HAND, FOOD AND MOUTH DISEASE

I was scrolling in facebook yesterday when I saw a photo of this beautiful young girl from Manila with rashes who was diagnosed with HFMD and later again today I read on Facebook that we have cases of HFMD here in our province. The other year, the same period there are a lot of reported HFMD cases here in our province however last year, we didn't have those humber of cases and again it hit this year.

Hand Foot and Mouth Disease is a common viral illness that affects people of all ages, but it is most prevalent in children under the age of 10. It is known for causing sores in the mouth and a rash on the hands and feet. 

Introduction to Hand Foot and Mouth Disease

Knowing the basics of Hand Foot and Mouth Disease is key to managing it. Its complex and fascinating history adds depth to our understanding of the disease. Exploring this history can give us a clearer picture of its effects on people of all ages.

Key Takeaways

• Hand Foot and Mouth Disease is a common viral illness that affects people of all ages.
• The disease is characterized by sores in the mouth and a rash on the hands and feet.
• Exploring the unpopular facts and history of Hand Foot and Mouth Disease can provide valuable insights into its symptoms, treatment, and prevention.
• Delving into the history of Hand Foot and Mouth Disease can help us understand the evolution of the disease and its impact on society.
• Understanding the basics of Hand Foot and Mouth Disease is crucial in navigating its symptoms, treatment, and prevention.

Understanding Hand Foot and Mouth Disease: Beyond the Basics

Hand Foot and Mouth Disease (HFMD) is a common illness that affects people of all ages. It's most common in children under 5. To understand HFMD, knowing its unique traits and how it differs from other viruses is key. HFMD symptoms can vary from mild to severe, including fever, sore throat, and a rash on hands and feet.

For HFMD treatment, there's no cure, but symptoms can be managed. Knowing the science behind HFMD symptoms helps in providing the right care. Misconceptions about HFMD can lead to delayed diagnosis and poor treatment.

• HFMD is highly contagious and spreads through direct contact with an infected person.
• The disease can also spread through contaminated food and water.
• Early recognition of HFMD symptoms is critical for effective management and prevention of complications.

The Discovery and Early Documentation of HFMD

The history of Hand Foot and Mouth Disease (HFMD) is quite interesting. The first cases were reported in 1957 in Canada. Since then, it has become a major health issue worldwide. Knowing about HFMD's history helps us understand how it has evolved.

In Asia, HFMD has been a big problem for decades. Every year, thousands of people get sick from it. By looking at HFMD's history, researchers can find ways to stop it from spreading.

Some important moments in HFMD's history include:

• 1957: First reported cases of HFMD in Canada
• 1960s: HFMD outbreaks reported in Asia (a paper entitled "Epdimeic dynamics, interactions and predictability of enteroviruses associated with hand, foot and mouth disease in Japan", was published in the Journal of the Royal Society Interface which reports that HFMD epidemics have been reported in Japan since 1963) 
• 1980s: HFMD becomes a global health concern

Geographic Distribution and Cultural Impact

Hand Foot and Mouth Disease (HFMD) is a global health issue. It has been reported in many countries. In Asia, it's a big public health worry. 

The spread of HFMD depends on climate, how crowded places are, and cleanliness. Where sanitation and hygiene are poor, the risk of outbreaks is higher. Many families and communities are touched by HFMD's impact.

Several factors play a role in where HFMD spreads and its cultural impact. These include:

• Climate and weather patterns
• Population density and mobility
• Hygiene practices and sanitation
• Socioeconomic factors, such as access to healthcare and education

Lesser-Known Symptoms and Manifestations

Hand Foot and Mouth Disease (HFMD) has symptoms we all know. But, there are some not-so-well-known signs and complications. These can vary in how severe they are and how they show up.

Rare Complications

Some rare but serious complications of HFMD include encephalitis, meningitis, and seizures. These are more common in young kids. If not treated, they can be very serious.

The Viral Family Tree: HFMD's Cousins

Hand Foot and Mouth Disease (HFMD) is caused by viruses like coxsackievirus A and enterovirus 71. These viruses belong to a big family called picornaviridae. The viral family tree of HFMD is complex, with many related viruses that can cause similar symptoms.

