December 2014 Bulletin

Increasing Influenza Activity Seen at Seattle Children’s

Since Tuesday, Nov. 25, Seattle Children’s has seen 10 patients with influenza. The predominant strain seen in these patients was influenza A H3 (likely H3N2), but there have been a few cases of Influenza B.

According to recent information from the Centers for Disease Control and Prevention (CDC) distributed by Public Health – Seattle & King County, 48% of the influenza A H3N2 viruses collected and analyzed in the United States through Nov. 22 were antigenically “like” the 2014-2015 influenza A H3N2 vaccine component, but 52% were antigenically different (drifted).

In past seasons, there has been decreased vaccine effectiveness when the predominant circulating influenza viruses have been antigenically drifted. However, vaccination has provided some protection, potentially reducing likelihood of hospitalization and death.

The 2014-2015 influenza vaccine protects against:

  • an A/California/7/2009 (H1N1)pdm09-like virus
  • an A/Texas/50/2012 (H3N2)-like virus
  • a B/Massachusetts/2/2012-like virus

The quadrivalent 2014-2015 flu vaccine also protects against an additional B virus (B/Brisbane/60/2008-like virus).

Because of these drifted influenza A (H3N2) viruses, the CDC is re-emphasizing the importance of the use of neuraminidase inhibitor antiviral medications when indicated for treatment and prevention of influenza as an adjunct to vaccination.

The two prescription antiviral medications recommended for treatment or prevention of influenza are oseltamivir (Tamiflu®) and zanamivir (Relenza®).

For more information, see:


Long-Acting Reversible Contraceptives for Adolescents: A Q&A with Dr. Kate Debiec

In an updated policy statement published in the October 2014 Pediatrics, the American Academy of Pediatrics recommended that a long-acting reversible contraceptive (LARC) – either an intrauterine device (IUD) or a subdermal implant (Nexplanon) – be the first-line contraceptive choice for sexually active adolescents.

Dr. Kate Debiec, a pediatric and adolescent gynecologist at Seattle Children’s, provides answers to frequently asked questions.

Q: Are IUDs safe and tolerated in adolescents?

A: Yes and yes. Older IUDs were associated with a greater risk for pelvic infections, but current IUDs are very safe. The rate of pelvic infection increases only 0% to 2% immediately following placement. After 21 days, there’s no increase in infection rates.1

IUDs also do not increase infertility risk. I tell my patients I can’t guarantee their future fertility because there are many factors involved, but I can assure them that IUDs themselves do not cause infertility.

IUD placement can be uncomfortable or even painful, but I’m astonished at how well adolescents tolerate it. I provide a lot of guidance before insertion so patients know what to expect. I also provide pain medication for patients who request it. We can even do the procedure under anesthesia if a patient is unable to tolerate clinic placement.

While expulsion rates are higher for adolescents, that’s not a contraindication for IUDs.

Q: What follow-up is necessary after IUD placement?

A: We give our patients an aftercare handout that tells them what to expect, under what circumstances they should call us and who they should call if they have concerns. If the IUD is strictly for contraception, we offer a follow-up appointment at one month, but some of our patients choose not to come to a follow-up visit if everything is going well.

In general, we see our gynecologic patients once a year to touch base, though an exam is not necessarily performed at each of these visits.

Q: How do you counsel patients about choosing an IUD versus a Nexplanon implant?

A: The choice that works best is usually the one they’re most comfortable with. Some patients are more uncomfortable with the idea of an implant in their arm. Others feel more uncomfortable with having something placed in their uterus.

The unintended pregnancy rate in the first year of use is 0.05% for implants and 0.2% to 0.8% for IUDs.1 More patients stop their periods with IUDs (20% to 40%) than with implants (20%).2 For those whose periods continue, IUDs typically make them lighter. Implants don’t necessarily do that.

Overall, similar numbers of patients decide to take out their IUDs or implants early.

Q: Do IUDs increase the risk for sexually transmitted diseases (STDs) because they increase sexual activity?

A: IUDs and other contraceptives do not increase promiscuity. I am very clear with patients that IUDs do not protect against STDs. I tell them the only way to protect against STDs is to use a condom. Condoms should not be their sole form of birth control, but they should always use condoms in addition to other forms of contraception to protect against STDs.

References

  1. Ott M, Sucato G, et al. American Academy of Pediatrics Contraception for Adolescents policy statement. Pediatrics 2014;134;e1244.
  2. Hidalgo M, Bahamondes L, Perrotti M, Diaz J, Dantas-Monteiro C, Petta C. Bleeding patterns and clinical performance of the levonorgestrel-releasing intrauterine system (Mirena) up to two years. Contraception 2002 Feb;65(2):129-32.

New Application Allows Providers to Upload Radiology Images to Seattle Children’s

You and your patients can now securely upload radiology images directly into Seattle Children’s system in a few simple steps using an application called eMix. This new capability helps reduce dependence on CDs or DVDs for transferring medical images. Learn how to upload images on Seattle Children’s Healthcare Professionals webpage.

New Faxed Urgent Care Notes for Primary Care Providers

To improve informational continuity between the urgent care and primary care settings, Seattle Children’s Urgent Care is now sending a fax to patients’ primary care providers (PCPs) after discharge.

The fax includes:

  • Chief complaint
  • Work-up with results
  • Medications given during the visit
  • Discharge diagnosis
  • Any new prescriptions
  • Follow-up labs needed
  • Recommended timeline for patient follow-up with their PCP

The patient and family will also receive follow-up instructions upon discharge with a summary of their visit, diagnosis education and PCP follow-up instructions. To speak with your patient’s urgent care provider, please call the Urgent Care Clinic during clinic hours, which are on Seattle Children’s Urgent Care website.

