Do I still need to worry about getting an H1N1 vaccine?

Q:  If I have not received an H1N1 pandemic vaccine yet, do I still need one?  Also, will I need another dose this fall, when I get my regular flu shot?

A: The first part of your question is tricky.  The flu pandemic of 2009-2010 is coming to an end (WHO report, 8/10/10), although people are still getting H1N1 flu in some parts of the world.  Most people would not need vaccination with the H1N1 pandemic vaccine, unless 1) they are at high risk due to health problems, or 2) they are planning to travel into areas still experiencing high H1N1 spread.  Talk to your healthcare provider to determine your risk.

The second part is easier.  The H1N1 vaccine strain used last fall IS INCLUDED IN the seasonal flu vaccine for 2010-11.  This is the same flu vaccine usually offered in the fall to protect against influenza during our typical Winter flu season. Each year, three strains (or types) of influenza are included in the vaccine.  These vaccine strains change from year to year, based on the most common strains being detected.  Since H1N1 is still out there, it was included for this fall.  (In fact, if it had been possible, the H1N1 pandemic strain would have been included last year, but with the pandemic appearing in the spring, there was no time to incorporate it into the 2009-2010 seasonal vaccine.)

Keep your eyes and ears open for more information about our Student Health seasonal flu vaccine programs, coming soon!

Roger Miller, MD
Student Health Services
The Ohio State University

Do Pelvic Exams Hurt?

Q: I’ve never had a pelvic exam before and I’ve heard that they hurt.  What can I expect? 

A: A pelvic exam is an important part of keeping your reproductive and sexual organs healthy.  There’s no denying that it is unpleasant and even embarrassing, but hopefully knowing how and why we do it will ease some of your fears. 

The pelvic exam includes three parts:

The external exam – the provider will inspect the outer part of your vagina for signs of infections or abnormal skin changes.  She has to look between the folds of skin so you may feel her touch the outside of your vagina and separate the labia slightly.   

The speculum exam – she will then insert a lubricated speculum (an instrument that looks like a long, thin duck bill) into your vagina and open it to inspect the inside of your vagina and cervix.  You’ll feel some pressure and may hear some weird clicking noises.  This is when she does the Pap test

The bimanual exam – next, she will insert her gloved and lubricated fingers into your vagina, and will press down on the outside of your lower abdomen with her other hand.  This allows her to feel your internal reproductive organs (cervix, uterus and ovaries) for any irregularities.

The whole exam takes only a few minutes to complete, and although it can be uncomfortable, it should NOT be painful. If you experience pain, be sure to let your healthcare provider know.  It may be as simple as adjusting the exam a little, but it may also be an indication of an infection or other problems. 

We put you through all of this for a good reason.  Many of the bad things that can happen to your reproductive system – sexually transmitted infections (STI) and cervical cancer to name but a few – often don’t cause any symptoms.  This means you could have a serious health issue and not be aware of it!

And just to clarify.  While the latest guidelines state that sexually active women don’t need to start getting pap tests until they’re 21 years old, once you start having sex you need to see a women’s care provider at least once a year for an exam, STI testing, and counseling on birth control and safe sex – no matter how old you are.

We realize that the pelvic exam can be a source of significant anxiety.  The health care providers in Women’s Services at the Student Health Center are very good at making the experience as comfortable as possible.  So call 614-292-4321 to make an appointment; you’ll be in good hands.

Cheryl Czapla, Med IV
College of Medicine
The Ohio State University

Ryo Choi-Pearson, MD
Student Health Services
The Ohio State University

Do I still need Pap tests if I got the HPV vaccine before I ever had sex?

Q: I got the HPV vaccine before I started having sex.  Do I still need to get Pap tests?

A: Absolutely!  All women regardless of their vaccination status need regular Pap tests.

A Pap test looks at the cells from the cervix, the opening of the uterus. The cervical cells are collected with a spatula or brush during a speculum exam to see if they have any abnormalities which can lead to cervical cancer. The Pap test is still the best way to prevent cervical cancer. There are a couple of reasons for this:

  • The HPV vaccine protects against 70% of the strains that can cause cervical cancer, so there are some cancer-causing strains that the vaccine does not protect against.
  • Because the vaccine is a recent development, we don’t yet know how long its protection lasts.  At this point, our best guestimate is about 5-9 years, so if you get the vaccine when you’re 10, it may not be effective when you’re 25.

