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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 24hour 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 fastfood 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… To develop immunity you either vaccinate or you… • Suffer the infection What’s on the horizon in the world of vaccines? Using foods as vaccines… • • • • • Potatoes Tomatoes Bananas Spinach Rice capsules Or using shampoos as vaccines… Flu season is coming… why do all of the flu viruses come from China? 3 factors… • Migratory birds • Pigs as the mixing vat • Reassortment of genes Antigenic drift vs. antigenic shift • How does the flu virus change it’s appearance each year? 2001 2002 Antigenic shift Antigenic drift Flu virus antigens • • • • • Hemagglutinin Neuraminidase H1N1 H5N1 (Avian flu virus) Virulence is related to these antigens H5N1—What do we know? • 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 • PANIC……… Know the symptoms of bird flu… • 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. • 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. Vaccine miracles…meningitis • H. flu meningitis—what are the numbers? 40-100 cases/100,000 of invasive H. flu in 1989; vaccine in 1990— • 1.4 cases/100,000 today • Strep pneumoniae meningitis—what are the numbers? 77% decline in kids; 60% decline in adults • And the story continues… • Lumbar punctures in kids— before, during, after…too many… 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 • Reasons unclear • **A nasal pertussis vaccine for infants may be coming soon to an infant nostril near you. 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 anemias 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 Kaposi’s sarcoma…1995 • HHV-8 • The 8th member of the Herpes “family” • STD 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 • Blood transfusions, 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… • TB on airplanes • Countries with the highest rate of TB and immigration to the US (Russia, Romania, Mexico) • Elderly, prison population, HIV+, homeless (shelters vs. street living) • Extensive Drug Resistant 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 Food-borne illnesses… • 1990 only 13 food-borne illnesses to worry about • Today there are 8 x that many • Why? • Centralization of processing plants • Distribution around the world Food-borne illness… • Guillain-Barre syndrome and under-cooked chicken • 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 … • Salmonella • Pasteurized eggs for “seizure” salad (Caesar salad) • No more sunny-side up, especially for high-risk patients E. Coli O157:H7 • Mid-70’s, mutation in Venezuela • Shigella + E. Coli Moved up through Central America into Southern Texas in the early ’80’s (1982 first identified) E. 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 • Unpasteurized apple juice • Apples from roadside stands—”drops” • Wash/rinse apples E. Coli O157:H7 • 3rd most deadly toxin in the world • 10-100 pathogens to make you ill or kill you • 1993-Seattle-Tacoma deadly outbreak at Jackin-the-Box restaurants • Very young, very old, very immunocompromised • Acute Renal Failure in Kids • Mickey D’s—30 outbreaks per year • Supportive Treatment 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… No, thanks, I’ll have the salmon sushi… • Oh no you won’t…1 in 10 salmon “sushi’s) have parasites… Pets and zoonoses • Can your pet make you sick? • Cuddly puppies and Campylobacter jejuni Zoonoses… • Kitty litter and toxoplasmosis What about feline leukemia, feline AIDS, and feline distemper? NO… • • • • Snakes Turtles Iguanas Salmonella Increased population of immunocompromised patients… • • • • • Diabetics HIV+ Cancer patients Transplant patients The elderly Sexual promiscuity… • • • • • • • HIV HPV HSV HBV HCV* (less than 5%) H_V Chlamydia and GC Sexual promiscuity… • Immature vagina including an alkaline pH in teenagers • Know your partner • Do condoms protect from STDs? YES • But not the “natural feel” condoms Does circumcision protect? • To circumcise or not to circumcise—that is the question… • YES (Auvert B. PLoS Medicine, November 2005; Science News 10/29/05, Vol. 168) Vaginal conditions also increase the risk of STDs— bacterial vaginosis, dry vagina, and any open lesions such as herpes, gonorrhea also increase the risk of another STD The pH of body fluids is protective • Stomach—pH 2 • Vaginal—pH 4.5 • Urine—pH 4 • Semen—pH 7 When our ovaries die… • Increased risk of vaginal infections and urinary tract infections • Fastest rising group with STDs is the elderly! • 300% increase in the past 10 years…WHY? the Pfizer Riser (Viagra)… and friends • • • • November 1, 1998 Before 11/1/98? After 11/1/98? Levitra, Cialis One last note on STDs… • A high risk group • Long-haul truckers play a significant role in the transmission of disease in Africa and maybe here in the U.S. • Some stats: 1/3 have frequent sex with prostitutes on the road and greater than 80% don’t use condoms • Why? “Because condoms don’t protect you and AIDS is only a disease found in gay men.” Whoa. Healthcare-associated infections • MRSA • MRSA in the community • The case of the hospital hairdresser • Clostridium difficile • Clostridium difficile in the community • MDR-TB, XDR-TB Infectious disease and chronic inflammation… • • • • • • C. pneumoniae and atherosclerosis CMV? H. pylori? Periodontal disease Hs-CRP and vasculitis (chronic inflammation) Drugs to reduce inflammation reduce MIs Flu vaccine for secondary prevention CV risk factor: Measure waist size The more fat around the middle, the higher the risk of CV disease and chronic inflammation Is obesity caused by a virus? • Ladies--35 inches or less • Gentlemen--40 inches or less BIOTERRORISM… • Have a high index of suspicion if there is “clustering” of a common disease • Or, if there are a few cases of an uncommon disease • Bugs most likely to be used: Anthrax, Yersinia pestis (bubonic plague), smallpox, botulism…HAVE A PLAN!!! Survey of counties in U.S.-2002 • One county in Iowa had a 3-pronged plan of attack: 1) Call for help 2) Hope someone comes 3) Stack the bodies in the high school gym THANK YOU … “Support bacteria—they’re the only culture some people have.” Anonymous Barb Bancroft, RN, MSN, PNP www.barbbancroft.com [email protected]