Allied’s trusted physicians talk COVID-19 vaccine, addressing questions, rumors, concerns, and why this vaccine is the only way to end the pandemic.
Category: Viruses, Diseases, & Infections
Rolling Up Our Sleeves For A COVID-19 Vaccine?
By: Rachel Levene, PhD Candidate in Molecular Microbiology at Tufts University School of Medicine and daughter of Dr. Eric Levene, Chester Pediatrics.
We’ve all seen the wonderful news about Pfizer’s and Moderna’s COVID vaccine trials – preliminary estimates of greater than 90% efficacy. I, too, am extremely excited and hopeful, especially since I am a participant in Pfizer’s trial. I’m here to break down what this all means and when we might actually be able to roll up our sleeves and get vaccinated.
How do these vaccines work?
Pfizer’s and Moderna’s vaccines were made using new vaccine technology called mRNA. Their vaccines are a message that encodes the instructions for our cells to make part of the protein on the surface of SARS-CoV-2 (the virus that causes COVID-19). Even though the cell is making a viral protein, it cannot give anyone COVID-19 as the virus needs all its proteins to cause infection. The thought is that the immune system will make antibodies against this protein, much like what happens when someone gets naturally infected. The thought is that these antibodies will neutralize SARS-CoV-2 before it enters any cells and causes illness. Both require two doses, spaced three-four weeks apart.
One challenge of this new vaccine technology is how it is stored and shipped. mRNA is notoriously unstable and it needs to be kept at ultra-cold temperatures. Pfizer’s vaccine needs to be stored at -104°F, something regular freezers simply cannot do. Moderna’s can be stored for a limited period of time in a regular freezer and/or fridge. This presents a shipping problem and problem for distributing the vaccine in areas that do not have major medical centers that have access to ultra-freezers. Both companies and the government are working on distribution plans and how long the vaccines can remain stable in regular fridges and freezers
What is vaccine efficacy?
The trials are blinded, meaning that neither the participant nor the study team knows whether a participant got the actual vaccine or a placebo (saltwater injection). Both are slated to last two years – meaning that participants are followed for two years to see if they develop confirmed COVID-19 and to look at their immune response to the vaccine. The trials are designed to be able to make vaccine efficacy estimates before the two-year mark. Vaccine efficacy is statistics – making predictions about how well the vaccine prevents illness based on numbers. After a certain number of events (COVID-19 illnesses) in the participants (deemed the endpoint), some statistical models are applied to determine how effective the vaccine might be. Based on these models, a certain number of cases among the participants, and how these cases are split amongst the vaccine and placebo group a certain percentage of efficacy can be calculated.
The trials are also designed for an independent monitoring board to take a “sneak peek” after a fewer number of cases. This is called an interim analysis. What we just learned about were these. Both trials had about 90 cases of COVID-19 in the participants and ~90% of these were in the placebo group, hence the greater than 90% efficacy estimate. While 90 cases do not seem like a lot in trials of 30,000-44,000 people, it is a lot for an event-driven vaccine trial. The primary endpoints are around ~150 cases, which based on current upticks in cases in the country should not take long to get to. While this seems like few, based on statistical modeling this is all we need to see if there is an efficacy over 60%.
What do we still not know?
The news was released by a press release, so no independent scientists have actually reviewed the data yet nor has the data been made public. Scientists, including myself, still have a lot of questions.
- How well does the vaccine prevent severe COVID-19? If the vaccine does not completely prevent illness altogether, is someone who is vaccinated less likely to need to be admitted to the hospital, need intensive care? We know this is the case for influenza vaccines. Moderna has said that 11 of the cases were severe and none of these were in the vaccine group – which is good news. Even if the vaccine does not prevent illness altogether but still prevents severe illness, it will greatly reduce the impact on our healthcare system.
- Does the vaccine prevent asymptomatic infection? We know that people can spread SARS-CoV-2 and never feel sick. It would be helpful to know if the vaccine prevents this, as it provides indirect protection to others. It is still possible to have a vaccine that prevents disease and illness but not an infection. Since the trial was primarily set up to look for illness as endpoints, this question may be harder to answer.
- How well does the vaccine work in the elderly and children? Both trials have participants over 65. There is some evidence to suggest that the elderly have weaker responses to vaccines, including the flu vaccine, and need a higher dose. The Pfizer trial is unique in that it includes children ages 12-18. This is so important because children may respond differently to the vaccine. It may take some time until the vaccine efficacy can be evaluated in children under 12.
- How long does any protection last? This is hard to know because only time can give us this answer. It is still too early to say if we will need to be vaccinated every year, need a booster every couple of years, or have lifelong immunity.
What’s next and when can we expect to get vaccinated?
The FDA has told us that they will not authorize a vaccine for use unless it shows at least 50% efficacy. The good news is that early data from both trials exceed this. The next step is for them to submit their data to the FDA for emergency use authorization (EUA). This does not mean full FDA approval but that given the circumstances, the FDA thinks the benefits outweigh the risks. This is still a very high bar. Thus, the FDA wants at least two months of safety data from the trial participants. Additionally, there will be systems in place to monitor any adverse events, should there be any, as people get vaccinated. As a Pfizer participant, I have seen first-hand that safety is the highest priority. Additionally, they must show that it can manufacture the vaccine consistently and with the highest quality standards. If the FDA gives EUA, you can be sure their experts think it’s safe.
If they have approval, there will be very limited doses at first. Many organizations and agencies have come up with early distribution plans. Healthcare professionals and first responders will likely be first followed by essential workers and those with the highest risk like those in congregate care facilities. The general public will likely not be able to be vaccinated until the spring of 2021. Until then it is so important to continue wearing a mask/face covering, practicing physical distancing, and not gathering in groups especially indoors. And be sure to get your flu shot!
Asthma and the Flu Vaccine
By Dr. Stephen Borchman
#1 asthma tip of the year- GET THE FLU VACCINE
Any parent with a child with significant asthma will naturally have an underlying fear that their child may have a catastrophic asthma episode. Their fears are well-founded, as every day in the United States between 3 to 5 individuals succumb to acute asthma. Approximately 1/3 of the victims are children. Acute asthma has a variety of triggers, and these triggers vary greatly from child to child. As I often tell parents, asthmatics are like snowflakes, no two are the same. They all have their own individual characteristics. One of the most common and potent triggers of acute asthma in children are respiratory tract infections. Fortunately, for the most dangerous of infections, we have vaccines. And of all dangerous infections, the one that is most common in our society is the influenza viruses. Influenza viruses change their characteristics every season, and there are at least a half a dozen strains that circulate the globe every year, with more evolving every year. The World Health Organization monitors the frequency and severity of influenza infections yearly and then will decide which strains to include in the annual vaccine. While not perfect, this is currently the best approach we have towards protecting people from the very potentially serious consequences of influenza infection.
Acute asthma occurs when the triggering agent, whether this is an infection, pollen, animal dander, or environmental pollutants causes a sudden inflammatory event in the child’s bronchial tubes. If this inflammation proceeds unchecked, it is often accompanied by airway spasms, resulting in respiratory distress. Any parent who has seen their child in respiratory distress knows exactly what this looks like. It is terrifying and any parent who’s been through a hospitalization with their child certainly never wants to experience that again. Influenza infection is a very potent trigger of airway inflammation. And although the vaccine may not stop every influenza strain from causing illness in your child, getting the vaccine will certainly improve your child’s chances of avoiding hospitalization. This was proven in a 2017 study. In that year, 171 children died of influenza infection in this country. Of those 171 children who died, only one had ever received an influenza vaccine, but not in the year that the fatal event occurred.
So please, on behalf of all the doctors at Allied Physicians group, please follow the recommendations of the American Lung Association, American Academy of Pediatrics, and every other medical organization, make sure your child receives influenza vaccination every year. In fact, everyone in the home should be vaccinated for influenza as well to increase the probability of keeping it out of your home. Every year your child receives the vaccine, his or her immune system acquires more information about influenza viruses and is better equipped to defend itself against these infections. Please also follow your doctor‘s recommendations as specified in your asthma control plan. Make sure you contact your practitioner if you feel your child’s asthma is unstable in any way. Lastly, please always keep your follow up appointment so your doctor can monitor and change your child’s medications as needed.
