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Atypical Pneumonia: the Mycoplasma Wave · Pediatrics Now: Cases Updates and Discussions for the Busy Pediatric Practitioner

• 0:00
  I'm Holly Wehmint, and this is Pediatrics Now, cases, updates,
• 0:04
  and discussions for the busy pediatric practitioner.
• 0:07
  Click on the link in this podcast for free credit that may include CME,
• 0:11
  MOC, or ethics credit, depending on our topic or podcast.
• 0:16
  Today, back here in the podcast studio, is Dr. Tess Barton.
• 0:21
  Tess is our infectious disease expert here at the University of Texas Health
• 0:25
  Science Center and University Health. And we're talking about something that
• 0:31
  community pediatricians are seeing a lot of.
• 0:35
  So we're talking about atypical pneumonia.
• 0:38
  Tess, thank you so much for being here today in the podcast studio.
• 0:41
  Thanks for having me back. It's always a pleasure.
• 0:44
  So we have been, we proactively track our lab tracks here at University Hospital and through UT,
• 0:52
  tracking kind of the ongoing respiratory pathogens that are circulating that
• 0:58
  we're getting through positive testing on respiratory testing.
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  And so certainly in the past few months, we have definitely seen an uptick in
• 1:06
  the number of mycoplasma and pneumonia positivity.
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  And mycoplasma is a bacteria that can cause a pneumonia that,
• 1:17
  you know, the medical field we call atypical pneumonia, I think colloquially
• 1:21
  called walking pneumonia.
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  And that's a pattern that's actually been seen at the other hospitals in the
• 1:28
  city, as well as nationwide.
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  So this is, you know, kind of a blossoming surge of mycoplasma.
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  It's not unusual for that to happen. There are actually mycoplasma comes in waves every few years.
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  And so it's been a few years since we had mycoplasma wave.
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  And so I think that this is sort of what we're seeing is kind of usual for mycoplasma illnesses.
• 1:55
  What's your advice? Just to be on the lookout and have increased awareness.
• 2:01
  So pediatricians are usually quite aware of mycoplasma.
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  It presents clinically with a fever and a cough, oftentimes with wheezing,
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  particularly maybe in a person who's never had asthma or wheezing before,
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  and now they have an illness that has wheezing.
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  So, you know, when you're seeing the patient in your clinic or your office,
• 2:28
  they look a lot like they begin with a regular respiratory illness and perhaps
• 2:32
  even like of viral pneumonia.
• 2:34
  So it could look like COVID, it could look like RSV, you know,
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  it could look like any of those illnesses may be very similar.
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  And we often differentiate it from a regular bacterial pneumonia,
• 2:48
  which may have very high fever, sort of more sudden onset,
• 2:52
  and usually has the kind of typical, bacterial pneumonia usually has kind of
• 2:58
  a typical dense, you know, mucus globs up in the lungs that are,
• 3:05
  you know, you can hear the difference between the two lungs.
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  Whereas mycoplasma you might hear more diffuse sounds like all over the lungs
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  and wheezing things like that.
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  So in the past you know we didn't really have common
• 3:18
  testing for mycoplasma so we sort of
• 3:21
  just diagnosed it clinically based on the the appearance of like well it kind
• 3:26
  of looks like a virus but it's sort of like a pneumonia but it's been going
• 3:29
  on for longer than it should be going on but it's not as severe as a bacterial
• 3:33
  pneumonia and that kind of combination of things would send us down the road of mycoplasma.
• 3:39
  There is now, there is a test that can be done, although many pediatricians
• 3:43
  don't have that like in their office. It's not a rapid test.
• 3:47
  But there is a PCR that we do from a nose swab that we've been,
• 3:53
  you know, doing quite widespread because it's one of the ways that we diagnose COVID and RSV now.
• 3:59
  And that actually has mycoplasma on it. So we do have a little bit of an increased
• 4:03
  ability to find mycoplasma.
• 4:05
  Than we have during those previous outbreaks or waves.
• 4:11
  One pediatrician was asking me, how do you know when to treat pneumonia or not? Sure.
• 4:18
  I mean, there's no, I don't have a great, perfect answer for that.
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  So as many pediatricians know, patients, you know, children come in in the cool
• 4:26
  weather season with respiratory illnesses nonstop.
