SHAMPOOS, TATTOOS, AND BARBEQUES—What’s new in the world of infectious diseases? “Flies spread disease, keep yours zipped.” ---Anonymous
Quiz • The average person, during a single 24-hour period, deposits in his or her underwear an amount of fecal bacteria equal to: a) the weight of a quarter of a peanut b) the weight of Milk Dud c) the weight of a chocolate chip cookie d) the weight of a Oscar Meyer wiener
QUIZ • If you had to make a choice, which of the following would you lick? a) the kitchen cutting board b) the top of your desk at work c) the top of the toilet seat d) your underwear
QUIZ • Which stall in the ladies room is contaminated with the most bacteria? a) the stall nearest the door b) the middle stall c) the stall at the end of the row
QUIZ • A Florida middle-school science student found that ___ percent of her local fast-food restaurants had more bacteria in their soft-drink ice than in the water from their toilets. Yuck. (March 3, 2006—The Week) a) 10% b) 30% c) 50% d) 70%
The 2 most important fundamental aspects of infectious disease prevention and control… • Hand washing • Vaccination • Should you shake hands with a man who has just exited the men’s room?
Handwashing • Use of alcohol-based gels for hand washing • C. difficile and soap and water (Canada; quinolones) • Screensavers and compliance
Cruisin’ • Noroviruses • Diarrhea-associated illness on cruise ships • In the community • In nursing homes • Use soap and water NOT alcohol-based hand washes
How long? • How long should you wash your hands to remove 99.9% of the pathogens?_____ • How long should you wash your hands to remove 95% of the pathogens?_____ • How long should you wash your hands to remove coliform bacteria?____ • How long do we have to talk about washing our hands?
How long? • How long does the flu virus live on a doorknob? • How long does the cold virus live in a hotel room? • How long does TB live in sputum? • How long does MRSA live on a keyboard? • How long can Legionella pneumoniae live on a showerhead? When is the last time you cleaned your showerhead?
How long? • How long does herpes simplex live on a toilet seat? • “Hey Nurse, can I get …” • How long does E.Coli O157:H7 live on a stainless steel countertop? • How long does the SARS virus live in diarrhea?
The 2nd most important fundamental aspect of preventing infectious diseases: • Vaccinate • Vaccinate • Vaccinate
Vaccines… • Kids receive a plethora of vaccines prior to the age of 2 to prevent a myriad of childhood diseases…
Suffer the infection To develop immunity you either vaccinate or you…
Potatoes Tomatoes Bananas Spinach Rice capsules What’s on the horizon in the world of vaccines? Using foods as vaccines…
Vaccine miracles…meningitis • H. flu meningitis—what are the numbers? 40-100 cases/100,000 of invasive H. flu in 1989; vaccine in 1990— • 0.2 cases/100,000 today • Reduction of 99.8% • Strep pneumoniae meningitis—what are the numbers? 77% decline in kids; 60% decline in adults • Lumbar punctures in kids—before, during, after…too many… • And the story continues…
Let’s look at the numbers • Declines of greater than 99% in cases of diphtheria (100&), measles (99.9%), polio (100%), rubella (99.9%), smallpox (100%), and invasive HiB infection (99.8%). • Reductions of greater than 90% in mumps (95.9%), tetanus (92.9%), pertussis (92.2%). • Notable reductions in HAV (87.0%), HBV (80.1%), varicella (85%), invasive pneumococcal disease (34.1%). • Reductions in mortality have been comparable to or greater than reductions in morbidity for all these illnesses, with the exception of invasive pneumococcal disease (25.4%) (Roush SW et al. Historical comparisons of morbidity and mortality for vaccine-preventable diseases in the United States. JAMA 2007 Nov 14; 298:2155.
