Measles may sound like an outdated disease, but measles cases within the United States reached a notable 15-year high in 2011, according to the Centers for Disease Control and Prevention. In Tennessee alone, there were three reported cases in 2011, according to the Tennessee Department of Health. We asked Infectious Disease Specialist Keith English, MD, to weigh in. Why are we seeing so many cases? English says it’s because kids are not getting vaccinated as they should.

"The increase in measles cases is a reminder of how important it is to vaccinate our children against measles,” said English.  “Though measles is no longer an 'endemic' in the United States, cases still occur when people from other countries who are infected with the measles virus come to the U.S.”

U.S. citizens who’ve traveled or lived in a foreign country can return with the virus, and tourists traveling to the U.S. from another country can bring the virus here, he says. And because measles is so highly contagious, unvaccinated people can become infected without direct contact with an infected individual.

"Most of the 222 cases reported in the U.S. last year could have been prevented by simply following the recommendations for universal immunization against the measles virus," said English.

We've posted about this topic before, but thought it was a good time for a reminder. At some time or another, we’re all going to come down with the sniffles, our kids included. Between the runny noses, cough and fevers, it’s tough for parents to know when their child has more than a common cold. But don’t worry. The experts at Le Bonheur Children’s Hospital have tips on identifying and preventing more serious ailments.

Bronchiolitis
Bronchiolitis is an infection caused by a virus typically seen in children 2 years of age and younger. Its symptoms include wheezing, coughing and chest congestion, vomiting and a low-grade fever (less than 101 Fahrenheit). A child may take a longer time to eat with the infection.

The most routine care for bronchiolitis is to treat the symptoms. Parents are encouraged to frequently wash their own hands and their child’s hands, keep their child’s nose cleaned out, encourage their child drink more fluids and control fever. Your child may need medicine for wheezing.

Dr. Barry Gilmore, medical director of Emergency Services at Le Bonheur Children’s, says parents should call or see a doctor if your child has difficulty breathing, is unable to eat or drink or has signs of dehydration. Dehydration signs include dry skin, dry mouth, a lack of tears, and lack of wet diapers or use of the potty.

Le Bonheur Children’s recommends parents seek emergency care if the child’s neck, chest or ribs sink deep when breathing, if the child has trouble breathing or stops breathing, turns blue around the mouth or fingernails, has less than three or four wet diapers per day, or has trouble feeding after suctioning the nose.

Bronchiolitis is caused by a number of different viruses, including respiratory syncytial virus (RSV).

Respiratory Syncytial Virus
RSV is a common winter virus that attacks the lining of the airways and lungs. Dr. John DeVincenzo, a leading investigator in the treatment of RSV, is based at the Children’s Foundation Research Center at Le Bonheur Children’s. He says the virus infects all age groups, but infants younger than 1 year of age are most severely infected. It is the most common cause of pneumonia in infants and the most common cause of hospitalization in infants. In fact, about 3 percent of all babies younger than 1 year of age are hospitalized for RSV infection.

Early signs of RSV infection are the same as a common cold – runny nose, sneezing and mild cough. However, RSV often turns into a deeper cough and causes difficulty breathing by the second or third day of runny nose.

“It is important to try to avoid RSV infections within the first few months of life and avoiding the infection during the entire first winter season of your child’s life would be best,” DeVincenzo said.

For premature babies and for babies with heart or lung problems, medication can help prevent RSV. For other babies, the only way to prevent RSV is to follow these precautions:

From mid-October through the end of March, DeVincenzo recommends that parents try to ensure infants 6 months or younger aren’t touched by adults and children with colds. RSV doesn’t float through the air, but can be sneezed onto your infant or physically brought to your baby by direct physical contact.

Flu
The flu’s peak season runs from late fall through mid-winter and symptoms usually hit hard and fast. Those include fever, headache, muscle aches, dry cough, sore throat and weakness and fatigue. See our recent post on the flu to learn more.

Due to a now-retracted British study that linked autism to childhood vaccines, there is still anxiety among parents when it comes to immunizing their children. A recent article published in the Commercial Appeal discussed various stories of parents seeking alternatives to childhood vaccinations.

To keep our readers educated and informed on this subject, Dr. Keith English, Le Bonheur Children’s Hospital’s interim pediatrician in-chief and director of  Infectious Disease, gives his insight below.

