|
|
November 2009 Newsletter
|
|
|
H1N1 is Here What Do We Know and What Can We Do?
|
The Influenza A H1N1 flu season is in full swing,
and we have been seeing many children with H1N1
infection. By the end of 2009, predictions are
that approximately 60%
of the US population will have been infected with
the H1N1 virus. It is estimated that less than
half of those infected
will have symptoms, and fortunately, from what
we’ve
been seeing and what has been confirmed by the
CDC, most people will have a relatively mild illness.
While there are certainly
children who are getting very sick and even dying,
the vast majority will not have an illness anywhere
severe enough to
even consider hospitalization.
Symptoms can range anywhere from mild cold-like
symptoms, to high fevers, chills, sore throat, runny nose and cough,
headache, body aches, and vomiting/diarrhea. The CDC notes that about
12% of those who have H1N1 do not have fever, and many have vomiting
and/or diarrhea as the predominant symptoms. Patients who are more likely
to be hospitalized are children and adults who have associated risks,
especially asthma, chronic lung or heart disease, diabetes, pregnancy,
and immunosuppression for whatever reason. The death rate appears to
be the highest in people 50-64 years of age, with the death rate 0.4%
compared to a rate of 0.1% for seasonal flu. The following populations
are considered at highest risk for influenza complications:
- Children younger than 5 years and especially those younger than 2 years;
- Adults older than 65 years;
- Pregnant women;
- Persons younger than 19 years who are receiving long-term aspirin therapy;
- Persons with chronic lung, cardiovascular, neurologic, renal, hepatic, or metabolic disease, including diabetes;
- Those with immunosuppression.
At the moment, virtually all of the Influenza A we are seeing is the
novel H1N1 strain. While many clinics and hospitals
are not testing for H1N1 infection, one advantage
to getting tested is that if you or
your child test positive, you will know that you
are subsequently protected against future H1N1
infections this season. The symptoms we are seeing
in our pediatric patients have ranged from a mild
cold to more severe flu-like symptoms complicated
by pneumonia. None of our kids has been
ill enough to be hospitalized (fortunately!). While
this is purely anecdotal, the children who seem
to be doing better with the illness are those
that are already on good immune supports – see below for our suggested
immune supports for the flu season.
What about the H1N1 vaccine?
We have received our first shipment of H1N1 vaccine.
Unfortunately, the vaccine we received does contain
thimerosal (a mercury-containing preservative).
Each 0.5ml dose (for
kids > 3 years and adults) contains approximately 25 mcg
of mercury, with each 0.25ml dose (for kids < 3 years) containing
approximately half that amount. We have ordered
the thimerosal-free vaccine from the health department; however,
we have no idea
when or if we will receive that shipment, and if
it will even arrive in time to be of any use before kids are
already infected.
We have received only a limited supply of H1N1
vaccine, and unfortunately do have to prioritize
who will receive it first – our priorities will be children with
asthma or underlying chronic illness/immunosuppression; children under
3 years of age; and
parents of infants younger than 6 months of age.
As we receive more shipments, we will be opening up vaccination to all
of our patients.
Should your child get the H1N1 vaccine? This
is an incredibly tough question to answer, and
a decision that only you as a parent can decide
for your own child. We do recommend that
children with lung/heart disease or other chronic
illnesses receive the vaccination. Apart from that,
we have enough concerns that we feel
the best thing we can do is to lay out the facts
as well as we can tell, and hopefully make the
decision easier for you as parents.
