What Is Meningococcal Meningitis?

Meningitis happens when an infection causes swelling of the meninges, the protective layers surrounding your brain and spinal cord. While many organisms can cause meningitis, the meningococcal bacteria (Neisseria meningitidis) is particularly deadly.

These bacteria live harmlessly in many people’s throats and noses. But when they invade the bloodstream or cerebrospinal fluid, they move fast. We’re talking hours, not days. The infection spreads easily in close living quarters: boarding schools, university residences, camps, and creches.

Who’s most at risk?

• Infants between 6 months and 3 years
• Teenagers and young adults
• Anyone in close living quarters (dormitories, camps)

Meningococcal Meningitis Symptoms: What to Watch For

The speed of this illness is what makes it so dangerous. A healthy child can deteriorate within hours.

Early warning signs:

• High fever that appears suddenly
• Severe headache
• Stiff neck
• Nausea and vomiting
• Confusion or difficulty concentrating
• Extreme sensitivity to light

Critical symptoms requiring immediate medical attention:

• Petechial rash (brown or purple pinpricks on the skin that don’t fade when pressed)
• Drowsiness or difficulty waking
• Seizures
• In infants: bulging fontanel (soft spot), constant high-pitched crying, body stiffness

That rash I mentioned? It’s caused by broken blood vessels. In severe cases, it leads to tissue death and amputations. This is why every hour counts.

Why Isn’t This Vaccine on the Government Schedule?

Many parents ask me this. The meningococcal immunisation isn’t part of South Africa’s free EPI schedule as yet, which means you’ll need to get it privately. But consider the numbers from the USA: before the vaccine, they saw 15,000 cases annually. In post-vaccination programs, the USA reported 422 cases in 2023 and 503 in 2024.

As Dr Maraschin, I’ve walked the meningitis path with families. The children who survived without permanent damage are the minority. Most face lifelong challenges, learning difficulties, hearing loss, or physical disabilities. When prevention exists, why take the risk?

When Should Your Child Get the Meningococcal Vaccines?

Recommended schedule for Men B vaccine:

• First dose: 10 weeks
• Booster: 18 weeks
• Catch-up schedules available for older children and adults

Recommended schedule for MEN A, C, W, Y:

• First dose: 9 months
• Booster dose: 15 months
• Catch-up schedule for older children and adults

Other Vaccines That Protect Against Meningitis

The meningococcal vaccine is important, but other routine vaccinations also prevent meningitis:

Pneumococcal vaccine (given at 6 weeks, 14 weeks, 9 months): Prevents pneumococcal meningitis, which primarily affects infants and young children.

Haemophilus influenzae vaccine (part of the 6-in-1): This bacterium once caused 80% of childhood meningitis cases. The vaccine has virtually eliminated it.

MMR and chickenpox vaccines: These prevent viral meningitis complications, less deadly than bacterial, but still serious.

Keeping your child’s vaccination schedule current provides layers of protection against multiple meningitis-causing organisms.

Beyond Vaccination: Daily Protection

Since meningococcal bacteria spread through respiratory droplets and saliva, teach your children:

• Don’t share drinks, food, or eating utensils
• Wash your hands thoroughly before eating and after using the bathroom
• Cough and sneeze into elbows, not hands
• Stay home when sick

These same practices we emphasised during COVID-19 apply here too.

The Bottom Line

I’ve treated children with meningitis. The devastating reality is that many don’t recover fully, despite our best medical interventions. Their parents face a lifetime of caring for a child with disabilities that could have been prevented.

The meningococcal vaccines aren’t perfect, no vaccine is, but it dramatically reduces risk. When you’re looking at an untreated mortality rate greater than 50% for an infection that strikes within hours, prevention makes sense.

Book your child’s meningococcal vaccine at our Johannesburg practice. As a paediatrician, I’ll review your child’s complete vaccination status and discuss which additional immunisations might benefit your family’s specific situation.

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What is Whooping Cough (Pertussis)?

Whooping cough is a bacterial infection that causes respiratory tract inflammation and uncontrollable coughing fits. The “whoop” sound occurs when a person gasps for air after a coughing spell.
Click here to listen to the distinct whooping sound in children.

How is Whooping Cough Spread?

The infection spreads easily through respiratory droplets when an infected person coughs, sneezes or breathes near others. Once exposed, symptoms typically appear within 5 to 10 days.

Symptoms of Whooping Cough

Whooping cough progresses through three stages:

1️⃣ Stage 1 (Early Symptoms):

• Runny nose, sneezing, mild fever, and a mild cough.
• Infants may have difficulty breathing rather than coughing.

2️⃣ Stage 2 (Severe Coughing Fits):

• Lasts 1 to 6 weeks, sometimes up to 10 weeks.
• Rapid, violent coughing fits that worsen over time.
• Symptoms may include vomiting, extreme exhaustion, and the signature “whoop.”
• Babies may experience apnoea (pauses in breathing for over 20 seconds).

3️⃣ Stage 3 (Recovery):

• Lasts 2 to 3 weeks.
• Coughing becomes less severe but may return for months.
• Increased vulnerability to respiratory illnesses.

Why is Whooping Cough a Concern?

Whooping cough can be particularly dangerous for infants under six months old due to their limited immunity. Complications may include:

• Breathing difficulties (apnoea).
• Pneumonia.
• Dehydration and weight loss from poor feeding.
• Pulmonary hypertension (increased pressure in the lungs and heart).
• Seizures.
• In severe cases, brain damage due to lack of oxygen.

Older children and teenagers may experience less severe complications such as:

• Broken blood vessels in the eyes or skin.
• Bruised or cracked ribs.
• Abdominal hernias from intense coughing.

How to Protect Your Child from Whooping Cough

Whooping cough is preventable through vaccination. Both the South African Government and private schedules recommend pertussis vaccines at the following intervals:

• 6 weeks, 10 weeks, and 14 weeks.
• Booster doses at 6 years and 12 years.
• Pregnant women: A pertussis vaccine in the second or third trimester protects newborns during their most vulnerable first six weeks of life.

