Meningitis

Meningitis is an inflammation of the meninges, the membranes that cover the brain and spinal cord. It is usually caused by bacteria or viruses, but it can also be caused by certain medications or illnesses.

Bacterial meningitis is rare, but is usually serious and can be life-threatening if it's not treated right away. Viral meningitis (also called aseptic meningitis) is relatively common and far less serious. It often remains undiagnosed because its symptoms can be similar to those of the common flu.

Kids of any age can get meningitis, but because it can be easily spread between people living in close quarters, teens, college students, and boarding-school students are at higher risk for infection.

If dealt with promptly, meningitis can be treated successfully. So it's important to get routine vaccinations, know the signs of meningitis, and if you suspect that your child has the illness, seek medical care right away.

Causes of Meningitis

Many of the bacteria and viruses that cause meningitis are fairly common and are typically associated with other routine illnesses. Bacteria and viruses that infect the skin, urinary system, gastrointestinal or respiratory tract can spread by the bloodstream to the meninges through cerebrospinal fluid, the fluid that circulates in and around the spinal cord.

In some cases of bacterial meningitis, the bacteria spread to the meninges from a severe head trauma or a severe local infection, such as a serious ear infection (otitis media) or nasal sinus infection (sinusitis).

Many different types of bacteria can cause bacterial meningitis. In newborns, the most common causes are Group B streptococcus, Escherichia coli, and Listeria monocytogenes. In older kids, Streptococcus pneumoniae (pneumococcus) and Neisseria meningitidis (meningococcus) are more often the causes.

Another bacteria, Haemophilus influenza type b (Hib), can also cause the illness but because of widespread childhood immunization, these cases are now rarer.

Similarly, many different viruses can lead to viral meningitis, including enteroviruses (such as coxsackievirus, poliovirus, and hepatitis A) and the herpesvirus.

Symptoms of Meningitis

The symptoms of meningitis vary and depend both on the age of the child and on the cause of the infection. Because the flu-like symptoms can be similar in both types of meningitis, particularly in the early stages, and bacterial meningitis can be very serious, it's important to quickly diagnose an infection.

The first symptoms of bacterial or viral meningitis can come on quickly or surface several days after a child has had a cold and runny nose, diarrhea and vomiting, or other signs of an infection. Common symptoms include:

• fever
• lethargy (decreased consciousness)
• irritability
• headache
• photophobia (eye sensitivity to light)
• stiff neck
• skin rashes
• seizures

Infants with meningitis may not have those symptoms, and might simply be extremely irritable, lethargic, or have a fever. They may be difficult to comfort, even when they are picked up and rocked.

Other symptoms of meningitis in infants can include:

• jaundice (a yellowish tint to the skin)
• stiffness of the body and neck (neck rigidity)
• fever or lower-than-normal temperature
• poor feeding
• a weak suck
• a high-pitched cry
• bulging fontanelles (the soft spot at the top/front of the baby's skull)

Viral meningitis tends to cause flu-like symptoms, such as fever and runny nose, and may be so mild that the illness goes undiagnosed. Most cases of viral meningitis resolve completely within 7 to 10 days, without any complications or need for treatment.

Treatment

Because bacterial meningitis can be so serious, if you suspect that your child has any form of meningitis, it's important to see the doctor right away.

If the doctor suspects meningitis, he or she will order laboratory tests to help make the diagnosis. The tests will likely include a lumbar puncture (spinal tap) to collect a sample of spinal fluid. This test will show any signs of inflammation, and whether a virus or bacteria is causing the infection.

A child who has viral meningitis may be hospitalized, although some kids are allowed to recover at home if they are not too ill. Treatment, including rest, fluids, and over-the-counter pain medication, is given to relieve symptoms.

If bacterial meningitis is diagnosed — or even suspected — doctors will start intravenous (IV) antibiotics as soon as possible. Fluids may be given to replace those lost to fever, sweating, vomiting, and poor appetite, and corticosteroids may help reduce inflammation of the meninges, depending on the cause of the disease.

Complications of bacterial meningitis can require additional treatment. For example, anticonvulsants might be given for seizures. If a child develops shock or low blood pressure, additional IV fluids and certain medications may be given to increase blood pressure. Some kids may need supplemental oxygen or mechanical ventilation if they have difficulty breathing.

Some patients who have had meningitis may require longer follow-up. One of the most common problems resulting from bacterial meningitis is impaired hearing, and kids who've had bacterial meningitis should have a hearing test following their recovery.

The complications of bacterial meningitis can be severe and include neurological problems such as hearing loss, visual impairment, seizures, and learning disabilities. The heart, kidneys, and adrenal glands also may be affected. Although some kids develop long-lasting neurological problems, most who receive prompt diagnosis and treatment recover fully.

How Does Meningitis Spread?

Most cases of meningitis — both viral and bacterial — result from infections that are contagious, spread via tiny drops of fluid from the throat and nose of someone who is infected. The drops may become airborne when the person coughs, laughs, talks, or sneezes. They then can infect others when people breathe them in or touch the drops and then touch their own noses or mouths.

Sharing food, drinking glasses, eating utensils, tissues, or towels all can transmit infection as well. Some infectious organisms can spread through a person's stool, and someone who comes in contact with the stool — such as a child in day care — may contract the infection.

The infections most often spread between people who are in close contact, such as those who live together or people who are exposed by kissing or sharing eating utensils. Casual contact at school or work with someone who has one of these infections usually will not transmit the infectious agent.

Prevention

Routine immunization can go a long way toward preventing meningitis. The vaccines against Hib, measles, mumps, polio, meningococcus, and pneumococcus can protect against meningitis caused by these microorganisms. Some high-risk children also should be immunized against certain other types of pneumococcus.

Doctors now recommend that kids who are 11 years old get vaccinated for meningococcal disease, a serious bacterial infection that can lead to meningitis. The vaccine is called quadrivalent meningococcal vaccine, or MCV4. Children who have not had the vaccine and are over 11 years old should also be immunized, particularly if they're going to college, boarding school, camp, or other settings where they are going to be living in close quarters with others. This vaccine may also be recommended for people who are traveling to countries where meningitis is more common.

Many of the bacteria and viruses that are responsible for meningitis are fairly common. Good hygiene is an important way to prevent any infection. Encourage kids to wash their hands thoroughly and often, particularly before eating and after using the bathroom. Avoiding close contact with someone who is obviously ill and not sharing food, drinks, or eating utensils can help halt the spread of germs as well.

In certain cases, doctors may decide to give antibiotics to anyone who has been in close contact with the person who is ill to help prevent additional cases of illness.

When to Call the Doctor

Seek medical attention immediately if you suspect your child has meningitis or if your child exhibits symptoms such as vomiting, headache, lethargy or confusion, neck stiffness, rash, and fever. Infants who have fever, irritability, poor feeding, and lethargy should also be assessed by a doctor right away.

If your child has had contact with someone who has meningitis (for example, in a child-care center or a college dorm), call your doctor to ask whether preventive medication is recommended.

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Measles

Measles, also called rubeola, is a highly contagious respiratory infection that's caused by a virus. It causes a total-body skin rash and flu-like symptoms, including a fever, cough, and runny nose. Though rare in the United States, 20 million cases occur worldwide every year.

Since measles is caused by a virus, there is no specific medical treatment and the virus has to run its course. But a child who is sick should be sure to receive plenty of fluids and rest, and be kept from spreading the infection to others.

Signs and Symptoms

While measles is probably best known for the full-body rash it causes, the first symptoms of the infection are usually a hacking cough, runny nose, high fever, and red eyes. A characteristic marker of measles are Koplik's spots, small red spots with blue-white centers that appear inside the mouth.

