Our Latest Perspectives Posts

Hantavirus in North America: Rare but Deadly
Written by Ralph Morris, MD, MPH

The Deer Mouse is one of at least four rodents known to spread hantavirus
(photo courtesy of CDC)

Spring cleaning time is here, and chores may include sweeping out garages, basements, sheds, cottages and cabins.  Keep in mind that these environments may contain rodent droppings, which can present a rare but deadly health risk from hantavirus.  Hantavirus was first recognized in North America in May, 1993 in The Four Corners area of Arizona, New Mexico, Colorado and Utah. The first case probably occurred in Utah in 1959.  It has since been found in other states and other countries.

According to the Centers for Disease Control & Prevention (CDC) website, people become infected with hantaviruses through contact with infected rodents, their urine or their droppings.  To date, CDC has identified Deer Mice, Cotton Rats, Rice Rats and White-footed Mice as hantavirus carriers. Descriptions of these rodents and maps showing their distribution throughout North America are available on the CDC website. Continue reading “Hantavirus in North America: Rare but Deadly” »

Does Exposure to Bleach Cause or Help Prevent Childhood Infections?
Written by The Water Quality & Health Council

A short report in the journal Occupational & Environmental Medicine concludes passive exposure to weekly use of bleach in the home could promote some infections in school-age children. The report is poorly documented, highly speculative and although the researchers recommend exercising caution when interpreting their results, some in the media have erroneously interpreted the findings as definitive, with headlines such as: “How cleaning with bleach can make children ill: Those living in super clean houses are 20% more likely to catch flu, tonsillitis and pneumonia.”
Continue reading “Does Exposure to Bleach Cause or Help Prevent Childhood Infections?” »

Easter Egg Safety
Written by Water Quality & Health Council

Dyeing Easter eggs and organizing Easter egg hunts are treasured traditions in many families. Enjoying these traditions safely—without foodborne illness—is a matter of following a few commonsense guidelines.  We provide the following Easter egg safety tips based on US Department of Agriculture (USDA) recommendations with our wishes for a healthy, enjoyable holiday.

Buying Eggs

Buy eggs from a refrigerated case.  Open the carton and inspect for clean, uncracked shells. The egg carton should be imprinted with a USDA grade shield and indicate a future “sell by” date (see photos below). Continue reading “Easter Egg Safety” »

Fighting Antibiotic Resistance at Home and Globally
Written by Water Quality and Health Council

The conclusion of a series of articles on the challenge of antimicrobial resistance

We all have a stake in the outcome of the battle against antimicrobial resistance. Everyone, from the global public health expert to the ordinary citizen, can play a role in reversing a dangerous trend in the balance of power between humans and pathogens.

Antimicrobial resistance has the potential to erase the astonishing gains made possible by the use of antibiotics over the past 70 years.  According to a report from the Infectious Diseases Society of America, although the widespread availability and effectiveness of antibiotics has positively impacted surgery, care of premature infants, cancer chemotherapy, care of the critically ill, transplantation medicine, and even our ability to respond to bioterrorism and pandemics, that widespread availability along with misuse has resulted in antimicrobial resistant pathogens.  This unintended consequence is already exacting a toll on both human health and wealth, as highlighted in a new UK report.  The toll will skyrocket if we fail to respond to the challenge of antimicrobial resistance over the course of the next several decades.

The Promise of New Discoveries

Researchers recently announced the preliminary discovery of a new class of antibiotics that may be effective against a wide range of drug-resistant bacteria for decades. The new class of drugs was identified using innovative culturing techniques. These antibiotics attack fat molecules in bacteria cell walls. A similar mechanism is responsible for 30 years of successful use of the antibiotic vancomycin before antimicrobial resistance developed against it.

Despite some encouraging new discoveries (see sidebar), pharmaceutical innovation has not kept pace with the ever-evolving resistance of our microscopic enemies.  Factors favoring development of antimicrobial resistance include overuse and misuse of antibiotics for both man and animals.  Inadequate attention to appropriate disinfection measures also contribute, as evidenced by recent news that a lack of wastewater treatment in Rio de Janiero, could result in the exposure of Olympic athletes to resistant superbugs in water venues chosen for the coming 2016 Olympic sailing and wind-surfing events.

