કબજિયાત / Foods For Constipation In Children

Definition :

1) Fewer than two Bowel Movements Per Week

2) Bowel Movements With Stools That are Hard, Dry and Small, making Them Painful or Difficult to Pass

Children From 1 to 18 Years of Age Who Suffered from Constipation Should Eat 14 to 35 Gm Of High Fiber Diet Per Day :

1) Lots Of Water & Fluids Orally

2) Fruits : Apple with skin, Papaya, Sweet Lime (raw/juice), Orange (raw/juice), Raspberries, Pomegranates (raw/juice), Coconut Water, Pear with skin, Banana

3) Vegetables : Green Leafy Vegetables (Specially Cooked Spinach), Broccoli (Cooked), Sweet Potato (Baked with Skin), Potato ( Baked with Skin), Green Peas (Cooked), Mixed Vegetable Soup, Salads

4) Toilet Training : Use Indian Toilet or Squat position in Western Toilet

5) Milk : Not more than 500 ml per Day

Which Food Should Avoid If Child Has A Constipation ?

1) Cheese
2) Chips
3) Fast Food
4) Ice Cream
5) Meat
6) Prepared & Processed food : Wafers, Frozen Meals, Snack Foods, Cake, Hot Dog, Pizza, Bournvita, Horlicks, Complan, Meggie

Iron Rich Foods For Children

Children Below 10 Years of Age has a More Iron Deficiency Anemia Due to Low Appetite, Busy School Schedule, Unhealthy Diet Habits.

Children Should Know That Iron Is an Important Part of a Healthy Diet.

Iron Rich Foods :

1) Eggs, Read Meat, Fish, Sea Foods

2) Dark Green Leafy Vegetables Specially Spinach, Broccoli

3) Citrus fruits

4) Dry Fruits Specially Almond, walnut, Dates, Raisins

5) Lentils

6) Beetroot

7) Iron Fortified - Cereals, Bread, Pastas

8) Dried Beans & Peas

How Much Iron Do Children Need ?

> Infants Up to 6 months of Age Who Breastfeed Get Enough Iron from      Mother's Milk. 

> Infants 7 to 12 Months Need 11 mg / day

> Toddlers 1 to 3 Years Need 7 mg / day

> Children 4 to 8 Years Need 10 mg / day 

> Children 9 to 13 Years Need 8 mg / day 

> Teen Age Boys Need 11 mg / day 

> Teen Age Girls Needs 15 mg / day 
   ( Increase Iron Require Due to Menstruation )

Repeated Infections in Children

How common are repeated infections in children?

Babies are born with immature immune systems. As a result, babies tend to get a high number of infections, usually 1 every 1 to 2 months. Babies’ immune systems begin to mature soon after birth. The number of infections begins to go down with time. By the time children are school-age, their rate of infection is usually the same as the rate for adults.

Why might my doctor be concerned about repeated infections in my child?

Most doctors become concerned if children go from simple viral infections to more  complicated and severe bacterial infections,

such as blood infections and pneumonia. Unusual infections or an increase in the number of infections over time are other warning signs.

Will my child be okay?

Most children who have repeated infections don’t have any serious problems and grow up to be healthy adults. Their infections occur less frequently by the time they reach school-age. Make sure your child gets plenty of sleep and eats a healthy diet. Sleep and proper nutrition may be just as important as medicine in helping your child fight off infections.

Causes

What causes some children to have more than the usual number of 

infections?

Sometimes it’s easy to see the cause of an infection, such as being in day-care centers. Children in day-care centers give infections to each other. They drool and their noses drip. They touch each other and touch all the toys. This spreads infections.As adults we have far less contact with each other’s germs, so we are less likely to catch so many infections.

Exposure to cigarette smoke (sometimes called “passive smoking”) is another cause for runny noses and wheezing in young children. Because more women of childbearing age are smoking, passive smoking is a more common cause of respiratory infection in children. Passive smoking is now linked to infections and asthma in children.

Do specific medical conditions cause repeated infections in children?

Structural changes in the sinuses or the eustachian tubes (connecting tubes in each ear) are a common cause of repeated infections in children. The term “structural changes” refers to differences in the bony parts of the skull, the sinuses and the ears. These differences may be inherited. Some differences in body structure make it easier for that person to get infections because the normal drainage of the eustachian tube (in the ear) or sinuses (in the nose) is blocked. When the drainage is blocked, the number of bacteriagrows. This leads to infection. In most children, as the head grows, drainage problems get better. If young children are having too many ear infections, they might need antibiotics or special ear tubes.

Allergy and asthma can also cause repeated sinusitis (stuffy or drippy nose) and wheezing. Allergy can cause inflammation inside the nose that lasts for a long time. Because of the inflammation, the normal drainage pathways of the nose and sinuses swell and get plugged up. Bacteria grow, causing an infection. Medicine is necessary to treat the cause of the infection, which is the allergy.Coughing that goes along with mild viral infections may be a sign of asthma. Sometimes when we think children have pneumonia as a complication of a cold, they really have asthma. These children need asthma medicine in addition to other medicine for infection.

What causes children to have really serious repeated infections?

In some cases, the answer is chance alone. In rare cases, an otherwise healthy child will have 2 or 3 severe infections for no obvious reason. However, your doctor may want your child to have some simple screening tests to check if your child has an immune deficiency (a weakness in the immune system). This is the main cause of repeated severe infections.

Prevention

What can I do to prevent repeated infections in my child?

·         If you smoke, stop. Until you quit completely, smoke only outside of your home 

·         and outside of your car. Smoking in a room away from your child does not help. 

·         Air filters also do not help protect your child from secondhand smoke.

·         The worst season for colds is the winter. If you have a relative or friend who can 

·         take care of your child during the winter, you could move your child out of day care, 

·         where so many other children would have colds. Smaller home-care situations 

·         (with 5 children or less) would be another good choice. Fewer children in day care 

·         means fewer infections to be exposed to.

·         If you have a family history of allergies and asthma, you may want to have your 

·         doctor check your child for these conditions.

Top 10 Super Brain Foods For Children's

1) Whole Grains : 

Improve Motor Coordination

2) Strawberries / Blueberries : 

Improve Cognitive Skills & Memory Power

3) Yogurt : 

Helps in Sending and Receiving Information

4) Nuts Butter : 

Overall Growth and Development of Brain 

5) Spinach : 

Promote Growth of New Brain Cells

6) Oats : 

Better Performance in Memory Tasks & Map Skills

7) Water : 

Highly Overlook Foods, Children's Usually Drink Little Water that Affect Brain Functions, so Child Remains Irritable and Lethargic & Will not Be in Frame of Mind  to Listen or Memorize.

8) Apple : 

Improve Cognitive Skills, Specially For Those Children When They Are Sluggish.

9) Cauliflowers & Broccoli : 

Effective For Communication of Brain with Rest Of Body Parts

10) Organic Foods Likes Tomato, Onion, Capsicum, Drumstick, Corn etc. : 
Helps in Neuro-development Functioning

Pneumonia disease & vaccine (Pneumococcal)

1) What causes pneumococcal disease?
Pneumococcal disease is caused by Streptococcus pneumoniae, a bacterium. There are more than 90 subtypes. Most subtypes can cause disease, but only a few produce the majority of invasive pneumococcal infections. The 10 most common subtypes cause 62% of invasive disease worldwide.

2) How does pneumococcal disease spread?
The disease is spread from person to person by droplets
in the air. The pneumococci bacteria are common inhabitants of the human respiratory tract. They may be isolated from the nasopharnyx of 5%–70% of normal, healthy adults.

3) What diseases can pneumococci bacteria cause?
There are three major conditions caused by invasive pneumococcal disease: pneumonia, bacteremia, and meningitis. They are all caused by infection with the same bacteria, but have different symptoms.
Pneumococcal pneumonia (lung disease) is the most common disease caused by pneumococcal bacteria. It is estimated that 175,000 hospitalizations due to pneumococcal pneumonia occur each year in the United States. The incubation period is short (1–3 days). Symptoms include abrupt onset of fever, shaking chills or rigors, chest pain, cough, shortness of breath, rapid breathing and heart rate, and weakness. The fatality rate is 5%–7% and may be much higher in the elderly.
Pneumococcal bacteremia (blood infection) occurs in about 25%–30% of patients with pneumococcal pneumonia. More than 50,000 cases of pneumococcal bacteremia occur each year in the United States. Bacteremia is the most common clinical presentation among children younger than age two years, accounting for 70% of invasive disease in this group. The overall case-fatality rate for bacteremia is about 20% but may be as high as 60% among elderly patients.
Pneumococci cause 13%–19% of all cases of bacterial meningitis (infection of the covering of the brain or spinal cord) in the United States. There are 3,000–6,000 cases of pneumococcal meningitis each year. Symptoms may include headache, tiredness, vomiting, irritability, fever, seizures, and coma. Children younger than age one year have the highest rate of pneumococcal meningitis, approximately 10 cases per 100,000 persons. The case fatality rate is high (30% overall, up to 80% in the elderly).
Pneumococci are also a common cause of acute otitis media (middle ear infection). Approximately 28%–55% of such ear infections are caused by S. pneumoniae.
In the U.S., there were 5 million cases of otitis media each year in children younger than age five years prior to the use of the pneumococcal conjugate vaccine. Middle ear infections are the most frequent reason for pediatric office visits in the United States, resulting in more than 20 million visits annually.