The website also includes guidelines about when patients should go to Urgent Care versus the Emergency Department.


Seattle Children’s Designated to Offer Ongoing Care for Potential Ebola Patients

Seattle Children’s is one of eight Washington hospitals preparing to care for patients with suspected or confirmed Ebola virus.

Seattle Children’s has conducted simulations and developed protocols to keep patients, families and staff safe in the event that a patient with symptoms of Ebola virus comes to the hospital. Protocols are based on guidelines from the Centers for Disease Control and Prevention (CDC) and modeled after isolation units at hospitals like Emory Healthcare and National Institutes of Health (NIH) that have successfully and safely treated Ebola patients.

Seattle Children’s has a team of more than 200 staff and faculty who volunteered to undergo extensive training and preparation to provide care for Ebola patients. In the event a case is confirmed, the CDC will send a team to assist the hospitals in providing care safely and effectively.

Anyone arriving in Seattle from West Africa has passed through airports that assess risk. Public Health will perform temperature and symptom monitoring of potentially exposed individuals during the 21-day incubation period. This monitoring will ensure prompt identification of anyone who has contracted Ebola and allow for isolation before others can be infected.

If you have a febrile patient who has traveled recently to West Africa, contact Public Health – Seattle & King County immediately at 206-296-4774 for guidance and assistance transporting the patient to the appropriate facility.

To learn more, read the Department of Health press release.

For questions, contact Dr. Danielle Zerr.


Psychiatry and Behavioral Medicine Unit Remodel and Expansion

Seattle Children’s opened the first phase of a two-phase remodel and expansion of the former Inpatient Psychiatric Unit (IPU), now called the Psychiatry and Behavioral Medicine Unit (PBMU).

The first phase includes 25 single-patient rooms and newly remodeled common areas, including a school room, living rooms, group therapy rooms and a dining area for patients and their families. When the second phase of construction is complete in spring of 2015, the PBMU will have 41 beds – 20 more beds than the former IPU.

“The space was designed with input from patients, families and staff to create a safe, comfortable healing environment,” says Dr. Bryan King, director of Psychiatry and Behavioral Medicine. “Once this much-needed expansion is complete, we will be better able to serve our region’s children and families.”

IPU room

All 25 rooms are single-patient and include an area for one parent or caregiver to stay with a child.

IPU classroom

The new unit has its own classroom where specially trained teachers seek to understand behaviors in a school setting and prepare patients to return to their community schools.

IPU dining

After the remodeled Level 4 opens in spring 2015, five beds on River 5 will be dedicated to patients with severe autism spectrum disorders (ASDs). This dining area will serve patients with ASD; it also offers space that can be used for social activities.

IPU living

Living rooms provide areas for patients to relax.

IPU comfort

Comfort rooms provide a private, calm environment to help reduce stress. They offer a new and progressive alternative to seclusion and restraint rooms, which Seattle Children’s eliminated several years ago.


Upcoming CME: Practical Pediatrics: Improving Pediatric Practice

Saturday, Feb. 7, Seattle Children’s Main Campus

Topics include:

  • Diagnosis and Management of Hydronephrosis
  • Assessing and Managing Risk of Fractures in the Child with a Disability
  • Pediatric Sleep-Disordered Breathing
  • Genetic Testing
  • When Does Bleeding Suggest a Problem with Hemostasis?
  • My Child Must Be Immune-Deficient: An Approach to Testing and When the Primary Care Physician Should Refer

View the brochure (PDF) and register online.


Grand Rounds for December 2014 (CME Credit Available)

Upcoming Grand Rounds

  • Environmental Influences on the Health of Children and Those Who Care for Them, Dec. 11
  • Elephants, Genomes and Cancer: Lessons Learned in Pediatric Oncology, Dec. 18
  • See all upcoming grand rounds.

Watch Past Grand Rounds Online

  • Type 1 Diabetes in Youth: Where Have We Come From, Where Are We Now and a Path to a Cure
  • Pediatric IBD: Evolution of Disease Understanding and Management
  • What Healthcare Providers Need to Know About Spiritual Care
  • Ethics of Early-Phase Trials in Children
  • See all online grand rounds.


New Medical Staff and Allied Health Professionals, December 2014

Medical Staff

  • Helen Chea, MD, PRMC Everett – Pavilion for Women & Children, Hospital Medicine
  • Deepti Gupta, MD, Seattle Children’s, Dermatology
  • Christopher Ingraham, MD, University of Washington, Radiology
  • Cherry Junn, MD, Harborview Medical Center, Rehabilitation Medicine
  • Mital Patel, MB, BS, University of Washington, Orthopedics and Sports Medicine
  • Trucian Ostheimer, MD, Harborview Medical Center, Ophthalmology
  • Yolanda Tseng, MD, MPhil, SCCA Proton Therapy – ProCure Center, Radiology

Allied Health Professionals

  • Lisa Chui, ARNP, Seattle Children’s, Psychiatry and Behavioral Medicine
  • Michele Hinatsu, ARNP, NW Asthma & Allergy Center, PS, Immunology
  • Danielle Hyatt, ARNP, Seattle Children’s Bellevue, Psychiatry and Behavioral Medicine
  • Heather Hymel, ARNP, Seattle Children’s, Emergency Medicine
  • Maya Kaneyasu, ARNP, Overlake Medical Center, Neonatology
  • Lauren Sacco, ARNP, Seattle Children’s, Neonatology