Germ warfare

If you are at your desk or have your laptop or tablet handy, take a look at the screen. No, no, not the glowing pixels. Turn the device off and look at the glass surface. Unless you are someone who carries a bottle of glass cleaner in a holster on your belt, you will see a speckled pattern. Depending on how vigilant you are, what you are looking at is a day, or a week, or in my case, several months’ accumulation of sneezes. I recently learned that each of these droplets of dried snot is called a biofilm. I acquired this addition to my vocabulary by chasing down an article I found in one of our local newspapers. ("Researchers report strep bacteria can last up to several months on objects," Portland (Maine) Press Herald, Dec. 29, 2013).

I found the original article in Infection and Immunology ("Biofilm formation enhances fomite survival of S. pneumoniae and S. pyogenes" 2013 Dec. 26 [doi: 10.1128/IAI.01310-13]), and discovered that it was previously thought that once a fomite dried, the bacteria it contained died in a matter of a few days. However, this assumption was based on microbiologic studies using a plankton-containing broth. Using a different technique, the researchers from Buffalo demonstrated that bacteria can survive in biofilm for months and are virulent enough to infect mice.

This is new information about bacterial survival, but does it warrant inclusion in a lay publication intent on alarming its readers? Even if the bacteria from one sneeze survive only for a couple of days as was once thought, the sneezer is going to continue to replenish his environment with fomites for a week or three. And, by the time he is no longer spewing a spray of fomites, a new cohort of children he has exposed will have taken over his role. So, does it really matter whether bacteria survive for 2 days or 2 months?

There is plenty of evidence that bacteria are crafty survivors that can mutate so quickly that they can fill environmental niches in the blink of an eye. For example, some viruses survive longer on hard smooth surfaces than on soft rough ones. Who would have guessed that? Recently, veterinarians have discovered that some individual bovines are "super shedders" of pathogenic Escherichia coli. This may be the result of a coinfection with parasites. It’s not unreasonable to postulate that certain children are also "super shedders," the modern day equivalents of Typhoid Mary. Should we enter the murky twilight zone of ethics and begin looking for the respiratory syncytial virus (RSV) Jasons in our day cares?

Does all this recent news about germ survival and dispersal mean that we are losing the war? Should we rethink the utility of day cares? Or, should we be steam cleaning them every evening on a daily basis?

On the contrary, this news on bacterial survival is good news. When one considers how many virulent bacteria surround our children, it is encouraging how few of them become seriously ill. Looking back on 40 years of practice, it seems to me that with few exceptions, it wasn’t supervirulent germs that were keeping me busy. It was the variability in host vulnerability that made things interesting. The reason that only a few children in a class became sick with strep was less a result of fomite concentration than the poorly understood child to child differences in immune response. It remains our obligation to be frugal with our use of antibiotics so that when those few unlucky or vulnerable children become ill, we will have an effective arsenal.

Look back at your computer screen. The authors of a recent letter to the editor in the American Journal of Infection Control report that a damp microfiber cloth was effective in removing methicillin-resistant Staphylococcus aureus (MRSA) type A bacteria from iPad screens (Am. J. Infect. Control 2013;41:1136-7). That’s what my grandmother would have suggested.

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics including "How to Say No to Your Toddler." E-mail him at [email protected].

If you are at your desk or have your laptop or tablet handy, take a look at the screen. No, no, not the glowing pixels. Turn the device off and look at the glass surface. Unless you are someone who carries a bottle of glass cleaner in a holster on your belt, you will see a speckled pattern. Depending on how vigilant you are, what you are looking at is a day, or a week, or in my case, several months’ accumulation of sneezes. I recently learned that each of these droplets of dried snot is called a biofilm. I acquired this addition to my vocabulary by chasing down an article I found in one of our local newspapers. ("Researchers report strep bacteria can last up to several months on objects," Portland (Maine) Press Herald, Dec. 29, 2013).

I found the original article in Infection and Immunology ("Biofilm formation enhances fomite survival of S. pneumoniae and S. pyogenes" 2013 Dec. 26 [doi: 10.1128/IAI.01310-13]), and discovered that it was previously thought that once a fomite dried, the bacteria it contained died in a matter of a few days. However, this assumption was based on microbiologic studies using a plankton-containing broth. Using a different technique, the researchers from Buffalo demonstrated that bacteria can survive in biofilm for months and are virulent enough to infect mice.

This is new information about bacterial survival, but does it warrant inclusion in a lay publication intent on alarming its readers? Even if the bacteria from one sneeze survive only for a couple of days as was once thought, the sneezer is going to continue to replenish his environment with fomites for a week or three. And, by the time he is no longer spewing a spray of fomites, a new cohort of children he has exposed will have taken over his role. So, does it really matter whether bacteria survive for 2 days or 2 months?

