Posted in allergies, Employment, Health, news

Runny Nose And Congestion Can Imply COVID Infection

As employees return to work battling allergies, many are being sent home if they exhibit any signs or symptoms of COVID.

Initially these included cough, fever and/or shortness of breath. But as COVID positive cases were investigated and reviewed, officials found a myriad of symptoms reported by patients including nausea, diarrhea, loss of taste and sense of smell.

Last month the CDC updated their list of symptoms that could be associated with a COVID-19 infection, including runny nose and congestion.

According to the CDC website:

People with COVID-19 have had a wide range of symptoms reported – ranging from mild symptoms to severe illness.Symptoms may appear 2-14 days after exposure to the virus. People with these symptoms may have COVID-19:

  • Fever or chills
  • Cough
  • Shortness of breath or difficulty breathing
  • Fatigue
  • Muscle or body aches
  • Headache
  • New loss of taste or smell
  • Sore throat
  • Congestion or runny nose
  • Nausea or vomiting
  • Diarrhea

Severe symptoms can include chest pain, worsening breathing, change in skin color, dizziness, confusion, severe headache and more, prompting immediate medical attention.

Runny nose and congestion were incorrectly used by many patients and medical providers as “disqualifiers” that they had a COVID infection, when we needed to remind patients that COVID could manifest in a variety of symptoms. Moreover someone could suffer from allergies and COVID at the same time, so as to not exclude the viral disease based on having additional symptoms not yet listed on the CDC website.

The CDC further explains: This list does not include all possible symptoms. CDC will continue to update this list as we learn more about COVID-19.

As allergy season plagues most the nation and resurges in the Fall for many, common symptoms such as sneezing and nasal congestion can prevent many from returning to work or school, requiring isolation.

There is no clear cut way to diagnose or exclude a diagnosis of COVID without testing. Hence many employees cannot return to work until their testing proves negative or they have completed their period of isolation, despite swearing that “all I have is allergies!!”

If you suffer from allergies for months on end…..you’re not have an easy time no matter how you look at it…..

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What are allergies?

Allergies are the result of the immune response to a foreign particulate that our body senses.  One could be allergic to pollen, dust, dander, food, insects, mold, metals, transfused blood, grafts, medicine and anything the body senses as a foreign intruder.  Even though these may be individually harmless, a hypersensitivity reaction occurs as a result of their intrusion into the body.  IgE antibodies find the allergen (intruder) and activate mast cells in the tissue and basophils in the blood.  When these cells get activated, they release substances to help protect the body, including histamines, leukotrienes, and cytokines. These help the body attempt to sneeze and cough the allergen out, wall off the antigen, signal more antibodies, or produce tears and nasal secretions to flush it out.

What are symptoms of seasonal allergies?

Symptoms of allergies could include any or a combination of the following:

  • Sneezing
  • Coughing
  • Wheezing
  • Runny nose
  • Eye watering
  • Red Eyes
  • Itchy eyes
  • Itchy skin
  • Rash
  • Itchy throat
  • Fatigue
  • Congestion….. to name a few.

How do they differ from a cold?

Colds may have very similar symptoms to allergies.  However they are different.

The common cold is caused by a virus.  When one gets infected by the virus they may feel malaise, fever, and achy.  This does not occur with allergies.

Moreover, nasal secretions from allergies are usually clear.  In a cold, the mucous could be thicker and with color.

The same holds true with sputum.  During an allergy the cough may have little to no mucous and if so, be light-colored.  Thick mucus could be a sign of an infection.

An allergic sore throat will seem more dry and scratchy.  A sore throat from a cold is more uncomfortable and less easy to soothe.

Allergies may persist or be cyclical.  Cold symptoms will usually subside after a few days and rarely persist longer than 10 days.

Can allergies lead to a cold?

Yes and no.  Allergies should not in and of themselves cause an infection. However they may make one more vulnerable for a virus or bacteria to take over.    Hence a bronchitis, sinus infection, or pneumonia could uncommonly follow an asthma attack.

Are seasonal allergies dangerous?

As stated previously, if one is susceptible to colds, an allergic attack could make them vulnerable. Moreover if one suffers from asthma, an allergy attack could incite an asthma attack.  Very rarely would we see a life threatening anaphylaxis to an allergen such as pollen.

Allergy season is here: What are the worst offenders?

How can we prevent and treat allergies?

Avoiding, or decreasing exposure to the allergen is key.   We suggest the following:

  1.  Be aware of your local weather and pollen counts.  If the weather begins to warm and regional vegetation is blooming, allergy season may be upon you sooner than you know.
  2. Avoid outside pollen from coming into your house.  Avoid the urge to open all the windows during Springtime as wind will bring the pollen in.
  3. Clean your air filters.  Replace air filters frequently and consider using HEPA Filters
  4. Wash off pollen from your hair and clothes before you sit on the couch or jump into bed.
  5. Close your car windows when you park.
  6. “Recirculate” the air in your car
  7. Discuss with your medical provider if you are a candidate for medications such as antihistamines, nasal corticosteroids or leukotriene antagonists.  
  8. If you suffer from respiratory illnesses or a chronic medical condition, discuss with your medical provider if you need to start your allergy medication before allergy season hits. Some of these medications may take a couple of weeks to reach therapeutic levels.