Vaccines to prevent diseases… • Gardisil to prevent cervical cancer (HPV 16, 18) and warts caused by HPV-6 and11; new info on HPV-16 and oral cancers • When will boys get the HPV vaccine? • Vaccines to prevent heart attacks • Vaccines to prevent amyloid plaque formation in the brain (in clinical trials) • Vaccines to prevent UTIs, STDs (Chlamydia)
Do vaccines trigger chronic disease? • MS? NO… • Autism? NO… • Crohn’s disease? NO… • Don’t believe everything you read on the Internet… • Ethyl mercury vs. methyl mercury • Madsen KM Et al. A population-based study of measles, mumps, and rubella vaccination and autism.N Engl J Med 2002 Nov 7;347:1477-82. • Lancet 2004;364:9438
What vaccines do you need as an adult • Tdap (tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis)Boostrix (ages 11-18) and Adacel (ages 11 to 64)—every 10 years • Pertussis “whooping cough”—introduced in the 1940s; average of 175,000 cases per year; 1980-1990 an average of 2,900 cases per year • On the rise—9,771 cases in 2002 • The “100-day” cough • Immunity waning, kids not getting vaccinated because of the “fear” of autism, parental denial of continuing risks of infectious diseases
What vaccines do you need as an adult? • Flu every year • Hepatitis B (x3)(if you haven’t had it as a child) • Pneumococcal vaccine after age 50 • Zostavax after age 60 to prevent shingles (14x stronger than Varivax—the kids version)
Parvovirus B19--1975 • “Fifth disease” in kids “slapped cheek” • Migratory arthritis • Fetal wastage during pregnancy • Aplastic crisis in patients with hemolytic anemia
Staphyloccocal TSS--1981 • The tampon wars • Who won? Proctor and Gamble and RELY • Super, dooper, dooper absorbent tampons • 39 deaths; hundreds ill • You could get it in, but ya’ couldn’t get it out!
Lyme disease--1982 • Tick-borne--spirochete—Borrelia burgdorferi • 24-36 hours for the spirochete to make it’s way from the stomach of the tick to the salivary gland of the tick and into the host • Bull’s eye lesion • Arthritis • Neuritis • Doxycycline “Tickacillin”
Helicobacter pylori—1983 • Dr. Barry Marshall and Dr. Robin Warren and the tale of H. pylori • Antibiotics to RX • Antibodies will last for at least 3 years in the blood so that re-infection will be picked up by breath test or stool antigens for H. pylori • Or endoscopy (if you have insurance)
H. pylori • How do we get it? • Is it “normal flora”? • Common housefly may be a vector… • Municipal water systems • Kissing your “shweethaht” in the mornin’ (reflux)--???
Human Immunodeficiency Virus--1983 • What do we know? • 2 receptors are necessary for the HIV virus to enter the T4 lymphocyte • Natural immunity • Worldwide 33 million • 67% in Sub-Saharan Africa with 3/4th of deaths for 2003 • New drugs, no vaccine
GABHS mutations--1985 • Group A Beta Hemolytic strep, new strains • M1, M3, M18 • Resurgence of Rheumatic Heart disease, necrotizing fasciitis, Streptococcal TSS
Hepatitis C virus--1989 • Blood transfusions prior to 1992 (1 in every 3,000 units prior to 1992) • Hemodialysis patients • IV drug use • Sexual transmission with multiple partners • Vietnam veterans • Intranasal cocaine use • Tattoos, piercings
Guys tattoos… • Out there… • Everywhere… • Showin’ them off
The 8th member of the Herpes “family”—HHV-8 STD It is NOT an AIDS defining illness as it can be transmitted without having HIV Kaposi’s sarcoma…1995
Avian Flu (H5N)--1997 • 1997 strain from birds hops to humans—6 people die in Hong Kong • 2003—the strain re-emerges, killing one man in Hong Kong • 2005—SE Asia, west to Europe, Turkey, Africa; infected more than 130 people, killing more than 65 • Bird to person; person to person… • Deep lung tissues—hard to spread via respiratory route • The Center for Disease Control has released a list of the symptoms of bird flu. If you experience any of the following, please seek medical treatment immediately.
Know the symptoms of bird flu… • 1) High fever • 2) Congestion • 3) Nausea • 4) Fatigue • 5) Aching in the joints • 6) And…an irresistible urge to s#!t on someone’s windshield.
