AMM Fall Health Alert:
From Vaccine Shortages to Back Pain
Fall is in the air, and with the back-to-school season comes renewed concerns about immunizations, contagious diseases, aches and pains, and general health of children. Two of the hottest issues swirling around back-to-school health are the rising incidence of concussions in youth, primarily the result of increased sports activity, and the vaccine shortage.
Last May, Sanofi Pasteur, the largest company in the world devoted entirely to human vaccines, issued a letter to health care providers indicating it could not “meet market demand for several products following a delay in the release of new lots.” This included Adacel®a vials, DAPTACEL®b, and Pentacel®c vaccines, as well as TUBERSOL®d Diagnostic Antigen – basically, the vaccines for diphtheria and tetanus, pertussis, polio and the flu vaccine. Unfortunately, the vaccine delay put a damper on the back-to-school rush for immunizations.
The company hoped to resolve the issue by mid-October, but now that target date is in question and the delay may expand to other products. Diphtheria, Tetanus, and Acellular Pertussis (DtaP) vaccine manufacturer GlaxoSmithKline and Haemophilus Influenzae Type b (Hib) vaccine manufacturer Merck and Co. have indicated they will help fill the supply gap.
According to the Centers for Disease Control and Prevention (CDC), enough infant and adult pertussis-containing and Hib vaccine remains available to ensure that no changes to the current immunization recommendations are needed.
In the meantime, Sanofi Pasteur recommends:
Providers continue to follow the recommended immunization schedule and ensure that patients receive all recommended doses of DTaP, Hib, and polio vaccines.
Vaccines for Children (VFC) providers should contact their state or local immunization program for guidance about ordering vaccines.
Considerations when changing vaccine products:
The Advisory Committee on Immunization Practices (ACIP) recommends using the same brand of vaccine for all doses of a vaccination series when feasible. If providers do not know or do not have available the brand of vaccine previously administered, another brand may be used.
A child who began the series with Pentacel, then received single-component products at one or more visits, may receive Pediarix in lieu of DTaP, IPV, and HepB at subsequent visits when all three vaccines are indicated.
With the exception of Hiberix, which is licensed only for use as the last dose (booster) in the Hib series, Hib vaccines are interchangeable. If different brands of a vaccine require different numbers of doses, use the higher number when mixing brands. The Hib vaccine component in Pentacel is licensed as a four-dose series.
Additional vaccine information and sample schedules using single-component and combination vaccines for children who have already received one, two, or three doses of Pentacel, Pediarix, or both are available at cdc.gov or you may click here.
Why Get Immunized?
Some consumers question the importance of vaccinations, but according to the CDC, vaccine-preventable diseases continue to be transmitted despite high levels of vaccination at the national and state levels. For the 2012-13 school year, median vaccination coverage in the 48 states and the District of Columbia continued to be high, with medians of 94.5% for measles, mumps, rubella; 95.1% for diphtheria, tetanus toxoid, and acellular pertussis; and 93.8% for varicella vaccines. The level of exemptions remained low overall, with a median of 1.8%, and four awardees saw decreases of >1 percentage point for children with exemptions in the 2012–13 school year.1
Emergency room visits for sports and recreation-related traumatic brain injury (TBI) among children and adolescents increased by 60% within the last decade, according to the CDC. Between 2009 and 2012, 42 states and the District of Columbia passed laws on concussions in sports for youth athletes. In fact, total direct and indirect costs resulting from TBI was $76.5 billion in the United States in 2000.2 Imagine what that number is today!
A concussion is a type of TBI, caused by a bump, blow, or jolt to the head that can change the way your brain normally works. Concussions can also occur from a blow to the body that causes the head to move rapidly back and forth. Even a “ding,” “getting your bell rung,” or what seems to be a mild bump or blow to the head can be serious. Signs and symptoms of a concussion include:
Headache and sensitivity to light and sound;
Changes to reaction time, balance and coordination;
Changes in memory, judgment, speech and sleep; and
Loss of consciousness or a “blackout” (happens in less than 10% of cases).
Each year 52,000 die and 275,000 are hospitalized annually from TBIs—173,285 of those concussions are related to youth sports. Neurologists are increasingly realizing the severe impact of brain injuries, especially to children and teenagers, even if they are not immediately felt or noticed. Federal, local and state laws are being introduced to lessen the risks of head injuries to young and professional athletes, including providing schools with guidance for concussion awareness, treatment, and back-to-play strategy.
It’s important to know some facts about concussions:
A concussion is a brain injury and all are serious.