We are concerned with lack of safety data on the
H1N1 vaccine, especially in children and pregnant
women. It reassures us to know that none of the previously mentioned
adjuvants about which
we had major concerns, such as squalene, are in
any of the H1N1 vaccines. Likewise, the H1N1 vaccine is manufactured
using the same process as
the seasonal flu vaccine, with the flu strains
replaced by the novel Influenza A H1N1 strain. Therefore, we would anticipate
that the H1N1
vaccine wouldn’t be any more or less safe than the seasonal flu
vaccine. Adverse reactions to the H1N1 vaccine
are not well-characterized given the limited studies performed, but
can include headache, malaise,
muscle aches, nausea, chills/shivering, fever,
and vomiting. All significant adverse events that occur after vaccination,
even if you are not sure
whether the vaccine caused the adverse event, should
be reported to the national Vaccine Adverse Event Reporting System by
the parent or
healthcare provider. This may be done online at
www.vaers.hhs.gov.
The H1N1 vaccine is contraindicated for patients
with severe egg allergy or life-threatening reactions
after previous flu vaccines. Precautions should be taken for those who
have experienced
Guillain-Barre syndrome after previous influenza
vaccination.
Given that we know which H1N1 flu strain is prevalent,
and this strain is in the H1N1 vaccine, we anticipate
that the H1N1 vaccine should be effective in preventing H1N1 infection.
However, it
will only be effective if those people receiving
the vaccine mount an appropriate immune response. While 97% of adults
ages 18-64 years given
the vaccine may show protective levels of antibody
titers at 21 days after vaccination, the same isn’t necessarily
true for children. At 10 days, the antibody response to the H1N1 vaccine
in kids was found
to be much lower (see table below). These results
are similar to the response rate with the seasonal flu vaccine. The
low response in children
under 9 years of age accounts for the recommendation
that children 6mos – 9
years receive 2 doses of the flu vaccine (both
H1N1 and seasonal) approximately 1 month apart. After 2 doses, the antibody
response has been found to
be approximately 77%.
Antigenic Response to 2009 H1N1 Vaccine (Sanofi) by Age (10 days after 1st dose)
| Age Group |
Response |
| 10-17 years |
76% |
| 3-9 years |
36% |
| 6-35 months |
25% |
We do have concerns with the thimerosal in the
vaccines. While most kids should do fine with this
small amount of thimerosal at one time, we would exercise caution for
those with underlying neurologic
disorders such as autism. Governor Schwarzenegger
has signed an emergency exemption allowing children younger than 3 years
and pregnant women
to receive thimerosal-containing H1N1 vaccine for
the period between October 12, 2009 – November 30, 2009 to ensure
that those who are at high-risk for H1N1 flu complications can receive
the H1N1 vaccine
even if preservative-free formulations are not
available (which is currently the case).
One last consideration is that for many, by the
time the H1N1 vaccine is available, it may already
be too late. According to a study published by
Purdue University on October 15, the greatest
number of people was predicted to be infected with
H1N1 during the last weeks of October. It likely
takes 10-21 days to develop any significant
immunity from the vaccine. Given that the H1N1
vaccines have only recently become available and
are in much shorter supply than anticipated, it
is likely that the H1N1 vaccine has arrived too
late to benefit many patients.
So should you give your kids the H1N1 vaccine?
It really depends on what risks you as parents
are willing to take. While H1N1 infection tends
to produce mild illness in most, it certainly
can cause more serious and even life-threatening
complications, especially for those populations
considered at risk. On the other hand, while the
H1N1 vaccine shouldn’t cause any more adverse events than the
seasonal flu vaccine and should help to prevent
the swine flu, the one that we have available right
now does contain thimerosal, and the safety
and efficacy data are limited at best. It’s not an easy choice.
But we do urge that if you decide you would like
your child to receive the H1N1 influenza vaccine,
please call our office ASAP so that we may
put you on our vaccination list and have your child
vaccinated as soon as the vaccine is available.
Please note that given the limited supply
of H1N1 vaccine we have received so far, we will
first be prioritizing those children under 3 years
of age and those who have chronic medical
conditions (i.e., asthma, diabetes, autoimmune
illness, etc.).