Some of the cousins of HFMD include other types of coxsackieviruses and enteroviruses. These viruses can cause a range of symptoms, from mild to severe, and can affect people of all ages. Understanding the viral family tree of HFMD can help researchers and healthcare professionals develop more effective treatments and prevention strategies.

• HFMD is caused by a group of viruses, including coxsackievirus A and enterovirus 71 (In 2012, EV killed more than 50 children in Cambodia)
• These viruses are part of the picornaviridae family
• Other related viruses can cause similar symptoms, including other types of coxsackieviruses and enteroviruses

Climate Impact on HFMD Spread

The climate greatly affects HFMD spread. Warm weather and high humidity are perfect for the virus. Places with mild winters and hot summers see more outbreaks. Key environmental factors include:

• Temperature: Warm temperatures between 25-30°C (77-86°F) help the virus survive and spread.
• Humidity: High humidity, above 60%, is great for spreading the virus.
• Precipitation: Heavy rain and flooding increase cases, as the virus thrives in moist places.

Prevention Strategies Through the Ages

Stopping Hand Foot and Mouth Disease (HFMD) from spreading is key to controlling outbreaks. Over time, many prevention strategies have been created. These include old methods, new hygiene practices, and today's approaches.

Historical methods include:

• Isolating sick people
• Improving how we handle waste
• Teaching better personal hygiene

Economic and Social Impact of HFMD

Hand Foot and Mouth Disease (HFMD) can have a big economic impact. This is especially true in areas with limited healthcare. It can cause big losses, especially in tourism and hospitality.

A single outbreak can drop tourism, causing lost money for local businesses.

HFMD also affects society. It brings stress and worry to families, especially those with young kids. It changes communities, making parents miss work to care for their sick children. Some ways HFMD impacts communities include:

• More people missing school and work
• Healthcare systems get overwhelmed
• Families face financial strain

The economic and social effects of HFMD are a big worry. We need to work on stopping and controlling it. By understanding these impacts, we can lessen the disease's burden on people, families, and communities.

What are the symptoms of HFMD?

Symptoms include fever, sore throat, and a rash on the hands and feet. Some people may also get blisters or ulcers in their mouth.

How is HFMD treated?

There's no cure for HFMD, but it usually goes away on its own. Over-the-counter meds can help with symptoms. It's also important to stay hydrated to avoid dehydration and complications.

Can HFMD be prevented?

Yes, you can prevent HFMD by washing your hands often. Avoid touching people who are sick and clean surfaces well.

SOME FACTS ABOUT THE NATIONAL CHILDREN’S MONTH

This year Philippines is celebrating its 30^th National Children’s Month and the theme for this year is “Kalusugan, Kaisipan, at kapakanan ng Bawat Bata Ating Tutukan”. The theme focuses on the well-being and mental health of every child. Individuals who are below 18 years old are considered as children.

November is the National Children’s Month here in the Philippines under Republic Act No. 10661 that was signed on 2015 by the late President Benigno Aquino. It was declared in commemoration of the Convention on the Rights of the Child by the United Nations General Assembly on November 20, 1989.

The first country that celebrated Chidren’s Day and turned it into a holiday is Turkey back in 1920. In 1925, the global adoption of this holiday happened when International Children’s Day was proclaimed during the World Conference on Child Welfare at Geneva Switzerland.

The Focus of National Children’s Month is to offer help to those children who suffered violence, abuse, natural calamities and poverty. In fact, as of 2022, there were more than 246,000 street children in the country. The main problems faced by children in the Philippines are sexual violence, psychological violence, exploitation, bullying and violence in the internet.

 

    

Bauko and Work

Whew! I resumed work at Bauko last week and a day after that there was a lock down due to Corona virus. I’ve been reporting at the clinic during the past however today I was asked to go to the municipal gym to help in issuing Health Declaration Form for those individuals going outside the municipality.

