Mass gathering behaviors present unique health challenges

massMass gatherings always are a potential health threat. It’s important that travelers are vaccinated and in the best health possible. This applies to those who attend any events where crowds are present.

Adding a psychological dimension to mass gatherings medicine notes the differences between day-to-day behavior and behavior that surfaces in mass gatherings that affects general health. “Mass gatherings pose distinctive challenges for medicine. One neglected aspect of this is that the behavior of people participating in such events is different from the behavior they exhibit in their everyday lives. This paper seeks to describe a social psychological perspective on the processes shaping people’s behavior at mass gatherings and to explore how these are relevant for an understanding of the processes impacting on the transmission of infection. . . . First, one behaves in terms of one’s understanding of the norms associated with the group. Second, the relationships between group members become more trusting and supportive. Understanding these two behavioral changes is key to understanding how and why mass gathering participants may behave in ways that make them more or less vulnerable to infection transmission. Implications for health education interventions are discussed.”

Half of pilgrims unaware of MERS, at Arab News, reports on a 33-country study about “Pilgrim Awareness of Corona (MERS) Virus,” conducted during the last Haj season. It revealed that about half of the pilgrims were unaware of the virus and prevention methods. . . . The study confirmed the lack of accurate information about the disease among pilgrims, and general lack of awareness, noting the need for effective awareness programs and improved teaching methods about health issues during the Haj season. MERS is a source of concern for the World Health Organization, with the majority of cases emerging from Arab Gulf states, especially Saudi Arabia. This indicates the serious risk of the virus spreading during the pilgrimage. . . The aim of the Saudi study was to assess the awareness of pilgrims of the corona virus, and their responses toward protective standards in dealing with it. The study confirmed that knowledge and awareness is essential and will certainly contribute to the development and improvement of health awareness programs for pilgrims in the future.


Studying disease in humans and animals provides early warning system

downloadZoonotic diseases account for almost 60 percent of all disease among humans. Developing a multi-disciplinary look at disease in humans and animal gives us early warning on pending issues. MERS, SARS and PEDv are all corona viruses hence they model is very similar ways.  In the links below, note the studies that clearly show PEDv and SARS are airborne dangers.

A Unified Framework for the Infection Dynamics of Zoonotic Spillover and Spread says that “disentangling the contribution of animal-to-human from human-to-human transmission is of crucial importance to inform appropriate control measures. The shape of the cumulative number of occurrences can provide indications of the modes of transmission. A concave, saturating profile is an expected outcome due to depletion of susceptibles. In contrast, a convex region in the profile of cumulative number of occurrences suggests that human-to-human transmission plays an important role. Alternative explanations are possible. A convex shape in the cumulative number of occurrences might arise from temporal variations in the model parameters (e.g. probability of contact between humans and rodents, infection prevalence in rodents, infection-response efficiency) and/or in the human population size. A fundamental gap in our current knowledge is the mechanisms governing the transition from spillover to stuttering chain to sustained transmission.”

Database of host-pathogen and related species interactions, and their global distribution discusses “interactions between species, particularly where one is likely to be a pathogen of the other, as well as the geographical distribution of species, have been systematically extracted from various web-based, free-access sources, and assembled with the accompanying evidence into a single database. The database attempts to answer questions such as what are all the pathogens of a host, and what are all the hosts of a pathogen, what are all the countries where a pathogen was found, and what are all the pathogens found in a country. Two datasets were extracted from the database, focussing on species interactions and species distribution, based on evidence published between 1950–2012. The quality of their evidence was checked and verified against well-known, alternative, datasets of pathogens infecting humans, domestic animals and wild mammals. The presented datasets provide a valuable resource for researchers of infectious diseases of humans and animals, including zoonoses.”

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 in part concludes that “revisiting the role of air distribution in SARS transmission during the large nosocomial outbreak in (a hospital ward), we found that the two-way airflow effect at the openings plays an important role in bioaerosols transmission. The most likely reason for the two-way airflow effect may be the thermal pressure effect. This paper aimed to investigate the role of air exchange owing to temperature difference in SARS transmission in (the ward) using a validated multi-zone model combining the two-way airflow effect. Within the scope of this research, the following conclusions can be drawn:

·        Air exchange owing to temperature difference played a significant role in SARS transmission during the nosocomial outbreak in Ward 8A.

·        The validated multi-zone model combining the two-way airflow effect may be a better simulation approach than CFD owing to its convenience and accuracy for actual application

·        Reducing the area of the openings between cubicles and corridor (e.g. installing curtains at the openings) may be a more convenient and economical improvement on general ward design.”

