Covid vaccine: India drones deliver Covid jabs to remote areas

Dr Samiran Panda said drones are being used to deliver doses in mountainous states in the country’s north-east.

India aims to vaccinate all eligible citizens by the end of 2021 but experts say the drive needs to pick up a consistent pace to meet the target.

India has so far given more than 925 million doses of three approved jabs.

About 70% of the country’s eligible population have received at least one dose of a Covid vaccine, according to official data.

India has reported more than 33 million Covid cases, second only to the US, and more than 440,000 deaths – behind the US and Brazil.

On Monday, India tested its first drone delivery of vaccines in the north-eastern state of Manipur.

A drone carrying ten doses flew from Bishnupur to a primary health clinic in the Karang island in Loktak – a 240-sq-km lake riddled with islands – in 12 minutes. The journey to Karang, where 3,500 people live, usually takes some four hours by boat and road.

Dr Panda, chief scientist and head of epidemiology at the Indian Council of Medical Research (ICMR), said the trial run was successful and 10 people on the island took the jabs.

The states of Manipur and Nagaland are now likely to ferry doses to far-flung villages, a journey which often takes up to 12 hours by mountain roads and across streams, he added

Drones will also be used to ferry doses to the eastern archipelago of Andamans and Nicobar where “transportation by boat” was taking a long time.

“We are trying to make sure there are no outbreaks in these sparsely populated remote areas by vaccinating residents fast. If people get infected and contract severe disease they don’t have access to ventilators or intensive care or oxygen in these areas,” Dr Panda said.

The government is using drones which can carry a payload of 4.5kg or a maximum of 900 doses and fly at least 70km (43 miles) to ferry doses.

How is India’s rollout going?

Since 16 January, India has administered more than 925 million doses.

More than 670 million people have received the first dose and another 255 million or so have received both doses so far.

On 17 September, India administered more than 20 million doses in a day in a record-breaking effort to mark Prime Minister Narendra Modi’s 71st birthday.

Experts say record-breaking days are encouraging but vaccination rates need to rise consistently. They estimate that India needs to give more than 10 million doses a day to fully vaccinate all eligible adults by the end of 2021.

Much will depend on levels of vaccine hesitancy and the availability of doses in the coming months.

India’s daily case count has been dropping – it has been reporting less than 40,000 new daily cases in the past month.

But doctors fear that a third wave is likelygiven that the country has fully reopened even as the threat of new variants looms large.

While the vaccination drive has gained momentum, experts worry about a gender gap – government data shows 6% fewer women are getting vaccinated. This is especially true in rural India where women have limited access to the internet and are hesitant or scared to take the vaccine.

Although a higher number of doses are being administered daily in rural areas, the share of population being vaccinated in urban areas is still greater. BBC

Some Home Remedies for Hemorrhoids.

Treating hemorrhoids

Hemorrhoids, sometimes called piles, are swollen veins in your anus and rectum. Common symptoms can include pain, itching, and rectal bleeding. They can develop inside or outside of the anus and rectum, called internal and external hemorrhoids, respectively. Hemorrhoids are an extremely common problem. While they typically go away in a few weeks on their own, they can cause mild to severe discomfort. Home remedies can make them more tolerable.

1. Witch hazel

Witch hazel can reduce both itching and pain, two main symptoms of hemorrhoids. It’s a natural anti-inflammatory, so it could also reduce swelling. Witch hazel can be purchased in liquid form and applied directly to the hemorrhoids. It can also be found in products like anti-itch wipes and soaps.

2. Aloe vera

Aloe vera gel has been used historically to treat hemorrhoids and various skin conditions. It’s thought to have anti-inflammatory properties, which might help reduce irritation. The gel can be found as an ingredient in other products, but you should only use pure aloe vera gel on hemorrhoids. Pure aloe vera gel can also be harvested directly from inside an aloe plant’s leaves. Some people are allergic to aloe vera, particularly those who are allergic to garlic or onions. Check for allergic reaction by rubbing a dime-sized amount onto your forearm. Wait 24 to 48 hours. If no reaction occurs, it should be safe to use.

3. Warm bath with Epsom salt

Warm baths can help soothe the irritation from hemorrhoids. You can use a sitz bath, which is a small plastic tub that fits over a toilet seat, or take a full-body bath in your tub. Taking a warm bath for 20 minutes after every bowel movement will be most effective. Adding Epsom salts to the bath can provide further relief by reducing pain.

4. Over-the-counter ointments

Over-the-counter ointments and creams can be found in almost every drug store and can offer immediate relief. Some can even reduce swelling and help your hemorrhoid to heal faster. If you use a cream with hydrocortisone, though, don’t use it for more than a week at a time.

