More than 113,000 children in Tarrant County live in poverty. Carol Klocek and the team at the Center for Transforming Lives work alongside women and their children to disrupt the cycle of poverty in a way that is compassionate and trauma-informed. On this episode of Raising Joy, we talk to Klocek about her role as CEO of the 115-year-old nonprofit, and how mental health, domestic violence and substance abuse impact the women and families they serve. 

We also want to hear from you! Please take our brief survey to let us know how we’re doing and what topic you want to hear discussed on Raising Joy.

Raising Joy is part of Cook Children’s Health Care System’s Joy Campaign, a communications initiative aimed at preventing youth suicides. For more information about the Joy Campaign, visit cookchildrens.org/joy.

New episodes of the Raising Joy podcast will be available each Tuesday. It is currently available on all major streaming platforms including Apple, Spotify and Google Podcasts.

Story by Eline deBruijn Wiggins. Video by Tom Riehm.

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

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

Did you know?

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

Meet 6 of our doctors and specialists

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

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

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

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

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

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

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

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

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

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

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

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

“Because of the sensitive nature of the information, we can’t share any other details, other than to say that the child had underlying health conditions,” said Tarrant County Public Health Director Vinny Taneja. “The patient tested positive for Influenza B which is circulating early and predominately this season.”

Tarrant County Public Health stated there has been a “sharp rise in flu activity this season, trending nearly a month ahead of the previous two years.”

Taneja added, “We want to remind everyone to get their flu shot. It’s definitely not too late, and the vaccine offers you the best protection against the flu.”

Last week at Cook Children’s (Nov. 24 through Nov. 30), 964 children were tested for the flu at the medical center. Of those children, 231 tested positive for Influenza B and 24 more for Influenza A.

“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. “The vaccine is especially important for children aged 6 months to 5 years. They are at the highest risk for serious flu-related complications, including death. Even if you do get the flu, people who are vaccinated generally get a milder and less dangerous form of the illness.”

You may remember the spray shot wasn’t previously available for children because it didn’t work as well. The newer versions appear to work as well as the shot. So the vaccine can be given this year either by a shot or nasal spray, depending on the child’s age and general health. Both protect against four types of influenza viruses: Influenza A (H1N1), Influenza A (H3N2) and two influenza B viruses.

The nasal spray is approved for use in people 2 years through 49 years of age. People who are pregnant or have certain medical conditions (such as asthma) should not receive the nasal spray influenza vaccine.

Based on guidelines from the CDC and the American Academy of Pediatrics, people with egg allergies no longer need to be observed for an allergic reaction for 30 minutes after receiving a flu vaccine. It is now recommended that people with a history of severe allergic reaction to egg (any symptom other than hives) can now be vaccinated in an inpatient or outpatient medical setting, under the supervision of a health care provider who is able to recognize and manage severe allergic conditions.

"All children with egg allergy of any severity can receive an influenza vaccine without any additional precautions beyond those recommended for all vaccines," the AAP wrote in the September 2018 edition of Pediatrics as part of its "Recommendations for Prevention and Control of Influenza in Children, 2018-2019."

Backing up the AAP and CDC, is recent research in the Annals of Allergy, Asthma and Immunology, which found the flu shot to be safe and recommended its use for people who are allergic to eggs.

Jason Terk, M.D., a Cook Children’s pediatrician in Keller, said previous recommendations on egg-allergic individuals not receiving a flu vaccine were based on the fact that most of the flu vaccine currently available is created from viral cultures in chicken embryos. Experts theorized there was a risk because of the concern that small amounts of the egg that the viral cultures come from could end up in the vaccine.

“After years of study and observation, it was found that no significant increased risk for reactions occured in egg-allergic people,” Dr. Terk said. “The recommendation to avoid flu vaccine for egg-allergic people has been removed. No medical intervention is without risk. But the risk of influenza and the complications arising from it far exceed the infinitesimal risk of influenza vaccination.”

If you have concerns, Dr. Terk said your pediatrician should be happy to answer questions about your child and why the flu vaccination should be given.

Influenza, commonly known as "the flu," is a highly contagious viral infection of the respiratory tract. It affects all age groups, though kids tend to get it more often than adults.

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

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

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

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

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

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

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

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

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

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

More Resources:

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

To identify the hot spots, researchers from the University of Texas at Austin and Johns Hopkins University looked at each area’s volume of international travel from foreign countries with large measles outbreaks and the prevalence of nonmedical exemptions from childhood vaccinations.

The same researchers previously predicted outbreaks in Washington, Oregon and New York which are all experiencing an influx of measles cases.

“For measles, most experts believe that there will be one to two deaths per 1,000 cases, most likely infants. We are set to see over 1,000 cases in the U.S. in 2019. So, for the first time since the 1980s, we may expect infant deaths from measles in the U.S.,” said the study’s lead author, Sahotra Sarkar, a philosophy and integrative biology professor at UT Austin and an expert on public health, in UT news. “We have long known that vaccine avoidance is a critical public health issue in the U.S. and Europe. Our results show how travel from regions elsewhere compounds this risk.”