4) How serious is pneumococcal disease?
Pneumococcal disease is a serious disease that causes much sickness and death. In fact, pneumococcal disease kills more people in the United States each year than all other vaccine-preventable diseases combined. More than 40,000 cases and more than 4,400 deaths from invasive pneumococcal diseases (bacteremia and meningitis) are estimated to have occurred in the United States in 2005. More than half of these cases occurred in adults for whom pneumococcal
polysaccharide vaccine was recommended. Young children and the elderly (individuals younger than age five years as well as those older than age 65 years) have the highest incidence of serious disease.
Case-fatality rates are highest for meningitis and bacteremia, and the highest mortality occurs among the elderly and patients who have underlying medical conditions. Despite appropriate antimicrobial therapy and intensive medical care, the overall case-fatality rate for pneumococcal bacteremia is about 20% among adults. Among elderly patients, this rate may be as high as 60%.
Before a vaccine was available in the United States, pneumococcal disease caused serious disease in children younger than age five years. Each year it was responsible for causing 700 cases of meningitis, 13,000 blood infections, five million ear infections, and 200 deaths. Children younger than age two years are at the highest risk for serious pneumococcal disease.
Since the introduction of a pneumococcal vaccine for children, the incidence of pneumococcal disease has dropped. Data from 2003 indicated that rates of invasive pneumococcal disease declined 70%–80% among children younger than age 2 years compared to 1998–99 (prior to vaccine licensure). There also has been a smaller decline in the rate of invasive pneumococcal disease in older age groups, probably due to a reduction in transmission from vaccinated children to their family members and other close contacts.

5) Is there a treatment for pneumococcal disease?
Penicillin is the drug of choice for treatment of pneumococcal
disease; however, resistance to penicillin and other antibiotics has been on the rise. Studies indicate that in some areas of the United States up to 40% of invasive pneumococci are resistant to common antibiotics. Treating patients infected with resistant organisms requires expensive alternative antimicrobial agents and may result in prolonged hospital stays. The increased difficulty of treating this serious bacterial infection makes prevention through vaccination even more important.

6) How long is a person with pneumococcal disease contagious?
The exact period of communicability is not known. It appears that transmission can occur as long as the organism remains in respiratory secretions.

7) How common is pneumococcal disease in the United States?
Healthcare providers are not required by law to report pneumococcal disease to health authorities, so exact numbers are not known. Estimates have been made from a variety of population studies, however, and it is believed that more than 40,000 cases of invasive pneumococcal disease (meningitis and blood infections) occur each year in the United States. (Pneumonia and middle ear infections are most common but are not considered “invasive” diseases.) The incidence of the disease varies greatly by age group. The highest rate of invasive pneumococcal disease occurs in young children, especially those younger than age two years. Children with certain chronic diseases (e.g., sickle cell disease or HIV infection) are at very high risk of invasive disease.

8) Can you get pneumococcal disease more than once?
Yes. There are 90 known subtypes of pneumococcus bacteria, with 23 subtypes included in the current pneumococcal polysaccharide (adult) vaccine and 7 subtypes included in the current conjugate (child) vaccine. Having been infected with one type does not always make the patient immune to other types. Even if an individual has had one or more episodes of invasive pneumococcal disease, he or she needs to be vaccinated.

9) When did pneumococcal vaccine become available?
There are two types of pneumococcal vaccine, pneumococcal polysaccharide vaccine and pneumococcal conjugate vaccine. The first pneumococcal polysaccharide vaccine was licensed in the United States in 1977. In 1983, an improved pneumococcal polysaccharide vaccine was licensed, containing purified protein from 23 types of pneumococcal bacteria (the old formulation
contained 14 types). This pneumococcal polysaccharide vaccine is commonly known as PPSV23. The PPSV23 vaccine is licensed for use in adults and persons with certain risk factors who are age two years and older. The pneumococcal conjugate vaccine was licensed in early 2000. It is recommended for use in preventing pneumococcal disease in infants and young children (from age six weeks to the 5th birthday). It is commonly known as PCV7.

10) What kind of vaccines are they?
Both pneumococcal vaccines are made from inactivated(killed) bacteria. The pneumococcal polysaccharide vaccine (PPSV23) contains long chains of polysaccharide (sugar) molecules that make up the surface capsule of the bacteria. The 23 types of pneumococci that are included cause 88% of invasive pneumococcal disease. The pneumococcal conjugate vaccine (PCV7) includes
purified capsular polysaccharide of seven types of the bacteria “conjugated” (or joined) to a harmless variety of diphtheria toxin. The seven types of purified bacteria included account for 86% of bacteremia, 83% of meningitis, and 65% of acute otitis media (ear infection) among children younger than age six years in the United States.

11) How is this vaccine given?
The polysaccharide vaccine (PPSV23) can be given as a shot in either the muscle or the fatty tissue of the arm or leg. The conjugate vaccine (PCV7) is given as a shot in the muscle.
Who should get the pneumococcal polysaccharide vaccine (PPSV23)?
• All adults age 65 years or older
• Anyone age two years or older who has a long-term health problem such as cardiovascular disease,
sickle cell anemia, alcoholism, lung disease, diabetes, cirrhosis, or leaks of cerebrospinal fluid
• Anyone who has or is getting a cochlear implant
• Anyone age two years or older who has a disease or condition that lowers the body’s resistance to
infection, such as Hodgkin’s disease, kidney failure,
nephrotic syndrome, lymphoma, leukemia, multiple myeloma, HIV infection or AIDS, damaged
spleen or no spleen, or organ transplant
• Anyone age two years or older who is taking any drug or treatment that lowers the body’s resistance to infection, such as long-term steroids, certain cancer drugs, or radiation therapy
• Adults ages 19–64 who have asthma
• Adults ages 19–64 who smoke cigarettes
• In special situations, public health authorities may recommend the use of PPSV23 after PCV7 for Alaska Native or American Indian children ages 24 through 59 months who are living in areas in which risk of invasive pneumococcal disease is increased.
• In special situations, public health authorities may recommend PPSV23 for Alaska Natives and American Indians ages 50 through 64 years who are living in areas in which the risk of invasive pneumococcal disease is increased.

12) Who should get the pneumococcal conjugate vaccine (PCV7)?
All infants beginning at two months of age should receive a four-dose series of vaccine; catch-up vaccination is recommended for children younger than age 5 years who did not receive PCV7 vaccine on schedule.

13) What is the schedule for the routine doses of PCV7 for children?
All infants and toddlers should get four doses of PCV7 vaccine, usually given at ages two, four, six, and 12–15 months.

14) What if my three-year-old child never got his PCV7 shots?
The number of doses a child needs to complete the series depends on his or her current age. Older children need fewer doses. For example, a healthy unvaccinated
child age 24–59 months needs a single dose of PCV7. Your healthcare provider can tell you how many doses are needed to complete the series at a certain age. PCV7 is not routinely recommended for individuals who are age five years or older.

15) Do some children need to get both PCV7 and PPSV23?
Yes, children at high risk of invasive pneumococcal disease should receive PCV7 and then also receive PPSV23 when age two years or older. PPSV23 is not given routinely to healthy children.

16) If influenza is recommended for healthcare workers to protect high-risk patients from getting influenza, why isn’t pneumococcal vaccine also recommended?
Influenza virus is easily spread from healthcare workers to their patients, and infection usually leads to clinical illness. Pneumococcus is probably not spread from healthcare workers to their patients as easily as is influenza, and infection with pneumococcus does not necessarily lead to clinical illness. Host factors (such as age, underlying illness) are more important in the development of invasive pneumococcal disease than just having the bacteria in one’s nose or throat.
My elderly neighbor got a second pneumococcal shot. I thought just one was required.
Revaccination is not done routinely, but a single revaccination dose is recommended for groups of people at highest risk of serious infection. No one should receive more than two doses of PPSV23.
For example, persons who received a first dose when they were younger than age 65 years should receive a second dose at age 65 years if at least five years have elapsed since the previous dose. Likewise, persons age two years or older who are at high risk for pneumococcal disease due to certain long-term health problems, in particular immunosuppression, HIV infection, and not having a functional spleen (or having no spleen) should get a second dose five or more years after the first dose.

