M. P. Ravindra Nathan

Chikungunya can be quite a debilitating disease, at times even lethal and it often takes weeks for full recovery. Always thought to be a benign disease in the past, the infection may be fatal as per the health advisory from World Health Organization (WHO) and emerging reports from afflicted regions. This could be from mutation of the virus to a more virulent form. With international travel being so common, it is a matter of time before this disease hits Europe and America. So beware!

Recently, a few movie stars � in Kerala and Tamil Nadu � caught the disease which created quite a commotion. It certainly helped to create more awareness of this illness.

Several deaths have already been reported in South India, especially in Kerala. The latest count is 80, but it could be more. There has been constant debate about the outbreak in the Kerala assembly, but nobody knows how to control the epidemic. Tourists coming from Europe and America have been advised to take all precautions. WHO also has jumped into the fray and is trying to raise global awareness. The organization recently sent a team to India to study the situation. Some areas in Indian Ocean such Madagascar and Reunion Islands are affected and a few deaths have occurred there as well.

Every year, especially during monsoon time, these infections become rampant. The earth is sodden and buildings start to decay, some even collapse. Heavy growth of tall grass and other vegetations and make-shift shops along the road side make the cleaning crew�s work (if there is such a crew working in your town) difficult. Garbage and even raw sewage collect around the buildings and road side, the best breeding grounds for mosquito.

Here is another caution for all the travelers. There is a resurgence of malaria in many parts in India, especially Mumbai and Mangalore, and it is good to take precautions before you leave. Three friends of mine who returned from India after a vacation were stricken with malaria. Many of you thought that it has been eradicated long ago; not so! It exists in many pockets in India and is still killing people all over the world. Even anthrax, polio and whooping cough are trying to make a comeback, so beware! And of course, dengue is everywhere; even the prime minister�s grandchildren were hospitalized with it recently. One good news was at least I didn�t hear any stories about rabies this time. And the threat of avian flu may be subsiding.

Unfortunately water, air and ground pollution, motor vehicle accidents and infections are some of the hot-button issues, which both travelers and locals must face in India. And their socio-economic impact is quite staggering. Tragically, the government and the local municipalities do not seem to have much interest in any kind of cleanup and respond poorly to the residents� grievances. So, every day, people � young and old � die of viral fevers in India. The government�s wherewithal to cope with a true pandemic is suspect. What was considered in the past as an exhilarating and enjoyable trip to our homeland is turning into nightmare to many. It is important to recognize that there are so many infectious diseases waiting to prey on you, especially travelers like us from foreign lands with our own lack of immunity for those local infections.

So, take adequate precautions and best of luck with your next trip. Cardiologist Dr. M. P. Ravindra Nathan, director of Hernando Heart Clinic in Brooksville and editor-in-chief of the AAPI Journal, lives in Brooksville.

	Payal Patel

We have arrived into the peak season of RSV virus, as well as the flu virus, which I talked about in my last two articles. Another crucial illness among children is the stomach virus known as gastroenteritis. The most common virus that causes vomiting and diarrhea among children is the rotavirus along with other viruses. The rotavirus does tend to occur in the colder winter months from November-April with the peak in Florida being March and April. In the United States, most children have at least 1-2 episodes of gastroenteritis by the age of 4.

The infection usually begins with vomiting followed by diarrhea. The vomiting usually lasts for 1-2 days and then subsides. Usually there can be 10-20 bowel movements a day in healthy children. Symptoms last from 3-7 days with a gradual decrease in the watery diarrhea. Most children have a primary episode that is more severe then the following episodes, since immunity develops after the first rotavirus infection. Most adults do not acquire this infection because of immunity, but if they themselves have a mild episode then the children are likely to be infected with symptoms. The younger the child, (3-24 months) the more chances of a severe infection. The infection is acquired most commonly by touching rotavirus contaminated toys, food prep areas, and toilet facilities.

Prevention

The most important method of prevention is through hand washing. The rotavirus can easily contaminate surfaces because of the large amount of viral shedding in an infected child�s stool. The virus can survive for days to weeks on surfaces, toys, etc. The usual disinfectants such as bleach are ineffective. Cleaners with alcohol or 95 percent ethanol are most effective.

Another key measure is vaccination. The Rotateq is a 3-dose vaccine given by mouth at the age of 2, 4 and 6 months. This vaccine decreases the likelihood as well as the severity of the infection. This vaccine was recently made available and is recommended for all infants.

Management

There is no treatment for the Rotavirus or any other stomach viruses. The goal is to keep the child hydrated with fluids such as Infalyte, Pedialyte and simple things like water. Juice is not a good choice for children with diarrhea since it contains fructose and can make diarrhea worse. Also avoid sodas and other sugar filled drinks like Kool-Aid since they are not appropriate for rehydration. For a formula-fed infant with frequent diarrhea it may help to change to soy formula or lactose-free formula until the episodes decrease.

It is more important to get the vomiting under control in 12-24 hours for the child to be rehydrated. Because a child�s stomach will be upset from the virus, it is key to give small amounts of fluids for any child that is vomiting. For any child less than 1 years of age, use Pedialyte, or Infalyte or Kao-Lectrolyte if the child is vomiting greater than two times, since the child will be less able to tolerate regular formula. Give small amounts, usually half of what the child normally takes, or sometimes even a quarter of the normal amount, but more frequently. Once the vomiting is under control, then reintroduce formula slowly as tolerated. For children 6 months and over, you also can return to cereal, mashed bananas, etc. as tolerated.

For a breast-fed baby, feed smaller amounts more frequently. If the child vomits more than two times than nurse only nurse for 5-7 minutes but every half an hour to an hour. Once the vomiting is controlled for greater than eight hours, then continue normal breast-feeding schedule. For an older child greater than one, give small amounts of Pedialyte or water sometimes even 1-2 tablespoons every 15 minutes or so and increase as tolerated. After half a day of no vomiting, increase the fluids slowly and add a diet containing crackers, rice, bananas, bread, mashed potatoes, apple sauce. Normal diet can be continued after 24 hrs of no vomiting. If your child wants to sleep at night, do not wake him/her up if there is no immediate threat of dehydration. When the child rests, the stomach also gets a break and helps recover the stomach from the viral gastroenteritis.

If the child wears diapers and has diarrhea, it is very likely that the skin surrounding the anus will get irritated from the diarrhea and break down causing diaper rash. It is best to wash the child after each episode of diarrhea to decrease the irritation from wiping so much and also to protect the area by using diaper rash cream such as Desitin, Balmex, etc., and coating it further with Vaseline.

Warning signs: Call your pediatrician or go to the Emergency Room Signs of dehydration are no urine production in more than seven to eight hours, or no tear production when crying, or very sleepy and hard to wake up, or any drastic change in the child�s behavior. If the diarrhea or vomit is bloody.

If the child has persistent vomiting and is unable to keep even small amounts of fluids down or if the diarrhea occurs frequently with eight episodes in eight hours or less.

Dr Payal Patel , a board-certified pediatrician in Tampa, can be reached at [email protected]