The Texas Department of Public Safety has confirmed 15 measles cases in Texas this year, including one in each: Tarrant, Dallas and Denton counties and two in Collin County. Comparatively, Texas had nine measles cases in 2018 and only one in 2017.

Already this year, more than 760 cases of measles have been confirmed in the United States, the highest number in decades.

Physicians at Cook Children’s call this news frustrating because measles is a disease once thought to be all but gone from the planet. Texas has one of the highest rates of unvaccinated children in the U.S., partly due to a 2003 state law allowing parents to opt out of getting their children immunized for reasons of conscience.

“It’s not a coincidence that as we have seen more people hesitant to receive the vaccine, we have seen the number of measles cases increase nationwide,” said Justin Smith, M.D., a pediatrician at Cook Children’s. “The numbers are very concerning.”

Measles is a highly contagious respiratory illness spread by contact with an infected person through coughing and sneezing. Measles is so contagious that if someone has it, 90 percent of the people around that person who are not immune will become infected.

The Centers for Disease Control and Prevention (CDC) recommends children who are older than 12 months get two doses of MMR vaccine, starting with the first dose at 12 through 15 months of age, and the second dose at 4 through 6 years of age. Teens and adults should also be up to date on their MMR vaccination.

Two doses of the MMR vaccine are about 97% effective at preventing measles; one dose is about 93% effective.

"Populations who choose to not follow the recommended vaccine schedule are actually setting up the perfect conditions for the diseases they are unvaccinated for to erupt into an outbreak. It is really not a question of whether these outbreaks will occur but when," said Jason Terk, M.D., a Cook Children's pediatrician.

Other Texas counties to make the Top 25 were Harris at No. 9 and Travis at No. 22.

To learn more about where you can receive vaccines in the Tarrant County area, visit the Immunization Collaboration of Tarrant County website.

For More on This Topic:

• 25 U.S. Counties Identified as Most at Risk for Measles Outbreaks
• Vaccines and Immunizations
• Immunization Collaboration of Tarrant County
• Common Questions About Immunizations
• Why Children Like Olivia Need You to Immunize
• From Vaccine Hesitant to Pro Vaccines. Why This Mom Changed Her Mind.
• Pediatricians Remember Experiences with Measles
• What The First Measles Case in Tarrant County Means for Your Child
• 'Vaccines Are Safe and Effective'
• When It Comes to Your Kids It's Never Just a Virus
• Measles Outbreaks Increase as Vaccination Rates Decrease
• Measles In the Classroom
• MMR/thimerosal/mercury: What you should know

Last year, TCPH reported two associated deaths for the season. 

According to the Centers for Disease Control and Prevention (CDC), in 2016 there were:

• 354 human West Nile Virus cases in Texas
• North Texas accounted for the most WNV cases in the state
• Dallas county had 61 WNV cases, more than any other county in Texas
• Tarrant County had 44, the second largest number of WNV cases in the state
• The number of cases peaked in August

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

About 20 percent of infected people will develop a fever with other symptoms such as headache, body aches, joint pains, vomiting, diarrhea or rash.

Most people with this type of the disease recover completely, but fatigue and weakness can last for weeks or months. Less than 1 percent 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.

“West Nile Virus infection is found in local mosquitoes. It is acquired from mosquito bites and not from infected people," said Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cook Children's. "Most children who are infected with this virus do not develop symptoms. It has been circulating in mosquitoes in the United States for many years and is not new."

Precautions to take

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

The Tarrant County “Be Mosquito Free” campaign hopes to eradicate mosquitoes through taking simple precautions such as:

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

TCPH’s video Mosquitoes Love Water has NEW tips to show residents how to take control of their property and help protect their neighbors. You can also view the following videos: Eliminate Mosquito Breeding Sites and Barrier Treatments to Prevent Mosquitoes.

Other resources:

• West Nile Virus Fact Sheet (English)
• My Kid Minute: What You Need To Know About Mosquitoes
• The deets on Deet
• Chikunguna Fact Sheet (English)
• Zika Virus Fact Sheet (English)
• Zika Virus Fact Sheet (Spanish)
• Mosquito Facts (English)
• Mosquito Facts (Spanish)
• Backyard Checklist (English and Spanish)
• Keep Mosquitoes Away (English and Spanish) 
• Skeeter Syndrome


•  

"Parents may think buying costumes that are too big allow children to wear the costumes for several years, but outfits that are too big can cause falls," said Dana Walraven, manager of Community Health Outreach at Cook Children's and coordinator of the Safe Kids Tarrant County Coaltion.

