Covid, Kids and Vaccination

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Vaccine.

As the Coronavirus pandemic spreads across the United States and our world, I worry about friends, family, and my community in general. The virus has the potential to be truly devastating, with the potential to cause thousands of deaths, especially among the elderly. Fortunately there is a ray of good news: the virus does not seem to cause severe disease in children. In fact, the data from China which experienced a majority of the cases and deaths early on in the pandemic, has been reassuring. Of approximately 3,300 deaths to date, child deaths have been rare. And in Washington, where we have had almost 200 deaths, there have been no deaths among children or young adults.  

While the elderly are at risk for developing severe and life threatening infections, children and young adults are more likely to have mild symptoms such as nasal congestion, sore throat and a mild cough. The good news is that our children seem to be spared, but there is a down side as well: since children have mild symptoms, they have the potential to easily  spread the coronavirus to adults. Not only should adults stay home when ill, but it is also vital that children stay home and not interact with other children even if they may only seem to have a “mild cold.”  In addition to staying home when sick, the concept of avoiding close person-to-person contact, also known as “social distancing,” is an essential measure to slow the spread of the virus. 

But how do we stop the virus? The coronavirus pandemic will stop when enough people are immune to prevent spread, social distancing efforts have paid off enough to interfere with spread, or an effective vaccine is created. Scientists are working hard to develop a vaccine and there is already at least one vaccine in early clinical trials. I am confident that science will come to our rescue with a vaccine to prevent coronavirus infection. The big question is how long it will take to create and produce enough of the vaccine for Americans to receive; the time frame currently cited in the medical community is that it make take a year.

While we hope for and envision a successful vaccine to combat the coronavirus, it is an important time to reflect upon and learn from other vaccination efforts to prevent adult deaths from infections. Namely, to stop the virus and prevent adult deaths, it may be most important to vaccinate children. A pneumonia vaccine called the “PCV13” as well as the influenza vaccine are perfect examples of how vaccinating children saves adult lives. Known as the “PVC-13,” the pneumococcal conjugate vaccine protects against 13 different strains of the pneumococcus bacteria, and was first recommended in 2000 to protect children from pneumonia and blood stream infections. The vaccine has been a tremendous success and has saved pediatric lives. The miracle of this vaccine however, was the surprise finding that by vaccinating children, researchers also saw a dramatic drop in adult deaths from pneumonia even though the adults had not received the vaccine. In other words, by reducing the infection in children, the bacteria could not be transmitted to adults, and as a result adults benefited as well. Five years ago, the CDC decided to try giving the PCV13 vaccine to adults with the hope of preventing even more adult pneumonia infections. After studying the effects of this intervention however, they found that vaccinating adults did not have the same benefit. Unfortunately, vaccinating adults with PCV-13 did not further reduce adult disease. 

Similarly, recent research has shown that giving the influenza vaccine to children may be more effective at preventing adult influenza deaths- more effective than vaccinating the adults themselves. 

There are two important reasons why vaccinating children can be more helpful than vaccinating adults when it comes to preventing adult disease. First, children are an extremely important way that disease spreads. Kids play with kids, don’t wash their hands very well, and are in general very good at sharing germs. By preventing infections in kids, we very effectively prevent the spread of infections to everyone else. 

Second, and very importantly, the immune systems of children respond much better to vaccination than the immune systems of adults. As a result, vaccines are better at preventing infections in children compared to adults. As adults age, they experience a process called “immunosenescence,” which is an aging process for the immune system such that the elderly become slower to respond to infections, and responses to infections are less strong. When older adults are given a vaccine, they are less likely to develop a protective immune response compared to children. Meanwhile, children typically develop an immune response to vaccines quickly and in a robust manner.

In summary, what does this mean for us today as we worry about the spread of coronavirus? 