Many parents have asked what I have done, and
I feel that I should share with you my decision
and my thought process. I did get the H1N1 vaccine
just last week. My decision to do so was
based on many different factors. The first was
that as a pediatrician, I have been and will be
exposed to many kids with H1N1 infections – my
priority is to be available for all of my patients
and not miss any days due to illness, and also
to not transmit H1N1 infection to my patients
unintentionally. The second was that, as many of
you know, I am pregnant and therefore in a high
risk category, and the thought of anything happening
to my baby due to an H1N1 complication was not
a risk I was willing to take. The third factor
was that I do not have a major family history
of neurologic illness including autism, autoimmune
illness, or other chronic illness. And the final
factor is that I have been rigorous about
eating a diet rich in antioxidants and taking supplements
that support my detoxification processes and immune
system.
Are There Other Places For Me to Bring My Child
for the H1N1 Vaccine?
If we are unable to provide your child with the
H1N1 vaccine as soon as you would like, please
note that Santa Clara county is holding several public vaccination
clinics
for those who are considered at high risk (pregnant
women; care providers and household contacts of infants less
than
6 months; children and young adults between 6 months
and 24 years; adults 25-64 years with high-risk medical conditions;
and healthcare and emergency medical services workers.
These
clinics will be held between Saturday, November
7 through Saturday, November 21, as follows:
| Day |
Time |
Location |
| Saturday, November 7 |
9:30 a.m. 3:30 p.m. |
Santa Clara County Fairgrounds
EXPO HALL
334 Tully Road
San Jose, CA 95111
View Map |
| Sunday, November 15 |
9:00 a.m. 3:30 p.m. |
| Saturday, November 21 |
9:00 a.m. 3:30 p.m. |
| Saturday, November 7 |
9:30 a.m. 3:30 p.m. |
Valley Health Center Gilroy
7475 Camino Arroyo
Gilroy, CA 95020
View Map |
| Saturday, November 7 |
9:30 a.m. 3:30 p.m. |
Valley Health Center Moorpark
2400 Moorpark Avenue
San Jose, CA 95128
View Map |
| Saturday, November 7 |
9:30 a.m. 3:30 p.m. |
Valley Health Center Sunnyvale
660 S. Fair Oaks Avenue
Sunnyvale, CA 94086
View Map |
| Saturday, November 7 |
9:30 a.m. 3:30 p.m. |
CompreCare Health Center
3030 Alum Rock Avenue
San Jose, CA 95127
View Map |
| Saturday, November 7 |
9:30 a.m. 3:30 p.m. |
Gilroy Health Center
7526 Monterey Street
Gilroy, CA 95020
View Map |
| Saturday, November 7 |
9:30 a.m. 3:30 p.m. |
St.
James Health Center
55 E. Julian Street
San Jose, CA 95112
View Map |
Updated information can be found at www.sccgov.org.
We are not currently aware of any similar clinics
in San Mateo County, but it does not appear that
you need to be a Santa Clara county resident
to participate in their vaccine clinics. Please
go to www.flu.gov or
www.co.sanmateo.ca.us/portal/site/health for
updates. We will post additional flu clinics we
become aware of on our website.
What Can I Do to Keep My Kids Healthy?
Whether or not you decide to vaccinate your child
(and even if you do get the vaccine, the vaccine
is not 100% effective), we believe it is of utmost importance
to do as
much as you can to keep you and your kids as healthy
as possible. Many of my patients want to know what I do to
stay healthy.
And as I mentioned before, the kids who seem to
be doing the best with H1N1 infection are those that are already
taking
good immune supports. There are commonsense measures,
such as washing hands frequently and before eating or touching
your
face, avoiding close contact with people who are
sick, staying well-hydrated, eating lots of colorful fruits
and vegetables,
avoiding refined sugar and processed/junk food,
getting fresh air and daily exercise, getting adequate sleep,
and minimizing
stress.
Apart from these measures, I also take and recommend
the following supplements. The dosages that I mention
are only intended as general guides, and may vary according
to each child’s
unique needs. Please contact your pediatrician
for specific dosage recommendations:
- Fish oil.
