What’s Going Around: Chicken pox, Fifth disease, ringworm

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UPMC Pinnacle’s Heritage Pediatrics in Camp Hill reports viruses with fever and congestion and some lingering cases of the flu.

This week, they’re seeing more strep throat as well.

“Most kids start with fever, sore throat, headache, and sometimes belly pain,” Dr. Kathleen Zimmerman said.  “Younger children often do not complain of a sore throat, but parents may notice they aren’t eating normally.”

Strep throat needs to be confirmed with a throat swab strep test. Antibiotics are needed to treat it. If your child has these symptoms, Zimmerman says they should be seen and tested.

This week at Penn Medicine Lancaster General Health Physicians Roseville Pediatrics, they have continued to see a lot of patients with seasonal allergy symptoms and a moderate number of patients with viral colds. They have also continued to see moderate numbers of ear infections and sinusitis cases, which stem from these initial sources of nasal congestion.

Strep cases have continued to rise and made up almost 70 percent of the sore throat cases seen.
“Strep is everywhere,” Dr. Joan Thode said.

Roseville also saw an increase in viral gastroenteritis, or the stomach bug.  They had four cases of the flu. That’s a lower number, but it’s not yet gone from the area, they noted.

A few schools and day cares are reporting multiple cases of chicken pox, as well as Fifth disease, a virus that has high fevers and a characteristic “slapped cheek” look of very flushed cheeks. Both of these viruses are very contagious and can be potentially damaging to a developing fetus. There is a vaccine for chicken pox, although Fifth disease just needs to run its course.

Thode offered the following advice about chicken pox:

“Chicken pox is a virus that causes a rash of spots that look like a clear bubble on a small, red base. The rash always starts on the trunk (belly or back), then spreads to the arms, legs and face. The bubble contains fluid with active virus inside, so chicken pox can be spread by secretions (spit, coughing, etc.), as well as by the liquid within the lesions. These lesions will eventually rupture, then scab over.  The child is contagious starting from a few days prior to the eruption of the lesions until all of the lesions are scabbed and dry. The spots are itchy, which unfortunately makes spreading easier, as the child can get the infectious fluid under their fingernails and spread it by touch.

This is a vaccine-preventable disease! The typical schedule to get chicken pox vaccines is the first between 12 to 15 months of age and the second at 4 years old. Vaccinated children should be immune to the disease, but if they do get a few lesions, the course of the disease will be minimal. In these cases, cover the few lesions until they crust over.

Chicken pox can cause damage to a developing fetus, so it’s important for pregnant women to avoid contact with kids with current or suspected chicken pox. Vaccination for chicken pox is very important to protect not only your child but also the children around them, particularly those who are too young for the typical immunization schedule or those with diseases or treatments that prevent them from having full immunity to the disease.

As always, contact your child’s doctor with any and all questions related to your child’s symptoms. Though your child may feel a bit tired and have lower energy, they should still be alert and responsive to you during their illness.”

CVS MinuteClinics across the area reported the following this week:

Lancaster:

Submitted by: Jessica Myers, Nurse Practitioner, MinuteClinic in Lancaster
“We have seen children with croup (laryngotracheobronchitis) this week. Croup is a viral illness with symptoms including a barking cough and fever. It often begins abruptly at night and recurs two to three nights. It is usually a self-limiting illness that can be treated at home. If severe, a one-time dose of steroids can be prescribed. Home care measures can include a hot shower running in the bathroom and exposure to cold, outside air alternating. Over the counter fever reducers for fever and discomfort, rest, and fluids. Seek emergency care if rapid breathing, decreased responsiveness, and audible wheezing sounds (stridor).

A stye (hordeolum) is a localized area of swelling, tenderness and redness to the internal or external eyelid. Warm compresses should be applied to encourage spontaneous drainage, do not express manually. Cleanse the eyelids with a mild and tear free soap. Usually the stye spontaneously drains aided by the compresses. Sometimes an eye antibacterial ointment is used or oral antibiotics if topical treatment therapy fails. Typically able to be self-treated at home within a week. There is no need to exclude from normal activities or school.

We are seeing a significant increase in seasonal allergies (allergic rhinitis). Symptoms include clear nasal discharge, post nasal mucus drainage, nasal congestion, itching of the nose, ears, eyes and sneezing. Avoidance of the offending environmental allergen is first line treatment. Over the counter oral antihistamines like Claritin/Zyrtec/Allegra and nasal sprays like Flonase/Nasacort are used. If unable to control symptoms with OTC medicines prescription therapies are available along with testing at an allergist office for severe cases. Complications included secondary infection such as otitis media (ear infection) or sinusitis.”
 