Click here to learn more about our Asthma Control Education (ACE) program.
Pediatric Inflammatory Multisystem Syndrome (PIMS): What Parents Should Know
We have been sheltering at home and following the recommendations of social distancing, handwashing and wearing a mask when we have to go out. The good news in our area is the dropping mortality and hospitalization rates of COVID patients. There is a new concern, however, for our children – Pediatric Multisystem Inflammatory Syndrome or PIMS.
PIMS is a very rare syndrome similar to Kawaski Disease and Toxic Shock syndrome, which most of you have never heard about. While extremely rare, about 100 children have been affected. The syndrome is thought to be a post-viral process, most likely related to COVID 19. The majority of patients with PIMS are COVID-antigen negative, but antibody positive or have a history of close contact with a COVID-positive patient.
Children with PIMS look sick. They have had a few days of fever greater than 101, and may have symptoms that include abdominal pain, vomiting, diarrhea, headache, rash, red eyes, swollen hands or red cracked lips. Younger children may not want to drink. Few patients actually have the respiratory symptoms we see in adults.
Our concern is the syndrome may affect heart function requiring hospitalization and ICU care. The majority of children do well with this syndrome but they need special attention and supportive care. Pediatric Multi-system Inflammatory Syndrome is new. We are watching this very carefully and scientists around the world are working hard to understand this syndrome and how best to treat it.
Until then, we want to reassure parents that most children are not affected by the coronavirus, and reports of children who become seriously ill remain rare and unusual cases. Many children have red eyes, or rash or diarrhea without fever or looking ill. These children do not have PIMS. What should parents do? If you are concerned, contact your Allied pediatrician. We can set up a telehealth visit and your pediatrician can evaluate your child and answer all your questions.
We are here for you and we will get through this together.
Kawasaki, Kids, and the (K)oronavirus, what you need to know
By: Dr. Eric Levene
While sheltering at home, we have become news junkies hanging on every piece of information COVID related. The latest is a potentially scary illness in children. The New York State Department of Health is reporting 15 cases of children hospitalized with signs of shock and something called Kawasaki disease.
What is Kawasaki Disease
Kawasaki Disease is a rare childhood illness that pediatricians have known about for years. This illness causes the walls of blood vessels to become inflamed. Symptomatic patients usually have high fevers for at least 5 days, rash, cracked lips, and swollen glands in the neck. If not diagnosed and treated in a timely manner, the illness can cause swelling of the coronary arteries and lead to heart problems in children. The good news is with proper treatment this serious complication can be avoided.
The cause of Kawasaki Disease is still unknown. But why are we seeing recent clusters in New York, England, Italy, and France? There is speculation that there may be some relation to SARS-CoV-2, the virus that causes COVID 19. Only 4 of the 15 patients reported in New York State tested positive for the virus, although 6 of the patients that tested negative, had positive antibody tests. We are not certain about the validity of the antibody test used on these patients.
What is happening in NYS?
The Department of Health in New York has released a statement describing 15 cases of children with shock-like symptoms both with and without Kawasaki symptoms. Most of these children showed symptoms that included fever rash, abdominal pains, vomiting, and diarrhea. Only about half had respiratory symptoms. The good news here is that although the children are very ill, no child has died.
Every day we learn more about COVID 19. Most children do well with this illness. These new reported symptoms are very rare. While the news is scary, remember these children are very ill and look sick. What should parents do? If your child is feverish, not drinking, or developing a rash, call your Allied pediatrician. We can set up a Telehealth visit and your pediatrician can evaluate your child and answer all your questions.
COVID-19: Testing, Testing, 1,2,3, Testing.
By: Rachel Levene, PhD Candidate in Molecular Microbiology at Tufts University School of Medicine and daughter of Dr. Eric Levene, Chester Pediatrics.
We have all heard a lot about the novel coronavirus or COVID19 testing lately. In fact, many of our public health experts and health professionals believe that having a strong and rapid testing infrastructure in place will be necessary before we can relax some of the social distancing protocols in place. This would allow us to quickly identify COVID19+ people in our community, isolate them and trace their contacts so that they can be isolated as well. This will help stop the spread and help us return a sense of normalcy. But where do we stand on our ability to test, treat, and even prevent COVID19?
Molecular vs. Serology Testing: What’s the difference?
There are two main ways we have to test for COVID19: molecular and serology testing. The main difference between these two is that the molecular test looks for genetic material (RNA) from COVID19 and the serology test looks for our immune response to the virus in the form of antibodies. The molecular test can tell us if someone currently has the virus while the serology test just tells us if someone had the virus at some point and produced an immune response.
What is the molecular test?
The molecular test looks for the presence of the virus in a patient and is the main testing method used by the World Health Organization (WHO), Centers for Disease Control and Prevention (CDC), state and local public health labs, and commercial labs (like Quest Diagnostics). This is what is being done at drive-in test facilities. This test involves inserting a long swab into the back of the nose (nasopharyngeal) and then sending it off to the lab. The lab then performs a test called reverse-transcription polymerase chain reaction (RT-PCR) that detects pieces of the viral RNA. This test only takes a few hours, but results have been delayed because the labs are overwhelmed. While this is not ideal because it could take many days to get a positive result and start contact tracing, this test is the most accurate and is the least likely to give false negatives or false positives
Recently, the Food and Drug Administration (FDA) has given emergency use authorization (EUA) for molecular tests that are rapid and can give results in under an hour and will greatly expedite contact tracing and isolation. These are referred to as point of care testing and are very similar to the rapid strep or influenza test that is done in the doctor’s office. The most commonly discussed rapid molecular test is the one developed by Abbott Laboratories, but there are more that are being deployed across the country. They all involve the nasopharyngeal swab but instead of sending it off to the lab, it is inserted into a machine or cartridge that will analyze it and give a result quickly. While these tests are faster, they can occasionally give false positives or false negatives which are problematic for contact tracing and isolation.
What is the serology test?
When we get sick, our immune system makes highly specific antibodies to the pathogen that made us sick. The serology test looks for the presence of those antibodies to the coronavirus in a person’s blood. Unlike the molecular test, it can detect if someone had COVID19 and has recovered. It helps give us a picture of how COVID19 has spread in the community. This test is done via a blood draw that is sent off to a lab. The lab performs a test called ELISA that looks for antibodies specific to the coronavirus that causes COVID19. This is not point of care and could, therefore, take a couple of days especially if the lab is backlogged. There is an ongoing effort to develop a rapid point of care serology test that takes under an hour and can be done with a finger stick instead of a blood draw.
Why is there so much talk about serology tests? They identify individuals that had the virus and recovered or individuals that had an asymptomatic infection. The presence of antibodies suggests these people are immune to the virus, however it is unclear how long immunity lasts and if it is possible to get re-infected. Rapid deployment of serology testing could unveil that a lot more people than we thought had COVID19 and could, therefore, be immune. This could help inform decisions about relaxing social distancing.
Are there any treatments for COVID-19?
As of now, we have no approved drug that can directly target the virus. However, there are drugs and treatments in a clinical trial. A couple of the ones in active trials in the US are described below but there are more in clinical trials across the globe. Additionally, scientists are working tirelessly to develop new drugs and see if drugs that work on other viruses can be “repurposed” to treat COVID19.
Convalescent Plasma: Individuals who were sick with COVID19 made antibodies that helped them recover. These antibodies could also help individuals currently sick with COVID19 recover by boosting their ability to fight the virus. This was done for some Ebola patients treated in the United States and had some success. This treatment is currently in clinical trials across the nation including many in NYC. Another goal of this treatment is to determine if convalescent plasma can prevent exposed individuals from becoming sick.