17) Who recommends pneumococcal vaccines?
The Centers for Disease Control and Prevention, the American Academy of Pediatrics, and the American Academy of Family Physicians have all recommended routine vaccination for infants and young children with PCV7 vaccine. The Centers for Disease Control and Prevention, the American College of Obstetricians and Gynecologists, the American Academy of Family Physicians, and the American College of Physicians all recommend the PPSV23 vaccine.

18) Should all nursing home patients ages 65 years and older be vaccinated against pneumococcal disease?
Yes.

19) Can pregnant women get this vaccine?
The safety of PPSV23 vaccine for pregnant women has not been studied, although no adverse consequences have been reported among newborns whose mothers were vaccinated with pneumococcal polysaccharide vaccine during pregnancy. Women who are at high risk of pneumococcal disease should be vaccinated before becoming pregnant, if possible. Unvaccinated pregnant women who are in a high-risk group should consult with a healthcare professional about getting the vaccination during pregnancy.

20) How safe is this vaccine?
PPSV23 and PCV7 are both very safe vaccines.
For PPSV23, about 30%–50% of the people who get the vaccine have very mild side effects, such as redness or pain where the shot was given. Fewer than 1% of recipients develop a fever, muscle aches, or more severe local reactions. Serious allergic reactions have been reported very rarely. For PCV7, about 10%–20% of children develop redness, tenderness, or swelling where the shot was given. About 11% may have a mild fever.

21) How effective is pneumococcal polysaccharide vaccine (PPSV23)?
Overall, PPSV23 is 60%–70% effective in preventing invasive disease. Older adults (e.g., older than age 65 years) and persons with significant underlying illnesses do not respond as well, but vaccination with PPSV23 is still recommended because such persons
Page 4 of 4are at high risk of developing severe pneumococcal disease.

22) How effective is pneumococcal conjugate vaccine (PCV7)?
In a large clinical trial, PCV7 was shown to be 97% effective in preventing invasive disease caused by the pneumococci contained in the vaccine and 89% effective
against all types of S. pneumoniae, including those not found in the vaccine. Children with chronic diseases such as sickle cell disease and HIV infection also seem to respond well to PCV7.

23) Who should NOT receive pneumococcal vaccine?
• For both PPSV23 and PCV7, persons who had a severe allergic reaction to one dose should not receive another (such reactions are rare).
• Persons who are moderately or severely ill should wait until their condition improves to be vaccinated.

24) Can the vaccine cause pneumococcal disease?
No. Both PPSV23 and PCV7 are inactivated vaccines containing only a portion of the microbe; therefore the vaccines cannot possibly cause pneumococcal disease.

Pertusis / મોટી ઉધરસ

1) What causes pertussis?
Pertussis is caused by a bacterium, Bordetella pertussis.

2) How does pertussis spread?
Pertussis is spread through the air by infectious droplets
and is highly contagious.

3) How long does it take to show signs of pertussis after being exposed?
The incubation period of pertussis is commonly seven
to 10 days, with a range of 4–21 days.

4) What are the symptoms of pertussis?
Pertussis disease can be divided into three stages:
Catarrhal stage: can last 1–2 weeks and includes a
runny nose, sneezing, low-grade fever, and a mild
cough (all similar symptoms to the common cold).
Paroxysmal stage: lasts 1–6 weeks, but can persist
for up to 10 weeks. The characteristic symptom is a
burst, or paroxysm, of numerous, rapid coughs. At
the end of the paroxysm the patient suffers from a
long inhaling effort that is characterized by a highpitched
whoop (hence the name, “whooping cough”).
Infants and young children often appear very ill and
distressed, and may turn blue and vomit.
Convalescent stage: usually lasts 2–6 weeks, but may
last for months. Although the cough usually disappears
after 2–3 weeks, paroxysms may recur whenever
the patient suffers any subsequent respiratory
infection. The disease is usually milder in adolescents
and adults, consisting of a persistent cough similar
to that found in other upper respiratory infections.
However, these individuals are still able to transmit
the disease to others, including unimmunized or incompletely
immunized infants.

5) How serious is pertussis?
Pertussis can be a very serious disease, especially for
infants. Rates of hospitalization and complications
increase with decreasing age. During the two-year
period 2004–05, a total of 66 deaths from pertussis
were reported to CDC. Children age 3 months and
younger accounted for 85% of these deaths.
As noted above in the section on symptoms, the
breathing difficulties associated with this disease can
be very distressing and scary for the patient and his
or her family.
Although adults are less likely than infants to become
seriously ill with pertussis, most make repeated visits
for medical care and miss work, especially when
pertussis is not initially considered as a reason for
their long-term cough. In addition, adults with pertussis
infection have been shown to be an important
source of infection to infants with whom they have
close contact.

6) What are possible complications from pertussis?
Younger patients have a greater chance of complications
from pertussis than older patients. The most
common complication is secondary bacterial infection,
which is the cause of most pertussis-related
deaths. Pneumonia occurs in one out of 20 cases;
this percentage is higher for infants younger than
age 6 months. Infants are also more likely to suffer from such neurologic
complications such as seizures and encephalopathy,
probably due to the reduction of oxygen
supply to the brain. Other less serious complications
include ear infection, loss of appetite, and dehydration.
Adults with pertussis can have complications such as
pneumonia (up to 5% of cases) and rib fracture from
coughing (up to 4% of cases). Other reported side
effects include (among others), loss of consciousness,
female urinary incontinence, hernias, angina,
and weight loss.

7) How do I know if my child has pertussis?
The diagnosis of pertussis is usually made based on
its characteristic history and physical examination.
A laboratory test may be done, which involves taking
a specimen from the back of the patient’s throat
(through the nose).

8) Is there a treatment for pertussis?
Antibiotics are somewhat helpful in treating pertussis.
The drug of choice is usually erythromycin that
is given to all household and other close contacts of
the patient to minimize transmission, regardless of
age and vaccination status.
All close contacts younger than seven years of age
should complete their DTaP vaccine series if they
have not already done so. If they have completed
their primary four dose series, but have not had a dose within the last three years, they should be given a booster dose.
Patients also need supportive therapy such as bed
rest, fluids, and control of fever.

9) How long is a person with pertussis contagious?
Persons with pertussis are most infectious during the
catarrhal period and during the first two weeks after
onset of the cough (approximately 21 days).

10) Can you get pertussis more than once?
Reinfection appears to be uncommon but does occur.
With natural infection, immunity to pertussis will
likely wane as soon as seven years following disease;
reinfection may present as a persistent cough, rather
than typical pertussis. Unfortunately, it is difficult
to verify pertussis infection with existing laboratory
methods.
If someone has a recent culture-documented case
of pertussis, he or she may not need immediate immunization
against pertussis; however, a vaccine
containing pertussis antigen will not be harmful,
and they should continue on the routine immunization
schedule for future protection against tetanus,
diphtheria, and pertussis. If culture is lacking, even
with a history of pertussis, do NOT withhold a dose
of pertussis vaccine, if it is recommended per the
routine schedule.
11) When did pertussis vaccine become available?
The first whole-cell pertussis vaccine was developed
in the 1930s and was in widespread use by the mid-
1940s, when pertussis vaccine was combined with
diphtheria toxoid and tetanus toxoid to make the
combination DTP vaccine.
In 1991, DTaP vaccine was licensed in the United
States. The pertussis component of this vaccine is
a more purified “acellular” version, which produces
fewer side effects.
In 2005, two new tetanus toxoid-diphtheria-acellular
pertussis (Tdap) vaccines were licensed. These vaccines
are the first acellular pertussis-containing vaccines
that make it possible to vaccinate adolescents
and adults against pertussis.
Pertussis is not available as a single vaccine.

12) What kind of vaccine is it?
DTaP and Tdap vaccines are “inactivated” vaccines.
Inactivated vaccines do not contain live bacteria or
virus and cannot reproduce, which is why multiple
doses are needed to produce immunity.
For the pertussis component of DTaP and Tdap vaccines,
purified components of the bacterium are
grown and then inactivated. DTaP is for children
younger than 7 years and has a higher concentration
of pertussis than Tdap, which is intended for persons
10 years and older.

13) How is this vaccine given?
The DTaP and Tdap vaccines are given as a shot in
the muscle.

14) Is there more than one brand of pertussis vaccine?
At the present time, there are three different brands
of DTaP vaccines available in the U.S. All three vaccines
are equally effective and safe, and are given on
the same schedule at two, four, six, 15–18 months,
and 4–6 years. DTaP is also part of four childhood
combination vaccines that include other vaccines
(e.g., IPV, Hib, HepB). Two companies produce the
Tdap vaccines that are approved for use in adolescents
and adults through the age of 64 years.

