Child Health ALERT

Volume 14 A Survey of Current Developments Affecting Child Health Care October 1996

Salmonella In Eggs: The Problem Persists

Salmonella are bacteria that can produce serious cases of diarrhea and other intestinal problems. However, a form of salmonella (called enteritidis) can cause milder cases of illness, and these particular bacteria have been traced to chicken eggs. The U.S. Centers for Disease Control (CDC) now report that among all the salmonella bacteria they've isolated, the egg-related form has increased from only 5% in 1976 to 26% in 1994. In the last 10 years, over 500 outbreaks due to this infection have been reported, with over 24,000 cases of illness, over 2200 hospitalizations, and 70 deaths (deaths tend to occur in particularly vulnerable people, such as elderly individuals in nursing homes). To underscore the public health importance of these infections. the CDC describe four recent outbreaks blamed on eating raw eggs (that is, unpasteurized eggs).

Outbreaks occurred in a Washington, D.C., hotel (traced to hollandaise sauce), an Indiana nursing home (baked eggs), a wedding reception in New York State (Caesar salad), and a household in New York City (home-made "Jamaican malt"). These examples reinforce that salmonella infections can occur in foodservice establishments, institutions, and private homes throughout the U.S. These risks can be limited by following some recommendations, including:

* Avoid eating raw or undercooked eggs (this is especially important for people with weak immune systems).

*Infood-service settings, substitute pasteurized egg products for pooled, raw, or undercooked eggs.

*Eggs should be cooked at temperatures of at least 145º F for at least 15 seconds (until the white is completely set and the yolk begins to, thicken) and eaten promptly after cooking.

*Hands, cooking utensils, and food-preparation surfaces should be washed with soap and water after contact with raw eggs.

*Eggs should be purchased refrigerated and stored refrigerated at 41º F or lower at all times. (Morbidity & Mortality Weekly Report, August 30, 1996, pp. 737-742)

COMMENT: Health officials have been trying to eliminate these bacteria from chicken flocks, but it's not clear that the efforts are working, Until there is a solution to this problem, it's important to follow the CDC recommendations aimed at prevention.

There's another perspective that's also worth considering. Health authorities become aware of these infections when they are called in to investigate an epidemic. However, since these salmonella are present in a small percentage of eggs, it's also likely that there are many cases of illness due to these bacteria which escape notice, simply because the affected child or adult seems to have a bad case of the stomach flu (symptoms include diarrhea, stomach pain, and vomiting). If a child (or adult) is particularly susceptible to these salmonella, the bacteria could account for repeated episodes of "stomach flu". For this reason, it is worth finding out whether these episodes occur one or two days after eating foods made with eggs, particularly if those eggs are
COMMENT: Health officials have been trying to eliminate these bacteria from chicken flocks, but it's not clear that the efforts are working, Until there is a solution to this problem, it's important to follow the CDC recommendations aimed at prevention.

There's another perspective that's also worth considering. Health authorities become aware of these infections when they are called in to investigate an epidemic. However, since these salmonella are present in a small percentage of eggs, it's also likely that there are many cases of illness due to these bacteria which escape notice, simply because the affected child or adult seems to have a bad case of the stomach flu (symptoms include diarrhea, stomach pain, and vomiting). If a child (or adult) is particularly susceptible to these salmonella, the bacteria could account for repeated episodes of "stomach flu". For this reason, it is worth finding out whether these episodes occur one or two days after eating foods made with eggs, particularly if those eggs are
COMMENT: Health officials have been trying to eliminate these bacteria from chicken flocks, but it's not clear that the efforts are working, Until there is a solution to this problem, it's important to follow the CDC recommendations aimed at prevention.

There's another perspective that's also worth considering. Health authorities become aware of these infections when they are called in to investigate an epidemic. However, since these salmonella are present in a small percentage of eggs, it's also likely that there are many cases of illness due to these bacteria which escape notice, simply because the affected child or adult seems to have a bad case of the stomach flu (symptoms include diarrhea, stomach pain, and vomiting). If a child (or adult) is particularly susceptible to these salmonella, the bacteria could account for repeated episodes of "stomach flu". For this reason, it is worth finding out whether these episodes occur one or two days after eating foods made with eggs, particularly if those eggs are raw or undercooked (and it's not easy to destroy the bacteria in eggs-it requires 7 minutes of boiling, 5 minutes of poaching, and 3 minutes of frying on each side). If that is the case, the situation should be brought to the attention of the child's health care provider, since the problem might be solved by switching to pasteurized eggs, which are now more common in supermarket refrigerator and freezer compartments. It's also worth avoiding cooking projects that involve the use of raw eggs, such as making certain lee creams, raw cookie dough, some salad dressings, and meringues.

RESOURCES

Useful Information On Controlling Head Lice

It is still early in the school year, and a good time to consider how to deal with the frustrating problem of head lice epidemics. Not only are head lice a recurring problem, but they are difficult to eradicate and therefore cause considerable anxiety and disruption to children, their parents, and child-care professionals alike.