  1. To stop the spread of virus now, we need to use the only tool available to us: social distancing. Stay home and wash your hands frequently.  Don’t spread the infection; don’t get the infection.
  2. Children thankfully appear to be spared severe disease and death, but are an important way the virus can spread to adults and other children.
  3. When a vaccine becomes available, vaccinating our children may be critical to saving adult lives, and stopping the Coronavirus Pandemic.

Mental Health in Kittitas County- the Time Is Now.

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Hello Kittitas County!

Thanks for being patient- it has been over a year since I last posted, but now it is time to get back at it!

Mental health:  happiness, sadness, stress, coping, and how we manage the challenges  of day to day life.
We could use more help in our community;  we need more mental health counselors and more resources to help people, of all ages, to live to their fullest. In Washington State, the ratio of community members to mental health providers is 360:1. In Kittitas County, the ratio is almost double at 710:1. This means that for an individual with mental health needs in our community, it is more difficult to receive help.

In a 2018 community health survey, Kittitas County residents rated mental health as their #1 concern. In a way, it is no surprise: Kittitas County data suggests our community is vulnerable to mental health stress. Kittitas County is one of the worst in the state when it comes to income disparity. We have many who are very wealthy and many more who are very poor. 17% of children live in poverty here, while 25% of homes are single parent households. A staggering 24% of high school students had a suicide plan in 2018. Meanwhile, Kittitas Fire and Rescue experienced a 74% increase in calls related to mental health issues from 2017 to 2019.

We need help, and you can help: Kittitas County Health Network supports a 1/10th of 1% sales tax initiative to provide funds to support mental health services in our community. This sales tax requires approval from our county commissioners. Write them or call them to encourage approval of the 1/10th of 1% sales tax initiative. To me, it’s clear- lets do it!
Learn more: on  March 6th I interviewed Greg Aubol, director of Central Washington Comprehensive Mental Health and Steve Panattoni, our Kittitas County Jail Superintendent, on my radio show about mental health in our community and the proposed sales tax. Listen to the podcast to hear from these amazing individuals working tirelessly to make our community a better place to live. Dr John’s Radio Show on Ellensburg Community Radio. Eburgradio.org. Follow the link to listen :

 

It’s Not Just a Ritual

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“It has been over 10 years- we can give you your tetanus booster before you leave today,” my medical assistant cheerfully remarked as she recorded the vital signs.

“Um, okay, I guess so…  if I’m due. Sure,” my patient awkwardly replied.  Not sure if it was an extra bonus to the visit or an unwelcome surprise, my patient considered the scene unfolding and thought, “I’m here because I have a cough-  I didn’t realize I would be getting a shot in the arm today.”

Since a tetanus booster is given every ten years to protect against an uncommmon disease, getting the shot may seem almost as if it is a ritual.  Yet most people somehow know that tetanus is a disease worth preventing, and tetanus boosters are often readily accepted by patients. Staying up to date on your tetanus booster is a wise decision:

1.  The vaccine provides immunity to the toxin, but not the bacteria.  Clostridium tetani, the bacteria that makes the tetanus toxin, is just as prevalent in our world today as it was in 1938 when the tetanus vaccine first became available. In fact, the bacteria is present in 30% of American soil samples, while up to 40% of American livestock have the bacteria present in their stool. There’s a good chance that throughout your life you have been- or will be- exposed to the tetanus bacteria.  But thanks to the vaccine, the bacteria’s toxin will not harm you. 

2.  The tetanus toxin, which is called “tetanospasmin,” is one of the most potent toxins on a weight basis known to humans. The tiny amount of 2.5 nanograms per kilogram, is enough to cause death.  To give perspective, the weight of a nanogram is equal to one billionth of a gram.

3. Preventing tetanus is well worth the effort because the disease is truly devastating. The toxin causes muscles to become painfully rigid, in which legs straighten, arms become flexed, and the face becomes contorted. A person with tetanus becomes unable to breath as the muscles that move the lungs become paralyzed. The mind is unaffected while one’s body stiffens out of control.

