International Infection Prevention Week 2012

In 1896, a physician by the name of Sir William Osler declared,  “Humanity has but three great enemies:  fever, famine, and war; of these by far the greatest, by far the most terrible, is fever.”  During this time period, people were starting to understand some of the causes of infection and disease, but were unable to do much in terms of prevention or treatment.  More than a century later, infection continues to be a worldwide concern.  This is despite the advent of antimicrobials and vaccines, along with improvements in public sanitation, that have had a tremendous impact on reducing complications and deaths associated with infections.  These advancements are not universally available, and infection is still a real problem for many third-world countries.  In fact, the most recent reports indicate that 7 out of 10 deaths in low-income countries are due to infectious diseases, with the top 3 causes being lower respiratory infections, diarrheal diseases, and HIV/AIDS.  Globally, infectious diseases account for 4 of the top 10 causes of death.  In addition to high mortality rates, infectious diseases create a tremendous burden in terms of healthcare costs (emergency care, hospitalizations, prescription medications), loss of productivity (missed work/school days), and reduction in overall quality of life.  This clearly illustrates that infection remains a major health concern and stresses the importance of infection prevention.  This blog entry will provide a basic overview of infectious disease and offer several simple, but effective measures that can be taken to not only protect an individual from becoming sick, but also help prevent the spread of infection to others.

What causes an infection?

Infections are caused by a number of organisms of varying shapes and sizes.  Organisms that have the ability to cause disease in humans are known as pathogens.  These include microscopic bacteria, viruses, and parasites, and larger fungi and parasitic worms.  The table below shows common diseases caused by these pathogens.

Type of Pathogen	Commonly Caused Diseases
Viruses	Common cold, flu, cold sores, chickenpox, AIDS
Bacteria	Pneumonia, tuberculosis, chlamydia, gonorrhea, syphilis
Fungi	Athlete’s foot, jock itch, ringworm, yeast infections
Parasites	Malaria, diarrhea, gastrointestinal symptoms (stomach pain, nausea, vomiting)

International Infection Prevention Week 2012

Microorganisms are found virtually everywhere, including soil, water, food, computer keyboards, doorknobs, and throughout the human body.  There are even microorganisms that permanently reside within the body, called normal flora.  The major sites that these are found are the mouth, nose, throat, and intestines.  The normal flora are a part of the body's natural defense system and protect us by competing with pathogens that invade the body.  Pathogens cause infections by coming into contact with and invading the human body.  Once inside your cells, the pathogens multiply, overwhelm the body’s defenses, and cause harm or disease.

Fever is considered the hallmark of infectious disease.  Other signs and symptoms are specific to the organism causing the infection and its location and may include pain, chills, sore throat, shortness of breath, nasal congestion, stiff neck, diarrhea, nausea, or vomiting.

The reason why you do not get sick every time you are exposed to a pathogen is because the body has a natural defense system known as the immune system.  The main function of the immune system is to find and destroy anything unfamiliar to the body that could potentially cause you harm.  In this manner, the immune system effectively prevents infection, saving you from being miserable and sick.  However, even the best immune system cannot eliminate all disease-causing organisms because of the ability of some pathogens to evade the immune response. 

What can increase my risk of an infection?

There are several risk factors that make an individual susceptible to developing an infection:

·      Contact with people who are sick

·      Weakened immune system

§  Very young children, elderly, critically ill, transplant patients

·      Being in a hospital or nursing home

·      Poor wound care

·      Pregnancy

·      Living in an area affected by a natural disaster

§  Poor sanitation or lack of fresh food or clean water

·      Poor hygiene, eating habits, and living conditions

§  Improper hand washing/teeth brushing

§  Eating junk food, unwashed fruits and vegetables, or perishable foods that have been left out of the refrigerator

§  Unsanitized water, dirty floors, garbage

Simple preventative measures are effective in reducing your chance of becoming ill.  Some useful practices include healthy eating, a clean environment, sufficient sleep, and frequent hand washing.  Also, vaccinations offer an extremely effective method for protection against many diseases.  These practices will not only protect you from contracting illnesses, but they also decrease the spread of diseases to others.

Is hand washing really that important?

