Dr. Scafuri is a contributing writer to the Staten Island Advance, specializing in healthcare and travel medicine. Below are his most recent articles which can be found in the Health and Fitness section in the newspaper.
A closer look at PIDD
Could your child's frequent sinus infections or reoccurring bronchitis be more than just an infection?
March 29, 2010
By DR. FRANK SCAFURI, III
STATEN ISLAND, N.Y. — Could your child’s frequent sinus infections or reoccurring bronchitis be more than just an infection? Do you suffer from the same illnesses everyone else does, but in abnormal quantities or severity? If that is the situation, you or your child may be suffering from primary immune deficiency disease (PIDD). However, you are not alone. Each year, 250,000 Americans are diagnosed with PIDD. Thousands more go undiagnosed.
PIDD occurs when a part of the immune system is not working or is missing. It is caused by genetics and is not contagious. PIDD is not visible and it affects any age, race or sex. Often, the first signs appear early in life. There are more than 150 different types of PIDD that vary widely in their severity and symptoms.
For example, David Vetter, who was dubbed by the media as the “boy in the plastic bubble” during the late ‘70s and early ‘80s, had severe combined immune deficiency. This is one of the most serious disorders of PIDD. Similarly, someone who suffers from eight or more new ear infections within one year is considered to be suffering symptoms of PIDD.
Today, with early diagnosis and treatment, many PIDD patients can go to work or school, enjoy hobbies and lead productive lives. Though once thought to be very rare, as many as 1 in 1,200 people have some form of PIDD. One of the most common types, IgA deficiency, may be as common as 1 in 500 people. Hence, there are hundreds of people with PIDD on Staten Island and many may not know they are living with this disease.
According to the Immune Deficiency Foundation, it takes an average of nine years between the onset of symptoms to the diagnosis. Fifty percent of patients will be 18 years old or older, and 37 percent of patients will have permanent damage to their bodies by the time they are diagnosed. Early diagnosis and treatment leads to better outcomes, so it is important to recognize the signs of PIDD sooner rather than later.
Even mild immune deficiencies can lead to serious infections if left untreated.
SYMPTOMS OF PIDD
So how many infections are normal? The symptoms of PIDD are as follows:
- Eight or more new ear infections within one year.
- Two or more serious sinus infections within one year.
- Two or more months of taking antibiotics with little effect.
- Two or more bouts of pneumonia within one year.
- Failure for an infant to gain weight or grow normally.
- Recurrent deep skin or organ abscesses.
- Persistent thrush in mouth or elsewhere on skin (after age 1).
- Need for intravenous antibiotics to clear infections.
- Two or more deep-seated infections, such as sepsis, meningitis or cellulites.
- A family history of PIDD.
If any of these describe you or your child’s infections, talk to your doctor about getting tested for PIDD. Testing involves gathering medical and family history, physical exam, blood and immune globulin level tests and vaccines to test immune response. The treatment used most often for PIDD is immune globulin, which contains antibodies that come from healthy human blood plasma and help fight infection.
When blood is donated, just the antibodies are extracted from the plasma and these are given to the patient. Replacing the deficient antibodies usually results in fewer and less severe infections and a better quality of life for the patient. It is like a temporary immune system.
Some other treatments that are used for PIDD are gamma interferon, Peg-Ada, bone marrow or stem cell transplants, Neupogen or gene therapies.
Early infant screening tests are being developed and hopefully one day all infants can be screened for PIDD. However, in the meantime, if you feel you are suffering from PIDD, please contact your family physician.
For more information on PIDD, on the local level please contact Joanna Tierno at www.primaryimmune.org.
This column is provided by the Richmond County Medical Society. Dr. Scafuri is a member of the Society and co-chairs the Society’s Public Health Committee. He specializes in infectious disease and maintains a practice in West Brighton and in Eltingville.
Men and HPV vaccine
Gardasil is 90 percent effective in preventing genital warts caused by the human papillomavirus
Monday, December 28, 2009
By DR. FRANK SCAFURI, III
STATEN ISLAND, N.Y. -- In a January article published in the Staten Island Advance, I reviewed the human papillomavirus (HPV) vaccine approved by the Food and Drug Administration for girls and women ages 9 through 26. The FDA has now approved the same vaccine for boys and men in the same age group for the prevention of genital warts due to the HPV.
HPV is the most common sexually transmitted infection in the United States and most genital warts are caused by HPV infection. Gardasil was the first vaccine developed to prevent cervical cancer, precancerous genital lesions and genital warts due to the HPV in females. However, it turns out, Gardasil is nearly 90 percent effective for preventing HPV-caused genital warts in boys and men.
