Family Webicine: Back to School - Let the Diseases Begin

When excited parents see their children heading out the door for that first day of school after a long summer vacation, you can hear the collective cheers. All summer long, medical offices that see children and adolescents have been a bit slower. Aside from broken arms and lacerations of the face, physical examinations for sports and camp have been filling our schedules. As soon as school starts, we will see an immediate increase in illness visits.

Children and infectious disease are inseparable pairs, especially in our crowded schools. Coupled by their inherent poor hygiene practices, and the lack of surface disinfection by the janitorial staff, the first week after school begins will hallmark the rise in viral illnesses, namely colds and gastrointestinal problems (diarrhea, vomiting).

We all know that kids are poor hand-washers even though the hands may get wet. If you watch a child washing their hands, you will note that they tend to miss the pads of the fingers where most of the germs reside. Since hand-washing tends to be one of our best defenses against getting ill, you can see why children get more colds than adults. Of course, children also bring colds home to their parents, who, in turn, will spread them around to people at work, and so on. Colds are truly the "Gift that Keeps on Giving."

When was the last time you visited a school restroom? While girls' restrooms are a bit cleaner (like girls), the boys' restroom is absolutely frightening. One wall is lined with urinals, but only one or two boys will use it simultaneously. The unused urinals in between are used as buffer urinals so no one will look at their penises. Most young boys will opt for the stalls, where they will freely pee on the seats, thus preventing any future use for defecation. Should an unlucky boy approach this urine-soaked toilet needing to have a bowel movement, he will often opt to try and hold it until he gets home. Sometimes it works; sometimes it doesn't. The idea of cleaning off someone's urine, or sitting down on that seat is more than some kids can tolerate. Unlike girls who develop the fine art of hovering above the seat, boys do not usually possess this advanced skill.

Most medical offices will see a rise in intestinal viruses (diarrhea and vomiting) soon after the beginning of school. These viruses are transmitted by the fecal-oral route (poop to mouth) usually from contaminated surfaces. Regardless of the bathroom act, handwashing is sparse, if at all.

By the end of September or early October, the new flu vaccines will start to arrive, just in time to get people immunized before Thanksgiving and Christmas. Since we really do not know how bad the flu season will be until it's actually here, most people line up for their flu vaccines based on faith (or fear). For the last several years in our office, we have run out of flu vaccine, even though we pre-ordered thousands of doses. Keep in mind that most community outbreaks of influenza typically originate in the schools. When children get the flu, parents will need to stay home from work and take care of them. A particularly bad flu season can slow down the economy.

We are seeing fewer cases of chicken pox, thanks in part to the vaccine. However, the vaccine is not as effective as we were led to believe. A second chicken pox vaccine (varicella) is now recommended. The fall and winter school months usually see the highest incidence of chicken pox.

Now is the time to be prepared. Make sure your children's immunizations are up to date, and be proactive when the flu vaccine for this year becomes available. Stress the importance of hand-washing to your children and see that they do it correctly. Just in case, make them wash their hands when they come home from school and get them to change their school clothes (many germs will hitchhike home on clothing).

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