Soap vs Sanitizers

You squirt it on your hands as you enter the grocery store, and then again on your way out. You have bottles in your car, on your desk and in your home too – and you use them often.

And no, you’re not a germophobe, it’s just that your hand-sanitizer habit is helping to protect you from colds and flu and other nasty’s, that are wet, sticky and not yours!

And even if it doesn’t, it’s harmless. Right?

Not so fast! Word on the street has it that despite how clean your hands feel after using a hand sanitizer, they’re actually still dirty.  Worse still, they’re potentially toxic and might actually lower your resistance to disease.

So are these rumors true?!  Let’s take a look at the evidence.

When it comes to safety and effectiveness, the main concern with hand sanitizers is triclosan, – the main antibacterial ingredient used in non-alcoholic hand sanitizers.

“There’s no good evidence that triclosan-containing products have a benefit,” says Allison Aiello PhD, associate professor of epidemiology at the University of Michigan. In fact, hospitals in Europe and the United States, won’t even use them because it’s thought that they don’t reduce infections or illness.

Dr. Anna Bowen, an epidemiologist at The Centers for Disease Control and Prevention, says, “Triclosan-containing products don’t provide any disease protection beyond what you get from washing with soap and water.”

Research has shown that triclosan can disrupt the endocrine system, amplifying testosterone. In animal studies, it reduced muscle strength. It may also harm the immune system. Whether these findings add up to human toxicity isn’t established yet, but the FDA is currently reviewing the issue.

A more established concern: “When you expose bacteria to triclosan, it can elicit antibiotic resistance,” says Aiello. “Once the resistance is transferred, pathogenic bacteria can become resistant to many types of antibiotics.”   She also points out that quaternary ammonium, another antibacterial found in nonalcoholic hand sanitizers, has been shown to elicit antibiotic resistance.

The main concern with triclosan, that it’s an anti-bacterial, meaning it doesn’t protect against viruses or fungi.  Which means, colds and flu are not destroyed because they are caused by viruses, not bacteria.

Alcohol-based sanitizers, on the other hand, are fairly effective and safe. Those that contain  60% alcohol are good at killing bacterial pathogens and can also kill some viruses though not all of them.  Norovirus, for example, the bug responsible for the recent cruise-ship outbreaks is not affected.

“If you can’t get to a sink quickly, an alcohol-based sanitizer is a good alternative to washing with soap and water,” says Aiello.

One caveat: They don’t work on visibly dirty hands.  The alcohol can’t get past the dirt.

So how does soap and water match up?   First, they are both safe and effective. That’s right. Good old-fashioned hand washing before you prepare food or after you go to the toilet has been shown to drastically reduce the risk of diarrhea.

“Hand-washing campaigns reduce absenteeism in schools,” says Bowen, “and that means parents miss fewer days of work, too.”

But, and it’s a big but – you have to wash your hands correctly.

According to the CDC you need to wash for about 24 seconds to remove bacteria and viruses from your hands. You need to cover all parts of your hands, front and back and under your nails and then dry your hands well.

How long is 24 seconds? Apparently it’s about as long as it takes to sing two verses of Happy Birthday.  However, as I always tell my infection control students, if you’re in public, sing it with your inner voice …or you could have more than germs to worry about!

Bottom line –  soap and water beats sanitizers hands-down.  Suds up and stay safe this cold and flu season.

Honoring the Health Sacrifices of Our Veterans

“On Veterans Day, America pauses to honor every service member who has ever worn one of our Nation’s uniforms. Each time our country has come under attack, they have risen in her defense. Each time our freedoms have come under assault, they have responded with resolve. Through the generations, their courage and sacrifice have allowed our Republic to flourish. And today, a Nation acknowledges its profound debt of gratitude to the patriots who have kept it whole.

As we pay tribute to our veterans, we are mindful that no ceremony or parade can fully repay that debt. We remember that our obligations endure long after the battle ends, and we make it our mission to give them the respect and care they have earned. “

These two paragraphs are taken directly from the 2013 Veterans Day Presidential Proclamation.

But getting Veterans the care they deserve is not always easy.  The wounds of war can go far beyond what meets the eye. From mental health issues to pain and illness that persist long after they’ve left the battlefield, veterans face a multitude of health troubles either unique to their service or more frequent among them than the general population.

