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Pertussis Outbreak Plus: Preparing for a Tough Flu Season · Pediatrics Now: Cases Updates and Discussions for the Busy Pediatric Practitioner

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I'm Holly Wehmint, and this is Pediatrics Now.
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Click on the link in the podcast for free credit that may include CME,
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MOC, or ethics credit, depending on our topic or podcast.
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Our talk by the Chief Medical Officer at Microsoft is going to run next week
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because we're focusing today and this week on a more breaking story, the flu and pertussis.
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And joining me here in the podcast studio is Dr.
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Dina Sutter. She is our pediatric infectious disease doctor at University Health
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and UT Health San Antonio.
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Dina, thank you so much for being here in the podcast studio.
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Thanks, Holly. Appreciate it. So just in time for Thanksgiving,
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we're getting these warnings.
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There's, for example, there's a story out today on Texas Public Radio that reads,
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When most Americans think about 1968, their minds turn to the twin tragedies
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of the assassination of Martin Luther King Jr. and Robert F. Kennedy.
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They may think of the escalation of the Vietnam War or anti-war protests.
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Few recall that it was the year that H3N2 variant of the influenza virus emerged
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in Asia and began a steady march around the globe and resulting in a pandemic,
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killing between 1 million and 4 million people.
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And this is the strain of the flu that is strong this year. This sounds so dire.
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Yeah, I love TPR, but that's a little melodramatic. A way to get people's attention, I suppose.
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So basically, you know, to sum it up, and the rest of the article goes into
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this, that, you know, the H3N2, H1N1 and H3N2 kind of trade off year to year,
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not back and forth, you know, directly.
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But we typically have heavy H1N1 strains, infections.
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We do know that H3N2 infections, when we have those prevalent in years,
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they tend to be overall more severe than H1N1 infections.
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So the the they called it the Hong Kong flu is what they called it in that time period that that's,
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that was one of our pandemics. And this year, this is not considered pandemic.
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It's going to be considered an epidemic.
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So that intro was a little bit misleading in terms of what's going to happen.
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We do have years where H3N2 is prevalent and causes most of the infections.
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This year, we do have some drift as opposed to a shift.
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And so the subclade K, which they were referring to in this article,
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is slightly different, actually has several different mutations,
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but is a little different than what they anticipated and put in the vaccine this year.
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So there were some mutations from the southern hemisphere H3N2 that happened
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towards the end of their yearly epidemic.
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And so there's a little bit of mismatch in the vaccine. So far,
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we've seen in, not so much in the U.S., but in Asia and in...
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The UK, there has been a very early influenza season, and they have seen this
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H3N2 subclane K be the predominant flu type that's circulating right now.
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So the concern is because of an early season and because of a mismatch,
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and there's more severe influenza in those areas,
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even though it's not an actual shift versus a drift, which classically causes
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these pandemics, we may have a more severe year.
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And so far this year, we do know that flu cases are ticking up a little bit
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faster in the U.S., not as fast as in those other countries,
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but a little earlier than we typically expect.
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So we're kind of on the brink here.
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So what's your advice to pediatricians and to us all?
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I think really talking to families about the importance of an influenza vaccine,
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which I know pediatricians are already doing.
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I mean, this is kind of like, you know, standard fare, but really emphasizing
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the fact that this vaccine is still probably very effective in terms of influenza vaccines.
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The mismatch is not, at this point, with the data we have, felt to be such a
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mismatch that it's not going to work.
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Sometimes families, when they hear about this on the news, they'll get a little
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bit discouraged and they'll say, well, what's the point of getting the vaccine.
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But overall, I think that there are a lot of families out there that either
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have mistrust in vaccines in general, or they just feel like the flu vaccine
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isn't necessary for them, and then by extension, their children.
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And the most important influence that they can get, you know,
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besides, you know, hearing maybe misinformation from the other parents,
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that type of thing, or family members, is their pediatrician.
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And if they are bringing a child to the pediatrician, they tend to,
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that's like the strongest influence on them, really.
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And I think the pediatricians out there are very familiar with this and they know it. So bottom line.
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Bottom line, Dina, what is the data showing right now regarding the efficacy
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of the flu vaccine this year for kids and also adults?
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So since we're kind of on the cusp of the major part of the flu epidemic this
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year in the U.S., we don't have a ton of data from the U.S.
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And I don't see anything nationally gathered so far in terms of vaccine efficacy, but effectiveness.
