Bambini Newsletter   June 2014

Rabies Update   

As some of us may recall, rabies was quite uncommon in New York years ago. In 1989, 55 animals tested positive. However, over the next four years, a "rabies tsunami" rolled northward from Pennsylvania and peaked in 1993 with over 2,700 confirmed animal cases. Since then, the incidence has been steadily falling. In the first quarter of 2014, 58 positives were reported out by Wadsworth Laboratory.


Two human deaths, one in 1993 the other in 1995 have occurred in New York. Maria Fareri Children's Hospital was named after one of the victims. Both cases were from bat rabies.


Three weeks ago, we received two calls on the same day. Both were relatively common scenarios. In the first case, parents reported that a bat had entered the bedroom where an 11 month-old infant had been sleeping. Fortunately, the parents were able to catch the bat and it tested negative. We recently had another similar scenario but the bat was not caught. That can be a sticky situation.


The second phone call came from the parent of an 11 year-old girl whose dog had been attacked by a raccoon. The girl had comforted the dog. In theory in this instance, the fur could retain some infectious saliva. If a child, after comforting the pet, touched their eye or other mucous membrane, the rabies virus could theoretically gain a foothold. The rabies virus gains access to the brain by traveling through nerve roots. When a child is bit or inoculated on the head, the incubation period can be short (e.g. 7-14 days). With a bite on the foot, incubation is much longer (e.g. 7 to 14 months).


The most common scenario we get calls about involves an unprovoked attack by a neighborhood dog. In most cases, these pets have been vaccinated but as a measure of precaution, are confined and observed for a period of 10 days.


The latest rabies vaccine, when given after exposure, requires only four shots given over the course of two weeks. In high risk situation, a dose of Rabies Immune Globulin is also administered (at least some in injected directly into the bite / scratch sites).  

Baby Powder:  Practical Considerations 

Traditionally, the main ingredient baby powder was talcum, which was derived from talc, a magnesium and silica rich mineral rock deposit. Back in the 1970s or so, it was discerned that talc deposits were sometimes contaminated with asbestos fibers. In 1971, British doctors found particles of talc embedded in 75% of the ovarian tumors studied.


Speculation was raised that talc powder spattered on the perineum worked its way up the vagina and into the reproductive organs. Moreover, studies in mice found that even non-asbestos containing talc caused enough inflammation that it might be carcinogenic. By the early 1990s, doctors in England as well as the US came out against talcum powder for infants.


More recently, the AAP now discourages any kind of baby powder. Yet, babies continue to get hot and sticky in summer - and store isles are full of Johnson & Johnson and other brands of zea mays (fancy name for corn) starch.


Likely you have heard concerns expressed that this stuff may be a culture medium for candida and other yeast - something we don't like to see showing up on our little baby behinds. Sadly, no one has ever really done a study to prove or disprove this reasonable theory. Other parents may be concerned that 88% of corn grown these days is GMO -- again, not something we want to expose our little ones to.


So what do we do? One option might be an organic powder such as California Baby. It contains some cornstarch, but also tapioca starch, kaolin clay, rice, baking soda, and essential oils. We do stock a little in the apothecary - but it's pricey. Burt's Bees Baby Dusting Powder is an affordable (albeit not organic) alternative.


We wonder if some enterprising parents in our practice might mix up some bentonite, coconut flour, red clay, etc. and come up with an even better product.  Let us know. 

Practice News  

As some of you are aware, one of our nurse practitioners, Rita Giordano C-PNP, lost her husband unexpectedly two months ago.  Rita had already been planning to step back from practice and enjoy her grandchildren.  We wish her the best as she moves on. 

A pediatrician with sub-specialty expertise has been orienting with us over the last two weeks.  It looks promising that we will have additional help soon -- just didn't want to say anything definite quite yet -- stay tuned.

Finally, a reminder to those of you with kids entering six grade in the public schools,  a second chicken pox shot (or positive titer) will be required.  Likewise for kindergarten entrants.  Moreover, kindergarteners will need additional DPTs and polios as well (although MMR#2 can be delayed til age 7).  It's going to be a wild ride.  Try not to wait until last second to address.

Do Pro-Vaccine Messages Backfire? 

A few weeks ago, Brendan Nyhan PhD from Dartmouth College and other co-authors published the results of their study on the effect of pro-vaccine messages on vaccination rates. Their research involved almost 1800 parents. The messages included photos of children with severe measles and evidence against the association of the MMR vaccine and autism.


What was the result? Did the messages increase the likelihood that parents would have their kids vaccinated? No - they actually had the opposite effect!


This is kind of a big deal since the CDC alone spends $8 to $12 million annually on pro-vaccine messages. Who knows how much the AAP and pharmaceutical companies ante up?


Why did this happen? One explanation offered is that parents simply do not trust the federal government. Given the rampant conflicts of interest among the FDA, CDC, and big pharma industry, this is an encouraging finding - most parents are pretty sharp.  In a NY Times article, Dr. Nyhan recommends that parents discuss the risks and benefits of vaccines with their pediatrician.   


What are your thoughts?  A link to this newsletter will be posted on our Facebook page in a day or so.  Let us know. 

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