IVIG and Flare

[Bttrfly1]

School is about to start and I'm worried about strep exposure. We are recently diagnosed PANDAS and got IVIG in June. We have been advised to get 504 this year - here's my question, what do I do if someone in his class has strep and they let me know? Other than anxiety what am I supposed to do? He is on a year of antibiotics- do I watch for flare and test for strep? Do I call and ask for stronger dose of antibiotics? Do pAndas kids flare with common cold virus? Should I call doctor? Thanks for your comments.

[bobh]

I hate to give bad news about strep at school, but your child is very likely to be in the same class as a strep A carrier without you knowing about it.

Because carriers have no symptoms, they will not likely be tested or letting anyone that they are strep carriers. According to this study: https://www.ncbi.nlm.nih.gov/pubmed/3909737, 10.9% of children 14 or under are strep A carriers.

That means that in a class of, say, 25 students 14 or under, the probability of having at least one strep carrier is 95.4% (see http://www.vassarstats.net/textbook/ch5apx.html, and put in N=25, k=1, p=0.109, and look at "P: 1 or more out of 25").  Even if the class is only 12 kids, that probability is still 75% (just change N in that calculator).  And then, there is the possible exposure at recess, on the bus, etc.

I would guess that strep carriers may not spread their strep around as much if they are not coughing and sneezing all over the class room.  So it is probably still useful to try to track overt symptoms in the class.

 

Edited August 24, 2017 by bobh

[Bttrfly1]

Thanks you are right.. both my kids are carriers too. Never presented with sore throat or fever. Frustrating.

[ABdualPT]

 My son who is nine years old just had IV I G treatment over the weekend and will be starting school in a couple of weeks. I am really nervous.  I have and Kate with him about handwashing and not sharing utensils with others and try not to eat with his hands. We have put him in a smaller school with a class size of about 24 kids in the upper elementary part of the school. In addition, I am giving a talk to the parents at the school and sending home fliers with the kids to let us know if anyone has strep throat and to educate others about PANDAS. In the meantime we are Asking other parents before play dates if their child or anyone in their family has had strep throat in the recent past. Then we can make an informed decision about whether the play date should happen or not.this is uncharted territory and we will see how it goes.

[bobh]

By the time the parent of a classmate notices, then takes their child in to see a doctor, then gets a positive strep result back from a doctor, and then notifies the school, and the school notifies you, your child has been exposed for several days or more.  This strategy is great for awareness, but beside not addressing the strep carriers, and false negatives, it doesn't address any other trigger, such as mycoplasma.

If your child is very easily triggered by nearby sickness, another approach might be to yank the child from the class if there is someone coughing or sneezing "incessantly", or someone missing due to any sickness.  By the time one person in the class is missing, it is already going around, and others already infected by that missing person but not yet sick will soon be multiplying the risk.  This way, your child is protected sooner, protected from mycoplasma ++l, and from those that have strep but don't know it because they decide not to go to the doctor, or any other failure in the link.