Other important things to remember once you become sexually active:

  • The vaccine prevents HPV infection; it does not treat it.  If you were infected with a high risk strain before you received the vaccine, the vaccine won’t eliminate it.
  • The Pap test is only one component of your annual evaluation.  To stay as healthy as possible, you still need a complete gynecologic exam regardless of your HPV vaccination status.

The good news is that HPV is typically slow to progress to cervical cancer.  The vaccine in combination with regular pap tests can dramatically decrease your risk for this horrible disease, but they only work if you use them.  So be sure to see your women’s health care provider at least once a year, no matter what vaccines you’ve gotten!

You can learn more about Pap tests and HPV tests here.  And of course, you can always make an appointment with our Women’s Services Department.

Cheryl Czapla, Med IV
College of Medicine
The Ohio State University

Ryo Choi-Pearson, MD
Student Health Services
The Ohio State University

15 Things No Dorm Room Should Be Without!

It's a blanket!  That you can wear!

Shower caddie?  Check.  Combination iPod, laptop, cell phone charger?  Check.  Officially Licensed Ohio State Snuggie?  Check. 

Now that you have your door room decked out with all of the comforts of home, you should stock it with stuff to keep you healthy on campus this year.  Here are the 15 health care items that no dorm room should be without:

1. Thermometer

2. Pain and fever medication: Acetaminophen (Tylenol), Ibuprofen (Advil, Motrin) or Naproxen (Aleve)

3. Ice pack and/or heating pad

4. Band-Aids

5. Antibiotic ointment

6. ACE wrap

7. Antihistamine medication for allergies or itchy rashes: Diphenhydramine (Benadryl), Loratadine (Claritin), Cetirizine (Zyrtec)

8. Cough and cold medication

9. Anti-diarrhea medication: Loperamide (Imodium AD)

10. Antacid medication: TUMS, Pepto-Bismol, Ranitidine (Zantac), Famotidine (Pepcid), Cimetidine (Tagamet), Omeprazole (Prilosec)

11. Sore throat lozenges

12. Hydrocortisone cream for itchy rashes

13. Alcohol-based hand sanitizer to prevent spread of germs

14. Lotion for dry skin

15. And last but not least, our phone number: 614-292-4321

You can pick up all of these things at our pharmacy.  They’re cheap, they don’t take up a lot of space, and they’re much more useful than that Hermione Granger pillow you snuck in on Move-In Day.  Don’t lie… we saw it.  

Welcome to Ohio State!  Have a great year!

Sheila K. Westendorf, MD
Student Health Services
The Ohio State University

The Ulcer Rap

You could spend the next 3 minutes reading about the risk of developing stomach ulcers from taking too much non-steroidal anti-inflammatory medications (NSAID’s), or you could just watch this “music video” made by an actual doctor rapping about ulcers courtesy of The ZBlogg.


We use NSAID’s all the time for aches, pains and fevers.  Odds are you’ve taken one within the last year, either alone or as an ingredient in one of those multi-symptom cold and sinus medicines.  The most common NSAID’s are ibuprofen (Motrin, Advil, Nuprin) and Naproxen (Aleve). 

These medicines really work well, but like all medications they have side effects, and one of the most serious – as ZDoggMD so eloquently points out – is ulcers in the stomach lining that can cause you to bleed internally. 

So if you need to use these medications, use as little as possible.  And if you develop fatigue, abdominal pain, black or tar-like stool, or bright red blood in your stool while taking them, make sure you get checked out right away.  In fact, if you need to take them that much, you should probably get checked out anyway.

And don’t worry – we don’t rap at the Student Health Center.

John A. Vaughn, MD
Student Health Services
The Ohio State University

Pertussis, People and Passion

Dr. Kendrick and Dr. Eldering

Dr. Hugh MacDonald

The story of how the pertussis vaccine was developed may sound like a dry history lecture, but it actually has all the trappings of a modern day thriller – a gritty tale of underdog heroes and heroines who overcome overwhelming adversity through tenacious persistence and personal sacrifice to save thousands of lives!  So pop up the corn, and read on.