“Folks returning from combat have a constellation of health concerns, including physical issues, psychological issues and psychosocial issues concerning things like work and family,” said Dr. Stephen Hunt, national director of the U.S. Department of Veterans Affairs Post Deployment Integrative Care Initiative.

Some of the most common physical complaints of returning soldiers cannot be classified into a single disorder. They include nonspecific symptoms such as fatigue, pain and cognitive disturbances such as memory and concentration problems.

Here are seven of the most commonly seen health conditions confronting veterans:

Musculoskeletal injuries and pain

Just over half of all veterans’ post-deployment health visits address lingering pain in their backs, necks, knees or shoulders.  According to a study in the Journal of Pain, about 100,000 veterans of the Gulf War nearly 20 years ago have reported chronic muscle pain.

Mental health issues

While post-traumatic stress disorder (PTSD) among soldiers has been well publicized, other mental woes can also result from the trauma of war. A study in the journal Archives of General Psychiatry [now JAMA Psychiatry] found that one in 10 Iraq war vets develop serious mental problems, including violent behavior, depression and alcohol abuse. The study found that PTSD or depression seriously impaired daily functioning in 8.5 – 14% of these vets.  Disabling on its own, PTSD is also linked to the development of physical illnesses for veterans as years pass. Researchers from Walter Reed Army Medical Center reported that 54% of veterans with PTSD also had sleep apnea, compared with 20%of PTSD patients in the general population. PTSD in vets is also associated with a greater risk of developing dementia.

Chemical exposure

Research by the American Heart Association found that exposure to nerve agents such as sarin – which can trigger convulsions and death on the battlefield – may cause long-term heart damage in Gulf War veterans. The damage can include an enlarged left ventricle, heart rhythm abnormalities or a reduction in the pumping strength of the heart.

Infectious diseases

Although all military personnel are given routine vaccinations before deployment, veterans suffer disproportionately from certain infections that civilians almost never experience.  They include bacterial infections such as brucellosis, which may persist for years; campylobacter jejuni, which causes abdominal pain, fever and diarrhea; and Coxiella burnetii, which in chronic cases can inflame the heart.

Leishmaniasis, a parasitic disease caused by the bite of a sand fly native to the Middle East, is a particularly brutal condition veterans experience. Those infected suffer weight loss, fevers, headaches, muscle pain and weakness, anemia, and enlargement of the spleen and liver. It can be fatal if untreated, according to the VA..

Traumatic Brain Injury (TBI)

TBI, often brought on by a blow or jolt to the head, disrupts brain function and has been called the signature wound of the fighting in Iraq and Afghanistan, according to the National Academy of Sciences. Blast exposures and other combat-related activities put service members at greater risk for sustaining a TBI compared to their civilian counterparts, according to the Defense and Veterans Brain Injury Center.

Common effects of TBIs include cognitive issues such as shorter attention span, language disabilities, and an inability to process information. Vets can also suffer from lack of motivation, irritability, anxiety and depression, headaches, memory loss and PTSD.

However, you choose to mark Veteran’s Day 2013, please remember the sacrifices made by all of our vets and be mindful of the long-term health problems they face. Ladies and Gentleman of the military, we thank you for your service.

A Fishy Tale of Lumps and Bumps

When you think about potentially dangerous pets,  which animals spring to mind? Alligators? Boa Constrictors? Any of the “big cats”? Pit Bulls? Goldfish?

Goldfish? Really?!?  Well, according to a new study from Henry Ford hospital, fish may not be quite as benign as they seem. To be fair, it’s not the fish themselves, but the water they swim in that may be harmful to health.

Researchers have shown that contaminated water in home aquariums can lead to a skin infection known as Mycobacterium marinum. The condition is characterized by reddish skin lesions or bumps on the hands or arms.

It’s difficult to diagnose and treat because skin lesions don’t appear for two to four weeks after contact with the bacteria, leading to delayed treatment and unnecessary and ineffective use of antifungal and antibacterial agents.

Complicating matters further is that patients fail to remember or mention the source of the exposure, which is often traced to them cleaning their aquarium. Infection results when bacteria in the non-chlorinated water attacks an open skin wound on the arm or hand.

