Enteritis during mountaineering above the snow line
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Enteritis during mountaineering above the snow line – how to practice prophylaxis? (preliminary results)

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Enteritis during mountaineering above the snow line how to practice prophylaxis

Enteritis during mountaineering above the snow line – how to practice prophylaxis?

(preliminary results)

Robert Adamek (1), Beate Kraft (2), Michael Pietsch (2) and Hans-Volkhart Ulmer (1)1) Institute of sports science, Johannes Gutenberg-Universität, Mainz, Germany2) Department of hygiene, Universitätsklinikum Mainz

4th international Symposium: “High altitude influence on human performance: science and praxis”

– Bohinjska Bela (Slovenia) Sept. 8-13, 2009

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Adamek et al.: Enteritis above the snow line. 4th Symposium: Altitude & praxis, 2009


Enteritis during mountaineering above the snow line how to practice prophylaxis

Introduction, aim, methods, results, discussion, final conclusions

INTRODUCTION

ZOCHOLL (2008) described, that diarrhea by infection with faecal bacteria under difficult hygienic conditions above the snow-line is a typical problem in mountaineering

Faeces contain many pathogenic and non pathogenic microorganisms,

–> enteritis

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Adamek et al.: Enteritis above the snow line. 4th Symposium: Altitude & praxis, 2009


Enteritis during mountaineering above the snow line how to practice prophylaxis

Introduction, aim, methods, results, discussion, final conclusions

Introduction

Enteritis –>diarrhea:

Loss of water and electrolytes,

negative for physical and psychic performance capacity

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Adamek et al.: Enteritis above the snow line. 4th Symposium: Altitude & praxis, 2009

3


Enteritis during mountaineering above the snow line how to practice prophylaxis

Introduction,aim, methods, results, discussion, final conclusions

Mountaineering in high altitudes:

No WC,

only „SC“ („snow closet“)

with an alternative: Clean mountain can

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Adamek et al.: Enteritis above the snow line. 4th Symposium: Altitude & praxis, 2009


Enteritis during mountaineering above the snow line how to practice prophylaxis

Introduction,aim, methods, results, discussion, final conclusions

„SC“ (snow closet)

using the „clean mountain can“ in the Mt McKinley region

Foto: M.

Tannheimer

Hier Foto

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Adamek et al.: Enteritis above the snow line. 4th Symposium: Altitude & praxis, 2009


Enteritis during mountaineering above the snow line how to practice prophylaxis

Introduction,aim, methods, results, discussion, final conclusions

„Clean mountain can“:

Rigorous reglementation of use

with supervision after return

Only in the Mt McKinley-region (Alaska)

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Adamek et al.: Enteritis above the snow line. 4th Symposium: Altitude & praxis, 2009


Enteritis during mountaineering above the snow line how to practice prophylaxis

Introduction,aim, methods, results, discussion, final conclusions

Process of infection by faeces during mountaineering in high altitudes above the snow line:

1) Defaecation only possible in snow

(better in the clean mountain can)

2) Snow used for melting water

3) Melting water: Potential of infection with pathogenic microorganisms, if not disinfected,

risk of diarrhea

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Adamek et al.: Enteritis above the snow line. 4th Symposium: Altitude & praxis, 2009


Enteritis during mountaineering above the snow line how to practice prophylaxis

Introduction,aim, methods, results, discussion, final conclusions

To prevent infection with pathogenic microorganisms from faeces, usually snow water is boiled or disinfected chemically or physically (filter) as prophylaxis against enteritis

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Adamek et al.: Enteritis above the snow line. 4th Symposium: Altitude & praxis, 2009


Enteritis during mountaineering above the snow line how to practice prophylaxis

Introduction,aim, methods, results, discussion, final conclusions

For boiling gas is used – problem of additional weight for transportation

Chemical disinfection – less weight for transportation, but needs effecting time

Physical disinfektion – also weight of filter-systems for transportation

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Adamek et al.: Enteritis above the snow line. 4th Symposium: Altitude & praxis, 2009


Enteritis during mountaineering above the snow line how to practice prophylaxis

Introduction,aim, methods, results, discussion, final conclusions

PIETSCH (2008) – specialist of hygiene – argued, however:

The risk of infection by the own hands could be more important

than

the risk of infection by melted snow

Therefore disinfection of the hands would be very important

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Adamek et al.: Enteritis above the snow line. 4th Symposium: Altitude & praxis, 2009


Enteritis during mountaineering above the snow line how to practice prophylaxis

Introduction,aim, methods, results, discussion, final conclusions

  • AIMS

  • Check

  • – melted snow and

  • – gloves

  • Basal consideration:

  • Coliform bacteria etc. are an indicator for faecal contamination and so for the risk of enteritis

  • 2) Check practicability of hand disinfection in high altitude

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Adamek et al.: Enteritis above the snow line. 4th Symposium: Altitude & praxis, 2009