Washing your hands is easy to do, takes little time, and is one of the most effective ways to prevent the spread of many common infections.  In spite of this, global studies have shown that people wash their hands with soap only 20% of the time.  This is particularly concerning since it is estimated that proper hand washing could save a million lives per year.

When should  you wash your hands?

It is important to wash your hands frequently, but it is especially important in the following situations:

·      Food preparation and cooking−before, during, and after

·      Before you eat

·      Before touching or washing your face

·      Before taking out contact lenses

·      Before holding a baby

·      Before and after being with somebody who is sick

·      Before and after taking care of a wound

·      After going to the bathroom

·      After spending time with animals

·      After blowing your nose, sneezing, or coughing

·      After handling money

·      After taking out the garbage

How should you wash your hands?

1.     Wet your hands before using soap.

2.     Rub hands together to form a soapy lather.

3.     Make sure you rub all areas of the hand, including between the fingers, back of the hand, the thumbs, fingertips, and under fingernails.

4.     Rub your hands together for at least 20 seconds to optimize the cleansing activity of the soap.  An easy way to pass the 20 seconds is to sing “Happy Birthday” twice.

5.     Rinse your hands well under running water to ensure all the soap and trapped germs and dirt are removed.

6.     Dry your hands with a clean paper towel or air dry them.  Use the towel to turn off the water.

What should you do if you do not have access to running water?

If your hands are not visibly dirty, alcohol-based hand sanitizers containing at least 60% alcohol offer an alternative option.  Hand sanitizers will not remove as many germs as soap and water, but they still help to prevent infection.  These products are easy to use:  squeeze small amount into palm of your hand, then rub hands together, covering all surfaces until dry.

Why should you get vaccinated?

Some diseases, such as smallpox and polio, which were once thought to be incurable have nearly been eliminated from the world thanks to the widespread use of vaccinations.  Several other diseases can now be prevented by vaccines, including hepatitis A and B, human papillomavirus, and tetanus.  Although preventable, these diseases are not benign and individuals unfortunate enough to be infected may experience severe symptoms and complications.  A simple vaccination can ease one’s concerns about ever becoming infected and having to deal with the associated complications and disease burden.  Also, vaccinations are the most effective way to help prevent the transmission of diseases to others.  This reduces the possibility of the infection becoming a much larger, widespread health concern.

Are all vaccines the same?

No, vaccines are broadly classified as either being live or inactived based on the components used to create the vaccine.  The immune system actively responds to these components, and this generally confers protection against disease.  The table below explains key points about the types of vaccines and provides examples of each.

Type of Vaccine	Description
Live, attenuated	·      Weakened or modified versions of live pathogens so that they do NOT produce the disease, but stimulate the immune response.  Infection fighting cells of the immune system will remember the pathogen and be able to eliminate it if you are ever exposed. ·      Have the potential to cause disease, but this is more likely to occur in people with weakened immune systems. ·      Many live vaccines should not be used in pregnant women. ·      Includes vaccines against measles, mumps, and rubella.
Inactivated	·      Organisms have been killed, or killed and purified to only contain components that stimulate immune response. ·      Requires multiple shots over time to build-up and maintain protection against pathogens. ·      Cannot cause disease in anyone. ·      Includes vaccines against hepatitis A and B, diphtheria, tetanus, and pneumonia.

Who should get vaccinated?

Different pathogens target different groups of people.  For instance, pneumonia and shingles are  major concerns for the elderly.  Chickenpox, measles, mumps, and rubella predominantly affect children.  It is important to receive the appropriate vaccinations at the appropriate age.  The Centers for Disease Control and Prevention provides age-based vaccination recommendations.  A link to these easy-to-read schedules can be found at the end of this blog.

Where can I go for vaccinations?

To get the maximum benefit from vaccinations, they must be available to as many people as possible.  There are several locations at UIC that offer vaccinatios:

Wood Street Pharmacy

840 S. Wood St

Chicago IL, 60612

312.996.6887

University Health Services
835 South Wolcott, Room E-144
Chicago, Illinois 60612

312.996.7420

University Village Pharmacy
722 West Maxwell Street
Chicago IL, 60607

312.355.2345

In addition, community pharmacies, walk-in clinics, and your doctor’s office all offer a number of vaccinations.