• 4:31
  And so differentiating between a bacterial infection and a viral infection can be difficult.
• 4:38
  I think usually the indications for treating for pneumonia, for a bacterial
• 4:43
  pneumonia or an atypical pneumonia, really depends on the patient's lung exam.
• 4:49
  Does it sound like they have a focal disease, right?
• 4:53
  One lung sounds different than the other lung, or are they not getting better
• 4:57
  in the time frame that you expect them to get better with a virus infection?
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  So, for example, what would be the time frame? It really depends on how long
• 5:07
  they've been sick and how sick they look.
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  So, you know, kids who have a viral infection, they usually come in,
• 5:14
  you know, if it's in the first three days or so of their illness and they're
• 5:19
  hanging in there and looking okay.
• 5:21
  You know, the probability is that that's just a regular old virus infection. Maybe it's RSV.
• 5:27
  RSV should peak around day three or four of illness and then begin to get better.
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  So I think the time to begin thinking about other things,
• 5:36
  whether it's a regular bacterial pneumonia or a mycoplasma atypical pneumonia,
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  is if now you're on day four, you're on day five, and they're just not getting
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  better the way you expected that they should get better, is one of the ways
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  for most of the kids who have these infections.
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  And that's actually why it's called walking pneumonia, is because people who
• 5:57
  have that atypical mycoplasma pneumonia, they're not...
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  Usually like horribly, horribly ill requiring hospitalization and IV antibiotics
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  for their pneumonia. They're usually not requiring oxygen or things like that.
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  They're walking around with their pneumonia, coughing, having fever,
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  but otherwise sort of functioning generally well.
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  I mean, there's absolutely can be very serious cases of mycoplasma and especially
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  when you combine mycoplasma with another infection, so RSV plus mycoplasma or
• 6:31
  influenza plus mycoplasma is a really terrible combination.
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  But usually, you know, it's that kind of combination of it looked like a virus,
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  but it's a little bit worse or it's not getting better like the virus should be getting better.
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  But it's not so bad that I think that the patient has full-on pneumonia.
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  And this is a question from a parent, which I know pediatricians are getting
• 6:56
  questions like this, too.
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  Is walking pneumonia, is it contagious?
• 7:01
  Yeah, absolutely. That's how this is spread. So it's spread from person to person,
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  just like viruses are spread from person to person.
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  And mycoplasma actually has the ability to remain alive on dry surfaces for a long time.
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  So all of those like touching the doorknobs and, you know, those types of ways
• 7:20
  that we talk about washing your hands to prevent getting a respiratory infection.
• 7:24
  It's exactly, you know, that type of that type of creature.
• 7:29
  So if if someone has walking pneumonia, should that person stay home as long
• 7:34
  as they have a cough or wear a mask or. Yeah.
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  So they should stay home as long as they are in the kind of fever and bad cough
• 7:44
  part of their illness, ideally.
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  If they've started on antibiotics, they actually should be able to return to
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  wherever they're going within 24 to 48 hours after starting their antibiotics
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  because they become much less contagious on the antibiotics. Yeah.
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  You know, this particular illness can often have a long lingering cough that lasts for weeks.
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  So, you know, staying at home while you have a cough could be completely intrusive in your life.
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  But, you know, during that kind of acute phase, until you begin getting better
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  or until you've been on treatment for a day or so, it would be better to not
• 8:23
  be at school or at work spreading your mycoplasma around to everybody.
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  So we don't have a vaccine for mycoplasma. So, you know, we do have,
• 8:33
  you know, we have vaccines for influenza. We have vaccines for COVID.
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  Infants routinely get pneumonia vaccine that should take them through their
• 8:42
  time of their greatest vulnerability to pneumonia. And of course,
• 8:47
  grandparents get a pneumonia vaccine. Now we have RSV vaccines.
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  We have RSV vaccines for pregnant women. We have RSV, you know,
• 8:56
  preventions for vaccines and monoclonal antibodies for newborn babies.
• 9:02
  And we have RSV vaccines for grandparents. parents.
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  So, you know, we have vaccines for a lot of other respiratory illnesses besides mycoplasma.