The measles rash typically has a red or reddish brown blotchy appearance, and first usually shows up on the forehead, then spreads downward over the face, neck, and body, then down to the arms and feet.

Measles is highly contagious — 90% of people who haven't been vaccinated for measles will get it if they live in the same household as an infected person. Measles is spread when someone comes in direct contact with infected droplets or when someone with measles sneezes or coughs and spreads virus droplets through the air. A person with measles is contagious from 1 to 2 days before symptoms start until about 4 days after the rash appears.

Measles is very rare in the United States. Due to widespread immunizations, the number of U.S. measles cases has declined in the last 50 years. Before measles vaccination became available in the 1960s, more than 500,000 cases of measles were reported every year. From 2000 to 2007, just an average of 63 cases per year was reported.

However, in 2008 the United States saw an increase in measles cases and outbreaks (more than three or more linked cases), with 131 cases reported between January and July. More than 90% of those infected were not immunized or immunization status was unknown.

The most important thing you can do to protect kids from measles is to have them vaccinated according to the schedule prescribed by your doctor.

Prevention

Infants are generally protected from measles for 6 months after birth due to immunity passed on from their mothers. Older kids are usually immunized against measles according to state and school health regulations.

For most kids, the measles vaccine is part of the measles-mumps-rubella immunizations (MMR) or measles-mumps-rubella-varicella immunization (MMRV) given at 12 to 15 months of age and again at 4 to 6 years of age.

Measles vaccine is not usually given to infants younger than 12 months old. But if there's a measles outbreak, the vaccine may be given when a child is 6-11 months old, followed by the usual MMR immunization at 12-15 months and 4-6 years.

As with all immunization schedules, there are important exceptions and special circumstances. Your child's doctor should have the most current information regarding recommendations about the measles immunization. Measles vaccine should not be given to pregnant women or to kids with untreated tuberculosis, leukemia or other cancers, or people whose immune systems are suppressed for any reason.

Also, the vaccine shouldn't be given to kids who have a history of severe allergic reaction to gelatin or to the antibiotic neomycin, as they are at risk for serious reactions to the vaccine.

During a measles outbreak, people who have not been immunized (especially those at risk of serious infection, such as pregnant women, infants, or kids with weakened immune systems) can be protected from measles infection with an injection of measles antibodies called immune globulin if it's given within 6 days of exposure. These antibodies can either prevent measles or make symptoms less severe. The measles vaccine also may offer some protection if given within 72 hours of measles exposure.

Measles vaccine occasionally causes side effects in kids who don't have underlying health problems. The most common reactions are fever between 6-12 days after vaccination (in about 5%-15% of kids getting the vaccine) and a measles-like rash, which isn't contagious and fades on its own (in about about 5% of vaccinated kids).

Treatment

There is no specific medical treatment for measles. To help manage symptoms, which usually last for about 2 weeks, give your child plenty of fluids and encourage extra rest. If fever is making your child uncomfortable, you may want to give a non-aspirin fever medication such as acetaminophen or ibuprofen. Remember, you should never give aspirin to a child who has a viral illness since the use of aspirin in such cases has been associated with the development of Reye syndrome.

Kids with measles should be closely monitored. In some cases, measles can lead to other complications, such as otitis media, croup, diarrhea, pneumonia, and encephalitis (a serious brain infection), which may require antibiotics or hospitalization.

In developing countries, vitamin A has been found to decrease complications and death associated with measles infections. In the U.S., vitamin A supplementation should be considered for children between 6 months and 2 years who are hospitalized with measles and its complications. Also, all kids older than 6 months with risk factors, such as vitamin A deficiency, weakened immune system, or malnutrition may benefit from vitamin A supplementation.

When to Call the Doctor

Call the doctor immediately if you suspect that your child has measles. Also, it's important to get medical care following measles exposure, especially if your child:

• is an infant
• is taking medicines that suppress the immune system
• has tuberculosis, cancer, or a disease that affects the immune system

Remember that measles, a once common childhood disease, is preventable through routine childhood immunization.

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Mad Cow Disease

Mad cow disease has been in the headlines in recent years. While a serious illness, it primarily affects cattle and, possibly, other animals, like goats and sheep — the risk to human beings is extremely low.

What Is Mad Cow Disease and How Do People Get It?

The medical name for mad cow disease is bovine spongiform encephalopathy, or BSE for short. BSE is an incurable fatal brain disease. It is called mad cow disease because it affects a cow's nervous system, causing the animal to act strangely and lose control of its ability to do normal things, such as walk.

Only certain animals can get BSE — people don't actually get mad cow disease. However, experts have found a link between BSE and a rare brain condition that affects people called variant Creutzfeldt-Jakob disease (CJD). Researchers believe that people who eat products from cows that have BSE are at risk of developing a form of CJD.

CJD is caused by an abnormal type of protein in the brain called a prion. When people have CJD, cells in the brain die until the brain eventually has a "sponge-like" appearance. During this time, people with the disease gradually lose control of their mental and physical capabilities.

To date, very few people have been diagnosed with the form of CJD that's been linked to mad cow disease. By November 2006, only 200 cases of this rare condition had been reported worldwide. Of these, most were identified in Britain. Several of the people diagnosed with the disease outside Britain — including two cases in the United States — had a history of exposure in Britain or in a country where government officials reported BSE.

Because the form of CJD that's been linked to mad cow disease is relatively new and extremely rare, experts are still learning about it. However, researchers believe that the disease is not contagious among people — in other words, you can't get CJD from someone else who has it. There have been a few cases of CJD that are believed to have been transmitted through blood transfusions. At present, it appears that the main way people get the disease is from eating contaminated meat.

Experts don't yet know exactly how long the incubation period is for CJD (in other words, how long it takes from the time a person contracts it to the time that symptoms appear). However, they do believe that it takes years, if not decades, from the time someone gets the disease until the first signs appear. Once they do, the brain can deteriorate within a year.

What's Being Done About It?

BSE doesn't spread naturally from cow to cow; it's suspected to be transmitted by feeding cows animal meal. However, the U.S. Food and Drug Administration (FDA) introduced an "animal feed" rule in 1997 prohibiting the feeding of most proteins made out of mammals to ruminant animals (such as cows, sheep, and goats), which was what was thought to have begun the BSE epidemic in the United Kingdom. According to the FDA, 99% of the facilities raising cattle for human consumption are currently in compliance with the feed rule.

The type of protein that causes mad cow disease can't be removed or destroyed when beef is processed or cooked. For this reason, the U.S. government has established several procedures to protect the public. One of these involves removing the parts of the cow that are at highest risk of containing BSE-causing proteins — the brain and spinal cord — to reduce the chances of contaminating the meat people eat.

In October 2005, the FDA proposed additional safeguards to help protect consumers from BSE. These prohibit the use of any high-risk cattle materials in the feed of any animal. In this way, the FDA continues to decrease the already tiny possibility of infection with BSE.

In addition, there is a system in which samples of animals are tested. This is one way to help prevent contaminated meat from reaching the shelves. The testing system helped officials identify some contaminated meat in Washington state in December 2003 — one of only three cases of mad cow disease found in the United States so far. The government also has a recall policy in place for meat that's suspected of being contaminated.

If you're wondering if it's safe to continue drinking cow's milk, rest assured that it is — the U.S. Department of Agriculture (USDA) says there is no evidence that the disease can be transmitted through cow's milk and milk products. It's also extremely unlikely that a person will contract CJD from eating beef.

