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recognizing childhood diseases, part 3
By | May 1, 2010
i’ve been reading a very interesting book called The Big Necessity by rose george (2008), about the politics and realities of “sanitation.” did you know that 4 in 10 people worldwide do not have a bathroom – or even a bucket? just the street or the bushes. and that’s as a mattter of everyday life, cradle to grave – not just during big emergencies like the haitian earthquake.
although there have been multiple important campaigns to guarantee clean water to citizens, from the worldwide United Nations level to local (Lane County) efforts, very little attention (or money) is devoted to the “sanitation” (i.e., toileting) problems that are the major source of dangerous water contamination. this is why many, many parts of the world have very high death rates from gastrointestinal diseases.
this last entry on how to recognize childhood diseases that are usually prevented by vaccination, concerns gastrointestinal diseases. polio, rotavirus, and hepatitis A are transmitted by means of “sanitation” or lack thereof. hepatitis B, on the other hand, is blood-borne and transmitted through contact with body fluids – including ways you might not suspect.
rotavirus:
this is the main cause of severe diarrhea in babies and young children, and before vaccination, 55,000 babies were hospitalized with it every year in the US. it’s a “sanitation-bourne” virus – spread by contact with diarrhea, including diapers, clothing, washcloths/towels, and surfaces. unlike most forms of diarrhea, “rotavirus season” is in the winter, from november through april.
rotavirus is easy to describe. the incubation period is about 2 days, followed by vomiting and diarrhea for about a week. some kids have fever and abdominal pains as well; about half of babies and kids will also have breathing symptoms like cough and wheeze. seizures and encephalitis occur rarely. about 1 in 40 babies and young children will need to be hospitalized due to dehydration.
the only treatment is symptomatic. you would need to safeguard against dehydration to the best of your ability, using oral rehydration fluids to preserve vital electrolytes lost through the intestinal tract. if your child stopped urinating, stopped crying tears, or had any suspicious change in behavior, you’d need to get them evaluated – they might need IV fluids to prevent worse consequences.
after having rotavirus once, it’s possible to get it again, but repeat infections are less severe. some individuals will have long-term problems with digestion after the acute virus is cleared. they can continue to have loose stools, belly pain, and carbohydrate or lactose sensitivity or intolerance. in some cases, long-term irritable bowel syndrome appears to have resulted from a severe gastrointestinal virus.
polio:
the gastrointestinal virus causing the disease poliomyelitis (“polio-my-a-LITE-is”). recall, “myelo-” means spinal cord, and “-itis” means inflammation. “polio” means grey; the virus can infect and inflame the grey matter (nerve tissue) of the spinal cord, causing paralysis.
polio virus is transmitted hand-to-mouth, usually through contaminated water or food, most prevalent in summer and autumn (may be year-round in tropical areas).
the incubation period is 6-20 days, and the virus is contagious for 10 days before and 10 days after symptoms first appear. there are no treatments, so control focuses on prevention.
as you probably know, polio outbreaks caused many public-health panics in the first half of the twentieth century (58,000 cases in the US in 1952 alone) and led to widespread vaccination campaigns. this also led to the first anti-vaccination campaigns, after 120,000 contaminated doses of vaccine caused polio in 56 kids and killed 5.
north and south america were declared to be effectively polio-free in 1994, and europe was declared polio-free in 2002. currently, polio is still a widespread problem in India, Pakistan, Afghanistan, and Nigeria, so unvaccinated kids are at risk mainly when they or their close contacts have visited these areas.
in about 90% of cases, polio causes no symptoms and the person is not aware they have been infected. in the remainder of cases, the virus causes mild illness, including sore throat, fever, body aches, nausea, vomiting, abdominal pain, and constipation.
in about 3% of cases, polio goes on to infect the nervous system, causing paralysis. when polio infects the nervous system, it usually occurs after the person has been feeling better for a day or two.
2/3 of people develop meningitis, with fever, headache, stiff neck, vomiting, and sometimes seizures. they will need a spinal tap to rule out any bacterial infection that could be treated with antibiotics (antibiotics can’t help a viral infection). this meningitis usually resolves completely. some kids are left with lasting nervous system development problems.
about 1/3 of the time, the nervous system infection advances to paralytic polio, causing death of the spinal nerves, and resultant wasting away of the muscles. (muscles need nerve signals to stay strong.) symptoms of paralytic polio begin with high fever and muscle pain and weakness (usually one-sided), without loss of sensation – for example, can’t stand on one leg, and no knee-jerk (or ankle-jerk) reflex in that leg, but can feel touch and temperature on the leg. the muscles are limp rather than spastic.