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But in a study in the UK at the beginning of the season where they had a large
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number of cases coming into the ED, they compared two cohorts.
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And between adults and children, the vaccine effectiveness appeared to be about the same,
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which they quoted 72 to 75 percent effective at influenza related emergency
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department attendances and hospital admissions in pediatric patients.
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That was lower in adults, but the reference was, you know, the baseline effectiveness,
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and they felt that this was not very different than the norm,
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despite those mutations in the H3N2.
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So, as we're heading into, you know,
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we're recording this the day before Thanksgiving, and I'm sure that pediatricians
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will be getting questions from patients and families leading into the holidays
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and holiday gatherings.
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What is your advice there for babies who are too young to be vaccinated?
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For the flu or children who are maybe more susceptible to complications from the flu?
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I think most pediatricians would give the same advice in terms of hand-washing,
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in terms of trying to keep the child away from sick people and don't let a family
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member hold your child without hand-washing.
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Anybody who's sick should be wearing a mask.
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The hope would be that post-COVID people would be wearing a mask.
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People are a little more receptive, at least most people are a little more receptive to wearing a mask.
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It's less of a social stigma. And I think it's very appropriate if you can't
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keep sick family members from attending a gathering.
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And Dr. Jason Bolling, our colleague in infectious disease,
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adult infectious disease, he was mentioned in an article saying a baby who's
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not vaccinated or a baby who's too young to be vaccinated should not be around
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friends or family who are not vaccinated for the flu.
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I was thinking like for my family tomorrow, that's not realistic.
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I know everyone's not. I mean, in a perfect world, that's true.
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I definitely would feel uncomfortable, especially if we were a little further
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into our annual epidemic.
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But there are certainly flu cases. The numbers are increasing very rapidly.
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So I know that there are families that have been very strict about all family
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members must be vaccinated against things like pertussis and influenza.
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I don't think that depending on when you're in a large gathering,
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I think you just have to use common sense and try to mitigate the risk a little
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bit by keeping, you know, sick people away from the child.
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And, you know, everybody has the sort of their own willingness to to take a
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risk. But I think really the role of the pediatrician is to emphasize trying
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to reduce those risks and talking about it in a common sense way.
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And a lot of us have families where, like in my big family, we know that family
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members are more likely to bring their kids while they're sick or show up to
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family events while they're sick. So it gets complicated with family gatherings.
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Yeah, I mean, kids are sick. Kids in daycare are sick. Kids in school are sick.
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And we have many, many different viral infections going on based on,
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you know, my experience in the hospital in the last couple of weeks. I can name many viruses.
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So it isn't just influenza for sure.
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And I think, you know, I think that really trying to talk to family members
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in a common sense way in terms of, you know, your kid is sick.
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Please, you know, don't let them be near my baby, et cetera.
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But, you know, otherwise it's a little difficult. Mm-hmm.
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So regarding the flu, have you seen very many cases of the flu in the hospital?
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I have not, which is great. I think I'm about to see a whole lot.
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There have been certainly some adult cases, and I've seen a few pediatric cases here and there.
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But I think given the risk of a more severe influenza season based on the information
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we have from other countries and from, you know, preliminary information from the U.S.
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We have a very complex population at university, and so the patients who have
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influenza, certainly, you know, healthy children in the community hospitals
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who could get sick, and I'm expecting to have a lot of complications this year.
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When should clinicians initiate antivirals at any lower thresholds this year?
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I think that remains to be seen. I certainly think that the definition of a
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high-risk patient could be somewhat interpreted based on, you know,
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a child with mild asthma.
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I think I would definitely, if there was not a contraindication, treat.
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And other chronic illnesses, which may not be listed in the list, the classic list.
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I think everybody needs to go and identify your high-risk population.
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Make sure your staff really knows what a high-risk population is.
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Maybe even posting a list of those high-risk conditions where the parents can
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read them so that they can understand that if their child is high risk.
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Not that the pediatrician wouldn't identify that, but making sure that they
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really know that if their child is diagnosed with flu, that they should be asking
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for antiviral medication.
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So you're really getting the parent involved in the decision-making process. That's a great idea.
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How are you advising clinicians about simultaneous testing for flu,
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RSV, COVID versus targeted testing?
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That's like, I don't know that, I don't really know how to answer that because
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each practice has their own,
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you know, whether they send the patient to the lab and order tests,
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whether they have their own PCR tests that they're running in their practice, point of care testing.
