Child Health ALERT

Volume 16 A Survey of Current Developments Affecting Child Health Care March 1998

The Impact Of One Vaccine On Children's Health

While most people are familiar with the value of vaccines designed to protect against illnesses such as polio. measles, and mumps, many are less familiar with a more recent vaccine designed to protect against a bacterial infection caused by Haemophilits influenzae type b, or as it is called in the medical community, "H. flu b", or "Hib".

The first such vaccine became available in the mid-1980s, and was intended for children between 2 and 5 years of age; another version was introduced in 1990, and this vaccine was effective in children as young as 2 months of age.

Two recent studies examined whether the Hib vaccine has made a difference in children's health. In one, researchers in New York State found that before the vaccine was available. Hib was responsible for 49 hospital admissions per 100,000 children, but after the vaccine, that figure had dropped by about 6-fold, to 8 per 100,000 children. Further, epiglottitis (infection of the epiglottis, which can block the airway) and meningitis, which are potentially fatal diseases caused by Hib, almost disappeared as a result of the vaccine. (Liptak GS et al: Journal of Pediatrics, June, 1997, pp. 923-930)

Another problem commonly caused by Hib was infection of the skin surrounding the eye (called periorbital and orbital cellulitis).

Researchers in Manhasset, New York point out that Hib was a common cause of these very serious conditions before the vaccine became widely used, but when they looked at children who had periorbital or orbital cellulitis between 1985 and 1995, they found no cases that were due to Hib after 1987. (Barone SR & Aiuto LT. Journal of Pediatric Ophthalmology & Strabismus, SeptemberlOctober, 1997, pp. 293-296)

COMMENT: If you asked physicians who care for hospitalized children which bacterial infections were the most serious and most common only a dozen or so years ago, infections due to H. flu easily topped the list, since they caused diseases, such as meningitis, epicylottitis, and cellulitis, that were usually quite serious and sometimes fatal; and when diseases like meningitis weren't fatal, they often left the children who survived with life-long problems, such as deafness and neurologic conditions.

What these and many other reports clearly prove is that, thanks to this underappreciated vaccine, this situation has changed. Parents can feel very good about the fact that children who receive the Hib vaccine are being protected from what was, until recently, the most common cause of serious bacterial infections in young children.

INFECTIONS/ILLNESS

Tuberculosis Is Back--Who Should Be Tested?

Tuberculosis (TB) was becoming a rare disease in the U.S., but in recent years it has been making a comeback, and many who care for children may wonder whether everyone should be screened for the disease. Pediatric and public health experts have concluded, however, that mass screening for TB is not cost-effective; instead, screening should focus on those children who are most at risk for the disease. These include children who:
* come from a family with one or more cases of TB
* were born in a foreign country where TB is common
* were in contact with someone with HIV or AIDS
* were in contact with someone who's been in jail within the past 5 years, or
* are foster children (since it's hard to get good background information on such children)

Other factors may also place children at high risk, such as homelessness, being a migrant worker, or living in a neighborhood or apartment complex where there's been a lot of TB.

As for how testing should be done, one expert urges that the multiple puncture test should be avoided, and instead screening should be done with a small injection just under the skin (called the Mantoux test); the same expert points out that interpreting the test result following the injection should be done by a health care professional, not the family, since the result has important consequences for how the child will be managed. (Infectious Diseases in Children, February, 1998, pp. 13-16)

COMMENT: Many readers may have been confused by news about TB's comeback, but the approach described above has the support of most child health professionals and should help identify, as early as possible, cases of TB among those children who have the greatest risk for this re-emerging but treatable disease.

ASTHMA/ALLERGY

Does The "EpiPen" Injector Work As Well As A Standard Needle?

If children (and adults) with serious allergies to foods, insect stings, or medications come into contact with one of those agents, they can suffer a potentially life-threatening allergic reaction, called anaphylaxis. This reaction can involve shock, facial swelling, and difficulty breathing, and it can begin within minutes of swallowing a particular food or medicine or after being stung by an insect. First aid for anaphylaxis consists of a shot of epinephrine (also called "Adrenalin"), and many allergic children and adults are advised to keep an "EpiPen" available where they live, go to school, or attend child care. The EpiPen is an autoinjector, meaning it is a needle and syringe combination that, when it is activated and pushed against the child's thigh (or arm), injects a certain amount of epinephrine into the child's muscle. However, some physicians, other health care providers, and parents might feel that the EpiPen might not be as effective as the more "traditional" way of giving epinephrine, which is done by drawing up the drug from a vial and injecting it under the child's skin (this kind of injection is called a subcutaneous injection). A recent study offers some strong reassurance about the likely effectiveness of the EpiPen.

