HPV Vaccine in Boys: New AAP Guidelines:

The vaccine already has been recommended for girls and young women since 2006 largely to prevent cervical cancer. But health authorities never expressly encouraged the vaccine for young boys, saying only that they “could” receive it to protect against genital warts and certain cancers and to help prevent the spread of HPV.

The American Academy of Paediatrics now recommends giving the HPV (human papilloma virus) vaccine to boys as well as girls. As you know I have always recommended this. The new Guidelines include:

§               Boys aged 11 to 12 years should be routinely immunized with HPV4, using the same schedule as for girls.

§               Boys and men aged from 13 to 21 years who have not already been immunized or who have not completed their vaccines should finish the series.

§               Men aged from 22 to 26 years who have not already been immunized or who have not finished the full series may be administered the recommended vaccine. (The AAP guidelines note that "cost-efficacy models do not justify a stronger recommendation in this age group.")

(View article via this link http://www.medscape.org/viewarticle/759495 )

If you would like me to administer the vaccine to your children or indeed yourself please contact Kelly on 02072244668

In common with American practice I administer Gardesil which protects against more papilloma viruses than Ceverix which is the vaccine currently administered to girls in schools.

Gardesil also has the advantage that it can also be given earlier.

Shingles:

Shingles:

Shingles is an illness in the elderly (ages 60 and above) which is caused by the same virus as chicken pox, meaning that anyone who has had the common childhood illness is at risk of developing shingles in the future. The virus lies dormant following recovery from chickenpox and may become active to cause shingles later in life.

Symptoms include over-sensitivity and a burning sensation, followed by a rash of small raised spots that turn into fluid-filled blisters and then scabs. The rash can be debilitating and the pain may last for a long time after the rash is gone.

In 2010 a Department of Health edict said that all people in the United Kingdom over 70 should receive the new shingles (chickenpox reactivation) vaccine. This move could help to prevent many cases of Shingles which affects one in four adults at some point.

Shingles can be life threatening at any age but tends to be more severe in older people. The NHS has not been able to create a vaccination schedule for these yet as there is difficulty in manufacturing and the manufacturers are already at full capacity. Due to these supply problems very few eligible people have received it. Production is currently being increased to accommodate the potential demand of the vaccine. However it is unknown how long this will take. 

The vaccine may prevent shingles in half of those who receive it and ease the symptoms for the rest.

If you have a family member who has not received the vaccine and wishes to then please contact us on 02072244668 to make an appointment. The cost of the vaccine and administration is £200. 

February 2012 Newsletter

Meningococcal C vaccine in adolescents

The meningococcal C strain can cause life threatening meningitis at any age. It is particularly prevalent in the teenage years.

Your child will have received immunisation against this bacterium as a baby if he/she is less than seven years of age otherwise not. In any event this immunity wanes over 10 years so in America a follow up dose is recommended at 11 years of age. This is not given in the UK but I recommend it.

It was originally thought that this would provide immunity for at least another 10 years but recent research has shown  that this is not the case and in many protection wanes after about 5 years .

The recommendation in America is now that a second dose is given at least 2 months after the first.

I also recommend this for my patients.

This is important as the peak incidence of meningococcal disease is in the teenage years.

If your child is coming up to the teenage years then I recommend that he/ she should be given 2 doses of the conjugate meningococcal vaccinesepareted by 2 months.

 Two doses of the Human Papilloma Vaccine can be given at the same time.

I use the Gardesil preparation as this protects against 4 strains of the papilloma virus causing cervical carcinoma rather than Ceverix the vaccine used routinely in UK which protects only against two

At present it is only given to girls but I recommend giving it to boys as well as  they are generally the vectors.

Contact Kelly on 020 7224 668 to book an appointment or if you have any questions.

Human Papillomavirus

CIN (cervical intra-epithelial neoplasia) is usually the result of a virus infection: the human papilloma virus (HPV). HPV is a very common virus that can affect the cells of the cervix. It is mainly passed on during sexual intercourse. Most women who have had sexual intercourse will have the virus at some time in their life, but for many their immune system will get rid of the virus and they won't even know they had it.