CJD itself is pretty rare — each year, only one in 1 million people in the United States die of the disease. And because only three cows in the United States have been found to be infected with mad cow disease, which can't be spread from cow to cow, the chance that you will or anyone in your family will eat meat infected with the disease is extremely low.

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Listeria Infections

Listeria infections (known as listeriosis) are caused by the bacterium Listeria monocytogenes.

Infection is rare, but when it does occur it most frequently affects pregnant women in their last trimester, newborns, and kids and adults whose immunity is weakened by diseases such as cancer or HIV. People who have had various types of transplants are also more at risk for listeriosis.

Listeria bacteria can be transmitted through soil and water. A person can also ingest listeria by eating certain foods, such as deli meats and cold cuts, soft-ripened cheese, milk, undercooked chicken, uncooked hot dogs, shellfish, and coleslaw made from contaminated cabbage. Many cases of infection, however, have no identifiable source.

Listeria infections may create symptoms such as fever, vomiting, diarrhea, lethargy, difficulty breathing, and poor feeding. Pregnant women who develop listeriosis may experience only mild flu-like symptoms, although they are at risk for premature delivery, miscarriage, and stillbirth.

People who have weakened immune systems are at particular risk for developing other more serious illnesses from listeriosis, including pneumonia, meningitis, and sepsis.

Cases of listeriosis are relatively rare. In 2004, just 120 cases were reported in the United States. In all cases, the earlier listeriosis is detected and treated, the better. And particularly if you are pregnant or in one of the other high-risk groups, avoiding certain foods and beverages can reduce your risk of contracting this infection.

Treating Listeriosis

Listeriosis is usually treated with antibiotics administered in the hospital through an intravenous catheter (IV). Typically, treatment lasts for about 10 days but that can vary depending on the body's ability to fight off the infection.

Children whose immune systems are compromised by illness or infection, such as cancer or HIV, are more likely to develop severe listeriosis infections and may require additional treatment.

Preventing Listeriosis

Although there are no vaccines against the bacteria that cause listeriosis, you can help reduce the risk for your family by taking these food safety precautions:

• Always cook food (especially meat and eggs) thoroughly to the proper internal temperature.
• Wash fruits and vegetables thoroughly before eating.
• Only drink pasteurized milk, and make sure that milk is refrigerated at the appropriate temperature, which is less than 40° Fahrenheit (4° Celcius).
• Avoid foods made from unpasteurized milk.
• If you're in a high-risk group, avoid soft cheeses such as feta, Brie, Camembert, blue-veined and Mexican-style cheeses unless they have labels that clearly state they are made from pasteurized milk.
• Reheat precooked, prepackaged foods — such as deli meats or hot dogs — to steaming hot temperatures, especially if you're pregnant.

When to Call the Doctor

Call your doctor immediately if your child develops rapid or labored breathing, fever, poor feeding, vomiting, a high-pitched cry, excessive sleepiness (lethargy), or irritability. If your child has listeriosis, the doctor can rule out any other illnesses and start treatment.

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Infections That Pets Carry

Caring for pets offers a tremendous learning experience for kids, teaching them responsibility, gentleness, and respect for nature and other living beings. Like adults, kids can benefit from the companionship, affection, and relationships they share with their pets.

But animals and pets can transmit infections to humans, especially kids. So if you're thinking about buying a pet, or already have one, it's important to know how to protect your family from infections.

How Pets Spread Infections

Like people, all animals carry germs. Illnesses common among housepets — such as distemper, canine parvovirus, and heartworms — can't be transmitted to humans.

But pets also carry certain bacteria, viruses, parasites, and fungi that can cause illness if transmitted to humans. Humans get these animal-borne diseases when they're bitten or scratched or have contact with an animal's waste, saliva, or dander.

These diseases can affect humans in many ways. They're of greatest concern to young children, infants, pregnant women, and people whose immune systems have been compromised by illness or disease. Infants and kids younger than 5 years old are at risk because their immune systems are still developing, and some infections that might make an adult just mildly sick can be more serious for them.

Healthy Family, Healthy Pets

But you don't have to give up your family's furry friends either. Pets can enrich your family life, and taking a few precautions can protect your kids from getting sick.

Protecting your family from pet-related infections begins before bringing a pet home. For instance, reptiles and amphibians should not be allowed as pets in any household with infants and young children.

Also consider the health and age of your kids before getting a pet. A pet that would require frequent handling is not recommended for any immunocompromised child (such as a child who has HIV, has cancer and is undergoing chemotherapy, or uses prednisone frequently). Kids with eczema should probably avoid aquariums.

Common Infections That Pets Carry

Dogs and Cats

Dogs and cats are popular pets but can carry infections such as:

• Campylobacter infection: can be transmitted by household pets carrying Campylobacter jejuni bacteria, which cause diarrhea, abdominal pain, and fever in people. The bacteria may be in the intestinal tract of infected dogs, cats, hamsters, birds, and certain farm animals. A person can become infected through contact with contaminated water, feces, undercooked meat, or unpasteurized milk.
  
  More than 2 million cases of campylobacter infection occur each year in the United States, and C. jejuni is now the leading cause of bacterial gastroenteritis. Campylobacter infections are contagious, especially among members of the same family and kids in childcare or preschools. Infection is treated with antibiotics.
• Cat scratch disease: can occur when a person is bitten or scratched by a cat infected with Bartonella henselae bacteria. Symptoms include swollen and tender lymph nodes, fever, headaches, and fatigue, which usually resolve without treatment. However, a doctor may prescribe antibiotics if the infection is severe. Cat scratch disease rarely causes long-term complications.
• Rabies: a serious illness caused by a virus that enters the body through a bite or wound contaminated by the saliva from an infected animal. Animals that may carry the rabies virus include dogs, cats, raccoons, bats, skunks, and foxes. Widespread immunization of dogs and cats has decreased the transmission of rabies in these animals and in people. Human rabies is rare in the United States, and a vaccine is available for treatment following a bite from a potentially rabid animal.
• Rocky Mountain spotted fever (RMSF): is transmitted by ticks infected by the Rickettsia ricketsii bacteria. Symptoms of RMSF include high fever, chills, muscle aches, and headaches, as well as a rash that may spread across the wrists, ankles, palms, soles, and trunk of the body. RMSF, which can be treated with antibiotics, is most common in the south central and the mid-south Atlantic regions of the United States.
• Ringworm: also called tinea; a skin infection caused by several types of fungi found in the soil and on the skin of humans and pets. Kids can get ringworm from touching infected animals such as dogs and cats. Ringworm of the skin, or tinea corporis, usually is a dry, scaly round area with a raised red bumpy border and a clear center. When the scalp is affected, the area may be flaky, red, or swollen. Often there are bald patches. Ringworm is treated with antifungal medications including shampoo, cream, or oral medicine.
• Toxocariasis: an illness caused by the parasitic roundworm Toxocara, which lives in the intestines of dogs and cats. The eggs from the worms are passed in the stools of dogs and cats, often contaminating soil where kids play. When a child ingests the contaminated soil, the eggs hatch in the intestine and the larvae spread to other organs, an infection known as visceral larva migrans. Symptoms include fever, cough or wheezing, enlarged liver, rash, or swollen lymph nodes. Symptoms may resolve on their own or a doctor may prescribe drugs to kill the larvae. When the larvae in the intestine make their way through the bloodstream to the eye, it is known as ocular toxocariasis, or ocular larva migrans, which may lead to a permanent loss of vision.
• Toxoplasmosis: contracted after contact with a parasite found in cat feces. In most healthy people, toxoplasmosis infection produces no symptoms. When symptoms do occur they may include swollen glands, fatigue, muscle pain, fever, sore throat, and a rash. In pregnant women, toxoplasmosis can cause miscarriage, premature births, and severe illness and blindness in newborns. Pregnant women should avoid contact with litter boxes. People whose immune systems have been weakened by illnesses such as HIV or cancer are at risk for severe complications from toxoplasmosis infection.
• Dog and cat bites: may become infected and cause serious problems, particularly bites to the face and hands. Cat bites tend to be worse, partly because they are deeper puncture wounds. Significant bites should be washed out thoroughly. Often these bite wounds require treatment in a doctor's office or emergency room; antibiotics are sometimes necessary.