4.  The highest risk of infection and succumbing to tetanus is in individuals whose tetanus boosters have gone overdue, most commonly older adults. Don’t let this happen to you.

5. Finally, getting a tetanus booster is a two for one bonus package; the tetanus booster also includes protection from diphtheria. A tetanus booster is “Td”, tetanus and diphtheria. The diphtheria bacteria causes a severe airway infection, and like the tetanus vaccine, the diphtheria vaccine provides immunity to the bacteria’s toxin but not the bacteria itself.

Preventing tetanus and diphtheria requires ongoing maintenance because immunity wanes after about ten years. These diseases are rare in the United States today thanks to an outstanding vaccine, but can occur if boosters are neglected. 

The next time you see your healthcare provider and a tetanus booster is recommended, here’s what to say: 

“That’s great- let’s do it!”

Loving Big In Kittitas County

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1529106390704Cancer turns life upside down; for individuals and their loved ones, life becomes overwhelmed with medical care. Instead of working, socializing, and enjoying daily routines, days are suddenly filled with doctor appointments, tests, surgical procedures, and treatments. Even simple appointments or medical tests can swallow up a day. In addition, the lives of spouses, friends, and family- the patient’s support group- are disrupted. Whether it is offering emotional support, attempting to understand insurance coverage, or coordinating appointments and navigating the medical system, providing support is practically a full time job!

To top it off we live in Kittitas County, which means that for virtually any cancer related medical care, patients must drive to Yakima or Seattle. For chemotherapy, radiation therapy or other treatments given at regular intervals, the necessary travel time can be a heavy burden on individuals and families. People with cancer – and those who support them- need help. They need time, monetary support, and importantly, emotional support.

The silver lining is that we live in Kittitas County, a place where people are exceptional at caring for one another. There is a generosity of spirit here that is unique, and it is from this sense of caring and generosity that a grass-roots organization called “The Gretchen Weller Foundation” was formed in 2015. Gretchen Weller is a mother of three who was diagnosed with breast cancer while still breast feeding her youngest child. She and her family have responded to cancer by choosing to “live life intentionally,” which she describes as “loving big”: living and loving the best she can, every day.

Inspired by Gretchen, Cathie Day and a group of dedicated individuals created The Gretchen Weller Foundation, whose mission is to support patients and families during their journey with cancer: “When one family member has cancer, everyone in the household becomes affected by that struggle. Besides medical expenses, cancer is costly in many ways. Families need transportation, meals out, car maintenance and a host of other expenses. The Gretchen Weller Foundation helps to bridge some of these gaps.”

If you know of a friend or family member with cancer, help ease their burden by connecting them with The Gretchen Weller Foundation. In addition, donating to the Gretchen Weller Foundation is a great way to support fellow residents of Kittitas County in their journey with cancer. One hundred percent of donations go directly to Kittitas County patients. To learn more, visit their website at https://gretchenwellerfoundation.com/, or listen to an inspiring interview with Gretchen and Cathie Day at https://soundcloud.com/eburgradio-org/dr-john-36-gretchen-weller-foundation?in=eburgradio-org/sets/dr-johns-radio-show.

PechaKucha

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Twenty images and for each image twenty seconds to say what you want to say, for a total of 6 minutes and 40 seconds of sharing.  PechaKucha, which in Japanese means “chit-chat,” first began in 2003, and has spread around the world as a way to share ideas in a concise and creative format. Our own Gallery One in Ellensburg has been hosting PechaKucha evenings every four months since 2014. If you have the opportunity to attend a PechaKucha evening, I highly recommend it- it is fun, stimulating, and a great way to connect with your community.

Each Pecha Kucha has a theme, and in March the theme was “on being human.” I was invited to do a presentation, and I would like to share it with you:

https://www.pechakucha.org/cities/ellensburg/presentations/on-being-human-perspectives-as-a-doctor-and-as-a-patient

 

Hope you enjoy it!