The pertussis bacterium was discovered in 1906, but initial vaccines didn’t work very well.  Children were dying by the thousands.  Sparked by the epidemic plaguing their Grand Rapids community in 1932, Dr. Pearl Kendrick and Dr. Grace Eldering, research bacteriologists at Michigan State, determined to develop a pertussis vaccine.  

After their day job of water and milk analysis, Drs. Kendrick and Eldering gathered specimens from children in their homes, often at night by the light of kerosene lamps, and distributed bacterial culture plates to local physicians.   

Despite the harsh conditions and shoestring budget, they developed precise methods of preparing vaccine; established sterility, safety, and effectiveness tests; and even conducted well-controlled field trials.   In 1936, Eleanor Roosevelt visited their lab and was instrumental in increasing their personnel and funding.   Kendrick’s and Eldering’s vaccine went on to virtually eliminate all fatalities from pertussis.

At about the same time, Dr. Hugh MacDonald, a physician in Skokie, Illinois, developed his own version of a pertussis vaccine and actually tested it on his own family!  He gave his wife Edith and two of his sons the vaccine in February of 1933, and then in June he sprayed the pertussis bacteria into their noses!  I’m guessing there was no IRB back then…

Dr. MacDonald then quarantined his family in an apartment for the summer.   Within two days, his unvaccinated children developed a cough that became progressively worse.   The vaccinated children did not cough at all.  The family survived the summer, and their story was told to the world through newspapers and scientific journals.  

So if you haven’t already, be sure to get the pertussis vaccine.  Getting a shot may not be as dramatic as CSI Skokie, but you’ll be saving lives just the same.  And we won’t even have to lock you in your apartment all summer.

Jo Hanna Friend D’Epiro, PA-C, MPH
Student Health Services
The Ohio State University

Do I need to get a pneumonia vaccine?

Q: Do I need a pneumonia vaccine?

A:  We’ve been spending a lot of time talking about vaccines this summer, which we know is kind of lame and boring.  But it’s our job to keep you healthy – in other words, to be lame and boring – so as much as I’d rather be talking about the Miami game tomorrow, I’m forced to subject you to yet another discourse on vaccines.  This time… the pneumonia shot!

But this one really is worth talking about, because the Centers for Disease Control just changed their recommendations for this vaccine and they could actually impact you.

The pneumonia vaccine used to only be recommended for people over 65, or for those who had certain chronic medical conditions.  But now, anyone 19 years of age or older who smokes or has asthma is being advised to get it.  People tend not to think of asthma as a chronic lung disease for some reason, but it is and if someone with asthma gets pneumonia, they’re at a much higher risk for having a bad outcome from it.  And we all know that smoking damages your lungs and weakens their ability to withstand infections.

If either of these conditions applies to you, you only need to get one shot and most of you will be good until you are 65 years old.  Depending on the rest of your health status, some people might need a booster shot 5 years after the first one.   If you have any questions about whether or not you need to get a pneumonia vaccine, or if you’d like to schedule an appointment to get one, contact our preventive medicine department and they’ll be glad to help you out.

John A. Vaughn, MD
Student Health Services
The Ohio State University

Let’s Not Turn Back Time

On a recent hike in the Smoky Mountains I chanced upon the remains of a turn-of-the-century community. Romantic images of a simpler time crumbled as I wandered through a cemetery. Most of the small, crude, poignant headstones were for infants and children.  I was reminded that at that time, one in ten infants died before turning one.

A significant cause of death was whooping cough, or pertussis.  This disease kills a few ways.  Some individuals suffocate from airway inflammation.  Infants can become so short of breath they are unable to feed and die of starvation.  Secondary pneumonia (no antibiotics then) was also a common, miserable cause of death. Infectivity of this bug was (and is) quite high, often affecting entire families.

The cures these desperate souls pursued seem outlandish.  They ranged from the benign – walking around with cloves of garlic in your socks – to the frightening – being lowered into a coal mine or inhaling cresolene made from coal tar.  How about drinking nitric acid?  None of these cured the illness or relieved the cough, of course.  In fact, we still don’t have an effective treatment for the cough associated with pertussis. 