Birds

Pet birds, even if they are kept in a cage, may transmit the following diseases:

• Cryptococcosis: a fungal disease contracted when someone inhales organisms found in bird droppings, especially from pigeons, that can cause pneumonia. People with weakened immune systems from illnesses such as HIV or cancer are at increased risk of contracting this disease and developing serious complications such as meningitis.
• Psittacosis: also known as parrot fever, a bacterial illness that can occur from contact with infected bird feces or with the dust that accumulates in birdcages. Symptoms include coughing, high fever, and headache. It is treated with antibiotics.

Reptiles and Amphibians

Reptiles (including lizards, snakes, and turtles) and amphibians (including frogs, toads, and salamanders) place kids at risk for:

• Salmonellosis: Reptiles and amphibians shed Salmonella in their feces. Touching the reptile's skin, cage, and other contaminated surfaces can lead to infection in people. Salmonellosis causes symptoms such as abdominal pain, diarrhea, vomiting, and fever. Young children are at risk for more serious illness, including dehydration, meningitis, and sepsis (blood infection).

Other Animals

Handling and caring for rodents — including hamsters and gerbils — as well as fish may place kids at risk for:

• Lymphocytic choriomeningitis (LCM): People can contract lymphocytic choriomeningitis virus by inhaling particles that come from urine, feces, or saliva from infected rodents, such as mice and hamsters. LCM can cause flu-like symptoms — fever, fatigue, headaches, muscle aches, nausea, and vomiting — and may even lead to meningitis (an inflammation of the membrane that surrounds the brain and spinal cord) and encephalitis (an inflammation of the brain). As with most viruses, there is no specific treatment, but some patients may require hospitalization. Like toxoplasmosis, LCM may be passed from infected mother to fetus.
• Mycobacteria marinum: This infection may occur in people exposed to contaminated water in aquariums or pools. Although mycobacteria marinum infections are generally mild and limited to the skin, they can be more severe in people with HIV or with weakened immune systems.

Precautions When Adopting or Buying a Pet

If you're adopting or purchasing a pet, make sure the breeder, shelter, or store is reputable and vaccinates all of its animals. A reputable breeder should belong to a national or local breeding club, such as the American Kennel Club. Contact the Humane Society of the United States or your veterinarian for information about animal shelters in your area.

As soon as you choose a family pet, take it to a local veterinarian for vaccinations and a physical examination. Don't forget to routinely vaccinate your pet on a schedule recommended by your vet — this will keep your pet healthy and reduce the risk that infections will be transmitted to your kids.

You'll also want to regularly feed your pet nutritious animal food (ask your vet for suggestions) and provide plenty of fresh water. Avoid feeding your pet raw meat because this can be a source of infection, and do not allow your pet to drink toilet water because infections can be spread through saliva, urine, and feces. Limit young kids' contact with outdoor pets that hunt and kill for food because a pet that ingests infected meat may contract an infection that can be passed to people.

Safely Caring for Your Pet

Here are some tips to help your family safely care for pets:

• Always wash your hands, especially after touching your pet, handling your pet's food, or cleaning your pet's cage, tank, or litter box. Wear gloves when cleaning up after an animal's waste, and if you have a bird, wear a dust mask over your nose and mouth to prevent inhaling urine or fecal particles. Don't have kids clean cages or litter boxes unless there is supervision or until they have demonstrated they can do this safely and responsibly (and again, hands should be washed afterwards).
• Avoid kissing or touching your pet with your mouth because infections can be transmitted by saliva. Also, avoid sharing food with your pet.
• Keep your pet's living area clean and free of waste. If your pet eliminates waste outdoors, pick up waste regularly and don't allow kids to play in that area.
• Don't allow pets in areas where food is prepared or handled, and don't bathe your pet or clean aquariums in the kitchen sink or bathtub. Wash your pet outdoors or talk to your veterinarian about professional pet grooming.
• Avoid strange animals or those that appear sick. Never adopt a wild animal as a pet.

Watch kids carefully around pets. Small children are more likely to catch infections from pets because they crawl around on the floor with the animals, kiss them or share food with them, or put their fingers in the pets' mouths and then put their dirty fingers in their own mouths. Also, if kids visit a petting zoo, farm, or a friend's house where there are animals, make sure they know the importance of hand washing.

For your pet's comfort and for your family's safety, control flea and tick problems in your pet. Fleas and ticks can carry diseases that may be easily passed to kids. Oral and topical medications are available for flea and tick control; avoid using flea collars because kids can handle them and become sick from the chemicals they contain. Check your pet regularly for fleas and ticks, as well as bites and scratches that may make them more susceptible to infection. Keep your pet leashed when outdoors and keep it away from animals that look sick or may be unvaccinated.

And, finally, spay or neuter your pet. Spaying and neutering may reduce your pet's contact with other animals that may be infected, especially if your pet goes outdoors.

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Infant Botulism

Infant botulism is an illness that can occur when an infant ingests bacteria that produce a toxin inside the body. The condition can be frightening because it can cause muscle weakness and breathing problems. But it is very rare: Fewer than 100 cases of infant botulism occur each year in the United States, and most babies who do get botulism recover fully.

Infant botulism is treatable, but because of its severity, it's important to learn the symptoms so you can recognize it early. Also know that honey is a known source of the bacteria spores that cause botulism. For this reason, honey shouldn't be given to babies under 12 months of age.

About Infant Botulism

Infant botulism can occur when a child ingests spores of Clostridium botulinum bacteria, which are found in dirt and dust and can contaminate honey. This illness typically affects babies who are between 3 weeks and 6 months old, but they're susceptible to it until their first birthdays.

These bacteria are typically harmless to older kids and adults because their mature digestive systems can move the spores through the body before they cause any harm.

But very young babies haven't developed the ability to handle the spores yet. So once an infant ingests them, the bacteria germinate, multiply, and produce a toxin. That toxin interferes with the normal interaction between the muscles and nerves and can hamper an infant's ability to move, eat, and breathe.

Two other types of botulism tend to affect older kids and adults: wound botulism occurs when the bacteria infect a wound and produce the toxin inside of it; food-borne botulism is usually caused by eating home-canned foods that contain the toxin.

Signs and Symptoms

Symptoms of botulism appear between 3 to 30 days after an infant consumes the spores. Constipation is often the first sign of botulism that parents notice (although many other illnesses also can cause constipation). Call your doctor if your baby hasn't had a bowel movement in 3 days.

Other symptoms can include:

• flat facial expression
• poor feeding (weak sucking)
• weak cry
• decreased movement
• trouble swallowing with excessive drooling
• muscle weakness
• breathing problems

Infant botulism can be treated, but it's important to get medical care as soon as possible. Call your doctor right away if you see any of the warning signs in your baby.

Treatment

Infant botulism is treated in the hospital, usually in the intensive care unit, where doctors will try to limit the problems the toxin causes in the baby's body. The toxin can affect the breathing muscles, so doctors may put the infant on a ventilator. Because the toxin can affect the swallowing muscles, they may give the baby intravenous (IV) fluids to provide nourishment.