At National Geographic Channel, The Big Picture with Kal Penn, talks of the 2003 SARS outbreak in China that quickly became a global epidemic. It attempts to get to the origins of the outbreak to understand how virus spreads.

Also, Evidence of infectivity of airborne porcine epidemic diarrhea virus and detection of airborne viral RNA at long distances from infected herds.

Detroit News sheds light on alarming hygiene issues at Detroit Medical Center

detroit news logoThe Detroit News published a report recently that brought to light shocking hygiene shortcomings at Detroit Medical Center (DMC). The News reported – and the findings weren’t contradicted by DMC administrators, who acknowledge there are problems to fix – that among other things surgeries were cancelled because of unsterile instruments. Time will tell what the hospital does to fix its issues. For the time being, you have to believe patient confidence is seriously shaken. That DMC acknowledges the system needs to be fixed is at least encouraging. What they do, and how quickly, will be something to watch.

Dirty, missing instruments plague DMC surgeries appears in the Detroit News. It says that “more than 200 pages of internal emails and reports indicating that surgeons and staffers have complained for at least 11 years about improperly cleaned, broken and missing instruments. The complaints have continued under the tenure of the for-profit Tenet Healthcare of Dallas, Texas, which acquired the DMC in 2013, the documents show. The records show improperly sterilized tools complicated operations from appendectomies and brain surgeries to cleft palate repair and spinal fusions. Patients were kept under anesthesia for up to an hour as staffers replaced instruments. Dozens of operations were canceled at the last minute, some after anesthesia was administered.” The paper also notes in Hospital records kept from public that the internal reports and emails aren’t made public and were “cloaked in secrecy by Michigan law. State and federal agencies collect a substantial amount of data, but allow hospitals to supply it voluntarily on the condition that much of it is kept confidential. That means only the broadest information — typically about regional rates or whether hospitals are above or below averages — is available to the public.”

Fight against AMR is one we simply cannot afford to lose

3The Centers for Disease Control published a bombshell report in 2013, strongly warning against the negative ramifications of antimicrobial resistance (AMR). And in 2014, the World Health Organization labeled antibiotic resistance as a “major threat to public health.” Antibiotic resistance is a direct result of antibiotic use. The more antibiotics are used, the greater the odds that antibiotic-resistant populations of bacteria will increase. It is imperative the fight across multiple disciplines continues because since these reports, it doesn’t appear the situation is improving significantly. Consider some of the following reports.

Antibiotic resistance – A global health crisis is a wonderful piece that discusses what is being done to combat AMR and includes a personal experience that hammers home the point that we are at a critical point in the fight.

Below are three YouTube pieces that discuss various aspects of AMR and are well worth the time to watch:

  • CDC now admits era of antibiotics at an end as bacteria out-wit drug companies is one that should really make folks stand up and take notice. If you don’t think you should be concerned because there always will be new drugs to combat AMR, you’re probably wrong. “In a breakthrough moment of truth for the CDC, the agency now openly admits that prescription antibiotics have led to a catastrophic rise in superbugs, causing the death of at least 23,000 Americans each year (an estimate even the CDC calls “conservative”).” Staggering numbers, indeed.
  • Maryn McKenna: What do we do when antibiotics don’t work anymore? “Penicillin changed everything. Infections that had previously killed were suddenly quickly curable. Yet as Maryn McKenna shares in this sobering talk, we’ve squandered the advantages afforded us by that and later antibiotics. Drug-resistant bacteria mean we’re entering a post-antibiotic world — and it won’t be pretty. There are, however, things we can do … if we start right now.”

Hand hygiene is a key to community, home, school wellness

Hand hygiene clearly impacts the wellness of any community. Keeping hands clean at home, in schools and elsewhere makes a significant difference in keeping folks healthy. The impact of poor hand hygiene habits is linked to increased occurrences of illness, absences, and their associated costs. A renewed commitment to “shared responsibility” in our homes and classrooms may be one of our most important infection prevention strategies.

Hand Hygiene at Home and School, written by Patrick Boshell at Infection Control Tips, says “studies demonstrate that poor hand hygiene practices can contribute to an increase in community-based infections including gastrointestinal, skin and respiratory infections. Additionally, there has been a steady increase in the global burden of infectious diseases, resulting in an reported 13 million deaths annually. Between 1980 and 1992, deaths attributed to infectious disease increased by 22%, according to reports.  This is a cause for concern as we continue to see a decline in hand hygiene promotion and education.”

Hand Sanitizer Alert draws attention to the fact that “efficacy experiments reported here reinforce what has been known for more than 50 years: 40% ethanol is a less effective bacterial antiseptic than 60% ethanol. Consumers should be alerted to check the alcohol concentration in hand sanitizers because substandard products may be marketed to the public.”