Use these tips as your kids are preparing for Halloween:

1. Select costumes that fit well.
2. Trick-or-treat with your children.
3. To help drivers see kids in the dark, put reflective tape at the top and bottom of costumes. This lets drivers better see your kids' height and movement.
4. Use face paint instead of masks so trick-or-treaters' vision isn't blocked.
5. Plan a familiar trick-or-treating route on safe, well-lit streets, use sidewalks and cross the street at intersections.
6. When crossing the street, use the crosswalk and make eye contact with the drivers so you know they see you and your group.
7. Use a flashlight or glow stick to light the way.

For more safety information

Being a parent is tough. We want you to know that you are not alone. We've compiled tips, resources and practical advice on a variety of safety and prevention topics designed to help you raise a safe and healthy family.

Placing a crib, changing table or chair next to a window might offer your child a nice view outside or access to fresh air, but be careful – window falls can happen to anyone and in some cases, can be deadly. Safe Kids Tarrant County, a program within Cook Children’s Community Health Outreach department, recommends that adults actively supervise their children when around open windows. Toddlers have been known to fall out of windows open as little as five inches.

Sharon Evans, Trauma/Injury Prevention coordinator at Cook Children’s, worries that the early cooler weather could produce even worse numbers than the previous year. 

From Oct. 1, 2014, to Oct. 21, 2015, Cook Children's cared for 13 children who had fallen from a second or third story window from Oct. 1 2014. During that time frame, one child died.

This is definitely a ‘fair weather’ injury and children 3 to 4 years old seems to be the highest risk,” Evans said. “In talking to parents, we’ve also found that families with special needs children, such as autism, have a special concern about falling out of windows. It’s more common than I ever thought.

“Some families have to worry about the kids just wandering off, but the impulse control is missing in a lot of these children so if they see something out the window they will sometimes dive to get it.”

According to the U.S. Consumer Product Safety Commission, on average eight children ages 5 and under die each year as a result of falling out of windows, and 3,300 are injured. In Safe Kids’ 2015 Report to the Nation: Protecting Children in Your Home, 70 percent of parents surveyed said they had never used window guards or stops that prevent windows from opening.

Another concern according to that same report is the risk of window blind cords. On average a child dies almost every month from strangling in window blind cords. To protect children, cords and strings should be kept out of reach of children and cribs, beds and furniture should be placed away from windows and cribs.

Cook Children's and Safe Kids Tarrant County strongly recommend window guards on all windows above the first floor, preferably guards equipped with an emergency release device in case of fire.

“A screen is not a safety device,” said Dana Walraven, Cook Children’s Community Health Outreach manager and Safe Kids Tarrant County coordinator. “It’s designed to keep insects out, not to keep children in. Proper safety guards on windows save lives.”

A pilot program in New York City showed that window guards reduce window fall-related deaths by up to 35 percent. “In an apartment in a high-rise building, window guards should be considered essential safety equipment,” Walraven said.

Walraven also reminds parents and caregivers:

• Install window guards to prevent children from falling out of windows. For windows above the first floor, install window guards with an emergency release device in case of fire.
• Install window stops so that windows open no more than 4 inches.
• Keep windows locked and closed when they are not being used.
• Keep furniture away from windows so kids can’t climb to the ledge.
• If you have double-hung windows — the kind that can open down from the top as well as up from the bottom — it is generally safer to open the top pane, but growing kids may have enough strength, dexterity and curiosity to open the bottom pane.
• Never try to move a child who appears to be seriously injured after a fall — call 911 and let trained medical personnel move the child with proper precautions.
• Consider using cordless window products in your home if you have young children or if they visit your home frequently.
• Check all Roman blinds and roll up shades in your home — kids have been strangled while playing with dangling cords. If looped pull cords, exposed inner cords, or exposed lifting loops are found, replace the blinds or shades with products that do not have exposed pull cords or inner cords.

For more information

Cook Children's partners with the community to raise awareness and meet learning centered around injury prevention and child safety. Whether it is the correct use of a car seat, drowning prevention education in the schools, or providing a better awareness of poison hazards to new moms, we are working to create safe homes and communities for children. Learn more here.

Last year, 24 kids died in the U.S. and from 1998 to present, 676 children have died.

“What’s heartbreaking is that this is a serious public health issue that is totally preventable,” said Dana Walraven, Community Health Outreach manager at Cook Children’s and Safe Kids Tarrant County Coordinator. “Every mom and dad out there must realize it can happen to you. Texas leads the nation in child heat-related car deaths.”

Parents may mistakenly think they can safely leave a child in a vehicle for a “quick” errand, but that’s simply not true. Temperatures inside the car can be 20 or more degrees hotter than the temperature outside, rising to dangerous levels in minutes. Unfortunately, it only takes a few minutes for tragedy to occur.

Safe Kids Worldwide says that heatstroke is the leading cause of non-crash, vehicle-related deaths for children.

