Dr. Allen Cherer is an accomplished neonatal care specialist with decades of medical experience.

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Author: Dr. Allen Cherer Page 2 of 3

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Tips for After you Receive your COVID-19 Booster Shot

It’s been hard to get through your day without feeling overwhelmed by the news of the COVID-19 pandemic. However, with the help of this blog post, you can start to feel like you have a handle on things. This blog post will provide you with tips for living a healthy life during this pandemic.

What to do if you receive your COVID-19 booster shot

If you’re lucky enough to receive your COVID-19 booster shot, there are a few essential things to know. First of all, you must take the vaccine as soon as possible. The sooner you do so, the better your chances of avoiding the pandemic.

Secondly, while it might be tempting to wait until after a few doses to see if side effects happen, there is no reason to do this. If you avoid being vaccinated now and wait for the virus to start affecting you, later on, you will be putting yourself at risk for more severe symptoms because by then, it will be harder for your body to fight off the virus.

Thirdly, make sure that you have access to plenty of water during this time and stay hydrated at all times. It’s not just good for your health; dehydration can cause severe complications with traveling, work hours, and even home life in general.

How to live a healthy life during COVID-19

It can be challenging to keep up with the news as it comes; however, there are some important things you need to know. You should make sure you’re hydrating, staying active, and watching your diet.

Many experts agree that eating lots of fruits and vegetables is good during this pandemic. Fruits and vegetables provide antioxidants that can help boost your immune system. Additionally, they are nutrient-rich foods that offer a variety of vitamins and minerals.

Some other key areas to focus on during this pandemic include:

  • · Hydration
  • · Exercise
  • · Watching what you eat
  • · Avoiding overusing technology

Tips for managing stress.

If you’re feeling stressed and overwhelmed, here are some helpful tips for managing your stress.

  • Drink a glass of water before jumping into anything else.
  • Take a walk or go to the gym.
  • Make a list of things that help lift your mood, like listening to upbeat music or spending time with friends and loved ones.
  • Practice mindfulness meditation.
  • Ask for help if you need it.
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Understanding Vaccine Mandates

Vaccines have saved millions of lives over the years by preventing diseases like polio, measles, and diphtheria from spreading. But as more people refuse to vaccinate their children because of unfounded fears, those numbers could rise again. This post will explore the mandates of a vaccine.

Prevents diseases

Vaccines are typically thought to work by stimulating the body’s immune system to defend against disease-causing microorganisms, called pathogens. The weakened or killed virus in a vaccine cannot make you sick, but your body can develop the ability to fight the real thing. This is called immunity and the only way to build it is through vaccines.

Safe to use

Vaccines are tested extensively for safety and effectiveness before they come to market. In the United States, vaccines must be approved by the Food and Drug Administration (FDA). This means that vaccines have met strict scientific guidelines, proving them safe and effective. Most vaccine reactions are mild such as fever, redness or soreness where they were given, or temporary aches. Severe side effects are very rare but may include allergic reactions, a severe allergic reaction called anaphylaxis can occur within minutes after vaccination occurs in someone who is known to be allergic to certain vaccine components.

Prevent epidemics

If a critical number of people in a community are vaccinated against the same disease, the odds of outbreaks become very small. This is called ‘herd immunity. Even those who cannot be vaccinated because they have compromised immune systems or other conditions benefit from herd immunity. This is why it is so important for everyone to get vaccinated, especially when an epidemic is looming.

Protects future generations

When enough people are vaccinated, diseases stop spreading. This protects everyone, including future generations because many vaccine-preventable diseases have no cure. Preventing disease through vaccination is one of the most successful and cost-effective health strategies in history. It is crucial to maintain high vaccination rates to ensure that these diseases do not return. Vaccines were responsible for making our world what it is today with all the achievements we’ve had so far.

Vaccines have saved millions of lives over the years by preventing diseases like polio, measles, and diphtheria from spreading. We must keep vaccinating ourselves and our children to protect against outbreaks.

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A Potential Universal Vaccine from Scientists at UVA

While many think that the COVID-19 pandemic is a thing of the past, dozens of scientists throughout the world are working to develop a universal vaccine against the contagion. As demonstrated by the recent rise of the Delta variant, the coronavirus, like any other type of virus, can alter itself to resist vaccines, ensuring its continued survival. A universal vaccine would protect people from any mutation of the coronavirus. Accomplishing this, however, is difficult as scientists must determine what part of the virus is constant throughout all of its variations. Doctors at UVA Medical Center in Virginia believe that they have determined what part of the coronavirus to target in a universal vaccine.

