Asthma is major contributor to absenteeism among low-income students

young boy using asthma inhaler child asthmatic model releasedAsthma impacts kids and adults everywhere, but it has particularly profound impact in low-income areas. It is one of the leading causes for health-related school absences, according to this story published at the Centers for Disease Control (CDC) website, which examines whether school absenteeism is related to school-level concentration of low-income students, independent of family income.

Results indicate that students who attend schools with the highest concentrations of low-income students were more likely to miss school because of asthma. The study concludes that “the use of school level interventions to decrease school absenteeism due to asthma should be explored, especially in schools with high concentrations of low-income students. Potential interventions could include school-based asthma education and disease management or indoor and outdoor air pollution control. Sub-micron filtration in schools is a tool that possibly could help.

Another study cited in a story at the British Broadcasting Corporation (BBC/Health) website suggests that “right bugs at the right time could be the best way of preventing allergies and asthma. In the body, bacteria, fungi and viruses outnumber human cells 10 to one, and this “microbiome” is thought to have a huge impact on health. A team, at the University of British Columbia and the Children’s Hospital in Vancouver, compared the microbiome at three months and at one year with asthma risk at the age of three. Children lacking four types of bacteria – FaecalibacteriumLachnospiraVeillonella, and Rothia (Flvr) – at three months were at high risk of developing asthma at the age of three, based on wheeze and skin allergy tests. The same effect was not noticed in the microbiome of one-year-olds, suggesting that the first few months of life are crucial. Further experiments showed that giving the bacterial cocktail to previously germ-free mice reduced inflammation in the airways of their pups.

Exposure to Environmental Microorganisms and Childhood Asthma, a piece at the New England Journal of Medicine website, cites results that show: Children who lived on farms had lower prevalences of asthma and atopy and were exposed to a greater variety of environmental microorganisms than the children in the reference group. In turn, diversity of microbial exposure was inversely related to the risk of asthma (odds ratio for PARSIFAL, 0.62; 95% confidence interval [CI], 0.44 to 0.89; odds ratio for GABRIELA, 0.86; 95% CI, 0.75 to 0.99). In addition, the presence of certain more circumscribed exposures was also inversely related to the risk of asthma; this included exposure to species in the fungal taxon eurotium (adjusted odds ratio, 0.37; 95% CI, 0.18 to 0.76) and to a variety of bacterial species, including Listeria monocytogenes, bacillus species, corynebacterium species, and others (adjusted odds ratio, 0.57; 95% CI, 0.38 to 0.86).

Ease with which people can travel great distances brings with it disease challenges

one pikEver-improving technology has made global travel available to larger and larger numbers of people. We can travel affordably for the most part across multiple time zones in a matter of hours to close business deals or simply visit family and friends. It has allowed us to improve our quality of life, our economies in ways not available mere decades ago. But it isn’t all good news.

With the convenience of moving people long distances in short times come some issues we’ve not had to deal with in the past. Among those are the problems created when disease and illness have the same unprecedented access to traveling great distances as we do.

Preparing for the Next Flu Pandemic explores what we’ve learned and continue to learn from the 1918 pandemic that killed 50 million people worldwide and, significantly, what it taught and is teaching us still about how to prepare. The piece published at PBS (NOVA NEXT) brings several excellent points to the fore, perhaps most importantly the need for international cooperation. The League of Nations created an international health organization in 1920 on the heels of the pandemic. But while that entity faded away into history, countries took the important step of being more accustomed to sharing information, and that is a vital when it comes to countering fast-moving epidemics. Less than forthright accounting of Severe Acute Respiratory Syndrome (SARS) by China and Middle East Respiratory Syndrome Coronavirus (MERS) by Saudi Arabia continue to be a health front battles that must be won.

Global Transport Networks and Infectious Disease Spread examines some of the historical examples of disease and vector movements, such as global influenza pandemics, and it outlines potential approaches for future studies of disease movement.

The Role of Human Transportation Networks in Mediating the Genetic Structure of Seasonal Influenza in the United States is a study that uses spatially-referenced hemagglutinin nucleotide sequence data to investigate how human movement along the aviation and commuter networks in the United States contributes to influenza transmission at the regional scale. It says, “we confirm that commuters can play an integral role in interstate influenza transmission, but found that this pattern was specific to the influenza A subtype under investigation. We additionally show that strong county-to-county commuter flows do not necessarily fall within state boundaries, emphasizing the need for more precise spatial data to be associated with publically available sequences. Our results demonstrate that genetic structure does exist for influenza populations during the course of a single season at the regional scale and highlight the need to incorporate host movement patterns when studying spatial population structure.”