Effects of Hand Hygiene Campaigns on Incidence of Laboratory-confirmed Influenza and Absenteeism in Schoolchildren, Cairo, Egypt: Elementary schoolchildren are important vectors for spreading infectious diseases between themselves, their families, and their communities, especially in developing countries where public schools are extremely overcrowded. Aiello et al. noted that infectious agents that children contract in schools can result in infections in up to 50% of household members.

Previously, at our blog:

Studying the connection between NDM-1 and Acinetobacter species

Multi-drug resistant Acinetobacter

New Delhi Metallo-beta-lactamase-1 (NDM-1) is an enzyme that makes bacteria resistant to a broad range of beta-lactam antibiotics. These include the antibiotics of the carbapenem family, which are a mainstay for the treatment of antibiotic-resistant bacterial infection, among those Acinetobacter and more specifically Acinetobacter baumannii. Here are some links to studies that include a look at the relationship of NDM-1 and A. baumannii.

Co-occurrence of blaNDM-1 with blaOXA-23 or blaOXA-58 in clinical multidrug-resistant Acinetobacter baumannii isolates in Algeria aimed to study aim of this study was to characterize the mechanisms of carbapenem resistance in Acinetobacter baumannii strains isolated in an Algerian hospital. It reports “or the first time the co-occurrence of blaNDM-1 along with blaOXA-23 or blaOXA-58 in recent clinical isolates of A. baumannii from Northeast Algeria. These findings re-emphasize the dissemination and rapid spread of blaNDM-1 carbapenemase genes in multidrug-resistant clinical A. baumannii isolates in Algeria.”

Draft genome sequence of a multidrug-resistant New Delhi metallo-β-lactamase NDM-1-producing Acinetobacter pittii sequence type 207 isolate from China notes that the increasing emergence of carbapenem-resistant Acinetobacter spp. worldwide has resulted in the limited availability of effective antimicrobial agents and has become a major public health concern.

Multidrug Resistant Acinetobacter reports that “there is an urgent need to enforce infection control measures and antimicrobial stewardship programs to prevent the further spread of these resistant Acinetobacter species and to delay the emergence of increased resistance in the bacteria.”

Previously, at our blog:


Prisons need to look at prevention of disease as population ages

prisonMaria Schiff, in a piece that appears at Health Affairs blog, notes that an aging prison population – state and federal prisoners more than 55 years old – has grown from 43,300 to 144,500 from 1999-2013. With that rising number comes with a corresponding increase in health care costs. In Examining State Prison Health Care Spending: Cost Drivers And Policy Approaches,  Schiff reports that the National Institute of Corrections said the cost of keeping prisoners 55 and older costs two to three times as much for all other inmates. Not among the cost containment strategies is prevention, which should be looked at along with other methods.

Treating Prisoners With Hepatitis C May Be Worth The Hefty Price, a Health News piece at NPR, says “more than 15 percent of U.S. prison inmates are infected with Hepatitis C. The study, published Monday in Annals of Internal Medicine, shows that as many as 12,000 lives would be saved if inmates were screened and treated. And while it would cost a lot of money up front, over time the savings to society at large would be huge. . . . Treating just those in prison would save $750 million over 30 years, the study finds, even including the cost of screening and medication.”

Legionnaires’ disease case at San Quentin prison prompts shutoff of water, which appears at the Los Angeles Times, says “California public health records show 348 reported cases of Legionnaires’ disease in 2014, two-thirds of them affecting individuals 65 or older. More than half of the cases occurred in Los Angeles County. The U.S. Centers for Disease Control and Prevention estimates that fewer than half the cases of legionellosis, the proper medical term for the disease, are reported. From 2009 to 2012, California reported 82 deaths attributed to the bacteria, according to the state Department of Public Health.”

Also, An epidemic of pneumococcal disease in an overcrowded, inadequately ventilated jail.

C. diff is stubborn and deadly, and no shortcuts should be taken when trying to prevent spread

Clostridium difficile

Clostridium difficile (C. diff) is a known killer that has drawn plenty of attention from the Centers for Disease Control. C. diff is on the CDC shortlist of microorganisms with a threat level of “urgent.” It no longer is isolated in hospitals, moving to the community at large. Additionally, it can be spread through the air. These are a few of the factors that make it important to continue to study and analyze it as well as develop methods to combat its spread.

Airborne Spread of Clostridium difficile, at UPCM Center for Health Security, points out that a recent paper authored by British researchers, published in Clinical Infectious Diseases, demonstrates that C. diff spores may also be spread through the air. It’s already been known that patients in hospitals infected with C. diff can shed large numbers of spores, which leads to them being found of myriad surfaces and thus leading to the spread of the disease. Additionally, healthcare workers can help move them outside of rooms as fomites on clothing and equipment.

