August 26, 2011 | 12:06 pm

Vaccines Are Much Safer than the Diseases They Prevent

Posted by Albert Fuchs, M.D.

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A child develops a fever of 104 ⁰F, cough, runny nose and red eyes. A few days later she develops a red bumpy itchy rash as in this photo. Any guesses as to the diagnosis? Many of us would be stumped, having never seen this disease. This is the classic presentation of measles, which prior to the development of the measles vaccine in the 1960s affected hundreds of thousands of U.S. children annually. There is no treatment. Complications from measles caused 3 fatalities for every one thousand cases.

With the near disappearance of vaccine-preventable illnesses a full generation ago, today’s parents don’t have personal memory of the misery and fear that illnesses such as mumps, polio and rubella caused. Instead, fueled by a simmering mistrust of modern medicine and of science generally, some anti-vaccine groups have raised concerns about possible side effects of vaccines. The best known such concern was fueled by the fraudulent scientific study linking the MMR vaccine with autism. (I posted about this paper, its retraction, and the damage it did in January.)

A report released by the Institute of Medicine this week analyzed over 1,000 studies and detailed what is currently known about vaccine side effects. The report is over 600 pages long, and I promise you that I’m not going read it all. The report concludes that “while no vaccine is 100% safe, very few adverse events are shown to be caused by vaccines.” The report also highlighted that vaccines do not cause some of the side effects that have been receiving much attention. The MMR vaccine was again found not to cause autism or childhood diabetes. Flu shots also do not cause asthma exacerbations or Bell’s palsy.

Vaccines do sometimes cause adverse events, and the report identifies 14 such adverse events that are known to be vaccine related. Febrile seizures in children, severe allergic reactions and fainting are some of them.

But none of them are as dangerous as polio, or measles, or tetanus or a handful of other diseases I hope to never see.

Learn more:

Vaccine Cleared Again as Autism Culprit (NY Times)

Report Finds Few Health Problems Tied to Vaccines (Wall Street Journal Health Blog)

Study Linking Vaccines to Autism not Just Wrong, Intentionally Fraudulent (My last post about vaccine safety, which at the bottom has more links to my previous posts on the anti-vaccine movement and vaccine refusal)

Measles (Wikipedia article)

Adverse Effects of Vaccines: Evidence and Causality (Institute of Medicine publication)

Photo credit: Centers for Disease Control Public Health Image Library, CDC/Dr. Heinz Eichenwald (ID 3168)

Important legal mumbo jumbo:
Anything you read on the web should be used to supplement, not replace, your doctor’s advice.  Anything that I write is no exception.  I’m a doctor, but I’m not your doctor.

August 19, 2011 | 10:49 am

Keep Calm, Carry On, and Get Your Flu Shot

Posted by Albert Fuchs, M.D.

Ah, the magical serenity of mid-August! Students face the new school year with dread, parents face the new school year with joy, London is set ablaze, Syria shells its own civilians, and the stock market behaves like a brick thrown out of an airplane window.

But for primary care doctors, mid-August is the time when the new flu shots arrive. Our office received a batch this week. The flu season is not yet upon us, but it’s not too early to get your flu shot.

Who should get the flu shot? Since last year, the CDC has been recommending the flu shot for everyone over 6 months, but the people for whom the flu shot is particularly important are:

• Children younger than 5
• Adults 65 or older
• Pregnant women
• People with chronic illnesses that would make flu more dangerous
• Health care workers
• Household contacts of people at high risk for complications from flu
• Household contacts and caregivers of children younger than 6 months

Take a look at the CDC Seasonal Flu Shot page for details.

Who should not get a flu shot?

• People who have ever had a severe allergic reaction to eggs
• People who have ever had a serious reaction to a previous flu shot
• People with a history of Guillain–Barré Syndrome that occurred after receiving influenza vaccine

So make an appointment to get your flu shot. Because the only thing I can think of worse than a double-dip recession would be a double-dip recession with the flu.

Learn more:

CDC Questions and Answers: Seasonal Flu Shot

Keep Calm and Carry On

Important legal mumbo jumbo:
Anything you read on the web should be used to supplement, not replace, your doctor’s advice.  Anything that I write is no exception.  I’m a doctor, but I’m not your doctor.

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August 12, 2011 | 10:36 am

Linaclotide is Safe and Effective for Chronic Constipation

Posted by Albert Fuchs, M.D.

Chronic constipation affects about one in six people in the U.S. and is a problem that primary care doctors hear about very frequently. Symptoms include infrequent bowel movements, hard stools, straining, abdominal bloating and discomfort, and a sense of incomplete evacuation. It’s not a dangerous problem, but it causes plenty of misery for lots of people. Though doctors have a few remedies for chronic constipation (which I’ll list at the end of this post) they are only temporarily and modestly effective.