- Probiotics I have been using Metagenics Ultra Flora Plus
at a dosage of Ό tsp or 1 capsule 2x/day. A study found this
particular probiotics blend to be
effective in significantly reducing the rates
of fever and upper respiratory symptoms
when taken daily throughout the cold/flu season.
- Vitamin C I have been using Metagenics Ultra-Potent C because
it has added ingredients such as lysine and
glutathione which assist in fighting viruses. In general, I
recommend Vitamin
C 500mg 2x/day.
- Vitamin D3 there is speculation that the rates of illness increase over the winter because of the widespread deficiency of Vit D. In general, I recommend 1000IU daily for children, but some kids who are very deficient may require higher dosages.
- Arabinogalactan this is a natural sugar derived from the bark of the larch tree that enhances natural killer cell activity these cells are part of our first line of defense against any invading organism. We carry the Vital Nutrients arabinogalactan powder, and generally recommend ½-1 tsp 2x/day.
- Oscillococcinum and/or SyImmune these are homeopathic medicines that may help to prevent influenza infection.
- Xlear nasal spray I am religious about irrigating my nasal passages with Xlear nasal spray at the end of every day, and after any potential exposure (work, school, playgroups, plane travel, etc.). This is a saline nasal spray with xylitol and grapefruit seed extract, both of which have antimicrobial properties. You cannot overdo it, and will not get addicted to it. Other options for nasal irrigation are a regular saline spray or neti pot. Apart
from regular hand washing, I believe that daily and frequent nasal
irrigation is one of the MOST important things that we can do to
prevent influenza and other viral infections. This is because after exposure to a virus, the virus tries to invade and multiply in your nasal passages for at least 1-2 days before you develop any symptoms. Nasal irrigation can wash away viral particles before they have the opportunity to take hold, and thereby prevent many infections from happening in the first place!
What If My Child Gets the Swine Flu?
I have found that starting various homeopathic
and herbal medicines at the very beginning of my
cold/flu symptoms can often shorten the duration and severity
of illness and
knock it out of my system within a day or two.
This is what I take and recommend for my whole family at the
start of a
cold/flu:
- Windbreaker this is a Chinese herbal formula by Kan Herbs. It works GREAT! I will add Chest Relief if there is a cough or other formulas depending on the specific symptoms.
- Oscillococcinum this is a homeopathic flu remedy, general dosage is 1 vial 3x/day.
- SyImmune or SyInfect these are also homeopathic flu remedies, general dosage is 1 tablet every 2-3 hours during the first 1-2 days of illness.
- Elderberry syrup a recent study found that elderberry has the ability to inhibit H1N1 infection in vitro. The authors of the study note that the H1N1 inhibition activities of the elderberry flavonoids compare favorably to the known anti-influenza activities of Oseltamivir (Tamiflu).
- Increased Vitamin C.
- Increased nasal irrigation with Xlear nasal spray.
Specific homeopathic medicines, such as homeopathic
Belladonna, Gelsemium, Bryonia, and Nux vomica have also been useful,
depending on the specific symptoms that are being experienced. Please
call your pediatrician for more specific advice to help your child with
his/her specific flu symptoms.
As noted in our previous newsletter, Tamiflu is
a prescription antiviral medication that may be effective in preventing
influenza-related complications when started within the first 1-2 days
of illness, and may also be effective when used to prevent illness in
high-risk populations. Virtually all of the current H1N1 infections
have been found to be susceptible to Tamiflu. Tamiflu has been associated
with significant adverse side effects, but may be of considerable benefit
for children older than 1 year of age and adults who are considered
at higher risk for influenza-related complications.
When Should My Child See the Doctor?
In general, if you or your child has come down
with the swine flu, it is best to stay at home and rest, and
avoid contact with others. You should, however, seek medical
attention for your child if he/she has:
- Fever for more than 3-4 days;
- Confusion, excessive drowsiness;
- Inconsolability, excessive irritability;
- Difficulty breathing;
- Severe or persistent vomiting;
- Dehydration (no urine for more than 6-8 hours);
- Or if your child falls in a high-risk category and he/she
may benefit from Tamiflu administration.