Speaking with reporters from Charlottesville Tomorrow, Dr. Steven Zeichner, an infectious disease specialist at UVA Medical Center, says that his team believes that the fusion peptide of the coronavirus can provide a powerful opportunity in a universal vaccine. Dr. Zeichner explains that the fusion peptide is the part of the virus that sticks to a host’s cells and transfers genetic material. The fusion peptide is present in all variants of COVID-19 and even exists in other types of coronaviruses, namely MERS and SARS. The experts at UVA Medical Center quickly developed a vaccine centered around the fusion peptide and tested it on pigs. Results from the study found that the test animals were immune to COVID-19.

Although Zeichner’s team was happy with the results, it came as a great surprise. Originally, Zeichner and his colleagues were attempting to develop an inexpensive alternative to the current COVID-19 vaccines. Zeichner explains that while the mRNA vaccines from Pfizer and Moderna provide excellent protection against COVID-19, the manufacturing process for them is highly intricate and not available in many parts of the world. Zeichner sought to develop a new vaccine against the coronavirus that would be easier to manufacture by infusing the virus with e-coli bacteria. In preparing to develop the new vaccine, Zeichner’s colleagues examined the genetic sequencing of COVID-19 and realized that the fusion peptide was universal throughout all of its variants.

While Zeichner is excited about the results, he explains that the vaccine is still in development and his team is still altering it to ensure that it offers maximum protection against the coronavirus. Furthermore, as a small lab, UVA Medical Center is not ideally suited to manufacture the vaccine and distribute it on a worldwide basis. To help with this problem, Zeichner has already reached out to the International Vaccine Institute of the World Health Organization.

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Avoiding the Delta Variant While Outdoors

For the majority of the pandemic, it has been recommended that people gather outdoors if they must gather at all, but that appears to be changing a little. The Delta variant of covid-19 has changed the playing field even among the vaccinated. Initially, we were advised to take as much of our daily lives outdoors as possible in order to reduce transmission of the virus. Makes sense, right? Well, with how the Delta variant has changed things, we thought we should put together a list of measures people can take to reduce their risk of exposure to the Delta Variant.

Mask Up!

First and foremost, the easiest thing a person can do to reduce transmission, regardless of whether or not they’re indoors, is to wear a mask. Surgical masks, respirators, and N95 masks have all been shown to reduce transmission by limiting the number of aerosolized particles that spread in our breath, sneezes, and coughs.

Get Vaccinated

Vaccinated people are 25 times less likely to fall significantly ill with the delta variant. Getting vaccinated is simple, free, and absolutely encouraged right now. It is the best way we can help reduce transmission and do our part to flatten the curve. By bolstering our immune systems through vaccination, we can ensure that our bodies will be better equipped to fight off the virus more effectively, and thereby lowering our risk of infecting someone else.

Social Distancing

Beth K. Thielen, MD, Ph.D., is an assistant professor of pediatrics at the University of Montana has encouraged people to continue socially distancing even when outdoors. The Delta Variant has been shown to spread even when outdoors, which has some medical professionals, like Dr. Thielen, rightfully suggesting that we revert to older, more established, and cautious preventative measures.

Conclusion

The increase in both breakthrough cases and outdoor infections indicates that we might need to exercise a little more caution with the new prominence of the Delta Variant. Doing our part to minimize transmission of the virus has become our civic duty as citizens not of our countries, but of humanity itself. The tips and recommendations here aren’t comprehensive by any means, but all of them offer a good rule of thumb to go by.

Reducing Costs and Saving Lives

Sick newborns often rely on a ventilator to supply oxygen, and are tethered by a plastic endotracheal tube (ETT).  Often-times, this tube accidentally pops out.  This represents the fourth most common complication experienced by newborns in NICUs.  It can cause oxygen deficiency (hypoxia), high carbon dioxide levels in the blood, trauma to their airway, intraventricular hemorrhage, code events, and more.  “Unplanned extubations” also have the potential to nearly double the time of a hospital stay and increase the cost of care by $36,000 per patient.  Because of this, the Children’s National Health System’s NICU spearheaded a quality-improvement initiative to reduce the prevalence of unplanned extubations.