5. Soothing wipes

Using toilet paper after a bowel movement can aggravate existing hemorrhoids. Wipes can help keep you clean without causing further irritation. For an added boost, you can find wipes with soothing, anti-hemorrhoid ingredients, like witch hazel or aloe vera. Make sure that the wipes you choose don’t have alcohol, perfume, or other irritants in them. These substances could aggravate symptoms instead of relieving them.

6. Cold compresses

Apply ice packs or cold compresses to the anus to relieve swelling for 15 minutes at a time. For large, painful hemorrhoids, this can be an extremely effective treatment. Always wrap ice inside a cloth or paper towel, and never apply something frozen directly to the skin.

7. Stool softeners

stool softeners or fiber supplements, like psyllium, can help reduce constipation, make stool softer, and make it easier to have quick, painless bowel movements. Many of these stool softeners come in forms like powders, capsules, and liquids that you take by mouth between once and three times a day.

8. Loose, cotton clothing

Swapping out tight clothes made with polyester with ultra-breathable cotton (especially cotton underwear) can help keep the anal area both clean and dry. This can potentially reduce symptoms. Avoid using perfumed detergents or fabric softeners to reduce irritation.

Preventing hemorrhoids

Lifestyle and dietary changes are the best way to prevent hemorrhoids. Staying physically active and eating healthy help to keep your bowel movements regular. Eat lots of high-fiber foods (especially from plants) and drink plenty of water to keep the digestive process moving correctly and prevent constipation. Regular exercise and avoiding sitting for long periods of time can also help prevent hemorrhoids. The most effective way to avoid constipation is to go to the bathroom when you first feel the urge. Delaying a bowel movement allows the bowel to reabsorb water from the stool. This makes stool harder when you finally do go.

When to see your doctor

Hemorrhoids are typically easy to treat and clear up on their own. In very rare cases, a hemorrhoid could cause complications. Chronic blood loss from a hemorrhoid could cause anemia, which is a shortage of red blood cells. Internal hemorrhoids can also have their blood supply cut off, resulting in strangulated hemorrhoids, which can cause extreme pain. If home treatments haven’t been effective after more than two weeks, make an appointment to see your doctor. Your primary care physician can diagnose and treat hemorrhoids. They can write prescriptions for medicated creams, ointments, and suppositories. If these treatments don’t work, they may recommend treatments like rubber band litigation or surgery to remove the hemorrhoids. You should also make an appointment to see your doctor right away if you notice rectal bleeding for the first time or if your rectal bleeding increases.

Covid-19: France suspends 3,000 unvaccinated health workers

About 3,000 health workers in France have been suspended because they have not been vaccinated against Covid-19.

A new rule, which came into force on Wednesday, made vaccination mandatory for the country’s 2.7 million health, care home and fire service staff.

But French Health Minister Olivier Véran said on Thursday that “most of the suspensions are only temporary”.

Many are now agreeing to get jabbed because “they see that the vaccination mandate is a reality”, he said.

The rule applies to all doctors, nurses, office staff and volunteers.

President Emmanuel Macron first gave workers notice of the rule change on 12 July, warning them that they needed to get at least one jab by 15 September or resign from their jobs.

“I am aware of what I am asking of you, and I know that you are ready for this commitment, this is part, in a way, of your sense of duty,” he said at the time.

After the president’s announcement, Doctolib, the website people use to book their jabs, crashed as so many people tried secure appointments.

But with the mandate now in place, and thousands still refusing to get the vaccine, there are fears of a disruption to healthcare services.

In just one hospital in Nice in southern France, for example, almost 450 workers have been suspended – sparking protests outside the building.

And in another southern city, Montélimar, one hospital confirmed that it had already begun cancelling non-urgent operations because of a shortage of vaccinated anaesthetists, AFP news agency reports.

“We have to keep these people on the job until they have been replaced,” Christophe Prudhomme, an emergency doctor and left-wing MP, said.

But Mr Véran told French RTL radio on Thursday that “the continuity of care and the security of care and quality of care were assured yesterday in all hospitals and medico-social facilities”, although a few services, such as MRI scans, were impacted for a few hours.

He added that the suspensions mainly affected support staff, and “few white coats”. There have also been “a few dozen resignations” across the country, he said.

When the vaccines were first rolled out globally, France was one of the most vaccine-sceptical countries in the world.

Then, about 40% of eligible people said they planned to get immunised, according to a survey by Ipsos. At the same time research from BBC Monitoring found that the number of followers of French-language pages sharing anti-vaccine content grew in 2020, from 3.2m to almost 4.1m likes.

But since the introduction of a Covid “health pass” in July, France has become one of the world’s most vaccinated countries.

