Dr. Harley Rotbart’s GERMBlog™

Not to be outdone by bacteria “superbugs” in the news lately (see GERMBlog posts of 10/17/07 and 10/28/07), a usually benign “common cold” virus has taken upon itself to become more potent and even deadly. Adenoviruses are well known causes of the common cold and other respiratory (and gastrointestinal) infections in kids and adults. While we can blame the bacteria “superbugs” on overuse of antibiotics and the “learned” resistance by bacteria to those antibiotics (see GERMBlog post of 10/17/07), this mutated adenovirus is not the result of overtreatment – we don’t have medicines for the adenoviruses, and so we haven’t been able to overuse them! Rather, this virus illustrates the natural ability of germs to change for the worse, something we fear with other viruses as well, such as those that cause Bird Flu and AIDS (see Chapter 3 in Germ Proof Your Kids – The Complete Guide to Protecting (without Overprotecting) Your Family from Infections (ASM Press, Washington, D.C., 2008).

Adenoviruses are not the most common of the common cold viruses – rhinoviruses hold that distinction (see Chapters 1-3 in Germ Proof Your Kids – The Complete Guide to Protecting (without Overprotecting) Your Family from Infections). But adenoviruses also cause this benign and ever-present infection and up until recently, that hasn’t been of great interest or concern – a cold is a cold is a cold, right? Well, that was true until May, 2006 when a 2 week old baby died of adenovirus type 14. This past spring (2007), 140 additional cases of adenovirus 14 infection were diagnosed across 3 states (Oregon, Washington, and Texas). More than one-third of those patients were hospitalized and one in 6 required intensive care; nine of the patients died – not your typical common cold, by any means. Pneumonia was the cause of the severe disease and deaths in most of the cases; numerous cases have been in kids; one large cluster of cases in Texas occurred among trainees at an air force base.

Even though there has been no clear contact between the first patient in NY in 2006 or the subsequent outbreaks in OR, WA, and TX, genetic analysis shows that all of the viruses from these patients are identical. It is adenovirus 14, indeed, but it has mutated from the benign common cold version of adenovirus 14 that has been known about for more than 50 years.

Once infected, there is no specific (that is antiviral drug) treatment for adenoviruses – the best that can be done is to provide good supportive care to ill patients. That includes supporting their breathing requirements, fluid requirements, and nutrition. Prevention of respiratory virus infections like adenovirus 14 is discussed extensively in Chapters 9-11 of Germ Proof Your Kids – The Complete Guide to Protecting (without Overprotecting) Your Family from Infections

For further reading, see the November 16 issue of the CDC’s Morbidity and Mortality Weekly at www.cdc.gov/mmwr.

Severe malnutrition is virtually unheard of in nursing babies regardless of where in the world those babies are born and regardless of what horrific nutritional hardships their mothers may face. Indeed, the term “kwashiorkor” referring to one of the most serious forms of protein-energy malnutrition, is derived from the Ghana word meaning “the one who is displaced” – the child weaned from the breast when a new sibling is born – it is the weaned child who faces the gravest risk of malnutrition.

It has been estimated that optimizing breast feeding worldwide would save the lives of more than 1 million children who die of gastrointestinal and respiratory infections. Analysis of the components of human milk reveals a wide array of immune-enhancing substances. Antibodies, the essential infection protection proteins targeted to specific germs (see Chapter 4 in Germ Proof Your Kids – The Complete Guide to Protecting (without Overprotecting) Your Famiily From Infections), are plentiful in breast milk. The infection experiences of moms, as reflected in the antibodies circulating in their bodies, are passed on to babies through breast feeding. Once consumed by the baby, breast milk secretory antibodies coat the baby’s gastrointestinal tract, protecting the infant against germs that mom has been exposed to – and therefore against germs likely to infect the baby. Cow’s milk, in contrast, contains only negligible amounts of these antibodies, targeting only germs to which the lactating cow has been exposed – clearly, not as useful a protection for human babies.