An antitoxin is now available for the treatment of infant botulism called Botulism Immune Globulin Intravenous (BIGIV), which should be given as early in illness as possible. Babies with botulism who have received BIGIV recover sooner and spend less time in the hospital.

With early diagnosis and proper medical care, affected infants should fully recover once the effects of the toxin wear off.

Prevention

Like many germs, the Clostridium botulinum spores that cause botulism in infants are everywhere in the environment. They're in dust and dirt, and even in the air. Experts don't know why some infants contract botulism while others don't.

One way to reduce the risk of botulism is to not give infants honey before their first birthday. Honey is a proven source of the bacteria and has led to botulism in infants who've ingested it. Light and dark corn syrups were thought to be a source of spores, but no proven cases of infant botulism have been attributed to ingesting them. However, check with your doctor before giving these to an infant.

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Impetigo

Impetigo, a contagious skin infection that usually produces blisters or sores on the face and hands, is one of the most common skin infections among kids.

It is generally caused by one of two bacteria: group A streptococcus or staphylococcus aureus. Impetigo usually affects preschool and school-age children, especially in the summer months. A child may be more likely to develop impetigo if the skin has already been irritated or injured by other skin problems, such as eczema, poison ivy, insect bites, or a skin allergy to soap or makeup.

Good hygiene can help prevent impetigo, which often develops when there is a sore or a rash that has been scratched repetitively (for example, poison ivy can get infected and turn into impetigo). Impetigo is typically treated with antibiotics.

Signs and Symptoms

Impetigo may affect skin anywhere on the body but commonly occurs around the nose and mouth, hands, and forearms.

When impetigo is caused by group A streptococcus, it begins as tiny blisters. These blisters eventually burst and leave small wet patches of red skin that may weep fluid. Gradually, a tan or yellowish-brown crust covers the affected area, making it look like it has been coated with honey or brown sugar.

Impetigo that is caused by staphylococcus aureus triggers larger fluid-containing blisters that appear clear, then cloudy. These blisters are more likely to stay intact longer on the skin without bursting.

Contagiousness

Impetigo may itch and can be spread by scratching. Kids can spread the infection by scratching it and then touching other parts of the body.

Impetigo is contagious and can spread to anyone who comes into contact with infected skin or other items, such as clothing, towels, and bed linens, that have been touched by infected skin.

Treatment

When it just affects small areas of the skin, impetigo can usually be treated with antibiotic ointment. But if the infection has spread to many areas of the body, or the ointment isn't working, the doctor may prescribe an antibiotic pill or liquid.

Once antibiotic treatment begins, healing should start within a few days. It's important to make sure that your child takes the medication as the doctor has prescribed it. If that doesn't happen, a deeper skin infection or a blood infection could develop.

While the infection is healing, gently wash the areas of infected skin with clean gauze and antiseptic soap every day. Soak any areas of crusted skin in warm soapy water to help remove the layers of crust (it is not necessary to completely remove all of it).

To keep your child from spreading impetigo to other parts of the body, the doctor or nurse will probably recommend covering infected areas of skin with gauze and tape or a loose plastic bandage. Keep your child's fingernails short and clean.

Prevention

Good hygiene practices, such as regular hand washing, can help prevent impetigo. Have kids use soap and water to clean their skin and be sure they take baths or showers regularly. Pay special attention to areas of the skin that have been injured, such as cuts, scrapes, bug bites, areas of eczema, and rashes caused by allergic reactions or poison ivy. Keep these areas clean and covered.

Anyone in your family with impetigo should keep fingernails cut short and the impetigo sores covered with gauze and tape.

Prevent impetigo infection from spreading among family members by using antibacterial soap and making sure that each family member uses a separate towel. If necessary, substitute paper towels for cloth ones until the impetigo is gone. Separate the infected person's bed linens, towels, and clothing from those of other family members, and wash these items in hot water.

When to Call the Doctor

Call the doctor if your child has signs of impetigo, especially if he or she has been exposed to a family member or classmate with the infection. If your child is already being treated for impetigo, keep an eye on the sores and call the doctor if the skin doesn't begin to heal after 3 days of treatment or if a fever develops. If the area around the rash becomes red, warm, or tender to the touch, notify the doctor as soon as possible.

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Hepatitis

The word hepatitis simply means an inflammation of the liver without pinpointing a specific cause. Someone with hepatitis may:

• have one of several disorders, including viral or bacterial infection of the liver
• have a liver injury caused by a toxin (poison)
• have liver damage caused by interruption of the organ's normal blood supply
• be experiencing an attack by his or her own immune system through an autoimmune disorder
• have experienced trauma to the abdomen in the area of the liver

Hepatitis is most commonly caused by one of three viruses:

• the hepatitis A virus
• the hepatitis B virus
• the hepatitis C virus

In some rare cases, the Epstein Barr Virus (which causes mononucleosis) can also result in hepatitis because it can cause inflammation of the liver. Other viruses and bacteria that also can cause hepatitis include hepatitis D and E, varicella (chickenpox), and cytomegalovirus (CMV).

Hepatitis A
In children, the most common form of hepatitis is hepatitis A (also called infectious hepatitis). This form is caused by the hepatitis A virus (HAV), which lives in the stools (feces or poop) of infected individuals. Infected stool can be present in small amounts in food and on objects (from doorknobs to diapers).

The hepatitis A virus is spread:

• when someone ingests anything that's contaminated with HAV-infected stool (this makes it easy for the virus to spread in overcrowded, unsanitary living conditions)
• in water, milk, and foods, especially in shellfish

Because hepatitis A can be a mild infection, particularly in children, it's possible for some people to be unaware that they have had the illness. In fact, although medical tests show that about 40% of urban Americans have had hepatitis A, only about 5% recall being sick. Although the hepatitis A virus can cause prolonged illness up to 6 months, it typically only causes short-lived illnesses and it does not cause chronic liver disease.

Hepatitis B
Hepatitis B (also called serum hepatitis) is caused by the hepatitis B virus (HBV). HBV can cause a wide spectrum of symptoms ranging from general malaise to chronic liver disease that can lead to liver cancer.

The hepatitis B virus spreads through:

• infected body fluids, such as blood, saliva, semen, vaginal fluids, tears, and urine
• a contaminated blood transfusion (uncommon in the United States)
• shared contaminated needles or syringes for injecting drugs
• sexual activity with an HBV-infected person
• transmission from HBV-infected mothers to their newborn babies

Hepatitis C
The hepatitis C virus (HCV) is spread by direct contact with an infected person's blood. The symptoms of the hepatitis C virus can be very similar to those of the hepatitis A and B viruses. However, infection with the hepatitis C virus can lead to chronic liver disease and is the leading reason for liver transplant in the United States.

The hepatitis C virus can be spread by:

• sharing drug needles
• getting a tattoo or body piercing with unsterilized tools
• blood transfusions (especially ones that occurred before 1992; since then the U.S. blood supply has been routinely screened for the disease)
• transmission from mother to newborn
• sexual contact (although this is less common)

Hepatitis C is also a common threat in kidney dialysis centers. Rarely, people living with an infected person can contract the disease by sharing items that might contain that person's blood, such as razors or toothbrushes.

Diagnosis

All of these viral hepatitis conditions can be diagnosed and followed through the use of readily available blood tests.

Signs and Symptoms

Hepatitis, in its early stages, may cause flu-like symptoms, including:

• malaise (a general ill feeling)
• fever
• muscle aches
• loss of appetite
• nausea
• vomiting
• diarrhea
• jaundice (a yellowing of the skin and whites of the eyes)

But some people with hepatitis may have no symptoms at all and may not even know they're infected. Children with hepatitis A, for example, usually have mild symptoms or have no symptoms.

