Our Latest Perspectives Posts

CDC’s Message to Healthcare Workers: “Think Ebola, Care Carefully”
Written by Barbara Soule, RN., MPA, CIC, FSHEA

Colorized scanning electron micrograph of filamentous Ebola virus particles (green) attached to and budding from a chronically infected VERO E6 cell (blue) (25,000x magnification).
PhotoCredit: National Institute of Allergy and Infectious Diseases

Ebola Disinfectants

Ebola is an enveloped virus, susceptible to many disinfectants. Non-enveloped viruses are more resistant to disinfection.  As a precautionary measure, EPA-registered hospital disinfectants with label claims for non-enveloped viruses are recommended for Ebola disinfection, along with instructions for cleaning and decontaminating surfaces or objects soiled with blood or body fluids. Non-enveloped viruses include norovirus, rotavirus, adenovirus and poliovirus.

CDC provides additional online information regarding Ebola virus environmental infection control in hospitals.

As the nation follows the progress of Ebola-infected healthcare workers being treated in US hospitals, the US Centers for Disease Control and Prevention (CDC) urges all professionals on the front lines of the Ebola wars to exercise greater caution.  CDC released more stringent new guidance October 20 that highlights additional personal protective equipment (PPE) for caregivers and the critical matter of properly donning and removing personal protective equipment.  CDC notes: “Recent experience from safely treating patients with Ebola at Emory University Hospital, Nebraska Medical Center and National Institutes of Health Clinical Center are reflected in the guidance.”

Three Principles of the Enhanced Guidance

The new, tightened guidance focuses on these three areas:

  1. Rigorous and repeated training:  CDC and its partners will increase training in the proper use of equipment, “especially in the step by step putting on and taking off of PPE.”
  2. No skin exposure when PPE is worn:  For example, single-use, disposable, full-face shields are recommended under the new guidance instead of goggles.  The reason:  Goggles may not provide full cover, are not disposable, and healthcare workers may be tempted to manipulate them with contaminated gloved hands.
  3. Trained monitor:  CDC recommends a dedicated, trained monitor  actively observe and supervise workers as they put on and take off PPE.  This is particularly important when removing visibly contaminated PPE.  In that circumstance, CDC recommends disinfecting visibly contaminated PPE with an EPA-registered disinfectant wipe before removing the PPE.  CDC also recommends disinfecting gloved hands with an EPA-registered disinfectant or alcohol-based hand rub between steps of taking off PPE.

The current Ebola outbreak is the largest in history and the first Ebola pandemic the world has ever known (see the CNN interactive global outbreak map).  It is to CDC’s credit that in the spirit of continual improvement it is using current evidence to improve infection control recommendations.  In the meantime, we echo CDC’s message to the brave and committed healthcare workers:  “Think Ebola, Care Carefully.”

 

Barbara M. Soule, R.N. MPA, CIC, FSHEA is an Infection Preventionist and a member of the Water Quality & Health Council. 

State and local public health officials:  See CDC’s list of top 10 Ebola response planning tips.

Chlorine Bleach: A Trusted Ally in the Battle against Ebola
Written by Water Quality & Health Council

A group of San Diego women with close ties to the West African nation of Liberia is raising funds to help fight the Ebola outbreak in that country. Their chosen weapon:  buckets of bleach.  In a recent video, Deborah Lindholm, the founder of the group, Foundation for Women, describes life today in Liberia:  “There are no handshakes, no touching, no hugging; there is just complete and utter fear in Liberia right now…There are buckets of bleach all over the streets in Liberia and the people in Liberia and in the surrounding areas that have been affected by Ebola understand that if they keep their hands clean they can kill off the virus.

Hand washing is an extremely important component of infection control as germs picked up on the hands are readily transferred to the eyes, mouth and nose by touching.  Keeping all settings clean—homes, healthcare settings, schools and workplaces—is another critical factor in infection control because it helps prevent hands becoming re-contaminated between hand washings.

airplaneThousands of gallons of concentrated chlorine bleach and other critical equipment are loaded into the cargo hold of an airplane destined for Sierra Leone, September, 2014. World Vision and the American Chemistry Council coordinated the humanitarian airlift to help fight Ebola.  Chlorine bleach was donated by Olin Corporation; domestic transportation services for bleach were donated by CSX Corporation and the Buffalo and Pittsburgh Railroad; bleach bottling services were donated by The James Austin Company.