This treatment requires individuals who recovered from COVID19 to donate plasma. If you had confirmed or presumptive COVID19 and it has been at least 14 days from your last day of symptoms contact the American Red Cross to donate.
Remdesivir: This medication is an antiviral drug that was developed to treat Ebola. It forces the machinery that copies the viral genome to prematurely stop replicating the viral genome which stops the virus from making more of itself. There are reports that patients who received Remdesivir through compassionate use recovered. Medications provided through compassionate use are given outside of clinical trial when then are no other treatment options. There are currently clinical trials being conducted to determine if Remdesivir is truly effective against COVID19.
Chloroquine and Hydroxychloroquine: These are drugs used to treat auto-immune diseases like lupus and rheumatoid arthritis. They work by dampening down the immune system, preventing it from attacking the patient’s own body. Why could these be effective against COVID19 if we need our immune system to fight the infection? The answer is that many patients with severe COVID19 have what is called a cytokine storm. The immune system goes into overdrive causing so much inflammation in the lungs that fluid fills the lungs causing respiratory failure. The hope is that chloroquine and hydroxychloroquine would dampen the immune response so it does not go into overdrive. However, this could also be detrimental because we need the immune system to fight the virus. Nonetheless, these medications are in a clinical trial as well.
When will we have a vaccine?
An approved vaccine is likely more than a year away. We first need to find a candidate vaccine that is safe and elicits a protective immune response. COVID19 is caused by a novel coronavirus and we have no existing template for coronavirus vaccines to build from. We do not know what is safe and effective. For example, in the case of the 2009 swine flu pandemic, we already knew how to make safe and effective influenza vaccines because we do it every year when we make each year’s vaccine. This allowed us to develop and produce a vaccine for large scale distribution so quickly. However, for COVID19 we are starting from “scratch” and need to figure out what will make a safe and effective vaccine. Scientists are working around the clock to get there. Once there is a promising vaccine candidate it needs to pass Phase I, II, and III clinical trials that fully evaluate safety and efficacy. After that, the infrastructure and manufacturing need to be ramped up for large scale production and distribution. As of now, there is a candidate vaccine that has begun a Phase I trial.
This is a difficult time, but we will get through it together. Reach out to your Allied Pediatrics pediatrician via telehealth for guidance and support. For children who are interested and want to learn more about viruses, vaccines, and our immune system encourage them to reach out to their science teachers.
To Donate Plasma:
COVID-19 Asthma Update from Strauss Allergy & Asthma
By: Dr. Raphael Strauss, Dr. Robyn Kreiner, and Dr. Khalid Ahmad (Strauss Allergy & Asthma, Commack & Woodbury, NY)
Allied Physicians are getting many questions related to patients with asthma and coronavirus COVID-19. Fortunately, Strauss Allergy and Asthma is a great resource. While this is an evolving situation and information may change, our current recommendations are:
1 Take your controller asthma medications regularly as prescribed.
2 Have medication available but there is no reason to stockpile extra medication.
3 Children with asthma that is well-controlled do not appear to be at higher risk for severe outcomes. We are not hearing about excessive hospitalizations or severe cases in children in general in China, South Korea or other countries that have more cases.
We are concerned with the overall health and well-being of people and especially children in general at this time. The anxiety over this infection far exceeds the actual personal risk. We recommend keeping your kids in school if school is open. Follow public health recommendations regarding avoiding large gatherings, frequent hand washing, and reasonable social distancing. Above all, remain calm, rational and we will get through this together.
An update from Allied Physicians Group about the Coronavirus- COVID19 infections in our area
In the wake of the pandemic, private practices have faced many struggles. We acknowledge and support the American Academy of Pediatric’s stance on providing funding so that pediatricians can continue to provide essential care to children and their communities. Click here for the official letter from the President of the AAP.
7/29/20 Update:
Parent Alert:
We are receiving phone calls and emails asking for a COVID test so a child may attend a Prom/Party/weekend with friends that are being thrown and everyone coming to the party is required to have a negative test.
This is a VERY BAD IDEA that puts CHILDREN AT RISK, puts THE FAMILY OF THAT CHILD AT RISK, and puts our ALL OF US AT RISK. A negative COVID test is information. It is not a license to violate state laws on gatherings or to ignore social distancing practices.
You can be incubating COVID and have a negative test.
You can have a negative COVID test today, and be contagious tomorrow.
You can have a negative test that is inaccurate.
A negative test does not get you out of a required 14-day quarantine.
Our communities are still feeling the effects of graduation parties during which the COVID virus was spread.
DO NOT ALLOW YOUR CHILDREN TO ATTEND THESE PARTIES.
IF YOU KNOW ABOUT A PARTY LIKE THIS, REPORT IT TO THE POLICE AND THE DEPARTMENT OF HEALTH.
It is up to everyone to do their part to keep control of the virus. If we don’t we can expect an increase in spread and a return to a stay at home order for all of us. We are all in this together!
5/12/20 Update:
Many of you have called our offices asking about COVID testing. Antibody testing is a piece of the puzzle in determining whether or not someone has had COVID infection. The results of Antibody tests are best interpreted in the context of your clinical history. This means your pediatrician is the best person to help you decide if testing is appropriate and when it is most useful. Your pediatrician is also the best person to help you interpret the test. Please contact us before making any decisions about COVID antibody testing. We are here to help.
If you are interested in the possibility of having this test done for your children, please call or schedule a telehealth visit with your Allied pediatrician to discuss whether or not testing is right for you, and how we can make it happen. The COVID testing requires a venipuncture (blood draw) and cannot be done by fingerstick at this time. Results take 2-5 days to be reported.
While a positive antibody test may mean you have had COVID 19, no one can make any conclusions as to what the result will mean for the patient in terms of future immunity. We must all continue following the recommendations of social distancing, hand washing, and wear a face-covering while out.
Keeping you safe, healthy, and well-informed is Allied’s number one priority.
We are here for you and we will get through this together.
4/20/20 Update:
We have all heard a lot about the novel coronavirus or COVID19 testing lately. In fact, many of our public health experts and health professionals believe that having a strong and rapid testing infrastructure in place will be necessary before we can relax some of the social distancing protocols in place. This would allow us to quickly identify COVID19+ people in our community, isolate them and trace their contacts so that they can be isolated as well. This will help stop the spread and help us return a sense of normalcy. But where do we stand on our ability to test, treat, and even prevent COVID19?
Molecular vs. Serology Testing: What’s the difference?
There are two main ways we have to test for COVID19: molecular and serology testing. The main difference between these two is that the molecular test looks for genetic material (RNA) from COVID19 and the serology test looks for our immune response to the virus in the form of antibodies. The molecular test can tell us if someone currently has the virus while the serology test just tells us if someone had the virus at some point and produced an immune response.
What is the molecular test?
The molecular test looks for the presence of the virus in a patient and is the main testing method used by the World Health Organization (WHO), Centers for Disease Control and Prevention (CDC), state and local public health labs, and commercial labs (like Quest Diagnostics). This is what is being done at drive-in test facilities. This test involves inserting a long swab into the back of the nose (nasopharyngeal) and then sending it off to the lab. The lab then performs a test called reverse-transcription polymerase chain reaction (RT-PCR) that detects pieces of the viral RNA. This test only takes a few hours, but results have been delayed because the labs are overwhelmed. While this is not ideal because it could take many days to get a positive result and start contact tracing, this test is the most accurate and is the least likely to give false negatives or false positives
Recently, the Food and Drug Administration (FDA) has given emergency use authorization (EUA) for molecular tests that are rapid and can give results in under an hour and will greatly expedite contact tracing and isolation. These are referred to as point of care testing and are very similar to the rapid strep or influenza test that is done in the doctor’s office. The most commonly discussed rapid molecular test is the one developed by Abbott Laboratories, but there are more that are being deployed across the country. They all involve the nasopharyngeal swab but instead of sending it off to the lab, it is inserted into a machine or cartridge that will analyze it and give a result quickly. While these tests are faster, they can occasionally give false positives or false negatives which are problematic for contact tracing and isolation.