To see how well epinephrine is absorbed into the bloodstream, researchers from Winnipeg, Canada studied 17 children who had had an anaphylactic reaction to various substances, such as food and insect stings. Because these children might need a future shot of epinephrine, they took part in an experiment where they were given either the standard dose of epinephrine under their skin or they were given a shot with the EpiPen autoinjector. While the traditional epinephrine shot took over half an hour for the drug to peak in the childrens' bloodstream, the same target was reached in only 8 minutes among the children who got the EpiPen injection. Side effects were similar in both groups of children, and they included increases in heart rate and blood pressure, as well as some shakiness and pale skin; these effects are typical following epinephrine, and they did not last long.

The authors point out that since most experts believe that quickly reaching high epinephrine levels is critical if a child is to survive an anaphylactic reaction, the autoinjector is the preferred way to give epinephrine to children who require that drug to prevent or treat an anaphylactic reaction. (Simmons FER et al: Journal ofAllergy & Clinical Immunology, January, 1998, pp.33-37)

COMMENT: Anyone who has been at the scene when a child is having a serious allergic reaction knows how frightening it can be. In this setting, trying to give a shot of epinephrine by the traditional needle and syringe technique can be difficult. Someone has to be comfortable with drawing up the right amount of the drug from the vial, and then injecting it under the child's skin. On the other hand, the autoinjector requires no special skills or knowledge to use it correctly--a twist of the cap activates it, it is pressed against the thigh or arm, and a button is pressed to trigger the needle and injection.

While it is easier to use, the autoinjector gives a fixed dose, no matter whether the child is big or small, and some have worried that a small child may get too much drug.

That didn't seem to be a problem in this study, but it was too small to rule out that possibility. On the other hand, getting the epinephrine into the child quickly is the most important thing to do when an anaphylactic reaction is threatening, and the EpiPen is the most likely form of epinephrine to be available in homes, schools, camps, and child care settings; this study offers reassurance to parents, teachers, and other child care providers that if they need to use the EpiPen, it is likely to be as effective as the traditional epinephrine shot, and perhaps even better.

POISON SAFETY_

Artificial Nail Primer Cosmetic Products-- Beware Of Their Hazards

Artificial nail cosmetics have been growing in popularity in recent years, and though they were intended for purchase by professional cosmeticians only, many "wholesale beauty supply shops" are open to the public and sell these products to anyone who wishes to purchase them. Some of these products are also sold in pharmacies and other stores. As part of the process of applying artificial nails, a primer is used, and the primer usually contains methacrylic acid.

Poison control experts from Boston, Massachusetts reviewed two different national databases, covering 1991 through 1995, and identified 791 incidents where children had been accidentally exposed to nail primers or nail products containing methacrylic acid. In the large majority of cases, the children were under 6 years old, and they typically had tried to swallow the chemicals or had tried to swallow them and spilled some on their skin as well. Among the preschool children, 56 of the 59 had severe injuries as a result of bums to their mouths, skin, or eyes.

The authors warn that an increase in these kinds of injuries can be expected for a number of reasons. First, because of the expense of professional nail applications and marketing by the cosmetics industry, more and more people are using these products at home. Second, these primers are packaged in screw-top, small, amber colored bottles that do not have child resistant caps. Third, none of these bottles have adequate consumer warnngs.

These poison control experts urge a number of changes in the way nail primers are promoted and packaged, but from the standpoint of parents', the important message is that even though these products do not have label warnings about their hazards, they can pose a very serious risk to young children. If a child does come into contact with nail primer, the local poison control center should be called immediately. However the best way to deal with this risk is through prevention: Children should not be around nail primers when they are being used, and these products should be stored the same way other poisons are stored. (Wooffie A & Shaw J Archives of Pediatric & Adolescent Medicine, January, 1998, pp. 41-46)

PARENT/CHILD

National TV-Turnoff Week

During the week of April 22-28, 1998, millions of Americans are invited and encouraged to turn off their TVs for 7 days. Sponsors of this 4th annual event hope that this will allow families to have more time and discover rewarding family interactions with time to play games, read together, exercise, and have more conversations.