“Heat is much more dangerous to children than it is to adults,” Walraven said. “When left in a hot vehicle, a young child’s core body temperature may increase 3 to 5 times faster than that of an adult. This could cause permanent injury or death.”

Heatstroke, or hyperthermia, occurs when the body isn’t able to cool itself quickly enough and the body temperature rises to dangerous levels.

Safe Kids recommend the “ACT” method to prevent tragedy to your child or to a child you see left in a car:

• A: Avoid heatstroke-related injury and death by never leaving your child alone in a car, not even for a minute. And make sure to keep your car locked when you’re not in it so kids don’t get in on their own.
• C: Create reminders by putting something in the back of your car next to your child such as a briefcase, a purse or a cell phone that is needed at your final destination. This is especially important if you’re not following your normal routine.
• T: Take action. If you see a child alone in a car, call 911. Emergency personnel want you to call. They are trained to respond to these situations. One call could save a life.

It’s difficult to think that as parents, we could “forget” our children, but it happens each year with no exception to socioeconomic or education level. Often times, a change in routine, a distraction along the way, or the event a child falls quietly asleep, unseen, in the back seat, allows for a parent/caregiver to “forget” and leave a child in the car.

Here are some important tips to help prevent unintentional injury to your child:

1. Dial 911 if you see an unattended child in a car. Sometimes, people don’t want to get involved or just assume the parents are on the way out. But as you read earlier, it doesn’t take long for a child to die in a hot car. If you see a child or children alone in a car without an adult, call 911 immediately.
2. Never leave your child alone in a vehicle, even for 1 minute. Windows left slightly open will not affect rising temperatures in the car.
3. Set safe habits: leave a cell phone, purse, briefcase, etc. in the back seat before driving, forcing you to always check the back seat and see a child is/is not back there.
4. Program your cell phone and/or computer to remind you to drop off your child each day.
5. Have a plan with your daycare provider to contact you within a few minutes of being late or absent. Let your daycare know that you want them to call you if you are late or you have not called in saying your child will not be in that day.
6. Teach children not to play in any vehicle.
7. Lock all car doors, even at home.
8. If a child goes missing, always check the cars and trunks.

Learn more by clicking here. Also, visit noheatstroke.org for the latest on heatstroke deaths of children in vehicles.

For more information

Every year children are rushed to the emergency room to be treated for car related injuries, many don't even involve traffic or another car. Some injuries occur without the car ever leaving the driveway. Click here for some of the top dangers to be aware of and the key things you can do to help make your car safer for your kids.

As we expected, both mosquito-borne illnesses have been reported in Tarrant County.

West Nile

On July 13, Tarrant County Public Health (TCPH) confirmed the first case of West Nile virus for the 2016 season. The case is from Bedford and is the severe form – West Nile Neuroinvasive Disease. More information is not being released to protect the patient’s identity.

Symptoms of the more severe form of West Nile include neck stiffness, stupor, disorientation, coma, tremors, convulsions, muscle weakness and paralysis. This form of the disease can be deadly.

The mild form of the disease is commonly referred to as West Nile Fever. Symptoms include headache, fever, muscle and joint aches, nausea and fatigue. People typically recover on their own, although symptoms may last for several weeks.

“West Nile Virus infection is found in local mosquitoes. It is acquired from mosquito bites and not from infected people," said Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cook Children's. "Most children who are infected with this virus do not develop symptoms. It has been circulating in mosquitoes in the United States for many years and is not new."

TCPH reminds us that we can protect ourselves from the West Nile virus through prevention and protection.

Reduce mosquito breeding sites:

• Dump mosquito breeding sites:
• Dump standing water
• Overturn containers
• Dispose of trash

Use dunks, bits and briquettes

Protect yourself:

• Use EPA-approved insect repellent
• Wear long sleeved shirts and pants

Zika

Tarrant County Public Health has identified two new imported cases of Zika, raising the total number to 11. There is still no local transmission in Texas.

The chance of a healthy child living in this area becoming ill with either of these viruses, West Nile or Zika, currently is "very, very, low," according to Dr. Whitworth. She said if Zika begins to circulate in local mosquitoes this may change, but it hasn’t yet. She adds that the best thing parents can do is help their children avoid mosquito bites. And if your child becomes ill and you have concerns, seek medical care. 

"Zika Virus is not currently circulating in local mosquitoes and so in this area it only occurs in returning travelers who are infected, their sexual partners, and, sadly sometimes their infants," Dr. Whitworth said. "Until this is circulating in local mosquitoes, the risk of infection here is very close to zero with this virus."

The chance of a healthy child living in this area becoming ill with either of these viruses currently is very, very, low. If Zika begins to circulate in local mosquitoes this may change, but it hasn’t yet. The best thing parents can do is help their children avoid mosquito bites. And if your child becomes ill and you have concerns, seek medical care. “

The first patient had traveled to Jamaica and the second patient to St. Lucia.

