Bye-bye measles, hello mumps?

I saw an almost 2-year-old child this morning who’d been given all his vaccinations. He’d had fever since last night, and this morning his mother noticed that the right side of his face and the area under his lower jaw were swollen. My examination wasn’t conclusive – I wasn’t entirely certain that the infection was in the parotid salivary gland; it might also be a bacterial infection of the surrounding lymph nodes (acute lymphadenitis). But as I’d heard that mumps is now circulating in Borough Park among the ultra-Orthodox Jews – the very same location and demographic which had a measles epidemic a few short months ago, and whose relatives are among the population I serve, it was definitely worth checking to see if mumps had arrived in our area as well.

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What to do about the flu

Truth be told, I’ve been discussing the flu and flu vaccines – both seasonal and the swine/H1N1 variety – at work for at least 3 months now. We’ve been seeing a lot of swine flu around here – mostly, thank God, mild cases, but I’ve given my share of Tamiflu to ill pregnant women, asthmatics, and even a little girl with leukemia. It’s about time I discussed it here.

Seasonal flu vaccination is in full swing in our clinic. Spurred by the death of a local woman (she was not a patient of my clinic, but lived across the street) and her full-term fetus from swine flu, patients have been getting themselves and their children vaccinated in record numbers this year.

The first H1N1 vaccine doses arrived here in Israel about 2 weeks ago from Switzerland, but in typical Israeli fashion, the Health Ministry decided not to allow their use in pregnant women (who are 4-5 times as likely to die if they contract the flu) and children under 3 years of age. I was told by our local infectious disease specialist this week that the reason for this was because they contained squalene as an adjuvant, and because squalene is not FDA-approved, the Health Ministry decided to await the arrival of vaccine which doesn’t contain it to vaccinate these groups. The rest of us will be getting the vaccine starting December. (Hebrew link to the Israeli Health Ministry’s FAQ on the subject).

Yes, that sound you hear is my head banging on the desk in frustration.

Anyhow, if you’d like some reliable, alarming (but not alarmist) actual information about swine flu, you’ll want to go to the CDC’s website on the subject. I’m putting their flu widget on the sidebar for now as well, so that if you can access the site from anywhere on the blog if you want to be up on the latest.

Of course, no matter what vaccine is under discussion, you can count on the usual anti-vax crazies to come up with horror stories and conspiracy theories. Dr Val Jones and crew give Dr Joe Mercola (and I use the term ‘Dr.’ very loosely here) a well-deserved tongue-lashing; also has an excellent response to all those hysterical emails you might be getting on the subject (like the one on my local email list today, which quoted liberally from websites such as and

Orac, of course, also weighs in on a story being put out by anti-vaxers about a young woman who allegedly developed dystonia after receiving a flu vaccine. The verdict: most probably a psychogenic disorder. (I have to admit that I thought the same thing when I first saw the video in question, but not being an expert on the subject, I would have hesitated to state this categorically without an expert opinion).

EDITED Nov 5th TO ADD: Sure ’nuff

And I really can’t talk about vaccines – H1N1 or otherwise – without exhorting those of you (yes, all 3 of you 🙂 ) who haven’t read this fabulous article at yet, to go and read it. Now.

An Israeli look at elective cesareans

I’ve pointed out in the past that medical/scientific reporting in the lay press often leaves much to be desired, accuracy-wise. There are exceptions to this rule, however. I’ve found one of those exceptions to be Judy Siegel-Itzkowitz of the Jerusalem Post. I have no idea what credentials she posesses, but at least regarding the subjects I know enough about to judge, her writing has always been clear, fairly accurate and easy for an intelligent layperson to understand. All the more remarkable when you consider that she has several articles in every day’s paper, including a regular ‘Reader Rx’ column, where reader’s medical questions are matched up with, and answered by, Israeli and American medical experts.
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New to the science-based blogosphere

I’ve been updating my blogroll today, and I’m happy to say that compared to…well, not too long ago, there are plenty of link-worthy new blogs out there.

Most of you probably already know Dr. Amy Tuteur from Homebirth Debate (which is staying in my blogroll even though it’s no longer active, because it’s a great resource). Building upon the success of her newer blog at Salon, she has now launched The Skeptical OB. Some of the subjects might seem familiar to you from her previous blogs, but there is a lot of new material as well, and knowing Amy, the discussions in the comments are sure to be interesting. 🙂

Squillo, a commenter here who I first met in the comments of Dr. Amy’s blog, has decided to try her hand at blogging as well. She does so (and very well, I might add) at Confutata. Don’t miss her recent takedown of Jim Carrey’s HuffPo screed. (Yes, I know I should have tackled that one, but so many have already, and did it so much better).

Lastly, I recently found a new blog (up since January) written by a Canadian pharmacist, Scott Gavura, called Science-Based Pharmacy – not to be confused with the other two blogs in my blogroll with similar names (which are also always worth a look). Scott’s post on bioidentical hormones is a favorite of mine – a fellow family physician with an ‘alternative’ bent living in my city has made millions by prescribing these to all the posh Tel Aviv ladies with hypochondria and money to burn *sigh*. Similarly, his most recent post on the efficacy of other ‘natural’ treatments for menopausal symptoms is a great read.

Have fun reading! 🙂

Hope for a CMV vaccine

Cytomegalovirus, or CMV for short, belongs to the herpesvirus family, along with the herpes simplex, Epstein-Barr, and chickenpox virus. It causes a mononucleosis-like disease similar to EBV, mainly in teens and young adults (they don’t call it ‘the kissing disease’ for nothing!), and in children the primary infection may have no symptoms at all or mimic another viral infection. Like all herpesviruses, it stays in the body indefinitely, occasionally and asymptomatically entering the bloodstream and other bodily fluids. Transmission to another person is usually accomplished by sharing utensils, kissing, and rarely via blood products. In immunosuppressed people, CMV (either primary infection or reactivation) can cause very severe and life-threatening infections.
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