Almost 90% of all adults have now had at least one jab. France has also started vaccinating children aged 12 and over, and is administering booster jabs to vulnerable people.

Vaccine mandates elsewhere in the world

France is not the only country to introduce a vaccine mandate.

Italy is also making an anti-Covid “green pass” mandatory for all employees from 15 October, meaning that workers who can’t show proof of vaccination or a recent negative Covid test will be penalised.

“The government is ready to speed up on the ‘green pass’… (for) not just the public sector, but private too,” regional affairs minister Mariastella Gelmini said on Wednesday.

The green pass is already required for anyone in Italy who wants to eat indoors at restaurants, go to cinemas and sports stadiums, and take certain public transport or flights. It is also already mandatory for teachers.

In Greece, unvaccinated public and private sector employees have to have Covid tests once or twice a week, at their own expense. The rule came into force on 13 September.

And last week, the US made vaccines mandatory for federal government workers and contractors, and for all businesses with more than 100 employees. The rule affects covers about 100 million workers. BBC

Covid: Vaccine volunteers sought for children’s second dose study

A trial to test how well second doses of different coronavirus vaccines work in children is looking for volunteers.

Scientists want to see if giving two doses of different vaccines gives as good an immune response as two doses of the same vaccine.

The study, running at University Hospital Southampton, is looking for 360 volunteers aged 12-16 to take part.

From Monday, children aged 12 to 15 in the UK are to be offered one dose of the Pfizer vaccine.

The year-long trial is taking place in four locations in the UK – University Hospital Southampton, University of Oxford, St George’s University Hospital in London and Bristol Royal Hospital for Children.

It will see the volunteers given a full standard dose of Pfizer vaccine.

About eight weeks later they will then be given a second dose of one of the following:

  • A full standard dose of Pfizer vaccine
  • A half standard dose of Pfizer vaccine
  • A full dose of Novavax vaccine
  • A half dose of Moderna vaccine

However, they will not know which second dose vaccine they have received.

The vaccine has already been offered to those aged 16 and above. However 16-year-olds who have already received one dose are eligible for the trial.

Dr Katrina Cathie, from University Hospital Southampton, said initial results of the trial were expected at about Christmas and would “directly inform decisions about the roll-out of a second dose of a Covid-19 vaccine in this age group in the spring”.

Volunteers need to attend up to six study visits over the next year.

University Hospital Southampton said the visits would be “primarily after school and at weekends to avoid disruption to schooling”.

The study is being led by the University of Oxford and funded by the UK Vaccine Task Force and the National Institute of Health Research. BBC

Covid deaths rare among fully vaccinated – ONS

Out of more than 51,000 Covid deaths in England between January and July 2021, only 256 occurred after two doses.

They were mostly people at very high risk from illness from Covid-19.

The figures show the high degree of protection from the vaccines against illness and death, the ONS said.

Some deaths after vaccination were always expected because vaccines are not 100% effective, and it takes a couple of weeks after your second dose to build the fullest protection.

Of the 51,281 deaths involving Covid registered in England between 2 January and 2 July 2021:

  • both vaccine doses
  • This total includes people who had been infected before they were vaccinated
  • Some 458 deaths (0.8%) were people who died at least 21 days after their second dose
  • Just 256 deaths (0.5%) were people who were both fully vaccinated and who had their first positive PCR test at least 14 days after their second dose

“Breakthrough” deaths – occurring at least two weeks after the second jab along with a first positive PCR Covid test – tend to happen in the most vulnerable, men and those with weakened immune systems, with the average age being 84.

But overall numbers were very small – they accounted for only 0.5% of all deaths from Covid-19 over the first six months of the year.

Julie Stanborough, from the ONS, said: “Our new analysis shows that, sadly, there have been deaths of people involving Covid-19 despite them being fully vaccinated.

“However, we’ve also found that the risk of a death involving Covid-19 is much lower among people who are fully vaccinated than those who are unvaccinated.”

Among those who died after two doses, 13% were immunocompromised, 61% were male and more than 75% were clinically extremely vulnerable.

In the UK, 80% of people aged 16 and over have had two doses and nearly 90% have had one dose. BBC

Galleri cancer test: What is it and who can get it?

It’s hoped the Galleri test can detect more than 50 types of the disease before symptoms appear.

What is the Galleri cancer test?

It’s a simple blood test that looks for the earliest signs of cancer, particularly those that are typically difficult to identify early or for which there are no NHS screening programmes – such as lung, pancreas or stomach cancers.

Developed by Californian firm Grail – and already used in the US – the test can detect subtle changes caused by cancers, when patients may have no other obvious symptoms.