What Everyone Can Do to Fight Antimicrobial Resistance

Each of us can turn our concern over antibiotic resistance into action.  First, we can focus on preventing the illnesses that require antibiotics by adopting a healthy life style.  Promote a strong immune system with a healthy diet, regular exercise and adequate rest, and make sure family members and other close contacts are up to date with vaccinations and flu shots.  Implement safe disinfection practices in the home when a family member develops an infectious illness.  Isolating sick individuals and disinfecting frequently touched surfaces helps prevent the spread of infection to others.  Safe food handling is also extremely important in preventing infectious illness.  Consumers can consider purchasing meat and egg products that indicate animals were raised on a diet without unnecessary antibiotics.  The U.S. Food and Drug Administration, for example, is working with industry to promote only the appropriate use of antibiotics in animal agriculture as described on its website, “Judicious Use of Antimicrobials”.

If antibiotics are prescribed, they should be taken exactly according to directions.  Antibiotic use should not be discontinued until the entire prescribed dose is taken (unless otherwise instructed by a doctor), and antibiotic prescriptions should not be shared with others.  If any medication remains, it should be disposed of properly – returned to the pharmacy, not flushed down the toilet.

Antimicrobial Resistance as a Sustainable Development Goal

Antimicrobial resistance is beginning to be recognized as a global challenge.  Currently, representatives of the world community are developing a set of global Sustainable Development Goals1 for the UN’s “post-2015 agenda”.  To date, the UN General Assembly has accepted a set of 17 proposed Sustainable Development Goals as a starting point for the post-2015 agenda.  The goals encompass everything from poverty eradication to building resilient infrastructure and providing safe drinking water and sanitation. We suggest Goal #3, to “Promote healthy lives and ensure well-being for all at all ages,” include a target that promotes best practices to combat antimicrobial resistance, including responsible use of antibiotics, policies that encourage drug innovation and infection control and prevention.

When it comes to antimicrobial resistance, we stand at a crossroads:  The next steps determine the future.

Click here to download this article

1 These goals will further the progress achieved under the UN’s Millennium Development Goals (2000-2015).

Superbugs and the 2016 Summer Olympics
Written by Water Quality and Health Council

The second of a series of articles on the challenge of antimicrobial resistance

An antimicrobial resistant “superbug” could give sailors and windsurfers competing in the 2016 Summer Olympics more to worry about than their athletic performance.  Evidence of superbugs–bacteria resistant to common antibiotics—have been found in the sewage-laden Carioca River, which flows into Guanabara Bay, the planned site of Olympic sailing and windsurfing events.

A new study1 by Rio’s Instituto Oswaldo Cruz identifies a superbug enzyme at three points along the heavily polluted Carioca River. Infections from antimicrobial resistant superbug bacteria require stronger than normal antibiotics and could require hospitalization, according to the study’s coordinator (see RT article).  Additionally, carriers of antimicrobial resistant bacteria can spread serious infections to others.

A Dirty State of Affairs

Wastewater Treatment Basics

In the first steps of wastewater treatment, known as primary treatment, particles are physically removed by screening, settling and flotation. Secondary treatment includes bubbling air through wastewater to allow bacteria to metabolize pollutants. Next, much of the bacterial load is removed by settling in a chamber known as a secondary clarifier. In the final step, municipal wastewater is disinfected, but sometimes only on a seasonal basis or if the receiving stream is to be used for recreation.

Rio de Janeiro is the third largest metropolitan area in South America after Sao Paulo and Buenos Aires. The city’s population is estimated at 6.35 million (see World Population Review), but the population of the metropolitan area is nearly double that.  A very large portion of Rio’s sewage remains untreated before discharge, and much of it flows into Guanabara Bay resulting in a threat to human health and well-being. Beaches are unsuitable for swimming and fish die-offs signal environmental deterioration.