Using Bleach to Destroy Ebola on Surfaces

According to the World Health Organization (WHO), “The Ebola virus can be eliminated relatively easily from surfaces using heat, alcohol-based products, and sodium hypochlorite (bleach) or calcium hypochlorite (bleaching powder) at appropriate concentrations.” The Ebola virus can live on inanimate surfaces, especially those that are soiled with blood or other body fluids from infected people.  In the later stages of Ebola, when patients experience internal and external bleeding, they may vomit blood or have bloody diarrhea, all potential sources of infection for those around them.

WHO recommends surfaces or objects contaminated with blood, other body fluids, secretions or excretions from Ebola patients be cleaned and disinfected1 as quickly as possible.2  The following information on bleach use against Ebola is based on a September, 2014 WHO guidance document:

  • As soon as possible after a spill of bodily fluids, clean the affected surface with a standard hospital detergent; then apply disinfectant.  This order of operations helps prevent the disinfectant becoming inactivated by organic matter on surfaces.

 

  • A 0.5% chlorine solution or a solution containing 5,000 parts per million free available chlorine is an effective surface disinfectant against Ebola.  To prepare such a solution from liquid chlorine bleach or solid calcium hypochlorite, follow the directions in Examples I and II below.  Note that chlorine solutions have a limited shelf life, and should be prepared fresh daily.

 

  • Wastes, such as feces, urine, vomit and liquid waste from washing can be disposed of in the sanitary sewer or pit latrine with no further treatment.  WHO provides detailed guidance on Waste Management Procedures (see page 9 of the hyperlinked article).

 

  • Don’t use bleach for everything:   If an uninfected person is splashed with the bodily fluid of an infected person, as soon as possible wash the affected skin surface with soap and water.  If a mucous membrane is exposed to infected bodily fluid, as soon as possible irrigate with copious amounts of water or an eyewash solution, not with chlorine solutions or other disinfectants.

 

Bleach:  A Trusted Ally

In the rapidly unfolding saga of the West African Ebola outbreak, the critical role of surface disinfection is highlighted repeatedly by public health professionals along with public education, isolation and quarantine, contact tracing, good hygiene and personal responsibility.  From sanitizing healthcare environments used for Ebola patient care, to airplanes used for international travel, to homes formerly inhabited by Ebola patients, chlorine bleach proves time and again to be a trusted ally in the raging battle against Ebola.

 

For further information on Ebola, please see the Centers for Disease Control and Prevention website and our article Ebola:  What You Should Know.

 


1 Disinfectants are defined by EPA as either hospital or general use types. Disinfectants destroy or irreversibly inactivate infectious fungi and bacteria but not necessarily their spores.

2 Chlorine solutions of various concentrations are also recommended for machine-laundering contaminated linens, decontaminating equipment such as goggles and visors and even body bags containing Ebola victims.

 

 

Enterovirus 68: The New Respiratory Virus on Our Radar
Written by Ralph Morris, MD, MPH

 

SickpersonA previously uncommon respiratory virus has shown up on our radar:  Enterovirus 68 (EV-D68), a non-polio enterovirus.  According to the Centers for Disease Control and Prevention (CDC) website, from mid-August to October 1 of this year, 500 people in 42 states and the District of Columbia were confirmed to have EV-D68 infections, but these probably only represent “the tip of the iceberg,” as healthcare professionals are not required to report known or suspected cases of EV-68.  CDC reports that infants and children under 5 years old, children with asthma, and teenagers are at risk to contract enteroviruses, which are known to peak in the United States in late summer and early fall.  Many of the children affected in the recent outbreak required care in hospital intensive care units.

Blurring the Lines between Enteroviruses and Rhinoviruses

The five known species of enterovirus include Poliovirus and Human enteroviruses A, B, C and D.  Of all the known enteroviruses, the only one for which there is a vaccine is poliovirus. The three main species of rhinovirus, rhinoviruses  A, B, and C, are responsible for more than half of all cold-like illnesses.  Enteroviruses generally can withstand the acidic environment of the human stomach and tolerate higher temperatures better than rhinoviruses, which thrive at the temperature of the human nose.  Enteroviruses infect the digestive system and are transmitted through the mucous and stool of infected individuals.  Rhinoviruses infect the respiratory system and are transmitted only through the mucous of infected individuals. In their 2004 study, however, Oberste et al. concluded EV-D68 shares biological characteristics with rhinovirus (HRV) 87, potentially blurring the lines between certain enteroviruses and rhinoviruses.  More recent studies (e.g., Jacobs et al., 2013), categorize some rhinoviruses as enteroviruses based on a new understanding of genomic structures.