💡 Key Tip: Don’t skip the booster vaccines at 6 years and 12 years. Many cases occur in teenagers due to missed boosters, combined with vaccine hesitancy and the absence of mask-wearing.

What to Do if Your Child Contracts Whooping Cough

If your child develops whooping cough, immediate medical care is essential. Antibiotics are used to prevent the spread of the infection but do not cure the cough itself. Other supportive treatments include:

• Clearing thick mucus from the airway through suctioning.
• Administering oxygen during severe coughing fits.
• Providing intravenous fluids if dehydration occurs.

These treatments often require hospitalisation to monitor and manage symptoms effectively.

Conclusion

Whooping cough is a preventable disease that causes significant distress and complications, particularly in infants. Vaccinations remain the most effective way to protect your family from this illness. Let’s work together to ensure our children are vaccinated and kept safe.

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Should my child receive the measles booster?

The simple answer is YES! Over the last three weeks, my practice has been inundated with calls from parents inquiring about the measles booster vaccine.

Why are we doing a booster?

Toward the end of 2022, the Health Department reported some confirmed measles cases in the Limpopo area. Since then, the number of cases has risen to 406 cases. By the third week of 2023, Gauteng had reported a total of 25 confirmed measles cases. Limpopo reported a total of 149 cases, Mpumalanga had 81 cases, and North West Province had 133 cases.

Most cases are between the ages of 5 to 9 years, although children younger than a year have been reported in Limpopo.

Unfortunately, the vaccination status of 80% of cases is unknown. 11% were unvaccinated, and 9% were vaccinated. We must remember that COVID-19 did interrupt many vaccination programs, so it is essential that children now receive their vaccinations as a matter of urgency. Your Health Care Provider or clinic can assist you with a catch-up program if your child is missing any of his or her vaccinations.

My child has been vaccinated. Must they still have the booster?

Most of the children in my practice received their measles vaccinations at 12 months and 15 months. If they are old enough, then they would have received a booster at 6 years of age. Fantastic!  You must have the booster even if your child has had these vaccines. Not all vaccinations are 100% effective, so by doing the booster, you are ensuring the best possible protection for your child. The Health Department is going around the schools offering a measles booster. Parents are encouraged to allow their children to have this booster.

If your child received a measles vaccine or the MMR vaccine in the last two months, then you do not have to do the booster.

What happens with children under 1 year of age?

The current vaccination schedule offers a straight measles injection at the age of 6 months. This vaccination is generally available from your Government Clinics or pharmacies that offer vaccinations.

The MMR vaccination, which protects against Measles, Mumps and Rubella in a single injection, is usually given at 12 months. It is repeated at 15 months, and a booster is given between the ages of four years and six years.

Please discuss the options with your Health Care Provider.

Not all rashes are measles

Understandably there is a lot of concern about measles in our community. However, parents must please be aware that there are a lot of illnesses that cause rashes.

I have seen a lot of children in my practice recently with rashes. Not one of these children had measles. The majority of rashes turned out to be either Coxsackie (hand, foot and mouth) or Roseola. Coxsackie typically starts on the palms of the hands or under the feet and then spreads to the rest of the body. Roseola starts with very high fevers for 3 to 4 days with nothing else to find. The fever then breaks, and the baby gets a fine red rash all over the body (that is why some people like to call this “baby measles”).

If your child develops a high fever and a rash, you must have it seen to. If the doctor suspects measles, this must be confirmed by a test sent to the laboratory. Measles is a notifiable disease which means that the Department of Health needs to be informed and specific protocols have to be followed.

Measles has specific characteristics. As mentioned above, the illness is associated with high fevers and a rash. Over and above this, the patient will have a runny nose, red eyes and a cough. Measles is a very serious illness, and because of this, the diagnosis must be confirmed, and the necessary authorities informed.

Where do I go to get my baby vaccinated?

As stated above, the straight measles vaccine is available from Government Clinics and certain pharmacies. Many of the private healthcare facilities offer the MMR vaccine.

Many of the schools have been offering the booster so if your child’s school is offering the vaccine please have it done.

Parents with concerns about the vaccination schedule should seek the advice of trained Health Care Practitioners. It is really important that the information you receive is up-to-date and scientifically accurate.

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Vaccinations have begun in a number of countries including Britain, the US, France, Canada, Germany, Israel the Netherlands and other countries. The aim is to protect the most vulnerable in these societies. Despite the good intentions, people are cautious about the vaccine and asking a lot of questions. In times of uncertainty I always find it best to begin with what we do know. Thereafter, one can consider legitimate questions and then weigh up the pros and cons of the unknown.

What do we know?

1. There are many vaccines being developed at the moment. Most of these are either mRNA vaccines (eg Pfizer and Moderna) or viral vector vaccines (eg AstraZeneca and Johnson & Johnson).
2. It is most likely that South Africa will receive the viral vector vaccines. These vaccines do not have to be stored at extremely low temperatures and are less expensive.
3. These vaccines were being developed long before the COVID-19 outbreak in 2020. Following the outbreak of other Corona viruses such as SARS in 2002 and MERS in 2017/2018, scientists began working on a vaccine. The vaccines being tested and administered are an extension of this research.
4. Each of the vaccines being used have passed through the various phases of testing. Phase 1 (safety/dosage), Phase 2 (human safety), Phase 3 (human efficacy).
5. The trials have shown that the vaccines have prevented COVID-19 in the communities where they have been administered.
6. None of the vaccines contain any of the live virus. These vaccines use very clever technology whereby your own body is instructed to produce a protein which triggers an immune response to the COVID-19 virus, thereby killing the virus.

Why can’t we wait for herd immunity?

To answer this question it is important that we understand what herd immunity means. Essentially “herd immunity” is a term used when enough people in a population have enough immunity to prevent further outbreaks. In terms of COVID-19 that would be the population of the whole world as it has affected people all over the globe.

