I'm happy to read another vaccine success story which was recently published in JAMA. Rotavirus is the most common cause of severe dehydrating diarrhea in children worldwide and in the United States accounted for about 50% of acute gastrointestinal hospital admissions during the "rotavirus season" which typically runs from November - June depending where you live.
Rotavirus causes diarrhea in infants and children as well as adults. In many cases while a baby was having severe diarrhea and maybe associated vomiting and fever, their parents were also ill, but not as severely. The stool of rotavirus was notorious and could easily be identified by a "seasoned" pediatrician. No one looked forward to the season of rotavirus diarrhea. With all of that being said, we are on the cusp of rotavirus season, but there is good news!
The rotavirus vaccine was first licensed in 2006 and is routinely given to children at 2, 4 and 6 months of age. The recent study in JAMA showed that the annual rate of rotavirus associated diarrhea among children younger than 5 years of age dropped by almost 75% during the first 2 years after routine vaccination started. In other words, the decline in disease was proportional to the increased rates of vaccine coverage. WOW, that is a true success story for the value of vaccines.
This translates into an estimated 65,000 hospitalizations that were prevented in children younger than 5 years of age, for the years 2007-2009. I have noticed this in my own practice as I have not hospitalized a child for the last 4 years and I believe that the last child I remember being hospitalized was one of our young doctors own infants. Fortunately, that child recovered with IV hydration and a few stressful days in the hospital for both parent and child. She is now a happy, healthy 4 year old. She had not received the vaccine at that time as she was too old to receive the vaccine when it was released. This vaccine must be given as a series of either 2 or 3 vaccines (depending on the brand that is used) and must be completed before a child is 8 months of age.
While rotavirus vaccine is readily available in the United States the virus continues to cause an estimated 500,000 deaths worldwide each year. Many of those children are in low and middle income countries where infants are not able to receive the vaccine. WHO has now recommended that the rotavirus vaccine be given worldwide, and with vaccine more readily available my hope is that there will be good news to report about further disease reduction and mortality, outside of the U.S. as well.
So, if you have a new baby, talk to your doctor about rotavirus vaccine, it doesn't even hurt as it is an oral vaccine. Win, win wouldn't you say?
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I recently received a question from a Twitter follower related to cradle cap and dandruff. She wanted to know if there was a difference in the two.
You know there really isn't as they are both to...
You know there really isn't as they are both due to seborrheic dermatitis, an inflammatory condition of the skin in which the skin overproduces skin cells and sebum (the skins natural oil).
Cradle cap is the term used for the scaly dermatitis seen on the scalp in infants. It is also seen on the eyelids, eyebrows, and behind the ears. It is typically seen after about three months of age and will often resolve on its own by the time a baby is eight to 12 months old. It is usually simply a cosmetic problem for a baby as it looks like a yellowish plaque on a baby's scalp and is often not even noticed by anyone other than the parents.
Unlike seborrheic dermatitis in adults, cradle cap typically doesn't itch. It is thought that cradle cap may occur in infancy due to hormonal influences from the mother that were passed across the placenta to the baby.
These hormones cause the sebaceous glands to become over active. In some severe cases an infant's scalp becomes really scaly and inflamed and causes even more parental concern, as it appears that the infant is uncomfortable and may be trying to scratch their head by rubbing it on surfaces.
The treatment for cradle cap is to wash the baby's scalp daily with a mild shampoo and then to use a soft comb or brush to help remove the scales once they have been loosened with washing. When washing the head make sure to get the shampoo behind the ears and in the brows (keeping the soap out of baby's eyes).
This is usually sufficient treatment for most cradle cap. In situations where the greasy scales seem to be worsening it may help to put a small amount of mineral oil or olive oil on the baby's head and let it sit (I left a small amount on my children's heads overnight) and then to shampoo the following day. The oil will help the scales to loosen up and come off more easily.
For babies that have very inflamed irritated cradle cap a visit to your pediatrician may be warranted to confirm the diagnosis. In persistent cases I often recommend shampooing several times a week with a dandruff shampoo that has either selenium (Selsun) or zinc pyrithione (Head and Shoulders) making sure not to get any in the infant's eyes. I may then also use a hydrocortisone cream or foam on the scalp that will lessen the inflammation and itching. In these cases it may take several weeks to totally clear up the problem.
As children get older, especially during puberty, you may see a return of seborrhea as dandruff. Again you can use dandruff shampoos. It also seems that with the overproduction of sebum there is an overgrowth of a fungus called malessizia so using a shampoo for dandruff as well as a antifungal shampoo (Nizoral) often works.
I have teens alternate different shampoos, as sometimes it seems to work better than always using the same shampoo for months on end. Teens don't like white flakes falling from their scalp and unlike a baby, a teen is worried about the cosmetic issues of seborrhea!
That's your daily dose, we'll chat again tomorrow.
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