We wish everyone a healthy winter season. Eat your fruits and veggies,
get plenty of rest and exercise, and most of all – stay well!
Sincerely,
Dr. Song and all of us at Whole Child Wellness
|
|
|
Dr. Newmark Hits the Bookstands!
|
|
|
Dr. Newmark has published a chapter in a new textbook
called Integrative Pediatrics, part of the Weil
Integrative Medicine Library series. He wrote the
chapter on Developmental behavior Pediatrics,
which includes autism, ADHD, and sleep disorders.
It is mainly aimed at physicians and other health
professionals and is available on Amazon.com here. |
Dr. Newmark was also one of a group of authors
who published 2 articles in a journal called BMC
Clinical Pharmacology. These both stemmed from
a research study he helped perform in Arizona
concerning the safety and effectiveness of DMSA
chelation therapy for autism. 65 children were
given 1 dose of DMSA, and toxic metal
(mercury and others) excretion was measured. Those
children who had high toxic metals went on to a “placebo-controlled
trial” in
which half were given DMSA chelation for 3 months
and half were given a placebo or “fake” medicine. They
hoped to show that the ones given the real thing
showed more improvement than the ones given
the placebo.
What they found was very interesting. Both groups
improved, but there wasn’t much difference between the groups.
However, the initial round of DMSA appeared
to normalize glutathione levels and help significantly
with heavy metal excretion. This may have
accounted for the improvement in both groups. They
also monitored carefully for lab abnormalities
and side-effects and both were quite minimal.
Clearly, this is an area that needs a lot more
research.
Here are links to the full articles and references
for those who are interested:
Safety and Efficacy of Oral DMSA Therapy for Children with Autism Spectrum Disorders: Part A - Medical Results
J. B. Adams, M. Baral, E. Geis, J. Mitchell, J.
Ingram, A. Hensley, I. Zappia, S. Newmark, E. Gehn,
R.A. Rubin, K. Mitchell, J. Bradstreet, J.M. El-Dahr Safety and Efficacy
of Oral DMSA Therapy
for Children with Autism Spectrum Disorders: Part
A - Medical Results BMC Clinical Pharmacology 2009, 9:16
Safety and efficacy of oral DMSA therapy for children with autism spectrum disorders: Part B - Behavioral results
J. B. Adams, M. Baral, E. Geis, J. Mitchell, J.
Ingram, A. Hensley, I. Zappia, S. Newmark, E. Gehn,
R.A. Rubin, K. Mitchell, J. Bradstreet, J.M. El-Dahr Safety and Efficacy
of Oral DMSA Therapy
for Children with Autism Spectrum Disorders: Part
B - Behavioral Results BMC Clinical Pharmacology 2009, 9:17
|
|
|
WCW New Mom Update |
Kandice Stellmon is back November 2!
Kandice's maternity leave is over and Kandice
is taking appoinments starting November 2. For
now, she will be available on
Tuesdays and possibly by request on other days.
Dr.
Song on maternity leave from December 7 to March
1, 2010.
Dr. Song and Peter Johnson will soon celebrate
the arrival of their first child! Their daughter
is expected to arrive on January 1st. Of course,
not knowing exactly when
she might decide to come, Dr. Song will only see
sick visits starting December 7, 2009.
She will return from maternity leave on March
1, 2010. In the meantime, Dr. Sandy Newmark and
Dr. Ann Wolf will be available
for any well and sick visits that are
needed. Dr. Song will look forward
to seeing everyone in the New Year!
|
|
|
Thanksgiving Hours |
Our office will be closed on Thursday and Friday,
November 26 & 27 for Thanksgiving. We wish all
our families a happy holiday!
|
|
|
|