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I think that if you, you know, many places are just doing respiratory PCRs with
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the whole panel, which sometimes gives us more information than we really want
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and, you know, increases the expense depending on how the patient's insured.
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I think really it's up to the clinician to understand and to be on,
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you know, to be aware of what is circulating at that time.
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And then what can you treat? I mean, you know, RSV in a young infant,
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you know, you do need to know about it, but it's not treatable.
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COVID in most cases you're not going to be treating and the severe COVID cases
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have, you know, not been a huge problem lately.
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And if that worsened, then you should be testing for it. I think for influenza,
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knowing that these numbers are going up, I think you should have a very low
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threshold to test for it.
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When you get these respiratory PCRs, and sometimes the kid's got three viruses,
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right now I'm seeing a lot of them that are not treatable.
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It's more just for infection control and awareness in the hospital.
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But I would also like to warn against one thing that's not really the question you asked me.
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I have seen patients come in, and I don't know how many practices in San Antonio are doing this,
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but I have seen practices in San Antonio who have respiratory PCRs that include
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bacterial targets other than things like the atypicals like Bordetella pertussis and mycoplasma.
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So they're including classic typical bacteria like Streptococcus pneumoniae,
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Haemophilus influenzae, which are colonizing bacteria.
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And really, those tests are not useful. I don't like,
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seeing them because there's a lot of people who misinterpret them when a child
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is supposed to be colonized with these bacteria.
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And then I think the practices are getting kind of sold sometimes on these panels,
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which I think are inappropriate.
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And I actually had a patient in the hospital the other day that the mother came
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up after she got the results faxed and said, oh, there's this bacteria and this bacteria.
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And I said, yeah, we don't know.
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We don't care about that, really. That doesn't really represent what's going on in the child.
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It doesn't prove that the child's got you know, pneumococcal pneumonia.
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So if you have a panel like that, or you're seeing people come in with panels
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like that, really try to educate people and understand what that means.
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Okay, that's also great advice.
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Should we real fast, before we move on to pertussis, go through warning signs
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that this looks like it could, just a refresher, that this could be the flu,
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that it's a good idea to test for the flu?
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And then when is it red flags, this child in front of me should go,
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they should go to the emergency room?
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I think, you know, during flu season, a kid with a respiratory illness and high
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fever absolutely should be tested.
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I think flu testing tends to be very reflexive when there's a lot of flu circulating,
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and so a lot of people would test kids who are much less ill.
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I don't know that you need to be testing every child who comes in with a cold
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during flu season, but if they're exposed, which they probably were if there's
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a lot of circulating flu, whether it's at home or at school,
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I think it's appropriate to test them.
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So depending on your resources, you may want going to conserve them,
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but I think in most cases really just the reaction should be,
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you know, the child who is ill with severe,
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with high fever looks ill in particular, and then otherwise people are just
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kind of testing everybody during flu season if they come in with any kind of
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compatible presentation.
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In terms of sending a child to the hospital, I think most pediatricians are
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pretty comfortable with saying, you know, respiratory distress, hypoxemia.
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You know, signs of a secondary bacterial infection that might be more severe
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or a child who's at high risk.
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So your patients who have severe chronic medical problems, they may need to
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be assessed in the emergency department if you don't have the capability to do all the workup.
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And I think most pediatricians do a pretty good job of ascertaining who those patients are.
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Dina, before we move on to pertussis, anything else you want to say about the flu?
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I think, like you said, I think I would be comfortable with treating more patients
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as long as we don't have any shortages of drugs.
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We know we can treat, you know, any age with oseltamivir.
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And so I think that if we are able to mitigate some of these problems by treating
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kids, you know, I'm not advocating treating every child, but really be aware
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of those who are at higher risk.
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And then, you know, just continue to try to have those conversations about the
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importance of influenza vaccine.
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Just, I'd love to tell, you know, anecdote is always really powerful.
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And so like anecdotally,
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I mean, I have talked to several parents who are quite educated,
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working in healthcare, and just casually mentioned that they never get influenza
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vaccines when I'm seeing their chronically ill child.
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And it's just sort of baffling to me that people cannot understand that although
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it's certainly not 100% effective and we have to get them every year.
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It's really important because we do have, you know, we had almost 300 pediatric
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deaths from influenza in the United States last year and anticipating a higher number this year.
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And so, you know, some of those children were not chronically ill kids and almost
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all of them were unvaccinated.
