Transcript SHAMPOOS, TATTOOS, AND BARBEQUES—What`s new in the

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’
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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…
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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
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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?
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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
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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
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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
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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
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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…
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Snakes
Turtles
Iguanas
Salmonella
Increased population of
immunocompromised patients…
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Diabetics
HIV+
Cancer patients
Transplant patients
The elderly
Sexual promiscuity…
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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
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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…
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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]