urging everyone to continue to take precautions to keep everyone safe.”

The physicians worked on the document with the health and safety of students, teachers and their families at the top of mind, but they also thought about a common-sense approach to help bring a return of normalcy to kids’ lives.

“We want children to wear masks, but we also understand that’s going to be difficult for little kids,” Dr. Mazade said. “They may not understand why they are wearing masks, and it may cause problems for them emotionally. In those cases, we are asking for teachers and other adults around these children to take the proper precaution to protect younger children.”

It’s important to everyone involved in creating this document that kids are able to be kids. For instance, under the guidelines, athletes will return to the playing field, but that may mean playing in front of only family where everyone can be properly spaced out for safety.

“As we begin to look at these issues that students may face, we begin to focus on more than the spread of the virus,” Dr. Mazade said. “One of the concerns that came up was making sure we were screening kids for new problems such as starvation and hunger. We don’t know who all are dealing with these issues right now. The kid next door may not get enough to eat any longer. We want to think about screening for depression, too. We added those things to the document because it’s important to be proactive because the stresses are new, different, and so widespread.”

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

But as a pediatrician, let’s talk first about what’s most important to me and you: our kids.

Fortunately, we have not seen any cases of COVID-19 (coronavirus) at Cook Children's. The other good news is based on confirmed cases of COVID-19 from around the world, kids have been relatively protected from serious illnesses. According to the Centers for Disease Control and Prevention, children are less likely to get Novel coronavirus infections (COVID-19) than adults. And the good news is if they do get it, it’s usually a mild case.

In a study of more than 72,000 patients by the Centers for Disease Control in China, only about 400 cases occurred in children under age 9 with zero deaths.

Most of the kids who caught COVID-19 had mild symptoms, including a fever, runny nose and cough. 

"These limited reports suggest that children with confirmed COVID-19 have generally presented with mild symptoms, and though severe complications (acute respiratory distress syndrome, septic shock) have been reported, they appear to be uncommon," the CDC wrote.

The CDC adds, "However, as with other respiratory illnesses, certain populations of children may be at increased risk of severe infection, such as children with underlying conditions."

So now let’s get to some of the basics you may be wondering about.

What is the “Coronavirus?”

COVID-19 is a novel respiratory coronavirus which most often presents with symptoms of fever, coughing and shortness of breath. The rapid spread throughout China (and now outside of China) as well the significant percentage of cases that result in severe illness is what makes COVID-19 a particular concern.

Where can I find the latest?

I highly recommend checking out Tarrant County Public Health’s website for the latest on COVID-19 (Coronavirus). The site tracks the total cases confirmed worldwide, including deaths.

The Texas Department of Health and Human Services (DSHS) also has a COVID-19 webpage with information for the public, travelers, health care professionals, public health partners and others.

How do I take care of myself and my kids?

Currently, there is no vaccine to prevent COVID-19. So for now, the best way to prevent infection is to take the following precautions:

• Wash your hands often with soap and water for at least 20 seconds, especially after going to the bathroom; before eating; and after blowing your nose, coughing or sneezing. If soap and water are not available, use an alcohol-based hand sanitizer with at least 60 percent alcohol.
• Avoid touching your eyes, nose and mouth with unwashed hands.
• Avoid close contact with people who are sick.
• Stay home when you are sick.
• Cover your cough or sneeze with a tissue, then throw the tissue in the trash.
• Clean and disinfect frequently touched objects and surfaces using a regular household cleaning spray or wipe.

To add to the previous bullet, the World Health Organization states that “there are some chemical disinfectants that can kill the 2019-nCOV on surfaces. These include bleach/chlorine based disinfectants, either solvents, 75% ethanol, peracetic acid and chloroform.” Click here for the EPA's registered antimicrobial products for use against Novel Coronavirus report. 

But it’s important to add: “However, they have little or no impact on the virus if you put them on the skin or under your nose. It can even be dangerous to put these chemicals on your skin.

I know you’ve probably heard a ton about the Coronavirus disease (COVID-19) as far as what will and won’t work. Check out the WHO’s myth busters section for some great advice for the public.

What about masks?

We have been asked so much about masks. Should you wear one or not wear one? The CDC doesn’t recommend the routine use of respirators (or masks) outside of workplace settings (in the community).

“Most often, spread of respiratory viruses from person-to-person happens among close contacts (within 6 feet). CDC recommends everyday preventive actions to prevent the spread of respiratory viruses, such as avoiding people who are sick, avoiding touching your eyes or nose, and covering your cough or sneeze with a tissue. People who are sick should stay home and not go into crowded public places or visit people in hospitals. Workers who are sick should follow CDC guidelines and stay home when they are sick.”