Most concussions occur without loss of consciousness.
Recognition and proper response to concussions when they first occur can help prevent further injury or even death.
Free online concussion training for clinicians and physicians is available on the CDC’s website. Click here for more information. For the free downloadable report, Traumatic Brain Injury in the United States: Emergency Department Visits, Hospitalizations, and Deaths, 2002-2006, click here.
Another great resource for concussion information is the American Academy of Neurology (AAN), which recently released updated evidence-based guidelines for evaluating and managing athletes with concussion. One of the most important recommendations the Academy makes is that any athlete suspected of experiencing a concussion immediately be removed from play and not return until assessed by a licensed health care professional trained in concussion. They should return to play slowly and only after all acute symptoms are gone.
The AAN also suggests that athletes of high school age and younger with a concussion should be managed more conservatively in regard to return to play, as evidence shows that they take longer to recover than college athletes. The highest risk sports for boys are football and rugby, followed by hockey and soccer. The risk of concussion for young women and girls is greatest in soccer and basketball. An athlete who has a history of one or more concussions is at greater risk for being diagnosed with another concussion. The first 10 days after a concussion appears to be the period of greatest risk for being diagnosed with another concussion.
Licensed health professionals trained in treating concussion should look for ongoing symptoms (especially headache and fogginess), history of concussions and younger age in the athlete. Each of these factors has been linked to a longer recovery after a concussion, according to AAN. Risk factors linked to chronic neurobehavioral impairment in professional athletes include prior concussion, longer exposure to the sport and having the ApoE4 gene.
Concussion is a clinical diagnosis. Symptom checklists, the Standardized Assessment of Concussion (SAC), neuropsychological testing (paper-and-pencil and computerized) and the Balance Error Scoring System may be helpful tools in diagnosing and managing concussions but should not be used alone for making a diagnosis.
“If in doubt, sit it out,” says Jeffrey S. Kutcher, MD, with the University of Michigan Medical School in Ann Arbor and a member of the AAN. “Being seen by a trained professional is extremely important after a concussion. If headaches or other symptoms return with the start of exercise, stop the activity and consult a doctor. You only get one brain; treat it well.”
There’s an App for that…
AAN has launched a new app called "Concussion QuickCheck" to help coaches, athletic trainers, parents and athletes quickly evaluate if someone may have a concussion and needs to see a licensed health care provider, such as a neurologist, who is specialized in concussion. The app, which is available for iPad, IOS (Apple), Android, and mobile, features common signs of concussion, symptoms, things the athlete may tell you, what to do if an athlete has a head injury during a game, what to do if it appears the athlete has a concussion, when an athlete should return to the game, help finding a neurologist near you (GPS capability), and help finding state laws on concussion.
Back pain often is caused by muscle strain or sprain, often from an injury or wearing a heavy backpack. Incorrect backpack use can affect posture and cause bones of the spine to press on or pinch the nerves branching out from the spinal cord, according to www.kidshealth.org.
Stiffness and pain in the lower back, sometimes called lumbago, can be caused by such actions as lifting heavy objects or sitting in one position for too long. It usually will go away on its own within a few days or weeks, and in the meantime can be managed by staying active and taking short-term medications (acetaminophen or ibuprofen) to control pain.
Choosing a backpack with two wide shoulder straps and a padded back
Not carrying more than 10-15% of their body weight in the pack
The American Academy of Pediatrics (AAP) recommends parents look for the following when choosing the right backpack:
A lightweight pack that doesn't add a lot of weight to the child's load (for example, even though leather packs look cool, they weigh more than traditional canvas backpacks)
Two wide, padded shoulder straps—straps that are too narrow can dig into shoulders
A padded back, which not only provides increased comfort, but also protects kids from being poked by sharp edges on objects (pencils, rulers, notebooks, etc.) inside the pack
A waist belt, which helps to distribute the weight more evenly across the body
Multiple compartments, which can help distribute the weight more evenly
Although packs on wheels (which look like small, overhead luggage bags) may be good options for students who have to lug around really heavy loads, they're extremely difficult to pull up stairs and to roll through snow. Parents should check with their child’s school before buying a rolling pack; many schools don't allow them because they can pose a tripping hazard in the hallways.