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So why not do everything you can? Exactly. Yeah, for sure.
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And I think a lot of people don't realize that, that a child,
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a healthy child could, an otherwise healthy child, could die from the flu. And they do every year.
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There's kids who do. I have seen several, and it's absolutely devastating.
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I volunteer in the NICU at the Women's and Children's Hospital,
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and it was nice where there was a deadline.
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You absolutely have to get your flu vaccine by this date, you know,
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and it's nice to have that.
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But most, a lot of people don't have that reminder.
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Yeah, the NICU is extremely strict about things. You know, they really do a
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great job of protecting their babies.
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And, you know, but I don't, you know, I don't feel that like,
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you know, other environments are as strict.
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They don't tend to be as strict. And so really talking to the parents and really
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talking to the health care workers as well and just making sure people are passing,
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not passing on misinformation. information.
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And I was talking at a family dinner with extended family, and I quoted Dr.
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J.B. Canty, also in Pediatric Infectious Disease here, where he was saying,
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like, every time we get our flu vaccine, we're adding to our lifetime immunity for the flu.
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Absolutely. Which I think a lot of people don't realize. It's amazing.
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Yeah, it's important. You can say, oh, well, you want to get natural influenza.
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Well, that really stinks to get it. It does boost your immunity. But.
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And one of the examples is when we had the influenza pandemic in 2009,
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2010, I'm trying to remember the year, 2009, we thought we were going to have
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a lot of elderly people die.
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And actually, they actually had leftover immunity from having influenza, you know, decades ago.
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But every time you get another dose of vaccine and the vaccine's different every
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year, it It adds to your immunity, which is kind of like armamentarium,
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you know, against various types of influenza.
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So people who have been vaccinated every year and, you know,
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the people, unfortunately, people who have had natural disease,
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you know, but they are they're fairly well protected against new new variants.
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Shall we move on to the pertussis outbreak in San Antonio?
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Sure. Go ahead. And so we have, and our listeners, our pediatric practitioner
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listeners are also throughout the United States and the world,
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not just here in San Antonio, but worldwide.
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We are having an outbreak, apparently, here in San Antonio.
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One pediatrician was telling me that a patient, their baby, was having some
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difficulty breathing, and luckily they took the baby to an emergency room,
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and there was the panel test.
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The family went home with the baby, and then someone from the emergency room
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called and said, come back because it's pertussis. and they were shocked because
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there weren't really, there was no whooping with the cough, which apparently babies don't. Yeah.
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Yeah. I think, I mean, young infants really don't have the classic whoop.
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It's usually more of an, you know, older infant or toddler type of,
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or, you know, preschooler presentation.
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So it's harder to identify in a young infant for sure, but it's also hard to
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identify in anybody in the first phase of pertussis, you know.
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Because it seems like a cold? It seems like a cold.
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So the catarrhal phase is the first, you know, one or two weeks after an incubation
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period of maybe, you know, maybe a week to two weeks. You know, it's kind of variable.
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So, you know, you may not even know where the child acquired it,
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you know, if they were in school, around other kids, traveling, something like that.
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So in the early phase, it really just looks like a cold typically.
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They might have like a, you know, they'll typically have a runny nose,
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some sore throat, maybe a low-grade fever, you know, malaise, that type of thing.
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And then young infants, you know, towards the end of that phase is when they're
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at risk to develop apnea.
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And I've certainly seen young infants who had pertussis who looked,
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they looked different than infants who had RSV. You know, they just, they looked...
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A little bit more ill in some cases, but I also noticed when they got to that
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next phase, the pyroxysmal phase, they were coughing in a way that I don't see
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young neonates typically cough.
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They don't necessarily have that associated whoop because they don't have the inspiratory muscles.
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Their airway is not built to create that sound. Even if they breathe in very
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violently, they still wouldn't do that. But apnea is a big feature.
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And so any child, young child with respiratory distress or looking ill, you should spec this.
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The other classic feature that if you got labs is significant leukocytosis,
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specifically lymphocytosis, tends to occur in infants as opposed to older kids.
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And that can occur during the initial, the catarrhal phase before,
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you know, the later stages.
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And so that could be a clue if you have a kid who, let's say,
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is in the emergency department or the urgent care and you get labs and you see
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a very high lymphocyte count, if you weren't already testing that kid with the
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respiratory panel, then I think I might be doing that.