So, what can we do to prepare? 

Preparation is good advice in general for any new and emerging infectious disease, and not just dealing with the novel coronavirus. Preparation and thinking around the status of coronavirus could be divided into three categories:

Preparation Right Now 

Based on the current status, the following suggestions can be universally applied at relatively low cost. They could prevent problems down the road should an outbreak occur.

1. Gather medical supplies and prescriptions that you might need in advance. Children with chronic medical conditions should have enough supplies to last a few weeks in case local spread develops rapidly, and doctors or pharmacies are overwhelmed. Parents of children with chronic respiratory conditions such as asthma should especially consider this option.
2. Having some non-perishable food on hand to minimize trips outside is something relatively easy to do. At the same time, we wait to see what develops.
3. Reinforce with your children hand-washing, cough and sneeze hygiene and continue to develop good habits of staying home while sick.
4. Healthcare workers should discuss with their institution the efforts that are taking place to protect them from spread should their medical center have cases.

What to do in case of a community spread of the novel coronavirus

If one of the local populations of COVID-19 infections includes your area, some other things might help or be asked of you:

1. Schools, churches, employers and other places where people gather in large numbers should have preparation for allowing individuals who can have the ability to work from home. If the virus is spreading throughout a community, minimizing contact between community members may be a strategy employed.
2. Reach out to your health care providers if you think you or your child might have COVID-19 so that they can guide you to the right place and prepare for your visit. In the case of local spread, a non-essential visit to health care facilities may be postponed, so call ahead.
3. Use common sense when evaluating claims of products on the market for treatment or prevention of disease. Unfortunately, many will use this vulnerable time to take advantage of scared members of their community.
4. The local public health departments (Tarrant County for us) will be the ultimate source of the best information regarding the spread of the virus and recommendations regarding novel coronavirus.

What to do in case of a widespread outbreak of the novel coronavirus

Should the number of cases expand rapidly or broadly, further precautions will be undertaken. Remember, this is felt to be an unlikely scenario for the United States.

1. Minimize contact with others whenever possible to help avoid the spread of the virus.
2. Follow the CDC guidance for infection precautions and treatment. In the case of a widespread outbreak, they would be working with local health departments and healthcare facilities to address coronavirus.

I hope this helps ease your mind. We will continue to update you as needed and also provide the latest information from our friends at Tarrant County Public Health.

Stay well,

Doc Smitty

Note: Thank you to Tarrant County Public Health, Alice Phillips, M.D., Mary Whitworth, M.D., and Corwin Warmink, M.D., in putting this article together.

Resources:

• Tarrant County Public Health's COVID-19 (Coronavirus) Page
• Texas Department of State Health Services' Coranvirus Page
• Coronavirus Disease (COVID-19) and Children
• Centers for Disease Control and Prevention's Coronavirus DIsease Page
• How COVID-19 Spreads (CDC)
• Symptoms (CDC)
• Prevention & Treatment (CDC)
• What to Do If You Are Sick With Coronavirus Disease 2019 (CDC)
• World Health Organization's Coronavirus Page
• EPA's Registered Antimicrobial Products for Use Against Novel Coronvavirus SARS-CoV-2, the Cause of COVID-19

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.

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.

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.

The study, also published by the American Academy of Pediatrics, is the first of its kind to show how flu vaccinations significantly reduce a child’s risk of dying from influenza.

For four flu season, from 2010 to 2014, the CDC found that flu vaccines reduce the risk of flu-associated death by nearly two-thirds (65 percent) among healthy kids and by 51 percent among kids with underlying high-risk medical conditions such as asthma, chronic lung disease, heart disease and weakened immune systems.

“One of the questions we hear a lot from parents is does the flu vaccine really work,” said Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cok Children's. “I hope this study helps parents see the real, life-saving value of the vaccinations. This report from the CDC shows us that the flu vaccine can play a major role in preventing more children dying from the flu.”

The study looked at 358 laboratory-confirmed, flu associated deaths. Of the reported pediatric deaths with known vaccination status (291), only one in four children (26 percent) had been vaccinated.

During the 2016‐2017 influenza season, 0 Tarrant County influenza‐associated pediatric deaths has been reported. As of week 12 for the 2016-2017 season, two influenza‐associated pediatric deaths have been reported in Texas, with a total of 55 reported nationwide.

To learn more:

• CDC Report
• AAP Report
• It's Only The Flu That Killed Her

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.

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.”

But be careful when your child is chasing his furry friend. New research shows that children are among the highest at risk for cat-scratch disease (CSD).