My colleagues and I agree with the American Academy of Pediatrics (AAP) that vaccines are “one of the most successful medical advances of all time.”  Childhood vaccines have prevented millions of infections and saved hundreds of thousands of lives in the United States alone. They remain the greatest triumph of modern medicine and are the single most important way to protect our children from dangerous infectious diseases today.

There is no evidence that vaccines cause autism, period. Thousands of children have suffered and died from vaccine-preventable infectious diseases in the past 12 years because of the public concerns raised by an unethical and fraudulent claim.

At Le Bonheur, we recommend that parents make sure their children are fully immunized, according to the vaccine schedule published each year by the AAP. For reliable information about childhood vaccines, talk to your pediatrician or consult reputable sources such as the AAP.

To help inform our community about the flu, our infectious disease experts have compiled important information through a series of questions and answers.

What is the flu?
The flu is a contagious respiratory illness caused by influenza viruses. The seasonal flu typically runs from late fall through mid-winter, and symptoms usually hit hard and fast. Once symptoms occur, the fever and body aches typically last anywhere from three to seven days.

Is there a vaccine available?
Flu vaccine is an important way to reduce your child’s risk of developing influenza, and each year the vaccine protects against three different flu viruses.  All people ages 6 months of age and older should receive the influenza immunization this year unless they have a rare medical contra-indication such as allergy to chicken eggs or a history of allergic or severe adverse reaction to flu vaccine in previous years. Also note that individuals with a history of Guillain-Barre syndrome should consult with their physician regarding whether or not to receive the influenza vaccine.

How many doses of the vaccine will my child need?
This depends on the age of the child and whether the child received flu vaccines last year.  Children 9 years of age and older need only one dose.  Children 6 months to 8 years of age will either need one or two doses, depending on whether or not they received flu vaccines in previous years. Your pediatrician will be able to help you determine whether your child needs one or two doses of the flu vaccine this year. The American Academy of Pediatrics guidelines are available here.

Should my child receive the shot (injection) form or the nasal spray form of the flu vaccine?
In general, healthy children and adults ages 2-49 years of age may receive either the injection or the aerosolized (nasal spray) version of the vaccine.  Children ages 6 months to 2 years (and adults 50 years of age or older) should receive the injectable vaccine, as should children and adults with underlying medical conditions (a list of these conditions is available here.

How can you prevent the flu?
Children should be educated about the importance of hand hygiene and respiratory etiquette. These common-sense actions can help reduce the spread of influenza and many other infectious agents.

• Cover your nose and mouth with a tissue when you cough or sneeze. 
• If you don’t have a tissue, cough or sneeze into your upper sleeve, not your hands. 
• Throw the tissue in the trash after you use it. 
• Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand cleaners are also effective. 
• Avoid touching your eyes, nose and mouth. 
• Try to avoid close contact with sick people. 
• If you get sick, stay home from work or school, and limit your contact with others to keep from infecting them. People should stay home at least 24 hours after they are free of fever (100°F), or signs of a fever without the use of fever-reducing medications.

What are the flu symptoms?
Flu symptoms include:

• Fever (usually high, >101.5 or 102°F) 
• Headache 
• Extreme tiredness 
• Dry cough 
• Sore throat 
• Runny or stuffy nose 
• Muscle aches 
• Lack of appetite 
• Coughing 
• Stomach symptoms, such as nausea, vomiting, and diarrhea, also can occur but are more common in children than adults

When do I need to seek medical care for my child if I think he or she has the flu?
Parents should use the same judgment and common sense they would have used last flu season to decide to seek treatment for their children. If you suspect your child has influenza, call your pediatrician. Le Bonheur agrees with the Tennessee Department of Health that, “in the majority of cases, testing is unnecessary” and that “initiation of treatment should be based on clinical presentation and should not be delayed for a confirmatory test.”

There are several anti-viral medications that can be prescribed by your doctor, but these medications are most effective when given early in the course of illness, especially within the 48 hours of the start of the symptoms.  Treatment is recommended for all patients with severe symptoms and for patients at high-risk for complications of the flu. This includes children younger than 5 years of age and especially those younger than 2 years of age and children with chronic underlying medical conditions.

What can I do for my child’s symptoms?
To relieve your child’s pain and flu symptoms, first, administer fluids, and make sure your child is getting plenty of rest. Acetaminophen (Tylenol and other brands) helps with aches, pains and fever reduction.  Aspirin should not be given to children with suspected influenza.