Legionella outbreaks highlight need to be fastidious about maintenance and cleaning protocols

legionellaLegionella pneumophila bacteria (Legionnaires’ disease) is estimated to kill 4,000 a year in the United States alone. This bacteria is everywhere. American Society of Heating, Refrigerating, and Air-Conditioning Engineers (ASHRAE) 188 is the new standard for maintenance and is focused on addressing the ubiquitous problem of Legionella. It is critical to ensure your maintenance/cleaning teams recognize the importance of following ASHRAE 188 (Legionellosis: Risk Management for Building Water Systems). The publication offers new guidance to help minimize the risk of Legionellosis. It can be previewed for free or downloaded for a fee here. It includes:

  • Description of environmental conditions that promote the growth of Legionella
  • Informative annexes and an informative bibliography that contain suggestions, recommendations, and references to additional guidance

Some recent events highlight the need to keep a keen eye on potential problems:

Tests showed two of the towers on the roof of the prison’s Central Health Services Building had high concentrations of the bacterium that causes the disease, according to the federal receiver who controls inmate medical care. The report says people walking near the towers evidently inhaled contaminated mist, because no drinking water was affected. Receiver J. Clark Kelso blamed a buildup of sludge in the cooling tower water pans, as well as a heat wave in the San Francisco Bay Area, for the Legionnaires’ disease outbreak that sickened 81 inmates and sent 13 of them to outside hospitals.”

The officials, citing test results, also confirmed they had traced the source of the outbreak to a contaminated cooling tower on top of the Opera House Hotel on East 149th Street. The outbreak of Legionnaires’ disease — the worst in the city’s history — has claimed 12 lives and sickened more than 120 people since early July in the South Bronx. … In response, city health officials ordered this month that every building with a cooling tower had to disinfect it within two weeks of receiving the notice.”

Microfiber wipes away the other options when it comes to cleaning tools

Microfiber-2Using microfiber in cleaning processes impacts health outcomes by reducing secondary infections. Human error is a significant part of our cleaning problems. Nano Safe Coatings representatives recently visited a hospital to help them address a few problems. It didn’t take long to see the first one: The staff surprisingly was using feather dusters and brooms to clean.

Microfiber is the best tool for cleaning, bar none. Microfiber leaves no residue, and holds more dirt, dust, water and liquid than conventional fibers such as cotton or wool, which leave dirty residue as they push and scatter emulsified dirt and moisture. Microbiologic evaluation of microfiber mops for surface disinfection, a report at the National Center for Biotechnology Information (NCBI), says that recently, health care facilities have started to use a microfiber mopping technique rather than a conventional, cotton string mop to clean floors, and that the microfiber system demonstrated superior microbial removal compared with cotton string mops when used with a detergent cleaner. The use of a disinfectant did not improve the microbial elimination demonstrated by the microfiber system but did improve microbial removal significantly when used with a cotton string mop.

And remember, not all microfiber is created equally. There are significant quality differences that impact their ability to clean, as well as their durability. The color-coded systems help reduce human error. Additionally, microfiber doesn’t aerosolize particulate like vacuums and brooms do. Every hospital, and really anyone who cares about quality hygiene, should be cleaning with microfiber. From Infection Control Today: Room Turnover Times: ‘Trash-and-Dash’ Approach Jeopardizes Patient Outcomes.

Changing biocides often can limit bacteria’s ability to mutate, become immune to treatment

biocidesAntibiotic resistance is one of the great global challenges facing modern medicine. Biocides and disinfectants can expand multi-drug resistant organisms (MDRO) and resistance in bacteria. Because bacteria have the ability to build immunity to biocides – often rapidly – it is important to change often the biocides you use to limit their ability to become immune.

Parallel evolutionary pathways to antibiotic resistance selected by biocide exposure, a study published in the Journal of Microbial Chemotherapy, concludes that “exposure of bacteria to biocides can select for antibiotic-resistant mutants and this is mediated by clinically relevant mechanisms of resistance prevalent in human pathogens.”