How can I find my local pollen counts?

Local tree, ragweed and grass pollen counts can be obtained here.

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Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, iHeart Radio and is a Board Certified Family Physician

Posted in coronavirus, Covid-19, Health, masks, news

Easy Options For Face Mask/Coverings

With the CDC’s (Center for Disease Control’s) recommendation to cover one’s face to prevent the spread of coronavirus, many Americans are searching for ways to cover their nose and mouth.

They write:

The CDC recommends wearing cloth face coverings in public settings where other social distancing measures are difficult to maintain (e.g., grocery stores and pharmacies) especially in areas of significant community-based transmission.

It is critical to emphasize that maintaining 6-feet social distancing remains important to slowing the spread of the virus.  CDC is additionally advising the use of simple cloth face coverings to slow the spread of the virus and help people who may have the virus and do not know it from transmitting it to others.  Cloth face coverings fashioned from household items or made at home from common materials at low cost can be used as an additional, voluntary public health measure.

The cloth face coverings recommended are not surgical masks or N-95 respirators.  Those are critical supplies that must continue to be reserved for healthcare workers and other medical first responders, as recommended by current CDC guidance.

So what can be used for a substitute?

According to this chart, materials such those found in kitchen towels and vacuum bags may be the next best thing.

Mask-Materials-Effectiveness-1-Micron-EN-1024x744.jpg

Although they pale in comparison to the efficacy and protection offered by N95 masks they can be used in light of the CDC’s recommendations.

So here are some options on how to cover your nose and mouth:

Vacuum Bag Mask

FQD30N1K84NECL4.LARGE.jpg

Instructables.com offers instructions on how to make a mask out of a vacuum bag.

Dishtowels and T-Shirts

tea-cloth.jpg

Heddel’s gives you the step by step breakdown of how to cut and create earloops for a T-shirt, and similar instructions can be used for a dishtowel.

 

Bandanna or scarves

bandana.jpg

scarf.jpg

 

These can be easily folded and manipulated to cover both mouth and nose.  The more folds the better to allow extra layers over nose and mouth but ensure mouth and chin are covered.

Avoid large gaps between eyes and cheeks as pathogens can sneak down under the covering.

Ace Wraps

Assuring you can breathe and don’t wrap the ace too tightly, an ace wrap/elastic bandage may also provide a barrier over your nose and mouth.

ace wrap.png

Panties

Although not the most politically correct these days, panties do have the elastic and variety of shapes that may conform to the face and allow protection.

coronavirus-panties-mask-1.png

Bras

And of course a bra with an ample cup size may also be used if an adequate seal can be secured around the face and mouth.

bra mouth cover.jpg

Image by @HopClear

Other do-it-it yourself ideas

For those of you with more artistic qualities, these are other ideas:

 

CNN and Tom’s Guide gives the following options for face protection.

And Julie Eigenmann offers a video demonstrating how to make a simple face mask here.

 

Again, surgical masks and N95 respirators are not available and if become available are necessary for the front line healthcare workers.  So if you do make your own mask  remember that social distancing, hand washing and changing out one’s facial covering if it becomes wet or soiled are also crucial to preventing the spread of COVID.

 

 

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Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.

Posted in disease, flu, Health, news, vaccinations

This Year’s Flu Shot Efficacy Improved Over Last Year

The CDC reports a mid-season efficacy rate of 50% for this year’s flu shot, being 45% effective for adults and 55% effective for children, up from a 47% estimated efficacy last year.

In a good year flu shot efficacy may be 65%.  It’s difficult to reach higher numbers as viral flu strains mutate easily and immune systems of the general public are so varied.  Per the CDC the flu shot during the 2010-2011 flu season was one of the most effective.

 

vaccine-effectiveness_v3

This year two waves of flu strains hit the country, Influenza B and H3N2.  But despite the double whammy the flu shot offered fair protection.

They report the following:

The interim VE estimates published today also estimated the benefits provided by vaccination in different age groups. In addition to the VE estimate of 55% reported among children 6 months through 17 years of age, VE was estimated to be 25% among adults 18-49 years old, and 43% among adults 50 years of age and older. The lower VE point estimates observed among adults 18-49 years appear to be associated with a trend suggesting lower VE in age this group against A(H1N1)pdm09 viruses (VE = 5%). CDC will continue to monitor VE in this age group against A(H1N1)pdm09 viruses as more study participants are enrolled throughout the season. This will help CDC determine if VE against A(H1N1)pdm09 viruses in this age group is actually lower than in previous seasons, and if so, to investigate possible causes.