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  So yeah, people absolutely should get themselves protected against as many of
• 9:17
  those other things that you can be protected against, you know,
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  because it can be difficult to kind of sort through like, what is the thing
• 9:26
  that's causing my respiratory illness?
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  So, you know, older people are at risk of pneumococcal disease and pneumococcal
• 9:34
  pneumonias that's caused by a bacteria called streptococcus pneumoniae.
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  And young children are at risk of that, not only from pneumonia or bloodstream
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  infections with strep pneumo, but also meningitis.
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  And so since 2001-ish, we have been giving pneumococcal vaccine,
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  that's the Prevnar vaccine, to infants.
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  So they get it at their like 2, 4, 6-month plus 12 to 15-month booster.
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  And interestingly, there was actually, when that vaccine first came out,
• 10:04
  there was a study, it was a sort of a CDC,
• 10:08
  you know, affiliated monitoring network that sort of followed the pneumococcal
• 10:15
  diseases over time, before and after that vaccine started being used and in different age groups.
• 10:23
  And before we started giving extra vaccine or that vaccine to,
• 10:27
  you know, grandparents,
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  they actually saw a decline in pneumococcal infections after starting giving
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  that vaccine to infants, not only, of course, in the infants and the young children,
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  but also in older people.
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  So we colloquially called that the grandparent effect, where you had the young
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  kid who was picking up the pneumococcus in daycare or preschool,
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  and then going and hanging out with their grandparents and getting their grandparents ill.
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  And so they were no longer bringing it to infect their grandparents.
• 10:56
  Well, so it can be such a stressful time for our listeners, pediatric practitioner
• 11:01
  listeners, as you know, where so many different respiratory viruses are coming at them.
• 11:07
  And of course, you don't want to undertreat. You don't want to overtreat.
• 11:11
  What do you recommend is said to parents or caregivers about,
• 11:15
  you know, call me if you're seeing this, this or this, or I'd like to see you
• 11:20
  back in a week or any recommendations there? Sure.
• 11:23
  Yeah. So I think if the suspicion is that this is a viral infection,
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  I would tell that, you know, parents should call their pediatrician if they're
• 11:32
  now going on three or four days and the child's still having fever.
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  It was kind of a big clue that something may be going on.
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  Or if they're having a really productive cough or if they're having wheezing.
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  As always with any illness, regardless of what the thing that's causing it,
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  as far as respiratory illnesses, if you're having respiratory distress.
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  Right, if they're breathing hard, they're huffing, they're puffing,
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  they're panting, you see their muscles between their ribs or above their collarbones
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  kind of sucking in, their head bobbing.
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  Those are signs of, you know, severe respiratory distress and they need to be
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  seen at the emergency room immediately.
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  There's color changes. They look, you know, pale or purple or blue.
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  You know, those things are signs that there's something very serious going on
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  and that shouldn't, you know, wait until the next day.
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  But for parents who are worried that, oh, could this be more than just the virus?
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  Usually the big clue is that it's not getting better when the virus should already be getting better.
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  I'll put in the text of this podcast a program that our colleague, Dr.
• 12:39
  J.B. Canty, that he's doing with the NIH, where it's a number where you can
• 12:44
  get through, pediatricians can get through directly to ask if does this baby
• 12:49
  need antibiotics or not.
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  It's the antibiotic stewardship program.
• 12:54
  Yes. And of course, they can call you as well. Anything else you want to say
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  about atypical pneumonia?
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  I think for the practitioners, maybe, I did a little bit of investigating into
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  the types of mycoplasma tests that are available because,
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  of course, here in the hospital setting, we use a respiratory PCR panel that
• 13:19
  looks for a bunch of different viruses and mycoplasma and other things.
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  But that's not always feasible to do in a clinic, and many times you want to have a rapid test.
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  There is kind of a rapid test that is available for mycoplasma,
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  and just like there's rapid tests for strep and influenza and COVID.
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  And so looking into that, it looks like it has about a 50% sensitivity.
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  So it can potentially be a useful test, but it's not really a slam dunk.
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  So I think, you know, we often will end up, you know, logistically kind of treating for everything.
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  So, you know, the pneumonia guidelines suggest giving amoxicillin for community-acquired
• 14:07
  pneumonia and children, plus or minus azithromycin for mycoplasma.
