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Kids can pick up colds and flu in doctors' waiting rooms, study suggests

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TORONTO - They are called "well-child visits" — the checkups and appointments for vaccinations that are scheduled at regular intervals throughout the first years of a young life.

But a new study suggests there's a risk healthy children or their parents will go home brewing a cold or the flu, having picked up a bug while sharing a doctor's waiting room with others who are there because they are sick.

The study suggests the risk for individuals is small. But it estimates there are nearly 800,000 medical visits each year in the United States as a result of so-called influenza-like infections picked up in a waiting room by a child or parent there for a well-child checkup.

"The physical proximity of these two different forms of care can expose healthy people — or unhealthy people — to contagious illnesses, especially upper respiratory infections," says Dr. Philip Polgreen, a physician and a professor of computational biology at the University of Iowa. Polgreen is the senior author of the study, which is published in the March issue of the journal Infection Control and Hospital Epidemiology, released Thursday.

"Individually it's a small risk. But if you think about how many (of these occur) across the country, it really adds up."

Polgreen and his co-authors examined data from the U.S. Agency for Healthcare Research and Quality’s medical expenditure panel survey, looking for cases where children or members of their family visited a doctor for an influenza-like illness within two weeks of having a well-child visit.

They then used mathematical modelling to assess the risk and come up with the overall figure. As well, they looked at whether influenza-like illness return visits spiked during flu season. And they did see increased doctor visits for influenza-like illnesses in the period immediately after well-child visits, especially during cold and flu season.

Because of the design of the study, they cannot say there was a cause and effect relationship between the two. Also, the nature of cold and flu season would make that unwise. When the viruses that cause these kinds of illnesses are circulating, people are exposed to them in multiple settings. Asserting that an illness was contracted in one location rather than another would be impossible to prove.

Still, the work does raise concerns about infection control efforts in medical settings outside hospitals, a commentary on the paper notes.

"Anyone who has ... taken their own child to their pediatrician during the winter months has certainly noted the infants, children and adolescents crowded in the waiting room with cough, rhinorrhea (runny nose), fever and malaise, lying on or slumped against their parents," writes Dr. Lisa Saiman, who is with the department of infection prevention and control of New York-Presbyterian Hospital.

"It is likely many have then thought, 'Wow, this is the perfect setting for transmission of respiratory viral pathogens' or 'Oh, no, if she isn't sick yet, she is (or I am) going to get sick from all of these sick kids!'"

Polgreen's paper suggests that one idea might be to try not to schedule well-child visits during flu season. But that might not be feasible, he and his co-authors acknowledge, because the visits are often timed to try to give childhood vaccinations on the recommended schedule.

Saiman agrees.

"Altering schedules for well-child visits could adversely impact vaccination rates, including vaccination rates for influenza," she writes in her commentary.

"Such a strategy would clearly be unwise."

Polgreen says there are guidelines on how to reduce the risk of infection transmission in doctors' waiting rooms, "but I don't think they're universally followed."

"I think that we should try to promote a culture in outpatient visits in clinics and waiting rooms where, if someone is coughing, we should have a mask on them and try to get them in a private room as soon as possible," he says.

"Make masks available. And change that culture in the waiting room."

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