Dr. Harley Rotbart’s GERMBlog™

A study presented at last week’s national infectious diseases meetings generated lots of media interest because it looked at an issue that many people ask about all the time – how well, and how long, do germs stick around  on surfaces like those in your home? Unfortnately, because of the way the researchers did the study, we don’t have an absolutely clear answer yet, but there are some clues that reinforce all the advice I’ve given previously in this GERMBlog and in Chapter 9 of the book, Germ Proof Your Kids – The Complete Guide to Protecting (without Overprotecting) Your Family from Infections (ASM Press, Washington, D.C., 2008).

There were 2 parts of the study. In the first, people who had colds due to rhinoviruses (the most common, but by no means the only, cause of the common cold) were asked to name the surfaces in their homes that they had touched frequently in the past day – the usual suspects were named (doorknobs, phones, remote control devices, refrigerator handles, light switches, salt and pepper shakers, etc). The researchers then tested those surfaces for cold viruses and found them on many of the surfaces tested. Here’s the reason that this doesn’t give us an absolute answer to the “how well, how long” question – the test the scientists used was a test for a “footprint” of the virus (the genetic material, or RNA, of the virus), not the living virus itself. So, even though the virus footprint was detectable as long as a day or more on the surfaces after contact with a sick person, we don’t know if touching the surfaces could result in an infection (with a living virus).

A parallel report at the same meeting essentially found the same results in pediatricians’ offices where toys and surfaces tested positive for virus footprints (not living, infectious viruses). I’ve also told you about the doctor’s office “hot zone” for catching infections in Chapter 9 of  Germ Proof Your Kids – The Complete Guide to Protecting (without Overprotecting) Your Family from Infections.

Viruses, as is true for all other germs, live longer in moist environments. Moist surfaces, like bathroom sinks and toilets, kitchen sinks, and laundry areas, may harbor living viruses for many hours – even a day or more.  But, dry surfaces probably only sustain living, infectious, virus germs for minutes to an hour or two. Having said that, though, the studies presented last week remind us of the importance of home hygiene because germs do transfer from people to surfaces and do stay there long enough to potentially infect the next person to touch that surface. There are well-proven home “hot zones” (page 282 of Germ Proof Your Kids) where disinfecting surfaces can be expected to reduce the chances of catching an infection – especially during a time when someone at home is ill. But it’s not just during sick days – home kitchens just like yours are responsible for more than 90% of Salmonella infections in this country (see August 3, 2008 post of Dr. Rotbart’s GERMBlog)! Salmonella is a bacterium, not a virus, and bacteria can live on surfaces, wet and dry, much longer than viruses.

What can you do to make your home, and everyone who lives there, healthier? Establish a regular schedule for disinfecting your home. In Chapter 9 of  Germ Proof Your Kids – The Complete Guide to Protecting (without Overprotecting) Your Family from Infections, I recommend the following schedule:

Kitchen sinks and countertops – daily

Bathroom sinks, countertops, flush handles – 3-4 times/week

Toilets, Kitchen floors, Bathroom floors – weekly

Bedroom and playroom of a sick family member – 2 times/day

Finally, there is an important difference between “cleaning” and “disinfecting”. Disinfecting kills germs on contact, whereas cleaning works by washing away the germs that can be washed away. You should use a disinfecting product for most household hygiene. In Germ Proof Your Kids, I recommend using a disinfecting product that contains bleach. Bleach, unlike other disinfectants that only kill bacteria (“antibacterial”), kills bacteria and viruses. Viruses are the most common cause of household infections, far outnumbering the cases of bacterial infections in the  home.

Influenza has a special relationship with kids – it can cause worse disease and more severe complications than in adults. Additionally, kids serve as amplifiers of disease in the community – when the infection is introduced into the schools by students, it rapidly spreads within the close community of the classroom, and then re-emerges into the community in greater numbers and with greater vengeance.

This year, for the first time, the Centers for Disease Control and Prevention (CDC), along with the American Academy of Pediatrics and the Amercian Academy of Family Physicians, is recommending giving the flu vaccine to all children between the ages of 6 months and 18  years. Previously, the recommendation was more restrictive, including only those kids between 6 months and 5 years – because that age group is the most susceptible to more severe disease. The extension of the recommendations to older kids and adolescents is an acknowledgment of the importance of preventing flu in all kids – for their sake as well as for the sake of the communities in which they live.

There are two types of flu vaccines available – the shot (containing “killed” virus) and the mist (containing weakened “live” virus). The mist vaccine should not be given to kids under the age of 2 (or to adults over the age of 49 years) or to kids with abnormal immune systems or lung disease. Both vaccines contain the same “strains” of virus, 3 different varieties of flu virus that are predicted ahead of the flu season to be the most likely causes of most cases of flu. The strains in the vaccine change each year, hence the vaccine has to be given again each year. Usually, the experts who pick the strains for each year’s vaccine do a pretty good job of guessing correctly – when that happens, the protection against flu is 80% or higher. Some years (like 2007), the predictions are off and the protection level drops to about 50%. Still, even in a bad year of predicting which strains should be in the vaccine, 50% protection is better than nothing. This partial protection is due to overlap among flu strains in their structures, so that the immune boosting resulting from one strain of the virus given as a vaccine helps partially protect against other strains.

