What to Know About Xofluza for the Flu

Most people don’t understand that we have limited options to treat folks with the flu.

They still think that Tamiflu is some kind of wonder drug.

It isn’t. At best, if you take it within 48 hours of the start of your flu symptoms, you might “shorten the duration of fever and illness symptoms, and may reduce the risk of complications from influenza.”

Other flu drugs aren’t that much better, which is why they are typically reserved for those who are considered at high risk for flu complications.

What to Know About Xofluza for the Flu

That’s why many of us welcomed news of a new flu drug – Xofluza (baloxavir marboxil).

“This is the first new antiviral flu treatment with a novel mechanism of action approved by the FDA in nearly 20 years. With thousands of people getting the flu every year, and many people becoming seriously ill, having safe and effective treatment alternatives is critical. This novel drug provides an important, additional treatment option.”

Scott Gottlieb, M.D., FDA Commissioner

Unfortunately, while it has a new mechanism to treat the flu, there are plenty of reasons to not get too excited about Xofluza, despite what the headlines might be telling you:

  • the clinical benefit seems similar to Tamiflu
  • the two studies that were used to get Xofluza approved only looked at folks with mild to moderate flu symptoms (those with severe flu symptoms were excluded) and only looked at folks without complex medical problems, so we don’t know if it reduces hospitalizations, flu complications, or deaths from flu
  • flu virus strains might be able to mutate and develop resistance to Xofluza, although it is not clear if these strains could then be passed to others
  • the single dose treatment is only approved for adults and kids who are at least 12 years old
  • at $120 to $150, it is more expensive than generic Tamiflu

Still, if it works just as well as Tamiflu, but really does have fewer side effects, then that is a good thing, especially if it isn’t overused.

“The significant reduction in influenza viral replication with baloxavir treatment suggests the potential for reducing influenza virus spread to close contacts and should be studied through randomized, controlled trials in households and during institutional influenza outbreaks such as in longterm care facilities.”

Timothy M. Uyeki, M.D., M.P.H., M.P.P. on A Step Forward in the Treatment of Influenza

Could Xofluza make you less contagious to others?

That would be a good way to control outbreaks.

Why isn’t it approved for younger kids? The pediatric studies haven’t been completed yet, but among the postmarketing studies that the FDA are requiring are in infants, children between the ages of 12 months to less than 12 years, and the final report of a pediatric study from Japan.

Other postmarketing studies of Xofluza will include hospitalized patients, the use of Xofluza as post-exposure prophylaxis to prevent influenza in household contacts of an index case, and to monitor resistance.

Are you excited about Xofluza?
Are you excited about Xofluza?

Should folks be excited about Xofluza? While it is certainly nice to have an alternative to Tamiflu, an alternative that worked a lot better would have really gotten most of us excited.

Right now we’ll settle for folks only using anti-viral flu medications, whether it is Tamiflu, Relenza, or Xofluza, when they are truly necessary – for high risk children and adults.

Remember, not everyone with the flu needs these medications.

And they are certainly not a substitute for a flu vaccine, unless you have a true medical contraindication to getting vaccinated.

More on Xofluza

What Causes Acute Flaccid Myelitis?

Most people are aware that there is a so-called “mystery illness” going around.

A “mystery illness” that is paralyzing some kids.

What’s so mysterious about it?

What is Acute Flaccid Myelitis?

Lots of things are mysterious about acute flaccid myelitis…

We don’t know exactly what causes it, who will get it, why they get it, or how to treat it, etc.

What do we know?