“People just don’t know or think about their fish tank harboring this bacterial organism,” says George Alangaden, M.D., a Henry Ford Infectious Diseases physician and the study’s lead author.

“And unless they’re directly questioned about it by their physician, who may or may not have adequate knowledge of Mycobacterium marinum and its prolonged incubation period, appropriate treatment often gets delayed.”

During the study, conducted between January 2003 and March 2013, researchers identified five patients ages 43 to 72 treated at Henry Ford for Mycobacterium marinum. Skin biopsies performed on all five patients confirmed the infection.

The incubation period before skin lesions appeared ranged from 11 to 56 days. While all five patients responded effectively to antibiotic treatment, it took on average a staggering 161 days from the time of initial presentation to time of treatment.

“Mycobacterium marinum is not a life-threatening illness, but it remains an unrecognized cause of skin infection,” says Dr. Alangaden. “To accelerate diagnosis and treatment, physicians are encouraged to ask detailed questions about the patient’s history, especially questions about potential exposure to aquariums.”

 Or better still, may we suggest you wear gloves when cleaning out the tank!

School is in Session and So Too Are Germs

While many parents don’t remember much algebra or calculus, most know all too well that school + kids = sick days.

And with more than 200 cold viruses identified,  it’s no wonder parents feel like they are fighting a losing battle when it comes to keeping their kids healthy.

“Kids will be exposed to germs and inevitably get colds, even with the best preventive measures, and that’s OK,” said Jessica McIntyre, MD, family physician at Loyola University Health System and assistant professor in the Department of Family Medicine at Loyola University Chicago Stritch School of Medicine.

According to McIntyre, young children will get between 7 and 8 colds a year and school-age children will average 5-6 colds a year. Kids tend to get more colds during the school year because they are in an enclosed classroom surrounded by other children who are sharing these very common viruses.

“Parents sometimes worry that they have done something wrong to cause frequent colds, or that their child is not healthy. Actually, cold viruses help build a child’s immune system and are an unavoidable part of growing up,” McIntyre said.

Nevertheless, we bring you some tips to help keep your child’s sick days to a minimum

1. You’ve taught your kids their ABCs –  now teach them their CCCs?
   a. Clean – wash your hands and make sure your kids wash their hands frequently
   b. Cover – cover your cough and sneeze, preferably with a tissue, but if one is not available, cough or sneeze into your elbow
   c. Contain – stay at home if you are sick; germs are one thing that aren’t good to share
2. Family flu vaccines. Everyone who is 6 months or older should be vaccinated. Talk to your physician about which type of vaccine is right for your family members.
3. Have your children wash their hands as soon as they get home from school.
4. Change into “home clothes and shoes.”  It helps keep germs, allergens and dirt out of the house making it easier to keep clean. Plus, you won’t be searching the house for shoes that were kicked off under the couch.This is especially beneficial if you have a young infant at home
5. Wash their lunch box daily. Lunch boxes carry more than veggies and fruit to and from school. They also carry A LOT of germs. If they’re dishwasher safe, run them through the sanitizing cycle at the end of each day. If not, spray them down with vinegar and water and wipe them clean before packing a new lunch
6. Backpacks are another huge germ culprit. They make their way onto tables, beds and desks and can transfer nasty germs to all of these surfaces. Wash backpacks once a week to minimize the spread of germs.
7. Reduce consumption of sugary foods before and during school. Consuming just a teaspoon of sugar weakens the immune system for up to 4 hours. To help the body fight germs, make sure to offer a low sugar breakfast and low sugar lunch. Avoid processed foods as much as possible. They are generally loaded with sugars.

And if you’d still like to do more to keep your little darlings safe, there is some evidence that certain  products can be effective in cold prevention if taken regularly:
(i) Probiotics: 1 gram mixed with milk twice daily
(ii) Vitamin C: 1 gram daily
(iii) Zinc sulfate: 15 mg syrup or 10 mg tablet daily

Despite all that, if they do develop a cold, don’t stress about it!  Everyone gets sick sometimes. And while we all hate to see  kids feeling bad, just remember, when they get sick their bodies are building up their ability to fight future infections.