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The P-Hack

It’s been said that statistics can be used to prove just about anything.  Take, for example, one study that I recently read about, which examined the link between vegetarianism among pregnant women and an increased risk of drug and alcohol abuse among their children.  The study examined over 5,000 women and their children, and finding that if their mothers ate little to no meat while pregnant, then the children were more likely to drink, smoke, and do drugs at 15.  It’s an interesting study, but at the same time, it’s one that could be part of a phenomenon that’s tragically common in the field of science, and is often used to push an agenda at the cost of objectivity.  I’m talking, of course, about “p-hacking”.

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Working Towards the Elimination of Perinatal Hepatitis B Infection

Hepatitis B virus (HBV) infection  is a serious illness in the newborn and young infant.  The virus,  first discovered in the mid-1960s, is transmitted through percutaneous (i.e., puncture through skin) or mucosal (i.e., direct contact with mucous membranes) exposure to infectious blood or body fluids. The  virus is highly infectious, can be transmitted in the absence of visible blood, and remains viable on environmental surfaces for at least seven days.  Once the virus enters the body, it is transported to the liver where it replicates.  Although one generally thinks of the acute illness as a self-limited one in the adult with characteristic signs and symptoms, HBV infection in the infant is almost exclusively asymptomatic and hence, unrecognized. The devastating aspect of the infection is that the infant and young child frequently fail to clear the virus, and the illness becomes chronic. As many as 80-90% of infected infants progress to chronic infection, and chronically infected persons as adults are at increased risk of cirrhosis, hepatocellular carcinoma, and liver failure with approximately 25% dying from these serious complications.

Before 1982, an estimated 200,000-300,000 persons in the U.S. alone were infected with HBV annually, including approximately 20,000 infants. No effective pre-exposure prophylaxis existed, and only post-exposure prophylaxis in the form of hepatitis B immune globulin (HBIG) was available. However, the first hepatitis B vaccine was approved in the United States in 1981 and proved to be a real game changer. The availability of the vaccine set the stage for remarkable progress in the elimination of HBV infection among all age groups. With the advent of an effective vaccine, incurable hepatitis B infection had become preventable. The vaccine saves lives!

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Unraveling Fragile X Syndrome

In 1943, Julia Bell and James Martin first described the sex-linked heritable condition now termed Fragile X Syndrome (FXS). In their paper, “A Pedigree of Mental Deficit Showing Sex-Linkage”, they described a single kindred in which eleven males spanning two generations  exhibited mental deficiency. After detailed investigation, the researchers concluded that the condition was heritable, sex-linked, and involved abnormal brain development. Since their initial description, much has been learned about Fragile X Syndrome, and yet the odyssey to lessen its impact on affected individuals and their families as well as future generations remains challenging.

 

Fragile X Syndrome is considered the most common cause of inherited intellectual disability. Although disease estimates are probably not precise for a number of reasons, the incidence among males is considered 1/4000 and among females 1/8000. In the 1990’s, the molecular basis for the disease was identified and found to lie within the FMR1 (Fragile X Mental Retardation 1) gene on the long arm of the X chromosome. Since that time, a whole new class of molecular disease has been characterized based on the presence of unstable and abnormal expansions of DNA triplets (trinucleotides). The normal FMR1 gene has CGG (cytosine-guanine-guanine) trinucleotide repeats  in the range of 7-54 in the 5’ untranslated region. The gene codes for FMRP (Fragile X mental retardation protein) which is responsible for the regulation of a number of cellular processes, not the least important of which is the development of brain synapses and the relaying of nerve impulses. In FXS, the CGG repeat expands to over 200. It is this abnormally expanded and hypermethylated  CGG segment that turns off (silences) the FMR1 gene and halts the production of FMRP. The loss or shortage (deficiency) of FMRP disrupts nervous system functions and leads to the signs and symptoms of FXS. Identifying trinucleotide repeats as the basis for disease has brought about a greater understanding not only of FXS but also a complex set of neurological diseases, such as Huntington’s Disease, the spinocerebellar ataxias, and myotonic dystrophy.

 

Since the FMR1 gene is located on the X chromosome and expansions of the CGG repeat  can include greater than the normal but less than the over 200 with the full mutation, a  number of different phenotypes are described based on the affected sex and the number of CGG repeats. In males, the mutation (> 200 trinucleotide repeats) often results in the full spectrum of FXS  signs/symptoms, including intellectual disability, speech/language and developmental delay, facial characteristics ( long face, large ears, broad forehead, joint laxity, macroorchidism) which become more apparent with age, and behavioral disorders (social anxiety, ADHD, autism). In females with the full mutation, the symptoms are often less frequent and severe most probably due to females having two X chromosomes (as opposed to males having a single X chromosome) and skewing of X inactivation among females.