Cancer of the cervix can take many years to develop. Before it does, early changes occur in the cells of the cervix. These abnormal cells are not cancerous, and are called (CIN). Some doctors call these changes pre-cancerous. This means that the cells might develop into cancer if they are not treated. It is important to know that most women with CIN do not develop cancer. CIN may also be referred to as dysplasia or dsykaryosis.

Most women have regular cervical screening (the smear test). The test is designed to find early changes in the cells of the cervix, so that treatment can be given to prevent a cancer from developing. Although the aim of cervical screening is to prevent cancer, it can also sometimes detect a cancer that has already developed.

There are more than 100 types of HPV and each type is identified by a number (e.g. HPV 16). Some types of the virus can cause genital warts, and other types can cause CIN in the cells of the cervix. The CIN usually clears up once the immune system has got rid of the virus. In some women the virus remains for a number of years and in a few of these women the CIN will develop into cancer if it is not treated.

The type of HPV can affect whether CIN develops or not - only certain types, such as 16, 18, 31 and 33 (known as 'high risk' types) seem to be associated with the development of abnormalities of the cervix.

Many women have heard that having sexual intercourse at an early age and having multiple sexual partners can increase the risk of developing cervical cancer. They may be distressed that friends and family could think they fall into these categories.

It is important to remember that although these factors can increase the chances of catching the virus, many women who have only had one sexual partner have HPV, and may go on to develop CIN or cervical cancer. So there is no reason for yourself or others to feel that you are to blame for having cervical cancer.

You have heard about the new quadrivalent vaccine against human papilloma virus (HPV) GARDASIL which will both prevent cervical carcinoma (approximately 200 women a year die from this condition in the UK) (HPV16/8) and reduce this incidence of genital warts by 90%.(HPV 6/11) in the vaccinated population.

It now has a product license in the UK for children between the ages of 9-26 years (girls ) and 9-16(boys).

My wholehearted recommendation is that boys and girls should receive it when they attain the age of  9. (The boys should receive it both to reduce the risk of genital warts and to reduce the population carriage of HPV 16 and 18 which can cause cervical carcinoma in women.) Protection against the papilloma viruses is likely to be long lasting.

The immunisation programme is for 3 doses of the vaccine:

First dose             Time  0

Second dose        2 months

Third dose             6 months

Abdominal Pain

Abdominal Pain
There are many different causes of abdominal pain in children, sometimes the child’s other symptoms - fever,
nausea, vomiting or diarrhoea are a bigger clue to the problem than just the pain in the abdomen.
Some common causes of abdominal pain in children include:-

Gastroenteritis is an inflammation of the stomach and intestines caused by intestinal infection that causes
cramps and diarrhoea.  The diarrhoea may be very watery, and may contain blood or mucus.  Viruses cause up
to 40% of the infectious diarrhoea cases in the UK.  It is the second most common illness following upper
respiratory infections.  Treatment is directed at replacing fluids, salts and minerals (electrolytes) loss as a result
of diarrhoea - the objective is to prevent dehydration.  Viral gastroenteritis does not respond to antibiotic
therapy.  Prevention is directed at hand washing and proper food handling.

There are 20 to 35 million cases of gastroenteritis each year.  This can be caused by viruses, bacteria or
parasites.  Many types of virus are responsible for gastroenteritis.  The most common are Rotavirus and
Norwalk virus.  Rotavirus is often responsible for  severe gastroenteritis in infants and young children.
Norwalk virus is more often associated with institutional group related viral outbreaks - most common in
Winter in school aged children through contaminated food or water.  Gastroenteritis can also spread from
person-to-person contact, if it is caused by Shigella bacteria or by one of the intestinal viruses.