Enteritis during mountaineering above the snow line how to practice prophylaxis

Introduction, aim, methods, results, discussion, final conclusions

  • METHODS

  • Bacteriological check for faecal bacteria (usual bacteriological procedure similar as for drinking water) of

  • melted snow from the Muztagh Ata region (Kunlun-mountains – brought by B. HONKA): 4 steps between 4400 and 6800 m, 25 snow specimens, each August 2008

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Adamek et al.: Enteritis above the snow line. 4th Symposium: Altitude & praxis, 2009


Enteritis during mountaineering above the snow line how to practice prophylaxis

Introduction,aim, methods, results, discussion, final conclusions

Bacteriological check

2. of melted snow for comparison: 3 specimens from Kleinwalsertal (touristic region with many restaurants, cottages etc, 1500 m), Jan. 2009, snow ca. 1 week old

3. of a pair of gloves, used 14 days before during mountaineering

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Adamek et al.: Enteritis above the snow line. 4th Symposium: Altitude & praxis, 2009


Enteritis during mountaineering above the snow line how to practice prophylaxis

Introduction, aim, methods, results, discussion, final conclusions

Test of typical hand-disinfection with alcohol tampons during mountaineering above the snow line (Kleinwalsertal, Jan 2009, environmental temperature ca. – 10 until 0 °C, ca. 2000 m, no storm)

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Adamek et al.: Enteritis above the snow line. 4th Symposium: Altitude & praxis, 2009


Enteritis during mountaineering above the snow line how to practice prophylaxis

Introduction, aim, methods, results, discussion, final conclusions

RESULTS (preliminary)

In 21 of 100 Kunlun specimens coliform bac- teria or escherischia coli were found, the higher, the lesser:

Table: Frequency of coliform bacteria or e. coli

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Adamek et al.: Enteritis above the snow line. 4th Symposium: Altitude & praxis, 2009


Enteritis during mountaineering above the snow line how to practice prophylaxis

Introduction, aim, methods, results, discussion, final conclusions

In the other 3 specimens from the Kleinwalsertal (touristic region):

No faecal bacteria

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Adamek et al.: Enteritis above the snow line. 4th Symposium: Altitude & praxis, 2009


Enteritis during mountaineering above the snow line how to practice prophylaxis

Introduction, aim, methods, results, discussion, final conclusions

– Also in all fingers of one pair of gloves faecal bacteria (enterococcus faecalis)

were found

– The use of typical alcohol tampons under mountaineering conditions was very difficult or not practicable, due to cold and wind, e.g. coordination problems by cold fingers and additional cooling effect of the alcohol. Needed time: ca. 1 – 1½ min

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Adamek et al.: Enteritis above the snow line. 4th Symposium: Altitude & praxis, 2009


Enteritis during mountaineering above the snow line how to practice prophylaxis

Introduction, aim, methods, results, discussion, final conclusions

DISCUSSION

Methodical mistake in taking off the snow probes etc?

– The expedition leader HONKA was precisely instructed about the procedure (also the

coauthor Adamek) ,

– they used professional equipment for analyses

of drinking-water

– the bacteriolical analyses were performed in

a professional lab

So we are shure: no methodical mistakes

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Adamek et al.: Enteritis above the snow line. 4th Symposium: Altitude & praxis, 2009


Enteritis during mountaineering above the snow line how to practice prophylaxis

Introduction, aim, methods, results, discussion, final conclusions

Incidence of other pathogenic microorganism?

We only looked on coliform bacteria, e. scherischia coli and enterococcus faecalis as indicator for faecal contamination

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Adamek et al.: Enteritis above the snow line. 4th Symposium: Altitude & praxis, 2009


Enteritis during mountaineering above the snow line how to practice prophylaxis

Introduction, aim, methods, results, discussion, final conclusions

Check ofmelted snow:

The exemplary results show already, that a relevant part of the melted snow (Kunlun) was contaminated with faecal bacteria

The amount/ml is irrelevant:

Coliform bacteria indicate faecal contamination and so the risk of enteritis

To prevent infection (enteritis) by melted water it should be disinfected further on

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Adamek et al.: Enteritis above the snow line. 4th Symposium: Altitude & praxis, 2009


Enteritis during mountaineering above the snow line how to practice prophylaxis

Introduction, aim, methods, results, discussion, final conclusions

In the touristic region Kleinwalsertal with many people and many WC in restaurants, cottages etc. the contamination of snow with faeces would be a rarity

Even, if we had only 3 specimens, this exemplary finding underlines the importance of defaecation during mountaineering in high altitudes

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Adamek et al.: Enteritis above the snow line. 4th Symposium: Altitude & praxis, 2009


Enteritis during mountaineering above the snow line how to practice prophylaxis

Introduction, aim, methods, results, discussion, final conclusions

In 6800 m water boils at 77 °C.

