Contagion

Has your child been exposed to any of these situations in school?

“Doctor, what do we do?” Several students in a particular class had come down with chickenpox (varicella) infection. Stay calm was the first thing I said, followed by a detailed plan. I told the administrator who had the presence of mind to shift to online classes for the time being and sent the symptomatic children home, to disinfect the school premises and make a line list of students, teachers, and personnel who had received the full complement of varicella doses or had a history of natural infection. Everyone was to be closely observed as the possibility of exposure could not be dismissed given that chickenpox is transmitted via direct contact and through the airborne route, and they all shared communal spaces. One thing to remember is that varicella is highly infectious even two days before symptoms manifest. Furthermore, secondary cases can be more severe than the index case, which could be detrimental for those who are immunocompromised.

Upon receiving the list, I was surprised that a majority were not immunized against varicella. Our advice included having their children vaccinated as soon as possible—so that, even if they did not come down with the disease at this particular instance, they would be protected against future exposures—and closely observing their children at home. Should their children fall ill, they would need to consult their pediatricians. Those who had recovered were also advised to seek clearance before returning to school. While most of the parents were willing to comply, some shared that the cost of the vaccine was not within their budget. Others were unaware that there are vaccines outside the national immunization program that need to be given, including boosters for those vaccines received in the first year of life at local health units. This may have stemmed from their understanding that a “fully immunized” child meant only the vaccines defined as such by the national government.

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Recently, a young mother sought my advice on whether her child needed to be worked up for immunodeficiency because of frequent upper respiratory infections, which had been worrying her lately. I told her that a child can experience several upper respiratory tract infections a year from school exposure and that she need not worry as her child was otherwise healthy.

A colleague’s grandchild was bitten by a classmate, and though she laughingly told me that she knew that there was no risk for rabies, she asked whether her grandchild needed to be given a booster for hepatitis B.

Schools remain important sites where common infections, such as rhinovirus (a causative agent of the common cold), as well as vaccine-preventable diseases, can be transmitted. Respiratory infections are among the hardest to control. In dengue-endemic countries, such as ours, schools can also harbor breeding sites for mosquitoes, which serve as vectors not only for dengue but also for chikungunya. Dengue is one of the notifiable diseases, and clustering of cases in a community warrants investigation.

The school is a place where we entrust our children to be cared for. However, parents and caregivers also have the responsibility—and are encouraged—to report if their children have acute or chronic illnesses. This is why schools require you to fill out forms detailing your child’s medical history and mandate that immunization records be submitted and kept updated. Comorbid conditions can put children at greater risk of serious complications, and untreated or undisclosed illness can endanger not only other children but the entire school community. What if your child transmits rubella or German measles to an unprotected pregnant woman? This can have long-lasting and devastating consequences to her unborn child.

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These situations once again bring to light several things: the cost of preventive health care; the priorities and responsibilities of each parent to ensure their children receive the full complement of recommended vaccines; the need to keep on sharing knowledge about why prevention—of which vaccination is just one part of the total arsenal for staying healthy—matters; and the need to seek accurate information from health-care professionals. The last point stems from my growing discomfort with how many people are now relying on TikTok for health information. At the risk of sounding repetitive, let me just say: while no vaccine is 100 percent effective, it does protect your child from suffering serious consequences and complications from getting the natural disease.

For diseases without a vaccine, the simplest ways to prevent infection or avoid passing it on to others are practicing proper handwashing, covering coughs, keeping children home from school or away from crowded places when ill, and ensuring adequate ventilation whenever possible in schools, workplaces, and homes. These measures are helpful for any disease that spreads easily from person to person.

The pandemic was a clear example of how lives could be saved simply by adhering to these standard precautions. Moreover, it was a practice of mindfulness and respect for life.

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