The Centers for Disease Control and Prevention (CDC) released a report on CSD that stated that incidence of CSD was highest among those who lived in southern states and among children 5-9 years of age. Hospitalization is more common in males 50 to 64 years of age. The CDC estimates that each year 12,000 outpatients are given a CSD diagnosis and 500 inpatients are hospitalized.

Bartonella henselae is the bacterium that causes the disease. The bacteria live in infected cats’ saliva, but the cats do not develop symptoms or become ill. Often times, the kittens or cats may carry the bacteria for months.

Fleas spread the bacteria between cats, but humans get cat scratch disease after being scratched, having an open sore licked, or getting bitten. Humans are more likely to acquire this infection from a kitten than from a grown cat.

CSD is not spread from person to person, but multiple cases can happen in the same family if everyone has had contact with the infected cat.

Symptoms are usually mild. Commonly children will develop a swollen lymph node above the scratch site, such as in the underarm above a scratch on the hand or arm. In extremely rare circumstances, the disease can lead to complications of the brain or heart.

“The good news is that this is normally not anything too serious and most people only have one episode of cat scratch disease. That one case usually makes them immune for the rest of their lives,” said Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cook Children’s. “Antibiotics are rarely required to treat and only for the most severe forms of the disease.”

Dr. Whitworth advises parents to talk to their children on how to properly handle their cats and to stay away from stray or unfamiliar cats.

“Parents don’t have to get rid of their family pet in fear of cat scratch disease,” Dr. Whitworth said. “The chance of this occurring is rare and in most cases the disease is mild. Making sure your child knows how to treat the pet is important. Teach them not to play roughly with the cat and make sure to wash your hands after handling the pet. Controlling fleas is also very helpful.”

If your child is scratched by a pet, wash the injured area well with soap and water. Call a doctor if you noticed your child has swollen or painful lymph nodes in an any area of the body or:

• The bite or scratch doesn’t heal in an appropriate manner.
• The redness of the wound increases.
• Significant fever occurs.

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 CDC is monitoring nearly 300 pregnant women with Zika in the U.S. states, territories

Senate Passes Zika Bill That Will Go Nowhere Fast

Every time she sees a new headline about Zika, Mary Suzanne Whitworth, M.D., worries that the public is being inundated with scary news that is unlikely to affect them.

The medical director of Infectious Diseases at Cook Children’s knows that the more Zika stays in the headlines, the more fear will grow in people about the virus. And she expects the concern about the virus to increase during summer as mosquitos become more widespread.

Dr. Whitworth wants people to take the necessary measures to fight against Zika, but cautions parents to balance their fears with a common sense approach to the virus.

“Zika is very rarely found to be fatal,” Dr. Whitworth said. “It often causes a flu-like illness and many people who become infected with the Zika virus won’t even know they have it because they won’t have symptoms.”

Zika is not a bacterial disease that can be spread the same way as an illness such as strep throat. Zika is transmitted through mosquitoes or through sexual transmission.

The illness is usually mild with symptoms lasting for several days to a week. The most common symptoms of Zika are fever, rash, joint pain or red eyes (conjunctivitis). Other symptoms include muscle pain and headache.

So most of us won’t even know we have Zika or if we do, it will basically be the same as having a cold or possibly the flu for a few days.

That’s for the majority of people, but there are serious issues that can go along with some cases of Zika.

Microcephaly has been linked to the Zika virus. Microcephaly is a medical term for an abnormally small head. Between 2001 and 2014, Brazil had, on average, about 163 cases of microcephaly a year, but since 2015 things have taken a dramatic turn for the worse with more than 1,000 cases confirmed.

Zika virus can be spread to pregnant women through the bite of an infected mosquito and through sex. Pregnant women are advised to take precautions to protect themselves from Zika. Click here to learn more.

Guillain-Barré syndrome is a condition that has also been linked to Zika. GBS can affect people of any age, although rare in infants and toddlers. GBS symptoms usually begin with achiness of the muscles or burning or tingling of the feet and legs. GBS can cause the loss of the ability to walk and involve the diaphragm and breathing muscles which can be life threatening.

While microcephaly and GBS are newly linked to Zika, Dr. Whitworth says Cook Children’s has experience recognizing and treating both conditions.

“All of our neurologists are prepared to see patients with microcephaly and Guillain-Barré,” Dr. Whitworth said. “They already see these patients and have experience caring for them.”

Dr. Whitworth understands the fear of the unknown that comes with a new virus. But she says people should be diligent in protecting themselves from mosquito bites and that the CDC is monitoring the situation, as well as Tarrant County Public Health locally.

“The Centers for Disease Control and Prevention (CDC) is keeping up with this on an hourly basis and monitoring this and will keep us informed,” Dr. Whitworth said. “It's important for people to remember that sexual transmission, mother to fetus and blood transfusion are the only person-to-person routes to get Zika. Currently, there's no casual contact transmission that happens person-to-person."

