Fall, Flu, and Fowl

Another season, another flu shot; so it usually goes when the leaves start to turn. But this year, were facing a special treat, as Air Avian threatens to land in a passage or duct near youand youand you. Our feathered friends are typically exposed to the greater risk, with the more virulent of the two flu strains spreading through a flock in 48 hours, with 90 percent to 100 percent mortality rate. Some birds do get lucky and are infected only with the minimally pathogenic form. They tend to suffer mild, but perhaps embarrassing symptoms, such as ruffled feathers and low egg production. Actually, some coworkers come to mind.

The good news is that risk of human infection from avian influenza subtypes is low, especially if one is not frolicking in the coop with chickens. Even more encouraging is the fact that transmission from h-to-h has been limited, and has not continued beyond one person. Thats about it for the good news, however. The bad news is that pandemic H5N1 and friends loom as a very real possibility, and given the way viruses socialize, we may be in for trouble. Considering our typical cant happen here hang-loosity, I wonder how many of us have given any real thought to pandemic implications?

TB: Airborne But Under the Radar

According to the World Health Organization (WHO), 1.7 million people died of tuberculosis in 2004. I didnt know any of them, did you? And therein lies the rub. Because it is relatively rare in the U.S. (about 14,000 cases reported in 2004, and mostly in high density urban areas), healthcare providers today have little opportunity to see TB cases, and if they do, are not likely to recognize them. While TB continues to be one of historys great killers, it often flies under the diagnostic radar.

The case of Dr. Claudia Lacson, a physician married to a CDC behavioral scientist, is on point. In 2004, Lacson, pregnant with her first child, was admitted to an Atlanta hospital with symptoms of severe headaches and persistent fever. She had been seen in the emergency room a week prior to admittance, treated for a sinus infection, and later for bacterial meningitis. Ten days following her admission, she fell into a coma. By the time doctors began treatment for TB, it was too late; neither she nor her baby survived. Lacson was a native of Bogata, Colombia, and had treated many TB patients while training as a physician there both risk factors that would appear to provide clues. Lacson herself, suspected her underlying illness, but it remained unrecognized by those treating her. Quoting Dr. Kenneth Castro, director of the division of tuberculosis elimination at the Centers for Disease Control and Prevention (CDC), You have a young woman that died of a curable disease. Shame on us, collectively. For more information on this often misdiagnosed and overlooked threat, check out http://www.cdc.gov/nchstp/tb 

Dr. Germ Does the Man Ever Sleep?

Dr. Charles Gerba, a University of Arizona professor and a man well-known to the infection control community, is at it again. Many of us are already psychically scarred by the horrors of kitchen drains, keyboards, and accountants desks. Now, apparently, all that is childs play when considering the say it aint so, Chuck cellular phone! According to Dr. G., and corroborated by recent British studies, the typical cell phone is grossly contaminated with serious unlovelies, literally gajillions of them. Probably due to proximity to multiple warm body parts, our little communicators breed more microbes than door knobs, shoe soles, or even toilet seats! Heres a crack-up quote from Dr. G upon discovering some shocking results from a member of the Good Morning America crew: He has the dirtiest [phone] I ever tested if there is ever a new life-form on this planet, it will be on this phone!

And Speaking of Handi-Wipes

Youll be happy to know that many of the readily available disinfectant wipes are effective in sanitizing defendant fomites such as the aforementioned cell phones, keyboards, et al. Dr. Bill Rutala, director of hospital epidemiology at the University of North Carolina Health Care Center, conducted a study to find out if commonly used wipes really delivered on claims. In fact, they were very effective in removing germs, he concluded. Even sterile water did the job, although it did not provide the lasting germicidal action characteristic of the wipes. Clorox bleach wipes and most commercial brands were nearly 100 percent effective. Even after 300 wipes, they continued to scorch the little buggers, and causing no damage at all to our sneaky microbial assisted-living centers. Easy enough 

Roger Freeman, DDS, is a dentist and educator who is currently president of Infectious Awareables, Inc. (www.iawareables.com), an occasionally for-profit company producing popular science-based awareness products.