Harris County Public Health (HCPH) confirmed the first Zika related microcephaly case in the state of Texas. The mother had traveled from Latin America. The mother received inconclusive test results for Zika. The baby received a definitive positive lab result for Zika, which means the mom most likely carried the virus while pregnant and is thought to have been infected in Latin America.

Microcephaly, is a medical term for an abnormally small head. The causes of microcephaly can vary, but in this instance the small skull was directly related to abnormal fetal brain development.

The Centers for Disease Control and Prevention 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.”

The CDC asks that travelers protect themselves from mosquitoes by using insect repellent, wearing long sleeves and pants, and staying in places with air conditioning or that use window and door screens.

Related links:

• Tarrant County Public Health
• West Nile: What are the symptoms?
• How to fight and win against mosquitoes
• Will Zika affect your family?
• Zika: From nuisance to 'genuine threat to public health'
• Should we be afraid of Zika?
• Guillain-Barré syndrome: Are you at risk?
• 11 facts about the Zika virus
• The deets on DEET

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.

Tarrant County Public Health (TCPH) identified the first imported case of Zika virus in the county, in a positive sample tested in TCPH’s North Texas Regional Laboratory.

TCPH says the patient traveled to a Caribbean country with known local transmission of the disease. No other health information will be released at this time to protect the identity of the patient.

Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cook Children’s, expressed confidence in the job of Tarrant County Public Health monitoring the situation locally. She said people should know that attention that is being paid to the spread of the Zika virus.

“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."

TCPH says: “Zika virus is spread to people primarily through the bite of an infected Aedes species mosquito. The most common symptoms of Zika are fever, rash, joint pain, and conjunctivitis (red eyes). The illness is typically mild with symptoms lasting for several days to a week. People usually don’t get sick enough to go to the hospital, and they very rarely die of Zika.”

Sexual transmission of Zika virus can also occur and is of particular concern during pregnancy. TCPH adds: "If a person infected with Zika virus is bit by an Aedes mosquito, that mosquito may later bite another person and spread the virus further."

“The most important thing residents can do is to eliminate mosquito breeding sites around their home,” said TCPH Health Director Vinny Taneja. “When we stop the breeding cycle, we help stop the spread of mosquito-borne diseases.”

Although the beginning of mosquito season is still several weeks away, residents are encouraged to maintain their properties to reduce mosquito breeding sites. Residents should:

• Routinely dump standing water on their property,
• Overturn all small containers,
• Dispose of any trash or debris that can contain small amounts of water.

TCPH has produced a video to help residents Eliminate Mosquito Breeding Sites.

County residents can also call the health department’s Zika Hotline (817-248-6299), if they have questions about this disease. For more information on Zika virus and for other useful tips, click here.

More resources:

Zika virus information from Cook Children's

Zika: From nuisance to 'genuine threat to public health'

How to fight and win against mosquitoes

Centers for Disease Control and Prevention Zika site 

So why did the Tarrant County Health Department just announce that there is a case of rubella in a Texas Christian University student?

Unfortunately, the student returned from a part of the world where rubella continues to be an ongoing concern. The World Health Organization states that rubella continues to cause infection in Africa, the Eastern Mediterranean and Southeast Asia. Despite the fact that rubella is no longer transmitted in the United States, an average of 10 cases of rubella are diagnosed here each year from travelers who bring it back from affected areas.

Don’t get me wrong, rubella is a big deal. Prior to the vaccination, it used to cause millions of cases per year around the world. The most severe complication from rubella is congenital rubella syndrome (CRS) which can affect the babies of women who contract rubella during the first three months of their pregnancy. Children born with CRS are at risk for growth problems, developmental delays and other birth defects.

We should definitely be aware that there is a case of rubella in our area, but I’m advising parents not to panic about their children getting rubella.

Here are the 2 main reasons why I’m choosing not to panic:

1. Rubella is a mild illness in children. It can start with a mild fever (but often doesn’t) and then causes a rash that starts on the face and spreads downward. Other complications from rubella are very rare and are more likely to happen in teenagers and adults.

2. Rubella vaccine works very well. After the first dose of the rubella vaccine (given at 1 year), 90-95 percent of children are protected. After the 4-year booster dose, protection gets much closer to 100 percent. If your child is vaccinated, they are most likely protected. As with anything, the vaccination is not perfect so we are relying on each individual person getting vaccinated to help protect their neighbors from an outbreak. Despite the fact that cases of rubella have been imported into the United States, no outbreaks have occurred, thanks to our relatively high immunization levels.

Children (or adults) who are infected by rubella can spread the disease via droplets spread by sneezing or coughing. We recommend all children be vaccinated against rubella. The vaccination helps prevent children from getting the disease and it also helps protect anyone they may come in contact with, including pregnant women.

Pregnant women with rubella run the risk of potentially having a baby with congenital rubella syndrome.