Insect-borne infections

Infections caused by insects are different from other infections in how the infection is spread.  These insect-borne illnesses cannot be transferred from person-to-person.  Rather, the spread of disease is due to the presence of large populations of infection-causing insects.  As a result, infection prevention measures aim to decrease insect populations and protect individuals from being bitten.

How do insects cause disease in humans?

An insect bite may not only be irritating or annoying, but it may also be very dangerous.  Certain blood-feeding insects (such as mosquitoes or ticks) can carry a variety of disease-causing organisms, such as viruses, bacteria, parasites, and protozoa.  When these insects bite, the pathogens can be transmitted into the body and cause a number of potentially life-threatening infections.

Which insects cause infections?

Worldwide, mosquitoes are responsible for most insect-borne infections.  In the United States, ticks infect the greatest number of people.  Some other insects that have the potential to cause serious disease, include mites, fleas, lice, sand flies, black flies and tsetse flies.  The table below shows some of the diseases caused by these insects.

Insect	Commonly Caused Diseases11
Mosquitoes	West Nile virus, malaria, dengue fever, Japanese encephalitis
Ticks	Lyme disease, Rocky Mountain spotted fever
Mites	Scabies, scrub typhus
Fleas	Plague
Lice	Epidemic typhus, relapsing fever
Sand flies	Leishmaniasis
Black flies	Onchocerciasis (river blindness)
Tsetse flies	African trypanosomiasis (African sleeping sickness)

What is the most effective way to prevent infection and spread of disease caused by insects?

There are several steps that can be taken to lower your risk of being bitten and infected.  Public health measures, such as spraying of insecticide and removing areas where insect may live are effective in decreasing the number of insects.   Personal protection measures, such as topical repellents or insecticide-treated clothing, and staying indoors during periods of high insect activity are also effective in lowering your risk of being bitten.  It has been shown that use of both topical repellents and insecticide-treated clothing offers the best protection from insect bites and infection.  These personal protection products are available at retail or sporting goods stores.

What types of repellent are available and how long do they work?

The table below lists products containing the most-commonly used active ingredients registered by the Environmental Protection Agency (EPA) and their duration of action:

Active Ingredient	Brand Name	Duration of Action
DEET < 10%	OFF! Skintastic	1-3 hours
DEET 10%-30%	OFF! Active, Deep Woods OFF!	4-6 hours
DEET 20%-98.5%	Sawyer	6-12 hours
Picaridin 7%	Cutter Advanced	3-4 hours
Picaridin 15%	Cutter Advanced Sport	6-8 hours

Which repellent is right for me?

Insect repellents are available with a wide variety of active ingredients and formulations, which can make it difficult to choose the right one.  The EPA has a helpful online search tool (http://cfpub.epa.gov/oppref/insect/) that helps you decide on the most appropriate insect repellent depending on your needs.  This tool allows you to search for products based on the duration of time you will need to be protected, which insects you need to be protected from,  active ingredients, and specific product brands.

For more information:

About International Infection Prevention Week:  http://www.apic.org/Education-and-Events/IIPW

About impact of vaccines in the United States:  http://www.niaid.nih.gov/topics/vaccines/understanding/pages/vaccinebenefits.aspx

About vaccine-preventable diseases:  http://www.cdc.gov/vaccines/vpd-vac/default.htm

Easy-to-read vaccinations schedules:  http://www.cdc.gov/vaccines/schedules/easy-to-read/index.html

Centers for Disease Control and Prevention insect repellent search tool: http://cfpub.epa.gov/oppref/insect/#searchform

 

Written by: Mark Knaub, PharmD candidate

University of Illinois at Chicago

UIC Pharmacy

October 2012

Fighting Childhood Cancer

Although childhood cancer is uncommon, it is the second leading cause of death among children aged 14 years and younger.  Between 1 and 2 children in every 10,000 under 15 years of age are diagnosed with cancer each year in the United States. One out of every 300 boys and 1 out of every 333 girls are expected to develop cancer before the age of 20.  Due to improvements in treatments, research and early diagnosis, death rates for many cancers in children have declined by more than 50%.  However, those who do survive cancer may have to live the rest of their lives with side effects of treatment.  Two out of every 3 children who survive cancer will have at least one chronic health condition.

What is childhood cancer?