What is the serology test?
When we get sick, our immune system makes highly specific antibodies to the pathogen that made us sick. The serology test looks for the presence of those antibodies to the coronavirus in a person’s blood. Unlike the molecular test, it can detect if someone had COVID19 and has recovered. It helps give us a picture of how COVID19 has spread in the community. This test is done via a blood draw that is sent off to a lab. The lab performs a test called ELISA that looks for antibodies specific to the coronavirus that causes COVID19. This is not point of care and could, therefore, take a couple of days especially if the lab is backlogged. There is an ongoing effort to develop a rapid point of care serology test that takes under an hour and can be done with a finger stick instead of a blood draw.
Why is there so much talk about serology tests? They identify individuals that had the virus and recovered or individuals that had an asymptomatic infection. The presence of antibodies suggests these people are immune to the virus, however it is unclear how long immunity lasts and if it is possible to get re-infected. Rapid deployment of serology testing could unveil that a lot more people than we thought had COVID19 and could, therefore, be immune. This could help inform decisions about relaxing social distancing.
Are there any treatments for COVID-19?
As of now, we have no approved drug that can directly target the virus. However, there are drugs and treatments in a clinical trial. A couple of the ones in active trials in the US are described below but there are more in clinical trials across the globe. Additionally, scientists are working tirelessly to develop new drugs and see if drugs that work on other viruses can be “repurposed” to treat COVID19.
Convalescent Plasma: Individuals who were sick with COVID19 made antibodies that helped them recover. These antibodies could also help individuals currently sick with COVID19 recover by boosting their ability to fight the virus. This was done for some Ebola patients treated in the United States and had some success. This treatment is currently in clinical trials across the nation including many in NYC. Another goal of this treatment is to determine if convalescent plasma can prevent exposed individuals from becoming sick.
This treatment requires individuals who recovered from COVID19 to donate plasma. If you had confirmed or presumptive COVID19 and it has been at least 14 days from your last day of symptoms contact the American Red Cross to donate.
Remdesivir: This medication is an antiviral drug that was developed to treat Ebola. It forces the machinery that copies the viral genome to prematurely stop replicating the viral genome which stops the virus from making more of itself. There are reports that patients who received Remdesivir through compassionate use recovered. Medications provided through compassionate use are given outside of clinical trial when then are no other treatment options. There are currently clinical trials being conducted to determine if Remdesivir is truly effective against COVID19.
Chloroquine and Hydroxychloroquine: These are drugs used to treat auto-immune diseases like lupus and rheumatoid arthritis. They work by dampening down the immune system, preventing it from attacking the patient’s own body. Why could these be effective against COVID19 if we need our immune system to fight the infection? The answer is that many patients with severe COVID19 have what is called a cytokine storm. The immune system goes into overdrive causing so much inflammation in the lungs that fluid fills the lungs causing respiratory failure. The hope is that chloroquine and hydroxychloroquine would dampen the immune response so it does not go into overdrive. However, this could also be detrimental because we need the immune system to fight the virus. Nonetheless, these medications are in a clinical trial as well.
When will we have a vaccine?
An approved vaccine is likely more than a year away. We first need to find a candidate vaccine that is safe and elicits a protective immune response. COVID19 is caused by a novel coronavirus and we have no existing template for coronavirus vaccines to build from. We do not know what is safe and effective. For example, in the case of the 2009 swine flu pandemic, we already knew how to make safe and effective influenza vaccines because we do it every year when we make each year’s vaccine. This allowed us to develop and produce a vaccine for large scale distribution so quickly. However, for COVID19 we are starting from “scratch” and need to figure out what will make a safe and effective vaccine. Scientists are working around the clock to get there. Once there is a promising vaccine candidate it needs to pass Phase I, II, and III clinical trials that fully evaluate safety and efficacy. After that, the infrastructure and manufacturing need to be ramped up for large scale production and distribution. As of now, there is a candidate vaccine that has begun a Phase I trial.
This is a difficult time, but we will get through it together. Reach out to your Allied Pediatrics pediatrician via telehealth for guidance and support. For children who are interested and want to learn more about viruses, vaccines, and our immune system encourage them to reach out to their science teachers.
To Donate Plasma:
4/9/20 Update:
Dear Families,
Worry and fear are normal during the Covid-19 pandemic. Routines are disrupted. Grandparents and extended families are not around. Finances are changing. People we know are sick.
Your Allied physicians are here to provide mental and emotional support for your family during this stressful time. Telehealth is the perfect way to safely connect. We can help you and your children manage your thoughts and emotions and recommend resources to learn coping skills.
Many are unsure on how their child/teen is coping with all the change. Check-in with them.
How do they answer the following questions? How would you answer for them? How would you answer for yourself?
Over the last 2 weeks, how often have you been bothered by feeling nervous, anxious or on edge?
Over the last 2 weeks, how often have you been bothered by not being able to stop or control worrying?
Over the last 2 weeks, how often have you been bothered by little interest or pleasure in doing things?
Over the last 2 weeks, how often have you been bothered by feeling down, depressed, or hopeless?
Symptoms of anxiety or depression may be present if the answer to any of these questions is “more than half the time.” Symptoms of anxiety or depression are not the same as a diagnosis of anxiety or depression, but they do mean that your child may need your help. You can use these questions as an opening to a meaningful conversation, and/or as a reason to suggest a telehealth visit with a trusted caregiver.
Your Allied physicians are here to support you. We will get through this together.
4/8/20 Update:
Based on new recommendations from the CDC, we are now asking everyone, coming into our office, to please wear a face covering. If you have a mask or equivalent (face covering), we would be grateful if you would wear it to the office. We understand that not everyone has a “hospital type” mask, but any cloth face covering is ok. For our younger patients, pretending to wear “superhero costumes,” can make this seem fun!
We appreciate your help in keeping our Allied patients, families, staff, and our country, safe and healthy.
Recommendation Regarding The Use Of Cloth Facemask Coverings From The CDC:
https://www.cdc.gov/…/prevent-getting…/cloth-face-cover.html
Surgeon General Shows How To Make Facemasks, By The CDC:
https://www.youtube.com/watch?v=9YLXEhSjVsw
Remember, we will get through this together!
4/3/20 Update:
Dear families,
Being a parent is difficult under normal circumstances; it is even harder right now. Our own stress levels are high, and we see signs of anxiety in our children. Is this normal? Is there anything we can do? Your pediatrician, as always, is a great resource for anything having to do with your children. Telehealth visits are a perfect way to touch-base with your pediatrician over specific concerns related to your child and stress, anxiety or depression. Allied telehealth visits are covered by all insurance plans and there is no co-pay to use this service.
These general guidelines may be helpful as well:
We listen to news broadcasts and read online about COVID-19 illnesses and how our country is responding, our anxiety levels will tend to increase. We hunker down with our families and worry about our kids, elderly relatives and ourselves. Many parents are essential workers and worry about bringing home the illness to their families. Being a parent is difficult under normal circumstances, even harder today.
While our anxieties will increase at these times, we should remember our children will follow our lead. Parents should take the quantity and content of information that their children hear and adjust it to their child’s individual emotional needs. Enjoy some time as a family. Keep an eye out for problems.
Young children are wondering why there are no activities, school or playdates. Reassure them that they are safe, and everyone is staying home to keep everyone healthy. Stay calm and use words and tones that will make them feel a sense of calm. Mr. Rogers quote “Look for the helpers, you will always find people who are helping”, seems like the appropriate quote for calming young children. Tell them people like doctors and nurses are working hard to keep everyone safe. It’s ok to say you don’t have all the answers.