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What about in older kids with pertussis? We would hear that classic whoop?
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Yeah, I mean, you don't always get that, but if you hear that,
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those are, you know, the severe cases. Those kids are miserable.
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You know, these kids are coughing, coughing, coughing, coughing, gasping for air.
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They can have associated complications just from the severity of the cough.
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You know, they can, rib fractures have been described and subconjunctival hemorrhages
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and other sequelae because they're just coughing so violently.
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So if the whoop is like, you know, kind of the icing on the cake,
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like you might, you know, you might get it, you might not get it.
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And so you should still have a clinical suspicion when there's an outbreak that
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going on like there is right now, even if you don't hear it.
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And with the outbreak, I mean, would you recommend doing that panel test for
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any baby that has cold-like symptoms?
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I don't, you know, I think it's, I really want to defer to the pediatrician's
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judgment here as long as they know what's circulating.
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So, you know, some practices tend to do a lot more tests than others.
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If the child is, especially if the child's mother was unvaccinated during pregnancy,
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you know, if you have a young infant, if the family is unvaccinated,
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if they're around unvaccinated people,
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then the risk of the child having pertussis, especially if you knew they were
22:53
exposed, is higher overall.
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So you need to kind of use that, you know, calculate that out and say,
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you know, if you have a child with a mild runny nose and the parent brings them
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in for whatever reason, I'm not sure I would test it for every single child.
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But if you thought there was a possibility they were exposed and they were,
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especially if the family is unvaccinated, you know, and they're around other
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unvaccinated people, that's what I would say.
23:13
Okay, you know, we have an outbreak going on. The child has a runny nose.
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You know, what's your level of suspicion? And so, but I would really defer to
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the pediatrician's judgment.
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You know, if the child looks ill, they're probably going to the emergency room
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anyway, and they are going to get tested.
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But when it comes to a baby with pertussis, the baby could seem like she has
23:33
a cold and then just stop breathing?
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It can happen. I mean, that can also happen with things like RSV as well.
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Apnea is a significant concern, and we tend to hospitalize those children to
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have them monitored and watched closely if we know they have pertussis.
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So the problem is, as you said, if the child just has like mild symptoms initially
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and then develops apnea out of nowhere, it's really hard to predict.
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And so, you know, I think really the pediatrician identifying cases where the
24:03
child is at increased risk for protestis during an outbreak and testing them
24:06
is the best prevention for this case,
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is that the child either should be treated and possibly observed in the hospital.
24:15
It's not, we've only had, I was going to say only, we had about 10 infant deaths
24:21
in the United States that were reported associated with protestis.
24:24
We've had- So far this year? Last year, in 2024.
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And so this year we've had, I don't know what the number is exactly.
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I know at least seven of at least seven, mostly in southern states.
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And so overall, there are not that many infants who actually die from this,
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but there are quite a few in these outbreaks who become hospitalized and have
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prolonged hospitalizations.
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And then the other issue is even the older children who may not be at risk for apnea,
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the severity of this illness with a prolonged cough, treatment does not prevent
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that from happening unless you treat them in the very early stages where you
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may not be suspecting the infection.
25:02
Treatment is mainly geared towards or mainly directed at, you know,
25:07
trying to prevent transmission of infection. And if...
25:12
Elderly grandparents are exposed, that could be a big problem too, right?
25:16
Yeah, older people can have severe pretty much anything you give them.
25:21
You know, they're going to be at risk potentially.
25:23
You know, so you might have the younger, you know, healthier people in the middle,
25:27
you know, transmitting, you know, just with, you know, cold and cough, not severe symptoms.
25:32
And then other people have the sequelae.
25:36
What about vaccination gaps? Are we seeing particular pockets of underimmunization
25:40
contributing to the outbreak?
25:42
I know a lot of our listeners and community pediatricians, it's so frustrating
25:46
where so many people seem to be declining vaccinations these days.
25:51
Yeah, I think, I mean, the data, I don't know about specifically for San Antonio
25:57
per se in terms of like any kind of, and it would be really interesting to do an analysis about,
26:03
you know, like where people are getting their information and who they're, you know,
26:08
who exactly is making these decisions.
26:11
Certainly older people who are not getting their boosters are at risk for transmitting
26:16
when they're exposed to young children.
26:18
So those grandparents you're talking about, if they're not getting,
26:20
you know, they may be relatively immune to pertussis if they've had pertussis
26:25
as a child or if they've had multiple vaccinations.