Some other notable takes from the study: 

  • Prevention of infection is of paramount importance as the outcomes of infection with an antibiotic-resistant bacterial strain are often more severe than those of infections with antibiotic-susceptible strains
  • Many antimicrobial products are present in the environment at low levels;25 here we showed that exposure to sub-lethal concentrations of all the biocides evaluated resulted in the selection of antibiotic-resistant mutants.
  • Many antimicrobial products are present in the environment at low levels;25 here we showed that exposure to sub-lethal concentrations of all the biocides evaluated resulted in the selection of antibiotic-resistant mutants.
  • The role of environmental selection of antibiotic-resistant bacteria by biocides should be considered by government agencies as policies to control antibiotic-resistant bacteria are formulated and implemented.

Here’s a piece that can help with making the right choices in sanitization and disinfection procedures.


One Health initiative is much needed interdiscplinary collaborative effort

one health logoThe June 2007 landmark American Medical Association (AMA) One Health initiative is a concept designed to develop a worldwide strategy for expanding interdisciplinary collaborations and communications in all aspects of health care for humans, animals and the environment. It recognizes that the health of humans is undeniably and forever connected to animal and environmental health. One Health is not a new concept, but it has become more important in recent years because many factors have changed the interactions among humans, animals, and the environment, according to the Centers for Disease Control (CDC). These changes have caused the emergence and reemergence of many diseases. Successful public health interventions require the cooperation of the human health, veterinary health, and environmental health communities. The goal is that this collaboration, when embraced by the various disciplines, will help to help achieve optimal health outcomes for both people and animals.

Database of host-pathogen and related species interactions, and their global distribution, for example, provides some data that demonstrates the importance of One Health. The piece cites sources that indicate communicable diseases were directly responsible for nearly nine million deaths in 2013, some 16% of the total.  These bugs also impact length of life and quality of life.  About three-fifths of human diseases are believed to have arisen from animal pathogens, especially those of livestock.  It also notes that despite the importance of communicable diseases, there have been few attempts to construct datasets of the full set of infectious agents of humans or animals. Such datasets have many uses, for example facilitating the estimation of comprehensive infectious disease burdens, quantifying important characteristics of diseases, such as type of agent, whether they are zoonotic etc.; and providing a baseline for studying the rate of emergence of new diseases. The most notable attempt that has been made found 1415 pathogens of humans.

Studies strongly suggest that potential airborne transmission of disease deserves our attention

Middle East Respiratory Syndrome Coronavirus

Airborne transmission of disease continues to be studied in detail by a variety of researchers. While existing results might not definitively confirm air as a mode of transmission, many of the results suggest that dismissing it as a possibility isn’t wise. We should continue to look at airborne transmission as a possible means to transmit infectious disease. Consider:

  • Porcine epidemic diarrhea virus (PEDV) spread rapidly after being diagnosed in the USA in April 2013. To assess whether PEDV could become airborne and, if so, whether the virus was infectious, a study was done by members of the College of Veterinary Medicine at the University of Minnesota: The study showed that “PEDV genetic material could be detected up to 10 miles although infectivity could not be shown. To the authors’ knowledge, this is the first report to establish that PEDV can be found in the air, that suspended airborne particles can be infectious, and that PEDV genetic material can be transported over long distances. In summary, we have demonstrated that PEDV can become airborne, remain infectious while suspended in the air, and that PEDV genetic material can be transported long distances following natural infections. Further studies are needed to assess the risk of airborne transmission of PEDV among farms and the need to address this route in biosecurity and health control programs.”
  • From Eurosurveillance, a study titled Stability of Middle East Respiratory Syndrome Coronavirus under different environmental conditions, notes the ability of MERS-CoV to remain viable in an airborne state suggests the potential for MERS-CoV to acquire the ability to be transmitted via aerosols.
  • Role of two-way airflow owing to temperature difference in severe acute respiratory syndrome transmission: revisiting the largest nosocomial severe acute respiratory syndrome outbreak in Hong Kong. Comparing with the previous computational fluid dynamic simulation results, we found that the air exchange owing to the small temperature differences between cubicles played a major role in Severe Acute Respiratory Syndrome (SARS) transmission. Additionally, the validated multi-zone model combining the two-way airflow effect could simulate the pollutant transport with reasonable accuracy but much less computational time. A probable improvement in general ward design was also proposed.
  • Center for Disease Control recommends taking airborne precautions for both SARS and MERS-CoV. From the New England Journal of Medicine: If the form of transmission is not understood, health care professionals should adhere to the precautionary principle that reasonable steps to reduce risk should not await scientific certainty. It is for this reason that the Centers for Disease Control and Prevention (CDC) recommended airborne precautions (the use of respirators rather than surgical masks), in addition to standard and contact precautions, for all patients with MERS-CoV.