To avoid back injury, encourage kids to:
Use their locker or desk frequently throughout the day instead of carrying the entire days’ worth of books in the backpack
Only tote necessary items — laptops, cell phones, and video games can add extra pounds to a pack
Bring home only the books needed for homework or studying each night
Plan ahead for homework—a heavier pack on Fridays might mean that a child is procrastinating on homework until the weekend, making for an unnecessarily heavy backpack
Pick up the backpack the right way. As with any heavy weight, they should bend at the knees and grab the pack with both hands when lifting a backpack to the shoulders
Use all of the backpack's compartments, putting heavier items, such as textbooks, closest to the center of the back
Get Some Zzzzz’s
How much sleep is enough? It depends on the child’s age, and even then each child’s needs are different. The importance of a good night’s rest is vital to a child’s success in school and basic well-being. When adults are tired, they can be grumpy or have low energy, but kids can become hyper, disagreeable, and experience mood swings.3
Here are some approximate numbers based on age, accompanied by age-appropriate pro-sleep tactics, according to www.kidshealth.org.
Preschoolers sleep about 10 to 12 hours per night. A preschool child who gets adequate rest at night may no longer need a daytime nap. Instead, a quiet time may be substituted.
Most nursery schools and kindergartens have quiet periods when the kids lie on mats or just rest. As kids give up their naps, bedtimes may come earlier than during the toddler years.
School-Age Children and Preteens
School-age kids need 10 to 12 hours of sleep a night. Bedtime difficulties can arise at this age for a variety of reasons. Homework, sports and after-school activities, TVs, computers, and video games, as well as hectic family schedules might contribute to kids not getting enough sleep.
Lack of sleep can cause irritable or hyper types of behavior and may make it difficult for kids to pay attention in school. It is important to have a consistent bedtime, especially on school nights. Be sure to leave enough time before bed to allow your child to unwind before lights out.
Adolescents need about 8½ to 9½ hours of sleep per night, but many don't get it. Because of early school start times on top of schedules packed with school, homework, friends, and activities, they're typically chronically sleep deprived.
And sleep deprivation adds up over time, so an hour less per night is like a full night without sleep by the end of the week. Among other things, an insufficient amount of sleep can lead to:
decreased short-term memory
delayed response time
These can cause bad tempers, problems in school, stimulant use, and driving accidents (more than half of "asleep-at-the-wheel" car accidents are caused by teens).
Ideally, a teen should try to go to bed at the same time every night and wake up at the same time every morning, allowing for at least 8 to 9 hours of sleep, according to the National Sleep Foundation.
The Foundation offers these sleep tips for school-aged children:
Teach school-aged children about healthy sleep habits
Continue to emphasize need for regular and consistent sleep schedule and bedtime routine
Make child's bedroom conducive to sleep—dark, cool and quiet
For questions or concerns about immunizations, contagious diseases, aches and pains, and general pediatric and adult health, Alicare Medical Management (AMM) offers Nurse HelpLine and Health Information Services under its Care Management programs, which are accredited pursuant to URAC’s Health Call Center Standards. Currently, over two million people have access to our Nurse HelpLine.
Experienced, registered nurses are available via a specially assigned toll-free telephone number for each client or group, 24 hours a day, seven days a week, 365 days a year. Using advanced clinical criteria, Nurse HelpLine staff can provide health information and education to patients and their families. Telephone triage and health care counseling assesses health status and provides immediate health information, directing patients to the appropriate level of care and reducing health care costs. In addition, all of our Care Management programs provide physician back-up availability if needed.
AMM’s Health Information Library includes over 1,000 pre-recorded health related messages, available in English and Spanish. A website library is also available.
The Nurse HelpLine program helps reduce unnecessary emergency room and physician visits and provides patients with around-the-clock access to care.
For more information about Alicare Medical Management’s services, visit www.alicaremed.com.
Alicare Medical Management (AMM), a member of the Amalgamated Family of Companies, is a national leader in developing care management solutions that promote cost savings and patient satisfaction. AMM’s call center is open 24 hours a day, 365 days a year to provide maximum access and assure optimum program effectiveness. The company’s services include: 24-hour Nurse HelpLine, Utilization Management, Maternity Management, Case Management, Disease Management, Health Coaching and Wellness, Independent Physician Review, Medical Claims Review and Hospital Bill Auditing. AMM holds four URAC accreditations for Utilization Management, Case Management, Health Call Center and Independent Review.
1www.cdc.gov/vaccines/news/newsltrs/imwrks/2013/201308.htm 2Finkelstein E, Corso P, Miller T and associates. The Incidence and Economic Burden of Injuries in the United States. New York (NY): Oxford University Press; 2006. 3 http://kidshealth.org/parent/general/sleep/sleep.html#cat190