Written By: Hanan Khalaf. RPH

What could be the harm of the sun while we are enjoying its warmth?

The main concern about the sun is the invisible form of radiation it sends to us, namely ultraviolet (UVR). This kind of radiation is able to penetrate and change the structure of skin cells leading to various problems, depending on the duration of exposure. Short term exposure leads to acute effects such as burns and blisters. On the other hand long term exposure leads to chronic effects as early aging of the skin with deep wrinkling, risk of photosensitivity, and various forms of skin cancers.

Labels on some eyeglasses indicate they provide protection against UVA & UVB, what does that mean?

This means that there is more than one type of UVR, A, B, & C.
UVA is the most abundant on earth, available throughout the year, and it has the ability to penetrate the human skin deeply causing damage to connective tissue and premature aging.
UVB is less abundant since it is absorbed to some extent by the ozone and it penetrates human skin less deeply compared to UVA. They are known to cause skin burns.
UVC is extremely hazardous, but the good thing it is totally absorbed by the ozone layer.
Accordingly, protection against UVA and UVB is required to get a healthy skin.
How can we protect ourselves and our children from the sun?

Most important ways are:

Avoid outdoor activities during the peak time for UVR as much as possible.Wear protective clothing as tightly knitted, long sleeved, and dark-colored.Eye protection is warranted and can be accomplished using wraparound glasses that provide 100% UVR protection against both UVA & UVB.Apply sunscreens with a SPF of 15 at least to the skin and lips.

What is the peak time for UV rays during the day?
It is estimated that the peak time for UVR during the day is between 10 a.m to 4 p.m. This time might be different from one country to another.

How do sunscreens work?

Chemical sunscreens work by absorbing, reflecting or scattering a certain portion of UVR from your skin to prevent its penetration. Their activity is measured by what is called Sun Protection Factor (SPF). The higher the value, the greater the protection offered by the sunscreen. A value of 15 for example means, if the sunscreen is applied evenly, it will allow you to stay in the sun 15 times longer than you could without the sunscreen.
It is important to remember that sunscreens should be applied at least 30 minutes before going out-door to get the maximum effect.

How can I choose the best sunscreen for me?

The choice of the right type of sunscreen for you depends on several factors as color of the skin, condition of the skin (wet or dry), type of outdoor activity, site of application, and presence of allergic reactions. In general, we can say that fair skin needs SPF of 15 at least while very dark skin needs lower SPF values. When around water or if you sweat profusely, the use of water-proof sunscreen is a good choice, or consider reapplication of the regular preparation. ? If your skin is dry, then lotion or cream will work better for you than gel. Person with known allergies should apply a small amount of the product on a small area of the skin to observe the effects 24hours before using it.
You should follow manufacturer’s recommendation for any reapplication indicated.

Do I need to use sunscreens during summer only?

Sunscreens should be applied during summer even if you are in shade and during winter as well, since UVR can reflect off any surface as sand, concrete, clouds and snow. These reflective surfaces can get you 80% of the sun’s harmful rays.

How important it is to get sun-protection for my kids?

It is very important to make sure that kids are protected from the sun’s rays. This is due to the fact that one-half of persons’ lifetime exposure to UVR occur by the time they are 18 years old. Moreover, studies have shown that severe sunburns during the first 18 years of life can lead to skin cancer later in life.

December 6, 2005.

References:
http://www.cdc.gov/ChooseYourCover/qanda.htm
http://www.surgerydoor.co.uk/coe/skincentre/sun1.shtml
Compendium of Nonprescription products, Canadian Pharmacists Association 2000.

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Written by Hanan Khalaf

Category: English Contents

Written By: Hanan Khalaf. RPH.What vaccines are included in the immunization schedules for adults?

Immunization schedules for adults cover vaccines like Tetanus-diphtheria (Td), MMR, Varicella, and Influenza. Number of Doses required from the mentioned vaccines (except Influenza which is usually given annually) depends on history of primary vaccination.