 

The males and females with lesser repeats of the CGG segment (55-200) but greater than normal are said to have an FMR1 gene premutation primarily because expansion to the full mutation can occur in succeeding generations (genetic anticipation). Individuals with the premutation typically are intellectually normal. However, they may have lower than normal amounts of FMRP and consequently exhibit milder versions of the physical features and emotional problems  seen with the full mutation. On the other hand, two related disorders due to the premutation of the FMR1 gene are FXTAS (Fragile X-associated Tremor/Ataxia syndrome), a Parkinsonian-like syndrome occurring mostly in older males, and POI (Premature Ovarian Insufficiency) in females.

 

It is apparent that the spectrum of symptoms in individuals with the full mutation and with the premutation is extremely broad. In addition, the behavioral and developmental symptoms have significant overlay with autism and may be compounded by other neurologic disorders such as seizures. These  features make the clinical diagnosis of FXS difficult and often time-consuming. Fortunately, Fragile X Syndrome can be diagnosed with the blood FMR1 DNA test using Southern Blot analysis or Polymerase Chain Reaction (PCR). Clearly, it is imperative that any child who presents with global developmental delay, autism, and/or intellectual disability be tested for FXS with the FMR1 gene test.

 

Despite advances in the molecular understanding of FXS and its pathophysiology, treatment remains for the most part symptomatic and includes special education, behavioral therapy, and medication specific for ADHD, seizures, and neuropsychiatric problems. Molecules  aimed at targets in pathways that are dysregulated in the absence of FMRP continue to be developed and tested in order to offer effective drug therapies, but thus far overwhelming satisfaction has not been achieved. In the future, it is intriguing to envision the role of genome editing and CRISPR technology in the cure of this single gene disorder.

 

Tackling Postpartum Issues

Tackling Postpartum Issues by Dr. Allen ChererWorking in the field of neonatal care, I know all too well the health risks that come with pregnancy and childbirth, especially among women who can’t readily access health care.  Some common (and serious) postpartum health conditions include diabetes, hypertension, and depression, all of which are more common among racial and ethnic minority women.  However, it’s hardly a lost cause, and doctors can do their part to connect women suffering in the pregnancy and postpartum period to healthcare.  I recently read an article by Elizabeth A. Howell, whose work creating an “intervention design” at Mount Sinai is based around providing postpartum care to women.  This was recently published in the Maternal and Child Health Journal.  

According to the Healthcare Effectiveness Data and Information Set (HEDIS), at least 80 percent of commercially-insured women in this country have a timely postpartum visit.  Yet among those insured by Medicaid, that percentage goes down to about 60.  This is due to various factors: transportation, child-care demands, money, and poor doctor-patient communication.  While there isn’t an “easy fix” to this problem, reducing the barriers between patient and doctor makes it much easier for women to receive the necessary postpartum care.  In the article, Howell outlines various ways that her design reduces that barrier: education about the risks and importance of postpartum care, community resources, and financial incentives for providers who help make sure women return for postpartum care.  Since such a large percentage of patients are Spanish-speakers, her interventions are available in both English and Spanish.  

So far, Howell’s program seems to be yielding some good results: the visit rate for Healthfirst patients at her hospital was up to 71 percent through 2016.  Patients, many of whom are socially isolated, have also expressed their appreciation.  Through my experience, I can tell you just how serious the postpartum period is for the health of mothers as well as children.  I’ve thought about the many positive benefits of assuring comprehensive postnatal care.  In the end, I think this may turn out to be the best way to improve prenatal care, and consequently newborn outcomes.

Tackling Rotavirus

National Infant Immunization Week Blog-a-thon with woman holding baby. #ivax2protect

Rotavirus gastroenteritis is the leading cause of diarrhea-associated hospitalizations and death in children younger than 5 years of age. Rotavirus illness is caused by a virus which enters the body by mouth and infects the intestines. It is a particularly hardy and contagious virus, capable of surviving on inanimate surfaces for long periods and spreading readily from child to child and also to adults. Large quantities of virus are shed in the stool both prior and following acute illness which is characterized by fever, vomiting, and watery diarrhea. Illness typically lasts 3-7 days; death may ensue due to severe dehydration. Since the infection is caused by a virus, antibiotics and antiparasitic drugs are ineffective, and care is primarily supportive. Prior to the development of effective vaccines, 80% of children in the U.S. would develop rotavirus gastroenteritis. Elsewhere in developing countries, the numbers were staggering with more than 500,000 deaths occurring annually in children under 5 years old.