Older children are more aware of what is going on. Let them ask questions. Validate their feelings, give simple direction and reassuring answers. Repeat what we are hearing from the professionals. “Wash your hands, don’t touch your face and social distancing are most important to prevent the spread of the virus.” Encourage them to do schoolwork and help out around the house. Actual teaching/learning does not always happen in the “classroom.” Cooking and baking are great ways to learn math, fractions, and for older kids, Chemistry. If your family thrives on routine, make sure you keep it. If your family excels in chaos, enjoy this time and don’t set that schedule. If possible, virtual playdates are great. Showing your children their friends are fine, and doing the same as they are, can be very reassuring. If they are showing signs of anxiety such as sleepiness, sleeplessness, jumpy, decrease in appetite, you should reach out to your pediatrician. These discussions can be done by telehealth with the pediatrician that knows your family.
Your teens are online and probably giving you more information than you want. Talk about what the trusted information sources are and what is possibly fake news. Teens can get nervous and many of their end of school year plans have been disrupted and they are feeling angry. Teens might want to see their friends beyond Facetime and Zoom. Discuss the safety issues and reinforce the stay at home orders that we are under. Empathize with them. We cannot really understand what they are going through since these are unique times. Physical activity can help. When the weather is nicer, encourage them to get outside. Talk about plans for the future and how any event missed might be made up or delayed. Again, reach out to your pediatrician if you think your teen is experiencing depression or anxiety
Your pediatrician is your first and most trusted resource. They will help, if more help is needed, and will find the right person for your child. These are hard times for everyone. Don’t forget that parents should take time for themselves. The better you are, the better you are to take care of your family.
Please remember, we are not stuck at home, we are safe at home.
We will get through this together.
3/30/2020 Update:
Hello Allied Families,
We hope the new normal finds you well and you are enjoying this valuable time with your families.
We want to remind you that we are here for you and your children. Routine visits with your pediatrician are an essential part of good health and well-being. Well visits and vaccines are very important. When we finally get through the current pandemic, we certainly do not want to see an increase in vaccine preventable diseases, such as whooping cough (pertussis) and measles. These diseases can be extremely dangerous to your children. Most of our offices are still open, but office hours might have changed. Keep your well visits, it’s important.
Most of our offices, that are open, are separating well and sick visits by either time or space or both. We are doing everything to keep our patients, families, and staff safe. The offices are cleaned often, and you will see the staff working hard to make sure you feel at ease.
Additionally, all our offices are doing daytime telehealth visits, it’s the new 21st century house call! Download the Anytime Pediatrics App, (directions below), or call your pediatricians office for help making these appointments. We also have evening after hours telehealth visits from 6:30pm to 10:30pm, 7 nights a week. In addition to providing this awesome service to our own patients, Allied is now offering our telehealth service to non-Allied patients. If your friend’s pediatrician does not have telehealth, please let them know an Allied pediatrician is here to help during this crisis.
Remember to reach out to your pediatrician to get the true information on COVID19. We will have the most current information and recommendations. We are posting on Facebook about up-to-date news, homeschooling tips, and entertainment suggestions for your families. If you are not already following your doctor’s office on Facebook, now is a good time to start. If someone in your family has allergies or asthma, we suggest you follow Strauss Allergy and Asthma for recommendations and for important information about COVID19 and patients with allergies and asthma. Please also check the Allied Website for important information about Epipens. Click here for important Epipen update!
Remember we are not stuck at home; we are safe at home!
We will get through this together.
3/27/2020 Updated:
Dr. Raphael Strauss talks with romper.com about COVID and children with asthma. He is a trusted resource for all families! Click here for the article,
Is Coronavirus More Dangerous In Kids With Asthma? Doctors Weigh In.
Dr. Strauss says the recommendation is for kids and adults to take their asthma controller medications as recommended by their doctors. If you are looking to schedule an appointment with the team at Strauss Allergy and Asthma, he recommends visits by telehealth, when possible, rather than office visits for evaluation of kids and adults who have concerns. For more information about telehealth, visit, https://bit.ly/2JjingC
3/23/2020 Update:
Dear Allied Families,
We are all struggling with the new normal and hope you and your families are safe.
Your Allied offices are open for your children. Our offices are creating safe ways to see patients for the important well visit and vaccines that your children need. We need to remember vaccines are necessary, so we don’t eventually see a return of illnesses, which we can prevent.
Your pediatricians are available for needed sick visits. We ask that you call your pediatricians office first. The staff is taking precautions to separate well and sick patients by either appointment times and/or space. We ask that you limit the number of people coming into the office with the patient. We are cleaning and sanitizing often. We are grateful that Allied Physicians Group has the resources and access to needed supplies that keep your children and our staff safe.
Telehealth visits are a great way to access your pediatrician right now and are covered by most insurances. We can see you virtually for sick visits or to discuss anxiety and concerns about COVID19, or to make sure you are ready for allergy season. Call your regular office for daytime telehealth. Our after-hours telehealth has expanded to 7 days a week, 6:30-10:30PM and can be accessed directly from the Anytime Pediatrics app, or by calling 833-269-2444. Allied telehealth is better than those offered by urgent cares or insurance companies because Allied telehealth connects you with a board-certified pediatrician who has your child’s medical chart and history. Also, tell your friends that due to the COVID19 crisis, Allied is offering our telehealth to non-Allied families as well. Non-Allied families should download the Anytime Pediatrics app or call 833-269-2444, enter practice code 2444, to be connected with an Allied pediatrician near them! Visit our website for more information.
We are posting frequent updates on your pediatric offices’ Facebook page. Please check it often. We plan to post suggestions for keeping your children entertained, safe ways to combat everyone’s stress, and more! We are open to any suggestions our families can share with everyone. We need to work together.
What’s new information concerning COVID19? Persons with a COVID19 like illness, not requiring hospitalization, should stay home and self-isolate. It is not recommended that those with mild COVID19 like illness be tested at this time.
What else can you do? If you have a business that uses mask or gloves, that is closed due to government orders, consider donating them. If you drop these items at one of our offices, we will make sure to get them to the healthcare workers that need them most. Check on your elderly neighbors, offer to go food shopping or pick up needed medications. Get outside if you can.
We will get through this, together!
3/18/2020 Update:
Dear Parents & Patients,
It’s Tuesday and your pediatric clinicians are on the job and at your service! While our “routine” is not quite the same as last week’s or last month’s routine, we remain ready to help you care for your children.
In order to continue practicing safely, you will see our staff using plenty of hand soap and sanitizer, disinfectant wipes and spray. Nothing that’s not new for us, especially during cold and flu season, but something that we are practicing with extra diligence for the care of all concerned. Our offices are also instituting scheduling changes and other protocols to keep us all safe. Call your office to find out what specifically they are doing to help keep us all safe.
While the current COVID-19 outbreak is top of the mind for all of us, life does go on and other illnesses do as well. It’s important that we continue to protect our children from the many other diseases that we take for granted. Keep your regularly scheduled checkup appointments and keep your child’s immunizations up to date. It is not too late to get a flu shot, and this year, in particular, we all very strongly recommend it.
With springtime, besides flowers, we also usually see more children with strep throat, allergies, and other illnesses. If your child seems ill and it’s something you would normally see us for, we are here.
We also ask that you call the office before your appointment if your child or you have any respiratory or flu-like symptoms. Most of our offices can handle many of these appointments remotely via our telehealth services. Please visit https://alliedphysiciansgroup.com/telehealth/ and get set up today.
If your children are home from school, and you’re still at work, why not see if you can hire a friend’s college-age student to help you out with childcare. Take advantage of the beautiful weather today and get outside!
As you can imagine, with COVID-19 dominating the news, hackers are working to find ways to exploit the fears of those of us who are working remotely. Phishing email scams have been reported where the hackers are claiming to be from legitimate organizations with information about coronavirus. As you seek information, please always remember to visit ONLY trusted sites such as the Centers for Disease Control (www.cdc.gov), the World Health Organization (www.who.int) and the New York State Department of Health (www.health.ny.gov).
And once again, please remember that children with coronavirus are not getting very sick.
We will get through this… together.
Stay well, Allied family!