An hour after starting, the senior nurses from the clinic showed me their cloth masks and told me to go get one at MDRRMO, I was thinking does it have filter and does it offer same protection as the 3-ply disposable masks? But since they told me to go and get one for me even if I am wearing one, I went without thinking which I regretted after. When I went there they asked me who is going to use it? I answered “me” and was asked “what about the one you are wearing? there is no stock”. Oh my I was embarrassed and thought, what was I doing there and just told them “sorry, they just told me to come and get here that is why I came”. 

You know what it felt like, why can't people a little bit nicer when they say no? I know, it didn’t come to mind that there is a shortage of masks for health care workers especially the frontliners. I like the design but then cloth masks according to study won’t offer that much protection against corona virus, surgical masks and N95 still works 50% better as it adheres to FDA guidelines. However, according to another study any type of general mask use will likely decrease viral exposure and infection risk on a population level. It is always best to wear whatever protection that could minimize exposure to virus and bacteria.

Come lunch time, we went to eat and after eating I told one of the senior nurses that I’ll go back to the clinic. I then took the trail, a short cut going down to the highway, to my dismay it wasn’t that far. I wanted to have a long walk to at least smell the scent of pine trees however, I just ended up walking in the highway under the strong heat of the sun. Some cars stopped and the drivers asked me if I want to ride but I declined and told them laughing “it is ok, I need to burn some fats”.

I just took some amateur photos along the way and was thankful I am in this part of the country while most people in the city where I used to work are worried with space and crowd, here in the countryside I am not worried about it.  The mountain reminds me of how we used to go to the mountain when I was young to plant peanuts, corn and other crops. Wondering if my kids would ever love the idea of doing it, seem kids nowadays doesn’t have any idea of how hard it is to go to the farm so that a family could have something to eat.

Bauko is the biggest municipality here in Mountain Province, though the capital is Bontoc where I am from. Bauko is more progressive as compared to some municipalities of Mountain Province, it is also the point of entry to this province. The biggest hospital is also located here in Bauko, so it is quite challenging to the LGU sector. We have Persons Under Investigation and Persons Under Monitoring but we don’t have any confirmed cases of COVID-19 here in Mountain Province that is why we are taking extra precautions to avoid positive cases.

Anyway, came home after with a mild headache perhaps from walking thinking I will still do my laundry however, the caretaker of the house where I am renting, whom I call “mother Dalin” washed my clothes already. I don’t know if I’d be delighted or embarrassed but then I just consoled myself with the thought that she likes me and is glad I am there with her. I thanked her and told her she doesn’t have to do it.

I then took off my clothes, washed and wore an oversized polo and indulged myself with the local rice wine I bought last week at the market here… Aaahhh the feeling, oversized polo, braless and wine, I love privacy…My overweight body feels so sexy.. a sexy pharmacist...

Ahhh I need more wine... 

TEENAGE PREGNANCY: A NATIONAL SOCIAL EMERGENCY

Teenage Pregnancy is a national concern especially in developing areas like the Philippines however, some of those who have been through this and are now successful may find these degrading as evident on some of the comments on a caricature posted on Facebook.  However, the caricature is not being used to mock or put down teenagers who got pregnant or those who have been through these rather raise awareness. It was a poignant image.

Teenage pregnancy affects the social, emotional, spiritual, health and financial well being of an individual. It carries risk to both the mother and the baby. Teenagers who got pregnant are not supposed to be mocked or looked down on rather we need to boost their morale.

Teenage pregnancy in the Philippines has been a concern for decades wherein according to survey teenage mothers are predominantly poor, have low educational attainment and reside in rural areas. Five years ago, Philippine Statistics Authority released an article about teenage pregnancy stating that one in ten young Filipino women age 15 to 19 is already a mother or pregnant with their first child which is more common with women who have less education than those with higher education. It was a comparison between teenagers who attained elementary education versus those who attained a college education. 

At present, according to the Population Commission (PopCom), almost 200,000 Filipino teenagers get pregnant annually and most of them are 15 to 19 years old. Twenty Four babies are born to teenage mothers every hour and the number keeps on rising, a reason why socio-economic experts teenage pregnancy a “national emergency”.  More and more youngsters engaged in early sex before the age of 18. POPCom is now looking at teenage pregnancy at the 10-14 age group where there is a gradual increase in pregnancy since 2011. As of 2019, the Philippines ranked as 13th among the most populated countries worldwide.