Spread The News

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Not on the news today-
a child got to play. No,
not on radio, TV or social media feed-
a garden, a kid planting a seed.

2017
first time ever
deaths from Measles worldwide dipped below 100,000.

You won’t see it on a president’s tweet-
little kids played on the street. No,
no juicy gossip, headlines and politicians taking heat-
look around and see, less wheelchairs on the street.

2017
all time low
15 people in this world afflicted with Polio.

A tribute to science,
a gift to humanity:
Vaccines lessen death and disability.

Spread the news.

 

Chickenpox Is Not A Party

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Sick child with chickenpox, sad girl looking back.

Kids love parties and play-dates, and parents enjoy both organizing them as well as socializing with each other as their child is joyfully engaged with friends. After a high energy afternoon of play and socializing, parents and children return home to recover and begin the next day anew. It is a story repeated every day across America- a happy story.

I would like to address a different kind of party, the “chickenpox party,” where parents bring their children together in order to expose them to chickenpox, an infectious disease caused by the varicella virus. While the party begins the same with the theme of happy kids and socializing parents, it has a different ending in which children return home to later develop chickenpox.

The rationale behind a chickenpox party is that by experiencing the natural disease, a child develops natural immunity to the virus, which some feel is better than immunity from the vaccine. While this reasoning may seem appealing, please consider how the decision to join a chickenpox party can impact the health of your child as well as others in your community.

  1. When a child- or a person of any age for that matter- has active chickenpox, they experience a disease. Chickenpox can sometimes be mild, but is typically a moderate illness that lasts one to two weeks and is characterized by fever, headache, fatigue, and a rash of blisters that covers the body. Most children who have the infection miss 5-6 days of school or daycare. When a child receives the vaccine, they do not suffer from the disease.
  2. Complications of chickenpox can be serious. The most common complication of chickenpox is a bacterial skin infection, which at a minimum requires antibiotics. When the bacteria enter the body through one of the many ruptured blisters to cause a bloodstream infection, children need hospitalization for treatment. Meanwhile, the leading cause of death from chickenpox is pneumonia and a brain infection called encephalitis. Before the advent of the vaccine in 1995, 10,000-12,000 children were hospitalized and 100-150 children died every year in the United States from chickenpox.
  3. There are people in every community who are vulnerable to serious complications from chickenpox, such as babies, pregnant women and people with a suppressed immune system. Infants less than a year old are at an increased risk of severe disease, and since children are not routinely vaccinated until a year old they are vulnerable during this first year of life. In addition, varicella infection during pregnancy can be devastating to the developing fetus, causing birth defects and miscarriage. And lastly, a person with a suppressed immune system is at high risk of severe disease or death from varicella infection. Immunosuppression is increasingly common in medical care these days as people receive immunosuppressive medications for cancer, Rheumatoid Arthritis, or Crohn’s Disease for example.
  4. The varicella vaccine is 90% effective in preventing chickenpox, and immunity (protection) is typically long lasting. While it is possible to get chickenpox despite having received the vaccine, when this happens the infection is very mild. Of profound significance, the varicella vaccine is 100% effective in preventing serious complications and death from chickenpox.
  5. The natural course of varicella infection is such that following the initial infection, the virus lays dormant throughout one’s life. If the varicella virus reactivates in adulthood it causes “shingles,” which is a localized, painful blistering rash. A third of adults experience shingles during their lifetime. Almost as a special bonus to receiving the vaccine, research has shown that those vaccinated with the varicella vaccine tend to experience a milder case of shingles in adulthood compared to those who have had the “natural” infection.

A party to spread an infectious disease that could otherwise be prevented by a safe and effective vaccine is not my kind of party. Instead, my suggestion for a chickenpox party is to have a party to celebrate the vaccine and good health. Bring your vaccinated kids, have a great time, and go home without disease and suffering. Share happiness and health with each other rather than a viral infection. This is the type of happy story medical practitioners hope to see within our communities, as well as across America.