3/13/2020 Update: Information for patients with Asthama
By: Dr. Raphael Strauss, Dr. Robyn Kreiner, and Dr. Khalid Ahmad (Strauss Allergy & Asthma, Commack & Woodbury, NY)
Allied Physicians are getting many questions related to patients with asthma and coronavirus COVID-19. Fortunately, Strauss Allergy and Asthma is a great resource. While this is an evolving situation and information may change, our current recommendations are:
1 Take your controller asthma medications regularly as prescribed.
2 Have medication available but there is no reason to stockpile extra medication.
3 Children with asthma that is well-controlled do not appear to be at higher risk for severe outcomes. We are not hearing about excessive hospitalizations or severe cases in children in general in China, South Korea or other countries that have more cases.
We are concerned with the overall health and well-being of people and especially children in general at this time. The anxiety over this infection far exceeds the actual personal risk. We recommend keeping your kids in school if school is open. Follow public health recommendations regarding avoiding large gatherings, frequent hand washing, and reasonable social distancing. Above all, remain calm, rational and we will get through this together.
3/12/2020 Update:
Dear Families,
School closings, containment zones, and quarantines are ramping up Coronavirus anxiety amongst all of us, from the youngest, who respond to our stress, to the elderly, who are most affected, to those of us in the middle, who feels responsible for the whole family.
Your doctors at Allied Physicians Group are here for you, not only for medical care but as a source of reliable and sane information. We suggest you look at COVID-19 information from two perspectives.
1 Personal Safety: the vast majority of people infected by COVID-19 will have a mild illness, especially children.
2 Community Responsibility: the CDC and Health Department are trying to limit spread, or at least slow it down. Self-quarantine, containment areas, and social distancing are being implemented for these purposes.
The best way to stay healthy is by practicing good hand washing, remembering not to touch your face, and staying away from large gatherings when possible. Take advantage of the nicer weather and socialize outdoors. If you or anyone in your family is sick, stay home. When needed, cough into your elbow.
Your Allied physicians will help you through this crisis, as we have so many times in the past. Our doctors were on the front line of H1N1 infection – we made it through that, and together, we will make it through this.
If your child is sick, please call us. We are all screening patients carefully and doing what is needed to keep our families safe. Many of our offices currently utilize daytime telehealth or will soon implement telehealth. There is also After-Hours Telehealth offered from 630p-1030p Sunday to Friday for all Allied patients.
Allied Telehealth, day or night, is much better than the many other virtual visits you are hearing about because we use pediatric providers who have access to your full medical history. Call your Allied office with specific questions. For more info go to alliedphysiciansgroup.com/telehealth.
Keep your scheduled appointments. Children still need to get physicals and vaccines that protect them from illnesses much more serious than coronavirus. All of our offices have implemented procedures to keep you safe. We are following appropriate CDC recommendations. We are cleaning intensely and often.
What else can you do? Shut off the TV and give yourself and your children a break. Look for anxiety symptoms – such as moodiness, trouble sleeping, and separation anxiety. Talk to your children about their fears. Reassure them.
Check on your elderly neighbors, family, and friends. These people are most at risk for complications of Coronavirus. Ask if you can get them food, medicine or anything else they need. We are a community; we need to take care of each other.
As always #alliedcares.
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3/9/2020 Update:
We would like to give an update about how Allied Physicians Group is handling the Coronavirus- COVID19 infections in our area. Our main concern is the health and wellbeing of our patients and their families. The situation is evolving rapidly and we are making every effort to implement protocols to maximize safety within our 33 locations.
We understand there is a lot of fear and concern right now. The sensationalism and nonstop coverage from the media are making it difficult to respond rationally.
Fortunately, children have been having less severe infections. Children are exposed to many other coronaviruses every winter and this is thought to be one of the reasons why the infection is less severe in younger people. However, they can expose others who may be at greater risk for more severe outcomes.
In order to reduce the risk to our patients and their families, we are strongly encouraging the following:
We are asking families to limit the number of caregivers bringing the child to the office.
We are asking families to bring only the patient to the office, no siblings.
We are asking people over 60 to avoid the office unless there is absolutely no alternative.
We are asking all families to download our telehealth app, Anytime Pediatrics. To learn how to download the Anytime Pediatrics App, please see the directions at the end of this email.
If your doctor’s office has daytime telehealth visits, we strongly encourage considering virtual visits when appropriate. Check here to see if your practice offers telehealth during the day. Our after-hours telehealth practice is always open on Sunday – Friday, 6:30 – 10:30 pm.
If your child has a fever and coughs and is not ill-appearing, it is best to avoid our office. We are making every effort to safely keep these children out of the office. Currently, we are not able to test for COVID-19 in the office, and most hospitals are not testing unless there is a travel history or known direct exposure. Most ERs consult with infectious disease specialists and local Departments of Health. You cannot just walk in and ask for a test. If you think your child needs medical attention, please call us and we will arrange appropriate care.
Remember that washing hands and being aware of our surroundings is very important to staying healthy. There is no current need to wear masks unless instructed by medical professionals.
The most important aspect is to remain calm and rational. Allied physicians will continue to be accessible and provide the level of care you have come to expect. Our divisions are still doing well visits.
As things change, Allied will update our families as quickly as possible.
We are taking all the appropriate steps. Please still come see us, we are your best option.
Thank you for trusting us with the care of your families.
Adjuvant.Health Presents Covid-19 and your Kids Webinar
Part 1-
Part 2- Q&A Session
Coronavirus Update
By: Dr. Eric Levene
Many of us have heard on the news, or have seen on social media, about the Coronavirus descending from Wuhan, China. As of this morning, there are 5 confirmed cases in the United States and scattered cases in more than 6 countries besides China.
The Coronavirus is a family of viruses that typically affect the respiratory tract. The common cold we all experience is part of this family of viruses. What makes this new novel Coronavirus more dangerous is still unknown.
56 people have died and more than 2,000 cases are reported in China. On Sunday, China’s health minister stated that the virus can be spread in a 2 week incubation period before a person comes down with symptoms. This information has yet to be confirmed and China has not released any backup documentation.
So what does this mean for us? As of now, we continue our regular lives. We will practice good hygiene, wash our hands often, cough and sneeze into our elbows and stay home if we are sick. Right now, we will continue with flu prevention.
We will continue to update our Allied families as things change.
Addressing the Measles Outbreaks in New York
By: Kerry Fierstein, MD Pediatric Health Associates (Plainview, New York)
Dear Parents & Caregivers,
Measles outbreaks in Brooklyn and Rockland have put public health on the front page of our newspapers. A disease which had been declared eliminated from North America in 2002, is once again scaring parents, doctors and government officials.
Things to know:
-When Measles vaccine rates in a community fall below 95%, measles virus comes back.
-Measles is very contagious and it is difficult to avoid exposure when measles is in the community.
-Children with measles commonly have serious complications.
-There is no treatment for measles, but we can prevent it with the measles vaccine.
-Measles vaccine is safe and effective.
-Measles vaccine is given as part of the MMR (measles, mumps, rubella) or the MMRV (measles, mumps, rubella, varicella.)
-Measles vaccine is recommended at 12 months and again at 4-6 years of age. After the first dose 93% of children are immune to measles. After the second dose 97% of children are immune to the measles.
– The second measles vaccine may be given as soon as 28 days after the first one and still fulfill all school requirements.
-Infants 6-12 months of age who are going into high-risk areas may receive an early dose of vaccine, but would still need two more doses after one year of age.
-There are measles outbreaks in Brooklyn (mostly Williamsburg and Borough Park) and Rockland with isolated cases surrounding those areas. Westchester cases are starting to rise.
-Travel outside of the US is considered high risk.
Things to do:
-Vaccinate your infant for measles on time, at 12-15 months.
-Tell your pediatrician if your child is traveling internationally (or visiting a local area of outbreak.) If the child is 6-12 months, an early MMR should be given. If the child has only had one vaccine, it may make sense to give the second vaccine early.
– Speak out against anti-vaccine propaganda in social media. We can not allow the anti-vaccine minority to drown out well-established science and put our children at risk.