Asthma-like Symptoms

EV-D68 was first identified in four children in California in 1962, but until recently, was considered relatively rare.  The virus is making headlines because it does not seem to follow the classic pattern of viral infections, according to an article in Web MD.  Instead of starting out with fever, cough and runny nose, EV-D68 causes fever in only about 25 to 30 percent of cases.  It does cause coughing and breathing difficulties and sometimes wheezing.  The virus may produce asthma-like symptoms in some children who have no history of asthma.  Children with a medical history of asthma and breathing problems are particularly at risk, and may need to be given supplemental oxygen. There is no vaccine to prevent EV-D68 nor antiviral medications to treat it.

Recent Developments

CDC is currently investigating whether limb paralysis in children is caused by EV-D68.  Ten children in Colorado have developed acute focal limb weakness and spinal cord lesions. CDC is asking physicians to report possible cases to their health departments. Criteria for reporting include: patients 21 years and younger, acute onset of focal limb weakness that began before August 1 of this year, and MRI results of a spinal cord lesion largely limited to gray matter. Additionally, CDC reports that EV-D68 has been detected in four patients who died, but what role the virus played in these deaths is unknown as of yet.

Tips for Preventing the Spread of EV-D68

  • Wash hands often with soap and water for 20 seconds, especially after changing diapers.
  • Avoid touching eyes, nose and mouth with unwashed hands.
  • Avoid kissing, hugging, and sharing cups or eating utensils with people who are sick.
  • Teach children to cover their mouth with a tissue when they cough or cough into the crook of their elbow or upper sleeve instead of their hand.
  • Disinfect surfaces as EV-D68 can remain viable on surfaces for at least several hours.  Disinfect frequently touched surfaces, such as toys and doorknobs, especially if someone is sick.  Viruses are destroyed by weak bleach solutions. Mix up a simple germ-busting solution of chlorine bleach by adding ¼ cup of regular household bleach to one gallon of water.[1]  Apply to frequently touched doorknobs, handrails and faucets. Leave surface wet for 10 minutes, then rinse with plain water.

If You Have Asthma…

  • Take all asthma medications. 
  • Have an “Action Plan”; make sure it is up to date. If you develop worsening asthma symptoms, contact your doctor.
  • Get a flu shot to avoid additional respiratory illness.

 

Ralph Morris, MD, MPH, is a Physician and Preventive Medicine and Public Health official living in Bemidji, MN.

 

 

[1] If using concentrated bleach, reduce the amount of bleach to 2 ½ tablespoons.

 

Reduce Your Risk of Getting Sick at the Office
Written by Barbara Soule, R.N., MPC, CIC, FSHEA

officeOffice workers share more than reports and chit-chat when they show up for work each day. They also share germs, according to a new study by University of Arizona microbiologist Dr. Charles Gerba.  A recent article in Mother Nature Network describes how Dr.  Gerba tracked the spread of a harmless virus across surfaces in offices, hotel rooms and health care facilities.

The harmless virus was a surrogate for the flu and norovirus.  Norovirus is a highly contagious virus that annually causes about 20 million cases of illness and up to about 71,000 hospitalizations and 800 deaths. The flu can cause between 3,000 and 49,000 deaths in a given year, according to the US Centers for Disease Control and Prevention.  Gerba found from an initial contamination of one or two surfaces (also known as fomites) in these environments, 40 to 60 percent of available surfaces became contaminated with the surrogate virus within two to four hours.  This can happen in your office and any indoor work setting as well!

Knowing how quickly germs can spread through an office, here are some tips employees can use to avoid getting sick at work through the upcoming cold and flu season:

Tips to Reduce Your Risk of Getting Sick at the Office

  • Wash your hands frequently during the day. Hand washing is one of the most important steps you can take to prevent infectious illness.  Wash your hands with soap and warm water after using the bathroom, after sneezing or coughing into your hands (see 3rd bullet below) or a tissue, before preparing or eating food or touching a contaminated object/surface.  Wash correctly by rubbing your hands together—back and front—and interlocking and releasing your fingers to cleanse between fingers.  Wash for at least 20 seconds. (If you sing the “Happy Birthday” song twice in your head while washing, you’ve met the minimum requirement.)
  • Use hand sanitizer when hand washing facilities are inconvenient or unavailable. Small bottles of alcohol hand rub can be kept at your desk or in key locations in the office, such as the “break room”. To be effective, the alcohol-based hand rubs should be used following instructions (e.g., using recommended amounts of hand sanitizer per use) and rubbed until dry.
  • Be mindful of the potential to spread germs via handshaking.  Refrain from touching your face after shaking hands. Keep hand sanitizer in your desk, purse or brief case for discreet use after handshaking.
  • Cough into the crook of your elbow instead of your hands. Your elbow is not the germ transporter that your hands are!  Practice good respiratory hygiene.
  • Use a clean paper towel to act as a barrier between you and the bathroom door handle as you exit the restroom.  Door handles are a common source of infection.
  • Prepare your lunch on a disposable plate or paper towel instead of directly on the counter of the employee kitchen. In Dr. Gerba’s study, the coffee break room was the first place to be contaminated. Ask your employer to provide disinfecting wipes for kitchen surfaces such as microwave touch pads, refrigerator and cabinet handles and drawer pulls.  Gerba found that the spread of viruses could be reduced by 80 to 99 percent by using a combination of disinfecting wipes and proper hand hygiene.  The US Environmental Protection Agency lists all disinfectants that are registered for use against norovirus. These disinfectants are also effective against flu viruses.
  • Keep disinfecting wipes near commonly used computers and telephones and use them to wipe down keyboards, computer mice, telephone push keys and receivers.
  • Use your knuckle instead of the pad of your finger to depress elevator keys or automatic door openers.
  • Keep your hands away from your face to help prevent germs travelling from fingers to your eyes, nose and mouth.
  • Cleanup with chlorine bleach.  CDC recommends applying a chlorine bleach solution or other EPA-registered disinfectant to surfaces affected by vomiting or diarrhea (see downloadable poster directions in English and Spanish).
  • Stay home when you are sick! It may be the perfect time to telecommute, if you feel up to working. Your fellow employees will appreciate your courtesy, and just might follow your good example when they become sick.
  • Make sure you are getting adequate sleep, eating a healthy diet, and exercising to shore up your immune system.
  • Get a seasonal flu shot.  According to the CDC, the single best way to protect against the flu is to get vaccinated each year. The flu vaccine is recommended for all people over the age of six months, with rare exception.  See your doctor if you have questions about getting a flu shot.

Barbara M. Soule, R.N. MPA, CIC, FSHEA is an Infection Preventionist and a member of the Water Quality & Health Council. 

Chikungunya in the States
Written by A Guest Article by Sabrina Jacobson

chikungunya

Have you heard about the Chikungunya virus? Although it is rarely fatal, its symptoms include fever and severe joint pain. Originally only present in countries in Asia, Europe, and Africa, it is gaining a presence in the United States after being carried to the Caribbean. Starting in late 2013, a few Carribbean vacationers contracted Chikungunya, but the number of cases there has increased exponentially. This article will update you on what is happening with Chikungunya in the US since the Water Quality & Health Council’s first report on the virus.

Recently St. Lucie County health officials in Florida have been going door-to-door in order to warn citizens about the spread of the Chikungunya virus. Why should they warn people of this virus that has previously only existed as imported cases? If people contacted this virus only by vacationing in the tropics, why would we need to warn local people? Actually, a few people who did not vacation in the tropics have acquired this disease. CDC reported on the first locally acquired case of Chikungunya on July 17, which was picked up by a man in Florida. Since then, there have been at least four officially reported locally acquired cases of Chikungunya in Florida.

Locally Acquired vs. Imported Cases

What is a locally acquired case and how does it differ from an imported case? An imported case occurs when a person gets bitten by a mosquito while vacationing overseas and shows symptoms of the virus 3-7 days later, usually back at home. A locally acquired case occurs when someone who has the virus gets bitten by a mosquito while at home allowing the mosquito to acquire the virus through their blood. Then, the same mosquito bites someone else who develops Chikungunya.

Activity in the States

chikungunya_map

Data from CDC Website

So what should you do? Make sure to take precautionary measures against mosquitos- especially if you are vacationing in the Caribbean. Also, if you know of someone with Chikungunya, make sure that they avoid mosquitos as well so that they don’t help transfer it to other people. Although Chikungunya has only been locally transmitted in Florida, it would not be very difficult for it to be transmitted in another state as well. If a mosquito were to pick it up, it could easily be spread to more people in a state. Lastly, keep your eyes open for more news about Chikungunya.

To Protect Yourself from Mosquitoes, EPA recommends:

  • Choosing the right repellant and using it safely
  • Removing all still water at least once a week from outside of your house (birdbaths, trash can lids, etc.) and keeping swimming pools chlorinated and circulated
  • Wearing long-sleeved shirts and pants when possible and tucking in shirts
  • Staying indoors when mosquitos are active
  • Using yellow “bug” lights instead of ordinary lights
  • Filling in cracks around your home and repairing broken screens to keep mosquitos out

 

Sabrina Jacobson is a summer intern at the American Chemistry Council’s Chlorine Chemistry Division.

