Guatemalan Migrant Child Flu Death Illustrates Larger Deficiency in How Influenza is Managed

The tragic and likely avoidable death of a recent death of a Guatemalan child migrant in US Custody from influenza (type B) illustrates many deficiencies of how physicians and other providers mismanage influenza. In addition to the unique circumstances of the child’s detention that are being reviewed, there are important aspects of this case that merit scrutiny from a medical perspective.

1. The common cold does not ordinarily cause 103 degree fevers. The boy was reportedly diagnosed with the common cold after his medical visit yet exhibited fevers of 103F. While it is true that some benign viral infections in children can cause high fevers, I don’t think it is the usual course for a common cold caused by rhinovirus. In most circumstances a search for another etiology (including pneumonia with a simple chest x-ray), especially in someone who is a traveler and is being housed with many other travelers would be pursued. Additionally, there are ways to confirm the common cold through respiratory viral panels that are widely available, use sensitive molecular technology, and are rapid. It appears the patient was tested for Group A Streptococcal infection (“strep throat”) alone.

2. Antibiotics are not needed for the common cold. If one diagnoses the common cold, antibiotics are not warranted and are wrong to prescribe. The common cold is caused by a host of viruses and no antibiotic is indicated for their treatment. In fact, prescribing an antibiotic is incorrect and exposes the patient to unnecessary side effects and fosters the development of antibiotic resistance in the patient. Additionally, an antibiotic prescription may give one the false idea that they should wait out the illness waiting for the antibiotic to “kick in” when, for a viral illness, it never will. If the provider believed the patient to have the common cold — which was not confirmed — what justified the use of an antibiotic?

3. Flu (and other viral) testing and antiviral prescribing are underutilized. While it is true that clinicians are good at spotting influenza clinically in many cases and treated appropriately, it clearly wasn’t the case here. There are myriad flu tests available however it appears none were used in this case (not even the poorly sensitive rapid tests which are not recommended for use in the latest Infectious Diseases Society of America guidelines). Testing for flu helps establish the diagnosis and is often a prompt to prescribe antiviral medications as well as to refrain from prescribing antibiotics.

It is clear that this child’s experience was not usual — he may have been dehydrated, malnourished, not vaccinated against influenza, and suffering from other conditions — but his death really should prompt scrutiny of how the medical community interfaces with influenza in all settings. We will face future severe flu seasons and future pandemics. It is only by becoming adept at dealing with seasonal influenza that any resiliency to influenza pandemics will develop. As this case and others in migrant and non-migrant populations will illustrate in the upcoming season which has already accumulated 11 pediatric deaths, clinical management of influenza needs to be optimized.

A Tour de Force Defense of Vaccines and Science: A Review of Peter Hotez's Vaccines Didn't Cause Rachel's Autism

Peter Hotez is a rarity in the field of infectious disease. He is, at once, a brilliant vaccine scientist, a science diplomat to the world, a media expert, and an intransigent defender of the prowess of vaccines. I have had the pleasure to interact with Dr. Hotez several times and am always energized by his enthusiasm and passion for this field.

What many people might not know about Dr. Hotez is that he has a daughter with autism which is very significant given that much of the opposition to vaccines is driven by an erroneous debunked claim linking vaccines, thimerosal and whatever has anything to do with vaccines to this condition.

To combat this campaign of misinformation by providing an evidence-based defense of vaccines, along with an extensive discussion of cutting-edge theories and recent data about autism, Dr. Hotez wrote an excellent book. Vaccines Didn’t Cause Rachel’s Autism: My Journey as a Vaccine Scientist, Pediatrician, and Autism Dad, is to me, a tour de force in the field. I have read many book on vaccines and vaccine policies and this one stands out among all of them. Perhaps it is the way Dr. Hotez seamlessly weaves in his and his family’s experiences with Rachel’s autism. He covers the diagnosis, the daily trials and tribulations, the frustrations, and the successes.

Over 12 chapters, Dr. Hotez expertly addresses each vaccine “controversy” (“whack-a-mole”) and illustrates with data and scientific reasoning why such controversies are manufactured and, in my view, essentially arbitrary. He discusses the celebrity culture that abets the anti-vaccine movement as well as the history of the anti-vaccine movement in the US.

Vaccine programs such as GAVI are also detailed with an emphasis on how vaccination in developing countries are a crucial need and how vaccines against neglected tropical diseases are a major unmet need.

There are so many critical insights in this book that is hard to list the highlights. One aspect I took special interest in is Dr. Hotez’s interactions with the media, as this is something I do a lot of as well. Dr. Hotez hypothesizes that some of the misinformation is facilitated by the fact that scientists and physicians do not engage with the general public. as he notes:

“In a survey of 3,748 scientists, only about one-half have ever spoken with a reporter or science journalist about their research, while only 47 percent ever use social media to discuss their science. Only 24 percent have ever blogged about their science and research”

It can be no surprise then that“an overwhelming majority—81 percent—of Americans could not name a living scientist.”

Dr. Hotez also recognizes, as I came to during Ebola in 2014 that

“An added challenge is that public engagement is not usually considered a vital activity for a professor at an academic health center or university. These institutions depend on their faculty to generate revenue through clinical billing or research grants, and such public activities do not generally produce funds. Yet for someone like myself, committed to public engagement or aspiring to become a public intellectual, I have found that writing scientific papers and grant applications exclusively is seldom sufficient to persuade government leaders and policymakers to address a particular group of diseases or an approach to disease treatment and prevention”

I can’t recommend this book enough and hope it has a wide audience of physicians, parents, students, and policy makers. That the heroic Dr. Hotez is the subject of vicious primitive personal attacks is a disgusting fact he should not have to deal with and hopefully this book will help others realize what an asset he is.