It works by finding chemical changes in fragments of genetic code – cell-free DNA (cfDNA) – that leak from tumours into the bloodstream.

The signal does not mean that a person definitely has cancer. It just means that they might have cancer, and that they will need to have some follow-up tests to check.

“This quick and simple blood test could mark the beginning of a revolution in cancer detection and treatment here and around the world,” says NHS England’s Chief Executive Amanda Pritchard.

Who can volunteer for the NHS-Galleri trial?

The trial aims to recruit 140,000 volunteers across England.

But only people living in these areas can take part and they must be invited:

  • Cheshire and Merseyside
  • Cumbria
  • Greater Manchester
  • the North East
  • West Midlands
  • East Midlands
  • East of England
  • Kent and Medway
  • South East London

Letters have already been sent to tens of thousands of people asking them to take part.

Those being asked are aged between 50 and 77, from a range of backgrounds and ethnicities, and must not have had a cancer diagnosis in the past three years.

How will the trial work?

Participants will be asked to give a blood sample at a locally based mobile clinic.

They will then be invited back twice – after 12 months and two years – to give further samples.

Half those taking part will have their blood screened with the Galleri test immediately.

However, others will simply have their samples stored away to be tested in the future – should they go on to be diagnosed with cancer.

This is because the trial is what’s known as a Randomised Control Trial (RCT).

It will allow scientists to see whether cancer is detected significantly earlier among people who have their blood tested straight away.

Will participants know if their blood has been tested?

People will only know they’re in the first test group if they are among the small minority whose blood test detects potential signs of cancer.

Those people will be contacted by the trial nurses by phone and referred to an NHS hospital for further tests.

Everyone taking part will be advised to continue with their standard NHS screening appointments and to still contact their GP if they notice any new or unusual symptoms.

What is the aim of the trial?

The NHS hopes the blood tests will help increase five-year survival rates for cancer, which are below the levels seen in many other high-income countries.

Developing a blood test for cancer has been keeping scientists busy for many years without much success.

Making one that’s accurate and reliable has proved incredibly complex. The danger is that a test doesn’t detect a person’s cancer when they do have it, or it indicates someone has cancer when they don’t.

“The test could be a game-changer for early cancer detection,” says Prof Peter Sasieni, one of the trial’s lead investigators. But he adds a note of caution:

“Cancer screening can find cancers earlier when they are more likely to be treated successfully, but not all types of screening work.”

What difference could it make to cancer patients?

Patients whose cancers are found early – known as stage one or two – typically have a broader range of treatment options available to them, which can often be less aggressive.

NHS England says a patient diagnosed at the earliest stage typically has between five and 10 times the chance of surviving compared with those found at the more advanced stage four.

Initial results from the Galleri study are expected by 2023. If successful, the NHS in England plans to extend the rollout to a further one million people in 2024 and 2025. BBC

Some home remedies for earache.

1. Heat

Heat from an electric heating pad or hot pack can reduce inflammation and pain in the ear.

Apply a hot pad to the ear for 20 minutes. For best results, people should touch the neck and throat with the hot pad.

The heating pad should not be unbearably hot. People should never fall asleep with a heating pad, or allow a child to use a hot pack without adult supervision.

2. Cold

A cold pack can help with the pain of an earache.

Try wrapping ice in paper towels or freezing a cold pack and then covering it with a light cloth. Hold this to the ear and the area immediately under the ear for 20 minutes.

The cold should not hurt, and parents should never apply ice directly to their children’s skin.

Some people find that heat offers greater relief than cold. For others, alternating hot and cold packs (20 minutes hot, followed by 20 minutes cold) provides the best pain relief.

3. Ear drops

Ear drops can reduce pressure in the ear caused by fluid and earwax.

People should read the directions carefully, and talk to a doctor before using ear drops on a child.

Ear drops are no substitute for prescription ear drops or antibiotics, so people should only use them for a few days. If symptoms return, people should see a doctor.

It is important to remember that people should not use ear drops in a child with tubes in their ears or whose eardrum has ruptured.

4. Massage

Gentle massage can help with ear pain that radiates from the jaw or teeth, or that causes a tension headache.

People can massage the tender area, as well as any surrounding muscles. For example, if the area behind the ear hurts, try massaging the muscles of the jaw and neck.

Massage may also help with the pain of an ear infection.

  • Using a downward motion, apply pressure beginning just behind the ears and down the neck.
  • Continuing to apply pressure downward, work forward to the front of the ears.

This type of massage may help drain excess fluid from the ears, and prevent the pain from getting worse.

5. Garlic

Garlic has long been used in folk medicine to relieve pain. Some research suggests it has antimicrobial properties that can fight infection.