As always, if you are pregnant (especially in the first three months), use caution around sick individuals especially those with a rash. If you already have a baby, you were likely checked for rubella immunity at the delivery and your doctor should have the results of that test. If you are thinking about becoming pregnant, a doctor can check your immunity level now so that you can be vaccinated prior to getting pregnant.

Let’s not panic about rubella at TCU. If your child is starting classes there, feel free to send them on (I’ll be on campus for a meeting today if that gives you any peace of mind). Let’s be aware. We’ll follow the story and notify you if there are any updates or new reasons to be concerned.

More resources:

• Rubella
• Frequently asked questions about immunization
• Measles: Just a plane ride away
• Should you immunize?

That was the overall message from Fort Worth, Texas Mayor Betsy Price and representatives from the city of Fort Worth, including Cook Children's, at a press conference to address city-wide support of drowning prevention measures.

Mayor Price said that the message of the day was that tragedy in the water only takes seconds and that drowning is a silent killer. "Children drown without a sound," she said.

The press conference called for awareness and a city-wide call-to-action to protect our children through education, prevention and response. Along with the Mayor and Cook Children's, representatives from the Fort Worth Drowning Prevention Coalition, the Fort Worth YMCA, the Fort Worth Firefighter Charities, the Fort Worth Fire Department and MedStar were all in attendance.

The event included a poignant speech from Denise Doherty, an RN and director of Emergency Services at Cook Children's. Doherty said her staff is "drained and heart broken" from the number of children and patients affected by this "very preventable tragedy."

In the past two months, Cook Children's has seen nearly a child a day for drownings. The month of July began with two drowning deaths and Cook Children's Trauma Department seeing 19 total drownings from July 1 to July 22, compared to 11 drownings and two fatalities last year for the entire month of July. June saw more than double the amount of non-fatal drownings from a year ago with 26. 

Parents have been urged to watch their kids. Now the message has a new sense of urgency - you must protect your children. 

"We've seen more than enough children die this year," Doherty said. "It has to stop. Can you imagine being a parent, sitting in the ED waiting room, praying that the life of someone you love so dearly is spared, especially since it was something that didn't have to happen? No parent wants to be saddled with that guilt. I think it's also appropriate for me to say that no one is immune, and yes, it can happen to you. Cook Children's has witnessed this in a very intimate way, even our own medical community has experienced this heartbreak."

Doherty added," Today, we're making a plea. It's not only time to watch your kids near the water, but it's time to protect them."

So what does it mean to truly protect your kids? Help us spread the word with these tips:

1. Get in the water. Be in arms reach of your child. Don't let your child out of your sight and be there to grab your children out of the water at any sign of trouble.

2. 100 percent adult supervision at all times. Be active in the pool with the children or watch like a lifeguard. Don't take your eyes off of your child. If you aren't in the water, be sure to watch your kids at all times. Don't spend time on your smartphone, talking to friends or walking away for even a moment. Do have a phone nearby in case of an emergency. But that's the only time anyone should be using one.

3. Watch them until they are safe and inside. Monitoring your kids includes accounting for everyone who had been in the water all the way to the house or apartment. Once you are inside, count again and make sure all the kids are safe and inside.

4. Be a water watcher. If you are at a party with a group of children, take 15-minute shifts watching the kids. Count heads above water and look for any that are motionless on the bottom of the pool. Give your undivided while you are the water watcher. Stay sober and be alert. You can't have a more important responsibility.

5. Life jackets. Not just any flotation device will do. Make sure your life jacket is U.S. Coast Guard approved. Check the tag to say so.

6. Swim lessons. Mom and dad, you need to know how to swim. If you don't know, take lessons with your child. Make sure your child knows how to swim too. If they are in the pool, they need to know how to get to safety. But this is only a layer of protection and doesn't take away from the fact that you need to be in arm's reach.

7. Know CPR. Local CPR lessons are given in your area. A quick Google search should help you find a class.

8. Use pool and child alarms to alert you if your child gets in the water without you.

9. Isolate your pool from the rest of your backyard with a permanent, four-sided fence with self-latching gates to prevent kids from accessing the pool area without an adult.

Previous articles on this topic:

• Drowning prevention - watch your kids
• Drownings double from a year ago 
• Be a water watcher. Adult supervisions saves lives.
• Is your baby ready for swim lessons?
• Drowning tragedy - 'I can't believe this happened to me.'
• Swimming with Type 1 diabetes
• Cook Children's drowning prevention page

For more information

Learn more about drowning prevention and water safety here. This page gives helpful information on keeping your kids safe during swim season, including proper fit for life jackets, pool safety videos and fences/alarms information.

Since Oct. 1, 2014 to present, 40 drownings have been seen here and three of them have been fatal.

Those numbers are chilling and once again place an emphasis on water safety in the area.

Dana Walraven, community health outreach manager for Cook Children’s, wants to make sure that parents are prepared for warm weather and children in the water. She said the safety begins with making sure a grownup is watching the kids in the water at all times.