But there is a vaccine to prevent the illness.   

Six infants recently died in California of pertussis.  Infants remain at special risk for the disease.  Until they’re done with the whole series (of five) pertussis shots, their safety depends on “herd immunity”.  The more people in a community (or “herd”) are vaccinated, the lower the prevalence of the disease and the lower the risk of contracting it.

Pertussis immunity wanes over time creating a reservoir of whoop, if you will, starting in the teen years. Combine that with a growing number of herd members who skip or delay vaccines and you have a recipe for disaster.  

The CDC now recommends that everybody-you, me, your roommate, and your professor-get a booster.  It’s even packaged with tetanus, so you can kill two birds with one stone.  Give us a call or come in and see us if you have questions about tetanus or pertussis – especially if you work with infants.

Jo Hanna Friend D’Epiro, PA-C, MPH
Student Health Services
The Ohio State University

Sleep Tight, Don’t Let the Bedbugs Bite!

Here's what they look like

Here's where they hide

Another hiding spot

The rash from bedbug bites

Just reading about bedbugs may make you start itching, but they’re working their way across the country – they’ve already hit Columbus – so at the risk of totally grossing you out, here’s everything you need to know about these creepy little critters.

What are they?

Bed bugs (Cimex Lectularius) are external parasites that feed on blood.  Adults are reddish-brown, oval-shaped and about the size of an apple seed.  They prefer human blood, but can feed off of rodents, bats, birds, and pets in a pinch.  They can live 12-18 months and can survive up to a year without a meal.  They can’t fly.  They feed at night and hide during the day.

Where do they hide?

Bedbugs rarely hang out on the surfaces of beds or chairs. They like cracks and crevices in mattresses, cushions, bed frames, and floor boards.  Female bed bugs deposit 1-12 eggs per day in these areas, which hatch in 4-10 days.

Can they hurt me?

Not really.  The bites themselves are usually painless, but can cause itchy, red, bumps about the size of a pencil eraser.  In rare cases, the bites can get infected or cause a severe allergic reaction, but usually they go away on their own. 

Even though they feed on blood, as far as we know bed bugs do not transmit disease.  There have been no reported cases of a bed bug feeding off of one person with HIV or Hepatitis (or any other infectious blood-borne disease) and passing it to another person by feeding on them.  Researchers aren’t exactly sure why this is, but they’re trying to figure it out.

How can I tell if they’re on me or in my room?

The itchy red bumps caused by bed bugs are usually in a line because the bug walks and feeds at the same time.  You will also often see blood stains from crushed bugs on sheets or clothing, and little black spots of bedbug poop on mattresses, pajamas and along floorboards. 

If you find a bug, the Ohio Department of Health offers an insect identification service.  The Ohio State University Extension Office also has a Plant and Pest Diagnostic Clinic that can identify it for you.

What do I do if I think I have them in my room or apartment?

Do NOT try to get rid of them yourself.  Bug bombs only drive them further into their hiding areas and may make them spread to other rooms.  Baits, traps and other insecticides don’t work.  It wouldn’t hurt to vacuum your place really well, but if you do, spread a little talcum powder on the floor first – it suffocates the bugs in the vacuum bag so they don’t spread elsewhere.  Washing your sheets and clothes on hot (120 °F) and drying them for 15 minutes is sufficient to kill them.

If you live in a dorm, contact your RA or hall director who can contact Facilities Management to assess the situation and coordinate pest control contractors.  If you live in off-campus housing, contact your landlord to have the situation evaluated.

What can I do to avoid getting them? 

  • Never buy used mattresses
  • Remove clutter as much as possible, especially under the bed. Using plastic, under-bed storage containers with lids is a good idea
  • Put mattress and box springs in bed bug resistant encasements
  • Vacuum regularly
  • When you move into a new apartment or dorm, checking the mattress seams and baseboards isn’t too paranoid. Some people even keep their luggage in the bathroom when they stay in hotels

For more information, the extension office has a great fact sheet on bed bugs, and you can check out:

John A. Vaughn, MD
Student Health Services
The Ohio State University