Other vaccines are also recommended for adults but only for specific indications as occupational lifestyle, and certain medical problems. Such vaccines include:
Pneumococcal polysaccharide vaccine PPV: recommended for adults with certain medical problems as chronic pulmonary disorders, cardiovascular diseases, diabetes mellitus, chronic liver diseases, functional or anatomic asplenia and certain immunosuppressive conditions. It is given as a single shot with a revaccination after 5 years.

Hepatitis A vaccine: is required for persons with certain medical conditions as chronic liver disease and with certain occupations as laboratory personnel and for travelers. It is given in 2 doses separated by 6months at least. Hepatitis A vaccine is recommended now in the primary vaccination schedule of children in USA starting at one year of age.

Hepatitis B vaccine: Indicated for adults with certain medical conditions as hemodialysis patients, or for health workers or healthy adults who are at risk of acquiring the infection either through their work or personal life. It is given in a similar way to children as 3 doses the first and second dose are separated by 1month and third dose is given 6 months after the second.

Meningococcal vaccine: Two kinds of this vaccine exist the polysaccharide MPSV4 and conjucate MCV which is most recent. Meningococcal conjucate vaccine is indicated in certain medical conditions as functional or anatomic asplenia, adolescents and adults traveling to endemic areas or being at a risk of acquiring the disease.

MCV is indicated for age group 11-55 years, while MPSV4 is indicated for children 2-10 years of age and adults > 55years of age. MPSV4 can be used instead of MCV whenever it is not available.

What vaccines should be considered for travelers?

Vaccination for travelers depends on several factors as, country of destination, duration of residence, presence of certain medical conditions, age, and risk of exposure to rural areas. There is no standard schedule since each case should be individualized. Vaccines commonly involved in travel as:

Meningococcal and Hepatitis A vaccine, as mentioned in the previous question.

Yellow fever vaccine: used to protect against yellow fever virus which is transmitted by mosquito bite and is found is certain parts of Africa and South America. It is not transmitted from one person to another. It is given as a single shot for infants > 9 months of age and adults, should not be given to infants less than 4 months of age. Vaccination is usually accessible through specialized clinics. Revaccination is recommended after 10 years.

Japanese encephalitis vaccine: is similar to Yellow fever caused by a virus that is transmitted through a mosquito bite and found in some rural parts of Asia. It is not transmitted from one person to another. The vaccine is recommended for persons staying for > 4 weeks in endemic areas and is given as a series of 3 shot given at 0, 7, and 30days.

Cholera vaccine: is used to protect against cholera which is caused by a bacteria,is usually acquired through contaminated food and water, attacking gastrointestinal tract causing severe diarrhea. This vaccine is not recommended by CDC (center of disease control) and is not available is USA, because cholera is not a problem there and can be controlled and treated easily by taking appropriate sanitary measures. Cholera oral vaccine is available in few countries only on limited scale.

Typhoid vaccine: used to prevent typhoid fever, a serious disease caused by a bacterium, Salmonella typhi. It is available in 2 forms; an oral live attenuated, and injectable inactivated. Vaccination is recommended when traveling to endemic areas.

Injectable vaccine should not be given to children < 2 years of age and is given as a single shot 2 weeks before traveling with a booster after 2 years if indicated.

Oral vaccine is given as 4 doses 2 days apart with the last dose given 1 week before traveling. It should not be given to children < 6years of age. A booster can be given if indicated after 5 years.

How about vaccination during pregnancy?

Vaccination during pregnancy can be carried out with certain vaccines only if indicated, keeping in mind risk to the fetus versus benefit to the mother. In general, the best period for vaccination during pregnancy is during second trimester (middle period of pregnancy).

All live-attenuated viral vaccines are considered contraindicated in pregnancy as MMR, Varicella, and intranasal Influenza vaccine.

Some vaccines should be considered for pregnant women, if otherwise indicated, like

inactivated influenza, hepatitis B, Td, and meningococcal polysaccharide vaccine.