 

This year an estimated 26 million people were affected by the flu with over 250,000 hospitalizations and 14,000 deaths.

To date, 92 children have died this year from flu related illness, being a more severe season for children.

Flu season peak is still occurring and high flu activity is still being reported in multiple states.

It is not too late to get the flu shot and medical providers are still recommending vaccination.

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Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, iHeart Radio and is a Board Certified Family Physician

 

Posted in children, Health, news, Social Media, vaccinations

Over 2/3 of Online Vaccine Information Videos May Contain Misinformation

The number of children who are unvaccinated in the US is rising, and health experts believe misinformation obtained online could be to blame.

A study published in Clinical Pediatrics this month found over 2/3 of online videos to be incorrect when discussing vaccine health risks.

Dr. Daliah Wachs with students and faculty from Touro University Nevada reviewed 200 videos on YouTube that resulted when searching the terms “vaccines,” “vaccine risk,” “vaccine side effects,” and “vaccines and autism,” and found 68% of the videos to contain misinformation.   They additionally found that most of the misinformation occurred within the first 2 minutes of the video.

The most common types of misleading information were:

  • Factually contradicting the CDC or UpToDate, a widely used clinical resource for clinicians and patients
  • Offering anecdotal evidence (based on personal accounts or hearsay)
  • Utilizing unreliable resources or not citing resources

The study authors write: “It is important to recognize that most of the population does not possess a background in medicine or research. The majority of people are susceptible to taking information at face value, and lack the time and energy to delve into the credibility of a video on vaccines as we have in this study.”

The failure by the viewer to fact check the information or sources provided may also come from a misled perception that the online health video was produced by a renowned clinical resource.

If the video is an opinion piece, it many times does not specify.

Wachs states, “when a parent has a child who is unvaccinated, the reasoning can span over a wide range… anywhere from religious preference, to inability to take off work, to fearing a side effect, to distrust of the medical community.

“Parents on the fence about vaccination may feel apprehensive about bringing this up to their medical provider and turn to online education instead.  So this study gives insight to the types and quality of information to which some parents may be exposed.”

Although the majority of children in the US are routinely vaccinated, in 2018 the CDC found the proportion of children “who received no vaccine doses by age 24 months” to be gradually increasing.

 

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Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, iHeart Radio and is Board Certified Family Physician

 

 

 

 

Posted in flu, Health, news, seniors

Flu Deaths Reported in Multiple States: Do We Also Have a Severe Pneumonia Season?

 

This year’s flu season has claimed the lives of at least 6 children and many more adults.  It’s widespread in many states, and we are told to brace ourselves for yet another severe flu season as we enter the peak.

cdc week 48.png

CDC

 

However, the number one cause of death when it comes to the flu is pneumonia.  And the respiratory depression that appears to come on with these otherwise healthy individuals, appears to affect them within hours. Which brings the question…. Should we be entertaining the possibility that a severe pneumonia strain is affecting us this “flu season” and should we be encouraging pneumonia vaccines as well as the flu vaccine?

Most children are vaccinated against pneumonia

The vaccine schedule for children in the US includes the pneumococcal vaccine (PCV13) given at 2 months, 4 months, 6 months, 12 – 15 months of age.  Over 2 years of a child, one can get the PPSV23 if they did not receive the PCV13.

Not all young adults get the pneumonia vaccine, however if one if over 65, the CDC recommends the pneumococcal vaccines receiving a dose of PCV13 first, followed by a dose of PPSV23, at least 1 year later.

pneumonia.gif
CDC

 

Now a variety of pathogens can be responsible for pneumonia, including viruses’, fungi, and bacteria other than pneumococcus, but streptococcal pneumonia is the most common cause.  If those affected by pneumonia this year were vaccinated, we need to know the strain, meaning specifically what pathogen was responsible for their pneumonia.

Not all pneumonia presents with a cough

Although pneumonia presents with symptoms such as fever, body aches, cough, shortness of breath and sputum production, some individuals may not present with these symptoms when they have pneumonia. Some of the tragic “flu death” cases this year were in adults who initially had a “mild cough”. Since flu symptoms are similar, some may never know if they have pneumonia.

As a result we are telling patients who have the flu to return immediately to the doctor’s office/urgent care/emergency room if they have any of the below symptoms:

  • Recurring fever
  • Fever that won’t subside after 2 days
  • Shortness of breath
  • Difficulty breathing
  • Confusion
  • Weakness
  • Productive cough
  • Blood in sputum
  • Fast breathing
  • Fast heart rate
  • Chest pain

and speak with your medical provider regarding other symptoms they may want you to watch out for.