York:

Submitted by: Stacey Basta, Nurse Practitioner, MinuteClinic in York
Viral gastroenteritis:
A few cases of viral upper respiratory infections and viral gastroenteritis were noted in the York area. Typically a self-limiting illness lasting less than 14 days.  Quick onset of inflammation in the lining of the stomach and intestines cause by enteropathic viruses. Most common symptoms are nausea, vomiting and diarrhea.  May be accompanied by fever, abdominal pain, and loss of appetite.   Viruses are the most common cause of acute gastroenteritis.  They are transmitted by person to person contact.  In adults, most commonly caused by norovirus.  In children, rotaviruses are the most common cause of severe diarrhea.  Treatment is oral rehydration therapy for mild to moderate cases.  IV fluids may be needed for more severe cases.  Best prevention of infection is to practice good hand hygiene (washing).  A vaccine is available for prevention of rotovirus and approved for use in infants.
Streptococcal pharyngitis (aka: strep throat)
We’ve continued to see several cases of strep throat over the last week. Strep throat is most common in early Spring and in winter among school aged children.  Common symptoms of strep throat generally include rapid onset of sore throat In the absence of cough and nasal congestion.  Rapid antigen detection tests allow immediate assessment for Group A streptococcal pharyngitis.  For confirmed cases of Group A strep, treatment with antibiotics will likely be recommended to prevent acute rheumatic fever, reduce severity and duration of symptoms, and prevent transmission.  Children with strep, are generally considered no longer contagious after 24 hours of antibiotic therapy. 

Harrisburg:

Submitted by: Jessica Clabaugh, Nurse Practitioner, MinuteClinic in Lancaster
“As temperatures warm, and spring sport seasons get under way, the clinic has seen an increase in common fungal infections. Mild fungal skin diseases can look like a rash and are very common. One such infection is known as “ringworm” because it can cause a circular rash (shaped like a ring) that is usually red and itchy. The treatment for ringworm depends on its location on the body and how serious the infection is. Some forms of ringworm can be treated with non-prescription (“over-the-counter”) medications, but other forms of ringworm need treatment with prescription antifungal medication. See your provider if your infection gets worse or doesn’t go away after using non-prescription medications. Also, if you or your child has ringworm on the scalp, this infection needs to be treated with prescription antifungal medication.

Spring allergies have arrived. Allergies are an overreaction of the immune system to substances that generally do not affect other individuals. These substances, or allergens, can cause sneezing, coughing, sore throats and itching. Once a person knows they are allergic to a certain substance, they can avoid contact with the allergen. Strategies for doing this include being in an air-conditioned environment during peak hay-fever season, avoiding certain foods, and eliminating dust mites and animal dander from the home. Symptom management can include taking over the counter or prescription medication or being immunized with allergy injection therapy. Treatment for allergies generally does not start until age two. Come in to MinuteClinic or your family provider to talk about treatment options or if your allergies are getting in the way of enjoying spring.”

This week, WellSpan Medical Group providers are seeing an increase in seasonal allergy cases, while still observing a decrease in strep throat and flu cases.
 
For those with mild seasonal allergies, WellSpan Medical Group providers say low-drowsy, over-the-counter antihistamines can help. They urge users to follow label instructions. 
 
For strep prevention, WellSpan Medical Group providers also recommend frequent handwashing, as the bacteria can live for a short time on doorknobs, water faucets and other objects. They also recommend not drinking from the same glass or using the same eating utensils as an infected individual. For the flu, WellSpan Medical Group providers urge sick individuals to seek treatment. Early diagnosis may lessen the severity and duration of the illness.
 
As a reminder, those seeking care for respiratory illnesses – such as the flu -at any WellSpan care site, such as primary or urgent care locations or hospitals, are encouraged to adhere to respiratory etiquette practices. Techniques such as coughing into the inside of your elbow, frequent handwashing with antibacterial soaps for 20 to 30 seconds or using an alcohol-based hand sanitizer, such as Purell, are recommended to help prevent the spread of illness in public and at home.

Geisinger Holy Spirit reported the following:

Geisinger Holy Spirit Primary Care, Dauphin, Perry and York counties: Colds, sinus issues and congestion
Geisinger Holy Spirit Primary Care, Cumberland County: stomach bug, cough/colds, strep throat, sinus infections, bronchitis
Geisinger Holy Spirit Pediatrics, Dauphin and Cumberland counties: diarrhea, viral upper respiratory infections w/fever and cough, strep throat, ear infections

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