This week’s New England Journal of Medicine publishes the results of two trials testing a new medication, linaclotide, for chronic constipation. Linaclotide is taken orally as a capsule once a day. The two studies together randomized over two thousand patients with chronic constipation to linaclotide or placebo. The patients were followed for 12 weeks to assess improvement in their symptoms.

The patients taking linaclotide had significant relief of their symptoms. (The specifics are detailed in horrifying clarity in the article.) Unlike laxatives which lose effectiveness with repeated use, linaclotide continued to be as effective at the end of the trial as at the beginning. There is also a rebound effect with the chronic use of laxatives in which after stopping the medication patients are more constipated than before they started. This rebound effect was not observed with linaclotide.

Linaclotide also appears to be safe. The most common side-effect, as you would expect, was diarrhea.

Linaclotide is not yet available to patients. It has yet to go through the FDA approval process. I suspect a few patients will be emailing me daily to check if it’s on the market yet. In the meantime, our advice to patients with chronic constipation remains the following.

• Drink lots of fluids (not counting alcohol or caffeine)
• Increase your physical activity
• Eat more fiber, perhaps in a fiber supplement
• Use laxatives only intermittently

WebMD also has a very informative slideshow about constipation.

Learn more:

No more laxative? The drug linaclotide helps relieve constipation (LA Times Booster Shots)

Experimental Drug May Treat Chronic Constipation (WebMD article)

Myths and Facts About Constipation (WebMD slideshow)

Two Randomized Trials of Linaclotide for Chronic Constipation (New England Journal of Medicine article. Summary available without subscription.)

Important legal mumbo jumbo:
Anything you read on the web should be used to supplement, not replace, your doctor’s advice.  Anything that I write is no exception.  I’m a doctor, but I’m not your doctor.

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August 5, 2011 | 10:26 am

A New Species of Tick-Borne Bacteria Identified in Minnesota and Wisconsin

Posted by Albert Fuchs, M.D.

[Lunch warning: Parts of this post are kind of gross. If you’re reading this over a meal, you have been warned.]

What a depressing week. The debt ceiling debate postponed all difficult decisions, second quarter economic growth was revised so low that you need to squint to see it, and yesterday the stock market jumped off the balcony, losing all the gains it’s made over the year.

We need some happy news to distract us from what we used to call our portfolios. How about a new disease spread by tick bites?!!

Ehrlichiosis (er-lick-ee-OH-sis) is a disease characterized by fever, muscle aches and headaches. A third of the cases also have a rash. Severe cases can be fatal, but that amounts to fewer than five deaths per year.  It’s treatable with antibiotics. Ehrlichiosis is caused by two species of bacteria, Ehrlichia chaffeensis and E. ewingii which are spread by the bite of the lone star tick. The lone star tick is really ugly, so here’s a picture of it. As you would guess from its name, the lone star tick is found largely in the South, and that’s where cases of ehrlichiosis have usually occurred.

This week’s New England Journal of Medicine published a study which describes a new geography, a new bacterial species, and a new transmitting tick for ehrlichiosis. It describes patients with the typical symptoms of ehrlichiosis in Minnesota and Wisconsin. The bacteria isolated from these patients belongs to the genus Ehrlichia but is a newly discovered species. It is spread by the deer tick, which like the lone star tick is also not a contender for the most beautiful organism.

The deer tick also has the distinction of spreading the bacterium that causes Lyme disease as well as other infectious diseases. Since 2009 there have been 29 identified cases of infection with this new species of Ehrlichia in Minnesota and Wisconsin.

Will this new species spread across the US, giving the deer tick super powers and triggering the inevitable zombie apocalypse? Probably not, but it is likely to spread from its current geography.

The simplest way to manage ehrlichiosis is prevention. Preventing tick bites prevents ehrlichiosis and lots of other tick-borne illnesses. The CDC website has a very handy page about ehrlichiosis with tips for preventing bites and removing attached ticks. When going on hikes remember to wear long pants and to use insect repellant.

So there you go – a pleasant story to distract us from our creeping, blood-sapping, infectious economic woes.

Learn more:

Centers for Disease Control and Prevention Ehrlichiosis page

There’s a New Bacterial Species Causing Tick-Borne Illness in Two States (Wall Street Journal health Blog)

Yet Another Reason To Say Ick to Ticks (NPR health blog)

Emergence of a New Pathogenic Ehrlichia Species, Wisconsin and Minnesota, 2009 (New England Journal of Medicine, abstract available without subscription)

Important legal mumbo jumbo:
Anything you read on the web should be used to supplement, not replace, your doctor’s advice.  Anything that I write is no exception.  I’m a doctor, but I’m not your doctor.

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