How to tell when your flu is turning deadly

 

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, iHeart Radio, KDWN, and is a Board Certified Family Physician

 

 

 

Posted in food, Health, news

E. Coli Romaine Lettuce Outbreak Declared “Over” by FDA

The FDA has disclosed a new E. coli romaine lettuce outbreak, that has supposedly ended.

23 people from 12 states have become ill due to this recent outbreak of E. coli. 

No deaths have been reported.

The Shiga toxin-producing E. coli O157:H7 sickened 23 people and hospitalized 11 between the dates July 12 and September 8th, with cases occurring in Arizona, Florida, Georgia, Illinois, Maryland, North Carolina, Nevada, New York, Oregon, Pennsylvania, and South Carolina, with the majority of cases in California.

The FDA emphasizes that they believe the outbreak is over.  However many wonder why they this wasn’t disclosed earlier.

The CDC did appear to begin its investigation earlier this Fall, and forward their concerns to the FDA, but jointly the disclosure didn’t come until now.

On their website, the FDA reports the following:
Today, the U.S. Food and Drug Administration is sharing news of a recent E. coli O157:H7 outbreak, involving 23 illnesses, that was likely associated with romaine lettuce. No deaths were reported. The active investigation has reached its end and the outbreak appears to be over. The FDA and the U.S. Centers for Disease Control did not identify actionable information for consumers during this investigation. Additionally, when romaine lettuce was identified as the likely source of the outbreak, the available data at the time indicated that the outbreak was not ongoing and romaine lettuce eaten by sick people was past its shelf life and no longer available for sale. The FDA is communicating details about the outbreak at this time to help ensure full awareness by the public and to highlight the ongoing importance of industry actions to help ensure the safety of leafy greens. Federal health officials do not believe there is a current or ongoing risk to public health.
CDC notified the FDA of this illness cluster in mid-September 2019 and the agency promptly initiated a traceback investigation. The FDA, CDC, along with state and local partners, investigated the illnesses associated with the outbreak. A total of 23 people infected with the outbreak strain of E. coli O157:H7 were reported from 12 states: Arizona (3), California (8), Florida (1), Georgia (1), Illinois (2), Maryland (1), North Carolina (1), Nevada (1), New York (1), Oregon (1), Pennsylvania (2) and South Carolina (1). Eleven people were hospitalized and no deaths were reported. Illnesses started on dates ranging from July 12, 2019 to Sept. 8, 2019. No illnesses were reported after CDC began investigating the outbreak on Sept. 17, 2019.
Investigators were sent to visit farms located in California’s central coast region which were identified through the traceback investigation. They collected and tested many environmental samples, and the outbreak strain was not identified. While romaine lettuce is the likely cause of the outbreak, the investigation did not identify a common source or point where contamination occurred. Since the outbreak strain was not detected in samples collected from farms during the traceback investigation, and there have been no new cases since Sept. 8, 2019, the outbreak appears to be over.
The FDA remains committed to improving the safety of leafy greens and traceability from farm to fork.

Symptoms of E. coli poisoning can occur anywhere from 1-10 days after ingestion.

They include:

  • Nausea
    Vomiting
    Diarrhea, may be bloody
    Fever
    Chills
    Body Aches
    Abdominal Cramps

And if progresses, can cause

  • Shortness of Breath
    Nose bleeds
    Anemia
    Dehydration
    Seizures
    Renal Failure
    Death

Exposure to E. coli may occur from exposure to contaminated foods (from human or animal waste) or undercooked meats.

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.

Posted in Health, Millennials, students, suicide, teens, vaping

Teen Suicide Rates Soaring…Is Vaping and Nicotine Dependency a Cause?

The CDC reported this week that teen suicide rose 58% over the years 2007-2017 in the age group 10-24.  Although many experts blame social media and teen drug use, one theory may need to be considered:  nicotine withdrawal from vaping.

Millions of middle school and high school students admit to vaping…and many more are assumed who don’t admit to it when surveyed.  So we have an underestimation of how many adolescents take regular hits of their electronic cigarette, exposing them to the powerful, addictive nicotine. One pod, placed in an electronic cigarette to be vaped, contains as much nicotine as a pack of cigarettes.  Hence if a pod is smoked at school, and when the child is home goes hours without, they may “come down” off the nicotine high that they had hours earlier.

In 2002 Picciotto et al discussed how nicotine can affect mood swings, anxiety and depression, where in some cases it can act as an antidepressant but when one withdrawals from it can have increased and anxiety and depression.

The teenage mind and psyche is still developing during this time and a chemical dependency could muddy the mental health waters.

There’s no doubt social media and the misconception teens have that their lives are not as glorious as those who they view online is contributing to lack of confidence, poor self-esteem and depression.  But the decision to commit suicide may also be chemically induced, or a withdrawal of one and should be investigated.

Vaping Linked to Heart Disease and Cancer

 

A study from New York University found the nicotine in electronic cigarettes to cause DNA damage similar to cigarette smoking.