Organizers have promised to reduce Guanabara Bay pollution by 80 percent before the start of the Olympics, but Rio’s mayor admitted in June, 2014 that the city would not meet that target.

Reducing Opportunities for Superbugs

Wastewater treatment is of paramount importance for at least two reasons:

First, releasing untreated sewage into Rio’s waterways degrades the aquatic environment.  As organic substances in sewage biodegrade, water is depleted of dissolved oxygen, killing fish and other aquatic life.  Water is rendered disagreeable for recreational and aesthetic uses.  Second, untreated wastewaters contain microorganisms that can cause disease.  Scientists know that bacteria may share genes that impart antibacterial resistance. Are the dirty waters of the Carioca River spawning the superbugs recently identified? Are superbugs evolving even in treated wastewater that is not disinfected year-round?  What is the appropriate level and type of wastewater disinfection needed to avoid promoting superbug development?

Looking Ahead

Research is being conducted to understand how various wastewater treatment techniques affect antibiotic resistant bacteria.2  The ultimate goal is to eliminate or at least reduce antibiotic resistant bacteria to safe levels in effluent released into the environment, not just in Brazil, but everywhere because antimicrobial resistance has become a global problem.  We encourage Rio de Janeiro officials to work with Instituto Oswaldo Cruz and others to determine and implement the most effective action to address this public health aspect of water pollution.

The Water Quality and Health Council hopes that the intersection of the prospect of the 2016 Summer Olympics and the appearance of superbugs in the Carioca River will catalyze an appropriate response to a serious water quality problem in Rio de Janeiro.  We commend those who already are striving to clean up Guanabara Bay and wish them the greatest success, but we also hope that efforts being made to adequately treat Rio’s sewage prior to discharge do not wane after the Olympics.  While healthy waters many not be a reality by the time of the summer games, having a serious long-term plan in place could be the first step in a shining example of recovery.

Click here to download this article

1 The study is available in Portuguese only.

2 See, for example, “Urban wastewater treatment plants as hotspots for antibiotic resistant bacteria and genes spread into the environment: a review” (abstract)


Antibiotic Resistance: Standing at a Critical Juncture
Written by Water Quality and Health Council

The first of a series of articles on a looming global crisis

German philosopher Friedrich Nietzsche famously said:  “That which does not kill us makes us stronger.” If the many pathogens that are becoming immune to antibiotics could speak, Nietzche’s quote would be their battle cry.  These disease-causing germs are gaining the upper hand as they become increasingly resistant to the very weapons—antibiotics—that humans developed to kill them.  A new UK report1, titled “Antimicrobial Resistance:  Tackling a crisis for the health and wealth of nations,” explores the issue of antibiotic resistance with the goal of averting what the report calls “a looming global crisis”.

Antibiotics Changed the World

Sir Alexander Fleming’s accidental discovery of penicillin from a mold culture in 1928 is one of the most significant medical breakthroughs of all time. Penicillin helped cure tuberculosis and pneumonia, once common killers. Surgery and wound treatment became much more successful with the advent of antibiotic “wonder drugs”.

A Costly Health Threat

Antibiotic resistance undermines our ability to fight infectious diseases and manage the infectious complications common in patients undergoing chemotherapy, dialysis and surgery.  The US Centers for Disease Control and Prevention (CDC) calls antimicrobial resistance one of our most serious health threats, and notes that at least 23,000 people in the US die each year as a direct result of antibiotic-resistant infections.  CDC points out in a 2013 report2 that antibiotic use in food-producing animals may also contribute to the problem as animals and their droppings serve as carriers of resistant bacteria, transmitting them to humans through the food supply (see graphic below).

Resistant pathogens spread with ease throughout our highly interconnected world, and therefore the problem of antibiotic resistance must be tackled internationally. The UK report notes that antibiotic resistance results in an estimated 500,000 deaths globally each year, a figure that could rise to 10 million by 2050, outpacing all other major causes of death, including cancer, diabetes, diarrheal disease and road traffic accidents.  Economic costs could reach $100 trillion by 2050, with disproportionate impacts on the emerging economies of Brazil, Russia, India and China.