Cancer happens when normal cells in a part of the body become out of control and grow quicker than normal.   These abnormal cells can form a lump or mass called a tumor, which can be benign or malignant. Malignant tumors can spread to other parts of the body and invade tissues to interfere with normal cell function.  Although benign tumors do not invade tissues, they can sometimes also cause problems. Besides forming tumors, cancers can also occur in the blood cells.  Unlike adult cancers, more than half of all childhood cancers are leukemia (a cancer of the blood) and brain tumors.  Some of the more common childhood cancers are described below.

§  Leukemia is the most common childhood cancer and is responsible for 30% of all cancers in children. It is a cancer in the sponge-like tissue called bone marrow, which is inside the large bones and produces blood cells that are important to fight off infections and important to overall health. 

§  Brain and other nervous system tumors are the second most common childhood cancers.  They make up 27% of all childhood cancers.

§  Lymphomas, including Hodgkin and Non-Hodgkin’s lymphomas, are the third most common childhood cancers.  It is a cancer of a part of the immune system and begins in the lymph tissues, such as the tonsils or spleen, and can spread to other parts of the body.  Non-Hodgkin’s lymphoma is more common than Hodgkin’s lymphoma in children.  They differ in the type of cancer cells that form the lymphoma.

§  Blastoma is a type of cancer in the precursors of cells, called “blasts,” that originate in the embryo or fetus.  Examples included neuroblastoma, nephroblastoma, and retinoblastoma.

o   Neuroblastoma makes up 7% of cancers in children and is a type of cancer in nerve cells.  It is more common in infants and younger children than older children.

o   Nephroblastoma or Wilms’ tumor occurs in 5% of all childhood cancers. It is a cancer of the kidney. It typically occurs in children at 2 to 5 years of age

o   Retinoblastoma is a type of cancer in the eye and occurs in 4% of cancers in children. It typically occurs in children at 2 years of age.

§  Sarcoma is a rare type of cancer that is developed from connective tissues, such as muscles, fat, blood vessels, and bone.

o   Rhabdomyosarcoma is at type of cancer of the muscles that move parts of our body.  It occurs in 3.5% of childhood cancers.

o   Osteosarcoma is a cancer that occurs in the bone and is most often seen in older children and teenagers.  Ewing’s sarcoma is one type of bone cancer.

What are causes of cancer in children?

In adults, many cancers are influenced by lifestyle or long exposure to the environment. However, this is unlikely in children and the causes of childhood cancer are mainly unknown.  Only a small portion are associated with genetic disorders.  It is likely that many cancers in children result from an abnormality in the early developmental process.

Can childhood cancer be found early?

It is difficult to detect childhood cancers early because many of presenting signs and symptoms are not specific.  These signs and symptoms often look like those presented in common childhood illnesses or injuries.  Most of the time, a child’s cancer is detected when the disease is already at its late stages. This is why it is important for children to have regular medical check-ups, and for parents to alert their doctors if their children have any unusual signs or symptoms that do not go away. 

Most common signs and symptoms

§  Excessive, rapid weight gain or loss

§  Frequent headaches, often with vomiting in the morning

§  Persistent, localized pain

§  Prolonged, unexplained fever or illness

§  Sudden eye or vision changes

§  Sudden tendency to bruise

§  Unusual lump or swelling

§  Unexplained paleness or loss of energy

How can childhood cancer be prevented?

Since there are no lifestyle-related factors and only a few environmental factors that are known to influence childhood cancer, it is hard to prevent a child from getting cancer.  It is very rare that children may inherit genes that increase their chances of getting certain types of cancer.  Children who survive a first cancer may have a slightly higher risk in getting a second cancer compared with children who never have had cancer.  This might be due to the type of the first cancer, prior exposure of radiation or chemotherapy, or an inherited gene. Below are a few ways that you can help reduce your child’s risk of getting certain types of cancer later in life:⁷

§  Adopt a healthy lifestyle.

o   Make sure your child has good eating habits.

o   Make sure he or she gets plenty of exercise to keep a healthy weight.