Dr. Moon-shong Tang and his colleagues exposed mice to e-cig smoke during a three-month period, 5 days a week for three hours a day.  They found these mice, compared to those breathing filtered air, to have DNA damage to cells in their bladders, lungs and hearts. The amount of nicotine inhaled was approximately 10mg/ml.   That dose would be commonly consumed by many humans who vape.

nicotine.jpg

They then looked at human bladder and lung cells and found tumor cells were able to grow more easily once exposed to nicotine and vaping chemicals.

Last May, researchers from Vanderbilt-Ingram Cancer Center in Nashville found e-cig smoke to increase one’s risk of bladder cancer.

In 2015, the University of Minnesota identified chemicals commonly found in e-cig vapor to include:

  • Formaldehyde (human carcinogen)
  • Acetaldehyde (carcinogen related to alcohol drinking)
  • Acrolein (highly irritating and toxic)
  • Toluene (toxic) NNN, NNK (tobacco carcinogens related to nicotine)
  • Metals (possible carcinogens and toxins)

Although electronic cigarette “juice” may appear safe, it could produce harmful chemicals once heated to become a vapor.

A lethal dose of nicotine for an adult ranges from 30-60 mg and varied for children (0.5-1.0 mg/kg can be a lethal dosage for adults, and 0.1 mg/kg for children).  E-cigs, depending on their strengths (0 – 5.4%) could contain up to 54 mg of nicotine per cartridge (a 1.8% e -cig would contain 18mg/ml).

The topic of nicotine increasing one’s vulnerability to cancer is nothing new as decades ago researchers found nicotine to affect the cilia (brush border) along the respiratory tree, preventing mucous production and a sweeping out of carcinogens trying to make their way down to the lungs.

More research needs to be performed but this recent report reminds us that exposing our delicate lung tissue and immune system to vaping chemicals may not be as safe as we think.

For more on the study read here.

Toxic metals found in vaping liquid

Last week, experts warned that many chemicals in vaping liquid may change to toxic substances (once heated) that can irritate the lungs.

Last year one study reported that toxic levels of lead and other metals may leak from the heating coil element into the vapor inhaled during e-cig use.

Researchers at Johns Hopkins Bloomberg School of Public Health found these metals to include:

  • lead
  • nickel
  • manganese
  • chromium
  • arsenic

We’ve known for some time that vaping fluid could contain chemicals that turn toxic once heated, but this study shed light on e-cig metal components causing metal leakage to the vapor making contact with delicate respiratory epithelium (lining).

Reported by Forbes, Rich Able, a medical device marketing consultant, stated the following, “the FDA does not currently test any of the most popular vaping and e-cigarette instruments being manufactured at unregulated factories in Asia that source  low-grade parts, batteries, and materials for the production of these devices,” suggesting that “the metal and parts composition of these devices must be stringently tested for toxic analytes and corrosive compounds.”

These chemicals may act as neurotoxins, affecting our nervous system, cause tissue necrosis (cell death) and even multi-organ failure.  Moreover they can affect how our immune system reacts to other chemicals as well as foreign pathogens, affecting our ability to fight other diseases.

Although studies have suggested e-cig vapor to be safer than tobacco smoke, not enough research has been done, in the relatively few years vaping has been around, looking at how heat-transformed chemicals and leaked metals affect our breathing, lungs and other organs once absorbed into the body.

 

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Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.

Posted in disease, flu, Health, news

This Year’s Flu Season Has Begun

Although flu season officially starts in October, public health officials in Riverside, California have already reported the first “flu-related” death this year, a 4 year-old child.

And being that Australia’s flu season began a couple weeks early and was more “severe” than previous years, US health experts are bracing for a rough one of our own.

We still, however, cannot predict how “severe” this year’s flu season will be, but here are answers to the most commonly asked questions about the flu.

When does flu season begin and how long does it last?

Flu season has begun already. It typically starts in the Fall, and ends late Spring.  So the range is described as October to May with it peaking December to March.

How bad will this flu season be?

It is difficult to predict, but already this early in the season we’ve had a flu-related death.  As the season unfolds, more cases will be reported by the CDC’s Flu View.

What is the flu?  How can one die from it?

The flu is caused by a virus. Multiple strains of virus’ can cause the flu.  The virus itself can be lethal, however the greatest risk comes with what it does to your immune system, thereby putting one at risk of secondary infections.  Pneumonia is the number one cause of flu-related deaths.  Secondly, it can exacerbate existing conditions such as asthma, seizures, even promote preterm birth, hence those who are pregnant or have preexisting medical conditions are urged to get vaccinated against the flu.  Moreover those who qualify should get the pneumonia vaccine as well.

 

h1n1-swine-flu-virus
h1n1 virus

 

What does this year’s flu vaccine cover?

