Author Archives: Eric Garcia

Rabies: Tragically, It Happens… And Is Preventable

The Orlando Sentinel reported that a 6 year-old boy died after physical contact with a bat in his home. Link to the Story HERE

Critical facts from this report,

1.       Most rabies in the U.S. is related to bats. The bat was in this home a couple weeks, at least. Any bat in a home should be removed without skin-to-bat contact (professional exterminators, if needed). Finding one bat mandates checking for points of entry and fixing those, as well as searching for other bats.

2.       Presume a bat in a home is rabid.

3.       Have no contact with saliva, mouth, or claws of a bat. Any such contact requires,

a.       Vigorous washing with soap and water of contact area at least 20 minutes.

b.      Rabies post-exposure immunization as soon as possible, pending studies on the bat for rabies virus.

4.       If the bat is not decomposed, collect the carcass, with impermeable skin protection, such as rubber gloves, and place it in a plastic bag, to be submitted to the local Public Health Department Animal Control for rabies studies.

5.       This death was very likely preventable; the victim apparently deterred the parents from taking him for medical evaluation and treatment because he feared shots. The ultimate tragedy. Modern rabies vaccine is no more uncomfortable than flu shots and is considered nearly 100% effective.

Influenza: Facts To Know

                                                                                                                                        1/8/18

General Flu Vaccine

1.       The very young and very old (and those with medical problems, such as heart disease, impaired immunity, and diabetes) are most at risk for serious complications and death: on average, each flu season kills 40,000 Americans.

2.       No one has ever gotten flu from the flu vaccine- the routine injection vaccine is not a live vaccine and so cannot cause an infection (inhalation vaccine is live).

3.       Flu vaccine is imperfect, as are all vaccines. They provide relative, not absolute, protection. If you are exposed to a huge number of flu virus particles (virions), such as with a close, direct cough or sneeze, you will almost certainly become ill with flu. However, the immunity from flu vaccine may make it a milder, shorter duration illness; may save your life.

a.       The best flu vaccines (they vary year to year) are about 60% effective at preventing flu, but still may moderate the illness; 60% is better than 0%.

b.      Receiving flu vaccine is a civic-social act and duty. If all 325 million Americans received flu vaccine, the amount of illness (missed days at work and school) and death would absolutely dramatically decline.

Take the vaccine to protect your spouse, your kids, and your grandkids if you don’t care about yourself. By protecting yourself, you are protecting those you love.

4.       In Houston, flu vaccine is best taken in October or November; but anytime is worthwhile until the flu season is about over in April.

Flu Diagnosis/ Illness

1.       “Rapid” flu tests are 30-40% false negative; so, only conclusive if positive for flu. If negative, it must be followed by a more reliable, more costly test.

2.       If a physician suspects flu as the cause of illness, Tamiflu must be started immediately, as its chance for impact is best if started within 2-3 d of illness onset, prior to conclusive diagnosis.

3.       Tamiflu is only effective against influenza A, not B. There is no anti-viral drug for flu B. For many years, influenza A has been over 95% of our flu strains.

4.       Other treatment measures,

a.       Ibuprofen 400-800mg three times per day for fever, headache, and bodyaches.

b.      Symptom-specific meds: cough, nausea, congestion, pain

c.       Hydration: You are adequately hydrating if you are not thirsty, you sweat with fever, and you urinate frequently (every 1-2H) urine with almost no color or odor. (Check with your physician on the safest rate of rehydration if you have heart, kidney, liver disease, or high blood pressure)

d.      Fever: Most who die from flu are very old and do so because of the strain high fever imposes on their aged blood vessels, causing fatal heart attacks and strokes.

Minimization of fever in the elderly and the very young may be life-critical and is to be done proactively, not reactively (after high fever has occurred). —-

1.       Tylenol (every 4H) or ibuprofen (every 8H), by the clock, while the patient is ill. (read dosing precautions on the medicine bottle)

2.       Warm showers or baths frequently (immersion rapidly conducts heat out of the body).

3.       Avoid “bundling up” with blankets or clothing- cover up just for comfort, to keep uncomfortable cold drafts away from the patient. The more coverage, the more retained heat, the higher the fever.