If hepatitis progresses, its symptoms begin to point to the liver as the source of illness. Chemicals normally secreted by the liver begin to build up in the blood, which causes:

• jaundice
• foul breath
• a bitter taste in the mouth
• dark or "tea-colored" urine
• white, light, or "clay-colored" stools

There can also be abdominal pain, which may be centered below the right ribs (over a tender, swollen liver) or below the left ribs (over a tender spleen).

Contagiousness

Hepatitis A, hepatitis B, and hepatitis C are all contagious.

The hepatitis A virus can be spread in contaminated food or water, as well as in unsanitary conditions in child-care facilities or schools. Toilets and sinks used by an infected person should be cleaned with antiseptic cleansers. People who live with or care for someone with hepatitis should wash their hands after contact with the infected person. In addition, when traveling to countries where hepatitis A is prevalent, your child should be vaccinated with at least two doses of the hepatitis A vaccine.

The hepatitis B virus can be found in virtually all body fluids, though its main routes of infection are through sexual contact, contaminated blood transfusions, and shared needles for drug injections. Household contact with adults with hepatitis B can put people at risk for contracting hepatitis. But frequent hand washing and good hygiene practices can reduce this risk.

All kids in the United States are routinely vaccinated against hepatitis B at birth and use of the hepatitis B vaccine can greatly decrease the incidence of this infection. Ask your doctor about this vaccine. Even adults can be vaccinated if they feel they're at risk.

The hepatitis C virus can be spread through shared drug needles, contaminated blood products, and, less commonly, through sexual contact. Although hepatitis C can be spread from a mother to her fetus during pregnancy, the risk of passing hepatitis C to the fetus isn't very high (about 5%). If you're pregnant, contact your doctor if you think you may have been exposed to hepatitis C.

Over the past several years, improved medical technology has almost eliminated the risk of catching hepatitis from contaminated blood products and blood transfusions. But as tattoos and acupuncture have become more popular, the risk of developing hepatitis from improperly sterilized equipment used in these procedures has increased. Shared needles in drug use and shared straws in cocaine use are two very common ways for hepatitis C to spread.

Prevention

In general, to prevent viral hepatitis you should:

• Follow good hygiene and avoid crowded, unhealthy living conditions.
• Take extra care, particularly when drinking and swimming, if you travel to areas of the world where sanitation is poor and water quality is uncertain.
• Never eat shellfish from waters contaminated by sewage.
• Remind everyone in your family to wash their hands thoroughly after using the toilet and before eating.
  
• Use antiseptic cleansers to clean any toilet, sink, potty-chair, or bedpan used by someone in the family who develops hepatitis.

Because contaminated needles and syringes are a major source of hepatitis infection, it's a good idea to encourage drug awareness programs in your community and schools. At home, speak to your child frankly and frequently about the dangers of drug use. It's also important to encourage abstinence and safe sex for teens, in order to eliminate their risk of hepatitis infection through sexual contact.

A hepatitis A vaccine is available, and is especially recommended for those who:

• travel abroad
• have other forms of liver disease
• have many sexual partners
• are in high-risk occupations, such as health-care and child-care personnel

If you're planning to travel abroad, consult your doctor in advance so you and your family have enough time to complete the required immunizations. The vaccine is especially useful for staff of child-care facilities or schools where they may be at risk of exposure.

There's also a hepatitis B vaccine, which should be given to both children and adults as part of routine immunization.

Unfortunately, there's no vaccine for hepatitis C — animal studies indicate that it may not be possible because the virus doesn't cause the kind of response that would be needed for a vaccine to be successful.

Duration

For viral hepatitis, the incubation period (the time it takes for a person to become infected after being exposed) varies depending on which hepatitis virus causes the disease:

• For hepatitis A, the incubation period is 2 to 6 weeks.
• For hepatitis B, the incubation period is between 4 and 20 weeks.
• For hepatitis C, it's estimated that the incubation period is 2 to 26 weeks.

Hepatitis A is usually active for a short period of time and once a person recovers, he or she can no longer pass the virus to other people. It's practically unheard for people to become chronic carriers of hepatitis A. Almost all previously healthy persons who develop hepatitis A will completely recover from their illness in a few weeks or months without long-term complications.

With hepatitis B, 85% to 90% of patients recover from their illness completely within 6 months, without long-term complications.

However, 75% to 85% of those who are infected with hepatitis C do not recover completely and are more likely to continue to have a long-term infection. People with hepatitis B (the percentage who don't recover completely) or hepatitis C who continue to be infected can go on to develop chronic hepatitis and cirrhosis of the liver (the chronic degeneration and disruption of the structure of the liver). Some people with hepatitis B or C may also become lifelong carriers of these viruses and can spread them to other people.

Treatment

When symptoms are severe or laboratory tests show liver damage, it's sometimes necessary for hepatitis to be treated in the hospital. Here's a quick look at the treatments available for the various hepatitis viruses:

• There are no medications used to treat hepatitis A because it's a short-term infection that goes away on its own.
• Hepatitis B can sometimes be treated using medications. Four drugs are approved for use in adults with hepatitis B, but there hasn't been enough research yet on their use in children. However, you can talk to your child's doctor about a drug that may be available in some centers on a research basis for children.
• The treatment of hepatitis C has improved significantly with the use of two medications, only one of which is approved for use in children. Another more effective drug isn't approved for children yet but is available for kids in some centers on a research basis. In those adults who've just been infected with hepatitis C (by accidental needle injury, for example), combination therapy with the two drugs is the treatment of choice and can eliminate the virus in about 50% of the people infected.

Children with mild hepatitis may be treated at home. Except for using the bathroom, they should rest in bed until the fever and jaundice are gone and their appetite is normal. Kids with a lack of appetite should try smaller, more frequent meals and fluids that are high in calories (like milkshakes). They should also eat healthy foods rich in protein and carbohydrates and drink plenty of water.

When to Call the Doctor

Call the doctor if your child:

• has symptoms of hepatitis
• attends a school or child-care facility where someone has hepatitis
• has been exposed to a friend or relative with the illness

If you have an older child who volunteers at a first-aid station, hospital, or nursing home, be sure that he or she is aware of proper safety procedures for preventing contact with blood or body fluids. You may also want to have your child immunized against the hepatitis B virus. Call your doctor if you believe your child may have been exposed to a patient with hepatitis.

If you already know your child has hepatitis, call your doctor if you notice any of the following symptoms, which may be signs of their liver condition worsening:

• confusion or extreme drowsiness
• skin rash
• itching

Also, monitor your child's appetite and digestive functions, and call the doctor if your child's appetite decreases, or if nausea, vomiting, diarrhea, or jaundice increase.

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Gonorrhea

Gonorrhea is a sexually transmitted disease (STD) caused by a bacterium called Neisseria gonorrhoeae. It can also be transmitted from pregnant mothers to their babies at birth.

Gonorrhea most commonly affects teens and young adults. Experts believe that hundreds of thousands of cases go undetected and untreated because the infection does not always have noticeable symptoms. Many people who have gonorrhea also have another common STD called chlamydia. So when doctors diagnose or suspect a case of gonorrhea, they often screen for and treat other STDs too.

Gonorrhea is preventable — and treatable — so anyone having sex (oral, anal, or vaginal) should take precautions against STDs and get screened for them regularly.

Symptoms

Many times gonorrhea does not produce any symptoms. When there are symptoms, the infection can cause painful urination and a cloudy discharge from the penis or vagina. This discharge may be thick and may have a greenish-yellow color. Males may have swelling or pain of their testicles. Females may have lower abdominal pain, painful intercourse, and abnormal bleeding from the vagina.