People should not use it as a substitute for antibiotics a doctor has recommended. Instead, consider adding garlic to an antibiotic regimen to speed up relief.

To prevent ear infections, try eating a clove of garlic each day.

Garlic ear drops may also reduce pain and prevent an infection from getting worse. Cook two or three cloves in two tablespoons of mustard or sesame seed oil until brown, then strain the mix. Then, apply a drop or two to each ear.

6. Onions

Like garlic, onions can help fight infection and reduce pain. Also like garlic, onions are not a substitute for medical attention.

Heat an onion in the microwave for a minute or two. Then, strain the liquid and apply several drops to the ear. A person may want to lie down for 10 minutes, and then allow the liquid to flow out of the ear. Repeat this as needed.

7. Sucking

Sucking can help reduce pressure in the Eustachian tubes, offering some relief.

Babies who are nursing may feel better when allowed and encouraged to nurse as frequently as possible. Adults and children can suck on hard candy or cough drops.

8. Breast milk

Breast milk has antimicrobial properties. Some research suggests that a mother’s breast milk changes based on the microbes to which a baby is exposed.

This means that breast milk is most effective in babies. However, some sources suggest that breast milk may even help adults. Infants and children should continue nursing to get the most benefits from breast milk.

In nursing babies, as well as in children and adults, topical application of breast milk may also help. Even if it doesn’t, breast milk is unlikely to cause any serious side effects.

People can try dropping a few drops of breast milk in each ear, and repeat the application every few hours as needed

Causes of ear pain

Ear infections are the most common cause of ear pain. When the ear becomes infected, inflammation and buildup of pressure cause pain that can be intense.

People with ear infections often have other symptoms, such as sinus pressure or a sore throat because infections from nearby areas may affect the ear. An ear infection can also be a standalone condition. Most ear infections are bacterial, not viral.

Only a doctor can diagnose an ear infection. People should not take antibiotics without a prescription, or assume that symptoms are due to an ear infection.

However, earaches are not always caused by an ear infection. Other conditions can also cause pain in the ear.

Those include:

  • Referred pain: This may be from infections or inflammation elsewhere in the body. For example, a toothache may cause aching pain in the ear.
  • Chronic conditions: These include temporomandibular joint (TMJ) dysfunction.
  • Skin infections: If they are in or around the ear.
  • Allergic reactions: These could be from a range of things, such as soap, shampoo, or earrings.
  • Water: This may cause pain if trapped in the ear.
  • Pressure: Changes in altitude can affect pressure in the ears. This usually resolves on its own, often with a popping sensation.

If left untreated, ear infections can spread to the jaw and other regions of the body. They may also damage the ear itself and can cause dangerously high fevers.

When symptoms of an ear problem are present and do not resolve on their own within a day or two, people should speak to a doctor. If the pain is intense, is accompanied by a high fever, or includes hearing loss, people should seek medical attention immediately.

What is rabies?

Rabies is a serious disease that is caused by a virus. It is mainly a disease of animals, but humans can get rabies when animals infected with the disease bite them. The virus is transmitted to humans through the infected animal’s saliva. Very rare cases occur when infected saliva gets into someone’s eyes or mouth or into an open wound.

Infected wild animals – especially bats, but also skunks, raccoons, foxes, and coyotes – typically transmit the disease to humans. In the United States, dogs rarely transmit rabies to humans; however, outside the United States, infected dogs are the most common source of transmission to humans. Any mammal (i.e., warm-blooded animal with fur) can get rabies. Animals that are not mammals (e.g., birds, fish, snakes) cannot get rabies.

What are the symptoms of rabies?

Symptoms can appear as soon as a few days after being bitten by an infected animal. However, in most cases, symptoms may not appear until weeks or months later.

One of the most unique symptoms of rabies infection is a tingling or twitching sensation in the area around the animal bite. After the virus leaves the local bite area, it travels up a nearby nerve to the brain and can cause such symptoms as:

  • Pain.
  • Fatigue.
  • Headaches.
  • Fever.
  • Muscle spasms.
  • Irritability.
  • Excessive movements.
  • Agitation, aggressiveness.
  • Confusion.
  • Seizures.
  • Bizarre or abnormal thoughts.
  • Hallucinations.
  • Weakness, paralysis.
  • Increased production of saliva or tears.
  • Extreme sensitivity to bright lights, sounds, or touch.
  • Difficulty speaking.

At advance stages of the infection (when the infection spreads to other parts of the nervous system), the following symptoms can develop:

  • Double vision.
  • Problems moving facial muscles.
  • Abnormal movements of the diaphragm and muscles that control breathing.
  • Difficulty swallowing and increased production of saliva, causing the “foaming at the mouth” usually associated with a rabies infection.