Human presence greatly affects indoor air quality

particlechartoneA person’s mere presence in a room can add 37 million bacteria to the air every hour — material largely left behind by previous occupants and stirred up from the floor — according to new research by Yale University engineers. The study in Yale News, written by Eric Gershon, is titled With you in the room, bacteria counts spike.

Gerhson writes that “many previous studies have surveyed the variety of germs present in everyday spaces. But this is the first study that quantifies how much a lone human presence affects the level of indoor biological aerosols.

“(Jordan Peccia, associate professor of environmental engineering at Yale), said carpeted rooms appear to retain especially high amounts of microorganisms, but noted that this does not necessarily mean rugs and carpets should be removed. Extremely few of the microorganisms commonly found indoors — less than 0.1 percent — are infectious, he said.

“Still, understanding the content and dynamics of indoor biological aerosols is helpful for devising new ways of improving air quality when necessary, he said. ‘All those infectious diseases we get, we get indoors,’ he said, adding that Americans spend more than 90 percent of their time inside.”

Here are a couple related pieces worth taking a look at:

  • Human’s differ in their personal microbial cloud says that dispersal of microbes between humans and the built environment can occur through direct contact with surfaces or through airborne release; the latter mechanism remains poorly understood.Bacterial clouds from the occupants were statistically distinct, allowing the identification of some individual occupants. Our results confirm that an occupied space is microbially distinct from an unoccupied one, and demonstrate for the first time that individuals release their own personalized microbial cloud.
  • Another study’s abstract notes that exposure to specific airborne bacteria indoors is linked to infectious and noninfectious adverse health outcomes. However, the sources and origins of bacteria suspended in indoor air are not well understood. This study presents evidence for elevated concentrations of indoor airborne bacteria due to human occupancy, and investigates the sources of these bacteria.

Most assisted living facilities have inadequate infection control programs

Senior and young holding hands outsideThe close-in living arrangements at assisted living facilities, in addition to a steady flow of visitors and staff, make them ideal for the spread of infection and illness. Add to that the fact that most assisted living chains don’t have effective infection control programs, that is if they have a program at all. Seems they would know that large groups of people living together sets up perfectly for them to pass sicknesses around to each other. Maybe they do and choose not to address it. It’s especially perilous when you are talking about the elderly and infirm, who are much more prone to get sick because they generally have less robust immune systems.

Here is a link to an informative PBS Frontline episode on the topic as well as links to some related articles and studies:

Fastidious attention to hand hygiene affects health outcomes

kids hand washFastidious hand hygiene, while not a single solution to the spread of illness, has abundant impact on absenteeism among workers and students. Effects of Hand Hygiene Campaigns on Incidence of Laboratory-confirmed Influenza and Absenteeism in School Children, Cairo, Egypt, evaluates the effectiveness of an intensive hand hygiene campaign on reducing absenteeism caused by influenza-like illness (ILI), diarrhea, conjunctivitis, and laboratory-confirmed influenza.

From the study abstract: We conducted a randomized control trial in 60 elementary schools in Cairo, Egypt. Children in the intervention schools were required to wash hands twice each day, and health messages were provided through entertainment activities. Data were collected on student absenteeism and reasons for illness. School nurses collected nasal swabs from students with ILI, which were tested by using a qualitative diagnostic test for influenza A and B. Compared with results for the control group, in the intervention group, overall absences caused by ILI, diarrhea, conjunctivitis, and laboratory-confirmed influenza were reduced by 40%, 30%, 67%, and 50%, respectively (p<0.0001 for each illness). An intensive hand hygiene campaign was effective in reducing absenteeism caused by these illnesses.

Reduction of illness absenteeism in elementary schools using an alcohol-free instant hand sanitizer concludes that hand washing is the most effective way to prevent the spread of communicable disease.

Hungarian Ignaz Semmelweis pioneered the idea of washing your hands! He led the way in early antiseptic procedures and is the favourite scientist of Michael Loughlin, who works in the same field at Nottingham Trent University. Check out this YouTube video where Loughlin discusses the genesis of hand hygiene.