Previous articles on Zika:

• Should we be afraid of Zika?
• Guillain-Barré syndrome: Are you at risk?
• Zika virus confirmed in Tarrant County
• 11 facts about the Zika virus

About the source

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

“Everything we look at with this virus seems to be a bit scarier than we initially thought,” said Dr. Anne Schuchat, a deputy director at the U.S. Centers for Disease Control and Prevention.

Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cook Children’s knows that this news conference will increase the fear many already feel about Zika, but she points to a few facts to calm our nerves or at least let us take precautions to be safe:

1. Local transmission of the Zika virus from a mosquito hasn’t been documented in the United States. Zika virus has been reported in travelers returning to the U.S.
2. Pregnant women should consider not traveling to any area where Zika virus transmission is ongoing. Women who are trying to become pregnant should consult with their doctor.
3. Zika can be sexually transmitted. Women who are pregnant should not have sex with their partner if he has Zika. It is unknown how long the virus is present in semen.
4. The virus has been linked to the Guillain-Barré syndrome, which can cause paralysis.

The Zika virus is spread to people primarily through the bite of an infected Aedes species mosquito, the same mosquitoes that spread dengue and chikungunya.

Those mosquitoes have been in the states for years, but we have not seen a massive outbreak in this country.

Dr. Whitworth said the reason why those mosquito-borne illnesses have not spread as much in this country may be as simple as improved mosquito vector control and air conditioning.

With more air conditioned homes, people stay inside more and don’t sleep with the windows open or go outside as much. The other key may be the measures taken to prevent mosquito bites, such as wearing insect repellant and sprays.

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 Centers for Disease Control and Prevention (CDC) recommends the flu vaccine for everyone 6 months of age and older, with rare exceptions. The vaccine status of this particular infant's parents was not reported, but Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cook Children’s said parents must do their part to protect their children during flu season.

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

Vaccination is recommended as long as the influenza viruses are still circulating.

At Cook Children’s, this was the latest in the flu season that a child has started in at least 10 years.The latest numbers from March 19, 2016, state that 102 patients have been diagnosed with either flu A (42) or flu B (60).

During the 2014-15 flu season, the CDC says there were a total of 148 influenza-associated pediatric deaths reported in the US of which 19 were reported from Texas.There were two pediatric influenza deaths in Tarrant County during that time period.

“The death of a child is such a tragedy,” Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases said. “This flu season is much later than usual and so far this year there have been fewer reported cases. But parents must continue to do everything that we’ve always recommended for flu prevention, including vaccinations. Vaccinations are still the best answer to preventing the flu and protecting your children from the upcoming season.”

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.

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

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

Click here for prevention information from the CDC.

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

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

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

About the source

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

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.

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.

However, some moms and dads may not realize the harm they are doing their newborn by not getting themselves or their older children vaccinated for whooping cough, or pertussis.

Because the immunity of a newborn isn’t fully developed, babies are at high risk for contracting potentially fatal illness and disease.

A new study published in the journal Pediatrics stresses the importance of the entire family getting vaccinated, at least those old enough to receive the immunization. The study says babies who contracted whooping cough were now more likely to get the infection from a sibling than a parent.

The study states that pertussis “is poorly controlled” and that the incidence of pertussis in this country is on the rise.

In contrast to previous studies, data now shows that infants are contracting whooping cough more often from their siblings than from their mothers. Doctors suggest that this may be because of vaccine effectiveness wearing off over time in these older children. They then contract pertussis more easily and the younger siblings (including infants) are more likely to be exposed.

Five vaccine doses are recommended by age 6, with a booster shot at age 11 or 12. Booster shots also are recommended for adults.

Infants are at greatest risk for disease and death from whooping cough, especially during the first 2 months of life before pertussis immunizations begin. That means that everyone in the family should be vaccinated when a newborn is being brought into the family.

While the parents, adolescents and caregivers who will have direct contact with the baby should all be up-to-date on their immunizations, the two most important vaccinations for adults to receive are influenza and combination booster for tetanus, diphtheria and pertussis (Tdap).

“Tdap is recommended for all pregnant women during each pregnancy to prevent the baby from getting pertussis if coughed on in the first few months of life before the baby has time to get immunized,” said Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cook Children’s. “The mother makes antibodies that go into the baby’s bloodstream during the pregnancy. Those last until the baby gets his or her 2-month shots.

“It’s very important for everyone in the family, including parents, siblings and grandparents to have the vaccine. Pertussis can be deadly if a child contracts the disease in the first 3-4 months of life.”

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.