According to the CDC, the trivalent vaccine covers for these three strains of flu virus:

  •  A/Brisbane/02/2018 (H1N1)pdm09-like virus
  • A/Kansas/14/2017 (H3N2)-like virus
  • B/Colorado/06/2017-like (Victoria lineage) virus

Quadrivalent influenza vaccines will contain these three viruses and an additional influenza B vaccine virus, a B/Phuket/3073/2013–like virus (Yamagata lineage).

These vaccines are aimed at providing protection against the Swine flu, and some influenza A and B strains.

What about older individuals?

This year, those over 65 will have three options for their flu vaccine.

Fluzone High-Dose – a higher dose flu vaccine that will hopefully allow their immunity to protect against the flu longer

FLUAD – the trivalent flu vaccine with an adjuvant to stimulate more of an immune response.

Flublock Quadrivalent – provides protection against 4 strains.

What about the nasal spray vaccine?

This year, the CDC allows use of the nasal spray vaccine as it has shown to have improved efficacy from  prior years. However it is only recommended for  those who are between the ages of 2 and 49 and cannot be given to those who are pregnancy or who have compromising medical conditions as outlined by the CDC.

Who should get the flu shot?

All individuals 6 months old and older unless specified by their medical provider.

How long does it take the flu shot to “kick in”?

The average immune system takes a couple weeks of to prime, so we suggest getting the flu shot before the season starts…or peaks.  However, experts recommend to still get the flu vaccine to anyone who missed early vaccination.

What if I’m allergic to eggs?

Most individuals allergic to eggs can still get the flu vaccine, but if the allergy to eggs is severe (anaphylaxis, angioedema, difficulty breathing), the CDC recommends notifying your medical provider and being in a facility to monitor you if you do get the flu vaccine.

Will I get the flu from the flu shot?

No.  The flu vaccine has a “killed” version of the virus meaning it’s not an active virus (as opposed to a live attenuated vaccine, a weakened down version of it).   A “killed” or “inactivated” vaccine merely has the pathogen particles to induce an immune response.  Additionally, when one states they got the flu despite the flu shot it could be that the flu shot only protects against 3 – 4 strains and they were infected with a more rare strain not covered by the vaccine.

How effective is the flu vaccine?

The average effectiveness each year hovers around 60%.  Last year’s efficacy was much lower and this year’s has not been predicted as of yet. Australia is still reporting active cases on their Department of Health website.

I feel sick after the flu shot, why?

For some, the immune response that ensues can make one feel mildly ill, but should not resemble the flu. Those who state they got the flu “immediately” after receiving the shot, might have already been exposed and had not had a chance to produce immunity prior to their exposure.

sneezing

 

What are symptoms of the flu? How is it different from a cold?

A cold comes on slower and less severe.  Flu symptoms are more abrupt and can include:

  • Fever
  • Body Aches
  • Cough
  • Sneezing
  • Sore Throat
  • Shortness of Breath
  • Fatigue
  • Headache
  • Nausea
  • Vomiting

Are there medications to treat the flu? Will antibiotics work?

There are antiviral medications available, such as Tamiflu, to treat the flu.  Antibiotics, however, will not work since the flu is not caused by a bacteria but rather a virus. However if a secondary bacterial infection takes over, antibiotics may be used.

How can I prevent getting the flu?

Besides vaccination, avoid being around those who are sick, thorough hand washing, and take good care of yourself.  A balanced diet, exercise and sleep regimen can help boost your immune system.

Wishing you health this season!!

 

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Great Gift!!!

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Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.

Posted in Health, news, vaping

Vitamin E Acetate Linked to Vaping Illness

The CDC is currently investigating close to 450 cases of vaping related illness and 5 reported deaths.  A recent study in the New England Journal of Medicine has found evidence of a lipoid pneumonia in a case where a 21 year old became sick after vaping nicotine and tetrahydrocannabinol (THC) daily.

Macrophages, which are scavengers that rid the body of pathogens and other harmful substances in the body, were found to be “lipid-laden”, or full of a fatty substance. They suspect this fatty substance to be caused by inhalation of Vitamin E acetate that was only present in marijuana vaping products and not the average nicotine e-cig.  Vitamin E is commonly used in hand creams, moisturizers and as a supplement due to its oily nature, but is not to be inhaled.

Since the lungs are designed to oxygenate the lungs and exchange out carbon dioxide, oily substances can clog the works.

Experts say the Vitamin E acetate is not believed to be apart of regular e-cigarettes that do not vape THC, the psychoactive component to marijuana.

This is a developing story….

____________________________________________

 

Vaping linked to seizures

The FDA is investigating 127 reports of seizures in e-cigarette users (up from 35 this Spring).

Many were teenagers and young adults.

Since 2010 the agency has received multiple reports but is unclear if e-cigarettes actually caused the seizures or if there were underlying medical conditions predisposing the neurological disorder.

The 92 additional cases since this April is concerning and the FDA is working to determine if vaping contributes contributes directly to serious neurological conditions.