MANAGEMENT AND TREATMENT

How is rabies treated?

Rabies is both prevented and treated with a rabies vaccine. The rabies vaccine is made from killed rabies virus. The vaccine cannot cause rabies. Current vaccines are relatively painless and given in the arm similar to other common vaccines.

A special immune globulin can also be helpful in some cases. When it is useful; starting early is important. A medical professional can help you determine if rabies immune globulin is appropriate for your case.

To treat rabies:

If you have been bitten by an animal or exposed to rabies, call your doctor and go to a nearby emergency room immediately. Once there, the doctor will clean the wound thoroughly and give a tetanus shot if you are not up-to-date with your tetanus immunization.

The decision to treat rabies right away by beginning a series of rabies vaccine shots will be based on a number of factors. These include:

  • The circumstances of the bite (whether the bite provoked or unprovoked).
  • The type of animal (wild or domestic; species of animal).
  • The animal’s vaccination history (whether or not it is vaccinated).
  • Any recommendations from local health authorities regarding the circumstance surrounding the bite.

How dangerous is rabies if it is not treated?

Rabies is almost always fatal if it is left untreated. In fact, once someone with rabies starts experiencing symptoms, they usually do not survive. This is why it is very important to seek medical attention right away following an animal bite, especially if the bite is from a wild animal.

Is the rabies vaccine safe?

The risk of the vaccine causing serious harm is very small. Current vaccines used in the United States cause fewer bad reactions than previous rabies vaccines. Typical mild problems include soreness, redness, swelling, or itching at the sit of the shot. Other mild problems can include headache, nauseaabdominal pain, muscle aches, and dizziness.

More moderate to severe vaccine side effects include hives, joint pain, and fever. Signs of a severe allergic reaction include difficulty breathing, hoarseness or wheezing, hives, paleness, weakness, rapid heartbeat, or dizziness. Waiting in the doctor’s office or emergency area for 30 minutes after a vaccine will usually provide time to see if a severe allergic reaction will occur. If you experience any moderate to severe side effects, call your doctor right away.

How can I prevent rabies?

People at high risk of exposure to rabies should get the rabies vaccine before they come in contact with animals that might have rabies. Such people include veterinarians, animal handlers, and all rabies healthcare and scientific workers. Other people should consider pre-exposure vaccination. This group includes people whose activities bring them in frequent contact with animals that could be rabid. Also, international travelers who may visit parts of the world where rabies is common should get a pre-exposure vaccine.

The pre-exposure vaccination schedule consists of 3 doses, given as follows:

  • First dose given.
  • Second dose given 7 days after first dose.
  • Third dose given 21 days or 28 days after first dose.

If the decision is made to begin the rabies vaccine shots and you have never been vaccinated against rabies:

  • You should get 5 doses of the rabies vaccine – first dose immediately, then additional doses 3, 7, 14, and 28 days after the first dose.
  • You should also get a shot of Rabies Immune Globulin at the same time as the first dose of rabies vaccine.

If you have been previously vaccinated against rabies:

  • You should get 2 doses of the rabies vaccine – the first dose immediately, and the second dose 3 days later.
  • You do not need to get a shot of Rabies Immune Globulin.

What are the immediate steps I need to take in case of an animal bite?

  • Wash the bite area with soap and water for 5 to 10 minutes.
  • Cover the bite area with a clean bandage.
  • Call your doctor and go to a nearby emergency room.
  • If you know the animal’s owner, get all the information about the animal, including vaccination status and owner’s name and address. Call your local health department, especially if the animal hasn’t been vaccinated.
  • If you don’t know the animal’s owner or if a wild animal bites you, immediately call your local animal control authorities to get help finding the animal that caused the bite. The animal will need to be confined and observed for signs of rabies.

Gastrochisis

What Is Gastroschisis?

Gastroschisis is a birth defect that develops in a baby while a woman is pregnant. This condition occurs when an opening forms in the baby’s abdominal wall. The baby’s bowel pushes through this hole. The bowel then develops outside of the baby’s body in the amniotic fluid.

The opening is most often on the right side of the baby’s belly button. It can be large or small, but is typically one to two inches in size. In more severe cases, the stomach and/or liver can sometimes make their way through the opening as well.

Because the bowel is outside of the baby’s body, it is unprotected. That means there is a chance it can become irritated, swollen and damaged.

This condition is relatively rare but has seen an increase in recent years. It occurs in about one in every 2,000 babies. It develops early in pregnancy, during the fourth through eighth weeks. Gastroschisis occurs due to a weakness in the baby’s abdominal wall muscles near the umbilical cord. If your baby develops this condition during your pregnancy, you will not experience any symptoms related to it.