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Written by Hanan Khalaf

Category: English Contents

Written By: Abier Hamami. RPH. CPHQBe Honest with the doctor:
Tell your doctor the following:

The names of all medicines you are currently taking (over-the-counter, prescription medication as well as any dietary supplements).If you are allergic to any medication or have had side effects from a medication that has been prescribed to you.If you are or might become pregnant, or if you are nursing a baby.If you have any hereditary or family disease.Any illnesses followed or treated by another doctor.

Understand Your Medication:
be an informed patient and ask the doctor or pharmacist the following questions:

What is the name of the medicine (Brand and Generic)? Why are you taking it?What is the dose of the medicine, and how often should you take it?Are there food, drinks, other medicines, or activities you should avoid while taking this medicine?What are the possible side effects of the medicine? What should you do if they occur?How long will you need to take the medication?What should you do if you miss a dose?Where and how do you store it?What should you do if you accidentally take more than the recommended dose?How frequent will the medicine's effects be checked? For example, checking your blood pressure if you are taking a medicine to lower it.Is there any written information you can take home?

Double Check your medication

When you pick up your medicine at the pharmacy, you should check the label carefully to be sure it is the medicine you were prescribed by the doctor.Check the label against the physician directions.Read the label on the container each time before you take your medication.

Follow up with your physician to assess your medication effectiveness:
During the treatment, you should attend a follow-up visit to the doctor to monitor your progress by telling him or her:

About any problems you are having with his prescription( Compliance or Costs problems) About any side effects or problems.About any new medication or dietary supplement you have started taking since last doctor's visit.How you are feeling since starting the medication.

References

General Advice on Safe Medication Use, ISMP

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Written by Hanan Khalaf

Category: English Contents

Written By: Hanan Khalaf. RPH.

1. What do we mean by immunizing schedules?

These are schedules designed to categorize vaccines that should be given according to vaccine type and age at vaccination.

2. Immunizing schedules are they developed for children only?

No, although primary vaccination should be performed in early childhood, there are different schedules classified according to the age like those for children, adolescents, adults, and according to specific situations like pregnancy, and traveling.

3. What are the diseases covered by childhood vaccination?

Measles, is caused by a virus that is transmitted through the respiratory system causing rash, cough, runny nose, eye irritation, and fever. It can lead to ear infection, pneumonia, seizures, brain damage, and death.Mumps, is caused by a virus that is transmitted through the respiratory system causing fever, headache, and swollen salivary glands. It can lead to deafness, meningitis (infection of the brain), painful swelling of the testicles or ovaries, and, rarely, death.Rubella (German Measles), caused by a virus that is transmitted through secretions from nose or throat, causing rash, mild fever, and arthritis. If acquired during pregnancy can lead to serious birth defects.Poliomyelitis or Polio, a disease caused by a virus and it enters the body through the mouth, sometimes harmless and sometimes can be serious causing paralysis and even death.Pertussis (Whooping Cough), a respiratory disease caused by bacteria that produce uncontrollable, violent coughing. Whooping sound is usually heard when the patient tries to take a breath. It can be very serious in infants.Diphtheria, a serious infection of the throat caused by bacteria that can block the airway and cause severe breathing and swallowing difficulty.Tetanus (Lockjaw), a nerve disease, which can occur at any age, caused by toxin-producing bacteria called Clostridium tetani, through a contaminated woundHaemophilus influenzae type b (Hib disease) a major cause of bacterial meningitis in children who are 5 years of age and less.Hepatitis B, a disease caused by a virus that affects the liver and can lead to a carrier state or other complications on the liver as cirrhosis and hepatocellular carcinoma. Infection is usually acquired through shared needles, unprotected sex with an infected person, infected needle stick while on job, or through delivery if mother is infected. It is one of the viruses that affect the liver others are C (there is no vaccine against it) and A (there is a vaccine against it).Varicella (chickenpox), is a respiratory illness that is caused by Varicella-zoster virus. It spreads via air droplets or through fluid from blisters. It causes rash, itching, fever, and tiredness and can can lead to severe skin infection, scars, pneumonia, brain damage, or death.Pneumococcal is caused by a bacteria called Streptococcus pneumoniae causes bacterial meningitis, blood infection, ear infection, and pneumonia and can be very serious in children < 2years of age. It is transferred by close contactInfluenza (Flu), is caused by Influenza virus which affects the respiratory system and can lead to severe complication and is highly contagious.