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  And that's fine, you know, if there's a good suspicion that that's what they
• 14:18
  have, even if you don't have a test.
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  The other thing that I would say for clinicians is that we know that there's
• 14:27
  actually been an increase in macrolide or azithromycin resistance in mycoplasma.
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  So kids that have been treated with azithromycin and they're not getting better.
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  Of course, you could think about viruses and other things that it could be,
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  but those kids probably would warrant being formally tested to try to be sure
• 14:50
  that you're actually treating mycoplasma.
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  And if it's there, despite being on azithromycin, the next step or the next
• 14:59
  antibiotic choice, if you suspect that there's resistance, is actually doxycycline or levofloxacin.
• 15:04
  So in this time of respiratory viruses, how do you explain what a virus is to a child?
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  Kids, usually, you know, by the time you're going to be talking about that,
• 15:17
  they have some concept of germs, right?
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  So I think germs in general are, you know, little, tiny, you know, they're microscopic.
• 15:28
  You can't see them with your eyes, but they, you know, float around or they
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  get passed from one person to another, you know, when you're sniffles or you're
• 15:36
  coughing and that can make you sick.
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  And so, A virus is a germ that we carry in our noses and in our throats.
• 15:52
  At least for respiratory viruses. And, you know, when we sneeze or we blow our
• 15:57
  nose or we cough, they come flying out and they are able to be picked up by
• 16:03
  somebody else or breathed in by somebody else.
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  And that can make them sick too.
• 16:08
  We also have viruses, by the way, in our intestines. And so we poop them out as well.
• 16:16
  And so there are diarrhea viruses, right?
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  So similarly, we can poop out a virus that's living inside of us and it can
• 16:26
  get picked up on our hands or on the hands of the person who's helping us, you know, at the potty.
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  And if they don't wash their hands really well and they accidentally,
• 16:35
  you know, they put their hands in their mouth, then they can also get that virus.
• 16:40
  And it's important to dry hands that wash with soap and water and also dry.
• 16:47
  Yeah. I mean, it's that the drying process helps to kill things off.
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  I mean, you can let them air dry is fine.
• 16:54
  But yeah, so especially with the alcohol hand sanitizers, like the alcohol hand sanitizer,
• 16:59
  you know, you work on killing the stuff while you're rubbing the alcohol in,
• 17:03
  but the drying that happens is sort of, you know, busting apart the membranes
• 17:10
  of those various cooties that we can get. Yeah, cooties are real.
• 17:22
  It is, you know, winter cootie season soon, even though it doesn't feel like winter.
• 17:27
  Yes. It is here. Especially here in San Antonio.
• 17:31
  What about a vaccine? How would you explain that to kids? Yeah.
• 17:35
  So I think the very simple version of a vaccine is that, you know,
• 17:40
  you get a shot that helps to protect you against a germ.
• 17:47
  The version of explaining vaccines actually that I have very frequently give
• 17:52
  to parents because I have to counsel parents who sometimes don't want to give
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  vaccines is really that, you know,
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  the way our immune systems work
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  is that they see something. You're at the cells of your immune system.
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  They see a germ, the outside part of it, and some of your cells have to figure
• 18:15
  out what it is, and then they make some type of immune system reaction, usually an antibody,
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  so against that, the outside parts of that germ.
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  And those antibodies stick to the germ and allow it to get like eaten or cleared
• 18:31
  away by other immune system cells to get it out of your body.
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  And so making those antibodies is the way that your body has to sort of flag
• 18:41
  something so that it gets cleared away.
• 18:44
  And so a vaccine, most vaccines are, with a few exceptions, don't contain,
• 18:51
  you know, the living germ necessarily.
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  Most of the vaccines contain either the outside bits and pieces,
• 19:00
  the outside proteins or the capsules,
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  or some of the major proteins either inside or outside of the germ.
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  And the whole reason for that is to essentially show it to those immune system cells.
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  So they make their reaction and they know what, and so they've kind of learned
• 19:20
  what it looks like, how to fight it.
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  They've already made the tools so that when the real thing comes along,
• 19:27
  they already know what to do and they
• 19:30
  can act much faster and they can clear it away before it even really has a chance
• 19:36
  to start causing you a problem as opposed to waiting for it to like start infecting
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  cells and growing and getting out of hand while it's figuring out what it's doing.