The side effects of either preparation of the vaccine (shot or mist) are typically minor. For much more about the vaccine, its benefits, and its side effects, see Chapter 7 in Germ Proof Your Kids – The Complete Guide to Protecting (without Overprotecting) Your Family from Infections ASM Press, Washington, D.C., 2008).

Today’s news featured a story from New Jersey where flu vaccine has been made a mandatory requirement for entry into day care and pre-school. All states have mandatory vaccine requirements for school entry, many have mandatory vaccine requirements of day care entry, but NJ is the first state to include flu vaccine as a requirement for either day care or school. For more about the controversies associated with mandatory vaccines, see Chapter 7 in Germ Proof Your Kids – The Complete Guide to Protecting (without Overprotecting) Your Family from Infections ASM Press, Washington, D.C., 2008).

Your kids should get their flu shots this year. It will keep them and the whole family healhtier. If your kids are less than 6 months old, they can’t get the vaccine – but you and everyone else in the household should get vaccinated to protect those too young for the vaccine.

In this month’s issue of the journal Pediatrics from the American Academy of Pediatrics, experts from the Centers for Disease Control and Prevention (CDC) have reminded parents of the risks posed by some of the “easy” pets – the ones that don’t need walking, don’t shed, etc. The biggest risk to you and your kids from reptiles (turtles, lizards, iguanas, aligators), rodents (hamsters, gerbils, guinea pigs, mice, rats, hedgehogs, chipmunks, prairie dogs), fowl (baby chicks), and amphibians (salamanders, frogs, toads,  newts) is infection with Salmonella. You have read about Salmonella in this GERMBlog in the past as a common source of food poisoning, and indeed it is. But pets carry and shed Salmonella and, with the banning of small turtles (the leading offenders) a few years ago, the occurrence rate of Salmonella in this country was reduced.

This is a big issue because the popularity of non-traditional pets like those listed above, as well as even more exotic animals (monkeys, raccoons, etc), has increased dramatically. Although nearly 2/3 of all U.S. households now have a pet, most are still dogs and cats. But, since 1992, there has been a 75% increase in non-traditional pet ownership in the U.S. and with it, a steep rise in cases of salmonella infections, as well as other potentially lethal infections such as monkeypox, plague, rabies, and lymphocytic choriomeningitis virus. For a complete review of all the germs that kids (and adults) can catch from pets, petting zoos, farmanimals, and other “wildlife experiences” that we foist on our families, see chapters 2, 3, and 9 of Germ Proof Your Kids – The Complete Guide to Protecting (without Overprotecting) our Families from Infections (ASM Press, Washington, D.C., 2008).

Kids should not have reptiles, amphibians, or rodents as pets. No monkeys, either. To read the complete report from the American Academy of Pediatrics, go to: http://pediatrics.aappublications.org/cgi/reprint/122/4/876

Just this morning comes the report that the FDA opted not to ban cough and cold medicines for young children despite a recommendation to do so made nearly one year ago from a group of outside experts. The history of this issue is a bit complex and has been the subject of previous Dr. Rotbart’s GERMBlog posts (see October 19, 2007 and Jan 20, 2008). The over-the-counter cough and cold medicines for kids were approved by the FDA years ago under rules that are quite lax – many of the individual ingredients of the medicines have not been tested in kids to prove effectiveness or safety. More importantly, studies showing benefits of these medicines in kids under the age of 6 years are lacking. As a result, in January of 2008, the FDA ruled that the medicines should not be given to kids under 2 years – a vindication for pediatricians who have been urging this for years. But, anticipating FDA action and wanting to be out front in hopes of avoiding an outright ban, the manufacturers of the medicines had already voluntarily removed kids under age 2 from packaging and marketing of the products.

It was hoped by many of us that the FDA would then follow through with an official recommendation against the medicine for kids under the age of 6, per the outside panel of experts’ suggestions. However, the FDA instead decided that banning the medicines would drive parents to use adult formulations of the over-the-counter medicines for their kids, a potentially worse outcome.

Why shouldn’t these medicines be in your household with young kids? Because they don’t work (see Chapter 8, Germ Proof Your Kids – The Complete Guide to Protecting (without Overprotecting) Your Family from Infections (ASM Press, Washington, D.C., 2008), they have undesirable side effects, and thousands of accidental overdoses are reported each year (the medicines are pleasant-tasting and have appealing colors – very tempting for young kids).

Tis’ the season for colds and flu. There are lots non-medicinal ways to ease your kids through these illnesses once they get sick (including honey for coughs in kids older than 15 months – see Dr. Rotbart’s GERMBlog, December 9, 2007 post), and lots of good advice for reducing the number of episodes your kids and you get this winter (see Chapter 11, Germ Proof Your Kids – The Complete Guide to Protecting (without Overprotecting) Your Family from Infections.

Skip the cold and cough medicines for your kids.