Herd immunity to a specific illness depends on:

• How long immunity to that infection lasts
• How many people need to have immunity before the disease can be controlled. The number is usually around 70% of people. Scientists have stated that in the case of COVID-19 the number may need to be as high as 90%. This is due to the speed with which it is transmitted and mutates,

From the data that we currently have, natural immunity to COVID-19 only lasts for between three to nine months. This is why we are seeing evidence of people getting COVID-19 twice in a short space of time. For herd immunity to be achieved between 70 to 90% of the population would need to be ill every nine months. South Africa would need a minimum of 42 million COVID-19 positive people every nine months to achieve herd immunity. Our economy, health systems and population could not endure this. Imagine the population of the United States having to experience 230 million cases annually with around 2.3 million deaths each year.

To quote: “In other words, it’s impossible to achieve herd immunity to COVID-19 through widespread transmission”

Basically herd immunity is not an option. We need to have a vaccine which can achieve immunity without the devastating effects. We have seen the world literally rid itself of polio due to the vigorous vaccine programs. We have also seen measles contained and then cause huge devastation when the vaccine programs were interrupted. We want COVID-19 contained in a similar way.

Who can safely have the vaccine?

The answer to this question is not straight forward. As the vaccine is administered to more people we will learn more about it. For now however, we should consider what the Centres for Disease Control and Prevention are recommending:

• Children and teens – The vaccines were tested for people 16 years and older. There are new studies underway in the age group 12 to 15 years. Studies in children under the age of 11 years will take more time as there has not yet been work done to test the correct dose appropriate for this age group. So for now the vaccine would only be available to those over the age of 16 years in the priority group.
• Pregnant people – The vaccines developed for COVID-19 have not yet been tested on pregnant people. As one can imagine, drug and vaccine makers are always cautious of including pregnant people in initial trials for fear of injuring the foetus or threatening the pregnancy.
• Lactating people– To date the vaccine safety for lactating people has not been studied. Having said this, the mRNA vaccines are not thought to pose a threat so in instances where a lactating person is in a priority group then they may be vaccinated if they so choose.
• People with allergies-The CDC put out clinical guidelines for those who suffer from allergies. There are 3 main categories- don’t vaccinate, vaccinate with caution and proceed with vaccination. People who have had a severe reaction to any of the components of the vaccine should not be vaccinated. Those that have previously had a severe reaction to any vaccine or injectable therapy can be vaccinated, but with caution. In other words the decision would be made in conjunction with your healthcare provider. People who have minor reactions to food, insects, animals and latex and other common allergens can be vaccinated.

What about the side effects?

• Over 200 000 volunteers participated in the trial of the various vaccines and to date over 1.1 million people have been given a vaccine.
• Data thus far indicates that most people experience mild side effects like redness at the site of the vaccine, fever and a headache. The symptoms disappear after 2 days. These are side effects that many people experience with other vaccines.
• A few patients have had allergic reactions which is why it would be important to have the vaccination in a medical facility where a patient can be observed for 15 to 30 minutes.
• The Australian government cancelled an order for a vaccine which was being developed by an Australian firm, CSL and the University of Queensland. Candidates in their trials got false HIV positive results. The Australian vaccine has since been abandoned altogether.
• As greater numbers of the general public receive the vaccines, researchers will be provided with data of other or rare reactions to the vaccines. CNN reported that on 18.1.2021, 149 people per minute were being vaccinated in the UK. This is a huge number of people and it will certainly provide us with a lot of data.

Conclusion

Research has shown that we have not been able to rid our world of aggressive viruses without a vaccine program. This goes for illnesses such as measles, small pox and polio. COVID-19 is another aggressive, fast spreading virus. Healthy children will definitely be among the last group to be offered a vaccination, so parents will have time to process the facts.  Ultimately though, it is highly unlikely that we will be able to stop this illness without a significant vaccination program.

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From what age can my child wear a mask?

It is not recommended that a child under the age of two years wears a mask. The mask will probably not be tolerated by a younger child and this will also encourage the child to touch their face excessively. A child of this age cannot understand the concept of using a mask. The mask itself can pose difficulties in breathing and might be a choking or suffocation hazard.

Is it important for everyone to wear gloves?

The World Health Organisation does not recommend the use of gloves as a means of protecting against COVID-19 illness. The wearing of gloves gives you a false sense of security and may make you less likely to keep up handwashing and using alcohol sanitisers. A person also needs to know how to take off the gloves properly if you have worn them and most people will get this wrong and defeat the purpose altogether. Washing hands remains the number-one hygiene regime.

Is it true that coronavirus can live on a surface? If so, for how long?

Scientists are still doing research in order to answer this question fully. The length of time a virus can live on a surface is also dependent on the environment with factors such as heat and sunlight playing an important role. The virus prefers the cold. The virus generally prefers smooth, non-porous materials. Examples of these would be glass, jewellery, doorknobs and silverware, where it can live for up to five days.

The virus lives for a shorter time on other surfaces: on wood for four days, plastic and stainless steel three days, cardboard 24 hours and copper surfaces four hours. It is really important to remember that even if the virus is found on a particular surface, it may not necessarily cause illness. The virus starts to deteriorate the minute it hits the surface and is then less likely to cause you harm if you come into contact with it after some time.

Should I be taking my baby for their vaccines? What about my older children – can theirs wait?

Keeping your child’s vaccines up to date is really important. While COVID-19 is around at the moment, so are the other illnesses. It is crucial that you protect your child from the illnesses that are vaccine-preventable. Your child will be a lot sicker if dealing with an illness like chicken-pox or rotavirus and COVID-19. Please select a clinic where strict social distancing is adhered to. A healthy child should not be taken into an environment where there are a lot of other people for their vaccinations.

It’s flu season – must I still take my family for a flu vaccine?