Bullseye! Lyme Disease Without the Rash

With the weather finally starting to warm up, if you’re anything like me, you probably can’t wait to get outdoors and get active. However, and with apologies for being a Debbie Downer, we want to remind you that warmer weather also means that ticks become more active and are more likely to bite you, your kids and your pets. Just being outside in the garden could put you at risk of tick-borne diseases such as Lyme.

Should you contract Lyme disease, quick diagnosis and treatment are essential to avoiding long term complications. However, the diagnostic process may be delayed if the skin rash caused by Lyme disease does not have the typical bull’s-eye appearance.

A Research Letter just published in the CDC journal Emerging Infectious Diseases, shows that Lyme disease has been identified in patients with skin lesions that more closely resemble the classic signs of conditions such as contact dermatitis, lupus, insect or spider bites.

Based on these findings they urge doctors to consider Lyme disease when presented with patients complaining of such lesions, particularly when they have been in an area where Lyme disease is endemic.

The research team led by Steven E, Schutzer, MD, Professor of Medicine at the University of Medicine and Dentistry of New Jersey-New Jersey Medical School, studied 14 patients.

An advanced diagnostic technique, based upon polymerase chain reaction (PCR) testing was used to identify Borrelia burgdorferi, the bacterium that causes Lyme disease. Unlike existing methods, the new technique is able to detect evidence of B. burgdorferi early, even in cases where the bacterium is still at low levels in the bloodstream, and sooner than traditional antibody tests, which may require several weeks before becoming positive. It also is able to distinguish between new infections and prior exposure to B. burgdorferi.

Of the patients analyzed, ten were found to have strong microbiologic evidence of Lyme disease, despite the fact that they had presented with skin lesions that differed markedly from the classic bull’s-eye pattern. In fact, not all patients with Lyme disease will even have a rash.

Based on this finding, Schutzer says, “Doctors who see a rash in a patient who has been in an area where Lyme disease frequently occurs should be alert to the fact that the Lyme disease rash does not have to look like a bull’s-eye, ring-within-a ring. The rash may look different. Doctors should search carefully both for other signs that might suggest Lyme disease, such as flu-like symptoms, and equally for signs that may point towards other conditions. Early diagnosis of most diseases gives the best chance for a cure. This is especially true for Lyme disease.”

So, this summer, make sure your doctor isn’t in a rush to take any rash decisions about ruling out a diagnosis of Lyme Disease.

Stopping Herpes From Going Viral

On Wednesday SRxA’s Word on Health reported on a link between memory loss and cognitive decline and the herpes virus.  Today, we bring a glimmer of hope to the 65% – 90% of people worldwide affected with either type 1 or Type 2 herpes simplex virus.

In the US alone, it’s estimated that nearly 60 percent of U.S. men and women between the ages of 14 and 49 carry the HSV-1 virus, while >16.2% are infected with herpes simplex virus type 2 (HSV-2).

HSV-2 is a lifelong and incurable infection that can cause recurrent and painful genital sores and can make those infected with the virus two-to-three times more likely to acquire HIV.

Now, according to a study just published in the Journal of the Federation of American Societies for Experimental Biology (FASEB), researchers from Albert Einstein College of Medicine of Yeshiva University have discovered a novel strategy for preventing, treating or suppressing herpes virus infections.

“We’ve essentially identified the molecular “key” that herpes viruses use to penetrate cell membranes and infect cells of the human body,” said Betsy Herold, MD of The Children’s Hospital at Montefiore.

Dr. Herold and her colleagues had previously shown that infection by the herpes viruses depends on calcium released within the cells. In this study, they found that calcium release occurs because the viruses activate a critical cell-signaling molecule called Akt [also known as Protein Kinase B (PKB) ] at the cell membrane.

As part of their investigation of Akt’s role in herpes infections, the researchers took laboratory cultures of human cell and mixed them for 15 minutes with four different drugs known to inhibit Akt. The cells were then exposed for one hour to herpes simplex virus 2.

The drugs tested were:

• MK-2206 – an experimental drug being studied as adjunct therapy for cancer
• Akt Inhibitor VIII
• Miltefosine, a drug licensed for treatment of leishmaniasis and other protozoal infections
• Perifosine, an experimental agent in phase 3 clinical trials for treatment of several cancers

All four of the drugs significantly inhibited HSV infection in each of the cell types.  Miltefosine was the most potent and reduced viral plaques by 90% in all cell types.

