Dr. Harley Rotbart’s GERMBlog™

With summer vacation just around the corner, you’re probably wondering how to make sure your family stays healthy during, and after, that long-planned getaway. Depending on where your travel plans take you, the risks may vary from the benign summer cold to more serious germs unique to exotic locales. Here’s a 7 step guide to healthy summer travel excerpted from the new book, Germ Proof Your Kids – The Complete Guide to Protecting (without Overprotecting) Your Family from Infections (ASM Press, Washington, D.C., 2008):

1. Immunize your kids. If your travel is domestic, the important vaccines are those required for school. They protect against serious infections that can occur year round, like meningitis, whooping cough, hepatitis A (the kind your kids can get from food contamination in U.S. restaurants as well as those abroad), mumps, chickenpox, and stomach flu (due to rotaviruses). If you’re traveling abroad, the recommended school vaccines protect against those same infections, as well as diseases we see less often in the U.S., but which are still prevalent in other parts of the world – e.g. polio, tetanus, and measles. Finally, travel to certain parts of the world requires immunizations that are not required in the U.S. You should check with your local or state health department before travel to determine what special vaccine precautions are recommended for your destination. For a complete discussion of vaccine value and safety, see Chapter 7 of  Germ Proof Your Kids – The Complete Guide to Protecting (without Overprotecting) Your Family from Infections (ASM Press, Washington, D.C., 2008).
2. Wash their hands.  Whether your kids are at home or on the road, hand washing is the single most effective strategy in reducing the spread of infections. Kids typically spend less than 5 seconds washing and leave the sink with their hands dripping wet. A 20-30 second wash and thorough drying will reduce the germ load by as much as a 1000-fold. Simple soap and water work just fine, but sinks can be hard to find when you’re on the road. Alcohol wipes and rubs kill germs very effectively and are “self-drying”, making them ideal for your purse and the glove box in the car. Hand washing moments on trips include anytime there is contact with lots of people or with inanimate objects that lots of people handle – e.g. the security and customs lines at airports, the baggage claim carousel, tour buses and taxi cabs, public restrooms, etc. For a complete discussion of personal and community hygiene, see Chapter 9 of Germ Proof Your Kids – The Complete Guide to Protecting (without Overprotecting) Your Family from Infections (ASM Press, Washington, D.C., 2008).
3. Use bug spray and do “tick checks”. Mosquitoes and ticks continue to be the most common U.S. vectors for diseases like encephalitis, Lyme disease, and tick fevers but simple preventive measures can reduce their impact.  When possible, kids should wear long sleeves and long pants on camping trips and hikes in the woods. DEET-containing bug spray has been extensively studied and proven to be both effective and safe if used correctly. See my GERMBlog entry of 4/23/08 for safe use of DEET. When your kids come in to the tent or cabin or hotel for the night, do a head-to-toe check for ticks and carefully remove any that have attached.
4. Be smart around animals. From the dude ranch to the farm to petting zoos, animals can transmit lots of germs to kids. See Chapters 2 and 9 of Germ Proof Your Kids – The Complete Guide to Protecting (without Overprotecting) Your Family from Infections (ASM Press, Washington, D.C., 2008) for complete information on hygiene when your kids are near animals.
5. Don’t drink the water – or do, depending on where you are. Traveler’s diarrhea is a somewhat nastier version of the home town stomach flu. It is rare for U.S. travelers to get diarrhea from the water in Western Europe and Canada, but common in Mexico, Latin America, the Middle East, Asia, and Africa. Although antibiotics taken before departure are effective in reducing the occurrence of traveler’s diarrhea, they are not recommended because of the side effects and the potential for overuse of these medicines. Effective prevention strategies include drinking only bottled water, avoiding ice or raw fruits and vegetables, and eating foods that have been cooked to high temperature while still hot. See Chapters 2, 9, and 10 in Germ Proof Your Kids – The Complete Guide to Protecting (without Overprotecting) Your Family from Infections (ASM Press, Washington, D.C., 2008) for more on food and water safety.
6. Keep kids’ hands off the floor of the airplane. The recycling of airplane air makes germs that normally are not readily spread through the air more transmissible. The top to bottom laminar flow of air in the cabin actually reduces the spread of germs from row to row, but forces airborne germs to the floor of the craft. If your kids don’t crawl on the floor, they will have less exposure to the circulating germs; if they do crawl, use alcohol wipes to clean their hands before hands go to mouth. More on this in Chapter 9 of Germ Proof Your Kids – The Complete Guide to Protecting (without Overprotecting) Your Family from Infections (ASM Press, Washington, D.C., 2008).
7. Be cabin cautious. Cabins in the woods pose several unique risks. Bats, rodents, and ticks all like the shelter. Kids need to be warned to stay away from droppings of all sorts on the floor or on ceiling beams, and to never handle a dead animal. Perform “tick checks” more frequently when staying in a cabin.

And now, relax and enjoy your summer!!

This week’s news is filled with stories of the outbreak in China of a lethal form of Hand-Foot-Mouth (HFM) Syndrome. HFM is common childhood rash illness, usually appearing as sores in the mouth with a rash on the palms, soles, and other parts of kids’ bodies. The two most common groups of viruses that cause HFM are adenoviruses and enteroviruses. The vast majority of HFM cases in this country, and for that matter around the world, are benign and self-limited infections without serious consequences.

Over the past several decades, however, there have been numerous huge outbreaks of HFM in Asia due to an enterovirus strain called EV71. Although this strain is also usually benign, the huge outbreaks have included a number (usually several dozen to just over 100) cases of very severe brain infections or lung and heart complications. The risk of death or permanent injury from these complications is high.

The current outbreak of EV71 HFM in China has now killed 24 kids from the complications noted above. The Chinese are acting quickly to contain the outbreak, particularly as fears mount about the upcoming Olympics.

What about EV71 in the U.S.? Although the first strains of this enterovirus were discovered nearly 40 years ago in California, and there have been about 250 cases of EV71 reported in the U.S. over the past 20 years, it was not until a 2007 report from colleagues in Denver that 2 severe cases (one of which was fatal) were seen within the same year (2003). Both of those kids suffered the very rare lung and heart complications of EV71. There have been no cases of that magnitude seen in the U.S. since.

It is not known what factors have limited the spread of EV71 from Asia to the U.S., nor why the sporadic cases of EV71 infection in the U.S. have not turned into huge epidemics. However, much as we worry about the next influenza pandemic that might spread from Asia, we must also be attuned to the possibility that EV71 HFM syndrome will become a bigger threat to the Western Hemisphere than it has been to date.