Just recently, Senator Risa Hontiveros authored Senate Bill No. 161 or the “Prevention of Adolescent Pregnancy Act of 2018” that addresses teenage pregnancy. This bill deals with the main cause of health and social problem, it also mandates social protection for teenage protections. Department of Health launched a program focusing on the emerging issues of adolescents, these include teenage pregnancy, which is 10-19 years old range. 

In Mountain Province, particularly the SABATABATU area (Sabangan, Bauko, Tadian, Barlig and, Tubo) they launched their indigenized program called SHOTA or “SABATABATU Health Og-Ogbo Tut-uya sinan Anan-ak”. One of the things it addresses is the prevention of teenage pregnancies and repeat teenage pregnancies.

Teenage pregnancy is indeed a public health concern. 

Is it okay or not okay to swab alcohol prior to injection and take paracetamol before or after vaccination?

Last week I accompanied our PHA Nurse under the DOH-HRH to give immunization to some of the kids who were absent during their School Based Immunization (SBI) which they recently conducted within the vicinity.  The schools were just walking distance from the Rural Health Unit where we were deployed and so I agreed readily when she asked me if I want to go with her.  

So why is there School-based immunization? According to World Health Organization, one of the objectives of Global Vaccine Action Plan is to equitably extend the benefits of immunization to adults, adolescents and children. School-based immunization is then a strategy for reaching older children and adolescents with vaccination services. This is deemed necessary especially for children who have missed their scheduled vaccinations. The increase in school enrollment rates, particularly in low income countries, makes the school a growing interest as a platform for immunization. 

Here in the Philippines, before School-based immunization became a yearly activity it was piloted in selected provinces and cities nationwide in 2013 and it was in 2015 when August was declared School-Based Immunization month. As of this year, 2019, the target populations to be vaccinated are school children from kindergarten to grade 7 (K-7).

The first school where we went is a private school, though school-based immunization targets public schools, private schools can access the vaccines as long as they have letter of intent. I was informed that this private school participates annually with the program.  We went to the faculty office and she talked to one of the teachers luckily, the kid’s adviser was there and so he went to get his student. A handsome boy with a dimpled smile came; his adviser then led us to their clinic.

Our nurse swabbed the injection site with water before administering the vaccine. She injected Mumps Measles Rubella Vaccine and Tetanus Diptheria on the other side after explaining to him in a calm and friendly way why he needed the vaccines. She was quick and the kid didn’t flinch or cry, he just gave us his sweet dimpled smile.  She applied tactile stimulation by rubbing the child’s skin near the injection site where in the mechanism is thought to be that the sensation of touch competes the the feeling of pain from the injection and thereby results in less pain. She didn’t give a dose of paracetamol as well which is right but just advised the kid to take paracetamol when he is going to have fever.

She then asked me if I was the one or was it our physician who informed during our previous meeting that alcohol is not necessary to swab prior to injection and I told her it wasn’t me, what I remember telling was about the use of paracetamol before and after vaccination that it could reduce the potency of vaccine to which she replied, “oh yes, that is why one of the midwives reminded us what you said when we went to the other school to conduct SBI, so we didn’t give the kids paracetamol”. I felt happy and admired more my fellow DOH-HRH NDP’s for going beyond their job description to help other people and the community as a whole. The data they have also been gathering were very helpful.

So why is it not necessary to use alcohol prior to injection? It is mentioned in the Vaccination Practical Guideline to “clean the skin with water if dirty, it is not necessary to use alcohol”. Alcohol could “sterilize/disinfect” the skin only if it is done properly which is not usually the case and most important alcohol can affect the quality of some vaccines like BCG vaccine which is administered intradermic.

Related Articles: 

Paracetamol linked to decrease vaccine respone and low  testosterone level in men

Bridges of Madison County

Bridges of Madison County

February 2019

Almost three decades after “The Bridges of Madison County” by Robert James Waller was published, I found a copy of the book in one of the bookshelves at a tiny provincial library in a small, quiet town of Philippines- a thousand miles away from Iowa where the story actually happened.