Cleaning up Safely after Flooding
Written by Joan B. Rose, PhD

Cleaning up Safely after FloodingTorrential rainfall in the Midwest and Northeast US this week led to flash flooding, filling basements with water and sewage, which can contain hundreds of pathogens. Residents should assume flood waters are contaminated and that exposure to these waters may raise the risk of diarrhea, dysentery, even hepatitis, skin and eye infections and respiratory disorders.

The first step in the cleanup operation is to remove flood water and sewage and dry the affected area. Powerful fans and enhanced ventilation are helpful for drying damp structural surfaces. Meanwhile, it is important to evaluate items contacted by flood waters, deciding what to discard and what to keep. Whenever possible, a disinfecting solution of water and chlorine bleach should be applied to affected surfaces of saved items.

To help prevent disease transmission associated with flood cleanup, the Water Quality and Health Council offers the following tips:

  • When using a disinfecting solution to clean up after a flood, remember to:
    • Wear gloves and protective clothing. Do not touch your face or eyes.
    • Change the disinfecting solution often and whenever it is cloudy.
    • Be thorough. Wash and dry everything well.
    • When finished, wash your hands thoroughly with soap and water for at least 20 seconds, even if you have worn gloves.
  • If an item got wet, assume it is contaminated.
  • Disinfecting works best when all loose dirt and debris are removed first.
  • Use a disinfecting solution (3/4 cup regular strength chlorine bleach or 1/2 cup concentrated bleach to one gallon of water) to disinfect walls, floors and other surfaces touched by floodwaters. Keep the area wet for at least two minutes, then rinse thoroughly and dry.
  • Carpets and rugs that have been soaked for more than 24 hours should be discarded. If carpets and rugs were soaked for less than 24 hours, evaluate as follows: Carpets that contacted sewage-contaminated floodwater should be discarded. Carpets contacted only clean basement seepage or lawn runoff into a sub-basement, for example, may be dried and cleaned. Washable throw rugs usually can be cleaned adequately in a washing machine. For more information on cleaning flood-damaged carpets and rugs, see this North Dakota State University website.
  • When addressing exterior surfaces, such as outdoor furniture, patios, decks and play equipment, keep surfaces wet for 10 minutes (this may mean wetting the surface more than once), then rinse thoroughly and dry.
  • Chlorine bleach solutions degrade quickly- be sure to make a fresh solution daily as needed. Unused solution may be discharged into toilet or sink.
  • Contaminated clothing should be washed in the hottest possible water with detergent and chlorine bleach if fabric instructions permit.

Disinfecting Private Wells

If the wellhead has been submerged by floodwaters, the well has most likely been contaminated.

If microbial contamination is suspected (if well was flooded or if water is unusually cloudy, odorous or tastes different), immediate disinfection is recommended. If contamination is discovered through water sampling, disinfection is required. Private well water consumers may choose to have their water sampled again immediately after disinfecting to be certain water is safe to drink. Thereafter, periodic sampling can help provide assurance of good drinking water quality.

Consumers of private well water may contact the local health department for advice on well disinfection. This task can be carried out either by ground water professionals or by the homeowner using an array of information resources available from state and local health departments and government agencies. See, for example, the US Environmental Protection Agency’s website, “What to Do After the Flood” at: http://water.epa.gov/drink/info/well/wh atdo.cfm

Note: Depending on the local geology, it is possible for an aquifer (underground water-bearing formation) to become contaminated by floodwater. In such cases, disinfecting the well may not ensure safe water. Aquifer contamination by floodwaters usually clears up after a period of time, but until water sampling confirms good water quality, the household served by a private well should disinfect all water used for drinking and food preparation.

Joan B. Rose, PhD, is the Homer Nowlin Chair in Water Research at Michigan State University and a member of the Water Quality and Health Council.

Ebola: What You Should Know
Written by Ralph Morris, MD, MPH

The deadly Ebola virus is on the move in the West African nations of Guinea, Sierra Leone, Liberia and Nigeria (see outbreak map.) As of August 7, CDC reports the outbreak has infected over 1,700 people and claimed the lives of more than 900. Ebola Hemorrhagic Fever – the formal name of the disease – first appeared in 1976 in Sudan and the Democratic Republic of Congo. The virus was introduced to humans through close contact with the organs, blood, and other bodily fluids of infected animals, such as chimpanzees, gorillas, fruit bats and monkeys.

Ebola has closed schools in Liberia and prompted the president of Sierra Leone to quarantine affected neighborhoods and conduct house to house searches for people who might have been exposed to the virus. What should you know about Ebola?