15) Who should get this vaccine?
All infants should receive DTaP vaccine as part of
their routine immunization unless they have a medical
reason not to. Persons 10 years and older should
receive Tdap vaccine in place of a one-time routine
booster dose of adult Td vaccine.
Women who are pregnant or who have recently given
birth should be given a one-time dose of Tdap
to protect their newborn. Because other adults who
have close contact with infants also pose a risk of spreading pertussis to the infant, family members
and other caregivers of new infants should receive
Tdap vaccine.
Tdap vaccine is also recommended for healthcare
personnel in hospitals and ambulatory care settings
who have direct patient contact, especially those
working with infants, regardless of when they received
their previous dose of Td vaccine.

16) How many doses of DTaP vaccine are required?
The usual schedule for infants is a series of four
doses given at two, four, six, and 15–18 months
of age. A fifth dose, or booster, is recommended at
4–6 years of age, unless the fourth dose was given
late (after the fourth birthday). All adolescents and
adults younger than age 65 years should receive a
one-time dose of Tdap.

17) How safe is this vaccine?
Most children have no serious reactions from this
combined vaccine. The most common reactions are
local reactions at the injection site, such as soreness,
redness, and swelling, especially after the fourth or
fifth dose. Other possible reactions may include
fussiness, mild fever, loss of appetite, tiredness, and
vomiting. The use of the more purified DTaP instead
of the whole cell DTP has decreased these mild reactions
substantially. Tdap is a new vaccine but trials
have shown it to be safe.

18) What side effects have been reported with this vaccine?
About 20%–40% of children have some local reaction
such as pain, redness, or swelling after the first
three doses of DTaP. Such local reactions seem to be
more frequent after the fourth and/or fifth doses.
A temperature of 101° F or higher is reported in
3%–5% of DTaP recipients. Less common reactions
(e.g., persistent crying, higher fever, febrile seizure)
are rare and generally occur in fewer than 1 in
10,000 doses.
If a child has a medical reason not to receive the pertussis
vaccine, they can and should still be vaccinated
against diphtheria and tetanus with DT (pediatric)
vaccine.
The most frequently reported side effects following
vaccination with Tdap are headache, generalized
body aches, and tiredness.

19) How effective is this vaccine?
In general, inactivated vaccines are not as effective in
producing immunity as are live vaccines. In studies
of acellular pertussis vaccine, children who received
three or four doses were 80%–85% less likely to develop
pertussis than unvaccinated children. Tdap
vaccine is believed to be similar in effectiveness and
duration of immunity as pediatric DTaP vaccines.
Who should NOT receive pertussis vaccine?
People who had a serious allergic reaction to a previous
dose of DTaP or Tdap vaccine, or who developed
encephalopathy (brain injury) not due to another
identifiable cause, should not receive another
dose.
Certain rare adverse events following pertussis vaccination
usually serve as a precaution against receiving
further doses. Such events include a temperature of
105°F or higher, collapse or shock-like state, persistent
crying for more than three hours, or convulsions
within three days. Even if one of these precautions
exists, there may be occasions when the benefit
of immunization outweighs the risk (for example,
during a community-wide outbreak of pertussis). A
person who developed one of these adverse events
after pediatric DTaP vaccine may receive Tdap as an
adolescent or adult.
A person with a recognized, possible, or potential
neurologic condition should delay receiving DTaP
or Tdap vaccine until the condition is evaluated,
treated, and/or stabilized. Although DTaP vaccine
does not cause neurological disorders, receiving the
vaccine can cause an already-present underlying
condition to show itself.
Persons with a moderate or severe illness should
postpone receiving the vaccine until they are well.

20) Can the vaccine cause pertussis?
No.

21) Can a pregnant woman receive Tdap vaccine?
Tdap is not contraindicated during pregnancy. It
should be administered to a pregnant woman who
is in contact with an infant younger than age 12
months, is in an outbreak setting, or is a healthcare
provider who sees children. If there is no risk to
the pregnant woman of acquiring or transmitting
pertussis, the CDC’s Advisory Committee on Immunization
Practices recommends that Tdap vaccination
be deferred until the immediate postpartum period.
The new mother should receive Tdap before hospital
discharge, even if she is breastfeeding.

Mumps / ગાલપચોળિયું

1) What causes mumps?
Mumps is caused by a virus.

2) How does mumps spread?
Mumps spreads from person to person through the air. It is less contagious than measles or chickenpox.

3) How long does it take to show signs of mumps after being exposed?
The incubation period of mumps is 14–18 days, but can range from 14–25 days.

4) What are the symptoms of mumps?
Individuals with mumps usually first feel sick with nonspecific symptoms like headache, loss of appetite, and low-grade fever.
The most well-known sign of mumps is “parotitis,” the swelling of the salivary glands, or parotid glands, below the ear. Parotitis occurs only in 30%–40% of individuals infected with mumps.
Up to 20% of persons with mumps have no symptoms of disease, and another 40%–50% have only nonspecific or respiratory symptoms.

5) How serious is mumps?
In children, mumps is usually a mild disease. Adults may have more serious disease and more complications.

6) What are possible complications from mumps?
Central nervous system involvement (meningitis) is common, but is usually not serious. Meningitis (with headache, stiff neck) occurs in up to 15% of people with mumps, but usually resolves without any permanent damage. Up to 50% of postpubertal males experience “orchitis,” or testicular inflammation, as a complication of mumps. This may involve pain, swelling, nausea, vomiting, and fever, with tenderness of the area possibly lasting for weeks. Approximately half of patients with orchitis have some degree of testicular atrophy, but sterility is rare. An increase in spontaneous abortion (miscarriage) has been found among women who developed mumps during the first trimester of pregnancy; however,there is no evidence that mumps causes birth defects. Deafness, in one or both ears, can occur in approximately one per 20,000 reported cases of mumps.

7) Is there a treatment for mumps?
There is no “cure” for mumps, only supportive treatment (bed rest, fluids, and fever reduction).

8) How do I know if my child has mumps?
Mumps is diagnosed by a combination of symptoms and physical signs and laboratory confirmation of the virus, as not all cases develop characteristic parotitis and not all cases of parotitis are caused by mumps.

9) How long is a person with mumps contagious?
Persons with mumps are usually considered most infectious from 1–2 days before until 5 days after onset of parotitis.

10) If I think my child has been exposed to mumps, what should I do?
If your child has not been vaccinated against mumps, receiving the vaccine after exposure to the virus will not help prevent disease if the child has already been infected. However, if the child did not become infected after this particular exposure, the vaccine will help protect him or her against future exposure to mumps.

11) Can you get mumps more than once?
No.

12) What kind of vaccine is it?
The mumps vaccine is made from a live attenuated (weakened) virus. In the United States, it is recommended that it be given as part of the MMR vaccine, which protects against measles, mumps, and rubella (German measles) or the MMRV vaccine (MMR plus varicella [chickenpox] vaccine) when age-appropriate (licensed for use only from age 12 months through age 12 years).

13) How is this vaccine given?
This vaccine is given by subcutaneous injection, meaning that the vaccine is deposited just under the skin and not deep into the muscle.

14) Who should get this vaccine?
All children and some adults should have documentation of 2 doses of a mumps-containing vaccine. In the United States, mumps vaccine is commonly given as part of the combination vaccines MMR or, when age appropriate, MMRV. Adults born in 1957 or later without evidence of immunity (i.e., physician-diagnosed disease, laboratory evidence of immunity, or confirmation of disease) should receive at least 1 dose of vaccine; they should receive a second dose if they are at high risk of exposure to mumps (e.g., healthcare personnel, international travelers, college students). Unvaccinated healthcare personnel born before 1957, who do not have evidence of immunity, should also receive two doses of MMR.

15) At what age should my baby get his first mumps shot?
The first dose of MMR or MMRV should be given on or after the first birthday; the recommended range is from age 12–15 months. A dose given before 12 months of age may not be counted, so the child’s medical appointment should be scheduled with this in mind.

16) When should my child get his second MMR/MMRV shot?
The second dose of MMR is usually given when the child is 4–6 years old, or before he or she enters kindergarten or first grade. However, the second dose of MMR can be given anytime as long as it is at least four weeks after the first dose. MMRV can only be given through age 12 years and should be separated from a previous dose of varicella-containing vaccine by 12 weeks.

17) Who recommends this vaccine?
The Centers for Disease Control and Prevention (CDC), the American Academy of Pediatrics (AAP), and the American Academy of Family Physicians (AAFP) have all recommended this vaccine.

18) How safe is this vaccine?
Mumps is a very safe vaccine. Most side effects are mild and related to the measles or rubella components of the MMR vaccine (fever, rash, temporary joint symptoms).