the paralysis gets worse quickly, over 2-4 days. sometimes brain tissue is infected and brain damage results, with difficulty talking and swallowing, and even with breathing.
polio does look like some other causes of “flaccid paralysis,” including west nile virus (from mosquitos; check with a blood test in the first week of symptoms) and botulism (from infected canned food including honey).
polio does not look like guillain-barre syndrome, which causes two-sided muscle weakness starting at both feet/ankles and spreading up the legs. guillain-barre syndrome can be treated with medicines, while polio can not, so it’s important to distinguish between the two.
hepatitis A virus (HAV):
“hepatitis” means “hepato-”, liver, and “-itis”, inflammation. this is a virus that is very contagious, spread through the feces (stools). it is notorious for appearing at restaurants and childcare centers.
it makes adults much sicker than babies and small children; in the childcare setting, it’s not usually noticed until an adult staffer becomes jaundiced.
older kids and adults are more than twice as likely to need hospitalization from HAV due to liver failure (13% risk for under 5 years old; 31% risk if older).
this is why HAV was added to the standard childhood vaccine schedule in 2006 – to protect older kids and grownups. the liver damage is caused by the immune system’s overreaction to the virus.
hepatitis A can be prevented by handwashing, although it is difficult to enforce this in small children. household bleach solutions also deactivate the virus.
the incubation period is 2-6 weeks, followed by symptoms in about 30% of children under six years old and 75% of older kids and adults.
the symptoms include fever, nausea and vomiting, belly pain, and diarrhea.
jaundice (yellow skin and whites of the eyes) usually occurs one week after symptoms start; the urine can turn dark and the stools can become pale.
the symptoms can last for 1-2 weeks in younger kids, or 2 weeks to 6 months in older kids and adults. it is recommended that people who have been exposed to hepatitis A get the vaccine to avoid developing the disease, up to 2-6 weeks after exposure.
hepatitis B virus (HBV):
this is a blood-borne virus that infects the liver and causes cirrhosis (scarring) of the liver, and an increased risk of liver cancer.
many folks don’t see why there is a child vaccination program against this virus, since they know HBV is spread by sharing needles (for recreational drugs or tattoos), by blood transfusions, and by sexual body fluid contact. they say, “my newborn baby is not having sex or shooting drugs, so there is no point to this shot.”
there are three reasons why the US started the vaccine program:
1. when babies catch HBV, they have a 90% chance of it becoming a chronic, cirrhosis-producing infection, compared to adults who have a 1-5% chance of chronic disease. (the risk is 30-50%, in young kids.) 1 in 3 of the million adults with chronic HBV are believed to have caught it in infancy and young childhood, through cuts, scratches, bites and punctures, and from others who didn’t know they had it (see below).
2. when babies and young kids catch HBV, they often have no symptoms, or very vague ones. it’s estimated that for each young child who has symptoms, there may be 100 who are carriers and have no symptoms.
3. HBV can be transmitted in unexpected ways, including in medical, alternative health, and dental settings, sports, fitness, and cosmetological settings, etc. – see here for more.
the HBV shot is unusual in that it isn’t meant so much to protect against a typical childhood diseases, as to protect against cancer (of the liver) occurring in adulthood. the shot has been around for almost 20 years. the purpose of the program is to eliminate this infectious source of cancer.
for those who do not vaccinate, how can we recognize this childhood illness?
the incubation period lasts one to four months, followed by loss of appetite (and/or “failure to thrive”), nausea, jaundice (skin and whites of the eyes turning yellow) and discomfort in the upper right belly, where the liver is. these symptoms last one to three months. blood tests indicate the liver damage, but even after these return to normal, the child can still suffer fatigue.
some babies and young kids can can get Gianotti-Crosti syndrome, a flat-topped bumpy dark-red non-itchy skin rash on the arms, legs, bottom, and face (not the trunk or scalp). it is possible to have this rash and no other symptoms – for example, no jaundice. ( Gianotti-Crosti syndrome can occur as an immune reaction to any number of viruses, and is harmless in itself.)
breastfeeding is safe. although HBV has been found in milk of infected mothers, their babies don’t appear to go on to develop chronic disease.
kids are diagnosed with chronic HBV when blood tests show the virus has not gone away over six months. it doesn’t usually affect their growth and development. the risk of adult death from cirrhosis and liver cancer caused by HBV that started in infancy or childhood is around 25%. in the united states, HBV accounts for 5-10% of all liver transplants, even though people with chronic HBV have a high risk of having the virus damage the new liver.
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