Important Facts about Ebola1

  • Ebola becomes contagious only when symptoms appear in infected people. It is NOT contagious in an individual without symptoms.
  • Symptoms of Ebola include: fever, headache, joint and muscle aches, weakness, diarrhea, vomiting, stomach pain, lack of appetite and abnormal bleeding.
  • Symptoms may appear anytime from two to 21 days after exposure to the virus; most commonly, symptoms appear between eight and ten days after exposure to the virus.
  • Ebola infections are fatal up to 90 percent of the time.
  • Transmission of the Ebola virus is through direct contact with bodily fluids2 of an infected individual or through exposure to objects like needles that have been contaminated with infected bodily fluids. Based on a 2012 experiment in which Ebola was spread from pigs to monkeys without direct contact between them, CDC and the World Health Organization (WHO) are also concerned about the potential for limited airborne transmission.
  • Ebola is not transmitted from contaminated food or water.
  • Although researchers are working on vaccines, as of now there are no medicines or vaccines to cure Ebola. However, a highly experimental serum, “ZMapp,” a monoclonal antibody, is showing promising results in reversing the course of the disease (see CNN Health report).

The Role of Infection Control

CDC Information for Travelers

On July 31, CDC issued a “Level 3” alert to avoid nonessential travel to Guinea, Sierra Leone and Liberia. A Level 3 alert protects travelers and limits their use of overburdened clinics and hospitals in outbreak-affected regions. Consult the CDC Ebola Hemorrhagic Fever webpage for updates on Ebola’s geographic spread.

Practice good hand hygiene, washing your hands frequently with soap and warm water for at least 20 seconds; if soap and water are unavailable, alcohol-based hand sanitizer may be used.

Because Ebola symptoms usually take between eight and ten days to appear, and early symptoms may be nonspecific, it is possible that the virus will continue to spread geographically by travelers from West Africa who do not know they are infected. That is why it is so important, according to the WHO, that healthcare workers “apply standard precautions consistently with all patients – regardless of their diagnosis – in all work practices at all times. These include basic hand hygiene, respiratory hygiene, the use of personal protective equipment (according to the risk of splashes or other contact with infected materials), safe injection practices and safe burial practices.”

WHO notes further measures for healthcare workers caring for patients with suspected or confirmed Ebola virus include avoiding exposure to the patient’s blood and body fluids and direct unprotected contact with the possibly contaminated environment. WHO provides explicit directions for preparing bleach solutions for disinfecting reusable equipment, gloved hands between patients, spills of infectious body fluids and more.

Halting the Outbreak

The World Health Organization documents 24 Ebola outbreaks between 1976 and 2012. Commenting on “the biggest and most complex Ebola outbreak in history,” CDC Director Tom Frieden, MD, MPH noted CDC would supplement its current staff of approximately 24 disease control experts in West Africa with 50 additional workers to assist efforts to prevent Ebola-infected people from boarding airplanes. In the event that a sick passenger does board a plane, CDC has issued guidance to airlines for managing ill passengers and crew and for disinfecting aircraft.

There is no question that in addition to CDC participation, this outbreak will require harnessing a strong global public health partnership among the nations of the world. It’s what we need to do to combat the Ebola killer.

Ralph Morris, MD, MPH, is a Physician and Preventive Medicine and Public Health official living in Bemidji, MN.


1 Based on CDC information at: http://www.cdc.gov/vhf/ebola/outbreaks/guinea/qa.html and World Health Organization information at: http://www.who.int/mediacentre/factsheets/fs103/en/
2 Bodily fluids that may transmit Ebola include blood, urine, stool, semen, saliva and sweat.

Avoiding Chikungunya and Other Mosquitoborne Illnesses
Written by Ralph Morris, MD, MPH

Chikungunya
Chikungunya is spread by Aedes mosquitoes, which are found throughout much of the world.

A pediatrician returned home to Minnesota recently after providing voluntary medical service in Haiti. She arrived with “crushing joint pain” from chikungunya (pronounced: \chik-en-gun-ye), a viral infection spread by mosquitoes. The exotic-sounding disease can cause high fever in addition to joint and muscle pain. These symptoms are similar to those of dengue, another mosquitoborne illness that currently threatens the popular FIFA World Cup™ games in Brazil.

According to the Centers for Disease Control and Prevention (CDC), chikungunya is rarely deadly and most people feel better within a week, but for some, joint pain may persist for months.  The Minnesota pediatrician declared to the Minneapolis Star Tribune:  “I’ve broken a bone. I’ve had other medical issues. I don’t think I’ve ever been in so much pain.”

