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Our Baby's First Two Years
by Robert M. Selig, M.D., FAAP & Joann C. Cozza, D.O., FAAP

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Haemophilus influenzae type b disease, also called Haemophilus b or "Hib" disease can be a very serious disease, especially among children under 5 years of age. Hib causes about 12,000 cases of meningitis (inflammation of the covering of the brain) in the United States each year, mostly in the under 5 age group.  Of these 12,000 children, about 1 in 4 suffers permanent brain damage and about 1 in 20 dies.  Hib can also cause pneumonia and infections of the blood, joints, bones, soft tissues, throat, and the covering of the heart.


In the United States, Hib disease strikes about 1 child out of 200 before the fifth birthday Most serious Hib disease occurs in children between 6 months and 1 year of age.  Despite its name, Hib does not cause the flu (influenza).




There are several vaccines available at this time for protection against Hib disease, but only two are approved for use in children under 15 months of age.  These are the vaccines that are recommended, because they provide protection during the time chil­dren are most susceptible to Hib disease.  Depending on which vaccine your doctor or clinic is using, vaccine will be given either at 2, 4, and 6 months with a booster dose at 15 months, or at 2 and 4 months with a booster dose at 12 months.  For children who are late in getting their first dose, the total number of doses they receive may be different.   Hib vaccine is usually not recommended for children after their 6th birthday.




Hib vaccine is among the safest of all vaccine products.  The vaccine cannot cause meningitis, and has not been associated with any other serious reactions. About 2 in every 100 children who receive the current Hib vaccine will have some slight redness in the area where the shot is given, and about l in 100 will have swelling or warmth in that area.  About 2 in every 100 will develop a moderate fever (higher than 101 F).  These reactions begin within 24 hours after the shot and usually go away within 48 to 72 hours.






Although there are other types of hepatitis, hepatitis B is one of the most serious types.  Hepatitis B is a disease that affects the liver and is caused by the hepatitis B virus.


In the United States, there are about 300,000 new cases of hepatitis B infection each year. Children and adults who have hepatitis B may not look or feel sick at all when they become infected.  Some may develop a mild, flu-like illness.  Others become very ill and feel extremely tired, develop jaundice (yellow skin and eyes), have dark urine, suffer abdominal and joint pain, and may require hospitalization.  Fortunately, most people recover fully from hepatitis infections. Some people who get hepatitis B never fully recover and carry the virus in their blood for a lifetime.  This is known as chronic hepatitis B infection.  These people are hepatitis B carriers.




Currently, there are about one million chronic hepatitis B carriers in the United States who are "infectious," or capable of spreading the disease to others throughout their lives.  All carriers run the risk of developing life-threatening liver disease, cirrhosis, or liver cancer.  About 5,000 people a year die from liver disease caused by hepatitis B.


While anyone can get hepatitis B, children who are infected with the hepatitis B virus are more likely than adults to develop the chronic-carrier state of the disease.  The younger a child is when infection occurs, the more likely it is that the child will become a carrier.


In fact, more than 90% infants who get hepatitis from their infected mothers at birth become chronic carriers and have lifelong infection.  Among children who become infected before the age of 5 years, 30 to 60% may become chronic carriers, while only 6 to 1 0% of adults who get the disease become chronic carriers.  Also, it is estimated that about 25% of infants who become chronic carriers ultimately will die of liver disease, cirrhosis, or liver cancer.




HBV is found in blood and other body fluids, including semen, vaginal secretions, urine, and even saliva.  HBV is more contagious than HIV (human immunodeficiency virus), the virus that causes AIDS (acquired immunodeficiency syndrome).


Like AIDS, HBV is most commonly transmitted through sexual contact.  However, hepatitis B can also be spread through other close interpersonal contact, including the sharing of razors, toothbrushes, and earrings.  Transmission of HBV can also occur through the sharing of needles by I.V. drug abusers, injuries caused by contaminated objects, such as hypodermic needles, and infected blood or blood products entering the eyes, mouth, or a break in the skin.




