Protecting Your Health in Erie, PA | Erie County Medical Society

 

The Erie County Medical Society is a voluntary, non-profit professional organization of physicians, both MD and DO, in Erie, PA, founded in 1828. Our mission is to advance the standards of medical care, to uphold the ethics of the medical profession, and to serve the public with important and reliable health information.



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3:43 AM
June 23rd, 2019

Measles Has Returned

Measles Virus

 

Measles has returned. After having been declared eliminated in 2002, measles has returned, right here in northwest Pennsylvania. Certainly, a closer look at measles is timely.

 

History

 

In the ninth century, the Persian physician Rhazes was the first to describe measles. In 1757, the Scottish doctor Francis Home first attempted to make a vaccine.

 

Because of measles high level of contagion, it spread rapidly in island nations with no intrinsic immunity. An 1848 outbreak in Hawaii killed nearly a third of the population. An 1875 outbreak in Fiji likewise killed nearly a third of the population, in only four months.

 

In 1916, 12,000 people died of measles, three out of four of them being children under 5-years-old.

 

By the 1950s, deaths dropped to 400-500 a year, mostly because of antibiotics and public health measures. However, there were still an estimated 48,000 hospitalizations a year from measles-related ear infections, diarrhea, and pneumonia. An estimated 1000 children a year developed measles related encephalitis causing intellectual disability or death.

 

Finally, with school vaccination requirements and federal funding, measles was eliminated in the US in 2002. However, with some Americans desiring not to vaccinate, measles has begun to reappear.

 

Contagion

 

Measles is one of the most contagious diseases. At least 90% of susceptible household contacts will acquire the disease from an infected patient. Patients are typically contagious for over a week, beginning 3-5 days before the rash first appears until 4 days after. However, patients with immunodeficiency may remain contagious for the duration of the disease. Measles is transmitted by respiratory droplets, which remain infectious for 2 hours whether in the air or on surfaces.

  

Susceptibility

 

Although the measles virus is usually regarded as affecting mostly children, persons of all ages are susceptible. Conditions dramatically increasing susceptibility are malnutrition, pregnancy, vitamin A deficiency, and immunodeficiency. Causes of immunodeficiency are AIDS, leukemia, cancer chemotherapy, and corticosteroid therapy.

 

Symptoms

 

The onset of symptoms typically occurs 7-14 days after exposure.

 

Symptoms typically include a high fever (often 104 degrees Fahrenheit), cough, runny nose, and inflamed sensitive eyes. An itchy rash usually appears a day or two later. The rash characteristically progresses from the head to the trunk to the arms and legs. Patients are usually most ill during the first or second day of the rash. With recovery, the rash disappears in the same order. The rash may not appear in severely immunocompromised patients.

 

Complications

 

While measles usually resolves unremarkably, when complications occur, they can be quite serious. Complications include pneumonia, reactivation of tuberculosis, blindness, hemorrhage, hepatitis, pancreatitis, and viral infections of the heart.

 

In pregnant women, measles can cause preterm labor, preterm birth, and spontaneous abortion.

 

Finally, 1 in every 1000 patients may develop measles encephalitis. Measles encephalitis can be fatal in 10% of victims and cause permanent brain damage in others. Rarely, measles can result in behavioral and intellectual deterioration and seizures beginning an average of 10 years after the measles episode.

 

Public Health Hazard

 

Measles is a public health hazard because of the seriousness of the complications and the potential to affect a large number of susceptible people in a short time. For this reason, measles has been a reportable disease in the US since 1912. Additionally, respiratory isolation is recommended for hospitalized measles patients during their period of communicability. A final recommendation is that exposed, susceptible healthcare workers be excused from work from the fifth to the 21st day after being exposed to measles. The US Centers for Disease Control certainly takes measles seriously.

 

Treatment

 

The treatment of measles is largely supportive. Fluids are used for dehydration from the fever, diarrhea, or vomiting. Medications to reduce the fever are also considered appropriate. Antiviral drugs are sometimes used, but without specific FDA approval. Vitamin A supplements appear to help prevent eye damage and blindness and have been associated with reduced mortality. Human immune globulins may modify the disease if administered soon after exposure, before symptoms develop.

 

 

Prevention

 

Fortunately, measles is largely preventable. A single dose of measles vaccine administered to a child older than 12 months induces protective immunity in 95% of recipients. However, endemic transmission of measles may return if measles immunity falls to less than 93-95%. A second dose recommended for school-age children renders immunity to 95% of those still susceptible after the first dose, a total protection rate of 99.75%.