I am personally in favour of the flu vaccine. I recommend it for all my patients from six months of age. At the moment, we need people to be as healthy as possible so if we can prevent certain strains of illness then it is a good idea to do so.

Will this vaccine make them vulnerable to coronavirus (i.e. if they have any of the usual symptoms after the vaccine)?

South Africa uses an inactivated form of the flu virus in the vaccine. If a person gets symptoms after the flu vaccine, it will just be their immune response to the vaccine rather than the vaccine making them sick. The flu vaccine contains three to four different types of flu viruses. These are completely different from COVID-19, so it will not make a person more susceptible to COVID-19.

“KEEPING YOUR CHILD’S VACCINES UP TO DATE IS REALLY IMPORTANT. WHILE COVID-19 IS AROUND AT THE MOMENT, SO ARE THE OTHER ILLNESSES”

Will I know/how can I know the difference between a cold, flu and coronavirus?

It will not be easy to differentiate between a cold, flu or coronavirus. We know that there are many patients who do not even know that they are positive for COVID-19. Others may have mild symptoms, severe symptoms and still others may be critically ill. The symptoms are all similar so you would have to determine with your doctor if a test is necessary, as this is the only way to be really sure if you are dealing with COVID-19 or not.

My child has asthma – is there anything more I can to help protect them?

A parent with an asthmatic child will be more concerned at this time and rightly so. My recommendation would be to follow the asthma maintenance programme that your child has been given very strictly so that their asthma remains well controlled. For any child, I would recommend a supplement of vitamins C and D and zinc as we head towards the peak of COVID-19. Once the risk has subsided, you must reassess if the vitamins are still necessary. A child with a good, mixed diet would not need to take the vitamins indefinitely.

I’m too scared to take my child to a doctor’s office in case they are exposed. Do you offer online consultations?

I am very weary of online consultations. It is not easy for a parent to interpret a child’s symptoms especially when dealing with a young infant. I need to examine the patient and understand their history. In adults, it is very different. We can describe our symptoms. To protect my patients, I don’t allow more than one family in my rooms at a time. This way I can sterilise between each consultation.

Having the baby in front of me and physically examining the baby is vital. Most of my colleagues have not been at work at all. I have literally been the lone ranger at our office complex with 10 buildings all housing multiple doctors. I believe that seeing my patients, examining them and understanding the parents’ concerns is the best way to care for my patients.

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Having said this I am sitting in front of my PC, trying to decide if this is a topic I feel I should be tackling. It is a strange place to find oneself in as a medical practitioner because the truth is that this is a very new virus, hence it being called “novel” and not too much is known about it. Being “novel” also means that those first infected by the virus had no natural immunity to the virus.

I have spent some time reading the literature and trying to sift through the information overload which has been presented to us since the first reported case on 31 December 2019.

What I do know is that Africa has very few confirmed cases and South Africa currently has one confirmed case to date and really reassuring, to me as a paediatrician, is that children seem to have milder symptoms than adults, are less vulnerable to the infection and to date no child under the age of nine years old has passed away as a result of COVID-19. The highest risk of death is in the elderly (over 80 years old). This means that, much like with the influenza virus, granny and grandpa or those with chronic conditions such as diabetes or heart conditions are more at risk of developing life-threatening complications from COVID-19. Thankfully children appear to be protected from this novel virus, which is certainly not the case with influenza.

Let’s try to answer some of the current, burning questions, bearing in mind that the answers may change as new information is gathered around this novel virus.

What exactly is Coronavirus?

What we are all currently concerned about is COVID-19. This is a new strain of the Coronavirus family.

Coronaviruses are spread from animals to people and may result in a common cold or a severe chest infection like pneumonia.

The world has experienced other Coronaviruses. In 2002 the SARS virus spread throughout the world but was originally transmitted from civet cats to humans. MERS was another of the Coronaviruses with its origin being camel to human transmission.

COVID-19 also arose from animals but like the other viruses, is now spread from human-to- human through respiratory droplets and close contact (around 2m). The latest information coming out of America is that the virus has also become a community virus. In other words, a person who gets the virus may not be aware of being in contact with an infected person. Instead, they may pick it up because the virus itself has been left behind on a surface like a keyboard, desks, clothing and so on. This makes control more difficult.

Watch this video of Prof Barry Schoub, World Expert Virologist

When is the most infectious time for the virus?

Since the virus has only been present in humans for a couple of months the information is based on the current statistics.

The incubation period for the COVID-19 virus is thought to be 2 to 14 days. Most patients are thought to be contagious while they have symptoms. The symptoms may last as long as 19 to 21 days.

Four healthcare workers still tested positive for the virus 5 to 13 days after their symptoms had cleared.  Scientist are unsure at this point if these people were still infectious after the symptoms cleared despite the positive tests.

The statistics, therefore, indicate that some people may be ill for as long as three weeks to four weeks.

What are the symptoms of COVID-19?

In the majority of cases most people suffering from COVID-19 will have mild cold-like symptoms. There are reported cases of people who had no symptoms at all but for the most the symptoms would include:

In mild cases

• Fever
• A dry cough
• Headaches
• Muscle pain
• Sore throat
• Difficulty breathing

In severe cases

• Severe pneumonia
• Acute Respiratory Distress Syndrome
• Kidney failure
• Sepsis
• Death

What should I do if the symptoms do appear?

In most cases it is more likely to be a common cold or flu. If you or a family member have recently (in the last three to four weeks) traveled to areas where the COVID-19 virus is prevalent or if you have been in close contact with an individual from one of these countries and the symptoms described above develop then action should be taken. Phone ahead to your healthcare practitioner and describe the situation. Going and sitting in a waiting room full of other people is not a good idea as you may then spread the virus to other individuals. Your healthcare practitioner will be able to advise you on the correct steps to follow.

There are strict protocols in place to assist you.

What can we do about COVID-19?