4. What is the number of shots needed from each vaccine for children?

Measles, mumps & rubella vaccine (MMR) is a live-attenuated vaccine should be given as 2 doses at 12-15 month of age, 4-6years of age. Second dose, however, can be given any time as long as it is 28 days apart from first one. Usually MMR is started after the immune system is completely developed, i.e. at 1 year of life.Polio vaccine: exists in 2 forms Inactivated polio vaccine (IPV) which is given in the form of shots and Live attenuated oral polio (OPV) given through the mouth. OPV, which is no longer used in USA, is still widely used worldwide and is given as 4 doses at 2, 4, 6, 18 months of age and 4-6 years of age. OPV is contraindicated for children with disturbed immunity instead they should receive IPV. OPV can be given at the same time with other vaccines as DTaP, Hib vaccine, Hepatitis b vaccine.Diphtheria, tetanus & pertussis vaccine (DTaP) 4 doses given at 2, 4, 6, 15-18 months, and 4-6 years of age. It is not indicated for children > 7years of age as pertussis is only recommended for children < 7years of age, Instead Td (tetanus and diphtheria) should be given at 11-12 years of age and then every 10 years as a booster. It can be given combined with other vaccines as Hib vaccine.Hib vaccine 4 doses given at 2, 4, 6, 12-15 months of age. However, dose at 6 months of age might not be needed as it depends on the brand used. It is not needed for children > 5years of age except for individuals with certain health conditions as asplenia (functional or removal by surgery), HIV, sickle cell disease. It can be given combined with other vaccines as DTaP and Hepatitis BHepatitis B vaccine, 3 doses given at birth, then 2months after, and at 6 months of age. It can be given combined with other vaccines as DTaP, Hib vaccine, and OPV.Varicella vaccine, a live-attenuated vaccine should be given as 1 shot at 12-18 months of age. If not vaccinated until the age of 13 years, 2 shots should be given 4-8 weeks apart. It can be given with other vaccines as well.Pneumococcal conjucate vaccine (PCV) is a polysaccharide conjugate vaccine given as 4 shots at 2, 4, 6, and 12-18 months of life. It can also be given for children 2-5 years of age who have certain health conditions as sickle cell anemia, asplenia, HIV, any condition that leads to disturbed immunity. In addition such children can receive Pneumococcal polysaccharide vaccine (PPV) that is indicated for children > 2years of age and adults.
PPV vaccine does not include strains of Pneumococcal pneumonia that is available in PCV.Influenza vaccine: Is an inactivated virus that is given as a single shot during the Month of October or November as flu season usually peaks in February. Children < 9years of age who are getting the vaccine for the first time should receive 2 doses 1 month apart and should be repeated yearly. For full information about Flu vaccine please refer to the following link.
In USA, a live attenuated flu vaccine is also available and is used intra-nasally.

5. Combining multiple vaccines in one shot, does it affect immune system of the child?

Combining more than one vaccine in a single shot is advantageous, indeed. First, it allows giving vaccination as early as possible in the infant's life to give protection early since they are more prone to develop complications if they acquire infections. Second, it is less traumatic for the child and saves money. This practice is supported by the recommendations of the AmericanAcademy of Pediatrics (AAP), and Advisory Committee on Immunization Practices (ACIP) that are based on several studies.

6. What is the best way to find updates in immunization schedules?

Ministry of health in any country is the one responsible for updating immunization schedules. Moreover, it is not necessary that immunization schedules will be the same in all countries but will be very similar in essential immunizations.

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Written by Hanan Khalaf

Category: English Contents