 

Conclusion

 

Measles, once considered eliminated has returned. It is a public health issue for two reasons. First, the complications of measles can be severe, including blindness, neurological disability, and death. Second, this highly contagious disease can infect great numbers of people within a short time. But, inoculation against measles can confer almost perfect protection. Hopefully, after the current visitation, measles will not return.

 

Thomas Falasca, DO

 

References

 

Haelle, T. (2019, February 06). Why It Took So Long to Eliminate Measles. Retrieved June 4, 2019, from https://www.history.com/news/measles-vaccine-disease

Measles. (2019, May 30). Retrieved from https://emedicine.medscape.com/article/966220

Measles | For Healthcare Professionals | CDC. (n.d.). Retrieved from https://www.cdc.gov/measles/hcp/index.html

Measles | History of Measles | CDC. (n.d.). Retrieved from https://www.cdc.gov/measles/about/history.html

 

Vaping and Lung Damage

Centers for Disease Control (CDC) and Food and Drug Administration (FDA) have warned  ...See More


Vaping and Lung Damage

 

Vaping and Lung Damage

 

On September 6, 2019, the Centers for Disease Control (CDC) and Food and Drug Administration (FDA) issued a clear warning about lung toxicity related to e cigarette use. They along with state and local health departments are investigating the cause or causes of this potentially life-threatening disease. The investigation stems from a study of 53 patients from the states of Illinois and Wisconsin who presented to the hospital with lung and gastrointestinal symptoms. A third of those patients required mechanical ventilation and one death were reported in this study. The median age was 19 years.

 

E-cigarette, or more colloquially vaping, usage especially among adolescents has increased exponentially. Recent studies from Monitoring the Future, a 44 year old study, show that the increased prevalence of vaping represents the largest increase in risky behaviors since the initiation of monitoring.  Although used as a means to transition from cigarettes, use of the nicotine still carries with it the risk of addiction.

 

Investigations into the cause of lung toxicity are ongoing, but there are several clues at this juncture. The presence of tetrahydrocannabinol (THC) usage by users and use of black market devices and flavorants appear to be the focus of current investigations. More information will be forthcoming. For now, despite the use as a means of tobacco cessation, it is wise to avoid vaping until investigators have clarified more clearly the cause or causes of lung toxicity. At the same time it is important to continue to remain tobacco-free given the heart, lung and stroke risks which are clearly present.

 

Jeff McGovern, MD

Jeffrey McGovern, MD, FCCP, FAASM

Seasonal Flu

Influenza, or “flu,” is a highly contagious respiratory illness that occurs in seasonal epidemics.   ...See More


Seasonal Flu

What Is Flu?

Influenza, or “flu,” is a highly contagious respiratory illness that occurs in seasonal epidemics.  An episode of flu typically runs its course over several days.  Although usually just a severe nuisance, flu can sometimes result in respiratory failure and death.

 

Symptoms

An attack of influenza is usually accompanied by muscle aches, headache, fever, sore throat, red watery eyes, runny nose, and cough.  Only some of the symptoms may be present.

 

These symptoms sound like a cold, and like a cold, flu is a respiratory infection. However, influenza is caused by a different virus and is more severe.

 

Severity

Each year about 200,000 Americans are hospitalized because of flu complications. The number of deaths varies depending on the annual virus strain; but American deaths have recently ranged from 3,000 to 49,000 in a year.  While human lives are most important, it is noteworthy that even mild strains of the flu can impact the American economy by $10 billion annually in lost productivity.

 

Contagion

Influenza is typically spread by the aerosol droplets propelled in the course of a cough or sneeze.  Even people six feet from a sneeze are at increased risk of infection from these micro particles.  

 

Flu can also be spread from surfaces.  If a person coughs into their hand or sneezes into a handkerchief and then touches an object such as a doorknob or computer keyboard, that object becomes contaminated. A person who touches the object shortly afterward can be infected, usually when they transfer the virus from their hand to a mucous membrane such as the nose, mouth, or eye.

 

Because of the high level of contagion, it is important that flu patients remain home to avoid infecting co-workers.

 

Infectivity

Once a person becomes infected by the virus, it takes 1 to 4 days before they exhibit symptoms.  However, they may transmit the virus to others even before symptoms become evident. Thus it is not sufficient to avoid persons who appear to be sick.  It is important to make a habit of frequent hand washing as this can reduce both virus dissemination and acquisition.

 

Complications

Occasionally influenza does not run its normally uneventful course but instead results in complications.  Some of the most serious of these are viral pneumonia, bacterial pneumonia, respiratory failure, an inflammation of the heart (myocarditis), an inflammation of the membrane surrounding the heart (pericarditis), and multiorgan failure.