At the moment, we can protect ourselves by not traveling to the places where the illness is prevalent. This would include China, South Korea and Italy. Countries that should be avoided if possible include Iran and Japan with Hong Kong, Singapore, Taiwan, Thailand and Vietnam being cautioned against. Within South Africa, avoid areas where you will come into contact with lots of people and follow our steps below.

There are precautions which need to be taken. These are pretty standard things which I would hope people with flu would follow in any case:

• Wash hands often with soap and water for at least 30 seconds.
• Keep your distance from sick people.
• Cover your mouth with your elbow and turn away from people if you are going to cough or sneeze. Avoid using your hand to cover your mouth because you are likely to touch a surface and spread the virus.
• Put dirty tissues into a sealed packet or flush them down the toilet. Wash your hands immediately after throwing your tissue away.
• Stay at home when you are sick and get plenty of rest.
• Stay well hydrated
• Make sure you are eating properly and that your body is getting all the right nutrition to fight infection. Foods with good sources of vit C and zinc should be included in the diet. A zinc supplement may also be helpful because our food is often lacking in zinc.
• Thoroughly cook meat and eggs
• It has also been suggested that flushing your nose with a saline nasal spray containing xylitol will help control viral infections. This can be done throughout the day but can also be done at the end of the day when everyone is home. A normal saline solution will also do the trick.
• Normal surgical masks only protect others from you. If you cough or sneeze while ill it would prevent your droplets being released into the air. Most masks won’t fit properly over the nose and mouth to prevent other people’s particles getting into your airways unless you have a properly fitted respiratory mask that forms a tight seal around your nose and mouth.

In cases where symptoms are severe the authorities will advise us. Patients will need to be tested and isolated from the general public if necessary. Treatment is supportive with bed-rest, fluids and oxygen if necessary. If organ failure sets in then medical care in an ICU setting would be necessary.

What now?

This is truly the million-dollar question. For now, don’t get into a mad panic. I assure you that our authorities have put measures in place to deal with the virus. Protocols have been circulated to medical practitioners to prepare for the virus crossing our borders. We have to be vigilant but not hysterical. We are moving towards winter when colds and flu are part and parcel of family life.

I would suggest the flu vaccine to protect your family against the strains we can do something about. Other than that, eat well, get out into the fresh air and away from crowds and do your best to keep stress levels low. Stress, lack of sleep and poor nutrition are known factors in lowering of the immune system. We certainly don’t want any of that until we have found a vaccine or anti-viral agent that can contain this new, unpredictable virus.

Scientists are working frantically on a treatment but this may take as long as a year to be produced. The measures put in place in China have meant that the rate of new infections has slowed down in China relative to the rest of the world. In my opinion, this is a good sign as we are able to learn from and model ourselves on action taken by other countries.

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I have heard many grandparents in my practice tell me about the chickenpox parties or getting sick children to bath with their siblings so that the kids could get chickenpox over and done with. I get it! December holidays with the whole family confined for weeks at a time was not much fun back in the day. Today, however, we do have alternatives and you need to be informed about what this illness is and what the consequences are so that you can protect your baby.

What is chickenpox?

Let’s start with a definition. Chickenpox is an infection caused by the varicella-zoster virus. It is characterised by fever and blisters all over the body, and is highly contagious to those who have not had the illness nor have not been vaccinated against it.

The disease is generally mild in healthy children. In severe cases, the rash can cover the entire body, and lesions may form in the throat, eyes, mucous membranes of the urethra, anus and vagina.

Once the child has recovered from chickenpox, the virus may remain in the body (inactive or latent), usually in the nervous system. Later in life, the virus can be reactivated and the person will suffer a very painful illness known as shingles.

What are the symptoms of chickenpox?

The difficult thing about chickenpox is that an individual is contagious to others two to three days before the rash appears. If your child has been exposed to chickenpox, then it can take between 10 and 21 days before the rash appears. Once the rash appears it can last anything between five to 10 days for the illness to pass. Now you can understand why granny was keen to get the process over and done with!

The other signs and symptoms are:

• Fever
• Severe itching
• Loss of appetite
• Headache
• Tiredness and a general feeling of being unwell (malaise)

Once the chickenpox rash appears, it goes through three phases:

• Raised pink or red bumps (papules), which break out over several days;
• Small fluid-filled blisters (vesicles), which form in about one day and then break and leak;
• Crusts and scabs, which cover the broken blisters and take several more days to heal.

The blisters usually appear on the head or chest first and then spread to the rest of the body. New bumps usually continue to appear for a number of days, so you may have all three stages of the rash — bumps, blisters and scabbed lesions — at the same time. Chickenpox is contagious until all broken blisters have crusted over.

THE CENTRES FOR DISEASE CONTROL AND PREVENTION ESTIMATES THAT THE VACCINE PROTECTS 98% OF CHILDREN WHO GET THE CORRECT DOSE. IF THEY DO GET THE ILLNESS, THEN THE SEVERITY OF THE DISEASE IS LESSENED.

What are some complications associated with the chickenpox virus?

For most children, chickenpox is a mild illness. They will feel very miserable as a result of the itchy, painful blisters and fevers, but this will all be over in five to 10 days. However, there can be other complications as a result of this illness and this is why parents need to be informed.

These complications include:

• Bacterial infections of the skin, soft tissues, bones, joints or bloodstream (sepsis)
• Dehydration
• Pneumonia
• Inflammation of the brain (encephalitis)
• Toxic shock syndrome
• Reye’s syndrome in children and teenagers who take aspirin during chickenpox
• Death

Who is at risk for such complications?

In children these would include:

• Newborns and infants whose mothers never had chickenpox or the vaccine;
• Children with asthma or those with a lowered immune system.

Teenagers and adults are far more likely to suffer severe consequences from chickenpox especially:

• Pregnant women who haven’t had chickenpox.
• People who smoke.
• People whose immune systems are weakened by medication, such as chemotherapy, or by a disease, such as cancer or HIV.
• People who are taking steroid medications for another disease or condition, such as asthma.