• 19:47
  So it's kind of, you know, preparing and teaching your immune system what it
• 19:51
  looks like. But in order to do that, you have to give bits and pieces, right?
• 19:56
  Your immune system has to see some of those germs through one way or the other.
• 20:03
  So it's common when you get a vaccine, you might get some of the side effects
• 20:07
  of immune system reactions, right?
• 20:09
  You might get a fever, you might get a sore arm, you might get headaches or
• 20:13
  stomach aches or feel bad, right?
• 20:15
  Or feel like you have the flu after you get the flu vaccine.
• 20:18
  Because that's your immune system thinking, You've kind of tricked it into thinking
• 20:22
  that you have the flu when you really just gave it the fake flu.
• 20:29
  And it's learning. And it's learning. And that's not, you know,
• 20:33
  and later on when the real thing comes along, you'll be able to take care of
• 20:37
  it much quicker. And then –,
• 20:40
  Maybe a parent who's listening might say, well, why would I even want my child
• 20:43
  to have the fake flu? I don't even want the fake flu.
• 20:46
  Well, right. I mean, nobody wants the fake flu or the real flu, right?
• 20:50
  It's reasonable. But the idea is that the fake flu is way less uncomfortable.
• 20:57
  You know, like it's better to deal with the fake flu than it is to deal with the real flu.
• 21:02
  Which is coming. The real flu will come. Oh, yeah.
• 21:05
  Oh, yeah. I mean, we've had a couple of influences so far in the hospital,
• 21:13
  but we're definitely starting to see RSV.
• 21:15
  So RSV is here, as we expected. This is the time that we would expect to see
• 21:19
  RSV on the rise. And the flu will come. The flu will come in a month or two.
• 21:24
  And that RSV vaccine is a game changer, right?
• 21:29
  Absolutely. Absolutely. Especially, you know, especially for the grandparents, because, you know,
• 21:34
  adults, we always think of RSV as being kind of a baby disease,
• 21:37
  because babies are the ones who have tiny airways that can't accommodate the
• 21:41
  mountains of mucus that RSV likes to produce.
• 21:45
  And they're the ones who block off their airways and get stuck in the hospital.
• 21:50
  But actually, older adults really can get very severe RSV infections that can
• 21:59
  be quite dangerous for them.
• 22:01
  So it's nice that we, you know, this is an infection that has been the bane
• 22:07
  of the pediatrician for, you know, centuries.
• 22:11
  Bronchiolitis. It's something that every pediatrician sort of dreads bronchiolitis season.
• 22:17
  And, you know, in our training, we've all been in a hospital where,
• 22:22
  you know, your ward is completely full of wheezing, snotty RSV kits.
• 22:28
  So to be able to prevent that is great.
• 22:33
  And really, for a pregnant woman to be able to get a vaccine that then helps
• 22:38
  to protect her baby is also great.
• 22:42
  It's amazing. Yeah. I got my COVID and blue shots last week. And Dr.
• 22:47
  Ed Brooks, our division chief for allergy, immunology, and infectious disease,
• 22:52
  when he was talking about mucus, he was saying how it gets a bad rap.
• 22:56
  Like there's so many products to keep mucus away and make it you not have mucus.
• 23:00
  And really, that's what's getting rid of the virus.
• 23:04
  And it's doing amazing work. Like you want that mucus if you're sick with a virus.
• 23:10
  Yeah, that's true. I mean, you know, mucus is sort of binding everything up
• 23:15
  and packaging it into a way that you can expectorate it and get it out of your body.
• 23:21
  So, yeah, I mean, the problem is, you know, it just it just clogs clogs you
• 23:25
  up and blocks your airways.
• 23:26
  The same, honestly, the same thing with a fever, like fever, you know, or or.
• 23:33
  Organisms, right? Organisms that can make fever do that actually as a protective mechanism.
• 23:40
  Like we do that because certain, you know, viruses and bacteria,
• 23:45
  like the things that make us sick, many of them can't grow at a higher, at that temperature.
• 23:52
  And so we raise our temperature to partly to kill off the thing that's making us sick.
• 23:58
  So when we, you know, fever doesn't feel good.