To learn more about the Allied Physicians Group vaccine schedule visit, https://alliedphysiciansgroup.com/what-to-expect/
It’s time for ‘Pie in the Face’
Monroe Pediatrics’ third annual event seeks to raise $5,000 for pediatric cancer research
BY NANCY KRIZ
MONROE — Looking to build on last year’s whipped cream success, Monroe Pediatrics will host its third annual “Pie in the Face and Tricky Tray for Pediatric Cancer” on Saturday, Sept. 10 at 2 p.m. at its Gilbert St. offices.
Proceeds will be donated to The Truth 365, a multimedia campaign to raise awareness about childhood cancer. The group uses 100 percent of the funds for the campaign or pediatric cancer research.
Last year, $3,600 was raised in just a few hours’ time through the contributions of hundreds of kids and adults who stood on long lines to good-naturedly throw whipped cream pies in the faces and hair of their desired physician targets.
The goal for this year is $5,000.
That’s a lot of whipped cream to be schmeared into physician faces and hair.
All six of the physicians in the practice – Stacy Rosmarin, Nilufer Clubwala, Jamee Goldstein, Evan Harawitz, Danielle Dziedzic and Brent Jansen — in addition to Dr. Alan Harawitz, the practice’s founder who is now retired, will be present “to be pied.”
They want go home so full of Reddi-Whip that it will take days to get the whipped topping out of their hair.
The first 20 or so patients to throw pies at the physicians will be the practice’s current cancer patients/survivors.
“We dedicate this day to them and their families,” Goldstein said.
Every day in the U.S., approximately 250 children are diagnosed with some form of cancer, she explained, with only four percent of federal cancer research dollars devoted to children. Only two new drugs for children have come out in the last 20 years.
There are more than 50 donations for the tricky tray from local businesses including many restaurants, fitness centers, farms/farmers markets, golf outings and others.
Musical entertainment will be provided by DJ Baby Sal with performances by dancers from Terpsichore the Dancerschool.
“Hinck’s Pretzels will be donating a portion of their proceeds from sales that day,” said Goldstein. “Shop Rite, Walmart, Stop and Shop and O’Tooles have been kind enough to make the donations so we can make this event successful. We will also have a representative from ‘Be the Match’ present to help register people to be bone marrow donors.”
The event will also be collecting gently used sneakers for the “Dunk Your Kicks!” campaign, which will donate $1 for every pair donated to children of military families or underprivileged families to help pay for cancer treatments.
“Everyone in the community is invited to this event,” added Goldstein. “You do not have to be one of our patients. Throw a pie to show your thanks for the good health of the child in your life. It’s a sweet and sticky way to raise funds for an amazing cause and to have fun with your favorite pediatricians.”
To learn more, call 845-782-8616.
The Vaccine Imperative
This week’s story of a boy on Long Island with bacterial meningitis who required ICU care brought out raw emotions in all of us. We can’t help but empathize with the family, and think “what if this was my child?” The important take-away message is that certain infections are very serious and prevention is the best course of action, and that means vaccines.
Pediatricians are vaccine experts and most of us consider it our mission to protect your child by vaccinating him or her. We get frustrated when we need to convince parents of the need to vaccinate their children. In part, this is due to the effectiveness of vaccines in eliminating many life-threatening diseases. Unfortunately, if enough parents decide not to vaccinate their children, many of the diseases of the past will become all too real a part of our children’s futures.
Diseases which used to strike fear in the hearts of parents and pediatricians have all been virtually eliminated by vaccines.
Measles was virtually unseen in the United States for many years until a Disney World outbreak in 2014. This deadly disease is a major problem worldwide, killing over 700,000 children per year. There is a current outbreak of over 50 cases of measles in Minnesota due to fear of vaccines.
Polio infected nearly 60,000 children, causing more than 3,000 deaths in the United States, at the height of the 1952 epidemic. Since the polio vaccine was introduced, polio has been completely eliminated in North America.
Pertussis, also known as whooping cough, has seen a resurgence due to a decrease in vaccination rates. The pertussis bacteria produce weeks of coughing spasms that cannot be cured with an antibiotic. In infants, pertussis can lead to death.
Haemophilus Influenza B was the most common cause of meningitis and epiglottis in young children before the HIB vaccine came out in1983. The HIB vaccine has decreased invasive Haemophilus disease by over 95% and saved the lives of thousands of children.
Pneumoccocus is a very common cause of meningitis, pneumonia and sepsis (an infection of the blood and organs.) Since the introduction of the Prevnar vaccine in 2000, rates of serious pneumococcal disease have decreased 80%.
Meningococcus causes meningitis in infants and adolescents. The Menactra vaccine, which contains 4 strains of this organism, is so effective in preventing disease that New York State requires students be vaccinated before 7th and 12th grades. Many colleges are now requiring all students be vaccinated. A fifth strain, MenB for short, has emerged on college campuses in the last few years. A vaccine for Men B was approved for use in the United States about 2 years ago. There is no recommendation for routine use of this vaccine. Your pediatrician will be happy to discuss these recommendations and why you should or should not need the vaccine.
Human Papilloma Virus, commonly acquired during the teenage and college years is inextricably linked to cervical cancer. HPV vaccine has been available in the U.S. for over 10 years. In addition to preventing the strains of HPV associated with cancer, it also prevents the strains associated with genital warts.
Your pediatrician is your best source of vaccine information. Talk to your pediatrician about the vaccines that are available and make sure your child is safely protected against all vaccine preventable illnesses.
What to know about Acute Flaccid Myelitis(AFM)
By: Eric Levene, MD, Chester Pediatrics (White Plains, New York) (updated 11/18/19)
A rare neurological disease called Acute Flaccid Myelitis or AFM has made news recently as children are hospitalized with varying degrees of paralysis. The CDC estimates 1 in 1 million people will be affected, mostly children. The condition is not new but there has been an increase in reported cases since 2014. From August 2014 to September 2018 there were 386 confirmed cases of AFM in the United States, with most cases reported in the late spring and fall. The cause of AFM is still not completely known.
The CDC describes AFM as “rare but serious condition”. AFM affects the nervous system causing the muscles of the body to become weak. Most cases occur with sudden weakness of an arm or leg with loss of muscle tone. Some cases will have facial droop, difficulty moving eyes or difficulty swallowing. The most serious symptom occurs when the muscles that involve breathing are involved.
AFM may be difficult to diagnose, it shares similar symptoms as other neurologic diseases. There is no specific test or scan that will diagnose the illness. As soon as a parent/guardian may think their child might have symptoms, they should contact their doctor. The doctor may refer the patient to a neurologist or Pediatric Emergency Room for further testing and evaluation.
AFM actual cause is still under investigation, but most of the evidence is supporting a viral cause. Over 90% of the affected patient had a mild respiratory illness and or fever consistent with a viral illness prior to developing the symptoms of AFM
There is no specific treatment for AFM, but a neurologist may recommend certain treatments on a case-by-case basis. Usual recommendations include physical or occupational therapy to help with arm or leg weakness caused by AFM. Long-term outcomes of affected individuals with AFM are still unknown.
What can you do to prevent AFM. Nothing specific can prevent AFM. However, taking the usual precautions to stop the spread of illness is your best bet. Washing your hands with soap and water or using topical antibacterials hand sanitizers is one of the best ways to avoid getting sick and spreading germs to other people.
It’s Flu Season- AGAIN
By: Fatema Meah, MD (Peconic Pediatrics, Riverhead & Southold, NY)
Back to school time is the right time to think about getting this year’s flu vaccine. In general, flu season runs from October until April, and most cases are seen in the winter months. The peak of influenza disease in the Northeast is typically in February but varies every season. It is ideal to get your flu shot early in flu season.
Why should you get the flu vaccine? Influenza, or “the flu”, affects between 5 – 20% of our population. It is responsible for 200,000 hospital admissions and 36,000 deaths each year. Last year was especially severe with over 180 pediatric deaths and over 700,000 hospitalizations for flu-related illnesses. These are the highest numbers recorded since surveillance began. Influenza is the most common vaccine-preventable illness we see!
