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CLINIC NOTES

Helpful tips to stay healthy:
Some of the ways to help prevent spreading of illness is by frequently washing your hands. In the classroom, hand sanitizer can be used between restroom breaks. Remember to use a tissue to cover your mouth and nose when you sneeze, cough or blow your nose. Then throw the tissue away in the trash immediately after you use it.

Staying Healthy keeps kids jumping for joy!  Visit the “Staying Healthy” pages for online information and resources for parents at:  www.famis.org

• 5 age-specific well-child checkup schedules
• 2 new book lists for kids on “Staying Healthy” and “Healthy Smiles”
• Downloadable month-by-month booklets on caring for your baby during the first year
  
• Well-child checkups, prevention, immunizations, safety, nutrition, developmental milestones, behavior, parenting, dental care and more
• Pages tailored to your needs:
• Pregnant Women, Infants & Toddlers, Preschoolers, “Big Kids,” Preteens & Teens, and Dental Care
• 1-866-87FAMIS
• 1-866-873-2647

Over 200 health related links and resources for parents and parents-to-be

Norovirus (formerly called Norwalklike Virus)
What are noroviruses?
Norovirus is a virus that causes the “stomach flu,” or vomiting and diarrhea, in people.
What are the symptoms of illness caused by noroviruses?
Norovirus illness usually begins 24-48 hours after exposure, but can appear as early as 10 hours after exposure. Symptoms usually include nausea, vomiting, diarrhea, and stomach cramping. Sometimes people have a lowgrade fever, chills, headache, muscle aches, and a general sense of tiredness. The illness is usually brief, with symptoms lasting only 1 or 2 days.
How serious is norovirus disease?
Norovirus disease is usually not serious, but people may feel very sick. Most people get better within 1 or 2 days, and have no longterm health effects from the illness. Sometimes people are unable to drink enough liquids to replace what they lose from vomiting and diarrhea, and they can become dehydrated and need to see a doctor. This problem usually occurs only among the very young, the elderly, and persons with weakened immune systems.
How is norovirus spread?
Noroviruses are very contagious and spread easily from person to person. The virus is found in the stool and vomit of infected people. People can become infected in several ways, including eating food or drinking liquids that are contaminated by infected foodhandlers, touching surfaces or objects contaminated with norovirus and then touching their mouth before handwashing, or having direct contact with another person who is infected and then touching their mouth before handwashing. Outbreaks also have occurred from eating undercooked oysters harvested from contaminated waters cooking kills the virus. Drinking water contaminated by sewage can also be a source of these viruses. Persons working in daycare centers or nursing homes should pay specialattention to children or residents who have norovirus illness. This virus can spread quickly in these places.
How long are people contagious?
People infected with norovirus are contagious from the moment they begin feeling ill to at least 3 days after recovery. Some people may be contagious for as long as 2 weeks after recovery. Therefore, good handwashing is important. Persons infected with norovirus should not prepare food while they have symptoms and for 3 days after they recover. Infected people do not become longterm carriers of norovirus.
Who gets norovirus infection?
Anyone can become infected with these viruses. Because there are many different strains of norovirus, norovirus infection and illness can reoccur throughout a person’s lifetime.
What treatment is available for people with norovirus infection?
Currently, there is no specific medication or vaccine for norovirus. Norovirus infection cannot be treated with antibiotics. By drinking fluids, such as juice or water, people can reduce their chance of becoming dehydrated. Sports drinks do not replace the nutrients and minerals lost during this illness.
Do infected people need to be excluded from school, work or daycare?
Yes. Since the virus is passed in vomit and stool, children should not go to daycare or school while they have diarrhea or vomiting. Once illness ends, children can return to daycare, but handwashing must be strictly monitored. Persons who work in nursing homes, take care of patients, or handle food should stay out of work until at least three days after symptoms end.
Can norovirus infections be prevented?
You can decrease your chance of coming in contact with noroviruses by:
-Frequent handwashing with warm water and soap
-Promptly disinfecting contaminated surfaces with household chlorine bleachbased cleaners
-Washing soiled clothing and linens
-Avoiding food or water from sources that may be contaminated
-Cooking oysters completely to kill the virus

The Flu Virus:
As the flu season approaches, the flu virus can be a serious disease. The flu is an airborne virus which spreads from one person to another by droplets from coughing and sneezing. Some of the symptoms are:
- tiredness
- fever
- muscle body aches
- joint pain
- loss of appetite
- headache and cough

Although flu symptoms are felt throughout the body, the flu virus lives and multiplies primarily in the lungs. Upset stomach and vomiting are not symptoms of the flu—“stomach flu” is usually caused by other microorganisms.