  • AFM is not new, although we are seeing more cases lately
  • AFM refers to acute (sudden onset) flaccid (droopy or loose muscles) myelitis (inflammation of the spinal cord) and it is a subtype of acute flaccid paralysis
  • most cases occur in children, with the ages of affected children ranging from 5 months to 20 years, although some adults have been affected
  • these children have a magnetic resonance image (MRI) showing a spinal cord lesion largely restricted to gray matter and spanning one or more vertebral segments
  • it is thought that AFM can be caused by viruses (polio, non-polio enteroviruses, West Nile virus, Japanese encephalitis virus, CMV, EBV, adenovirus, etc., environmental toxins, and genetic disorders, and although no common etiology has been found in these recent cases, most experts think that these cases are caused by a neuroinvasive infectious process, likely of viral etiology, including EV-D68 and EV-A71.
  • these cases of AFM are not thought to have a post-infectious immune-mediated etiology
  • cases are occurring sporadically – after 120 cases in 34 states in 2014, there were only 24 cases in 17 states in 2015, but then 149 cases in 39 states in 2016 and 33 cases in 16 states in 2017. And there have been at least 90 cases in 27 states in 2018, with another 162 cases under investigation.
  • outbreaks of EV-D68 and sporadic cases of AFM have also been seen in other countries recently, including Denmark, France, the Netherlands, Spain, Sweden and the United Kingdom (UK)
  • most cases occur in the late summer and early fall
  • most had symptoms of a preceding viral illness, including respiratory symptoms or diarrhea
  • some were unvaccinated
  • few were recently vaccinated
  • no specific treatments, including steroids, IVIG, plasmapheresis, interferon, and anti-viral medications, have been associated with better outcomes
  • some patients have recovered, while many others have persistent paralysis
  • there has been at least one death
  • some, but not all, were positive for enterovirus D68
  • in Colorado this year, 9 of 14 cases were linked to EV-A71 infections
  • although there was a national outbreak of EV-D68 in 2014 that coincided with the first AFM cases, we didn’t see the same kind of outbreak in the following years
  • AFM isn’t polio, Guillain-Barrésyndrome (GBS), acute disseminated encephalomyelitis (ADEM), or transverse myelitis
  • EV-D68 is not new, being first discovered in California in 1962

While that’s a lot of good information, for parents wanting to protect their kids and avoid AFM, there is some key information missing. Same for those wanting to help treat their kids who have or have had AFM.

So although some folks don’t like that it is being called a “mystery illness,” there is still a lot of mystery to it.

It is no mystery that AFM isn't associated with vaccines - experts review patient vaccination records.
It is no mystery that AFM isn’t associated with vaccines – experts review patient vaccination records.

But that doesn’t mean that experts aren’t working very hard to take all of the mystery out of AFM.

What Causes Acute Flaccid Myelitis?

Some experts are fairly sure that AFM is caused by an enteroviral infection, to the point that they hope that the CDC focuses work on an enteroviral vaccine.

Which enterovirus though?

At least two different enteroviral infections have been associated with AFM, including EV-D68 and EV-A71.

Why not just make a vaccine to prevent both?

You would first have to make a individual vaccines, before thinking about combining them, and you can’t just make any vaccine you want. If you could, we would have vaccines to protect us against RSV, malaria, HIV, and many other diseases.

Still, since EV-A71 also causes serious outbreaks of hand, foot, and mouth disease in some parts of the world, a vaccine has actually been in development for some time, and two are approved for use in China. That at least means making an EV-A71 vaccine is possible, although we would likely need to make our own.

Why did they make a vaccine for a virus that causes hand, foot, and mouth disease (HFMD)? Because unlike the HFMD that we are used to, which is typically caused by coxsackievirus A16 virus, another enterovirus, when caused by EV-A71, it can be deadly, as we have seen in outbreaks in Asia.

What about an EV-D68 vaccine?

While likely possible, since developing a new vaccine takes a lot of time, we want to be sure that is what is causing the outbreaks.

Do some kids not have either EV-D68 or EV-A71 because it just isn’t detected or because something else is causing them to have AFM? Possibly. One of the biggest issues that is troubling some experts though is that they have not detected these enteroviruses in the spinal cord fluid of many children, as you would expect if the viruses were causing the damage.

But even if these enteroviral infections are the cause, are there other risk factors that make some kids who get these enteroviral infections more predisposed to develop AFM, instead of more typical viral symptoms, like a cold or diarrhea?

And why are we seeing cases now? Did the virus, if that is the cause, just mutate into one that is more virulent?

Hopefully we get some more answers and a way to prevent, treat or cure AFM soon.

Until then, we can make sure we take steps to prevent the known causes of AFM, including polio (get vaccinated) and West Nile virus (use insect repellent), and wash hands properly to help avoid all other viral infections. You also want to get your flu vaccine! The flu can cause Guillain-Barré syndrome, which can also cause AFM.

“…is there any relationship between vaccination status and a developing acute flaccid myelitis? Meaning, are vaccines a risk factor? And the data so far says no, the overwhelming number of children who have gotten AFM have had no recent vaccination of any kind or vaccine exposure. These cases over these years have been happening before flu season and flu vaccination starts, which is one of the questions that comes up, and there hasn’t been any pattern to vaccine exposure of any kind in developing AFM. So far, we have not found a link between the two.”