Gonorrhea can cause rectal pain, especially during a bowel movement. A sore throat can result from a gonorrhea throat infection.

If gonorrhea goes undetected and untreated, it can lead to more serious health problems. In males, it can cause scars inside the urethra, which can make urination difficult. In females, untreated gonorrhea can spread upward from the vaginal area to cause acute pelvic inflammatory disease (PID) — an infection of the uterus, fallopian tubes, or ovaries. It can lead to abscesses in the fallopian tubes and even infertility.

In males and females, gonorrhea that goes undetected can spread through the blood to parts of the body that are far from the reproductive organs, and lead to inflammation in the joints, the skin, the bones, tendons, heart, or even the area around the liver.

Prevention

Because gonorrhea is spread through sexual contact, the best way to prevent it is to abstain from having sex. Sexual contact with more than one partner or with someone who has more than one partner increases the risk of contracting any STD.

When properly and consistently used, condoms decrease the risk of STDs. Latex condoms provide greater protection than natural-membrane condoms. The female condom, made of polyurethane, is also considered effective against STDs.

Although birth control pills offer no protection against STDs, they may provide some protection against PID by causing the body to create thicker cervical mucus, making it more difficult for bacteria to reach the upper genital tract.

Using douche can actually increase a female's risk of contracting STDs because it can change the natural flora of the vagina and may flush bacteria higher into the genital tract.

Treatment

Like other STDs, gonorrhea may seem to get better but still be present. The fact that a discharge lessens or disappears after a few days with no treatment does not mean that the infection has gone away. And untreated STDs can spread and cause other complications.

If gonorrhea is suspected, the doctor will send urine or samples of fluid from the urethra (at the end of the penis) or the cervix to a laboratory for examination. If the doctor thinks it has spread, more tests may be necessary.

If gonorrhea is caught early, it can be treated with antibiotics. Because the symptoms of gonorrhea are similar to those of chlamydia, and because a person can be infected with both, people with gonorrhea are sometimes treated for both diseases.

A teen who is being treated for gonorrhea also should be tested for other STDs, and should have time alone with the doctor to openly discuss issues like sexual activity. Not all teens will be comfortable talking with parents about these issues. But it's important to encourage them to talk to a trusted adult who can provide the facts.

All teens who have had any type of sex (vaginal, oral or anal) should be screened regularly for STDs so that they don't lead to other more serious health problems. It's also important for them to notify any sexual partners if they have an STD.

Getting Help

If your teen is thinking of becoming sexually active or already has started having sex, it's important to talk with him or her about it. Make sure your teen knows how STDs can be spread (during anal, oral, or vaginal sex) and that these infections often don't have symptoms, so a partner might have an STD without knowing it.

It can be difficult to talk about STDs, but just as with any other medical issue, teens need this information to stay safe and healthy. Provide the facts, and let your child know where you stand.

It's also important that all teens have regular full physical exams — which can include screening for STDs. Your teen may want to see a gynecologist or a specialist in adolescent medicine to talk about sexual health issues. Community health organizations and sexual counseling centers in your local area also may be able to offer some guidance.

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Fifth Disease

Especially common in kids between the ages of 5 and 15, fifth disease typically produces a distinctive red rash on the face that makes the child appear to have a "slapped cheek." The rash then spreads to the trunk, arms, and legs. Fifth disease is actually just a viral illness that most kids recover from quickly and without complications.

Fifth disease (also called erythema infectiosum) is caused by parvovirus B19. A human virus, parvovirus B19 is not the same parvovirus that veterinarians may be concerned about in pets, especially dogs, and it cannot be passed from humans to animals or vice versa.

Studies show that although 40% to 60% of adults worldwide have laboratory evidence of a past parvovirus B19 infection, most of these adults can't remember having had symptoms of fifth disease. This leads medical experts to believe that most people with a B19 infection have either very mild symptoms or no symptoms at all.

Fifth disease occurs everywhere in the world. Outbreaks of parvovirus tend to happen in the late winter and early spring, but there may also be sporadic cases of the disease any time throughout the year.

Signs and Symptoms

Fifth disease begins with a low-grade fever, headache, and mild cold-like symptoms (a stuffy or runny nose). These symptoms pass, and the illness seems to be gone until a rash appears a few days later. The bright red rash typically begins on the face. Several days later, the rash spreads and red blotches (usually lighter in color) extend down to the trunk, arms, and legs. The rash usually spares the palms of the hands and soles of the feet. As the centers of the blotches begin to clear, the rash takes on a lacy net-like appearance. Kids younger than 10 years old are most likely to get the rash.

Older kids and adults sometimes complain that the rash itches, but most children with a rash caused by fifth disease do not look sick and no longer have fever. It may take 1 to 3 weeks for the rash to completely clear, and during that time it may seem to worsen until it finally fades away entirely.

Certain stimuli (including sunlight, heat, exercise, and stress) may reactivate the rash until it completely fades. Other symptoms that sometimes occur with fifth disease include swollen glands, red eyes, sore throat, diarrhea, and rarely, rashes that look like blisters or bruises.

In some cases, especially in adults and older teens, an attack of fifth disease may be followed by joint swelling or pain, often in the hands, wrists, knees, or ankles.

Contagiousness

A person with parvovirus infection is most contagious before the rash appears — either during the incubation period (the time between infection and the onset of symptoms) or during the time when he or she has only mild respiratory symptoms. Because the rash of fifth disease is due to an immune reaction (a defense response launched by the body against foreign substances like viruses) that occurs after the infection has passed, a child is usually not contagious once the rash appears.

Parvovirus B19 spreads easily from person to person in fluids from the nose, mouth, and throat of someone with the infection, especially through large droplets from coughs and sneezes.

In households where a child has fifth disease, another family member who hasn't previously had parvovirus B19 has about a 50% chance of also getting the infection. Children with fifth disease may attend childcare or school, since they are no longer contagious. Once infected with parvovirus B19, a person develops immunity to it and won't usually become infected again.

Parvovirus B19 infection during pregnancy may cause problems for the fetus. Some fetuses may develop severe anemia if the mother is infected while pregnant — especially if the infection occurs during the first half of the pregnancy. In some cases, this anemia is so severe that the fetus doesn't survive. Fortunately, about half of all pregnant women are immune from having had a previous infection with parvovirus. Serious problems occur in less than 5% of women who become infected during pregnancy.

Prevention

There is no vaccine for fifth disease, and no real way to prevent spreading the virus. Isolating someone with a fifth disease rash won't prevent spread of the infection because the person usually isn't contagious by that time.

Practicing good hygiene, especially frequent hand washing, is always a good idea since it can help prevent the spread of many infections.

Incubation

The incubation period (the time between infection and the onset of symptoms) for fifth disease ranges from 4 to 28 days, with the average being 16 to 17 days.

Duration

The rash of fifth disease usually lasts 1 to 3 weeks. In a few cases in older kids and adults, joint swelling and pain because of fifth disease have lasted from a few months up to a few years.

Diagnosis

Doctors can usually diagnose fifth disease by the distinctive rash on the face and body. If a child or adult has no telltale rash but has been sick for a while, a doctor may perform blood tests to see if the illness could be caused by parvovirus B19.

Treatment

Fifth disease is caused by a virus, and it cannot be treated with antibiotics used to treat bacterial infections. Although antiviral medicines do exist, there are currently none available that will treat fifth disease. In most cases, this is such a mild illness that no medicine is necessary.