Hepatitis B vaccine can help protect your child from hepatitis B infecton.  Your child can not get hepatitis B infection from the vaccine.  Side effects are uncommon after receiving the vaccine.


Protection from hepatitis B requires a series of 3 shots.  Newborn babies receive the first shot in the hospital.  The second shot is given 1-3 months later, and the third shot is given 4-12 months after the second.  Infants and children not immunized are given the same 3-shot series.  The first 2 shots must be given at least 1 month apart (or longer) and the second and third shots must be given at least 4 months apart or longer.






Chickenpox is a disease with a characteristic rash and is usually caught by children.  The disease is caused by a virus known as Varicella Zoster. This virus is highly contagious and can spread by an airborne route, for example, cough­ing or sneezing, so it can spread without physical contact.  This means that if you have not had chickenpox, you can easily catch it just by being around someone who is infected.


After coming into contact with someone who has the chickenpox virus, it usually takes about two to three weeks before symptoms begin.  This gap between contact with the virus and starting to feel sick is called an incubation period.  About a day before the telltale rash of chickenpox appears, the infected person may start to feel achy and feverish, doesn't feel like eating, and generally seems to be "coming down with something."


The next day, the pox, the Iittle red spots or rash, appear on the chest, stomach or back, and then on the face.  Groups of itchy spots in various stages are typical of the chickenpox rash.  There may be only a few spots or hundreds over the next three to five days.  These pox quickly develop into clear, fluid­-fiIled blisters. They become cloudy, break open, and then crust over to form scabs.  A person with chickenpox is con­tagious for 1-2 days before the pox appear and until they have all crusted over.


With chickenpox, the infected person often suffers from achiness, fever, irritability, and itching. The rash may even spread into the mouth or other internal parts of the body, causing particular discomfort.


Most cases of chickenpox occur in children younger than 14 years old, most often in children between the ages of five and nine. The disease is likely to be more severe in adults than in children.


Even among children, who commonly come down with a mild form of the illness, chickenpox still takes its toll.  The disease is not only physically uncomfortable, but infected children must avoid contact with others until all the pox have crusted over (7-10 days).  Children miss not only school days, but other group activities, including sports, vacations, and special events as well.


When chickenpox is in the household, the chance of a susceptible child catching the disease from an infected brother, sister, or even a parent, is about 90%.


Although most children with the disease recover, sometimes complica­tions such as encephalitis (infection in the brain), skin infections, skin scarring , and pneumonia can occur.  Nearly four mil­lion Americans get chickenpox each year.  Approxi­mately 90% of cases occur in children 1 to 14 years of age, with about 2% of cases occurring in adults.  Elementary school children have the highest risk of infection, with 50% to 60% of cases occurring in children between the ages of five and nine.


For adults, the risk of complications associated with chickenpox is much higher than in children or teens.  Although very few cases of chickenpox (about 2%) occur in adults, these cases account for more than 13% of hospitalizations for complications including pneumonia, other lower and upper respiratory tract conditions, and encephalitis-an inflammation of the brain.  So, adults who have never had chickenpox need to be especially aware of the risks of the disease.


Chickenpox, when acquired during pregnancy, can also have serious consequences for both the mother and fetus.  Varicella infections during the first trimester may result in fetal abnormalities, while infection five days or less before delivery is associated with significant infant mortality.




The chickenpox vaccine, called Varivax, is recommended for children beginning at the age of one.  It is also recommended for all children and adults who have not had chickenpox.  Two injections are necessary after the age of 13 years. It offers protection against chickenpox for up to ten years.  A booster injection may be necessary 10 years later.  Very few side effects occur after this vaccine is administered, but may include a fever and/or chickenpox-like blisters around the injection site 7-10 days later.  If either of these occur, please call our office.



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