• 24:01
  So when we're like taking, you know, medicines to reduce fever,
• 24:06
  we might make ourselves temporarily feel better, but we're actually, you know,
• 24:11
  we're actually fighting against our immune system's natural tendency to try to protect itself.
• 24:18
  And yet our culture, it's like, oh, no, you have a fever. Let's take care of the fever.
• 24:23
  And I've heard it described as the fever is our body doing its most magnificent work. Yeah, yeah.
• 24:30
  I mean, I think, you know, fever can be concerning when it's extremely high
• 24:34
  or when it goes up really fast.
• 24:36
  So when it goes up really fast or it's really high, you know,
• 24:39
  we worry about seizures in young children.
• 24:43
  But most people aren't going to have a seizure when they have fever.
• 24:46
  They're just going to feel terrible. and and so
• 24:49
  you know I always feel bad when there's you know somebody a patient who has
• 24:55
  fever and chills you know when you like feel cold but your but your your temperature
• 25:00
  is very high but you're feeling cold and then to like cover them with like cold
• 25:05
  towels or put them in a cool bath it just.
• 25:08
  Seems really mean and then because it doesn't feel good right it doesn't feel
• 25:12
  good to do that And the fever is, you know, the body's attempt to fix a problem.
• 25:19
  You know, it's a natural way that we fix a problem.
• 25:22
  So I think, you know, people are probably going to call in and be unhappy about that.
• 25:27
  But I think that tolerating a modest fever, you know, something that's 103 or
• 25:33
  less, like you should probably tolerate it.
• 25:36
  And if it's 104, call the pediatrician anyway about it.
• 25:41
  I mean, I think if your child is sick with a high fever, it's always a good
• 25:44
  idea to be in contact with your pediatrician to get advice to make sure that
• 25:51
  there's nothing else that you need to do,
• 25:54
  right? Every case is sort of different and individual.
• 25:57
  And so I think that trying to understand, okay, I've got this fever.
• 26:01
  Like, they're doing this and they're doing that. Do I need to be seen?
• 26:05
  Can I wait? What should I do? So, but I think, you know, for the most part,
• 26:10
  you know, fever, fever is a natural response.
• 26:13
  And I, I, I, personally, I feel like we should tolerate it more than we do.
• 26:17
  Yes, I agree. And if as the, for the pediatric practitioner listener who gets
• 26:21
  the call, my child has a 104 fever, what's your advice there?
• 26:27
  You know, for pediatricians, usually they'll want to, you know,
• 26:30
  double check are, you know, are there any warning signs of a more severe illness, right?
• 26:35
  Are they having those signs of respiratory distress?
• 26:38
  Are they eating and drinking? Are they having changes in their mental state?
• 26:43
  I mean, of course, a child who has a high fever is going to have,
• 26:46
  you know, a lot of blahs, right?
• 26:48
  They're going to be feeling, you know, pretty crummy, and they might be sort of laying around.
• 26:52
  But if they're really like, you know, lethargic, or they're not as responsive
• 26:57
  as they normally are, they don't seem, you know, they don't seem like their
• 27:01
  thought process or their mentation is normal.
• 27:05
  For little babies, are they not feeding well?
• 27:08
  Are they crying excessively? You know, those are kind of the warning signs that
• 27:12
  maybe something more sinister is happening.
• 27:17
  Okay. And do you have time for one more question? Yeah.
• 27:21
  One pediatrician was saying, well, a lot of kids are getting flu shots.
• 27:27
  Parents, for some reason, are not going for COVID shots this year.
• 27:30
  I have had the same observation.
• 27:33
  And I think, you know, the COVID shots are effective.
• 27:40
  They're not super effective, right? They're modestly effective.
• 27:43
  They may cut your risk of getting COVID by about half, right? Not 100%.
• 27:51
  They're safe. At this point, hundreds of millions of COVID doses have been administered.
• 27:58
  There are a lot of people who were very upset about COVID vaccine and the way
• 28:04
  that COVID vaccine was developed and rolled out, feeling like it hadn't been
• 28:09
  studied well enough, things like that.
• 28:11
  It had studies that were, you know, as good as other vaccine studies.
• 28:15
  But honestly, at this point, you know, the experiential data of multiple millions
• 28:24
  and millions of people receiving this vaccine has shown it to be overall safe.