4.       Cool or neutral temperature liquids ingested in high volumes will lower core temperature and produce sweat to evaporate heat from the body surface.

For all others fever control is a matter of personal comfort, not medical criticality. In fact, fever is of benefit in fighting infection; a tool we were evolved to have with infections.

5.       Post-Flu Illness: If a flu patient appears to have recovered but, within 1-3 weeks, develops new problems (fever, shortness of breath, chest pain, profound weakness), they should immediately be evaluated by their physician for the possibility of secondary bacterial infection, such as pneumonia, which is a worrisome complication.

6.       Flu Vaccine For Flu Contacts: Anyone ill with flu should notify all those who were in close contact with them the prior week in order to immediately receive flu vaccine if they had not already. It may be effective at generating some immunity within a week, certainly by two; may prevent or significantly moderate illness. This is “ring” vaccination — creates an immunity ring around the “index case” to diminish flu propagation through the community.

7.       You do not have flu if you DO NOT HAVE FEVER.

Contagion

1.       Flu is mainly spread by cough/ sneezing and hand contact.

2.       Flu patients shed flu virus up to a week after the end of illness; perhaps longer the weaker the underlying immune system, such as in those over 75 years-old.

3.       To minimize spread,

a.       Avoid contact with others when ill (such as at work or school), especially the very young, the very old, or those with major medical problems.

b.      Wear a respiratory mask (preferably N-95 from a pharmacy or medical supply store for exposed “contacts” and a plain respiratory mask for the ill patient) as much as possible when ill.

c.       Cleanse/ wash hands routinely and frequently throughout the day from illness onset until 2 weeks after becoming well (soap and water, alcohol, etc.).

d.      Once the diagnosis is established as flu A by tests (or even prior if flu is very highly suspected), all close contacts, such as those sharing air-space at work and household contacts or who have spent significant social time with the ill individual, should take Tamiflu once-a-day for 10 days (preventive dose), possibly longer if very old or otherwise immune-compromised.

 

Edward R. Rensimer, MD

Post-Hurricane Flood Water Commentary

As expected, per my article in The Houston Chronicle on 9/4/17, tests of flood water from Hurricane Harvey are suggesting that the water is not clean, probably due to contamination by human waste and water treatment facilities. This water cannot be ingested without medical risk unless treated first by mechanical filtration of particulate matter and then boiled and/or treated with sterilization chemicals, such as iodine or chlorine.

                Specifically, high levels of Escherichia coli (E. coli) bacteria have been found, as well as excessive lead and arsenic content. Unless there is direct substantial ingestion of lead or arsenic, these elements should not pose a risk of toxicity. Lead and arsenic poisoning result in illness by cumulative exposure over time, and so would unlikely account for symptoms or illness acutely. Further contaminants may yet be found.

                E. coli and other bacteria are a risk for diarrheal illness (and possibly systemic sickness with fever) if ingested. Otherwise, such bacteria are not worrisome unless they have a portal of entry into the body, such as through disrupted skin- broken down skin barrier from rashes, chronic skin disorders, or wounds.

                So, proper actions with flood water contact that had contaminated surfaces are,

1.       Update tetanus immunization if at least 10 years since last vaccination; or if there is an unclean, inflamed, or devitalized tissue wound.

2.       Wear protective footwear with thick soles, always.

3.       Be sure to clean the insides of footwear, especially boots, with decontaminating solution (such as 1:10 Clorox to water dilution), especially after wearing in such water.

4.       See a physician promptly for any wounds developing worrisome changes (discharge, significant discoloration or pain, blisters, extending inflammatory changes into surrounding tissues, or if accompanied by fever or general illness.

5.       See a physician for diarrheal illness.

6.       See a physician for new onset of systemic illness: fever, chills, poor appetite, weakness, nausea/vomiting, abdominal pain.

Edward R. Rensimer, MD

Director, International Medicine Center

Link to New York Times Article A Sea of Health and Environmental Hazards in Houston’s Floodwaters for more information

Photo Credit David J. Phillip/ Associated Press