Benjamin Greenberg, MD on 2018 Podcast on Acute Flaccid Myelitis

And remember, although there are many things we don’t know about AFM, we do know that vaccines do not cause AFM. It would also be great if everyone would get vaccinated so that the CDC and our local health departments could focus on health issues like AFM, instead of still battling measles outbreaks caused by folks who intentionally don’t vaccinate their kids.

What to Know About Acute Flaccid Myelitis

While it might be scary to think that there is a new condition out there that we don’t know everything about, parents should be reassured that experts are actively seeking the cause and a way to both prevent and treat AFM.

More on Acute Flaccid Myelitis

Updated on November 13, 2018

What Are the Best Foods for Kids?

What are the best foods for kids?

No, they aren’t brain foods, super foods, or clean foods…

Best Foods for Kids

Follow the My Plate guidelines to make sure your kids are eating healthy foods.
Follow the My Plate guidelines to make sure your kids are eating healthy foods.

In general,  the best foods are healthy foods packed with the nutrients that your kids need, including foods that are high in fiber, low in fat, and good sources of protein, calcium, vitamin D, and iron, etc.

And they are foods that make it easy to avoid things your kids don’t need, like trans fats and too much extra salt, added sugar and calories.

That’s why many of the best foods include things like fruits, vegetables, whole grains, lean meats, and low fat milk. Eat enough of them and you won’t have to worry about giving your kids vitamins.

High Fiber Foods

Do your kids get enough fiber in their diet?

According to the latest recommendations, based on their age, the average child needs:

  • 1-3 years old – 19g fiber/day
  • 4-8 years old – 25g fiber/day
  • 9-13 years old (female) – 26g / (male) – 31g fiber/day
  • 14-18 years old (female) – 26g / (male) – 38g fiber/day
Some snack bars have up to 9g of fiber per serving!
Some snack bars have up to 9g of fiber per serving!

Is 19 or 21g of fiber a lot? What about 38g?

When you consider that a high fiber food has 5g per serving and one that is a good source of fiber only has 2.5g per serving, then it might be hard for some kids to reach recommended levels each day.

To help make sure that they do, look for:

  • high fiber foods – beans, broccoli, peas, lentils, pears, prunes, raspberries, shredded wheat cereal, spinach, whole wheat pasta, snack bars
  • foods that are good sources of fiber – air popped popcorn, nuts, apples (with the skin on), bananas, brown rice, carrots, celery, corn, figs, oatmeal, raisins, strawberries, whole wheat bread

And compare food labels, looking for foods with high amounts of fiber.

Iron-Rich Foods

Since many kid-friendly foods have plenty of iron, getting kids to eat iron-rich foods isn’t as big an issue as some parents imagine.

It can be a problem if your exclusively breastfed infant isn’t eating much baby food, your toddler or preschooler drinks too much milk and doesn’t eat much food, or when a kid on a specialized diet doesn’t eat meat or other iron-rich food (vegans and vegetarians).

Fortunately, there are plenty of iron-rich foods, even if your kids don’t eat red meat, including:

  • most types of beans
  • iron fortified bread, cereal, rice, and pasta, including those made with whole grains
  • collard greens, kale, mustard greens, spinach, and turnip greens
  • broccoli, swiss chard, asparagus, parsley, watercress, Brussels sprouts and other vegetables
  • raisins, prunes, dates, apricots and some other dried fruits
  • tofu
  • egg yolks
  • blackstrap molassses
  • nuts

Seafood and poultry are also good sources of iron.

And while the iron in non-meat sources isn’t as easily absorbed by our bodies as the iron from meat, fish, and poultry, you can boost that absorption by pairing those iron rich foods with some vitamin C, such as drinking orange juice or eating citrus fruits.

Calcium-Rich Foods

Many kids don’t drink enough milk. That’s not necessarily a problem, as some kids actually drink too much milk, but it can be if they don’t make up for it with other foods to get calcium and vitamin D in their diets.

Some brands of American singles have more vitamin D than a glass of milk!
Some brands of American singles have more vitamin D than a glass of milk!

How much calcium do kids need?

