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| Sex Ed Matters |  |
"Sex ed matters to me because...half of all new STDs occur among young people aged 15-24." - Dr. Terence R. McAllister, MD FAAP We are proud to support "Sex Ed Matters", an online campaign that gives supporters of comprehensive sexuality education a home base. This year, the campaign is focused on getting state legislation, An Act Relative to Healthy Youth, signed into law. Research shows that providing medically-accurate, age-appropriate sexuality education leads to healthy decisions and helps keep teenagers in school. The Healthy Youth Act will make sure schools get it right when they offer sexuality education. Learn more at www.sex-edmatters.org. |
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Vaccination Corner
| Rotavirus
 In this issue of our on-going Vaccine Corner series, we take a look at
Rotavirus.
The rotavirus vaccine is a great example of how a vaccine can effectively protect the individuals who get the vaccine, but also others in the community who do not (herd immunity) and also how the safety of vaccines is constantly monitored to make sure the benefit of the vaccine is greater than any risks associated with the vaccine. Description of Disease Rotavirus is the most common cause of severe diarrhea among children. Prior the introduction of rotavirus vaccines in the United Sates in 2006, rotavirus resulted in illness in hundreds of thousands of children, 410,000 physician office visits, 270,000 Emergency room visits, and the hospitalization of approximately 70,000 children each year for IV hydration. Although today rotavirus caused very few deaths in the US (20-60 each year), worldwide more than half a million children under age 5 die as a result of rotavirus each year. Rotavirus causes vomiting and watery diarrhea for 3 to 8 days, and fever and abdominal pain occur frequently as well. Effectiveness of Vaccine The rotavirus vaccine is very effective. The vaccine was introduced in 2006, and a recent study compared hospitalization rates from rotavirus from 2000-2006 (before the vaccine) and 2008-2010 (after the vaccine). Hospitalization rates dropped by 80% in children less than 5, but also by 70% for children form 5-14, 53% for 15-14 year olds, and 43% among adults 24-44 years old. The vaccine is only given to infants and was introduced in 2006, so only the children in the less than 5 age group had ever received the vaccine. These significant drops indicate that the vaccine helps not only the children who receive the vaccine but the entire community by cutting down the numbers of children susceptible to the infection. Risk of Vaccine There can be side effects from this vaccine. The most common side effects are very mild including: irritability, low grade fever, vomiting or diarrhea. The most serious potential side effect is intussusception. Intussusception is a type of bowel blockage that occurs when a loop of the intestine gets pulled in on itself, and could require surgery. It happens spontaneously in some babies (about 44 per 100,000 children or 1 in 2,300) every year in the United States, and usually there is no known reason for it. There is also a small risk of intussusception from rotavirus vaccination, usually within a week after the 1st or 2nd vaccine dose. This additional risk is estimated to range from about 1 in 20,000 infants to 1 in 100,000 infants who get rotavirus vaccine. The affect of rotavirus vaccine on intussusception illustrates how effectively vaccines safety is monitored even after they are on the market. There are currently two rotavirus vaccines on the market (Rotateq and Rotarix) but there was an earlier vaccine (Rotashield) which was introduced in 1998. However Rotashield was pulled from the market in 1999 because it was found to cause a more increase in the risk of intussusception. Rotashield was found to cause an additional 1 case of intussecption per 10,000 children vaccinated. The studies show that the vaccines we use now cause a much smaller increase in the risk, and the benefit of the vaccine is far greater than the risk of intussusception. Recommendation The rotavirus vaccine is recommended for all children at 2, 4, and 6 months. The safety and effectiveness has not been studied in older children, so the first dose of the vaccine must be given before the child is 15 weeks old and no doses can be given after a child is 8 months old.
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| Lyme Disease |  A Public Health Threat
The CDC (Center for Disease Control) recently released a paper stating that the incidence of Lyme disease in the US is up to ten times higher than previously believed. About 30,000 cases of Lyme disease are reported to the CDC every year, however many cases do not get reported to the CDC. Researchers used a number of methods including billing data from insurance companies, analysis of data from clinical labs and a survey of the general public. Using all of these data sources the CDC now believes the number of cases of Lyme disease is closer to 300,000 per year, ten times more than previously thought. It is also important to realize that 96 percent of these cases of Lyme disease occur in just 13 states in the Northeast and Midwest including Massachusetts.
Lyme disease was first identified in 1975 in Lyme, Connecticut and since then has been found to be the most common tick borne disease in the United States. Lyme is caused by a bacterium called Borrelia burgdorferi and is transmitted to humans by the bite of an infected black legged tick (deer tick). In order to transmit the disease the tick must be attached to a person for at least 24-48 hours, so if you remove a tick quickly you can prevent the illness.