By contrast, cells not pre-treated with the Akt inhibitors were readily infected on exposure to the virus.

“For people infected with herpes, the drug acyclovir helps prevent herpes outbreaks from recurring and lowers the risk of transmitting the infection to others,” said Dr. Herold. “But some people have herpes infections that don’t respond to acyclovir, and unfortunately there is no effective vaccine. So new approaches for suppressing and treating herpes infections are badly needed, and our findings indicate that inhibiting Akt should be a useful therapeutic strategy to pursue.”

Forgetting Your Cold Sore?

Cold sores. Annoying, embarrassing, uncomfortable. Enough to drive you crazy?

Not quite. However, according to a new study the virus that causes cold sores may be associated with cognitive problems such as difficulties with memory and thinking.

During the study researchers from New York and Miami tested thinking and memory in 1,625 people. Participants gave blood samples that were tested for five common low grade infections: herpes simplex type 1 (oral) and type 2 (genital), cytomegalovirus, chlamydia pneumoniae (a common respiratory infection) and Helicobacter pylori (a bacteria found in the stomach).  The memory and thinking skills were tested every year for an average of eight years.

The results showed that the people who had higher levels of infection had a 25% increase in the risk of a low score on the Mini-Mental State Examination – a 30-point questionnaire that is commonly used to screen for cognitive impairment and dementia.

In other words, those who had higher levels of anti-viral antibodies in their blood, meaning they had been exposed over the years to various pathogens, were more likely to have cognitive problems than people with lower levels of infection in the blood.

“We found the link was greater among women, those with lower levels of education and Medicaid or no health insurance, and most prominently, in people who do not exercise,” said author Mira Katan, MD. “While this association needs to be further studied, the results could lead to ways to identify people at risk of cognitive impairment and eventually lower that risk.”

The authors suggest that exercise and childhood vaccinations against viruses could decrease the risk for memory problems later in life.

Just one more reason for us all to get vaccinated and stay fit!

Potential treatment for Ebola and other deadly viruses revealed

Illnesses caused by many of the world’s most deadly viruses cannot be effectively treated with existing drugs or vaccines. But this may all be about to change. Scientists have discovered several compounds that can inhibit the highly lethal Ebola virus, as well as the pathogens responsible for rabies, mumps, measles and other pathogenic viruses.

This finding, published in the journal Chemistry & Biology potentially opens up new therapeutic avenues for combating these diseases.

Such treatments are desperately needed. Ebola virus, for example, can be transmitted through direct contact with blood or other body fluids of infected persons or animals, and even close contact with a deceased Ebola-infected body. And mortality rates from ebola can be as high as 90%.

“The medical field currently does not have ideal antiviral therapies, often no therapeutics at all, and the development of broad-spectrum antivirals is a great way to provide treatment in the future,” says study author Claire Marie Filone PhD of Boston University School of Medicine. “Toward that end, we have identified a drug that targets multiple viruses – and may be developed into an antiviral treatment for known and emerging viruses.”

In contrast to the many antibiotics that work against a wide range of bacteria, there are currently no highly effective or safe broad-spectrum drug treatments for viral diseases.

To address this need, researchers screened thousands of diverse compounds for small molecules that showed strong antiviral activity against viruses.  They identified several that inhibited infection in cells exposed to either Ebola or vesicular stomatitis virus (VSV). These molecules, which are related to a class of plant-derived compounds called indoline alkaloids, share a common chemical structure that can be modified to enhance antiviral activity.

The most potent of these compounds demonstrated a consistent mechanism of action against genetically distinct viruses. It works by blocking viral transcription. Because it targets such a critical step in virus replication, in theory, scientists should be able to develop it into a therapeutic that could be used against many different types of viral infections.

As always, SRxA’s Word on Health will bring you further news as it develops.

Ho Ho Ho: health hazards for Santa

After weeks of harried holiday shopping, when the stores finally close on the evening of December 24, it will be a welcome reprieve from the madness. Families and friends gather together and enjoy a relaxing day or two of rest.

But for one man, the real work is just beginning. That’s right – Santa Claus is coming to town!

