A shot in the arm

Every year, influenza vaccine is available free to children and adults. But every year, many are hospitalized with complications of the flu because they don’t get vaccinated. I believe there are other winter viral infections that can be prevented. What is available? T.N., Safed Dr. Galia Grisaru-Soen, head of the pediatric infectious diseases service at Tel Aviv Sourasky Medical Center, says:

In addition to the flu vaccine, which should be given to everyone over the age of six months, there are two others – one of which is available to all young children and the other given only to high-risk populations.

Rotavirus is the most common cause around the world of acute intestinal infections in babies and children up to the age of five. Globally, it causes annually over 110 million mild infections, 25 million doctors’ visits, two million hospitalizations and 600,000 deaths. By age five, almost every child in Israel has been exposed to the virus, and one in five will have to see a doctor in a health fund clinic to treat it.

Most of the infections occur between October and December, and one-third of winter pediatric hospitalizations for acute gastro infections resulted from rotavirus infections. But rotavirus vaccine, containing the five most common strains and added to the basket of health services in 2010, is bringing the figure down significantly. It is given in three shots at two months, four months and six months of age.

The third dangerous winter virus is respiratory syncytial virus (RSV), which causes severe respiratory disease in all age groups. It is one of the most common infections in early childhood.

Most infants are exposed to it for the first time during their first year of life.

The symptoms can affect the upper respiratory system or reach the lower respiratory system and cause pneumonia or bronchiolitis. Between 1% and 3% of infants will end up in the hospital, especially if they have congenital heart disease or were born prematurely. A specialist, such as a pediatric cardiologist or pulmonologist, will decide whether the passive RSV immunization should be given to prevent infection in such children; the vaccine is not meant for treating the disease.The antiseptic dye gentian violet is not available in Israel, although it is an excellent remedy for infections like thrush (fungal infections of the mouth). Is there any reason for this policy? M.D., Jerusalem

Howard Rice, a veteran pharmacist and pharmaceutical consultant, replies:

For many years, gentian violet was used to treat fungal infections of the skin (such as ringworm and athlete’s foot). It also has weak antibacterial effects and may be used on minor cuts and scrapes to prevent infection.

It was used in Israel as a liquid for topical application as a disinfectant, an oral application for thrush (Candida) and as suppositories for ascaris (worm) infections. It was – and in many parts of the world still is – used extensively. But new pharmaceutical preparations have superseded it.

There had been concern that it was carcinogenic in large doses, and the GHS (Globally Harmonized System of Classification and Labelling of Chemicals) hazard statements, as well as those demanded by the European Union, agreed that it can cause cancer.

As such, cautionary statements such as “Harmful if swallowed,” “Limited evidence of cancer” must appear by law on packages. As a result of these directives, the Health Ministry decided to limit its sales – a move that would certainly increase panic among users if they read about it.

The evidence of cancer, however, is far from conclusive when used in small quantities that are well below those that are used therapeutically. But it seems that that the ministry’s caution is nevertheless well-founded.I am a 94-year-old man and have been suffering from the pain of shingles for nearly six months. The pain occurs on my waist and back. I have been prescribed with Lyrica 75 mg., twice a day, but it still hurts. Is there anything that you would recommend for a speedier recovery? L.A., Jerusalem

Dr. Yoram Singer, director of the home palliative care service and lecturer at Ben- Gurion University’s Faculty of Health Sciences in Beersheba, comments:

You have what is called post-herpetic neuralgia, which is a severe neuropathic pain syndrome. Eventually, it usually goes away by itself, but there is no way of telling how long that will take. There are quite a number of medications that may benefit. Lyrica is certainly one option. I would suggest increasing the dose, very gradually aiming for up to 300 mg. twice a day. Other options include one of the SNRIs venlafaxing or duoxepine, tricyclic anti-depressants and anti-epileptics such as gabapentene.

A short course of steroids sometimes helps. Adding opioids, especially methadone, is often of significant help.

Finally, when all else fails, go to a pain clinic and ask for a course of lignocaine IV. These medication can be prescribed by your neurologist.Rx for Readers welcomes queries from readers about medical problems. Experts will answer those we find most interesting. rite Rx for Readers, The Jerusalem Post, POB 81, Jerusalem 91000, fax your question to Judy Siegel-Itzkovich at (02) 538-9527, or e-mail it to jsiegel@jpost.1eye.us, giving your initials, age and place of residence.

It’s not too late to protect your body against the flu.