When to see your doctor?

I would recommend that if your child has been exposed to chickenpox or if you suspect they may have chickenpox, then a visit to the doctor is in order. There are other illnesses that cause blisters, like coxsackie, so getting a diagnosis is important. If your child is younger than six months then it is vital that you consult with your doctor.

Please call ahead and warn your doctor’s receptionists if you suspect chickenpox. I prefer for these children to be isolated from others in my waiting room. Once the diagnosis is made, please stay in contact with your doctor if any of these symptoms occur:

• The blisters spread to the eyes.
• The fever is around 39 degree Celsius and you are struggling to get it under control.
• If your child develops a cough, has a stiff neck, feels dizzy or disorientated, struggles to breathe or starts vomiting.

But what can the doctor do?

For the most part, your doctor will just make the diagnosis and advise on how best to control the fever and how to help your child deal with the pain of the blisters. In certain cases, your doctor may prescribe an antiviral medication.

Is the vaccine safe, and what if a woman is pregnant?

I am aware of the ongoing resistance towards vaccinations, but I can honestly say this is an illness that children shouldn’t have to suffer. Even if it is only a week and no other complications arise, your child will suffer from fevers, run the risk of scarring and have a very uncomfortable time.

“…YOU MAY HAVE ALL THREE STAGES OF THE RASH — BUMPS, BLISTERS AND SCABBED LESIONS — AT THE SAME TIME. CHICKENPOX IS CONTAGIOUS UNTIL ALL BROKEN BLISTERS HAVE CRUSTED OVER.”

The Centres for Disease Control and Prevention estimates that the vaccine protects 98% of children who get the correct dose. If they do get the illness, then the severity of the disease is lessened. The vaccine itself is well tolerated and in a recent article put out by the Mayo Clinic, it confirms that the vaccine is safe and very effective. This research and the risk of complications arising from chickenpox makes me an advocate for prevention through vaccination. Children don’t need to suffer and we certainly don’t want our aged to suffer the torment of shingles.

The vaccine has not been approved for pregnant woman, so it is crucial that women consult with their doctors before they fall pregnant to ensure they’ve had the necessary vaccines or are immune to the illnesses. Chickenpox in pregnancy is not to be taken lightly. If it is contracted in the first trimester, there is a risk that the baby is born with shortened limbs and low birth weight. If the mom gets chickenpox a few days before or after birth, the baby runs a significant risk of getting seriously ill.

This article was first published on BabyYumYum

The post Why you & your child should be vaccinated against chickenpox appeared first on Dr Maraschin - Paediatrician.

My approach for the workshop was simple: present the disease to my audience. As a paediatrician, I have personally treated every disease that we currently vaccinate against. I have witnessed the devastation of diseases and the joy of seeing a child survive an almost impossible situation. Once parents understand what they are up against, they can weigh the pros and cons of vaccinating.

In society today, we are fortunate enough to be spared the horrors of many of these diseases because we don’t often encounter sufferers. As a result, the diseases and their potential effects are softened, but this does not mean the diseases don’t exist.

The current measles crisis

A report* published by the World Health Organisation on 15 April 2019 states that the number of reported “measles cases rose by 300% in the first three months of 2019 compared to the same period in 2018”.  The report continues with the current available statistics from 2017 stating that 110 000 deaths occurred as a result of the disease. These deaths are not limited to underprivileged nations.

Six measles outbreaks are currently ongoing in the United States, with 206 reported cases in January and February of this year alone. Life-long disability, brain damage and hearing loss are some of the scars that could remain for those who survive the disease.

*Provisional data based on monthly data reported to WHO (Geneva) as of April 2019

What is measles?

• Measles is a viral infection that presents with a high fever, rash, conjunctivitis, severe cough, runny nose and muscle pain.
• It is one of the most contagious infectious diseases. It has a transmission rate of 90% to susceptible individuals.
• Patients with measles become immune supressed, making them highly susceptible to bacterial infections.
• SSPE is a condition which may occur as a result of a prolonged measles infection. SSPE leads to the complete degeneration of the brain.
• Outbreaks have been directly linked to vaccine refusal.

Why was there ever refusal of the vaccine?

• In 1998 a medical researcher, Andrew Wakefield, published a paper where he linked the MMR vaccination to autism. His study was completely flawed with only 12 cases in his study on which to base any statistics. Only one of these children actually had regressive autism which had been diagnosed well before the vaccination. Five of the children had developmental delays from birth and only received the MMR at 15 months. The other children had no developmental issues at all.
• In the science and the medical world, the Wakefield issue has been considered dismissed for more than 20 years. Numerous studies around the world have debunked his theory and the claims removed from medical literature.
• Society, however, has held onto this misplaced concern, according to researchers for the Annals of Internal Medicine. This idea is being fuelled by the anti-vax movement.
• In an article published by The Business Insider on 4 March 2019, Dr Saad Omar of Emory University was quoted as saying that we appear to be living in a “fact-resistant society”.

 What are the facts?

• Measles is a largely preventable disease through two doses of the vaccine.
• Globally, the first dose of the measles vaccine has stopped at 85% but 95% is needed to prevent outbreaks. This means that many people are at risk in our communities.
• The second dose coverage is as low as 67%.
• A huge study, conducted in Denmark, with more than 650 000 children participating concluded the following:

1. The MMR vaccine does not increase the risk of autism.
2. The MMR does not trigger autism in susceptible children.
3. The MMR is not associated with clustering of autism cases after vaccination.

One of the most contagious infectious diseases with 90% transmission to susceptible individuals.

“PATIENTS WITH MEASLES BECOME IMMUNE SUPRESSED, MAKING THEM HIGHLY SUSCEPTIBLE TO BACTERIAL INFECTIONS.”

A father who attended my vaccine workshop told me that he is involved in research. His baby was due three months later, and he was gathering information around the vaccine controversy. It was his view that everything he was reading around not vaccinating was fuelled by emotion with little or no scientific proof. He enjoyed hearing the facts about the diseases and would make his decision accordingly. I have a huge respect for such an approach.