 

Vulnerability

Fatalities are most common in infants and the elderly. Thus it is important that senior citizens receive vaccination, the “flu shot.”  Vaccination is also important for pregnant women.  Pregnant females are not at risk from the flu shot and they need vaccination because they are at increased risk of complications from flu and they need to pass on their immunity to the newborn.

Others who are at increased vulnerability are those who are immunocompromised from disease or chemotherapy.

 

Pandemics

A pandemic is an epidemic that occurs over a broad area.  Four flu pandemics have occurred in the last century.  These epidemics occurred when a highly contagious and aggressive strain of the virus emerged.  

 

The infamous “Spanish flu” of 1918 killed nearly 675,000 people in the US and a possible 50 million people worldwide.  

 

The “Asian flu” of 1957 killed about 69,800 people in the US.  

 

The “Hong Kong flu” of 1968 took the lives of 33,800 people in the US.  The relatively modest number may have been largely due to the availability of antibiotics to treat secondary bacterial infections.  

 

The “swine flu” of 2009 caused between 9,000 and 18,000 deaths.  The reduced number of deaths in this epidemic may have been due to the fact that 80 million people were vaccinated.

 

Flu Vaccination Does Not Cause Flu

Vaccination against flu can be by injection or nasal spray.  The injection contains virus that is inactivated (“killed”). The nasal spray contains virus that is attenuated (“weakened”) and so altered that it can be active only at the cooler temperatures of the nose and not in the warmer temperatures of the lungs. The result is that flu vaccination does not cause the flu!

 

Vaccination Side Effects

Serious vaccination side effects are quite rare.  They are circumvented by avoiding certain flu vaccinations in specific groups of people.

 

Traditionally, flu vaccine was produced using chicken eggs and was contraindicated in persons with egg allergy.  Since 2012 a vaccine prepared in a different manner has been available for persons 18 years of age and older who are allergic to eggs.

 

An inactivated virus vaccination rather than an attenuated virus vaccination is generally appropriate for persons with weakened immune systems congenitally, from illness, or from chemotherapy.

 

In short, some type of flu vaccination should be appropriate for most individuals 6 months of age and older.

 

So If I Get Vaccinated, I Can’t Get the Flu, Right?

Not quite!  In the recent past flu vaccination has had 70% effectiveness against influenza B and 60% effectiveness against influenza A.  This is so because:

  • The US Center for Disease Control (CDC) must project in advance the virus strains of the upcoming flu season.
  • Different individuals have different capabilities of manufacturing antibodies in response to the stimulus of the vaccine.
  • It takes 1-4 days after infection for flu symptoms to emerge.  Persons can be infected before they receive the vaccination.
  • It requires 7-14 days for the body to build antibodies from the stimulus of the vaccination. Vaccinated people can be infected with flu during this time period.
  • Symptoms of flu can be simulated by other virus infections.  Flu vaccinated persons who seem to get the flu may have these other infections.

 

How Can I Prevent the Flu?

The best method of dealing with the flu is not to have it!  In order to greatly reduce chances of getting the flu, it is most important to take these precautions:

  • Practice frequent hand washing, especially after contact with objects touched by infected persons or the general public.
  • Avoid proximity to infected persons.
  • If infected, stay home and avoid contact with others. Bear in mind that you are infectious for 4-9 days after onset of symptoms.
  • Finally, present yourself for vaccination.  This is your surest way of protecting yourself from flu.  As an added benefit, remember that by getting vaccinated, you are also protecting newborns, elderly, chemotherapy patients, and others unable to fully benefit from their own vaccination.

 

Conclusion

So please stay well this season and protect yourself from flu.

 

Thomas Falasca, DO

View this fact-filled video on flu symptoms from the US Centers for Disease Control!

 

Avoiding Frostbite

The cold weather is here and so is the danger of frostbite.

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Avoiding Frostbite

The cold weather is here and so is the danger of frostbite.

 

What Is It?

Frostbite is tissue injury resulting from the freezing and crystallization of the body fluids within and between the cells.  The ice crystals then damage the cell membranes.  Further damage results from obstruction within the smallest blood vessels and inflammation when blood flow is reestablished.

 

How Will I Know It?

Frostbite can develop insidiously.  It may begin with coldness that progresses to burning or throbbing.  This can eventuate in numbness and then loss of sensation.  The skin may subsequently become pale or bluish. Finally, frostbite causes finger clumsiness, difficulty walking, and severe joint pain.

 

The areas most often affected are fingers, toes, ears, and nose.

 

What Are the Consequences?

A case of frostbite can leave permanent reminders of the event.  Some consequences are minor, such as cold sensitivity.  Others are substantial, such as squamous cell carcinoma, arthritis, limb growth deformities in children, and gangrene.  Frostbite can result in limb amputations or require nose and ear reconstruction surgery. 