Epidemiology of community-associated Clostridium difficile infection, 2009 through 2011 sets out to determine epidemiological and clinical characteristics of community-associated C. diff infection and to explore potential sources of C difficile acquisition in the community. It concludes in part that “most patients with community-associated CDI had recent outpatient health care exposure, and up to 36% would not be prevented by reduction of antibiotic use only. Our data support evaluation of additional strategies, including further examination of C difficile transmission in outpatient and household settings and reduction of proton pump inhibitor use.”

Study Shows Healthcare Workers’ Hands Contaminated with C. difficile After Routine Care notes that “many healthcare workers may be passing on this highly contagious bacteria to patients even after routine alcohol-based hand rubbing. This points to the need for routine hand washing with soap and water, rather than alcohol-based hand rub, after care of C. difficile patients in all settings.” Alcohol-based hand sanitizers aren’t enough when it comes to C. diff spores.

Resuspension of particles relevant as viruses can remain viable for extended periods

ebolaSuspension and shedding require persistent cleaning. Viruses can hang around and be viable even three hours after being generated, making resuspension of particles a matter of concern. Droplets from sneezes might travel farther than the Center for Disease Control has suggested, too. Below are some studies that detail some of this.

Comparison of the Aerosol Stability of 2 Strains of Zaire ebolavirus From the 1976 and 2013 Outbreaks is a study that shows “the viability of 2 Zaire ebolavirus strains within aerosols at 22°C and 80% relative humidity over time. The results presented here indicate that there is no difference in virus stability between the 2 strains and that viable virus can be recovered from an aerosol 180 minutes after it is generated.” Think about this in the context that all particles can be aerosolized, and the new study from MIT that films droplets moving 6-8 meters vs. the CDC droplet precaution of three feet.

An evaluation of the impact of flooring types on exposures to fine and coarse particles within the residential micro-environment using CONTAM notes that flooring type significantly impacts the extent to which particulate matter (PM) exposures are elevated indoors from particle resuspension. Hardwood floors were identified as the most effective flooring type for the reduction of (daily, 24-h) incremental time-averaged exposure to either fine or coarse particles due to resuspension while walking.

Surrounded by a Cloud of Dust: Particle Resuspension in Indoor Environments is an informative YouTube piece presented by Brandon E. Boor, Ph.D. Assistant Professor of Civil Engineering, Purdue University at a gathering of the National Academy of Sciences, Engineering and Medicine.


Copper has its limits as antimicrobial agent as resistance grows

copperStudies show again and again what all pharmacists and microbiologists already know: Bacteria build immunity to antibiotics, pesticides and disinfectants, rendering them largely ineffective over time. Below are some studies that discuss the use of copper as an antimicrobial.

Characterization of Copper Resistance in Acinetobacter baumannii points out that Acinetobacter baumannii causes many types of severe nosocomial infections and that some isolates have acquired resistance to almost every available antibiotic, limiting treatment options. Copper is an essential nutrient, but becomes toxic at high concentrations. The inherent antimicrobial properties of copper give it potential for use in novel therapeutics against drug resistant pathogens. We show that A. baumannii clinical isolates are sensitive to copper in vitro, both in liquid and on solid metal surfaces. Since bacterial resistance to copper is mediated though mechanisms of efflux and detoxification, we identified genes encoding putative copper-related proteins in A. baumannii and showed that expression of some of these genes is regulated by copper concentration. We propose that the antimicrobial effects of copper may be beneficial to development of future therapeutics that target multidrug resistant bacteria.

Bacterial resistance to copper in the making for thousands of years suggests that genetic changes pose risks to human immunity. Published at The Ohio State University website, Misti Crane writes that more copper in the environment leads to more bacteria, including E. coli that develops a genetic resistance.

Characterization of copper-resistant bacteria and bacterial communities from copper-polluted agricultural soils of central Chile suggests that “bacterial communities of agricultural soils from central Chile exposed to long-term copper (Cu) pollution have been adapted by acquiring Cu genetic determinants. Five bacterial isolates showed high copper resistance and additional resistance to other heavy metals. Detection of copA gene in plasmids of four Cu-resistant isolates indicates that mobile genetic elements are involved in the spreading of Cu genetic determinants in polluted environments.”


The Nano Safe blog is about to change. Nano Safe, Inc., is very focused on antimicrobial coating for medical devices. In the near future we are going to turn this blog over to a sister company and they will continue to write on infection control issues for the built environment. Stay tuned for more news on the blog shift.