Students who develop the flu or flu-like illness (fever >100 degrees and upper respiratory symptoms of cough or sore throat) should be excluded from school until they are afebrile (no fever). Adults can spread the flu for 5 days after onset of symptoms; children can spread the flu up to 10 days after onset of symptoms.

Some ways to help fight off the flu virus:
- getting plenty of rest
- a well balanced diet including fruits and vegetables
- Drink plenty of water and liquids for hydration.

The "Mono" Virus:
Sometimes the flu can be mistaken for “Mono” which is caused by the Epstein-Barr virus. The incubation is from 30 to 50 days. It is transmitted by saliva through coughing, sneezing, kissing, and sharing of eating and drinking utensils. “Mono” commonly occurs between the ages of 15 and 25 years. Diagnosis is by positive blood test for mononucleosis.
Symptoms may start with 3-5 days of mild illness, malaise, fatigue, headache and anorexia. Then the person can become more acutely ill, with the following symptoms:
- severe sore throat (exudative tonsillitis)
- swollen glands in the neck, armpits, and groin
- fever for 7 to 14 days, tiredness, and enlarged spleen

Severe cases can last 2 to 4 weeks, with gradual recovery. Complaints of fatigue and malaise may last several months. Students can return to school when they are afebrile (no fever) for 24 hours and have enough energy. Students may need to start with reduced hours and no physical education classes. Those students with an enlarged spleen should avoid all contact sports or trauma to the abdomen for 3 weeks to 3 months. Heavy lifting can also cause increased abdominal pressure and should be avoided. The "Mono" virus can be shed in small amounts in saliva for up to 6 months. Students do not need to be isolated, but should avoid kissing others and use separate drinking and eating utensils for several days after the fever has subsided.

Strep Throat:
Step throat is caused by a bacterium called Group A Streptococcus. It can occur at any age, but is most frequent among school-aged children. Symptoms start 1 to 3 days after exposure and may include:
- fever
- sore throat
- and tender/swollen neck glands

Strep is usually spread person to person by direct contact. The strep bacterium is found in the nose and/or throat of infected persons and is spread to the next person through the air with sneezing and coughing. People with strep can spread the disease to others until 24 hours after treatment or for 10 to 21 days if untreated. Diagnosis is made with a throat culture. Treatment is with antibiotics and is important to prevent serious complications.

Food  Allergies and Anaphylaxis:
Food allergies are becoming increasingly common, and while the most widespread food allergies are related to milk, eggs, shellfish, wheat and soy, the list also includes peanuts and peanut products.  Approximately 2 million children are affected by food allergies, according to the American Academy of Allergy, Asthma, and Immunology.  It has been estimated that in an elementary school of 500 students, there may be as many as 15 children with a food allergy, and many of these allergies are life threatening.
    
An allergic reaction occurs when the body detects the presence of a substance that it deems harmful and mounts a reaction to protect the body’s vital organs.  The immune system produces antibodies called immunoglobulin E (IGE), which cause mast cells in the body to release histamine.  The first time the individual is exposed to the allergen, specific IGE antibodies are produced and attach to the surface of the mast cells.  With each successive exposure, the body recognizes the offending food and the body reacts to the perceived threat.  Each exposure to the allergen initiates this process, causing each allergic reaction a person experiences to be more severe than the last.
     
Following exposure to an allergen, the allergic person may experience a localized or systemic reaction to the offending food, depending on where in the body the mast cells release their chemical response.  In a localized reaction, there may be some itching, irritated eyes, a runny nose and hives.  In a more intense reaction, the child may complain of a burning sensation in the mouth, or they may vomit or have diarrhea.  A student with asthma can experience a more pronounced reaction to an allergen.  When experiencing a severe systemic allergic reaction, or anaphylaxis, the individual experiences a sudden, extreme, and possible fatal bodily response.  The victim may exhibit a tightening of the throat, difficulty swallowing, and report a sense of doom, or lose consciousness.  This constitutes a medical emergency and treatment must be initiated immediately.  Medication orders from the child’s healthcare provider should be in place for both an antihistamine (Benadryl) as well as epinephrine (in the form of an EpiPen).  The medication should be easily accessible, and arrangements should be made for these emergency medications to be immediately available to the student in any situation the child may be found in (field trips, physical education, cafeteria, or in the absence of the school nurse).
    
In the event that a student experiences an allergic reaction, it is important first to remove the student from the source of the allergen, if possible.  If emergency medications are needed, it is often recommended that both the Benadryl and the EpiPen be given in the initial treatment for anaphylaxis.  The epinephrine will provide immediate relief from the most dramatic symptoms, and the antihistamine will provide some protection from a potential “rebound” effect from the allergen over the span of the hours following the initial allergic event.  Emergency medical services is called immediately when giving a dose of EpiPen due to the possible need to repeat the medication in 15 to 20 minutes to provide continued treatment.