26:28
But typically people are getting Tdap every 10 years, and I think they really
26:32
should if they're going to be around young children.
26:35
Women who decline the tdap in pregnancy
26:40
when there are quite a few the uptake is not
26:43
really that high in a lot of places they're putting their child at risk because
26:47
we know that pertussis rates at least in the infant very young children range
26:52
of age once that vaccine recommendation was instituted in around like 2011 over
26:58
the next couple of years the rates in very young children went down.
27:01
So that gap, sometimes, at least when it first was instituted,
27:06
was really like a systems problem.
27:08
The OBGYN might recommend it, but they weren't giving it as a point-of-care vaccine.
27:13
And so I think that really having the pediatrician talk to the OBs in the community
27:18
and make sure that we're really encouraging those mothers to make them understand
27:22
that if they can help prevent pertussis by transmitting higher antibody levels,
27:28
that's not really a lifetime thing,
27:31
but it's protecting the infant at a very young age.
27:33
And so I don't know, you know, what the demographics of and the decision-making
27:39
processes of the women who are declining.
27:41
And then among school-age children, it's funny because any vaccine you look
27:46
at, the rates of vaccination, let's say in the high schoolers,
27:50
the seventh graders, the vaccination rates among kindergartners are lower kind of across the board.
27:56
And what does that mean? That means that those, you know, older children who
27:59
are getting fewer vaccines, but they're also from, they were also in kindergarten
28:03
several years ago, the messaging has gotten more, more intense and more
28:10
sharing this information, you know, especially between parents,
28:14
reading misinformation online, getting conflicting data from the government
28:19
and getting suggestions from the government.
28:22
COVID vaccine really led to a lot of mistrust.
28:26
And whether, you know, whether any of that was warranted has really caused a big problem.
28:33
So I think that it's the younger kids, the parents that are having children
28:37
in the last few years tend to be our group that we need to be targeting for education.
28:44
And as far as gaps, the data exists that certain schools have much,
28:50
much lower rates of vaccination in San Antonio as well as other across the country.
28:56
If you look, you can break down the data by school and it tends to be certain
29:00
private schools in particular, although some public school districts have lower rates.
29:05
And the very high rates of exemption in certain pockets in certain schools.
29:10
And I think that that culture of catering to some of those parents and parents
29:17
talking to each other and believing that vaccines aren't warranted,
29:21
that vaccines aren't natural, that vaccines are harmful,
29:24
that they really aren't necessary or that only some are necessary leads to these pockets.
29:29
And it's very frustrating because the anti-vaccine movement And it is not,
29:33
you know, I've been following this for a long, long time. It's just kind of gained steam.
29:37
And now it's like extremely dispiriting.
29:42
So much misinformation out there. A lot.
29:45
And you've seen one patient with pertussis at University Hospital? I've seen one older kid.
29:53
We've had other cases, but I've only had one in the last few weeks that I've
29:59
seen specifically in the older child cohort.
30:03
And this was a complex patient with multiple medical problems that the.
30:10
Pertussis infection, you know, you can't really identify how much it was contributing
30:15
to the other complications, but I really am concerned that that might have played a role.
30:20
And that was not a vaccinated patient.
30:23
So that was not a classic presentation. It was a patient who had like cough
30:28
and congestion and fever, that type of thing, but was identified on respiratory
30:31
viral testing, you know, the wide panel.
30:34
So the other thing to comment is, you know, we have more and more of pertussis
30:37
cases identified, some of this is really increased testing because we have these
30:43
panels that, you know, didn't used to exist. You would have to do targeted testing.
30:48
And, you know, I'm old enough to remember when, you know, PCR was kind of like,
30:52
you know, the culture was the gold standard and culture takes a long time and
30:57
it's less sensitive and it's hard to, you know, arrange.
31:00
So we are identifying a lot of cases that we weren't identifying before.
31:03
And so all of this needs to be taken into consideration when you look at total cases.
31:09
Dina, this is all so insightful. Thank you so much for being here in the podcast
31:13
studio and talking about this on such short notice.
31:18
Is there anything else you want to say to pediatricians regarding flu or pertussis?
31:23
I just want to keep emphasizing, like, keeping an eye on the numbers and knowing
31:29
what's going on in the community and also when you, you know, for parent education,
31:36
really try to, there's a lot of this shared decision-making going on that,
31:39
you know, is kind of a newer concept. It's not that new, I guess.