Usually, kids with fifth disease feel fairly well and need little home treatment other than rest. After the fever and mild cold symptoms have passed, there may be little to treat except any discomfort from the rash itself. If your child has itching from the rash of fifth disease, ask the doctor for advice about relieving discomfort. The doctor may also recommend acetaminophen for fever or joint pain.

Complications

The majority of kids with fifth disease recover with no complications. By the time the rash appears and while it's present, they usually feel well and are back to their normal activities.

However, some children with weakened immune systems (such as those with AIDS or leukemia) or with certain blood disorders (like sickle cell anemia or hemolytic anemia) may become significantly ill when infected with parvovirus B19. Parvovirus B19 can temporarily slow down or stop the body's production of the oxygen-carrying red blood cells (RBCs), causing anemia.

When a child is healthy, this slowdown of red blood cell production usually goes unnoticed because it doesn't affect overall health. But some kids who are already anemic can become sick if their RBC production is further affected by the virus. The RBC levels may drop dangerously low, affecting the supply of oxygen to the body's tissues.

When to Call the Doctor

Call the doctor if your child develops a rash, especially if the rash is widespread over the body or accompanied by other symptoms.

If you're pregnant and develop a rash or if you've been exposed to someone with fifth disease (or to anyone with an unusual rash), call your obstetrician.

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Encephalitis

Encephalitis literally means an inflammation of the brain, but it usually refers to brain inflammation caused by a virus. It's a rare disease that occurs in approximately 0.5 per 100,000 individuals — most commonly in children, the elderly, and people with weakened immune systems (i.e., those with HIV/AIDS or cancer).

Although several thousand cases of encephalitis (also called acute viral encephalitis or aseptic encephalitis) are reported to the Centers for Disease Control and Prevention (CDC) every year, experts suspect that many more may go unreported because the symptoms are so mild.

Signs and Symptoms

Symptoms in milder cases of encephalitis usually include:

• fever
• headache
• poor appetite
• loss of energy
• a general sick feeling

In more severe cases of encephalitis, a person is more likely to experience high fever and any of a number of symptoms that relate to the central nervous system, including:

• severe headache
• nausea and vomiting
• stiff neck
• confusion
• disorientation
• personality changes
• convulsions (seizures)
• problems with speech or hearing
• hallucinations
• memory loss
• drowsiness
• coma

It's harder to detect some of these symptoms in infants, but important signs to look for include:

• vomiting
• a full or bulging soft spot (fontanel)
• crying that doesn't stop or that seems worse when an infant is picked up or handled in some way
• body stiffness

Because encephalitis can follow or accompany common viral illnesses, there sometimes are signs and symptoms of these illnesses beforehand. But often, the encephalitis appears without warning.

Causes

Because encephalitis can be caused by many types of germs, the infection can be spread in several different ways.

One of the most dangerous and most common causes of encephalitis is the herpes simplex virus (HSV). HSV is the same virus that causes cold sores around the mouth, but when it attacks the brain it may occasionally be fatal. Fortunately, HSV encephalitis is very rare.

Encephalitis can be a very rare complication of Lyme disease transmitted by ticks, or of rabies spread by rabid animals.

Mosquitoes can also transmit the viruses for several types of encephalitis, including West Nile encephalitis, St. Louis encephalitis, and Western Equine encephalitis. Over the last several years in the United States, there's been concern about the spread of West Nile virus, which is transmitted to humans by mosquitoes that pick up the virus by biting infected birds.

Milder forms of encephalitis can follow or accompany common childhood illnesses, including measles, mumps, chickenpox, rubella (German measles), and mononucleosis. Viruses like chickenpox spread mostly via the fluids of the nose and throat, usually during a cough or sneeze.

Less commonly, encephalitis can result from a bacterial infection, such as bacterial meningitis, or it may be a complication of other infectious diseases like syphilis. Certain parasites, like toxoplasmosis, can also cause encephalitis in people with weakened immune systems.

Contagiousness

Brain inflammation itself is not contagious, but any of the various viruses that cause encephalitis can be. Of course, just because a child gets a certain virus does not mean that he or she will develop encephalitis. Still, to be safe, children should avoid contact with anyone who has encephalitis.

Prevention

Encephalitis cannot be prevented except to try to prevent the illnesses that may lead to it. Encephalitis that may be seen with common childhood illnesses can be largely prevented through proper immunization. Have your child immunized according to the immunization schedule recommended by your doctor. Kids should also avoid contact with anyone who already has encephalitis.

In areas where encephalitis can be transmitted by insect bites, especially mosquitoes, kids should:

• Avoid being outside at dawn and dusk (when mosquitoes are most active).
• Wear protective clothing like long sleeves and long pants.
• Use insect repellent.

Also, all standing water around your home should be drained, including buckets, birdbaths, flowerpots, and tire swings because these are breeding grounds for mosquitoes.

To avoid tick bites:

• Limit kids' contact with soil, leaves, and vegetation.
• Have kids wear long-sleeved, light-colored shirts and long pants when outdoors.
• Check your kids and your pets frequently for ticks.

Duration

For most forms of encephalitis, the acute phase of the illness (when symptoms are the most severe) usually lasts up to a week. Full recovery can take much longer, often several weeks or months.

Diagnosis

Doctors use several tests to diagnose encephalitis, including:

• imaging tests, such as computed tomography (CT) scans or magnetic resonance imaging (MRI), to check the brain for swelling, bleeding, or other abnormalities
• electroencephalogram (EEG), which records the electrical signals in the brain, to check for abnormal brain waves
• blood tests to confirm the presence of bacteria or viruses in the blood, and whether a person is producing antibodies (specific proteins that fight infection) in response to a germ
• lumbar puncture, or spinal tap, in which cerebrospinal fluid (the fluid that surrounds the brain and spinal cord) is checked for signs of infection

Treatment

Some children with very mild encephalitis can be monitored at home, but most will need care in a hospital, usually in an intensive care unit. Doctors will carefully monitor their blood pressure, heart rate, and breathing, as well as their body fluids, to prevent further swelling of the brain.

Because antibiotics aren't effective against viruses, they aren't used to treat encephalitis. However, antiviral drugs can be used to treat some forms of encephalitis, especially the type caused by the herpes simplex virus. Corticosteroids may also be used in some cases to reduce brain swelling. If a child is having seizures, anticonvulsants may also be given.

Over-the-counter (OTC) medications, like acetaminophen, can be used to treat fever and headaches.

Most people with encephalitis make a full recovery. In a small percentage of cases, swelling of the brain can lead to permanent brain damage and lasting complications like learning disabilities, speech problems, memory loss, or lack of muscle control. Speech, physical, or occupational therapy may be necessary in these cases.

Rarely, if the brain damage is severe, encephalitis can lead to death. Infants younger than 1 year and adults older than 55 are at greatest risk of death from encephalitis.

When to Call the Doctor

Call your doctor if your child has a high fever, especially if he or she also has a childhood illness (measles, mumps, chickenpox) or is recovering from one.

Seek immediate medical attention if your child has any of the following symptoms:

• severe headache
• convulsions (seizures)
• stiff neck
• inability to look at bright lights
• double vision
• difficulty walking
• problems with speech or hearing
• difficulty moving an arm or leg
• loss of sensation anywhere in the body
• sudden personality changes
• problems with memory
• extreme drowsiness or lethargy
• loss of consciousness

If your infant has any of the following symptoms, seek immediate medical care:

• high fever or any fever higher than 100.4° Fahrenheit (38° Celsius) in infants younger than 3 months of age
• fullness or bulging in the soft spot
• any stiffness
• floppiness or decreased tone
• lethargy
• poor appetite or reduced feeding
• vomiting
• crying that won't stop

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