19) What side effects have been reported with MMR vaccine?
Fever is the most common side effect, occurring in 5%–15% of vaccine recipients. About 5% of persons develop a mild rash. When they occur, fever and rash appear 7–12 days after vaccination. About 25% of adult women receiving MMR vaccine develop temporary joint pain, although this symptom is related to the rubella component of the combined vaccine. Joint pain only occurs in women who are not immune to rubella at the time of vaccination. MMR vaccine may cause thrombocytopenia (low platelet count) at the rate of about 1 case per 30,000–40,000 vaccinated people. Cases are almost always temporaryand benign.
More severe reactions, including allergic reactions, are rare. About one person per million develops inflammation of the brain, which is probably caused by the measles vaccine virus.

20) How effective is this vaccine?
Approximately 80% of individuals become immune to mumps after a single dose of vaccine. The second dose of MMR vaccine is intended to produce immunity in the 20% of persons who did not respond to the first dose. This also ensures that the individual gets another chance to become immune to measles and rubella.

21) Who should NOT receive mumps vaccine?
Anyone who experiences a severe allergic reaction (e.g., hives, swelling of the mouth or throat, difficulty breathing) following the first dose of MMR should not receive a second dose. Anyone knowing they are allergic to an MMR component (gelatin, neomycin) should not receive this vaccine.
Pregnant women should not receive the MMR vaccine, and pregnancy should be avoided for four weeks following vaccination with MMR. While there is no evidence that the mumps vaccine causes fetal damage, women are advised not to receive the MMR vaccine during pregnancy as a safety precaution based on the theoretical possibility of a live vaccine causing disease.
Severely immunocompromised persons should not be given MMR vaccine. This includes persons with a variety of conditions, including congenital immunodeficiency, AIDS, leukemia, lymphoma, generalized malignancy, or those undergoing immunosuppressive therapy.

22) Can individuals with egg allergy receive MMR vaccine?
In the past it was believed that persons who were allergic to eggs would be at risk of an allergic reaction from the vaccine because the vaccine is grown in tissue from chick embryos. However, recent studies have shown that this is not the case. Therefore, MMR may be given to egg-allergic individuals without prior testing or use of special precautions.

23) How do I know if I’m immune to mumps?
Persons are generally considered to be immune to mumps if they were born before 1957, have laboratory evidence of mumps immunity, have documentation
from their health professional of previous mumps disease, or have received appropriate mumps vaccination.

24) Can the vaccine cause mumps?
No. This vaccine is live, but attenuated. It can cause symptoms like fever but cannot cause mumps.
Does the MMR vaccine cause autism?
There is no scientific evidence that measles, MMR, or any other vaccine causes autism. The question about a possible link between MMR vaccine and autism has been extensively reviewed by independent groups of experts in the U.S. including the National Academy
of Sciences’ Institute of Medicine. These reviews have concluded that the available epidemiologic evidence does not support a causal link between MMR vaccine and autism.
The MMR-autism theory had its origins in research by Andrew Wakefield and colleagues in England. They suggested that inflammatory bowel disease (IBD) is linked to persistent viral infection. In 1993, Wakefield and colleagues reported isolating measles virus in the intestinal tissue of persons with IBD. The validity of this finding was later called into question when it could not be reproduced by other researchers.
In addition, the findings were further discredited when an investigation found that Wakefield did not disclose he was being funded for his research by lawyers seeking evidence to use against vaccine manufacturers.
The studies that suggest a cause-and-effect relationship exists between MMR vaccine and autism have received a lot of attention by the media. However, these studies have significant weaknesses and are far outweighed by many population studies that have consistently failed to show a causal relationship between MMR vaccine and autism.

Measles / ઓરી

1) What causes measles?
Measles is caused by a virus.

2) How does measles spread?
Measles is spread through the air by infectious droplets and is highly contagious.

3) How long does it take to show signs of measles after being exposed?
It takes an average of 10–12 days from exposure to the first symptom, which is usually fever. The measles rash doesn’t usually appear until approximately 14 days after exposure, 2–3 days after the fever begins.

4) What are the symptoms of measles?
Symptoms include fever, runny nose, cough, loss of appetite, “pink eye,” and a rash. The rash usually lasts 5–6 days and begins at the hairline, moves to the face and upper neck, and proceeds down the body.

5) How serious is measles?
Measles can be a serious disease, with 30% of reported cases experiencing one or more complications. Death from measles occurred in approximately 2 per 1,000 reported cases in the United States from 1985 through 1992. Complications from measles are more common among very young children (younger than five years of age) and adults (older than 20 years of age).

6) What are possible complications from measles?
Diarrhea is the most common complication of measles(occurring in 8% of cases), especially in young children. Ear infections occur in 7% of reported cases. Pneumonia, occurring in 6% of reported cases, accounts for 60% of measles-related deaths. Approximately one out of one thousand cases will develop acute encephalitis, an inflammation of the brain. This serious complication can lead to permanentbrain damage. Measles during pregnancy increases the risk of premature labor, miscarriage, and low-birth-weight infants, although birth defects have not been linked to measles exposure. Measles can be especially severe in persons with compromised immune systems. Measles is more severe in malnourished children, particularly those with vitamin A deficiency. In developing countries, the case-fatality rate may be as high as 25%.

7) How do I know if my child has measles?
Measles is diagnosed by a combination of the patient’s symptoms and by laboratory tests.

8) Is there a treatment for measles?
There is no specific treatment for measles. People with measles need bed rest, fluids, and control of fever. Patients with complications may need treatment specific to their problem.

9) How long is a person with measles contagious?
Measles is highly contagious and can be transmitted from four days before the rash becomes visible to four days after the rash appears.

10) If I think my child has been exposed to measles, what should I do?
You should contact your doctor immediately if you believe you or your child has been exposed to measles. If your child has not been vaccinated, measles vaccine may prevent disease if given within 72 hours of exposure. Immune globulin (a blood product containingantibodies to the measles virus) may prevent or lessen the severity of measles if given within six days of exposure.

11) How common is measles in the United States?
Before the vaccine was licensed in 1963, there were an estimated 3–4 million cases each year. In the years following 1963, the number of measles cases dropped dramatically, with only 1,497 cases in 1983, the lowest annual total reported up to that time. A measles epidemic occurred in the U.S. from large outbreaks in many cities. From 1989 to 1991, 55,622 cases were reported with a total of 123 measles-associated deaths. Half of the cases and deaths were in children younger than five years of age. The most important cause of this epidemic was low vaccination rates among preschool-age children.
Due to extensive vaccination efforts, the number of reported measles cases fell during the 1990s. Only 37 cases were reported in 2004. However, new cases continue to be reported, primarily in populations that have refused vaccination for religious or personal belief reasons. From January through July 2008, CDC received reports of 131 measles cases from 15 states and the District of Columbia—the highest year-to-date number since 1996. More than 90% of those infected had not been vaccinated, or their vaccination status was unknown. Many of these individuals were children whose parents chose not to have them vaccinated. Fifteen of the patients, including
four infants, were hospitalized.
In addition, measles is still common in many other countries and can be easily imported or contracted when traveling.

12) Can you get measles more than once?
No.

13) When did measles vaccine become available?
Measles vaccine became available in 1963. An improved measles vaccine became available in 1968. Combination measles-mumps-rubella (MMR) vaccine became available in 1971. Combination measles-mumps-rubella-varicella (MMRV) vaccine became available in 2005.

13) What kind of vaccine is it?
Measles vaccine is a live, attenuated (or weakened) strain of the measles virus grown in chick embryo tissue culture. In the United States, it is recommended that it be given as part of the MMR vaccine, which protects against measles, mumps, and rubella (German measles) or the MMRV vaccine (MMR plus varicella [chickenpox] vaccine) when age-appropriate (licensed for use only from age 12 months through age 12 years).

14) How is this vaccine given?
This vaccine is a shot given subcutaneously (in the fatty layer of tissue under the skin).

15) Who should get this vaccine?
Two doses of measles vaccine (given as combination MMR or MMRV when age-appropriate) are recommended for all children and certain adolescents and adults.

16) At what age should the first MMR/MMRV shot be given?
The first dose of MMR or MMRV should be given on or after the first birthday; the recommended range is from 12–15 months. A dose given before 12 months of age may not be counted, so the child’s medical appointment should be scheduled with this in mind.

17) When should children get the second MMR/MMRV shot?
The second dose is usually given when the child is 4-6 years old, or before he or she enters kindergarten or first grade. However, the second dose can be given anytime as long as it is at least four weeks after the first dose. MMRV can only be given through age 12 years.