The Making of a Crisis

The authors of the new report cite several factors leading to the current state of affairs regarding antibiotic resistance, including:

  • Antibiotic use has outpaced the development and approval of new antibiotics.
    Pathogens naturally evolve resistance to antibiotics over time. Key to overwhelming the “moving target” of pathogen evolution is a steady supply of new antibiotics—something we have failed to produce due to a variety of economic and policy disincentives.  The Generating Antibiotics Incentives Now (GAIN) Act (see FDA blog), signed by President Obama in July, 2012, provides incentives to developing new antibacterial drugs.  The new antibiotic Zerbaxa®, for example, was approved recently under this Act.  Zerbaxa® will be used to combat infections of resistant Gram-negative pathogens, which currently represent a serious public health threat.
  • There is widespread excessive and unnecessary use of antibiotics.
    Unwarranted antibiotic use exacerbates antimicrobial resistance.  In some countries, antibiotics are available without a prescription.  In addition, prescribing practices vary from place to place, and “counterfeit and sub-standard antimicrobials” further complicate the picture.
  • The availability of antibiotics may have reduced our focus on infection prevention.
    Instead of investing sufficient resources on infection control and prevention, we may have become overly dependent on antibiotics to combat pathogens.  A renewed focus on prevention, through immunization, hygiene and disinfection, is simpler, and preferable to treating human infection.

The discovery of antibiotics changed the world, combating a host of deadly infections that once shortened lifespans and reduced human productivity.  We now stand at a critical juncture:  Will we take the collective actions needed to preserve the use of antibiotics, or will we lose this precious technology at great human and economic cost?

Excerpt from CDC graphic in the report, “Antibiotic Resistance Threats in the United States, 2013”

For more information on antibiotic resistance, please see the CDC website:  Antibiotic/Antimicrobial Resistance.

Click here to download this article

1 Antimicrobial Resistance:  Tackling a crisis for the health and wealth of nations, December, 2014.
2 US Centers for Disease Control and Prevention, 2013. “Antibiotic Resistance Threats in the United States, 2013”

Thanksgiving Stress: What Rates High on Your Meter?


Thanksgiving is meant to be a delightful day centered on family, friends, and food. Traditions play a big role on this day, whether it is a brisk pre-dinner hike, watching football on TV, or giving everyone at the table a chance to express what he or she has been most grateful for this year.

Thanksgiving is not necessarily a stress-free holiday, however:  Cooks feel pressure to produce a special feast; travelers are forced to deal with transportation and traffic delays; and increasingly, advertisers tempt us to shorten our Thanksgiving celebration and start our holiday shopping on Thanksgiving or in the wee hours of “Black Friday.”  A survey we conducted a few years ago found more than one-third of Americans polled were concerned about “being around an annoying relative” on Turkey Day.  In fact, more folks were concerned about sitting next to crazy Uncle Joe (37%) than they were about getting sick from improperly prepared food (31%).

We can’t help you with your traveling, shopping or interpersonal skills, but we can offer a concise bit of advice on avoiding foodborne illness as the kitchen is activated for holiday cooking.  Just remember: Clean, Separate, Cook and Chill. See the box below for details:

Avoiding Foodbore Illness this Thanksgiving

Clean – wash all food contact surfaces with hot, soapy water followed by sanitizing with 1/2 tablespoon regular strength or 2 teaspoons of high strength chlorine bleach in 1/2 gallon of water. Do this before and after working with raw foods.

Separate – keep fresh fruits and vegetables separate from raw meat, poultry and seafood.

Cook – to kill any bacteria that might be present, thoroughly cook meat, poultry and eggs to the appropriate temperature.

Chill – refrigerate leftover perishables at 40 degrees within 2 hours of cooking or serving.

The Water Quality & Health Council wishes you a safe, healthy
and thoroughly enjoyable Thanksgiving!

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.


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