In its continuing efforts to educate us about preventing and managing head lice infestations, the National Pediculosis Association (NPA) is making a number of materials available to readers of CHILD HEALTHALERT. In return for $1 and your name and address written clearly, the NPA will send you "The Child-Care Provider's Guide" along with their current newsletter and new catalog of educational materials. To receive this package, send $1 along with your request to NPA, P.O. Box 610189, Newton, MA 02461. (The NPA can also be reached at their website: www.headlice.org)

CHILD SAFETY

A Pavement Stencil May Promote School Bus Safety

In the U.S. each year, there are an average of 45 school bus-related child deaths, and 90% of these occur when children are getting on or off their bus. Although children are often instructed about safe procedures for boarding a school bus, officials and parents remain concerned about children running into the street while waiting for the bus, or running close to the bus as it arrives. Since many bus stops have no clearly defined markers to serve as safety boundaries for children, researchers from the Connecticut Childhood Injury Prevention Center tested the effectiveness of a stencil that was applied to the pavement at school bus stops. The yellow stencil, in the shape of a school bus, was two-feet long and was painted on the sidewalk pavement at least 10 feet from the curbs; children were instructed to remain behind the stencils before boarding.

In an experiment, the researchers found that the stencil, along with education about safe boarding, reduced unsafe behaviors, especially when there were less than 10 children waiting at the stop. They conclude that "the pavement stencil may represent a cost-effective approach to reducing unsafe behavior at bus stops by children of elementary -school age." (Burke GS et al: Pediatrics, April, 1996, pp. 520-523)

COMMENT: There are many questions that are not answered in this study (for example, does the stencil still have an effect months and years after it's been painted?), but this simple stencil and appropriate education seem to make common sense. Readers who are interested in more information may wish to contact the Connecticut Childhood Injury Prevention Center at 80 Seymour St., Hartford, CT 061025037)

" Healthy Handwashing" Coloring Packet Now Available

This packet contains the same delightful animals that appear on the poster. Each of the 10 pages illustrates an important handwashing principle, and these loose 8.5 x I I inch sheets are designed to be reproduced so that children can color them and learn the importance and value of proper handwashing.

IMMUNIZATIONS

FDA Approves Acellular Pertussis Vaccine For Infants

After years of debate, the U.S. Food and Drug Administration (FDA) has approved the use of a relatively new pertussis vaccine in infants. Pertussis vaccine protects against whooping cough, and is the 'T" in the DTP vaccine. Unlike the older pertussis vaccines, the newer products (called "acellular" vaccines) produce high levels of immunity with far lower risks of side effects. The newly approved product (called Tripedia) is a DTP shot that includes the acelluar vaccine along with the diphtheria and tetanus vaccines. (Pediatric News, September, 1996)

COMMENT: Readers may be confused because many children have already been getting DTP shots with the newer, safer, acellular whooping cough (pertussis) vaccine. The confusion would be understandable, since many press reports suggested that the vaccine approved by the FDA was the first acellular product, which isn't the case. Acellular pertussis vaccines have been around for some time, but they were only approved for children who were getting their fourth and fifth DTP shots (after one year of age). Until now, the first three DTP shots (usually given at 2, 4, and 6 months of age) included the old version of the vaccine. The FDA action can be expected to prompt pediatric and other public health officials to replace all DTP shots with a vaccine that includes the safer, acellular, version of the pertussis vaccine.

PARENT/CHILD

Mothers Vs. Thermometers: Who's Better?

Most health professionals believe that the only accurate way to test whether a child has a fever is to use a thermometer. However, a current study offers some evidence that seems to challenge that view. Researchers at two Chicago, IL, emergency departments invited mothers of children up to age 10 years to answer several questions about their child's temperature, and then a nurse took the child's temperature.

Of 322 mothers surveyed, 99% reported that they could accurately detect a fever at home without the use of a thermometer (usually by feeling the child's forehead). After the authors compared mothers' assessments of their children's fever with actual temperature measurements, they found that if a mother said her child had a fever, there was a 68% chance that she was correct, and if she said her child didn't have a fever, there was an 88% chance of her being correct. (Graneto JW & Soglin DF: Pediatric Emergency Care, June, 1996, pp. 183-184)

COMMENT: This isn't the first study to suggest that mothers aren't bad at predicting their child's fever. All this may suggest that mothers know their children, and their children's health status, better than many would believe.

Still, it is important to keep in mind that even in this study, mothers were far from being as accurate as thermometers. In addition, the study didn't consider how high the child's fever might be before it becomes detectable by mothers. Particularly in young infants, small increases in temperature may be important, but may not be recognized by a mother's touch. Though this report indicates that mothers may be reasonably accurate in detecting a fever in their child, these assessments are not terribly accurate and are not a substitute for objective measurements.