In April FDA Commissioner Dr. Scott Gottlieb tweeted:

While we’re still learning about the long-term potential benefits and health risks of e-cigs, existing scientific research offers some clear evidence that several of the dangerous chemicals in tobacco smoke are also present in the aerosol of some e-cig products.

Dr. Ned Sharpless, current acting FDA Commissioner, is encouraging people to report adverse events as, “Additional reports or more detailed information about these incidents are vital to help inform our analysis and may help us identify common risk factors and determine whether any specific e-cigarette product attributes, such as nicotine content or formulation, may be more likely to contribute to seizures,” (Reported by CNBC).

What is a seizure?

A seizure occurs when there is abnormal electrical activity in the brain.  If the electricity doesn’t conduct properly, brain function gets disrupted. This could lead to convulsions  (involuntary jerking movements), loss of muscle tone, changes in senses such as vision, hearing and smell, loss of bladder control, loss of consciousness and sometimes stroke, brain damage and death.

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Nicotine toxicity has been linked to seizures.  E-cigs sometimes contain more nicotine than cigarettes alone.

 

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A study published by the American Heart Association found nine different E-cig flavors  to impair blood vessel function, which can impair heart health.

Endothelial cells, which delicately line blood and lymph vessels, were found to become inflamed at low concentrations of some vapor flavors.  And at high concentrations of others, exibited cell death.  Nitric oxide production, necessary for vessel dilation to improve blood flow, was impaired as well. These are often the same changes seen in early heart disease.

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The 9 flavors (and the chemicals within) cited in the report to cause the endothelial inflammation and/or damage were:

  • Mint (menthol)
  • Vanilla (vanillin)
  • Clove (eugenol)
  • Cinnamon (cinnamaldehyde)
  • Strawberry (dimethylpyrazine)
  • Banana (isoamyl acetate)
  • Butter (diacetyl)
  • Eucalyptus/spicy cooling (eucalyptol)
  • Burnt flavor (acetylpyridine)

Strawberry flavoring appeared to have the most adverse effect on the cells.

Now many other flavors were not included in this study, so its unknown how safe they may be.

For more on the study, read here.

An alternate study published last November looked at vaping flavors and their effects on heart muscle cells.

For more on this study, read here.

The moral?  Just because we love the taste of something, doesn’t mean its safe to inhale.

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Vaping Linked to Heart Disease and Cancer

 

A study from New York University found the nicotine in electronic cigarettes to cause DNA damage similar to cigarette smoking.

Dr. Moon-shong Tang and his colleagues exposed mice to e-cig smoke during a three-month period, 5 days a week for three hours a day.  They found these mice, compared to those breathing filtered air, to have DNA damage to cells in their bladders, lungs and hearts. The amount of nicotine inhaled was approximately 10mg/ml.   That dose would be commonly consumed by many humans who vape.

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They then looked at human bladder and lung cells and found tumor cells were able to grow more easily once exposed to nicotine and vaping chemicals.

Last May, researchers from Vanderbilt-Ingram Cancer Center in Nashville found e-cig smoke to increase one’s risk of bladder cancer.

In 2015, the University of Minnesota identified chemicals commonly found in e-cig vapor to include:

  • Formaldehyde (human carcinogen)
  • Acetaldehyde (carcinogen related to alcohol drinking)
  • Acrolein (highly irritating and toxic)
  • Toluene (toxic) NNN, NNK (tobacco carcinogens related to nicotine)
  • Metals (possible carcinogens and toxins)

Although electronic cigarette “juice” may appear safe, it could produce harmful chemicals once heated to become a vapor.

A lethal dose of nicotine for an adult ranges from 30-60 mg and varied for children (0.5-1.0 mg/kg can be a lethal dosage for adults, and 0.1 mg/kg for children).  E-cigs, depending on their strengths (0 – 5.4%) could contain up to 54 mg of nicotine per cartridge (a 1.8% e -cig would contain 18mg/ml).

The topic of nicotine increasing one’s vulnerability to cancer is nothing new as decades ago researchers found nicotine to affect the cilia (brush border) along the respiratory tree, preventing mucous production and a sweeping out of carcinogens trying to make their way down to the lungs.

More research needs to be performed but this recent report reminds us that exposing our delicate lung tissue and immune system to vaping chemicals may not be as safe as we think.

For more on the study read here.

Toxic metals found in vaping liquid

Last week, experts warned that many chemicals in vaping liquid may change to toxic substances (once heated) that can irritate the lungs.

Last year one study reported that toxic levels of lead and other metals may leak from the heating coil element into the vapor inhaled during e-cig use.

Researchers at Johns Hopkins Bloomberg School of Public Health found these metals to include:

  • lead
  • nickel
  • manganese
  • chromium
  • arsenic

We’ve known for some time that vaping fluid could contain chemicals that turn toxic once heated, but this study shed light on e-cig metal components causing metal leakage to the vapor making contact with delicate respiratory epithelium (lining).