“Active adult supervision and layers of protection such as door alarms and a fence can lower the risk for your child,” Walraven said. “The majority of these water-related incidents happen in the child’s own backyard pools and to children 4 years old and younger. Drowning prevention around the pool starts with adult supervision.”

Children are protected by layers of protection by using these safety techniques whenever children are around the pool:

· Always have adult supervision present when children are swimming or around pools.

· A fence with a locking gate should surround the pool.

· Install door alarms to alert adults when a child is entering the pool area.

· Require life jacket use for non-swimmers.

· Enroll children in swimming lessons.

· Parents and caregivers should undergo CPR training.

In nearly nine out of 10 child drowning –related deaths, the parent or caregiver said the child had been with them in the house or pool within five minutes of the accident. Walraven says she knows it is difficult to supervise children 100 percent of the time. She said the levels of protection provide barriers in case the child should slip out of supervision.

Safe Kids Tarrant County, led by Cook Children’s, also offers Water Watcher tags to anyone or group who will use or distribute them. These are especially helpful at parties around the pool or lake to help designate adults that are watching the water. After 15 minutes, the tag is given to another responsible adult – letting everyone enjoy the party while ensuring that the kids are being properly watched. To receive a Water Watcher Tag, call 682-885-4244.

In large pools, it’s ideal to split up in groups and take sections of the pool.

“If you are somewhere where children are in the pool, insist that an adult be on watch,” Walraven said. “It should be done by a sober adult and that should be his or her only focus during their time watching the kids.”

Aside from supervision, four-sided isolation fencing with self-closing/self-latching gates is the best protection for your child and pets. It could prevent 50-90 percent of childhood drowning and near-drowning incidents. This type of fencing goes beyond the yard, to fencing in the pool itself, preventing direct access from the house.

Door and gate alarms give another signal that a child may have access to the pool area without supervision. The tendency is to disconnect it – especially at parties where people are going in and out. But these are also the times when small children are the most vulnerable for injury because of the confusion.

Learning CPR can save a child’s life by restoring breathing and circulation until advance life support can be given by health care providers.

Swim programs for children should teach good water safety behaviors in and around the pool but should not be seen as the sole way to decrease the risk of drowning.

Use a U.S. Coast Guard approved lifejacket with children who can’t swim. It should fit snugly when the child is buckled in and should not go beyond the top of the ears when lifted at the shoulders. Many air-filled, float-type toys are thought to be lifesavers but are not.

Check your pool and spa for cracked or broken drain covers on a regular basis. The suction around the drain can catch hair or clothing, pinning the child underwater. Anti-entrapment drain covers are available for as low as $40 and serve as another level of protection.

Since beach balls, noodles and other toys are attractive to curious young children – put them away when not at the pool.

For more information

Cook Children's has many resources on drowning prevention, beginning here. Click the links below with downloadable information in both Spanish and English, as well as videos. 

• Drowning prevention tips - English
• Drowning prevention tips - Spanish
• Water safety resources
• Drowning prevention education (English and Spanish)

Videos:

• Pool safety video step 1: Supervision
• Pool safety video step 2: Fencing
• Pool safety video step 3: Pool and spa covers
• Pool safety video step 4: Alarms
• Pool safety video step 5: Safety drain covers
• Pool safety video step 6: Swimming lessons
• Pool safety video step 7: Learning CPR
• Safe Kids Tarrant County Drowning Prevention Tips
• Safe Kids Tarrant County sugerencias de prevención de ahogamientos 

When people think of homelessness, they commonly think of someone living in a park or on the street with no structure to sleep under but the effects of homelessness are felt by many in less dire circumstances. There are various classifications of homelessness which include homelessness without shelter but also include the following:

1. Homelessness with shelter - Living in a supervised private or public shelter.
2. Imminent homelessness - A chance that the primary residence will be lost in 14 days.
3. Youth/family instability

In survey data from 2012, the Cook Children’s Center for Children’s Health show than 7.5 out of 1000 kids in Tarrant and the surrounding counties had spent the night in an emergency shelter or with family/friends due to homelessness. Because of the nature of the study, my suspicion is that this number is likely understated. Despite the fact that it is more common in low socioeconomic areas, it is not restricted there. An example of this might include a child who is kicked out of the home for various reasons.

What are the effects of homelessness youth and children?

1. 97 percent have moved more than once in the last year.
2. Interrupted or ineffective school participation
3. 22 percent have been witnesses to domestic violence
4. 50 percent of homeless teenagers have depression or anxiety
5. More likely to have severe asthma, malnutrition, ear infections, exposure to toxins
6. More likely to have mental health and substance abuse issues
7. More like to engage in dangerous sexual activity leading to STDs and unintended pregnancies
8. 7 times more likely to be victims of violent crime

All of these issues can be categorized under the heading “toxic stress.” Toxic stress occurs when a child experiences strong, frequent and prolonged adversity. Studies show that these experiences can have significant effects on the development of the brain and other organs which can lead to increased risk for negative mental and physical health outcomes. These problems can persist well into the adult years, even when the stressful situations have resolved.

