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.