For the past three weeks and three days each week it became my routine to go to the library after dropping my two kids at their school. The town is 15 minutes away ride from the small village where we live and have to wait for a ride before we can go home so I decided to just stay in town while waiting for my kids to get out of school. I would spend two hours reading however books are old and very scarce. I only found 1 or 2 books I really like. They only have one book related to medicine and most are older editions about law, accountancy and social studies.

It was only last week when I saw the lone bookshelf near the window filled with old novels. One book caught my attention, there is an air of odd familiarity, I must have read or heard it somewhere or before, my subconscious mind reacted so I grabbed the book. Leafing through the pages, I found out it was an actual love story that happened in 1965 at a small town in Iowa. It is a love story of a couple almost 54 years ago in a town of Madison County, Iowa. Old country farm true love stories always excite me, it gives me a rush feeling, a connection only the universe knows as it brings me to another dimension where sometimes I feel I belong. I settled down to read.

My eyes were filled with tears, it was my 3rd day at the library and was reading the final chapter of the book, I was alone except for the librarian who was busy typing and the radio was playing the song “Let’s Make Love” by Faith Hill and Tim Mc Graw. I haven’t felt this deep feeling in the first and middle chapters of the book, I just admired how the author detailed the story; it was the final chapters that gave me a rush of emotions. It is so rustic, so real, so heart wrenching. I felt sad when I read Robert’s letter to Francesca and Francesca’s letter to her kids was heart wrenching. I wiped my tears and went out to blow my nose.

So what happened in the story? This is a story of a love shared by two people physically in just four days but the emotional bond and love lasted a lifetime. Is that possible? I don’t know, all I know is that it happened to two people, to Robert and Francesca.

They met in 1965 when Robert went to Madison County to take pictures of historic bridges for a National Geographic article. It was where he met Francesca when he was trying to ask for directions, Francesca at that time was married to an unromantic husband who was away at the Illinois State Fair for several days with their two kids. They fell in love at first sight with each other and shared love in four days they were together, they were both certain of their feelings and wanted so much to be together however they are not meant to be together or they choose to, out of respect for each other and what each one has.

They never contacted each other after Robert Kincaid’s left the town. Francesca’s husband, Richard died on 1979, he tried to contact Robert, but no one knows his whereabouts or what happened to him, she didn’t look further fearing something happened. Years later after her husband died she received a letter from a law firm on January 1982 stating that they are representing an estate Robert Kincaid left for her. You can imagine how she feels that time.

In his letter, he wrote how he loved her profoundly and never loved any woman than her, he also sent her a medallion with her name engraved on it. He wrote in his letter a lot of times he wanted to go see her and take her with him but said he remembered her words and he respect her. He ordered the firm to cremate his body and throw his ashes at Roseman bridge. Five years later after Francesca received that letter, she was found dead in her bed. She asked her children that her body be cremated and her ashes be thrown at Roseman bridge. Shortly after her death, her two grown children went back to their Iowa farm and discovered a box where they found mementos of Robert Kincaid and a letter from their mother telling them what happened back in 1965. 

The two grown children contacted James Waller who narrated their mom’s love story, which then becomes a novel. The book became a bestseller.

During the time Robert Waller was doing some research about Robert Kincaid, he met a Jazz musician whom Kincaid became friends with in his final years. Robert Kincaid told him about the woman he loved named Francesca and he decided to write a song for him and sing it every Tuesday night when Kincaid would go to the bar, a song he titled “Francesca”.

When I looked up the internet, I have learned that it became a well received Hollywood film in 1995. I wonder if things could have been different, if they did not recognize their feelings and have been afraid to show it, they would never have an experience that lasted a lifetime, there would be no Bridges of Madison County. Love is painful, love comes in all forms and love is true when it is not selfish.

Guys should not take this medicine because it could cause male infertility

Anabolic steroids and male infertility

How many more medicines will be found to cause male infertility or ruin a male’s reproductive health? Male infertility is the inability of the male to cause pregnancy in a fertile female.