18) How effective is this vaccine?
The first dose of MMR vaccine produces immunity to measles in 95–98% of children vaccinated. The reason for the second dose is to protect those persons who did not become immune after one dose. After two doses of measles vaccine, 99% of persons become immune to the disease.

19) Which adolescents and adults should receive the MMR vaccine?
In general, adults born before 1957 are likely to have had measles, mumps, and rubella during childhood and so are assumed to be immune. Exceptions to this guideline are women who want to become pregnant (see rubella section) and persons who work in medical facilities (see next question).
All persons born in or after 1957 should be immune to measles by having had one or more doses of MMR vaccine, a blood test that indicates immunity to measles, or written documentation of measles disease diagnosed by a doctor. Certain groups of people born in or after 1957 are at increased risk for exposure to measles and must be certain to be immune to measles. These adults are those attending college or other post-high school educational institutions, persons who work in medical facilities, and international travelers. These adults should receive two doses of MMR or have other evidence of measles immunity (lab test or physician-diagnosed measles).

20) Why do healthcare workers need proof of immunity to measles?
Persons who work in medical facilities are at much higher risk for being exposed to measles than is the general population (most people with measles are quite ill and will visit a medical facility at some point during their illness). Making sure that all workers are immune to this disease protects both the employee and the patients with whom he or she may have contact. All persons working in a healthcare facility in any capacity should have evidence of immunity to measles, including full- or part-time employees, medical or non-medical, paid or volunteer, students, and those with or without direct patient responsibilities.
Healthcare workers should have documentation of two doses of a measles-containing vaccine (e.g.,
MMR), laboratory evidence of measles immunity, or laboratory confirmation of disease.

21) Who recommends this vaccine?
The Centers for Disease Control and Prevention (CDC), the American Academy of Pediatrics (AAP), the American Academy of Family Physicians (AAFP), and the American College of Physicians (ACP), World Health organisation (WHO), UNICEF have all recommended this vaccine.

22) How safe is this vaccine?
Hundreds of millions of doses of measles vaccine have been given in the United States, and its safety record is excellent. Because it is a live vaccine, side effects following vaccination can be similar to a very mild case of measles. More than 80% of children will have no side effects at all.

23) What side effects have been reported with this vaccine?
Fever is the most common side effect, occurring in 5%–15% of vaccine recipients. About 5% of persons develop a mild rash. When they occur, fever and rash appear 7–12 days after vaccination. About 25% of adult women receiving MMR vaccine develop temporary joint pain, although this symptom is related to the rubella component of the combined vaccine. Joint pain only occurs in women who are not immune to rubella at the time of vaccination. MMR vaccine may cause thrombocytopenia (low platelet count) at the rate of about 1 case per 30,000–40,000 vaccinated people. Cases are almost always temporary and benign. More severe reactions, including allergic reactions, are rare. About one person per million develops inflammation of the brain, which is probably caused by the measles vaccine virus.

24) If my child develops a rash after getting the MMR vaccine, is he contagious?
Transmission of the measles vaccine virus does not occur from a vaccinated person, including those who develop a rash. No special precautions (e.g., exclusion from school or work) need be taken.

25) Who should NOT receive measles vaccine?
Anyone who experiences a severe allergic reaction
(e.g., generalized hives, swelling of the lips, tongue, or throat, difficulty breathing) following the first dose of MMR should not receive a second dose. Anyone knowing they are allergic to an MMR component (gelatin, neomycin) should not receive this vaccine. As with all live virus vaccines, women known to be pregnant should not receive the MMR vaccine, and pregnancy should be avoided for four weeks following vaccination with MMR. However, women who are breast-feeding can be vaccinated. Children and other household contacts of pregnant women should be vaccinated according to the recommended schedule. Severely immunocompromised persons should not be given MMR vaccine. This includes persons with conditions such as congenital immunodeficiency, AIDS, leukemia, lymphoma, generalized malignancy, and those receiving treatment for cancer with drugs, radiation, or large doses of corticosteroids. Household contacts of immunocompromised people should be vaccinated according to the recommended schedule. Although persons with AIDS or HIV infection with signs of serious immunosuppression should not be given MMR, persons with HIV infection without symptoms can and should be vaccinated against measles.

26) Can individuals with egg allergy receive MMR vaccine?
In the past it was believed that persons who were allergic to eggs would be at risk of an allergic reaction from the vaccine because the vaccine is grown in tissue from chick embryos. However, recent studies have shown that this is not the case. Therefore, MMR may be given to egg-allergic individuals without prior testing or use of special precautions.

27) Does the MMR vaccine cause autism?
There is no scientific evidence that measles, MMR, or any other vaccine causes autism. The question about a possible link between MMR vaccine and autism has been extensively reviewed by independent groups of experts in the U.S. including the National Academy of Sciences’ Institute of Medicine. These reviews have concluded that the available epidemiologic evidence does not support a causal link between MMR vaccine and autism.
The MMR-autism theory had its origins in research by Andrew Wakefield and colleagues in England. They suggested that inflammatory bowel disease (IBD) is linked to persistent viral infection. In 1993, Wakefield and colleagues reported isolating measles virus in the intestinal tissue of persons with IBD. The validity of this finding was later called into question when it could not be reproduced by other researchers.The studies that suggest a cause-and-effect relationship exists between MMR vaccine and autism have received a lot of attention by the media. However, these studies have significant weaknesses and are far outweighed by many population studies that have consistently failed to show a causal relationship between MMR vaccine and autism.
“MMR vaccine does not cause autism.

28) Can the vaccine cause measles?
As mentioned above, because the measles vaccine is “live,” it can cause mild measles-like symptoms in some recipients, but it does not cause measles disease.

Influenza disease & vaccine (Swine Flu H1N1)

1) What causes seasonal influenza?
Viruses cause influenza. There are two basic types, A and B, which can cause clinical illness in humans. Their genetic material differentiates them. Influenza A can cause moderate to severe illness in all age groups and infects humans and other animals. Influenza B causes milder disease and affects only humans, primarily children. Subtypes of the type A influenza virus are identified by two antigens (proteins involved in the immune reaction) on the surface of the virus. These antigens can change, or mutate, over time. When a "shift" (major change) or a "drift" (minor change) occurs, a new influenza virus is born and an epidemic is likely among the unprotected population.

2) How does seasonal influenza spread?
Influenza is transmitted through the air from the respiratory tract of an infected person. It can also be transmitted by direct contact with respiratory droplets.

3) How long does it take to develop symptoms of seasonal influenza after being exposed?
The incubation period of seasonal influenza is usually two days but can range from one to four days.

4) What are the symptoms of seasonal influenza?
Typical seasonal influenza disease is characterized by abrupt onset of fever, aching muscles, sore throat, and non-productive cough. Additional symptoms may include runny nose, headache, a burning sensation in the chest, and eye pain and sensitivity to light. Typical seasonal influenza disease does not occur in every infected person. Someone who has been previously exposed to similar virus strains (through natural infection or vaccination) is less likely to develop serious clinical illness.

5) How serious is seasonal influenza?
Although many people think of seasonal influenza as the “flu” or just a common cold, it is really a
specific and serious respiratory disease that can result in hospitalization and death. In the United States, the number of seasonal influenza-associated deaths has increased since 1990. This increase is due in part to the substantial increase in the number of persons age 65 years or older, who are at increased risk for death from seasonal influenza complications. An average of 36,000 influenza-associated pulmonary and circulatory deaths per season occurred during 1990–1999, compared to 19,000 such deaths per influenza season during 1976–1990.
Influenza disease can occur among persons of all ages; however, the risks for complications, hospitalizations, and deaths are higher among persons age 65 years or older, young children, and persons of any age who have certain medical conditions. Case reports and epidemiologic studies also indicate that pregnancy can increase the risk for serious medical complications from influenza.
In nursing homes, up to 60% of residents may become infected, with up to a 30% fatality rate in the infected. Risk for seasonal influenza-associated death is highest among the oldest of the elderly: persons age 85 years and older are 16 times more likely to die from a seasonal influenza-associated illness than persons age 65–69 years.
Hospitalization from influenza-related complications is also high among children age 24 months and younger – comparable to rates for persons age 65 and older. There were153 laboratory-confirmed seasonal influenza-related pediatric deaths reported during the 2003–04 influenza season. In the following four influenza seasons, the annual number of pediatric deaths reported to CDC ranged from 44 during the 2004–05 season to 84 during the 2007–08 season.

6) How is a pandemic different from an epidemic of influenza?
Occasionally, major influenza epidemics expand to a pandemic. The first recording of such an event was in 1580, and at least seven international pandemics have occurred in the nineteenth and twentieth centuries. The "Spanish flu" epidemic of 1918–1919 caused an estimated 21 million deaths worldwide, including more than 500,000 Americans. On June 11, 2009, the World Health Organization (WHO) officially declared that the spread of the novel influenza A (H1N1) virus had become a pandemic. The novel virus, which first appeared in Mexico during the spring of 2009, had demonstrated person-to-person transmission on multiple continents, meeting the definition of a pandemic.