West Nile Virus…1998-1999 • Mosquito-borne illness • Hitching a ride form Africa to NYC (Queens) • Has since spread throughout the U.S. • “Where the crow flies and dies…” and the blue jays, and the red, red robins… • 3-15 day incubation period • Polio-type picture, encephalitis • Other modes of transmission? Blood transfusions? (blood screened on pooled samples from 6-16 donors since 2003) (23 cases in 2002 to 0 in 2005; 2 cases in 2006)(MMWR 2007 Feb 2;56:76-9) • Breast milk?
SARS--2003 • What do we know? • Mutation of the corona virus • Most contagious around the 10th day during hospitalization • Explains the high rate of SARS in HCWs • Hong Kong tourism slogan
8 TRENDS IN INFECTIOUS DISEASES • Everything global—warming, travel, economics • Increased food-borne illnesses • Zoonoses • Increased population of immunocompromised patients • Sexual promiscuity • Healthcare-associated infections (HAIs) • Infectious disease and chronic inflammation • Bioterrorism
Global warming and mosquitoes… • Carry over 100 diseases • With global warming they are moving further away from the equator • Malaria (“mal aria”)—bad air • Dengue fever—”breakbone” fever
Global travel • When in Rome, don’t do as the Romans do!! Water in cocktails? Water to plump up vegetables at roadside vendors? Ice in drinks? Ice on the airplane coming home? Splurge for bottled water!
Multidrug resistant TB (MDR-TB)… • TB on airplanes • Countries with the highest rate of MDR-TB and immigration to the US (Russia, Romania, Mexico) • Elderly, prison population, HIV+, homeless (shelters vs. street living) • Extensive Drug Resistant TB (XDR-TB) • “If you have consumption…go up on the mountain…” • Vitamin D and the immune system
Global economics… • 1985—Houston, Texas ordered used tires from SE Asia • What were they thinking? • The tires were delivered right along with the Asian tiger mosquito (Aedes Aegypti) • Caused an outbreak of Dengue (breakbone) fever in SE Texas and LA in 1985 • Other issues in global economics brings us to another emerging trend in infectious diseases—
Food-borne illnesses… • 1990 only 13 food-borne illnesses to worry about • Today there are 8 x that many • Why? • Distribution around the world • Centralization of food processing plants
Food-borne illness… • Guillain-Barré syndrome and under-cooked chicken—Campylobacter jejuni • How long after the exposure will I see symptoms? • What temperature should I cook my chicken to? • White meat? • Dark meat? • BUY an instant read thermometer TODAY…
Food-borne illness… • Undercooked chicken, eggs and … • Cantaloupe from Honduras • Peanut butter • Salmonella • Pasteurized eggs for “seizure” salad (Caesar salad) • No more sunny-side up, especially for high-risk patients
The Hamburger BugE. Coli O157:H7 • Mid-70’s, mutation in Venezuela • Shigella + E. Coli exchanged genes in a cow’s bowel • Moved up through Central America into Southern Texas in the early ’80’s (1982 first identified) • 3rd most deadly toxin in the world • 10-100 pathogens to make you ill or kill you—enterohemorrhagic diarrhea • #1 cause of acute renal failure in kids • 1993-Seattle-Tacoma deadly outbreak at Jack-in-the-Box restaurants • Mickey D’s—30 outbreaks per year • Supportive Treatment
The Hamburger BugE. Coli O157:H7 • COOK your burgers to 160º F • Hamburgers are pretty safe these days—well, as safe as the 16 y.o. pimply kid talking on his cell phone, flippin’ the burgers • Biggest concern is produce—lettuce, spinach
The green leafys… • Between 1986 and 1995, Americans ate 17 percent more leafy greens than in the previous decade, yet food poisoning from those leafy greens rose more than 60 percent. In the subsequent decade (1996-2006) food poisonings rose 39 percent compared to a 9 percent rise in consumption (CDC, Atlanta, March 2008 Conference on Emerging Infectious Diseases)
How about a hot dog? • Listeria monocytogenes • Hot dogs, bologna, deli meats • Also soft cheeses, brie, feta, camembert • The very young, the very old and the…
Oh no you won’t…1 in 10 salmon “sushi’s) have parasites… No, thanks, I’ll have the salmon sushi…
Can your pet make you sick? Pets and zoonoses