Gardasil is given in a series of three intramuscular injections over a six-month period in the shoulder region of the upper arm or in the front side of the upper thigh. The second and third doses should be given at two and six months after the first dose. It is not yet known how much protection patients would get from receiving only one or two doses of the vaccine. As a result, it is imperative that patients receive all three doses.
Many patients are concerned with the safety of Gardasil. In order to monitor its safety, as well as all other vaccines, the FDA and the Centers for Disease Control and Prevention designed various systems. The first is the Vaccine Adverse Event Reporting System ("VAERS"), which receives unconfirmed reports of possible side effects following the use of Gardasil and all vaccines licensed in the U.S.
VAERS reports are regularly reviewed for safety concerns or trends of adverse events (possible side effects). Secondly, the CDC has the Vaccine Safety Datalink (VSD) Project, which is a collaborative effort between the CDC and eight managed-care organizations that monitor vaccine safety and address the gaps in scientific knowledge about rare and serious side effects following immunization.
Next, the Clinical Immunization Safety Assessment Network collaborates with six academic centers in the U.S. to conduct clinical research on vaccine-associated adverse events. Lastly, vaccines are manufactured in batches called lots. All vaccine lots are routinely tested and must pass all tests before they can be used and vaccine manufactures must comply with strict manufacturing standards. The FDA analyzes possible side effects associated with individual lots to look for any unusual patterns.
With that in mind, Gardasil does not appear to cause any serious side effects. However, anyone who has ever had a life-threatening allergic reaction to yeast, to any other component of Gardasil, or to a previous dose of Gardasil should not get the vaccine. Additionally, the vaccine is not recommended for pregnant women.
Several mild problems may occur with Gardasil at the injection site: pain, redness, swelling, or itching. Additionally, the patient may have a mild (100 degree Fahrenheit) to a moderate (102 degree Fahrenheit) fever, a headache or nausea. These symptoms do not last long and go away on their own.
Life-threatening allergic reactions to vaccines are very rare. If they do occur, it would be within a few minutes to a few hours after the vaccine. However, like all vaccines, Gardasil should be continued to be monitored for unusual or sever problems. If you have any of the following signs of a serious allergic reaction call your doctor right away: A high fever or behavior changes, such as difficulty breathing, hoarseness or wheezing, hives, paleness, weakness, a fast heart beat or dizziness.
At least 50 percent of sexually active people will contract HPV at some time in their lives. HPV causes cervical cancer, precancerous genital lesions and genital warts. However, Gardasil was developed to prevent these diseases and the research has shown it does this without causing any serious side effects.
Therefore, the benefit of the vaccine clearly outweighs the detriment. To date, I have recommended this vaccine to all female patients who meet the above-discussed criteria. Similarly, now based upon the new FDA approval, I will also recommend it to my male patients who meet the above-discussed criteria.
Staten Island Social Scene: RUMC honors community service at Vanderbilt
STATEN ISLAND, N.Y. — Medical staff at Richmond University Medical Center honored Kathryn K. Rooney, Dr. Edward Arsura and Dr. Peter Stathooulos for their longtime service and commitment to community during a reception at The Vanderbilt on South Beach Boardwalk.
Rooney has been an attorney since 1977, having served as Counsel to NYS Senate Finance Committee and 25 plus years as Special Counsel to Sen. John Marchi,and served on the Staten Island Secession Commission.
She was involved in closing Fresh Kills and converting Willowbrook State School to College of Staten Island. In addition to the RUMC board, she has been Involved on numerous not-for-profit boards in education and health care. She joined St. Vincent's Advisory Committee in 1985.
As RUMC Board Chair since 2007, she's been instrumental in the hospital emerging from its affiliations with St. Vincent's & Bayonne Medical Center. She is married to State Supreme Court Justice Stephen J. Rooney, and they are the parents of three daughters Megan, Elizabeth and MaryKate, and one granddaughter.
Dr. Arsura, who is leaving the hospital after a decade of service, became Chairman of the Department of Medicine at St. Vincent's in 2005 and Chief Medical Officer of the newly formed RUMC in 2008.
Prior to joining RUMC, he had a remarkable career at St. Vincent's in Manhattan and across the country in at Kern Medical Center in Bakersfield, Calif. and at the at the University of Virginia.
Dr. Stathopoulos, the outgoing president of the medical staff, opened his private practice in 1984 and joined the Medical Staff at St. Vincent's in June 1985. He has been recognized in being instrumental for building the network for the Uniformed Service Family Health Plan for the military and has received a Proclamation from the Council of the City of New York for On Your Mark.
He also has been recognized as New York Magazine's 100 Top Primary Care Physicians. His two-year term as president of the medical staff concluded on June 30th and Dr. Frank Scafuri has assumed his role.