31:42
Really trying to understand where the parents are coming from,
31:45
where they're getting their information.
31:47
And then instead of being adversarial, you know, really just getting them.
31:52
You know, the information that they need and reassuring them.
31:54
And I, you know, from, you know, when I interact with pediatricians in the community,
31:58
many of whom I know, they do a great job at this.
32:00
They already do a great job at this. So I'm just here to commend them.
32:03
And we have an episode on motivational interviewing where the doctor talks specifically
32:10
about when you're talking to a patient, a family,
32:14
a mom or dad or caregiver about vaccine hesitancy and how motivational interviewing
32:19
can help with that. Absolutely.
32:22
And how concerned are you just overall with flu and pertussis right now?
32:29
I am, I think, well, the good thing about Pertussis is that the big outbreak
32:35
that we started having in the fall last year, even though we have a lot of cases
32:38
going on and Texas is having a surge, actually, we have more cases than last year.
32:43
Nationally, we actually have a little bit of a decline in number of cases since last year.
32:49
So, I mean, I think some of that is reassuring. I think the Texas part is a
32:54
little frustrating, but, you know, it remains to be seen. I'm concerned.
33:00
As far as influenza, I'm pretty concerned. Not so much that the vaccine mismatch
33:05
is going to be such a problem,
33:06
but more about vaccine uptake and the natural history of H3N2 disease,
33:12
especially in the chronically ill or the kids who have complex medical needs,
33:17
but also in healthy kids.
33:19
So I'm just anticipating a rough winter.
33:23
Wear a mask indoors in crowded settings.
33:27
Sarah, do you advise that? I certainly, especially if you have any level of
33:31
immunocompromise, if you're in crowds where you can't control your exposure,
33:35
if you're on an airplane in particular, and in the hospital setting,
33:39
really adhering to infection control recommendations.
33:41
And I see sometimes when there's a patient who has a cough, but because,
33:45
you know, they haven't been tested yet, maybe people aren't wearing a mask.
33:49
In a clinic setting, it's hard to, where you aren't testing all the patients
33:54
as opposed to hospital, a lot of people are not wearing masks when they come
33:56
in the room. But really, children who have coughs or coughs and fever,
33:59
you really should be protecting yourself as the clinician.
34:03
And so I, you know, it's interesting to find out what people are doing in the
34:06
community because I really recommend not getting sick from every single thing
34:10
that you're exposed to. Put your mask on first.
34:12
Yes, put your mask on first. And Dina, thank you so much.
34:16
And are you doing anything fun for Thanksgiving, hopefully, as we're talking
34:19
about all this not fun stuff to talk about?
34:24
Well, I guess I'm going to go shopping after this and then I'm going to have, it's not fun.
34:29
It's kind of fun to cook all day for a bunch of people and then clean.
34:33
So kind of not fun. Are you having a big family gathering and are you doing the cooking?
34:38
Yeah. My sister and I do all the cooking every year. We try to,
34:42
you know, we get the kids to help some.
34:44
You know, we have a big clan, so we're going to get them together and have kind
34:49
of the traditional Thanksgiving dinner, whether they like it or not.
34:53
And so you're going to shop and then start cooking.
34:56
Yes. I haven't started doing anything yet. I haven't either.
34:59
And I'm changing the recipes because they were more complicated than ones I picked out last week.
35:03
And I'm shifting to just the easier recipes.
35:07
Yeah. I started thinking. I was looking at some of these like New York Times
35:09
things. Yes. I love this. Oh, I could make this. And then I was like,
35:12
no, forget it. We're just going to make the normal stuff.
35:14
Yes. I was looking at the New York Times one too. The squash pie.
35:17
Oh, yeah. Where you could do like candied squash on the top and then. Oh, yeah.
35:21
Yeah. I have all these grand aspirations.
35:24
And then in the end, it's like, and then I told my youngest I was going to make
35:27
the sweet potatoes in the little orange cups.
35:29
And that did not go over well. I was like, absolutely not, Mom.
35:33
So now from the New York Times, I'm going to make apple crumble.
35:36
The headline said that it's much easier than making apple pie and it tastes just as good.
35:42
That's a good idea. Maybe I will do that one if it's easier.
35:46
Dr. Dina Sutter with University Health at UT Health San Antonio,
35:50
our expert on infectious disease and pediatrics.
35:53
Thank you for being here on Pediatrics Now. Thanks so much, Holly.