It's estimated that before an average child has entered kindergarten, she has spent between 5,000 and 8,000 hours watching TV. TV-Turnoff week is endorsed by many national educational, health, and religious organizations. A packet of materials is also available, at $ 10, as an organizer's kit, which includes a guidebook, posters, suggested activities, and items designed to be photocopied for distribution. Some free materials are available for those whose budget is limited. To obtain the kit or the free materials, write TV-Free America, 1611 Connecticut Avenue NW, #3A, Washington, DC 20009, or call 202 887-0436 and ask for Mimi.

RESOURCES

Immunization Posters ...

The U.S. Centers for Disease Control and Prevention, through it's Immunization Program, is offering a series of three free posters designed to encourage childhood immunizations. All three feature Dr. Seuss's characters--in one, the Cat in the Hat reminds parents and child care providers to make every visit to the doctor and to get immunizations on time; in another, the Sneetches explain recent changes in the immunization schedule; and in the third, characters from The King's Stilts remind parents of the "old" days before the measles/mumps/rubella (German measles) vaccine.

To order a set of these posters (supplies are limited), write Curtis Allen, CDC, 1600 Clifton Road, Mailstop E52, Atlanta, GA 30333; or order via the internet at www.immunization.org

... Food Safety Coloring Book...

A new children's coloring book, entitled "Food Safety at Home, School, and When Eating Out" is now available, at no cost. Each page of this book teaches a basic food handling concept, including handwashing, proper food temperature, and how to reduce the risk of E. coli contamination; there are even a couple of recipes. The pictures are simple and attractive and the language is appropriate for ages 4-7.

Readers can request up to 50 copies by contacting the U.S. Department of Agriculture (USDA), Public Outreach Office, Room 1180, South Building, 14th and Independence, SW, Washington, DC 20250; requests can also be made by fax, to 202 720-9063.

... And Arts & Crafts Safety

Working with "arts and crafts" is an important source of enjoyment and learning for children. However, because these materials may occasionally contain toxic solvents and other harmful ingredients, adult&often have concerns about whether the materials they provide children are safe.

The Art & Craft Materials Institute (ACMI), an association sponsored by art and craft suppliers, has developed an updated booklet listing many hundreds of products that are authorized to carry a seal that indicates they have met specific standards of safety. The booklet is available free of charge by contacting Debbie Gustafson at the Art and Craft Materials Institute, Inc., 100 Boylston Street, Suite 1050, Boston, MA 02116; requests can also be made by fax: 617 426-6639.

CHILD SAFETY

Head Injuries From Plastic Hairbeads

Plastic hairbeads are often worn as decorative hair fasteners by children. They appear as two colorful beads connected by a thin, looped elastic band. Since 1985, the U.S. Consumer Pro-duct Safety Commission has received a number of reports of injury related to these beads, most of which have involved choking hazards. However, researchers from Philadelphia have recently reported three children who had serious head injuries from these beads.

The girls, ages 2, 4, and 9 years, had head injuries from falls or bike accidents. In all three, the hairbeads were pushed against the scalp during the accident, and they were believed to have caused skull fractures. In two of the girls, the skull fracture was serious and both children required surgery to correct the problem.

The doctors who described these injuries point out that if a child hits her head during an accident, the hairbeads make the head injury more serious because the hard an d unyielding plastic acts as a contact point. They conclude that "parents should be alerted to the injuries caused by the wearing of hairbeads, and safer alternatives, such as flat barrettes or plain elastic bands, should be recommended." (Geller E et al: Pediatric Radiology, 1997, pp. 790-793)

COMMENT: These injuries are likely to be quite rare, but they're worth keeping in mind when deciding what kind of hair decorations a child wears.

Healthy Handwashing Coloring Packet: A Great Teaching Tool!

Since our Healthy Handwashing Coloring Packets became available last year, subscribers have been telling us how helpful these materials have been in teaching children how to practice handwashing hygiene. The coloring packet includes 11 different line drawings, each of which illustrates an important message about handwashing; these messages are delivered in an attractive and joyful style, and coloring each picture helps children reinforce practices that will make a real difference in protecting their health.

The 8.5 x 11 inch pages are designed to be reproduced. Healthy Handwashing Coloring Packets are available at $7 for a single packet and $5 for each additional one (prices include postage and handling. Purchase orders: minimum $20). To order, use the enclosed form or contact us at CHILD HEALTH ALERT, P.O. Box 610228, Newton Highlands, MA 02461. (Prices for bulk orders will be provided upon request).