The first rotavirus vaccine, RotaShield (Wyeth Laboratories) was licensed in the United States in 1998 but was withdrawn in 1999 due to a suspected association with intussusception, a type of bowel obstruction. In 2006, RotaTeq (GlaxoSmithKline) was FDA approved, followed by Rotarix (Merck) in 2008. Both are live, attenuated, oral vaccines requiring either a 3 dose or a 2 dose series and have shown significant efficacy in the range of 80-90% in middle and high income countries. Prior to 2006 when routine rotavirus vaccination was recommended, rotavirus gastroenteritis was estimated to result in 400,000 visits to physician’s offices, 200,000 visits to Emergency Rooms, 55,000 hospitalizations, and 20-60 deaths annually among children under 5 years of age in the U.S. for an estimated total cost close to $300 million. Since introduction of the vaccine, the impact has been striking; hospitalizations and rotavirus-related Emergency Room visits have decreased by 80%. In addition, by vaccinating infants, serious rotavirus infections among older children and adults have demonstrated similar declines, presumably through the so-called “herd effect” resulting from wide-spread immunization practice. In summary, clinical trials and experience of rotavirus vaccines in middle and high income countries have demonstrated high efficacy against serious rotavirus disease. Rotavirus vaccination works!

Despite the high efficacy rates of RotaTeq and Rotarix vaccines in middle and high income countries, clinical studies consistently demonstrate lower efficacy rates in the range of 37-61% with either vaccine in the lowest income nations where the burden of rotavirus infection is greatest. Such performance is typical of other live oral vaccines in similar populations. The reasons are not completely understood, but factors such as earlier onset of recurrent episodes of infectious diarrhea, different gut microbiome, the presence of neutralizing antibodies, poor nutritional status, and varying circulating rotavirus strains may play a role. Nevertheless, even a moderately effective vaccine can have a huge public health impact when introduced into a population where the burden of disease is great, especially when combined with the herd protection that occurs when most children in an area are vaccinated and immune.

In 2000, the Global Alliance for Vaccines and Immunization (Gavi) was founded as a public-private global health partnership with the intent to improve childhood immunization coverage in poor countries and increase access to new vaccines. By design, Gavi leverages not only financial resources but also expertise to make vaccines more available, affordable, and their provision more sustainable. The two current rotavirus vaccines obtained prequalification by the World Health Organization (WHO) in 2008 which followed with UNICEF procurement of the vaccines through the financial support of Gavi. These vaccines have been introduced in 42 Gavi-eligible countries and in 6 additional countries classified as low and middle income and have had a major impact on rotavirus-associated hospitalizations and deaths in all settings.

According to WHO estimates in 2013, approximately 215,000 children under 5 years of age die each year from vaccine-preventable rotavirus infections with almost half of them in 4 countries: India, Pakistan, Nigeria, and Democratic Republic of Congo. Ten countries account for almost 2/3 of all deaths. It is in this context that findings recently published in the New England Journal of Medicine related to a new vaccine against rotavirus are incredibly encouraging. The study reported by Isanaka et al. was conducted in Niger in Sub-Saharan Africa, a region with the highest rate of death associated with rotavirus disease and where the current cost of vaccines is probably unsustainable and where refrigeration and transportation are unreliable. The new vaccine, BRV-PV (Rotasil), is a live, oral rotavirus vaccine manufactured by Serum Institute of India and is lower in cost relative to existing vaccines and heat stable for as long as 6 months at 104 degrees F. and for 2 years at 98.6 degrees F. In a double-blind, placebo-controlled randomized trial including over 4000 healthy infants, the new vaccine was found to have a calculated efficacy rate of 67% with no apparent short term adverse events. Since existing vaccines are costly and require refrigeration, the new vaccine provides major advantages in resource-constrained countries where the burden of rotavirus is greatest. If further surveillance continues to yield good findings, the new vaccine promises to provide a giant step in the progress against rotavirus.

 

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