7) How many people in the United States are hospitalized with seasonal influenza in a typical year?
A study conducted by CDC and published in the Journal of American Medical Association (JAMA) on September 15, 2004, provided new information on the number of people in the United States who are hospitalized from seasonal influenza-related complications each year. The study was based on records from 1979 to 2001 from about 500 hospitals across the United States. The study concluded that, on average, more than 200,000 people in the United States are hospitalized each year for respiratory and cardiac-related illnesses associated with seasonal
influenza virus infections.

8) What are possible complications from seasonal influenza?
The most frequent complication of seasonal influenza is bacterial pneumonia. Viral pneumonia is a less common complication but has a high fatality rate. Other complications include inflammation of the heart and worsening of pulmonary diseases (e.g., bronchitis). Reye's syndrome is a complication that occurs almost exclusively in children--patients suffer from severe vomiting and confusion, which may progress to coma because of swelling of the brain. To decrease the chance of developing Reye's syndrome, infants, children, and teenagers should not be given aspirin for fever reduction or pain relief.

9) What is the best way to prevent seasonal influenza?
The best way to prevent seasonal influenza is with annual vaccination.

10) Is there an alternative to vaccination in preventing influenza?
Vaccination is the principal means of preventing influenza and its complications. Here are some
additional steps that may help prevent the spread of respiratory illnesses like influenza:
1. Cover your nose and mouth with your sleeve or a tissue when you cough or sneeze--throw the tissue away after you use it.
2. Wash your hands often with soap and water, especially after you cough or sneeze. If you are not near water, use an alcohol-based hand cleaner.
3. Stay away as much as you can from people who are sick.
4. If you get influenza, stay home from work or school for at least 24 hours after the fever has ended. If you are sick, don't go near other people to avoid infecting them.
5. Try not to touch your eyes, nose, or mouth. Germs often spread this way.

11) What other drugs are available to prevent or treat seasonal influenza?
There are four antiviral agents approved for preventing or treating influenza in selected patients. Only two, oseltamivir and zanamavir, will offer protection against both A and B viruses; the other two, amantadine and rimantadine, protect only against the A viruses. Their use is generally limited to situations where an outbreak is underway and immediate protection of vulnerable, unvaccinated persons is critical (e.g., nursing home residents) or in persons who are expected to have an inadequate antibody response to the vaccine (e.g., persons infected with HIV) or who could not otherwise be vaccinated (e.g., persons with severe egg allergies). Antiviral agents are not a substitute for vaccination. (Note: Recent evidence indicates that a high proportion of currently circulating
influenza A viruses in the United States have developed resistance to amantadine and rimantadine and researchers are watching for additional antiviral resistance to any of these four agents that might develop in the future.)

12) If I contract influenza, what should I do?
Call your healthcare provider to discuss your particular situation. You will need to get plenty of rest and drink a lot of liquids. You can take medications to relieve the symptoms of influenza (but never give aspirin to children or teenagers who have influenza-like symptoms, particularly fever). If you are at high risk of developing complications from influenza, you should consult your healthcare provider immediately if you develop influenza-like symptoms. For purposes of treatment and prevention (chemoprophylaxis), antiviral medicines are prioritized for persons at high risk for influenza-related complications, such as people 65 years or older, people with chronic medical conditions, pregnant women, and young children.

13) When is a person with influenza contagious?
A person is most likely to pass on the virus during the period beginning one to two days before the onset of symptoms and ending four to five days after the onset.

14) Can you get influenza more than once?
Yes. Influenza viruses change frequently and infection with one strain does not provide protection against all strains.

15) When did seasonal influenza vaccine first become available?
The first seasonal influenza vaccine in the United States became available in 1945.

16) What kind of vaccine is it?
There are two types of influenza vaccine. The most common influenza vaccine is made from inactivated (killed) viruses. In June 2003, a live virus influenza vaccine was licensed. It contains live viruses that have been weakened (attenuated).

17) How are the vaccines made?
Every year, researchers and manufacturers develop a vaccine that contains virus strains they believe will be circulating in the upcoming influenza season.
Seasonal influenza vaccine typically contains both type A and type B viruses. The viruses selected for the vaccine are grown in chicken eggs.
For the inactivated (injectable) vaccine, the viruses are killed with formaldehyde, purified, and packaged in vials or syringes. Live virus vaccine is packaged in a special nasal sprayer. About six months are required to produce seasonal influenza vaccine each year.

18) How is the vaccine given?
The inactivated vaccine is given as an intramuscular injection. The live attenuated vaccine is sprayed into the nose.

19) Who should get seasonal influenza vaccine?
Many groups of people can benefit from being protected
from seasonal influenza.
Annual vaccination against seasonal influenza is recommended
for the following groups:
a. All persons age 6 months or older wanting to reduce the likelihood of becoming ill with influenza or of transmitting it to others
b. All adults age 50 years or older
c. Children and teens age 6 months through 18 years
d. Residents of long-term care facilities, nursing homes, and other chronic-care facilities
e. Adults and children who have chronic pulmonary (including asthma), cardiovascular (except hypertension), renal, hepatic, cognitive, neurologic/neuromuscular, hematologic, or metabolic (e.g., diabetes) disorders
f. Anyone whose immune system is weakened because of the following: HIV/AIDS or other diseases
that affect the immune system, long-term treatment with drugs such as steroids, or cancer treatment with x-rays or drugs
g. Children and adolescents age 6 months through 18 years on long-term aspirin treatment (who could develop Reye's syndrome if they catch influenza)
h. Women who will be pregnant during the influenza season
i. Healthcare personnel
j. All adults, children, and teens who are household contacts, caregivers, or workplace contacts of persons listed in categories e–g above, of children age 0–59 months, or of adults age 50 years and older The live virus (nasal spray) influenza vaccine can be given only to healthy, non-pregnant people ages 2 through 49 years. It should not be given to healthy children younger than age 5 years who have recurrent wheezing or have had a wheezing episode within the past 12 months. Children younger than age two years, persons age 50 and older, and anyone with a chronic medical condition (listed in e–g above) should receive inactivated influenza vaccine (injectable), NOT live (nasal spray) influenza vaccine.

20) What are the unique features of giving seasonal influenza vaccine to children compared with adults?
Children ages 6 months through 8 years should receive
two doses of seasonal influenza vaccine the first time they receive this vaccine, separated by at least 4 weeks. In addition, if that child received only one dose in their first year of vaccination, he/she should receive two doses the subsequent vaccination season.

21) Who recommends the seasonal influenza vaccine?
The Centers for Disease Control and Prevention (CDC), the American Academy of Pediatrics (AAP), the American Academy of Family Physicians (AAFP), the American College of Physicians (ACP), and the American College of Obstetricians and Gynecologists (ACOG) all recommend this vaccine.

22) How often should this vaccine be given?
Seasonal influenza vaccine is given each year because immunity decreases after a year and because each year's vaccine is formulated to prevent only that year's anticipated seasonal influenza viruses.

23) When should persons be vaccinated?
Health experts recommend that patients may be vaccinated
as soon as vaccine is available in their clinic, which can be as early as August or September. Vaccination should continue into the winter and spring, even until April or May. Travelers should be aware that the seasonal influenza season typically occurs from April to September in the Southern Hemisphere and throughout the year in the tropics. If they missed vaccination in the previous season, they should still be vaccinated before they travel, even if it’s in the following spring or summer.

24) Are there recommendations for the prevention of seasonal influenza outbreaks in institutions?
The most important factor in preventing outbreaks is annual vaccination of all occupants of the facility and all persons working or volunteering in the facility who share the same air as the high-risk occupants.Groups that should be targeted include physicians, nurses, and all other personnel in hospitals, long-term care facilities, other care facilities, and outpatient settings who have contact with high-risk patients in all age groups.

25) Should siblings of a person with a chronic illness receive seasonal influenza vaccine even though the chronically ill person has been vaccinated?
Yes. All household contacts (who are age six months or older) of persons with "high-risk" conditions, of people age 50 years and older, or of children from birth through age 59 months, should receive annual seasonal influenza vaccination. Either inactivated or live virus vaccine may be used; it is preferred that the inactivated vaccine be used for household contacts and caregivers of people with severe immunosuppression that must be in protective isolation.

26) Should siblings of a healthy child who is younger than age 6 months be vaccinated?
Yes, all household contacts of children too young to be vaccinated against seasonal influenza (i.e., younger than age 6 months) should receive annual seasonal influenza vaccination to protect the infant from serious infection. This is very important because these infants are too young to be vaccinated and are most vulnerable to complications from influenza.