It concerns me that the decision around vaccinating is largely driven by emotion and not fact. As many as 110 000 deaths seem awfully high for decisions to be emotionally driven. In my opinion your choice of a name, the colour of the nursery and such matters are the domain of our emotions. Death, brain damage or other lifelong disabilities are facts, which can be substantially supported.

This article was first published on BabyYumYum.

The post Measles: Everything you need to know appeared first on Dr Maraschin - Paediatrician.

I often watch the expression on parents’ faces as they exit the maternity ward, ready to go home with their new baby for the first time. There is such joy but at the same time, I know that there are also many concerns about what it will be like to have this little human at home and what it will take to keep it safe, healthy and happy.

Below are some of my take-home tips. I hope you will find them useful in the first few weeks of being home.

First-time parents don’t feel alone! There are many support structures available to you:

1. Clinic sisters on duty at the nursery 24 hours a day
2. Municipal clinic sisters
3. Your paediatrician
4. Private baby clinics
5. Private sisters who can call at your home
6. Breastfeeding association

Remember to choose the support that best suits you and your baby.

Car seat

• Babies must be transported in a car seat at all times. Spend money on a car chair, as having your baby properly secured in a car is of absolute importance.
• Car accidents are one of the leading causes of injuries in babies and children.
• I am putting this point first as it is vital that your baby be transported home from hospital in a well-fitting car seat. They are never too little for a car chair.

Feeding

• Breastfeeding is always the best option for a newborn. This is a very sensitive issue for new mothers and it comes with a tremendous amount of stress if the breastfeeding is difficult.
• Please don’t feel inadequate if you are struggling to feed. There are a number of resources available to assist with feeding. Mothers can make use of a lactation specialist who can visit you while you are still in hospital. Organisations such as La Leche have people who will come to your home and help you to get the breastfeeding established.
• Generally, breastfed babies will feed every 2.5 to 4 hours.
• Allow your baby to drink from one breast for about 10 minutes. If baby falls asleep on the breast, you may want to change the nappy at this point so that they wake up and are ready to feed on the other breast. Baby may not feed as long on the second breast.
• Try not to become your baby’s dummy. Baby should have at least two hours between feeds to allow baby to sleep and for you to get a break.
• Put a safety pin or ribbon onto your bra strap to remind yourself which breast you finished on. This way you will remember where to start the next feed. Starting on the same breast each time may result in you becoming engorged and baby may then begin to favour one breast over the other.
• If baby appears to be gulping, try putting pressure above the areola for a few minutes until your strong let-down reflex has subsided. This way the milk flow will slow down. You can also lie back on your bed or in a comfortable chair so that your breast milk doesn’t come out as fast.
• Wind baby properly between breasts.
• If you are not able to breastfeed, then find a formula that best suits your baby. It is important that you don’t chop and change between formulas too often, as this may upset the gut.
• A bottle-fed baby should not be fed more frequently than every three hours, as you are able to ensure the correct amount of milk per feed.

Sleep

Each baby is different.

• A newborn will sleep on average 9 to 18 hours per day.
• One stretch of between 4 to 5 hours in a 24-hour period is acceptable.
• Do not allow the baby to go longer than this without a feed in the first six weeks. If baby does sleep for too long, their blood sugar levels drop and they may find it difficult to feed later.
• Breastfeed on demand as frequent feeding increases the breast milk production.
• Try to encourage regular feeds during the day so that baby doesn’t make up for missed feeds at night. This helps to reduce the chances of day/night confusion, where baby sleeps well during the day but then makes up feeds at night.
• It is important that you try to establish a good sleep routine from the beginning. Swaddle baby in a light blanket so that they feel secure.
• Try to keep baby in a darkened room for each sleep and away from loud noise or excessive stimulation.
• Talking softly to your baby or singing will soothe baby.
• If you need to hold your baby to get them to sleep, that is absolutely fine. Once baby is asleep you can put them into their crib.

Crying

Crying is a baby’s only means of communication.

• A baby may cry because:
  • They are hungry.
  • They need a nappy change.
  • They are uncomfortable.
  • They are in pain.
  • They are tired.
• Remember to cuddle your baby as much as possible if needing to be soothed.
• If you are unable to soothe your baby and baby cries for an extended period of time, please contact your nurse or paediatrician. Your baby may be ill or in pain.

Stools

• A breastfed baby may pass a stool seven times in one day or as infrequently as once in seven days.
• Breastfed babies pass very wet and, at times, “explosive” stools.
• In breastfed babies, stools are watery with globular specks. The colour of the stool is usually bright yellow but can also be green or brown.
• Bottle-fed babies tend to have one or two stools a day.
• Bottle-fed babies may suffer from constipation and if this does occur please seek help from your clinic sister or paediatrician.

Umbilical cord care

• Clean the umbilical cord and the base of the cord with surgical spirits after each nappy change.
• When the cord starts to separate, the umbilical stump may bleed a little. Continue routine care.
• Babies cry when you clean the cord. This is because the spirits are cold and not because the cord hurts the baby.
• If the stump bleeds, it may also be that the cord is catching on the nappy. Fold the nappy down away from the cord to avoid this.

Jaundice

• If baby looks yellow, they may be suffering from jaundice. This is common and may lead to poor feeding and excessive sleeping.
• Please contact your clinic sister or paediatrician. It is of utmost importance that you communicate with the doctor’s rooms once you have done a jaundice test at the laboratories. This will enable correct management of jaundice.

Weekly weight check at the baby clinic

• Adequate weight gain is an important sign of your baby’s well-being. If your baby gains less than 90 grams per week for two successive weeks, please contact your paediatrician.
• Weekly weight gain checks are important to ensure that baby is getting adequate milk. This is especially important if baby is breastfed.
• There are a number of places one can go for weekly weight checks and these include pharmacies, private nurses or clinics.
• I would advise that baby gets weighed on the same scale each week for the first few weeks. Scales do differ so you want to have consistency with the weight assessment.