Beyond antibodies which provide direct anti-germ activity, human breast milk also contains the protein lactoferrin which binds tightly to iron molecules. Many intestinal bacteria need iron to do their harm – lactoferrin deprives these dangerous germs of this sustenance, making more room for the “good bacteria” that babies need to help them digest milk and food. By another mechanism, lactoferrin blocks the binding and penetration of several important viruses, including herpes, cytomegalovirus, and HIV (see Chapter 3 in Germ Proof Your Kids – The Complete Guide to Protecting (without Overprotecting) Your Famiily From Infections. Finally, lactoferrin stimulates certain parts of the immune system of the newborn while inhibiting other detrimental inflammatory reactions.

Other beneficial protein contents of human milk include: lysozyme which bursts bad bacteria; and casein which blocks the ability of certain dangerous bacteria to stick to stomach and respiratory cells while promoting the growth of good bacteria in the intestines.
Carbohydrates in human milk also afford protection against bacteria, bacterial toxins, and viruses by binding to them and preventing them, in turn, from binding to babies’ intestines and airways. Breast milk also contains carbohydrates which serve as “prebiotics” (see Chapter 9 in Germ Proof Your Kids – The Complete Guide to Protecting (without Overprotecting) Your Famiily From Infections), promoting the growth of “good bacteria” in infants’ guts. Fats in human milk are broken down to form smaller molecules which inactivate germs that contain fat in their own outer walls – like enveloped viruses (including herpes and HIV) and many bacteria, fungi, and parasites. Still other breast milk compounds help stimulate the development of the infant’s immune system. Human milk is also rich in anti-oxidants, anti-inflammatory enzymes, and vitamins.

For much more about the Miracle of Mom’s Milk, including the actual evidence for protection of babies against dangerous infections , see Chapters 4 and 9 in Germ Proof Your Kids – The Complete Guide to Protecting (without Overprotecting) Your Famiily From Infections.

The latest E.coli invasion appears to have occurred through the pepperoni toppings on frozen pizza. E.coli are everywhere, but strains that can cause severe disease in kids are fortunately rare. When they do appear, they usually get to kids via some kind of animal (usually cow) contamination – bad beef at the fast food restaurant, or veggies (e.g. spinach) grown in fields where cows grazed, or unpasteurized fruit juice from trees in fields where cows grazed. For much more about E.coli food poisoning and the Hemolytic Uremic Syndrome that it can cause in kids, see Chapters 3 and 9 of Germ Proof Your Kids – The Complete Guide to Protecting (witihout Overprotecting) Your Family from Infections.

Here are the important points, excerpted with my commentary, from the CDC alert regarding frozen pepperoni pizza:

-As of November 1st, at least 21 cases of E. coli food poisoning have occurred, scattered over 10 states: Illinois (1 person), Kentucky (3), Missouri (2), New York (2), Ohio (1), Pennsylvania (1), South Dakota (1), Tennessee (8), Virginia (1), and Wisconsin (1).

-People became ill between July 20, 2007, and October 10, 2007.

-The age of ill persons ranges from 1 to 65 years with a median age of 9.

-At least 8 people have been hospitalized, and 4 have developed a type of kidney failure known as hemolytic-uremic syndrome, or HUS. (For more about HUS, see Chapter 3 of Germ Proof Your Kids – The Complete Guide to Protecting (without Overprotecting) your Family from Infections.

-No deaths have been reported.

-A study comparing foods eaten by ill persons to foods eaten by well persons showed that eating frozen pizza that contained pepperoni and was produced by the General Mills company under the brand names of Totino’s or Jeno’s was the likely source of the illness.

-How the E.coli got into the pepperoni is not yet known, but past experience would point to possible contamination at meat processing or food preparation facilities.

-Consumers should not eat recalled Totino’s or Jeno’s brand frozen pizzas that contain pepperoni as a topping.

-Anyone who has eaten the product but did not become ill need not take any special action.

-People who are ill with diarrhea within a week of consuming this type of frozen pizza should seek medical care and let their doctor know about the exposure.

-Consumers with questions about the recall should contact the company at 1-800- 949- 9055. Representatives will provide information about how to contact the company for a full refund.
-Consumers are reminded to always thoroughly cook all products that are not ready-to-eat, such as frozen pizzas, according to package instructions.

Please see Germ Proof Your Kids – The Complete Guide to Protecting (without Overprotecting) Your Family from Infections for much more about ways to prevent food poisoning due to E.coli and other germs.

Harley A. Rotbart, M.D.
www.germproofyourkids.com