“That which bends up”

The term “chikungunya” comes from the African Kimakonde language, meaning “that which bends up,” a reference to the stooped appearance of those suffering with joint pain brought on by the virus. Mosquitoes become infected with the virus after biting someone with chikungunya; they then spread the virus when they bite others. CDC notes that people at risk for the most severe symptoms include newborns infected around the time of birth, older adults and people with medical conditions such as high blood pressure, diabetes or heart disease.  If you develop symptoms of chikungunya, seek medical attention and be sure to tell your doctor if you have traveled recently.

A Spreading Infection

The World Health Organization reports outbreaks of chikungunya have occurred in Africa, Asia, India and Europe.  The virus appeared in the Caribbean region late in 2013; since then, over 100,000 cases have been recorded.  CDC is monitoring the spread of chikungunya, which so far has not been transmitted locally on the US mainland.  According to a CNN interview with a CDC expert, however, based on a current major outbreak in the Caribbean, “it’s just a matter of time before it starts to spread within the United States.”

Tips for Avoiding Chikungunya1 and Other Mosquitoborne Illnesses

There are no vaccines available to avoid mosquitoborne chikungunya, dengue and West Nile Virus.  Control depends upon a multi-barrier approach to mosquito exposure:

  • Physical Barriers:  Use air conditioning or window/door screens to keep mosquitoes out of indoor areas.  Keep screens in good repair. If you are not able to protect yourself from mosquitoes inside your home or hotel, sleep under a mosquito bed net.
  • Chemical Barriers:  Use insect repellent2 before going to tropical (e.g., the Caribbean region) or wooded areas near water.  Be sure outdoor swimming pools and hot tubs are properly chlorinated.  If you use both sunscreen and insect repellent, CDC recommends applying sunscreen first, followed by insect repellent.3
  • Habitat Protection:  Remove standing water where it may collect in depressions, buckets, flower pots and other open containers.  These are choice locations for mosquito breeding.  If standing water cannot be easily drained, treat with chlorine bleach.
  • Clothing:  Wear long sleeves and long pants outdoors when possible.  Aedes mosquitoes—transmitters of chikungunya and dengue viruses—are most active during daylight hours. According to a CDC Fact Sheet, many of the mosquitoes that transmit West Nile Virus are active from dusk to dawn.
  • Transmission to Others:  Finally, if you are sick with a mosquitoborne illness, avoiding mosquitoes and their bites will help prevent spreading the virus to others.

A Word to the Traveler:  CDC’s interactive Travelers’ Health website can help you stay healthy while away from home.

 

Ralph Morris, MD, MPH, is a Physician and Preventive Medicine and Public Health official living in Bemidji, MN.

 


1 Based on CDC “Protect Yourself from Mosquito Bites” and the World Health Organization “Chikungunya”.

2 According to CDC, repellents containing DEET, picaridin, IR3535, and oil of lemon eucalyptus and para-menthane-diol products provide long lasting protection against mosquitoes.

3 Always follow label instructions when using insect repellent or sunscreen.

Middle East Respiratory Syndrome Corona Virus: MERS-CoV
Written by Barbara Soule, R.N. MPA, CIC, FSHEA and Joan B. Rose, PhD

Norovirus Season  Its Not Over Til Its OverAn Emerging Virus

Middle East Respiratory Syndrome, “MERS,” is a respiratory illness caused by an emerging coronavirus1.  Although other coronaviruses are common, the MERS coronavirus (“MERS-CoV”) has only recently been reported to infect people.  Symptoms of MERS include fever, cough and shortness of breath.  MERS has proven fatal for approximately 30 percent of individuals infected.  There is no vaccine or antiviral treatment for MERS, according to the Centers for Disease Control and Prevention (CDC).  Supportive therapy, such as assisted breathing devices may be provided to patients during the illness.

First reported in Saudi Arabia in September, 2012, CDC recently noted the frequency of reporting of MERS cases has increased since mid-March of this year.  Most cases of MERS are in the Middle East. Headlines were made in May when single cases of MERS were announced in Indiana, Florida and Illinois; the Illinois diagnosis was later determined to be in error.  The Indiana and Florida cases involved individuals who contracted MERS in Saudi Arabia and then traveled to the US.  CDC notes that most US residents have a very low risk of contracting MERS.

Animal Origin?

MERS Outbreak Statistics

The World Health Organization reports since April, 2012, 636 laboratory-confirmed cases of human infection with MERS, including 193 deaths (statistics as of May 28, 2014). Most MERS cases represent people in the Middle East, but also include people who had recently travelled from Middle Eastern countries. The latest MERS disease outbreak news can be found on the World Health Organization’s Global Alert and Response web page.