PRODUCT RECALLS

Recalls: Pacifiers ...

Lerma Import, of Ft. Worth, TX, is recalling about 10,000 pacifiers because they can break apart, releasing small parts and posing a risk of choking to young children. The pacifiers, imported from Mexico, were packaged in individual cellophane bags displayed on a cardboard header and sold for $.25 each from May, 1995 to May, 1996 in retail stores in Dallas. The pacifiers should be returned to the store where purchased for a refund; for more information, call Lerma Import at (817) 624-3404.

... Cozy Highback Swing...

The Little Tykes Co, of Hudson, OH, is recalling about 245,000 Cozy Highback Swings because they can tip forward and flip while a child is swinging. They sold for $15 to $18 from January through April of this year in toy, department, and discount stores nationwide. The swing comes in bright blue plastic, with the "Little Tykes" logo molded into the front crossbar. To exchange a swing for a different model or for a comparable Little Tykes product, consumers should call the company at (800) 3210 183 or write to Little Tykes, 2180 Barlow Road, Hudson, OH 44236.

..."Keepsake Kritters" Stuffed Animals...

Gibson Greetings Inc., of Cincinnati, OH, is recalling almost 70,000 "Keepsake Kritters" stuffed bears and cats because the eyes can separate ftom. the toys and pose a choking hazard. The toys sold for about $15 each in card shops, grocery stores, and specialty retailers from March 15 to April 22, 1996. The brown "Orson" bear has brown eyes and trim and wears a sweater patterned after the American flag; the white "Abby" cat has blue eyes with pink trim, and wears a multi-colored sweater. The stuffed animals should be returned to the place where purchased for a refund, or mailed to Gibson Greetings, Inc., P.O. Box 371804, Cinncinnati, OH 452221804, attention: Jo Poppe/Recall; for more information, call the company at (800) 345-6521. (Above recalls from: AAP News, August, 1996)

... Century Infant Car Seat Buckle...

Certain buckles on Century child restraints are being recalled because of a problem encountered during routine testing. The affected infant-only models have a number starting with "45" (for example, "4565") and the affected 4-in-1 infant car seat stroller systems have model numbers starting with "11" (for example, "11-570") and manufactured between September 12, 1995 and May 13, 1996. Customers should obtain a free replacement buckle by calling Century at (800) 762-74631, the seat can continue to be used pending replacement. (Safe Ride News, Summer, 1996)

... And Basketball Nets

Come Play Products, of Worcester, MA, has recalled 70,000 white nets in its Junior Pro Basketball Sets because they pose a strangulation hazard. If the basketball set's adjustable post is placed upside down (contrary to instructions), a child younger than 3 might get tangled in the net. Model 2800 Jr. Pro Basketball Set, with a white mesh net on a yellow plastic rim, sold for about $ 10 at Kay Bee Toy & Hobby Shops nationwide from October, 1992 to May, 1993. Sets with a pink net made after May, 1993 are not being recalled. Consumers should remove the white nets. Come Play will replace these with neon pink nets and reimburse consumers for postage. For more information phone Come Play Products Co. at (800) 528-3 )328. or write to Come Play Products, Co., 44 Suffolk Street, Worcester, MA 0 1604.

Making Halloween Fun, But Keeping It Safe

Halloween can be a time of great fun for children, but it is also a time when adults who care for children have special concerns about safety. The following tips from the Massachusetts Poison Control System should help insure that Halloween is safe without interfering with children's enjoyment.

Treats:
- Encourage children to have fun collecting treats, but tell them to wait until they return home before eating any.
- Inspect all treats and throw out any with torn or unsealed wrappers.
- Homemade treats should be discarded.
- Bringing candy or other treats to be x-rayed is not completely reliable, since many objects cannot be detected this way.
- Report any suspicious treats to your local police.
- If your child has allergies, check the ingredient list carefully.

Trick or Treating:
- Set curfews for your children.
- Children should understand that they can trick or treat only at homes of neighbors they know.
- Check your walkways and lawns for obstacles, and leave your outside lights on.
- Keep pets indoors or confined to an area where they will not interfere with children.
-- Younger children should always be accompanied by an adult.
- Consider sharing and planning neighborhood parties as an alternative to trick or treating.

Costumes:

- Check masks to be sure children can see and breathe easily.

- Make sure costumes are flame-resistant and roomy enough to allow the child to dress warmly underneath.

- Purchase face paints, glues, and glitters made- of nontoxic materials. Be aware that some children can have allergic reactions to these products.

- Neon glowsticks and neckbands contain a chemical that is irritating to skin and could be harmful to eyes. Children should not

bang, crush, or throw glowsticks or neckbands, and they should avoid doing anything that might release the chemicals.

Jack O'Lanterns:
- Let your child have fun drawing a face on the pumpkin and scraping out the contents, but an adult should do the carving.

- Jack O'Lantems with candles should be watched carefully and placed where they can't start a fire.