§  Avoid serious sunburns by protecting your skin from the sun.

o   Wear sunscreen with sun protective factor (SPF) 15 or higher and with UVA and UVB protection.

o   Make sure your child wears a hat with wide brim to shade face, head, ears, and neck and sunglasses that block both UVA and UVB rays.

o   Make sure he or she seeks shade, especially during midday hours, when UV rays are most intense.

o   Do not allow your child to use tanning beds or sunlamps because they also contain UV rays that are as dangerous as the UV rays from the sun.

§  Get vaccinated

o   Make sure that all of your child’s immunizations are up-to-date.

o   Recommended vaccines include hepatitis B, rotavirus, diphtheria, tetanus, pertussis, Haemophilus influenza, pneumococcal, poliovirus, measles, mumps, rubella, varicella, hepatitis A, meningococcal, and human papillomavirus (HPV).

§  Avoid smoking

o   Tobacco use may increase the risk of lung cancer.

o   Explain to your child why you do not want him or her to smoke.

o   Don’t expose your child to secondhand tobacco smoke because smoke from other people’s cigarettes may also cause lung cancer.

How is childhood cancer treated?

Although the overall frequency of cancer in children has slightly increased, survival rates have improved dramatically over the past years.  Many of these cancers can now be cured due to advancement in treatments and ongoing research.  Treatment is based on the types and/or stages of cancer and usually involves a combination of chemotherapy, surgery, and radiation.  Other treatments of childhood cancer include immunotherapy (use of the body’s immune system to fight cancer cells) and stem-cell transplantation.

Chemotherapy is the use of different drugs together to kill the cancer cells. It is the most widely used treatment for cancer.  Chemotherapy is more aggressive in children than in adults because children can tolerate the side effects of chemotherapy better than adults can.  The most common side from chemotherapy are fatigue, easy bruising or nose bleeds, decreased ability to fight infection, nausea, vomiting, diarrhea, painful mouth sores, hair loss, and red or itchy skin.  Another common treatment is surgery, which is the removal of cancer cells or tumor.  The goal of surgery is to remove the entire tumor and the tissues around the tumor.  Radiation is the use of high-energy x-rays or other particles to kill cancer cells. It is used more cautiously in children than in adults because of the delayed side effects of radiation, which can happen months to years after therapy.  Side effects of radiation are usually less intense than chemotherapy and depend on the area on the body being irradiated and how the therapy is performed.  The most common side effects of radiation are skin reactions, such as rash and skin irritations.  Other common short-term side effects, depending on the location of radiation, are nausea, diarrhea, painful mouth sores, fatigue, and hair loss. 

Is nutrition important during of cancer treatment?

Good nutrition is important for everyone, but especially for children undergoing cancer treatment.  However, malnutrition is common in children with cancer.  This may be due to side effects of cancer treatment.  The following are general steps to help improve oral intake during cancer treatment:

Loss of appetite

§  Offer your children small frequent meals or snacks throughout the day (6-8 meals/snacks per day)

§  Encourage drinks high in nutrients between meals

§  Offer your children their favorite nutritious foods when they are not having treatment

Nausea and vomiting

§  Feed your children 3 to 4 hours before treatment

§  Offer him or her small amounts of cold foods

§  Encourage slow eating

§  Do not give him or her foods that have strong odors

§  Offer clear liquids, such water, between meals

Mouth sores or pain

§  Have your child try soft or pureed bland foods or liquids for easier swallowing

§  Add butter, gravy, sauce or salad dressing to moisten foods that are dry or solid

§  Do not give him or her highly seasoned or hard, rough foods, such as chips or nuts

Changes in taste and smell

§  Do not give your child too much sweet food

§  Offer salty foods (if tolerated), such as hot dogs, pizza, or canned pasta

§  Have him or her try new flavors of foods

Where can I find more information on childhood cancer?

American Cancer Society (ACS)

Toll-free number: 1-800-227-2345

Web site: www.cancer.org

American Childhood Cancer Organization (ACCO)
Toll-free number: 1-800-366-2223
Web site: www.acco.org

Cure Search for Children's Cancer
Toll-free number: 1-800-458-6223
Web site: www.curesearch.org

National Cancer Institute
Toll-free number: 1-800-422-6237
Web site: www.cancer.gov

National Children’s Cancer Society

Toll-free number: 314-241-1600

Web site: www.beyondthecure.org

Written by: Hong-Yen Vi, PharmD candidate

University of Illinois at Chicago

October 2012