Appendicitis is an infection  of the appendix, a tube like glandular structure attached to the beginning of the
large intestine (colon).  Appendicitis can cause pain in the lower right portion of the abdomen along with
nausea, vomiting and fever.  It is uncommon below one year of age and most common in the late teens and
early twenties.  It is commoner in males than in females.  Appendicitis usually begins with crampy, colicky-like
mid abdominal pain and loss of appetite then progresses rapidly to the “classic” signs of appendicitis.

Irritable Bowel Syndrome is a condition characterised by increased motility of the small  and large
intestine. It is a mysterious illness which causes occasional attacks of abdominal pain, cramps and diarrhoea,
with or without episodes of constipation.  There is no fever.  The disease may be blamed on many different
factors, including diet and a stressful lifestyle.  Increasing dietary fibre and eliminating stimulants to the
gastrointestinal tract such as caffeine may be beneficial.  Anxiety reduction measures may also be helpful.

Urinary Tract Infections can affect the bladder, kidneys or both and are usually caused by one of the
species of intestinal bacteria, especially E. coli.  Urinary tract infections can cause pain in the lower abdomen,
in the flank or in the middle of the back.  They can also cause discomfort during urination, frequent urination,
bedwetting, fever and other symptoms.  Antibiotics are used to control bacterial infections.  Recurrent urinary
tract infection requires careful evaluation to see if a urinary tract abnormality is present, especially in children
under 3 when vesico-ureteric reflux can cause permanent kidney damage (see urinary tract infection).
Prevention of acute urinary infections centres around careful hygiene, liberal fluid intake, elimination of bubble
baths and prophylactic antibiotics.


Lactose Intolerance is marked by a difficulty digesting lactose (contained in milk and dairy products).
Lactose intolerant people have indigestion, bloating, and diarrhoea after eating or drinking anything that
contains lactose.  Primary lactose intolerance is genetically determined and increases with age.  Approximately
two thirds of the word population have lactose intolerance.  It is common in Asians, Africa Europeans, Native
Americans and South American Indians.  Severe lactose malabsorption may follow gastroenteritis or other
intestinal inflammation and can occur in anyone.  It is transient and treated by elimination of lactose containing
products.

Peptic Ulcers are an erosion in the lining of the beginning port small intestine.  While previously thought to
be due to diet and stress, current research indicates most peptic ulcers are caused by a bacterial infection due to Helicobacter Pylori.  They cause a burning pain under the ribs and this pain is often relieved by eating and by taking antacids.


A gastric ulcer is a result of an inbalance between acid and pepsin secretions, leading to
inflammation of the stomach.  Antacids and ulcer healing medications are usually an effective treatment,
combined with antibiotics to eradicate the H.Pylori if this is present (confirmed with blood test for anti-bodies)
Abdominal pain can be a symptom of many different kinds of illness in children, including illnesses that seem
to have no relation to abdominal organs.

What to look for:
Whenever your child has abdominal pain, it is important to find out as much as possible about the location of
the pain, the type of pain (burning, crampy, dull), and the time that the pain started (after/before eating).  For
example, pain in the lower right side of the abdomen may be a sign of appendicitis; crampy pain around the
naval is intestinal pain; and crampy pain that begins after a child drinks milk or eats ice cream may mean
lactose intolerance.

Look for other symptoms like nausea and vomiting or diarrhoea and cramps could be a sign of gastroenteritis.
Fever and a burning feeling when a child urinates can be signs of a urinary tract infection.  Fever with
occasional bouts of diarrhoea and/or constipation, can be irritable bowel syndrome.

Other signs to look for : a distended abdomen; a painful and rigid abdomen; bleeding in any form - bruises
(bleeding under the skin) on the surface of the abdomen); vomiting blood or bloody bowel movements.  These signs require immediate attention.

What to do
We may have a good idea of what is happening to your child after hearing the symptoms and performing a
physical examination.  Because the symptom of abdominal pain is a part of may illnesses, the next step can be
anything from reassurance that the problem is minor to an emergency hospital admission.  Lactose intolerance
can be treated by a simple switch to non-lactose products but appendicitis needs immediate surgery to remove the infected appendix.