What is Influenza? Influenza is a respiratory illness caused by influenza viruses. There are two main types of virus: influenza A and influenza B. Each type includes many different strains, which tend to change each year. This is why flu shots must be given every year.
Influenza is extremely contagious and is easily transmitted through contact with droplets from the nose and throat of an infected person during coughing and sneezing. These viruses may also be spread when a person touches these droplets on another person or an object and then touches their own mouth or nose (or someone else’s mouth or nose) before washing their hands.
If you have ever had “the flu” you know it is no fun. Symptoms may include high fever, body aches, headache, dry cough, sore throat, and extreme fatigue. Stomach symptoms like nausea, vomiting, and diarrhea can occur and are much more common in children than in adults.
Although anyone can get the flu, there are some groups that are at high risk for complications. The high-risk groups include:
- Adults 50 and older, especially those 65 and older;
- Children 6 months – 18 years;
- People age 6 months and older with chronic medical conditions, including heart disease, pulmonary disorders (including asthma), diabetes, kidney disease, hemoglobinopathies, and compromised immune systems (HIV or immunosuppressive therapy);
- People with certain conditions (such as neuromuscular disorders) that can cause breathing problems
- Pregnant women
- Residents of nursing homes and chronic-care facilities
Other individuals are at high risk of transmitting the flu. These include:
- Health care workers involved in direct patient care;
- Out-of-home caregivers and household contacts of children aged < 6 months.
There are 2 vaccines available to prevent influenza. The first is the “flu shot”— an inactivated vaccine containing a killed virus. The flu shot is approved for use in people older than 6 months, including healthy people, people with chronic medical conditions and pregnant women. The second is the nasal-spray flu vaccine— a vaccine made with live, weakened flu viruses. It is approved for use in healthy people 2-49 years of age.
This year there is some controversy about which vaccine is best. What is important is that you get one of them. If your child absolutely hates needles and will cause chaos for you getting “the shot” then opt for the nasal spray. What is most important overall is to be immunized and protected!
There are two common myths associated with the flu vaccine. The first is that the vaccine will give you the flu. It is not possible to get the flu from the flu vaccine! Side effects of the flu shot do include soreness, redness or swelling at the site of the injection, low-grade fever, and mild body aches. This is not the flu but your body’s response to the vaccine. Side effects of the nasal flu vaccine in children can include runny nose, cough, wheezing, headache, vomiting, muscle aches, and fever. In adults, side effects can include runny nose, headache, sore throat, and cough. The second myth is that the vaccine does not work. In years when the vaccine and circulating influenza viruses are well matched, the flu vaccine can be expected to reduce laboratory-confirmed influenza by 70 – 90%. In years when the viruses are not as well matched it will still lower incidence of disease as well as reduce severity in those who do get influenza. We must remember that not all flu-like illnesses are influenza, and the flu shot can only protect us against influenza viruses.
So is it time for your flu vaccine? Yes, the flu vaccine is now routinely recommended for everyone. That means babies over six months of age, children, and all adults including pregnant women. It takes about two weeks for your body to make a response to the vaccine. Call your doctor’s office to make an appointment today!
Measles: How To Protect Your Family
Officials Warn Of Possible Measles Exposure At Newark Airport
Officials: Possible measles exposure reported at O’Hare International Airport
Measles is a highly contagious virus and is spread by air through coughing and sneezing. Measles usually starts with fever, runny nose, red eyes and sore throat. It is followed by a rash that spreads over the body.
“Although usually a self-limited illness, children younger than 5 years of age and adults older than 20 years of age are more likely to suffer from measles complications. Ear infections occur in about one out of every 10 children with measles and can result in permanent hearing loss. As many as one out of every 20 children with measles gets pneumonia, the most common cause of death from measles in young children. About one child out of every 1,000 who get measles will develop encephalitis (swelling of the brain) that can lead to convulsions and can leave the child deaf or with intellectual disability.For every 1,000 children who get measles, one or two will die from it. Measles may cause pregnant woman to give birth prematurely, or have a low-birth-weight baby.” (https://www.cdc.gov/measles/about/complications.html)
Please make sure your child(ren) are vaccinated at the recommended time. If your child is exposed to a person with Measles please call your provider as soon as possible.
Ticks and Lyme: What you need to know for your kids
Ticks and Lyme: What you need to know for your kids
By: Jennifer Shaer, M.D., Eric Levene, M.D., Kerry Fierstein, M.D.
There has been a lot in the news recently about ticks and tick-borne infections, particularly Lyme disease. The CDC has warned that this summer ticks will be at an all-time high. So what can you do to protect your kids from Lyme and other tick-borne infections?
As with most things, the best treatment is prevention. The first and most obvious step is to try to avoid tick bites at all. That means avoiding high grass areas, keeping your body covered, and using insect repellants. The American Academy of Pediatrics and Centers for Disease Control recommend the use of 10%-30% DEET for all children over two months of age. There are different types of insect repellent. The following link discusses the differences and positive and negatives of each. It also discusses how to apply the insect repellent safely. https://www.healthychildren.org/English/safety-prevention/at-play/Pages/Insect-Repellents.aspx
However, despite your best efforts, a tick or two is likely to find your kids this summer. There are many different ticks out there but it is the deer tick that can carry the bacteria that causes Lyme. Keep in mind that an infected tick needs to be attached for over 36 hours to transmit infection. So your second line of defense is to check your kids for ticks daily. Don’t forget behind the ears, in the armpits, groin, belly button, and in the hair.
If you find a tick on your child, don’t panic. Remove it immediately with a tweezer. Do not use a smoldering match, nail polish, petroleum jelly (eg, Vaseline), liquid soap, or kerosene because they may irritate the tick and cause it to behave like a syringe, injecting bodily fluids into the wound. Don’t worry if a small piece of the tick gets left behind. Any small pieces left behind cannot transmit disease. After removing the tick, wash the skin and hands thoroughly with soap and water. Not all deer ticks carry the bacteria that cause Lyme and even if the tick is infected, not all tick bites will go on to cause disease in the bitten child. Testing the deer tick does not help predict infection and is not recommended.
Your next line of defense is to recognize the signs and symptoms of Lyme because when children are diagnosed, Lyme gets better with antibiotics. Even if you don’t remember a tick bite your child could still have Lyme disease. Typically it is not the tick you find that causes an infection, it is the tick that attaches, feeds, and falls off before you’ve even noticed it. Living or visiting a high-risk area puts your child at high risk for Lyme disease.
Early signs of Lyme include the classic circular rash that you should get familiar with and generalized, flu-like symptoms. The rash can occur 3-30 days after a tick bite. Later signs include multiple circular rashes, joint pain and swelling, and rarely neurologic problems like a facial droop also known as Bell’s palsy.
If your child has symptoms of Lyme, see his pediatrician for an evaluation. Making a diagnosis of Lyme with blood work can be misleading and routine testing is not recommended. Early in the course of disease the blood test can be negative. In addition, after successful antibiotic treatment, the blood test can remain positive for many years or may never even turn positive if the disease was treated early on. Unfortunately, having Lyme once does not protect you from getting it a second time. Your child’s pediatrician will help make the diagnosis and treatment plan based on a combination of a detailed history, physical exam, and blood work when needed.
Finally, sometimes your pediatrician will consider a prophylactic dose of an antibiotic after a tick bite. If a tick has been attached to your child for over twenty-four hours, go see your pediatrician to discuss the pros and cons of this approach. A prophylactic dose needs to be given within seventy-two hours of a bite so don’t wait too long. This is not typically recommended for children under 8 years of age.
Thankfully most cases of Lyme in children respond very well to antibiotics. If your child has been treated for Lyme and still feels sick, something else could be causing his symptoms. Schedule an appointment with his pediatrician for a complete exam.
Have a great summer, enjoy the outdoors but be on the lookout for ticks!