 

Who Is at Risk?

Both the very young and very old are at greater risk for frostbite.  They have greater difficulty producing and regulating heat as well as a proportionately greater body surface area from which to lose heat.

 

Groups especially at risk for frostbite are those of African, Middle Eastern, and Pacific Island descent. 

 

Women are usually more sensitive to frostbite than men.

 

People whose hands tend to become white in the cold are especially at risk for frostbite.

 

What to Avoid?

  • Avoid tight clothing.  It restricts circulation thus promoting cold injury.
  • Avoid smoking.  It also restricts circulation.
  • Avoid prolonged inactivity.
  • Avoid getting clothing wet.  The air trapped between the clothing fibers is an insulator that keeps heat from leaving the body.  Water is a conductor that facilitates passage of heat away from the body.

 

What To Do?

  • Seek shelter from wind as well as cold.  A small envelope of warm air surrounds the body and reduces the dissipation of heat.  Wind continuously blows away this envelope, thus accelerating dissipation of heat from the body.
  • Wear several layers of light, loose clothing.  The air trapped between the layers insulates against heat loss.  It is especially important to wear at least two pair of socks.
  • Wear mittens in place of gloves or on top of the gloves.  The reduced surface area of the mitten compared to the glove reduces the dissipation of heart. 
  • Cover the face and head and use a hat that covers the ears.  The face and head have a large blood supply that can rapidly dissipate heat.  Additionally, the ears and nose can easily have their blood flow compromised, predisposing them to frostbite.
  • Wear fabrics that are especially good insulators, such as fleece, polypropylene, and wool.

So be sure to protect yourself from frostbite and enjoy the many pleasant outdoor activities of winter.

 

Thomas Falasca, DO

Snow Shoveling Safety

The Erie County Medical Society wants you to enjoy winter without falling victim to snow shoveling perils, so here ar ...See More


Snow Shoveling Safety

The Erie County Medical Society wants you to enjoy winter without falling victim to snow shoveling perils, so here are some helpful tips.

 

First and foremost

  • Check with your doctor. Shoveling stresses the heart because of both exertion and cold. Consider hiring someone for the task.
    Do not shovel after eating or smoking as these activities reduce blood flow to the heart.
    Stop if you feel chest pain, or get excessively tired or have shortness of breath. You may need immediate professional care.
    Dress in layers with water-repellant clothing outermost. Remember hats, gloves, and warm socks because substantial body heat is lost from these areas.

 

Choose an appropriate snow shovel.

  • A curved-handled shovel helps keep your back straighter when shoveling.
    Choose a shovel with an appropriate length handle. The length is appropriate when, at the beginning of the shoveling stroke, it allows you to slightly bend your knees and bend your back less than 10 degrees while still holding the handle comfortably.
    A plastic shovel blade adds less weight to the lift than a metal blade.
    A smaller shovel blade may add to the time of the task; but, by picking up less snow, it reduces the risk of a heavy shovel load.

 

Be mindful of your shoveling actions.The American Academy of Orthopedic Surgeons recommends

  • If you must lift snow, squat with legs apart, knees bent, and back straight.
    Lift with the legs instead of bending at the waist; this reduces strain on the back.
    Scoop small amounts of snow with the shovel and walk to the dumping area.
    Outstretched arms exaggerate strain on the back.
    Remove deep snow in layers of an inch or two in thickness.
    Move feet instead of twisting.

 

In addition, remember that

  • Pushing the snow instead of lifting it reduces strain on the back.
    Gripping the snow shovel with your hands at least 12 inches apart increases leverage and decreases body strain.
    Throwing snow over your shoulder is dangerous. It twists the back and predisposes to injury.
    Warming up muscles before shoveling reduces the risk of strains and sprains.
    Frequent breaks to gently stretch back, arms, and legs reduce stress to these areas and distributes over time exertion on the heart.
    Wet snow is especially heavy and one shovelful can weigh 25 pounds.
    Clearing snow early and often to avoid dealing with a large amount of heavy, packed snow.

 

So follow these tips and avoid becoming a snow-shoveling casualty.

 

For more information, consult
· Colorado Spine Institute http://www.coloradospineinstitute.com
· AMERICAN ACADEMY OF ORTHOPEDIC SURGEONS http://orthoinfo.aaos.org/topic.cfm?topic=A00060
· National Safety Council www.nsc.org
· Toronto Emergency Medical Services
http://www.torontoems.ca/main-site/careers/safety-tips/show-shovelling.html

 

Thomas Falasca, DO



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