According to the CDC, it is likely that MERS came from an animal source, possibly camels or bats; the virus has been detected in these animals in the Middle East.  Some people who were infected with MERS had close contact with camels or with other persons infected with the virus.  The potential mode of transmission from animals to humans is not understood, but human to human transmission through close contact and contact with contaminated surfaces and/or virus transfer to the hands are all probable.  Viruses on the hands are transmitted to the eyes, nose or mouth through touching.

Who is at Increased Risk?

According to CDC, you may be at increased risk of contracting MERS if you:

  • Traveled recently to the Arabian Peninsula
    • If you develop fever and symptoms of respiratory illness within 14 days of travel to countries in or near the Arabian Peninsula, notify a healthcare provider of your recent travel and stay home to reduce the possibility of spreading the illness to others.
  • Have close contact with an ill person who recently traveled to the Arabian Peninsula
    • Monitor your health for 14 days after having had close contact with the ill person. If you develop fever and symptoms of respiratory illness, call ahead to a healthcare provider and mention your recent contact with the traveler.
  • Have close contact with a confirmed or probable case of MERS
    • Contact a healthcare provider for an evaluation.

Prudent Precautions

Disinfecting Surfaces

University of Michigan researchers showed that keeping surfaces disinfected is just as important as hand washing to reduce your risk of viral infection.2 The research was done as part of the Center for Advancing Microbial Risk Assessment, supported by the US Department of Homeland Security and the Environmental Protection Agency.

To reduce your risk of MERS, CDC recommends:

  • Wash your hands often with soap and water for 20 seconds and help young children do the same; alcohol-based hand sanitizer may be used when soap and water are not available.
  • Clean and disinfect frequently touched surfaces such as toys and doorknobs. A  Colorado State University fact sheet recommends one minute of surface contact with a 1:10 solution of household bleach and water3
  • Cover your nose and mouth with a tissue when you cough or sneeze, and then throw the tissue in the trash.
  • Avoid touching your eyes, nose and mouth with unwashed hands.
  • Avoid personal contact, such as kissing, or sharing cups or eating utensils, with sick people.

For more information on MERS, please see this CDC website.

 

Barbara M. Soule, R.N. MPA, CIC, is an Infection Preventionist and a member of the Water Quality & Health Council.

Joan Rose, PhD, is the Homer Nowlin Chair in Water Research at Michigan State University and a member of the Water Quality and Health Council.

 


1 Coronaviruses are named for the crown-like spikes on their surfaces.  Coronaviruses cause everything from the common cold to Severe Acute Respiratory Syndrome (SARS).

2 Li, S. et al. (2009).  “Dynamics and Control of Infections Transmitted From Person to Person Through the Environment,” American Journal of Epidemiology, 170(2): 257-65.

3 5,000 parts per million free available chlorine

What Can You Safely Mix with Bleach?
Written by Linda Golodner

Can bleach be mixed with…?1

Toilet bowl cleaner?

NO

Rust remover?

NO

Acids, such as vinegar or lemon or lime juice?

NO

Ammonia?

NO

Cleaning products containing ammonia?

NO

Plain water?

YES

Laundry detergent2?

YES

Mixing Cleaning ProductsWhen tackling household cleaning chores, soap and water and a little “elbow grease” are sufficient for ridding many surfaces of dirt and grime. When cleaning kitchen and bathroom surfaces, however, disinfectants are needed to destroy bacteria and viruses like E. coli, norovirus, salmonella and listeria, methicillin-resistant Staphylococcus aureus (MRSA) and other microorganisms that can spread illness.

One effective and inexpensive option for disinfecting surfaces is a simple solution of chlorine bleach and water. Most routine household disinfection can be done using just one teaspoon of bleach in one quart of water. Disinfecting surfaces can help ensure a healthier environment for your family. Disinfecting safely is another matter.

Mixing bleach with other cleaning products could produce hazardous gases! The key to using bleach safely is keeping it simple: Avoid mixing bleach or bleach-containing products with other cleaning products. And never, ever mix bleach or products containing bleach with ammonia or acids! For example, toilet bowl cleaners, which often contain acid, should never be mixed with bleach in a bucket, toilet, or anywhere. Always read and follow manufacturers’ directions carefully

Keep it simple: When disinfecting surfaces with bleach, just add water.

Linda Golodner is President Emeritus of the National Consumers League and Vice Chair of the Water Quality & Health Council.


1This list is not comprehensive of all the potential substances that are incompatible with chlorine bleach.
2Follow manufacturers’ directions on bleach or laundry detergent label.