Male infertility statistic

           WHO who conducted a survey from 1990 to 2004 and found out that male infertility in developing countries affects one in every four couples. In a study published by BMC on April 2015, it stated that male infertility affects an estimated 48.5 million couples globally and male infertility factors are responsible for 20-30% infertility cases and contribute to 50% cases overall. However, it does not represent all cases in all regions of the world thus the male infertility statistic presented is inaccurate.

            If you have read the previous blog linking acetaminophen and decreased testosterone production in unborn baby boys which could make it hard for these babies once adults to make their partners pregnant, unfortunately another medicine adult males take could make them infertile.

Male infertility causes

            According to American Pregnancy there are four causes of male infertility:

·         Sperm transport disorder (10-20%)

·         Gonad disorder (30-40%)

·         A hypothalamic or pitituary disorder (10-20%)

·         Unknown causes (40-50%)

            40-50% unknown causes don’t sound good thus, studies and researches are being conducted on this subject to determine these unknown causes.  In one of the researches that can be found at NCBI titled, “Anabolic steroids abuse and male infertility”, it found out that there is a higher aromatization of male testosterone when there is an excess use of anabolic steroids.  Aromatization means it is the process that converts testosterone into estrogen.  Estrogen plays an important role in men in the regulation of testosterone, sexual function/libido, cardiovascular function, cholesterol regulation, bone health and skin health however when the normal level of estrogen is elevated it could decrease testosterone leading to negative side effects like enlarged breasts, male infertility and erectile  dysfunction.

            Anabolic Androgenic Steroids are prescribed by physicians to men who don’t produce enough testosterone on their own and to help people with certain kinds of anemia. Anabolic steroids are synthetic derivatives of testosterone used to increase testosterone production thus it mimics the natural testosterone. When the testosterone levels in the blood are raised by use of anabolic steroids, it would cause the testicle to produce testosterone which is vital for sperm production. The effect is reversible when usage is stopped in three months to a year but if used for a long time and in high doses, it can damage fertility permanently.

            In a news article published by NHS on August 2016, it stated that one of the emerging main causes of preventable male infertility factor is the use of anabolic steroids. There is an increasing number of men as well as teenagers who opt in the use of steroids to help build up muscle bulk and most are not aware of the side effects that this could lead to male infertility.

          

 Natural Aromatase Inhibitors

            There are studies showing that estrogen level can be decreased naturally like red wine and cruciferous vegetables. A study titled, “Natural Product as Aromatase Inhibitors” was published in Bentham Science on 2008 evaluated nearly 300 natural products in their ability to inhibit aromatase.

            It is best to avoid steroids just to have big bulky muscles and should be only used when advised by a physician. For people who can’t be stopped from taking steroids just to look manly it is better to consult urologist-andrologist for advice.

Acetaminophen (Paracetamol) Linked to Decreased Vaccine Response and Low Testosterone Level in Men

Acetaminophen side effects on pregnant women and children

             Acetaminophen also known as paracetamol outside the United States is one of the leading over-the-counter drug globally. Tylenol the leading brand of acetaminophen in the United States sold more than 330 million dollars in 2018. Acetaminophen is the most commonly used fever reduction for infants and a drug of choice for pain on pregnant women.

            Acetaminophen side effects are one of the researches that are constantly being conducted. Acetaminophen at a recommended dose has established its safety and efficacy but when acetaminophen maximum daily dose which 4 grams is exceeded and the usage is prolonged it could lead to liver damage. The FDA is now asking drug manufacturers to limit acetaminophen’s strength in prescription drug products to 325 mg per tablet or capsule making these products safer for patients.   

             In the United States acetaminophen overdose is the second most common cause of liver failure requiring transplantation and it has replaced hepatitis as the most common cause of acute hepatic failure. In Great Britain, acetaminophen overdose is the most common cause of liver failure requiring liver transplantation.

Acetaminophen overdose

            According to the American Academy of Pediatrics there is a very low incidence of toxic effects on children but acetaminophen toxicity remains a concern because it is used widely in children. Way back in 1997, a data collected by 66 US regional poison control centers, of 94 fatal acetaminophen overdose cases, 25% of it were associated with unintentional therapeutic error and intentional misuse thus it indicates the lack of understanding on the part of caretaker or patient regarding acetaminophen therapy.  Over the years a lot of researches about acetaminophen side effects and acetaminophen toxicity have been conducted. To avoid acetaminophen overdose in children, dosing should be based on weight of the child using 10-15 mg/kg/dose.