Sufficient?

Boiling with bubbles at least 1 min is sufficient until 8.900 m Küpper et al., 2008), but needs lot of gas

Alternative for high altitudes:

Disinfection of melted snow :

chemically or physically with micropore filters

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Adamek et al.: Enteritis above the snow line. 4th Symposium: Altitude & praxis, 2009


Enteritis during mountaineering above the snow line how to practice prophylaxis

Introduction, aim, methods, results, discussion, final conclusions

Check of one pair of gloves:

Infection by gloves – until today not discussed:

A possible relevant problem, too, even if only one pair of gloves could be tested

In contrast to coli-bacteria enterococus faecalis (e. f.) can survive in dry environment

e. f. not effects enteritis,

e. f. low pathogenetic potential,

but e. f. indicates also faecal contamination inside of the gloves with other potential pathogenic mikroorganisms

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Adamek et al.: Enteritis above the snow line. 4th Symposium: Altitude & praxis, 2009


Enteritis during mountaineering above the snow line how to practice prophylaxis

Introduction, aim, methods, results, discussion, final conclusions

If the gloves are contaminated,

the hands are contaminated, too.

But which consequence?

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Adamek et al.: Enteritis above the snow line. 4th Symposium: Altitude & praxis, 2009


Enteritis during mountaineering above the snow line how to practice prophylaxis

Introduction, aim, methods, results, discussion, final conclusions

Hand-disinfection with alcohol tampons:

Even under mild climatic conditions for mountainee-ring (ca. 2000 m, environmental temperature ca. – 10 until 0 °C, no storm) classical hand disinfektion was hardly or not practicable

Recommendation:

Perhaps it could be possible after special training inside of a tent, at least after every defaecation

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Adamek et al.: Enteritis above the snow line. 4th Symposium: Altitude & praxis, 2009


Enteritis during mountaineering above the snow line how to practice prophylaxis

Introduction, aim, methods, results, discussion, final conclusions

Prevention of infection by own hands:

Avoid infection of the food with the own hands by handling all food carefully.

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Adamek et al.: Enteritis above the snow line. 4th Symposium: Altitude & praxis, 2009


Enteritis during mountaineering above the snow line how to practice prophylaxis

Introduction, aim, methods, results, discussion, final conclusions

FINAL CONCLUSIONS

Process of infection by faeces during mountaineering in high altitudes above the snow line:

Defaecation only possible in snow, (mountain clean can: not realistic world wide)

Snow is used for melted water

Melted water: risk of infection, if not disinfected

Own hands: Also

Pay attention to risk of infection by faecal microorganisms

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Adamek et al.: Enteritis above the snow line. 4th Symposium: Altitude & praxis, 2009


Enteritis during mountaineering above the snow line how to practice prophylaxis

Introduction, aim, methods, results, discussion, final conclusions

But all these recommendations need time, and so prevention of enteritis by melted snow is a question of risk balance.

The higher the used snow, the lesser the risk

The knowledge about the ways of infection may help for the risk balance

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Adamek et al.: Enteritis above the snow line. 4th Symposium: Altitude & praxis, 2009


Enteritis during mountaineering above the snow line how to practice prophylaxis

Introduction, aim, methods, results, discussion, final conclusions

  • Literature

  • Küpper, T.E.A.H., Schöffl, V. and Milledge, J. S.:Water disinfection in the mountains – state of the art recommendation paper of the Union Internationale des Associations d'Alpinisme Medical Commission

  • http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B7578-4V4KCB5-1&_user=10&_coverDate=01%2F31%2F2009&_rdoc=1&_fmt=high&_orig=browse&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=f81de86e6e24ab91f24efa0605bbfd00

  • 2) Backer, A: Water disinfection for international and wilderness travelers. Clinical infectious diseases, 34, Issue 3, 2002, 355-364.

  • http://www.scopus.com/record/display.url?eid=2-s2.0-0036467140&view=basic&origin=inward&txGid=oehk2myPywygC80wxWmgjME%3a2#corrAuthorFooter

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Adamek et al.: Enteritis above the snow line. 4th Symposium: Altitude & praxis, 2009

29


Enteritis during mountaineering above the snow line how to practice prophylaxis

  • Acknowledgment

  • The authors are very obliged to

  • Mr. B. Honka (Deutscher Alpenverein, Section Mainz) for collecting snow-probes in the Kunlun-region

  • and

  • to Mr. O. Schneider (Deutscher Alpenverein, Section Wiesbaden) for his support in the Kleinwalsertal.

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Adamek et al.: Enteritis above the snow line. 4th Symposium: Altitude & praxis, 2009


Enteritis during mountaineering above the snow line how to practice prophylaxis

The end

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Adamek et al.: Enteritis above the snow line. 4th Symposium: Altitude & praxis, 2009


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