Reported by Forbes, Rich Able, a medical device marketing consultant, stated the following, “the FDA does not currently test any of the most popular vaping and e-cigarette instruments being manufactured at unregulated factories in Asia that source  low-grade parts, batteries, and materials for the production of these devices,” suggesting that “the metal and parts composition of these devices must be stringently tested for toxic analytes and corrosive compounds.”

These chemicals may act as neurotoxins, affecting our nervous system, cause tissue necrosis (cell death) and even multi-organ failure.  Moreover they can affect how our immune system reacts to other chemicals as well as foreign pathogens, affecting our ability to fight other diseases.

Although studies have suggested e-cig vapor to be safer than tobacco smoke, not enough research has been done, in the relatively few years vaping has been around, looking at how heat-transformed chemicals and leaked metals affect our breathing, lungs and other organs once absorbed into the body.

 

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Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.

Posted in disease, Health, news

West Nile Virus Cases in Humans Reported in Multiple States including Nevada

 

Multiple cases of West Nile virus has been confirmed in Clark County, Nevada. The Southern Nevada Health District has declared an “outbreak of mosquito-borne diseases” following new cases of the virus being reported earlier this month.

This summer has been a wetter season in the Southwest, most likely causing an uptick in mosquito activity.

States throughout the country have been reporting cases of West Nile virus as well, with the highest occurring in Arizona (42 cases as of 7/23/19 per CDC).

 

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West Nile Virus Disease Cases* and Presumptive Viremic Blood Donors by State – United States, 2019 (as of July 23, 2019)

West Nile Virus Disease Cases and Presumptive Viremic Blood Donors by State – United States, 2018 (as of November 27, 2018)
State Neuroinvasive
Disease Cases†
Non–neuroinvasive
Disease Cases
Total
cases
Deaths Presumptive viremic
blood donors‡
Arizona 42 15 57 1 16
Arkansas 1 0 1 1 0
California 2 0 2 1 1
Colorado 0 1 1 0 0
Iowa 0 2 2 0 0
Kentucky 1 0 1 0 0
Maryland 0 1 1 0 0
Missouri 1 0 1 0 0
Nebraska 1 0 1 1 0
Nevada 1 0 1 0 0
New Jersey 1 0 1 0 0
North Dakota 1 0 1 0 0
Oklahoma 1 2 3 0 0
South Dakota 0 1 1 0 0
Virginia 0 1 1 0 0
Wyoming 1 0 1 0 0
Totals 53 23 76 4 17
*Includes confirmed and probable cases.
†Includes cases reported as meningitis, encephalitis, or acute flaccid paralysis.
‡Presumptive viremic blood donors (PVDs) are people who had no symptoms at the time of donating blood through a blood collection agency, but whose blood tested positive when screened for the presence of West Nile virus. Some PVDs develop symptoms after donation.
Please refer to state health department web sites for further details regarding state case totals.

What is West Nile virus?

West Nile virus was originally discovered in the 1930’s in the West Nile district of Uganda.  It is believed to have reached the United States in the late 1990’s.

It’s in the family of Flaviviridae in which the disease is vector transmitted, such as by ticks, or mosquitoes, and can infect mammals as hosts. West Nile is in the same family as Zika, Yellow Fever, Dengue Fever, and Japanese Encephalitis.

Culex genus/species of mosquitoes are the usual culprit.  They feed from evening to morning, hence are more active during those times.

How is West Nile transmitted?

A mosquito contracts the disease while feeding on an infected bird and then can transmit it to humans.

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What are the symptoms of West Nile virus infections?

80% of those infected do not exhibit symptoms.  Some however, may elicit the following if they have mild illness:

  • Fever
  • Body aches
  • Fatigue
  • Nausea
  • Vomiting
  • Joint  pains
  • Weakness
  • Rash

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Image from Reserachgate

Rarely (1 in 150 people) may become seriously ill with neuroinvasive symptoms.  These include:

  • Headache
  • Neck pain/Stiff neck
  • High fever
  • Sensitivity to the light (photophobia)
  • Tremors
  • Weakness
  • Paralysis
  • Confusion
  • Disorientation
  • Seizures
  • Coma
  • Death

Since mosquitoes are the primary vector, avoiding them is paramount to limiting infection.  We recommend the following:

Clean up areas of standing water around the house such as kiddie pools, puddles, buckets as they provide a breeding ground for mosquitoes.

Wear light long sleeve clothing, pants tucked into socks/shoes when outside.

Use DEET or insect repellent that can also be sprayed onto clothes when planning to be outdoors.

Be aware that many mosquitoes are active from dusk till dawn.

If bit by a mosquito, contact your local medical provider if you have any of the aforementioned symptoms.

 

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Great Gift!!!

The Ultimate Medical Student HandBook

 

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.