There is plenty of evidence that bacteria are crafty survivors that can mutate so quickly that they can fill environmental niches in the blink of an eye. For example, some viruses survive longer on hard smooth surfaces than on soft rough ones. Who would have guessed that? Recently, veterinarians have discovered that some individual bovines are "super shedders" of pathogenic Escherichia coli. This may be the result of a coinfection with parasites. It’s not unreasonable to postulate that certain children are also "super shedders," the modern day equivalents of Typhoid Mary. Should we enter the murky twilight zone of ethics and begin looking for the respiratory syncytial virus (RSV) Jasons in our day cares?

Does all this recent news about germ survival and dispersal mean that we are losing the war? Should we rethink the utility of day cares? Or, should we be steam cleaning them every evening on a daily basis?

On the contrary, this news on bacterial survival is good news. When one considers how many virulent bacteria surround our children, it is encouraging how few of them become seriously ill. Looking back on 40 years of practice, it seems to me that with few exceptions, it wasn’t supervirulent germs that were keeping me busy. It was the variability in host vulnerability that made things interesting. The reason that only a few children in a class became sick with strep was less a result of fomite concentration than the poorly understood child to child differences in immune response. It remains our obligation to be frugal with our use of antibiotics so that when those few unlucky or vulnerable children become ill, we will have an effective arsenal.

Look back at your computer screen. The authors of a recent letter to the editor in the American Journal of Infection Control report that a damp microfiber cloth was effective in removing methicillin-resistant Staphylococcus aureus (MRSA) type A bacteria from iPad screens (Am. J. Infect. Control 2013;41:1136-7). That’s what my grandmother would have suggested.

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics including "How to Say No to Your Toddler." E-mail him at [email protected].

If you are at your desk or have your laptop or tablet handy, take a look at the screen. No, no, not the glowing pixels. Turn the device off and look at the glass surface. Unless you are someone who carries a bottle of glass cleaner in a holster on your belt, you will see a speckled pattern. Depending on how vigilant you are, what you are looking at is a day, or a week, or in my case, several months’ accumulation of sneezes. I recently learned that each of these droplets of dried snot is called a biofilm. I acquired this addition to my vocabulary by chasing down an article I found in one of our local newspapers. ("Researchers report strep bacteria can last up to several months on objects," Portland (Maine) Press Herald, Dec. 29, 2013).

I found the original article in Infection and Immunology ("Biofilm formation enhances fomite survival of S. pneumoniae and S. pyogenes" 2013 Dec. 26 [doi: 10.1128/IAI.01310-13]), and discovered that it was previously thought that once a fomite dried, the bacteria it contained died in a matter of a few days. However, this assumption was based on microbiologic studies using a plankton-containing broth. Using a different technique, the researchers from Buffalo demonstrated that bacteria can survive in biofilm for months and are virulent enough to infect mice.

This is new information about bacterial survival, but does it warrant inclusion in a lay publication intent on alarming its readers? Even if the bacteria from one sneeze survive only for a couple of days as was once thought, the sneezer is going to continue to replenish his environment with fomites for a week or three. And, by the time he is no longer spewing a spray of fomites, a new cohort of children he has exposed will have taken over his role. So, does it really matter whether bacteria survive for 2 days or 2 months?

There is plenty of evidence that bacteria are crafty survivors that can mutate so quickly that they can fill environmental niches in the blink of an eye. For example, some viruses survive longer on hard smooth surfaces than on soft rough ones. Who would have guessed that? Recently, veterinarians have discovered that some individual bovines are "super shedders" of pathogenic Escherichia coli. This may be the result of a coinfection with parasites. It’s not unreasonable to postulate that certain children are also "super shedders," the modern day equivalents of Typhoid Mary. Should we enter the murky twilight zone of ethics and begin looking for the respiratory syncytial virus (RSV) Jasons in our day cares?

Does all this recent news about germ survival and dispersal mean that we are losing the war? Should we rethink the utility of day cares? Or, should we be steam cleaning them every evening on a daily basis?

On the contrary, this news on bacterial survival is good news. When one considers how many virulent bacteria surround our children, it is encouraging how few of them become seriously ill. Looking back on 40 years of practice, it seems to me that with few exceptions, it wasn’t supervirulent germs that were keeping me busy. It was the variability in host vulnerability that made things interesting. The reason that only a few children in a class became sick with strep was less a result of fomite concentration than the poorly understood child to child differences in immune response. It remains our obligation to be frugal with our use of antibiotics so that when those few unlucky or vulnerable children become ill, we will have an effective arsenal.

Look back at your computer screen. The authors of a recent letter to the editor in the American Journal of Infection Control report that a damp microfiber cloth was effective in removing methicillin-resistant Staphylococcus aureus (MRSA) type A bacteria from iPad screens (Am. J. Infect. Control 2013;41:1136-7). That’s what my grandmother would have suggested.

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics including "How to Say No to Your Toddler." E-mail him at [email protected].