Gastroschisis can be repaired with surgery after your baby is born. It is usually not associated with other malformations.

What Causes Gastroschisis?

The exact cause of gastroschisis is not known. It does not appear to be inherited. Having one baby with gastroschisis does not make it more likely that you would have another baby with the condition.

Severity of Gastroschisis

Gastroschisis is labeled as simple or complicated. This is based on how inflamed the bowel and/or organs are that have moved through the opening.

With simple gastroschisis

With complicated gastroschisis, one or more of the following occurs:

  • The bowel outside of the baby’s body is extremely damaged, e.g., a portion of the tissue has died (called necrosis), or the bowel has become twisted or tangled.
  • Intestinal atresia, which occurs when part of the baby’s bowel doesn’t form completely, or the intestine is blocked.
  • Other organs, such as the stomach or liver, protrude out of the opening as well.

Simple cases are more common than complicated ones.

Gastroschisis Evaluation and Diagnosis

It is possible for gastroschisis to be detected in the third month of pregnancy. However, we most often perform evaluations for it at 20-24 weeks, after it has shown up on an ultrasound. It is most commonly diagnosed by ultrasound around weeks 18-20 of pregnancy.

Some women are referred to us for gastroschisis late in pregnancy. We see them within two weeks of their referral. It is important to make a diagnosis and delivery plan as early as possible.

In babies with gastroschisis, the ultrasound will show loops of bowel floating freely. This often shows up when a woman goes in for a routine ultrasound with her obstetrician (OB). It is at this point that most of our patients affected by gastroschisis are referred to hospitals. Here, we’ll work with you to assess how severe your case is and create a plan for the remainder of your pregnancy. We will also talk to you about what to expect after delivery.

An evaluation for gastroschisis consists:

  • An ultrasound (we can use an ultrasound performed within two weeks of your appointment with us, or one will be done on the day of your evaluation)
  • Possibly an MRI and/or a fetal echocardiogram to test your baby’s heart function
  • A meeting with a nurse, social worker and genetic counselor
  • A team meeting with a maternal-fetal medicine specialist (MFM), pediatric surgeon and neonatologist

An important part of the evaluation is determining whether the condition is gastroschisis or omphalocele. These conditions can sometimes look similar on an ultrasound. In omphalocele, a sac from the umbilical cord covers and protects the intestines that are outside of the baby’s body.

After your tests are complete, our team of experts meets with you to discuss the extent of the baby’s condition and its impact on the rest of the pregnancy. We’ll also cover medical treatments that might be needed right after the birth of your child, and long-term prognosis of babies with gastroschisis.

For patients who are local or plan to deliver locally, we also discuss:

  • Delivery at one of our level III hospitals
  • Transferring your baby to Cincinnati Children’s
  • Postnatal surgical care for your baby
  • Length of stay in the neonatal intensive care unit (NICU)
  • Possible complications that could arise

We recommend frequent ultrasounds throughout the remainder of your pregnancy. These will help to monitor your baby’s health, the severity of the gastroschisis, and how it evolves.

Gastroschisis Treatment Options

There are no fetal interventions recommended for babies with gastroschisis. The condition cannot be corrected while you are pregnant. Rather, it must be treated right after your baby is born.

Any baby with gastroschisis must have surgery after birth. An infant cannot survive with his or her bowel outside of the body.

After your baby is born, doctors will assess how severe the gastroschisis is. The type of repair needed depends on how much bowel and/or organs are outside of your baby’s belly and any inflammation or damage to those tissues.

Primary Repair

With a simple gastroschisis, treatment often is what’s called a “primary repair.” This is a surgery where the bowel is placed back inside of the baby’s belly and the abdominal opening is closed. When possible, this surgery is done the day your baby is born.

This type of repair is performed when there’s relatively small amount of bowel outside of the belly, and the bowel is not overly swollen or damaged.

What is polio?

Poliomyelitis (polio) is a disease caused by poliovirus. It happens mostly in children younger than 5 and in parts of the world that have not yet seen wide-scale vaccination.

What causes polio?

A virus called poliovirus causes polio. The virus enters the body through the mouth or nose, getting into the digestive and respiratory (breathing) systems. It multiplies in the throat and intestines. From there, it can enter the bloodstream. It can also attack the nervous system, the nerve network that helps the brain communicate with the rest of the body.

There are three strains of poliovirus: types 1, 2 and 3. Types 2 and 3 have been eradicated (eliminated), but type 1 still affects people in a few countries.

