June 2003

Congratulations to Karl Schlegel, Timothy Murray and Samara Shandler for solving last month's mind bender. I won't give away the answers so those people that didn't come in to the office can pick up last month's gazette and try to solve it. The renovations of our examining rooms are nearly complete. Joining our aquarium and jungle rooms are our locker room and space room. Remember to bring in your children's pictures in their sports attire. We will copy them and hang them up in the locker room. Also, please schedule your children's sports and 2004 school physicals early so as to beat the rush and get your choice of appointments.

Dr. Barenfeld

Poison Ivy---------------------------------------------

Mind Bender of the Month

First puzzle answer: Ring around the rosy. Are you catching on??? Try the others.

Answers

Stay away from poison ivy. This seems to be easier said than done for our children. The old saying "Leaves of three, let them be," is good advice but our children can't resist retrieving an overthrown ball even if it is sitting in a patch of poison ivy. Besides having three leaflets to a stem, it is important to know that poison ivy generally grows as a vine (may also grow as a bush), is often the first to turn color - red - in the fall, has yellow or green flowers or white berries in the spring, and frequently has black spots on the leaf which result from damage to the leaf itself. It is also important to realize that the leaves, stems, roots and even the flowers and berries contain the poison. However, an intact plant is not capable of triggering an allergic reaction. The plant must have a break in it to release the poison. Poison ivy even occurs in the winter and can be spread by smoke from burning leaves or logs.

A person who is aware of making contact with poison ivy may be able to prevent a reaction by quickly washing with soap and water. Exposure typically produces a rash in 24 - 72 hours. The rash may appear on other parts of the body for up to two weeks. However, the rash is not spread by scratching. The rash only occurs where the skin initially came into contact with the poison. Also, the rash will not spread from blister fluid and is not contagious. Without treatment a mild case of poison ivy will resolve in 2 weeks. For most, the rash causes too much discomfort to ignore. Treatment includes Benadryl, oatmeal baths for itch, hydrocortisone cream, and in more severe cases or those involving the face and eyes - prednisone by mouth. An allergy shot for poison ivy was taken off the market about five years ago due to significant reactions.

Parent Question of the Month

Q. Dr. Barenfeld, can you tell me more about the meningitis vaccine recommended for my college bound child?

A. Many different germs are capable of causing meningitis. These include bacteria, viruses and fungi. When most people think of meningitis they are in general referring to bacterial causes. We already have two excellent vaccines in use for infants to protect against meningitis: the HIB vaccine and Prevnar vaccine. Menomune vaccine is given to students entering college. It protects against the bacterium meningococcus. This is the germ that gets the most media attention as it occurs in outbreaks and can be rapidly fatal. Meningococcal meningitis is the leading cause of bacterial meningitis in older children in the U.S. It strikes about 2,800 Americans each year, about 600 of which occur in the 15-24 year old age group. In spite of effective antibiotics about one in seven infected patients will die. Since 1971, routine mass vaccination of military recruits has led to a substantial decrease in disease. Actually, the highest incidence of meningococcal disease occurs in young children. However, menomune is not effective in children younger than 2 years of age. College-aged students have a greater risk of disease than the general population due to a number of factors including close contact dormitory living, cigarette smoking and alcohol consumption that are often a part of campus life. This is why the vaccine is recommended for this age group. Menomune is not 100% effective in preventing meningococcal disease. There are 5 major strains of meningococcus. Menomune acts against only 4 of these strains. Unfortunately this fifth strain (B strain) accounts for about 30% of disease. When one also takes into account other minor strains not covered by the vaccine and that like any vaccine, it is not 100% effective even for the strains menomune dose cover, then menomune is only about 60 - 65% effective in preventing disease among college students. Therefore about 400 cases of meningococcal disease could be prevented each year with vaccination. Serious side effects are rare with most people only having soreness at the site of injection. One other important fact is that the vaccine only produces immunity lasting for 3 - 5 years. This is why universal vaccination is not recommended for children greater than 2 years of age. Many states now require menomune for college entry. New York State does not. Our practice recommends menomune vaccination for your college bound children.