And while he spends most of the year enjoying a flexible work schedule, monitoring naughty-and-nice behaviors around the world and occasionally checking in on his elves and reindeer, things are about to get frantic for Old Nick.

And to be honest, this year we’re a little concerned about his health.  That belly fat!  The all-nighter he’s about to pull!  All those cookies!

He may know when you are sleeping, but the only way for Santa to get the job done is to stay up all night on December – and that can lead to some serious health concerns.
Studies have suggested that drowsy driving is as dangerous as drunk driving.  Even if he manages to get Rudolf and his friends safely parked on the rooftops, sleep deprivation could cause his judgment to become fuzzier, leading to the wrong presents traveling down the wrong chimneys.
What’s worse is that sleep loss has a cumulative effect. So while people in the Southern hemisphere might do OK, those of us in Northern climes, and especially those on the West Coast aren’t so lucky. Chronic sleep deprivation could mean he could fly over some houses altogether.

But even if we manage to keep him awake with coffee and Red Bull rather than the usual glass of milk, we’ve got to change Santa’s sack. By carrying something that weighs more than 10% of his body weight, one shoulder is going to end up taking on most of the burden, which could lead to back strains, sprains and spasms.
If you’re thinking of getting Santa a gift this season maybe you could consider a backpack, or better still, a rolling suitcase.

That’s not to say Santa doesn’t need the exercise of his Christmas Eve jaunt. Like 70% of adult men in the US, he is severely overweight. The health risks linked to obesity include Type 2 diabetes, coronary heart disease, stroke, hypertension, certain types of cancer and osteoarthritis.

With his giant waist comes the risk of belly fat associated problems such as insulin resistance, high triglycerides, heart disease and metabolic syndrome.

Then there’s that beard to worry about. After a month or so of letting thousands upon thousands of kids sit on your lap at the mall, we wouldn’t be surprised if he’s harboring some germs in his whiskers.  So if Santa touches his beard followed by his eyes, ears or mouth, he’s pretty much bound to catch something, especially in the midst of this cold and flu season.

We suggest leaving some hand sanitizer next to the milk and cookies this year to give him a fighting chance.

And finally we’re worried about that thin Red Suit. While we’ll give Santa props for covering his head with a hat, traveling outside all night in December in a red velvet suit and a touch of faux fur seems ill advised. In addition to the hat, he should probably throw on a scarf or knit mask, mittens, thermals and a water-resistant coat to ward off hypothermia.

So whether you’ve been naughty or nice, there’s still time to give some thought to Santa’s Health, as well as your own this Christmas season.

Swimming with Seals riskier than Surfing with Sharks?

Seals  –  those cute, semi-aquatic marine mammals hunted for generations by humans may be about to wreak their revenge.  While we don’t want to get into the pros and cons of the cull, we would like to warn our readers of a new strain of flu found in New England harbor seals.

According to experts, seal flu could potentially threaten people as well as wildlife. In a report just published online in mBio, scientists from several organizations, including Columbia University and the National Oceanic and Atmospheric Administration suggest that seal flu could lead to another pandemic just as we saw with bird and swine flu.

“There is a concern that we have a new mammalian-transmissible virus to which humans haven’t been exposed yet. It’s a combination we haven’t seen in disease before,” said Anne Moscona MD, professor of pediatrics and of microbiology and immunology at Weill Cornell Medical College.

“A dangerous virus infecting mammals increases the risk to us – not by direct infection – but by evolutionary development of even more riskier strains,” explained Bruce Hirsch, an infectious disease specialist at North Shore University Hospital in Manhasset, N.Y.

Although transmission via direct contact between humans and harbor seals is unlikely, the virus could find other ways to get to people.  For example, the strain might pass from seals to birds, expand its presence in the environment.  And because seal flu is able to target a protein found in the human respiratory tract, it may have the potential to mutate in ways that make it easily passed to or between humans.

The researchers analyzed the DNA of a virus linked to the death of 162 harbor seals in 2011 off the coasts of Massachusetts, New Hampshire and Maine. Five autopsies revealed that the seals died from infection with a type of flu known as H3N8.

Because pandemic flu can originate in unexpected ways, preparation is essential. The Centers for Disease Control and prevention (CDC) offers some excellent tips on its website.

And we suggest for this year at least you might be better off diving with dolphins than swimming with seals!