• 28:31
  Nothing is 100% safe. Nothing is 100% effective.
• 28:35
  And so, you know, we do know that COVID vaccine can help have people who get
• 28:43
  COVID vaccine and avoid getting COVID disease have a lower risk of getting like long COVID symptoms.
• 28:51
  And so I think that there are other reasons, you know, that we should think
• 28:55
  about for COVID. And I think in general, during respiratory illnesses,
• 29:03
  we spread them from person to person.
• 29:06
  That's how they work. And so when we, you were like, well, I'll just get the
• 29:12
  disease and get over it because I'm otherwise healthy and, you know, can handle it.
• 29:18
  Like, that may be fine for you. That may be fine for you.
• 29:21
  But, you know, the problem is that you then go and you give it to other people
• 29:26
  and you don't know those other people.
• 29:28
  Are they not healthy?
• 29:31
  Do they have a grandma at home that's not healthy? Do they have a mom who's
• 29:35
  having breast cancer treatments? Like, you don't know.
• 29:38
  And so I think that, you know, if we each sort of individually did our best
• 29:42
  to avoid getting cooties and avoid spreading cooties, it probably would make
• 29:47
  our society generally more, not only more healthy, but also more productive, right?
• 29:51
  We're not missing school and work and things like that. So that's my rationale.
• 29:55
  And should we stress at a young age about coughing into the elbow or with kids?
• 30:00
  Well, I mean, I think, yeah, covering your cough, covering your cough is good for any age.
• 30:04
  And I think that's something very simple that kids can do and that they can understand.
• 30:08
  And so, you know, each time that they like open mouth cough all over your face,
• 30:13
  to take that moment to try to teach them a better way to do their coughing.
• 30:22
  And how much does the flu vaccine protect us? So the flu vaccine is really variable.
• 30:28
  And so the flu vaccine that we give, it gets sort of adjusted or tweaked every year.
• 30:34
  Sometimes it's exactly the same as it was the year before. Sometimes it gets a major overhaul.
• 30:38
  And that's based on a prediction of what the flu strains, the changes that they
• 30:43
  see in flu strains, and what do we think is going to be circulating.
• 30:46
  And so, you know, to manufacture the vaccine takes months. And so you have to
• 30:52
  predict, like, what am I going to be protecting months from now that I haven't yet seen?
• 30:57
  So sometimes that prediction is spot on, and sometimes it's not.
• 31:01
  So the flu vaccine contains four strains of flu.
• 31:05
  And to try to cover for, you know, usually we have at least two and often three
• 31:11
  dominant strains that circulate each year.
• 31:14
  So there should be some protection against those.
• 31:17
  So sometimes we get a flu vaccine that's, you know, a hundred percent match
• 31:23
  for everything that's going around. And sometimes we get a flu vaccine that's
• 31:26
  a, you know, 25% match for everything that's going around.
• 31:30
  So the flu vaccine in general, even when it is a match, again,
• 31:33
  it's not a hundred percent effective vaccine. It's a vaccine that has somewhere
• 31:37
  between 50 and 85% protection. Yeah.
• 31:42
  Against the thing. So you significantly reduce your chance of getting the real
• 31:48
  flu, but it's not always perfect.
• 31:51
  And this flu vaccine so far, how is it looking? Well, we don't have a whole
• 31:55
  lot of flu strains circulating, so I can't tell you.
• 31:58
  So more to come on that. Yep.
• 32:01
  Anything else, Tess, you want to mention? This has been so enlightening.
• 32:04
  It's an honor to be sitting here with you today in the podcast studio.
• 32:08
  I know you're so busy and you're helping so many children and families.
• 32:12
  So thank you for being here. Yeah, thanks for having me.
• 32:14
  Music.
• 32:21
  Thank you so much for listening to Pediatrics Now, brought to you by the Department
• 32:26
  of Pediatrics at UT Health San Antonio and University Health's new Women's and Children's Hospital.
• 32:33
  Coming up next week, managing pain in children.
• 32:39
  It's a tough topic, and we talk about it in our grand rounds,
• 32:42
  and I will bring you the latest expert advice.
• 32:46
  That's next week on Pediatrics Now.
• 32:49
  Thank you so much for listening. I'll see you soon.