  • 700 mg a day for kids who are 1 to 3 years old
  • 1,000 mg a day for kids who are 4 to 8 years old
  • 1,300 mg a day for kids who are 9 to 18 years old

And when you consider that 1/2 cup of broccoli only has 21mg of calcium, you are probably going to want to turn to milk, cheese and yogurt and calcium fortified orange juice, cereal and bread to make sure your kids are getting enough calcium.

Other foods that are good sources of calcium include tofu, sardines, and salmon.

Foods with Vitamin D

Like calcium, good sources of vitamin D can include milk, cheese, and yogurt, but only because many of these foods are fortified. That’s why ice cream, even though it is made with milk, isn’t usually a good source of vitamin D! Neither is raw milk.

Some non-dairy foods that do contain vitamin D include:

  • fatty fish such as salmon, tuna, and mackerel (just don’t overdo it on the fish because of the risks from mercury)
  • beef liver and egg yolks
  • some mushrooms

And of course, many foods are fortified with vitamin D, including breakfast cereal and orange juice.

Are your kids getting at least 600 IU/d of vitamin D?

Protein-Rich Foods

Believe it or not, your child likely gets enough protein in their diet.

Kids should eat a variety of protein rich foods though, including lean meats, seafood, poultry, eggs, legumes (beans and peas), nuts, seeds, and soy products.

“Strategies to increase the variety of protein foods include incorporating seafood as the protein foods choice in meals twice per week in place of meat, poultry, or eggs, and using legumes or nuts and seeds in mixed dishes instead of some meat or poultry. For example, choosing a salmon steak, a tuna sandwich, bean chili, or almonds on a main-dish salad could all increase protein variety.”

2015-2020 Dietary Guidelines for Americans

For most kids, it is the variety of protein that’s the problem, not the overall amounts, as most of their protein likely comes from red meat and dairy products.

What to Know About the Best Foods for Kids

Are you worried that your kids are too picky? Are they overweight, with portion sizes that are too big?

Learn to make healthy food choices and help avoid kid-friendly junk foods, but still make sure your growing kids are getting all of the vitamins, minerals, and nutrients they need.

A registered dietician can be especially helpful in planning a healthy eating plan for your kids if you are still having trouble.

More on the Best Foods for Kids

What Is the Evidence for CBD Oil?

Are you wondering if your kids should be taking CBD oil?

That’s probably not a question you would be thinking of asking just a few years ago, but now that CBD products are everywhere, with hundreds of millions of dollars in sales, and claims that it can treat everything from seizures and anxiety to cancer, you might be thinking you need to jump on this new fad.

What Is CBD Oil?

Many folks are likely skeptical when they hear about all of the benefits of CBD oil.

This is the stuff that is extracted from marijuana plants, right?

How is it even legal to sell CBD oil or gummies infused with CBD?

To understand that, you have to understand that cannabidiol (CBD) oil is the part of the marijuana plant that doesn’t get you high. That comes from tetrahydrocannabinol (THC).

And many of the products you see with CBD oil that is sold over-the-counter aren’t even derived from marijuana, but instead come from hemp plants.

Labeling something as hemp doesn’t necessarily make it legal though. Regulators in Ohio, for example, recently announced that CBD oil derived from hemp is illegal and that the only legal CBD oil will be dispensed in state-licensed dispensaries.

What Is the Evidence for CBD Oil?

There is definitely evidence that CBD oil can have beneficial effects in some medical conditions.

Except for treating some types of resistant seizures, there is no good evidence that CBD oil has all of these other benefits.
Except for treating some types of resistant seizures, there is no good evidence that CBD oil has all of these other benefits.

In fact, the FDA recently approved Epidiolex oral solution for the treatment of seizures associated with two rare and severe forms of epilepsy, Lennox-Gastaut syndrome and Dravet syndrome. Epidiolex is an oral solution of oil-based CBD that is extracted from marijuana plants.

What other medical conditions?

While it is not approved to treat any other medical conditions, cannabidiol is being studied to treat people with ADHD, anxiety, autism, schizophrenia, chronic pain, Multiple Sclerosis, Parkinson disease, Tourette syndrome, and substance use disorders.

Should You Try CBD Oil?

What does that mean right now if you have a child with anxiety or another disorder and you are interested in CBD oil?

Although it might be tempting to buy and try the CBD oil that you can find at your local health food store, remember that they aren’t the same thing as Epidiolex, the prescription version of CBD. When you buy an over-the-counter CBD product, you have no idea what dosage of CBD you are really getting.