Immunisations

• Your baby should receive the BCG and oral Polio drops while still in hospital or within 10 days after birth.
• The next immunisation date will be between six and eight weeks of age.

Vitamins

• Babies are not exposed to sufficient sunlight in a modern lifestyle. For this reason, vitamin D needs to be supplemented. Your baby should, therefore, receive a multivitamin that contains 400IU of vitamin D daily. Some of these products contain probiotics and are also suitable for use.

Cardiopulmonary resuscitation and first aid

• A course in CPR can save your baby’s life in an emergency.
• There are a number of different people offering such courses and they will usually cover other medical topics such as burns, poisoning and choking.
• I would highly recommend that all parents do a CPR course before their baby even arrives or as soon as possible after birth.

Google it

• Google is an amazing tool for getting information, but you have to be careful.
• Please use recognised medical websites or those that make use of multi-disciplinary teams for information.
• Not all information on Google is necessarily acceptable practice.

Gadgets and technology

I know I am talking to Millennials who probably know way more than I do about gadgets and apps, so I’m going to note some items I feel are important. What I want to stress is that there are so many products and apps and sites available that new parents can be left feeling overwhelmed, anxious and certainly out of pocket. A parent’s intuition and common sense, in my opinion, is often way more accurate than that of a gadget. Remember, you know your baby’s every cry, you know your baby’s feeding and sleep routine, and you are the one who spends time with your baby. No gadget or healthcare professional can ever take the place of the carer.

“We have been raising healthy children for thousands of years. The modern parent is no different. Believe in yourself, find what fits into your lifestyle and trust your gut.”

• Screening tests are performed prior to your baby’s birth to make sure of the baby’s health. After the birth, there are further tests available to ensure that your baby is in optimal health. The thyroid function is critical for normal brain development and growth. This test should be performed either on cord blood or as part of a newborn screen after 48 hours of birth. The newborn screen is a test which looks for metabolic disorders and 24 conditions including cystic fibrosis and galactosemia can be identified. This new technology allows these conditions to be managed before they cause damage to your baby.
• Hearing tests can be performed from birth onwards to ensure that your baby can hear properly. This will be vital for the development of normal speech.
• Eye screening – A highly specialised visual screening machine is used to take a photo of your baby’s eyes. This can be done from six months of age and can exclude many eye abnormalities, allowing us to refer your baby for specialist treatment if necessary. Eyesight is a very important component of development.
• Thermometer – Invest in a good electronic thermometer. A baby’s temperature should be between 36.5 and 37.5 degrees Celsius. A reading lower or higher than that may indicate a medical problem.
• A baby monitor that allows you to hear and see your baby will give you peace of mind, especially if baby is sleeping in another room or being taken care of by another individual while you are at work. There are products which include audio and visual technologies. These technologies can link to your smart device and allow you to be aware of your baby’s well-being when you are not present.
• Heart-rate and breathing monitors – Babies who are high risk should have some form of heart-rate and breathing monitor. The most accurate of these are extremely expensive and not in the range of the average parent. I recently came across a little sock which does measure these functions. This is not the only product on the market, so I would recommend that you investigate various products to find one that best suits your needs. Babies who are at risk are premature babies or those with cardiac or other serious conditions. In my opinion, such a device is not necessary for every healthy, newborn baby.
• Vaccine record app – Every new parent is discharged with a vaccine record card. It is such an important record because many schools require it before enrolment and obtaining certain travel documents can only be done with proof of vaccinations. The problem is that we move house, misplace or misfile these cards. If all the child’s vaccines are done by a single professional then obtaining a copy of the records may be possible.

Generally, people struggle to get vaccination records if they lose their cards. There are, however, a number of apps that allow you to record your child’s vaccine schedule. I’d recommend that you investigate an app that is comprehensive and that has good backup so that your child’s vaccination records are forever safe on the cloud.

When to call your doctor

• If baby is lethargic to the extent that baby is not sucking well.
• Inconsolable irritability or crying.
• Jaundice (yellow skin discolouration)
• Frequent large vomits.
• Fever (temperature greater than 37.5 degrees Celsius or 99.5 degrees Fahrenheit).
• Low temperature (less than 36 degrees Celsius or 96.8 degrees Fahrenheit)

Parental health

• Parents also have needs and, on occasion, rights too.
• Take care of your own health. Keep a lookout for signs of postnatal depression (baby blues). Symptoms may include excessive weepiness, anxiety about the baby’s well-being and poor sleep. Seek medical advice earlier rather than later if such symptoms appear.
• Get rest while your baby rests. It is a good idea to get a family member or friend to babysit on occasion in order for you to get some rest.

Six to eight-week check-up

• This is an important check-up post discharge when baby is examined and normal development is assessed.
• Your baby will also receive a set of vaccinations at this age.
• Remember to bring along questions you wish to ask. So often parents get to the end of an appointment and have forgotten to ask about things that have been of concern.

Our modern world is filled with technology and all sorts of items intended to make our lives easier. That is all fine and well in the world of predictive outcomes. Unfortunately, babies do not fall into this category. They have not read the manuals, blogs or posts of the experts. They are little individuals who have unique needs.

As healthcare professionals, we can guide parents along a path that has proved successful in the past. Professionals writing blogs are communicating their professional opinions as well as their experiences. What we cannot do is predict if your baby is going to respond in the same way to the last. My advice is always for parents to find sources that speak to their heart when seeking advice. A multi-disciplinary approach is often the most comprehensive.

There is no right way or wrong way as long as your baby is loved, fed, warm and healthy. Trust your instincts, use products and sites that support your way of thinking, but never lose sight of the human factor. We have been raising healthy children for thousands of years. The modern parent is no different. Believe in yourself, find what fits into your lifestyle and trust your gut.

This article originally published on BabyYumYum

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