Clinical Pulse

• Polio is a highly contagious disease caused by the poliovirus. It is most commonly spread via fecal-oral transmission and less commonly via droplets.
• The vast majority of people infected with polio have no symptoms or a non-specific febrile illness. Less than 1% of all polio infections result in the classic “acute flaccid myelitis,” where the patient is left with permanent weakness or paralysis of legs, arms, or both.
• Healthcare providers should suspect paralytic polio if the following is present:
  • Acute flaccid limb weakness- note, often asymmetric Proximal muscles affected more than distal muscles
  • Low muscle tone
  • Decreased or absent reflexes
• The extent of paresis or paralysis is directly related to the extent of neuronal involvement; paralysis occurs if >50% of the neurons supplying the muscles are destroyed.
• If paralytic polio is suspected, a provider should contact the local health department (Rockland County DOH) immediately to coordinate obtaining appropriate specimen collection for testing.
• Vaccination. The best protection against contracting polio is completing the CDC recommended vaccine series of IPV. Children should get four doses one dose at each of the following ages: 2 months old, 4 months old, 6 through 18 months old, and – a booster dose at- 4 through 6 years old.
• It is imperative for providers to stress the importance of vaccination with their patients.
• There is no risk of getting polio from this vaccine, and it is highly effective in producing immunity to poliovirus. Adults who have previously completed a routine series of polio vaccine but are considered at increased risk of exposure to poliovirus and can also receive one lifetime booster dose of IPV.
• Adults who have never been vaccinated against polio should get 3 doses of IPV: the first dose at any time, the second dose 1 to 2 months later, the third dose 6 to 12 months after the second.

The CDC is closely tracking cases of monkeypox recently detected in the United States. As of July Ist, the total case count was 460 spanning across 36 states. Monkeypox is a rare disease caused by infection with the monkeypox virus and is part of the same family of viruses as smallpox. Monkeypox symptoms are similar to smallpox symptoms, but milder; and monkeypox is rarely fatal.

Monkeypox Quick Facts:

• Symptoms of monkeypox can include: Fever, headache, muscle aches and backache, swollen lymph nodes & a rash.
• The rash can look like pimples or blisters that appears on the face, inside the mouth, and on other parts of the body, like the hands, feet, chest, genitals, or anus. The rash will often go through different stages before healing completely.
• It is important to note that sometimes, people get a rash first, followed by other symptoms. Others only experience a rash.
• The illness typically lasts 2-4 weeks.
• The virus can spread from person-to-person through direct contact with the infectious
  rash, scabs, or body fluids.
• While there is no widespread treatment for monkeypox, antivirals, such as tecovirimat, may be recommended for people who are more likely to get severely ill, like patients with weakened immune systems.
• If health providers suspect a case of monkeypox, they should contact their local public health department (845-364-2512) OR the CDC Emergency Operations Center (770-488-7100). Currently, the CDC is recommending all suspected specimens be sent through the state public health department. Recommended specimen type is skin lesion material.

Clinicians and patients often have concerns about switching between synthetic levothyroxine products. Recent data has shown that this is generally not a clinical problem. In a comparative effectiveness study evaluating changes in TSH levels after switching or not switching between generic levothyroxine products in 2780 propensity-matched patient pairs, the proportion of individuals with TSH levels within the normal range was similar in non-switchers and switchers (82.7 and 84.5 percent, respectively). If a switch from one manufacturer to another is made by the pharmacy and the patient is concerned regarding equivalent efficacy, or if maintaining the serum TSH within a narrow range is important (eg, thyroid cancer treatment), it is recommended to repeat a serum TSH level six weeks after changing preparations to ascertain that the TSH is still within the therapeutic target.

The American Academy of Pediatrics recently released updated guidance on the Safe Sleep Policy. These updates provide detailed additions to the current safe sleep policy, where previous recommendations were more general. Some updates include:

• Sleep surfaces with inclines of >10 degrees are unsafe for infant sleep and should therefore be avoided.
• Given the questionable benefit of hat use for the prevention of hypothermia and the risk of overheating, it is advised not to place hats on infants when indoors except in the first hours of life or in the NICU.
• Parents are encouraged to place the infant in tummy time while awake and supervised for short periods of time beginning soon after hospital discharge, increasing incrementally to at least 15-30 min total daily by age 7 wk.
• Weighted swaddle clothing or weighted objects within swaddles are not safe and therefore not recommended.
• Use of home cardiorespiratory monitors are not required to meet the same regulatory requirements as medical devices and, by the nature of their FDA designation, are not to be used to prevent sleep-related deaths.

Recommendations published April 1, 2022

The Advisory Committee on Immunization Practices (ACIP) updated its guidelines to recommend HBV vaccination for all adults less than 60 years of age, in addition to prior recommendations to vaccinate adults of any age who are at high risk for acquiring HBV. This recommendation adjustment is due to two pivotal reasons:

1. Recent data has shown an overall increase in the incidence of acute HBV infection among adults in their 40s.
2. Many people may not recognize they are at risk for HBV infection.