Anyway, until further testing is done, you have no idea what dose to give your child with anxiety or any other disorder besides seizures anyway.

And like other drugs, CBD oil can have side effects.

So unless you can get in a clinical trial, you should likely wait and continue your current therapies.

But since Epidiolex is approved to treat certain seizures, can’t your doctor simply prescribe it off-label to treat other conditions, like anxiety, if they wanted to? While that does often happen for other medications, it is very unlikely to happen for Epidiolex, even after the rescheduling process is completed and it is no longer a Schedule I substance and can be prescribed in states where it is illegal to prescribe medical marijuana.

It is estimated that Epidiolex will cost over $30,000 a year.

More on the Evidence for CBD Oil

Which Vitamins Should My Kids Take?

All kids need vitamins.

So which vitamins or supplements should you give them?

“The American Academy of Pediatrics believes that healthy children receiving a normal, well-balanced diet do not need vitamin supplementation over and above the recommended dietary allowances, which includes 400 IU (International Units) of vitamin D a day in infants less than 1 year of age and 600 units/day for children over 1 year of age.”

AAP on Where We Stand: Vitamins

It depends. Most kids don’t actually need to take any extra vitamins.

Which Vitamins Should My Kids Take?

Follow the My Plate guidelines to make sure your kids are getting enough vitamins and minerals.
Follow the My Plate guidelines to make sure your kids are getting enough vitamins and minerals.

Wait, if all kids need vitamins, then why don’t you need to give them extra vitamins?

That’s easy. Most kids should get enough vitamins from the foods they eat.

Are your kids missing out on something? Then that would be a clue on which vitamins and minerals they would need to take.

Does your child have a chronic medical condition?

Are they on a special or restrictive diet?

Even if they are a little picky or don’t eat as much as you like, do they eat some foods from each food group, leading to a balanced diet by the end of the week?

In general, to see what your child might need, focus on your child’s intake of:

  • iron – can be low (anemia) in preterm babies, when infants are exclusively breastfeeding and not eating foods with iron, toddlers and preschoolers who are drinking excessive amounts of cow’s milk and not eating foods with iron, other kids who don’t eat many foods with iron, and teen girls who have heavy periods
  • vitamin D – can be low when infants are exclusively breastfeeding and don’t take a daily vitamin D supplement and older children who don’t eat or drink enough foods with vitamin D, including milk, cheese, yogurt, and orange juice
  • calcium – can be low when children don’t eat or drink enough foods with calcium, including milk, cheese, yogurt, and orange juice
  • fluoride – can be deficient when children mainly drink bottled water, soda, and juices, but since too much fluoride can lead to tooth staining, it is best to get fluoride from drinking fluoridated water – offer it daily once your child is about six months old
  • vitamin B12 and folate – can become classically low in vegans (who don’t take a supplement) and kids who drink goat milk that’s not fortified with vitamin B12 and folate
  • vitamin C – rarely low, which would cause scurvy, as most fruits and fruit juices are high in vitamin C

What other things do parents think about supplementing?

  • protein – while many parents worry that their kids aren’t getting enough protein in their diets, protein is rarely the thing that they are missing out on, as only about 20 percent of our calories need to come from protein.
  • calories – if your child is a picky eater, you might think that they aren’t getting enough calories and might think of supplementing them with a shake or two to boost their calories, but keep in mind that these typically end up replacing meals, leading kids to eat even less food and teach them to just drink their calories
  • vitamin K – typically only a problem for breastfeeding newborns who didn’t get a vitamin K shot, as vitamin K is found in many foods
  • vitamin A – since milk and many other foods are fortified with vitamin A, this is rarely a vitamin that we worry about being low. Supplements are also a concern, because too much vitamin A can be toxic.
  • potassium – few people worry about their potassium intake, but maybe they should. Most of us don’t eat enough foods with potassium.
  • magnesium – since magnesium is so easily absorbed, this is rarely a mineral that we get concerned about being low.
  • vitamin E – most kids get enough vitamin E in their diet, so a supplement probably isn’t necessary unless your child has a malabsorption problem or abetalipoproteinemia
  • iodine – most kids get enough iodine thanks to salt iodization, but extra iodine is recommended for pregnant and breastfeeding mothers
  • zinc – many foods contain zinc, so zinc deficiency is rare
  • fiber – giving kids extra fiber can be a good idea if your kids don’t eat enough high fiber foods, especially if they are having stomach issues
  • probiotics – although taking probiotics is one of the latest fads, there is little evidence that probiotics are helpful for much of anything in healthy kids
  • fish oil – another fad, there is likely no benefit to giving your kids omega 3 fatty acids

So which vitamins and supplements do your kids need?