In some parts of the world, a live poliovirus vaccine is still used. This oral live virus vaccine can very rarely cause polio. In the United States and many areas of the world, this live virus vaccine is no longer used and an inactivated vaccine that cannot cause polio is used instead.

Is poliovirus contagious?

Poliovirus is very contagious, and a person can transmit (spread) it even if they aren’t sick. The virus goes from person to person in two ways.

People with poliovirus in their bodies shed the virus through their feces (poop). The virus can then spread to other people when they swallow contaminated water or food. This exposure is more likely in areas that have poor hygiene or weak systems to clean water.

A person can also pick up the virus after someone sneezes or coughs. If you get droplets of an infected person’s phlegm or mucus in your mouth or nose, you can become infected.

What are the symptoms of polio?

About 90% of people infected with poliovirus have no signs of the disease or just mild symptoms. If symptoms do occur, they usually appear about seven to 10 days after exposure to the virus. But symptoms can take as long as 35 days to show up.

Early symptoms of polio are like those of influenza and last about two to 10 days:

  • Fatigue .
  • Fever .
  • Headache.
  • Neck stiffness.
  • Pain in the arms and legs.
  • Vomiting.

While most people fully recover from polio, the disease can cause very serious problems. These problems can sometimes develop quickly (hours after infection) and include:

  • Numbness , a feeling ofpins and needles or tingling in the legs or arms.
  • Paralysis,in the legs, arms or torso.
  • Trouble breathing because of muscle paralysis in the lungs.
  • Death when the muscles you use to breathe become paralyzed.

How is polio diagnosed?

If you have symptoms of polio, contact a healthcare provider. The healthcare provider will ask you about your symptoms and whether you have traveled recently.

Because polio symptoms look a lot like flu symptoms, the healthcare provider may order tests to rule out more common viral conditions.

To confirm polio, a healthcare provider will take a small sample of:

  • Cerebrospinal fluid (liquid around the brain and spinal cord).
  • Saliva from your throat.
  • Stool (poop).

The healthcare team will look at the sample under a microscope to identify poliovirus.

How is polio treated?

While there’s no cure for polio, and no way to prevent paralysis, some things may keep you more comfortable:

. Fluids (such as water, juice and broth).

. Heat to soothe the muscles

. Medications that relax the muscles, also called antispasmodic drugs.

. Pain relievers, such as NSAIDS (non steroidal anti inflammatory drugs) .

. Physical therapy and exercises to help protect the muscles.

. Rest.

. Mechanical ventilation , or a machine that helps you breathe.

How do I prevent polio?

The best prevention against polio is a series of four vaccine shots in the arm or leg.

The inactivated polio vaccine used in the United States is very effective and safe, and cannot cause polio.

The recommended vaccination schedule for children is based on age:

  • First shot when 2 months old.
  • Second shot when 4 months old.
  • Third shot between 6 and 18 months old.
  • A “booster” shot when 4 to 6 years old, for an extra dose to secure protection.

If you didn’t get polio vaccines as a child, you should get three shots in adulthood:

  • First dose at any time.
  • Second dose a month or two later.
  • Final dose six to 12 months after the second.

If you didn’t get all your vaccine doses during childhood, you should get the remaining shots as an adult.

Who should get the vaccine?

Everyone should get vaccinated for polio, preferably during childhood. But even if you’ve had all the normal polio doses, you may need a booster shot if:

  • You work in a lab where you might come into contact with poliovirus.
  • You work with patients who may have gotten exposed to poliovirus.
  • You’re planning to travel to certain areas of the world. (Check the list of countries where polio remains a risk, and talk to your healthcare provider.)

Are polio vaccines safe?

The Centers for Disease Control and Prevention (CDC) considers polio vaccines to be very safe. The CDC tracks vaccine safety and problems.

Any vaccine may cause:

  • Allergic reaction.
  • Pain that lasts awhile (in rare cases).
  • Redness where the needle entered the skin.
  • Soreness in the area where you got the shot.

If you’re not feeling well after a shot or have an allergic reaction, tell your healthcare provider. Also touch base with your provider before future doses.

What does post-polio syndrome feel like?

Symptoms of post-polio syndrome may start slowly and then get worse. They’re like the symptoms of polio:

  • Fatigue.
  • Muscle atrophy (slow decrease in muscle size).
  • New weakness in the same muscles that polio affected.
  • Pain in the joints.
  • Scoliosis (curved spine).

Symptoms of post-polio syndrome are rarely life-threatening, but they can cause difficulties with:

  • Breathing.
  • Participating in normal activities.
  • Sleeping.
  • Swallowing.

Is post-polio syndrome contagious, too?

Post-polio syndrome is not contagious. Only someone who once had polio can have the syndrome.