What can you do?

1. Be aware - One of the biggest problems with addressing homelessness is that many people are not aware that it is even an issue in their area.
2. Donate time - There are many programs available in our area where you can serve as a mentor to children in schools. Children going through toxic stress benefit greatly from having an adult who spends time with them and with whom they can process their experiences.
3. Donate financial resources - Many homeless shelters struggle to survive financially. They have a hard time providing healthy nutritional options and, certain times of year, even enough beds to house all those in need.

Learn more about homeless in Tarrant County here. 

The

I understand the fear. Ebola is a terrifying disease. Symptoms start off similar to flu and progress to liver and kidney failure, followed by internal and external bleeding and then often times by death (about 60 percent of the cases).

So, I get it, it’s scary. The way people die from Ebola is very unpleasant which makes it even scarier. But it shouldn’t be the scariest infectious disease to us. Here are three reasons why:

Reason No. 1 – It’s actually not that contagious.

Ebola is transmitted via blood and body fluids. Contrast that with measles and flu, which are spread via droplets. Obviously, doctors are using extreme caution when treating patients with Ebola and I agree with that. However, the likelihood of catching Ebola from being in the same room with a person with it is not that high. If someone with measles or flu coughs or sneezes near you, it’s very possible that you will contract the disease.

Hepatitis A is another virus that can spread quickly because it is spread via a pathway called the fecal-oral route (yes, it’s as gross as it sounds). It causes vomiting and in severe cases, liver failure. Outbreaks of Hepatitis A often occur when a food worker unknowingly spreads the disease by handling the food with contaminated hands.

Meningococcal meningitis is another illness that commonly spreads quickly and anyone who has been in the room with an infected person is at risk. Outbreaks used to occur commonly on college campuses prior to the introduction of universal vaccination. Health care workers who are exposed to a patient with meningitis have to undergo treatment to try to prevent contracting the disease. So remember that when the person next to you in a room looks sick; it’s probably not Ebola, but it could be any of these other scary things.

Reason No. 2 - People with Ebola are not contagious until the affected person is sick.

Because patients with Ebola are very sick, they are unlikely to be walking around infecting everyone in their path. There will not be people walking around looking fine, unknowingly spreading the disease to everyone they meet. This is not the case for many other infections. See my example for Hepatitis A above.

Pertussis, or whooping cough, is another disease where many infected people (usually adults) can walk around contagious for weeks at a time coughing the bacteria on everyone they meet. Pertussis is not that serious in adults (aside from an occasional broken rib here and there), but it can be deadly in small babies. Despite being sick, many people with flu suck it up and trudge into work or school because they think flu isn’t that big of a deal. The problem is that while one person may not have trouble with flu, they may have contact with small infants, pregnant women or older adults who can have significant complications from it.

Another disease that affects 1/3 of sexually active teenagers and adults is human papilloma virus (HPV). Most often boys and girls who carry HPV do not know they are infected and thus spread it to their sexual partners. HPV by itself is a troubling problem, but even more troubling is the fact that HPV is the leading cause of cervical cancer (about 99.7 percent of cases).

Reason No. 3 - Ebola is not that common and has not been transmitted in the United States.

The world-wide, all-time death total from Ebola sits in the thousands … the world-wide death toll from measles was 122,000 in 2012 alone. Ebola has a very high rate of death and severe illness, much more so than measles, but because measles is much more common it affects many, many more people. There has never been a case of Ebola transmitted from person to person in the United States. There have been over 600 cases of measles in the United States thus far in 2014. What about deaths? Fortunately, there were no deaths from measles, but in 2012 there were 52 deaths from the flu just in pediatric patients. It’s a simple reminder that we sometimes forget how dangerous things are when we have not heard about them for a while.

Now what?

If you aren’t convinced that many of these other infectious diseases are a more immediate concern for you than Ebola, I understand. When things are new and sound scary they tend to take over your mind. But after reading all the points I’ve made above, know there is something you can do to protect your child from the other diseases I’ve mentioned …

Every single bolded disease has a vaccine! While vaccines are not perfect and getting a vaccine in some cases does not protect you 100 percent, they significantly decrease your chances of contracting any of these diseases. In many cases, if vaccines don’t completely prevent the disease, they make the case milder and less serious. If you agree with my concerns about these other diseases, give your child the best chance by having them vaccinated.

I hope I’ve addressed all of your questions or concerns. Maybe, you still have questions about the diseases mentioned here or the vaccines to fight them? If so, please talk to your pediatrician.  

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

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

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

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

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

You can find more information about Measles by clicking HERE.

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

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