Best Vitamins and Supplements for Kids

Once you figure out which vitamins and minerals your kids need, you have to figure out the best way to make sure they get them, understanding that the answer isn’t always going to be a gummy vitamin.

You also will likely need a different supplement if you are actually treating a deficiency vs if you are just trying to prevent your child from developing a deficiency in the first place.

So the best supplement(s) might be:

  • a multivitamin with iron – keeping in mine that gummy vitamins typically don’t contain iron, so if your main concern is that your child isn’t getting enough iron, then you should give your child an iron vitamin or a multivitamin with iron. Also low in calcium. Either liquid (infants), chewable, or tablets.
  • a multivitamin without iron – keeping in mine that in addition to not containing iron, these types of multivitamins also often don’t contain very much calcium. Often available as liquid (infants), gummies, chewables, and tablets.
  • a vitamin D supplement – was your child’s vitamin D level low or do you just think that he doesn’t get enough vitamin D in his diet? These are typically available as liquid, gummies, chewables, and tablets.
  • a calcium supplement – These are typically available as gummies, chewables, and tablets.
  • a vitamin D supplement combined with calcium – These are typically available as gummies, chewables, and tablets.
  • an iron supplement – if  your child’s iron was low, then they will likely need an iron supplement, like Feosol, Niferex, or Fer-In-Sol. Either liquid or tablets.
  • a fluoride supplement – do you live in an area where the water isn’t fluoridated? Do you use a reverse osmosis system that filters out fluoride? Usually available as a prescription only. Or you can buy ‘baby water’ with added fluoride.

Again, remember that unless your child has already been diagnosed with a deficiency, you can often work to get your kids to eat more foods with these nutrients instead of giving them an extra supplement, including vitamin fortified foods.

Look to you pediatrician and a registered dietician if you need extra help.

More on Which Vitamins Should My Kids Take

 

What to Know About Hand, Foot, and Mouth Disease

Have your kids ever had a coxsackievirus A16 infection?

Don’t think so?

What about Hand, Foot, and Mouth Disease (HFMD)?

Symptoms of  Hand, Foot, and Mouth Disease

Hand, Foot, and Mouth Disease is a very common childhood disease that most of us end up getting at some point, typically before we are about five years old. At least you hope you do, because you don’t want to get it as an adult…

Would you recognize these symptoms of HFMD?
Would you recognize these symptoms of HFMD? Photo courtesy Medicina Oral S.L.

Most people are familiar with the classic symptoms of HFMD, which can include:

  • a few days of fever, often up to about 102 degrees F
  • red spots that can turn into blisters on the child’s palms (hand) and soles (foot), but often also on their knees, elbows, and buttocks
  • sores or ulcers in a child’s mouth which are often painful, causing mouth pain or a sore throat and excessive drooling
  • a reduced appetite, which can sometimes lead to dehydration

Symptoms which can last up to 7 to 10 days.

Although that’s the end of it for most kids, a few weeks after the other symptoms have gone away, some kids will have peeling of the skin on the child’s fingers and toes. They might even lose their fingernails and toenails (nail shedding). This is only temporary though, and new nails should quickly grow back.

To confuse matters though, like other viral infections, not all kids have classic symptoms when they get HFMD. Some don’t have a fever, while others don’t have the rash on their hands and feet, which can make it easy to confuse with other viral infections that cause mouth ulcers, like herpangina.

Some kids don’t have any symptoms at all, but surprisingly, they can still be contagious.

Facts About Hand, Foot, and Mouth Disease

HFMD is caused by the coxsackievirus A16 virus and a few other enteroviruses, including enterovirus 71 and coxsackievirus A6. Because more than one virus can cause HFMD, it is possible to get it more than once.