27) Is it safe for pregnant women to get influenza vaccine?
Yes. In fact, vaccination with the inactivated vaccine is recommended for women who will be pregnant during the influenza season. Pregnant women are at increased risk for serious medical complications from influenza. One recent study found that the risk of influenza-related hospitalization was four times higher in healthy pregnant women in the fourteenth week of pregnancy or later than in nonpregnant women. In addition, vaccination of the mother will provide some protection for her newborn infant.
The live intranasal vaccine is not licensed for use in pregnant women. However, pregnant women do not need to avoid contact with persons recently vaccinated with this vaccine.
Vaccination is recommended for all persons, including breastfeeding mothers, who are contacts of infants or children from birth through age 59 months because infants and young children are at higher risk for influenza complications and are more likely to require medical care or hospitalization if infected. Women who are breastfeeding may receive either type of influenza vaccine unless the vaccine is not appropriate because of other medical conditions.

28) How safe is this vaccine?
Influenza vaccine is very safe. The most common side effects of the injectable (inactivated) influenza vaccine include soreness, redness, or swelling at the site of the injection. These reactions are temporary and occur in 15%–20% of recipients. Less than 1% of vaccine recipients develop symptoms such as fever, chills, and muscle aches for 1 to 2 days following the vaccination. These symptoms are more likely to occur in a person who has never been exposed to the influenza virus or vaccine. Experiencing these non-specific side effects does not mean that you are getting influenza.
Healthy children ages 2 through 4 years who received the live attenuated virus (nasal spray) vaccine during clinical trials appeared to have an increased chance of wheezing. Consequently, children with a history of recurrent wheezing or have had a wheezing episode within the past 12 months are not recommended to receive the live nasal spray vaccine; instead, they should be given the inactivated (injectable) vaccine.
Healthy adults receiving the live seasonal influenza vaccine reported symptoms such as cough, runny nose, and sore throat at a rate 3%–10% higher than for placebo recipients. There was no increase in the occurrence of fever.
Serious adverse reactions to either vaccine are very rare. Such reactions are most likely the result of an allergy to a vaccine component, such as the egg protein left in the vaccine after growing the virus. In 1976, the swine flu (injectable) vaccine was associated with a severe illness called Guillain-Barré syndrome (GBS), a nerve condition that can result in temporary paralysis. Injectable seasonal influenza vaccines since then have not been clearly linked with GBS, because the disease is so rare it is difficult to obtain a precise estimate of any increase in risk. However, as a precaution, any person without a high risk medical condition who previously experienced GBS within 6 weeks of an influenza vaccination should generally not be vaccinated. Instead, their physician may consider using antiviral drugs during the time of potential exposure to influenza.

29) What can you tell me about the preservative thimerosal
that is in some injectable influenza vaccines and the claim that it might be associated with the development of autism?
Thimerosal is a very effective preservative that has been used to prevent bacterial contamination in vaccines for more than 50 years. It is comprised of a type of mercury known as ethylmercury. It is different from methylmercury, which is the form that is in fish and seafood. At very high levels, methylmercury can be toxic to people, especially to the neurological development of infants.
In recent years, several very large scientific studies have determined that thimerosal in vaccines does not lead to serious neurologic problems, including autism. Nonetheless, because we generally try to reduce people’s exposure to mercury if at all possible, the vaccine manufacturers have voluntarily changed their production methods to produce vaccines that are now free of thimerosal or have only trace amounts. They have done this because it is possible to do, not because there was any evidence that the thimerosal was harmful.

30) How effective is seasonal influenza vaccine?
Protection from seasonal influenza vaccine varies by the similarity of the vaccine strain(s) to the circulating strains, and the age and health of the recipient. Healthy persons younger than age 65 years are more likely to have protection from their seasonal influenza vaccination than are older, frail individuals. It is important to understand that although the vaccine is not as effective in preventing seasonal influenza disease among the elderly, it is effective in preventing complications and death. In general, the immunity following seasonal influenza vaccination rarely lasts longer than a year.
When the "match" between vaccine and circulating strains is close, the injectable (inactivated) vaccine prevents seasonal influenza in about 70%–90% of healthy persons younger than age 65 years. Among elderly persons living outside chronic-care facilities (such as nursing homes) and those persons with long-term (chronic) medical conditions, the seasonal influenza shot is 30%–70% effective in preventing hospitalization for pneumonia and seasonal influenza.
Among elderly nursing home residents, the shot is most effective in preventing severe illness, secondary complications, and deaths related to seasonal influenza. In this population, the shot can be 50%–60% effective in preventing hospitalization or pneumonia and 80% effective in preventing death from seasonal influenza.
In one large study among children ages 15–85 months, the live, attenuated (nasal-spray) seasonal influenza vaccine reduced the chance of seasonal influenza illness by 92% compared with the placebo. In a study among adults, the participants were not specifically tested for seasonal influenza; however, the study found 19% fewer severe febrile respiratory tract illnesses, 24% fewer respiratory tract illnesses with fever, 23–27% fewer days of illness, 13–28% fewer lost work days, 15–41% fewer health care provider visits, and 43–47% less use of antibiotics compared with placebo.

31) Can the vaccine cause influenza?
No! Neither the injectable (inactivated) vaccine nor the live attenuated (nasal spray) vaccine can cause influenza. The injectable influenza vaccine contains only killed viruses and cannot cause influenza disease. Fewer than 1% of people who are vaccinated develop influenza-like symptoms, such as mild fever and muscle aches, after vaccination. These side effects are not the same as having the actual disease. The nasal spray influenza vaccine contains live attenuated (weakened) viruses that can produce mild symptoms similar to a cold. While the viruses are able to replicate in the nose and throat tissue and produce protective immunity, they are attenuated and do not replicate effectively in the lung. Consequently, they cannot produce influenza disease.
Protective immunity develops 1 to 2 weeks after vaccination. It is always possible that a recently vaccinated person can be exposed to seasonal influenza disease before their antibodies are formed and consequently develop disease. This can result in someone erroneously believing they developed the disease from the vaccination. Also, to many people "the flu" is any illness with fever and cold symptoms. If they get any viral illness, they may blame it on the seasonal influenza vaccination or think they got "the flu" despite being vaccinated. Influenza vaccine only protects against certain influenza viruses, not all viruses.

32) Who should NOT receive influenza vaccine?
In general, the inactivated (injectable) influenza vaccine
can be given to most everyone except children younger than age 6 months, persons with a history of a serious allergic reaction to eggs, or to a previous dose of influenza vaccine (see additional contraindications below). The live, attenuated (nasal spray) influenza vaccine is licensed for use only in healthy, nonpregnant individuals ages 2 through 49 years.
The following persons should not be vaccinated with the live, attenuated virus (nasal spray) influenza vaccine;
however, most (except infants younger than 6 months) can be vaccinated with the injectable vaccine:
- Persons younger than age two years
- Persons age 50 years or older
- Persons with chronic pulmonary (including asthma) or cardiovascular (excluding hypertension)
diseases; persons with renal, hepatic, cognitive, neurologic/neuromuscular, hematologic,
or metabolic (e.g., diabetes) disorders; or persons with immunosuppression, including that caused by medications or HIV
- Children ages 2 through 4 years with a history
of recurrent wheezing or who have had a wheezing episode in the last 12 months
- Children or adolescents receiving long-term aspirin therapy
- Pregnant adolescents or women
Healthcare workers, household members, and others who have close contact with severely immunocompromised individuals during the periods in which the immunosuppressed person requires care in protective isolation should preferably receive the injectable vaccine over the live (nasal spray) vaccine. Persons having had serious allergic reaction to eggs or to a previous dose of influenza vaccine should not receive either type of influenza vaccine (injectable or nasal spray). Persons with a history of serious egg allergies who are at increased risk for influenza or its complications should consult with their healthcare provider regarding referral to an allergist to determine
if the vaccine can be given following treatment for desensitization.
Persons with a history of Guillain-Barré syndrome should also consult with their physician before receiving this vaccine, so that the potential risks and benefits of influenza immunization can be weighed.
Persons who are moderately or severely ill at the time of their influenza vaccination appointment should usually wait until their symptoms are improved before getting the vaccine.
Some people believe they are allergic to thimerosal, the preservative used in some brands of influenza vaccine, because in the past they developed eye irritation after using eye drops containing thimerosal. Past eye irritation is not a valid reason to avoid getting influenza vaccine. Only serious, life-threatening allergies to thimerosal are reasons not to be vaccinated with an influenza vaccine containing thimerosal.
Most brands of influenza vaccine are packaged in vials or syringes that contain natural rubber or latex. Persons with a severe allergy to latex generally should not receive vaccine packaged in these vials or syringes.