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Some illnesses aren't avoidable

Through their contacts at day care, schools and other activities, children come into contact with numerous infections and diseases. Here's what to do if our child is exposed.

AIDS and HIV infections. A child exposed to a classmate with AIDS in school or a relative similarly HIV-infected in the casual family setting is in no danger. Transmission through saliva or tears has never been documented.

Cat Scratch Disease. This illness is spread by the scratch or bite from a cat, not by person-to-person contact.

Chicken pox. No treatment is usually necessary unless the child is on steroid medication or has a severe underlying illness. Those children may be a candidate for a special gamma globulin to modify the severity of the chicken pox.

Considerable media attention has been given to a new medication, acyclovir, which if given within the first 24 hours of chicken pox will result in a one-day reduction of fever and a 15 percent to 20 percent reduction in the severity of the chicken pox lesions. Therapy with this medication has not been shown to reduce the rate of complications, itching, or duration of absence from school. Therefore, it is not recommended for routine use in otherwise healthy children with chicken pox.

There may be certain situations when the use of acyclovir might be considered (children with chronic pulmonary diseases, for example), and these should be discussed with your child's physician.

Fifth disease. Since this illness is minimal and self-limited, no treatment is necessary for the exposed child. By the time the disease is clinically apparent, the affected child is no longer infectious.

German measles (Rubella). No treatment is necessary. Symptoms are usually mild if a non-vaccinated child contracts the illness, and immunized children will not get the disease. The immunization against rubella is part of the MMR vaccination given at 15 months.

Giardia. Most children exposed to this intestinal parasite have no symptoms and frequently only a stool test can determine whether the child has contracted the illness. Diarrhea, abdominal bloating or other intestinal symptoms usually develop within one month after exposure. By the way, giardia is very common in the water supply of St. Petersburg Russia!

Head lice. The exposed child should be examined at one-week intervals for the presence of eggs ("nits") in the hair. No treatment should be given unless eggs are found. Children should avoid physical contact with infected individuals, their combs, hats and clothing.

Hepatitis. Parents should determine the type of hepatitis to which their child was exposed. Children get hepatitis A from drinking virus-contaminated water, eating contaminated food or putting their hands, contaminated with the virus, into their mouths.

A single injection of immune gamma globulin within two weeks of exposure is 80 percent to 90 percent effective in preventing or modifying the disease. While hepatitis B is spread by contact through sexual activity, children can be exposed by accidental needle sticks, lacerations or bites and close contact with infected people, such as family members, day-care providers and playmates.

Exposed children should begin their hepatitis B vaccine (if they have not already had the three-shot series) and if not vaccinated receive an injection of immune gamma globulin.

Impetigo. No treatment is necessary for the child exposed to another child with this common skin infection. Since impetigo is highly contagious but treatable, parents should watch for a rash on their child that appears as blisters, pustules or scabs.

Infectious mononucleosis. No treatment is necessary since the degree of contagiousness is minimal.

Measles (Rubeola). No treatment is necessary if the child has previously had the disease or has been immunized. The immunization against measles is part of the MMR vaccine given at 15 months. Gamma globulin may be given if the child is older than 15 months and has not been immunized.

Meningitis. Parents of the exposed child should try to elicit the type of meningitis from the family of the affected child. If the sick child has a viral ("aseptic") meningitis, no treatment for the exposed child is necessary.

If the meningitis is caused by a bacteria (Haemophilius influenzae type B, meningococcus), most physicians will treat certain contacts with an antibiotic called Rifampin. These contacts include all household contacts (adults and children) where there are children younger than 4 and nursery school/day-care center contacts (children and adults) where there are children younger than 4. By "contact," we mean a child who has been in close proximity to the child with meningitis the last few days before the child became sick. Rifampin is not recommended for pregnant women.

Mumps. No treatment is necessary if the child has had the disease or has been immunized against it. The mumps vaccine is part of the MMR immunization usually given at 15 months of age.

Pinworms. The exposed child should be examined at night for either pinworms or eggs around the rectal area. All family members (unless pregnant) should be treated if the child is infested.

Pneumonia. Many bacteria and viruses cause pneumonia, but they will often not cause the same illness in each child. An upper respiratory tract infection, sore throat or earache may occur in an exposed child. In most cases, no preventive treatment is given.

Ringworm. No treatment is necessary. Watch for the classic rash if your child touched the infected child or used such things as clothes, hat, comb or sleeping bag from the affected child.

Roseola. Roseola ("baby measles") has a low degree of contagiousness, and therefore no treatment is necessary.

Scabies. No treatment is necessary unless signs of scabies appear. Because of the long incubation period, signs may not be immediately noticeable. Preventive treatment of family members is recommended if a child does break out with scabies.

Scarlet fever and strep throat. The exposed child who has symptoms should be examined and probably started on antibiotics while culture results are pending.

Shigella. Most children exposed to this highly infectious intestinal bacteria will become sick with diarrhea (usually bloody), vomiting, headache and occasionally dehydration within a week after exposure. This infection usually is acquired from day-care or child-care facilities but can be contracted by eating contaminated food and coming into contact with infected family members.

Tuberculosis. The exposed child should have a tuberculin skin test performed by a doctor. Since the incubation period is two to 10 weeks, a second tuberculin test should be done three months later.

Whooping cough. If contact was intimate, the child should be examined and started on prophylactic antibiotic. Household and other close contacts younger than 7 also should receive a booster dose of the vaccine unless one was recently given, or they have had fewer than four doses of the whooping cough vaccine.

This column is written to draw attention to the issues discussed and should not be relied upon as medical advice and is not intended to replace the advice of your child's physician.

Dr. Bruce A. Epstein has practiced pediatrics in St. Petersburg since 1973. He is a member of the American Academy of Pediatrics. He is married and has three grown children.

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