Early Lyme disease (5-30 days after the tick bite) is characterized by flu like symptoms (fever, fatigue, headache, muscle and joint pains) as well as swollen lymph nodes and a distinctive red circular rash that starts at the site of the tick bite and spreads out circularly from there. Late Lyme diseases symptoms can appear weeks, months, or years after a tick bite and include arthritis (painful swelling of one or more joints), numbness, facial paralysis (Bell's palsy), meningitis, and occasionally irregular heart rhythms.
The simplest way to prevent Lyme disease is to avoid being bitten by a tick or to remove ticks as soon as possible after a bite. Ticks live close to the ground in tall grasses; they do not fly or jump off trees. Wearing long pants and keeping pant legs tucked into socks can keep ticks from being able to crawl up onto your skin. Use an insect repellant with 20-30% DEET on exposed skin. Anytime after you have been in tick habitat you should thoroughly check your entire body, and your children's bodies, and remove attached ticks immediately.
Ticks can attach anywhere; in particular, they will find spots like: the back of your knee, around waistbands, under armpits or any other constricted place. The best way to remove a tick is to grasp it's head with a pair of sharp tweezers or a tick removal tool (such as "Ticked Off" tick remover tool marketed to remove ticks from dogs but it also works very well on children) and pull it straight out (do not try to twist it out). After removing the tick apply a topical antibiotic ointment over the site to prevent infections.
If your child has a tick and you cannot remove it, or if you believe it has been on for more than 48 hours, or if he has any of the symptoms of Lyme disease listed above, contact Dr. McAllister.
For more information visit the CDC Lyme disease page at: http://www.cdc.gov/lyme/.
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| Symptoms |  Prepare for When Your Child is Sick
When your child needs medical help, you have options:
- Handle the problem yourself at home. Utilize our website as well as our helpful links page to educate yourself on how to treat common pediatric aliments at home.
- Call your insurance provider's 24/7 nurse line. Many insurance plans have 24/7 nurse lines that members can access to speak with a qualified healthcare provider. Call the number on the back of your insurance card to access your plan's nurse line.
- Call us at 508-747-8277. If you're unsure of the level of medical care your child needs, we can help you decide.
- Visit an urgent care center. Urgent-care clinics, like the ones offered by pharmacy chains, are a good option when you desire walk-in care.
- Visit a hospital emergency room. Use this guide to determine if symptoms warrant a trip to the ER.
- Call 911 for an ambulance. For life-threatening situations, dial 911.
Emergency Rooms are for Emergencies ONLY
When you choose to utilize our community's emergency rooms for anything other than a true medical emergency, you hurt us all. According to Blue Cross Blue Shield of Massachusetts, a trip to the emergency room to treat common pediatric ailments like fever, ear pain and cold symptoms costs four to five times more to treat in the ER than a primary care office like Performance Pediatrics.
If you need advice about your sick child or an appointment, please call the office at 508-747-8277.
Hours
Administrative personnel are available to answer your calls weekdays from 9 am to 5 pm and most Saturdays, 9 am - noon. When we are on the phone, all calls go directly to a voice mail system. This system is checked every 15 minutes during regular administrative hours.
Urgent Care by Appointment Only/No Walk Ins
Performance Pediatrics is open by appointment only and cannot accommodate walk-in patients. We leave an adequate number of appointment slots each day to accommodate urgent-care needs. Our policy is to see patients with urgent-care needs the same day they call provided they call at least 2 hours before we close. When one of our providers speaks with a parent or patient it is determined through triage how soon a patient needs to be seen.
After-hours Calls
For established patients, Dr. McAllister or a trusted colleague is available by telephone when our office is closed at 508-747-8277. Please use this service with respect; it is available for families with urgent and/or semi-urgent questions and concerns only.
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| Electronic Communication |  Are you getting our emails?Over the past few months we've heard from a few of you that you are not receiving our emails. After investigating the issue we learned that some Internet providers were classifying Performance Pediatrics as "spam" and either pushing us to a junk mailbox or blocking us all together. We believe the problem has been fixed, but please alert us if you think you are not receiving our emails.
We utilize electronic communication (email and texts) in a number of ways to improve the services we deliver to our patients. In addition to this quarterly newsletter, we also use email to alert patients when a well exam or follow up appointment is due. We send the alert so that established patients can book their desired appointment time before it is taken by a new patient. While we are accepting new patients, our priority is to meet the needs of our established patients first.
We also utilize emails to confirm appointments and to alert patients when the post-visit summary is available on the secure patient portal. The Performance Pediatrics Patient Portal is a safe, secure section of our web site that allows you to see and print many of your child's medical records, including growth charts, immunization records, lab results and prescriptions. The Patient Portal also allows you to interact with Performance Pediatrics; you can request prescription refills and school/camp forms with just a few simple clicks.
At your child's next appointment, ask our receptionist how to sign up for the portal or call in during normal business hours.
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Be Well!
Sincerely,
Terence R. McAllister, MD, FAAP
Medical Director
&
Jennifer L. Simmons, CPNP
Medical Home Care Coordinator
phone: 508-747-8277
fax: 508-747-1147
online: www.PerformancePediatrics.com
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