Other things to know about HFMD include that:

  • it is very contagious, especially if you have close contact with nose and throat secretions, fluid from blisters, and feces of someone infected with HFMD, especially during their first week of illness
  • the incubation period for HFMD, the time when you were exposed to someone to when you develop symptoms, is about 3 to 7 days
  • people with HFMD disease can continue to be contagious for days or weeks after their symptoms have stopped, although this isn’t a reason to keep them out of school or daycare. In fact, as long as they don’t have fever and feel well, kids with HFMD can likely go to daycare or school.
  • there is no specific treatment for HFMD, except symptomatic care, including pain relief, fever reducers if necessary, and extra fluids
  • unlike other viruses which are common in the winter, HFMD season is during the spring, summer, and fall
  • complications of HFMD disease are rare, but can include viral meningitis, encephalitis, and a polio-like paralysis
  • HFMD is not the same as foot-and-mouth or hoof-and-mouth disease that affects animals
  • there is currently no vaccine to prevent you from getting HFMD, although cross reactivity between polio vaccines and enterovirus 71 might lead to milder symptoms if you are vaccinated and an EV-71 vaccine is approved in China

Most importantly, to avoid getting HFMD, wash your hands after changing your child’s diaper, teach them to cover their coughs and sneezes, and don’t share cups or other personal items.

Although many of us had HFMD when we were kids, remember that there are multiple viruses that can cause it. When outbreaks occur and we see more cases in adults, it is likely because it isn’t being caused not by coxsackievirus A16, but by a less commonly seen enterovirus that we aren’t immune to, like coxsackievirus A6.

More on Hand, Foot, and Mouth Disease

Have Questions About the First Generic Version of EpiPen?

Have you heard the news that the FDA has approved the first generic version of the EpiPen?

“The U.S. Food and Drug Administration today approved the first generic version of EpiPen and EpiPen Jr (epinephrine) auto-injector for the emergency treatment of allergic reactions, including those that are life-threatening (anaphylaxis), in adults and pediatric patients who weigh more than 33 pounds.”

FDA Press Announcement on FDA approves first generic version of EpiPen

That’s likely surprising news to all of those folks who have been prescribing and using generic epinephrine injectors this past year.

Is This Really the First Generic Version of EpiPen?

Many remember that we all talk about EpiPens so much because their cost jumped from about $100 in 2006 to over $600 in recent years.

The current generic epinephrine injectors are authorized generics, so didn't need FDA approval.
The current generic epinephrine injectors are authorized generics, so didn’t need extra FDA approval.

That prompted Mylan, the company that makes the EpiPen 2-Pak and EpiPen Jr 2-Pak, to come out with a half-price authorized generic version last year.

“An authorized generic is made under the brand name’s existing new drug application using the same formulation, process and manufacturing facilities that are used by the brand name manufacturer.”

An authorized generic Adrenaclick injector also became available for a cash price of $109.99 CVS pharmacies. Combined with a $50 coupon, that’s often your best deal on an epinephrine injector if you don’t have insurance.

How Much Will the First Generic Version of EpiPen Cost?

And now we have a true generic version of the EpiPen 2-Pak and EpiPen Jr 2-Pak, from Teva Pharmaceuticals USA.

“The reduction in upfront research costs means that, although generic medicines have the same therapeutic effect as their branded counterparts, they are typically sold at substantially lower costs.”

FDA on Generic Drug Facts

Will it be cheaper than current EpiPens?

“When multiple generic companies market a single approved product, market competition typically results in prices about 85% less than the brand-name.”

FDA on Generic Drug Facts

It should be, but how much cheaper will it be?

“A company spokeswoman declined to say when it would be available, or how much it would cost.”

F.D.A. Approves Generic EpiPen That May Be Cheaper

While most folks would be happy with a $90 EpiPen and a tier 1 generic copay, I wouldn’t count on it. For one thing, we technically don’t have multiple generic EpiPens competing against the TEVA EpiPen yet.

And looking at drug prices of some of TEVA’s other medications, you can get a clue about their pricing plan:

  • Airduo generic (similar to Advair, but about 1/4 the price) – $98
  • Qvar (similar to Flovent) – $200
  • ProAir (albuterol inhaler) – $71
  • Budesonide Inhalation Suspension (generic Pulmicort Respules) – $176
  • Levalbuterol Inhalation Solution, USP (generic Xopenex) – $121
  • Clindamycin Phosphate and Tretinoin Gel (generic Ziana) – $600
  • Cefdinir oral suspension (generic Omnicef) – $45
  • Syprine (generic trientine hydrochloride) – $18,375

Their drugs typically ain’t cheap…

Will the first generic version of the EpiPen simply be a little cheaper than the authorized generic or can we expect TEVA to offer it at substantially lower cost?

What’s your guess?

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