           

             A study published in the British Journal of Clinical Pharmacology on March 2018 revealed that unintentional overdose of acetaminophen happens during cold and flu season. A lot of people taking over-the-counter cold and cough remedies that contain acetaminophen take it routinely with Tylenol or other acetaminophen brands for pain or fever thus ingesting excessive amount.

           

Prophylactic acetaminophen in infants reduces vaccine response

            The Lancet published a research sponsored by Belgium based Glaxo Smith Kline Biologicals which showed that acetaminophen administration decreases antibody responses to several vaccine antigens. Investigators randomized healthy infants in the Czech Republic and involved more than 400 healthy infants who are received vaccines against Pneumonia and Influenza co-administered with a diphtheria, tetanus, acellular pertussis, hepatitis B, inactivated poliomyelitis, and Haemophilus influenzaetype b (Hib) conjugate vaccine and oral human rotavirus vaccines (prevention of diarrhea to infants and children caused by rotavirus which is the common cause of diarrhea in children and infants globally).

            The study concluded that administration of acetaminophen at the time of vaccination should not be routinely recommended since it reduces vaccine response.

Prenatal acetaminophen exposure and language delay in girls

            In a study published on European Psychiatry on January 2018, researchers from the Icahn School of Medicine at Mount Sinai found an increased rate of language delay in girls at 30 months born to mothers who used acetaminophen during their early pregnancy.  There were 754 women on their 8-13 weeks of pregnancy were enrolled into the study. The participants were asked to report the number of acetaminophen tablets they had taken between conception and enrollment and tested the acetaminophen concentration in their urine at enrollment.  Their child’s language milestone at 30 months were assessed by nurses and follow-up questionnaire completed by participants regarding their frequency of language delay which is defined as the use of fewer than 50 words. Those parents who took acetaminophen more than six times in their early pregnancy were nearly six times more likely to have language delay than girls born to mothers who did not take acetaminophen in their early pregnancy. 

            The Study concluded that the use of acetaminophen in pregnant women should limit their use of the analgesic during pregnancy. The study’s senior author, Shanna Swan, PhD, Professor of Environmental and Public Health at the Icahn School of Medicine at Mount Sinai stated that it is important to look at the language development because it has shown to be predictive of other neurodevelopmental problems in children.

High acetaminophen level in men may delay pregnancy

            Couples in which the male partner had high levels of acetaminophen in his urine took longer to achieve pregnancy than couples in which the male had lower levels of acetaminophen in his urine. Prolonged acetaminophen use may reduce testosterone produce in unborn baby boys; a research has found which was published at Science Translational Medicine on May 2015. The study was funded by the British Society of Paediatric Endocrinology and Diabetes, Wellcome Trust and the Medical Research Council. The authors found that a single acetaminophen therapeutic dose had no effect on testicular development but continued dosing of acetaminophen for a week could reduce fetal testosterone by 45 percent. The authors recommended that that the lowest effective dose of acetaminophen should be taken for the shortest possible time by pregnant women.

            It should be noted that these acetaminophen side effects can happen when not used with caution and be always reminded that a very high fever and pain in pregnancy could put the baby at risk. The preferred antipyretic is still acetaminophen. A pregnant woman should not take aspirin or ibuprofen, taking ibuprofen regularly in the first trimester may increase the chance of having miscarriage. The baby could also develop cleft palate, heart defect or defects in the abdominal wall. Though a single dose of ibuprofen at any stage of pregnancy is unlikely to cause the mother or the baby harm, it is still best to be cautious and stick with acetaminophen being far safer.

           

            Don’t be afraid to take acetaminophen but be cautious. Do not take acetaminophen when not needed and do not prolong the use. All drugs have side effects and acetaminophen which is considered to be a very safe drug is not an exception.

            Perhaps you can manage common pains such as back pain which is one of the most common among pregnant women, in non-pharmacological way and not take acetaminophen. You can always talk to your Doctor on whatever recommendations she/he may have.