CREM CRME

DESIGNING A SAFER TOMORROW POUR UN FUTUR PLUS SAIN

THE ROLE OF THE ENVIRONMENT IN THE TRANSMISSION OF BACTERIA AND VIRUSES AMONGST CHILDREN
SYED A. SATTAR,
Ph.D.

DIRECTOR, CENTRE FOR RESEARCH ON ENVIRONMENTAL MICROBIOLOGY (CREM) UNIVERSITY OF OTTAWA, OTTAWA, ON, CANADA

INTRODUCTION
 

WHY THE EMPHASIS ON CHILDREN? WHY THE CONCERN WITH BACTERIAL & VIRAL INFECTIONS?
 

NEWER PATHOGENS & NEWER ROLES FOR THEM? LONGER-TERM IMPACTS OF INFECTIONS?

     

WHAT IS THE GLOBAL PICTURE? WHAT IS THE SITUATION IN CANADA & THE U.S.? HOW DO BACTERIA & VIRUSES SPREAD IN NATURE? WHAT ROLE DOES THE ENVIRONMENT PLAY? HOW CAN ENVIRONMENTAL SPREAD BE INTERRUPTED? WHAT DOES THE FUTURE HOLD?
SYED A. SATTAR, SIMMONS COLLEGE SYMPOSIUM, OCT., 2005 2

TERMS OF REFERENCE
A CHILD: ANY PERSON UNDER 18 YEARS OF AGE THE ENVIRONMENT: ANYTHING OUTSIDE THE BODY OF THE HUMAN HOST

SYED A. SATTAR, SIMMONS COLLEGE SYMPOSIUM, OCT., 2005

WHY THE EMPHASIS ON CHILDREN?

      

MORE VULNERABLE TO INFECTION GREATER EXPOSURE TO MICROBES POTENTIAL FOR LONGER-TERM HEALTH IMPACT DEPENDENCE ON CARE-GIVERS LOWER LEVELS OF AWARENESS INCREASING GROUPING IN DAYCARE CENTERS POVERTY, MALNUTRITION & NEGLECT
SIMPLY PUT, A HEALTHY CHILD IS MORE LIKELY TO BE A HEALTHY ADULT
SYED A. SATTAR, SIMMONS COLLEGE SYMPOSIUM, OCT., 2005 4

WHY WORRY ABOUT THE GLOBAL PICTURE?

NO ONE IS SAFE UNTIL EVERYONE IS SAFE


INFECTIONS CONTINUE TO BE A MAJOR KILLER OF CHILDREN WORLDWIDE (GRAPHS) INCREASING LEVELS OF

  

POLLUTION POVERTY MALNUTRITION

  

IMPACT OF NATURAL DISASTERS IMPACT OF DISEASES SUCH AS AIDS OVCS (ORPHANS & VULNERABLE CHILDREN)
SYED A. SATTAR, SIMMONS COLLEGE SYMPOSIUM, OCT., 2005 5

CHILDREN AND BASIC DEPRIVATION FACTORS

(UNICEF, STATE OF THE WORLD CHILDREN, 2005)

FACTOR NO ADEQUATE SHELTER NO ACCESS TO SANITATION NO ACCESS TO SAFE WATER NO ACCESS TO INFORMATION NO ACCESS TO HEALTH CARE SERVICES HAVE NEVER BEEN TO SCHOOL ARE SEVERELY FOOD-DEPRIVED AIDS HAS CREATED 15 MILLION OVCS
SYED A. SATTAR, SIMMONS COLLEGE SYMPOSIUM, OCT., 2005

MILLIONS 640 500 400 300 270 140 90

DEMOGRAPHICS IN CANADA AND THE U.S. 2003*

(http://www.unicef.org/statistics/index_countrystats.html)

CANADA
TOTAL POPULATION POPULATION UNDER AGE 18 POPULATION UNDER AGE 5 % OF CHILDREN LIVING IN POVERTY 31,510,000 6,942,000 1,663,000 14.9

U.S.
294,043,000 75,893,000 20,794,000 21.9

*BASED ON UNICEF REPORT THE STATE OF WORLDS CHILDREN, 2005

SYED A. SATTAR, SIMMONS COLLEGE SYMPOSIUM, OCT., 2005 7

MAIN CAUSES OF DEATH AMONG CHILDREN 0-4 YEARS

(WORLD HEALTH ORGANIZATION, 1999)

I D

I j N b -

SYED A. SATTAR, SIMMONS COLLEGE SYMPOSIUM, OCT., 2005

CAUSES OF PREMATURE DEATH AMONGST 0-44 YEAR OLDS

(WORLD HEALTH ORGANIZATION, 1999)

Maternal 3% Injuries 19% Non-communicable 8%

Infect. Dis. 48%

Nutritional 2%

Perinatal 10%
9

SYED A. SATTAR, SIMMONS COLLEGE SYMPOSIUM, OCT., 2005

BREAKDOWN OF KNOWN HUMAN PATHOGENS

(TAYLOR ET AL. PHIL. TRANS. R. SOC. LOND. B. 2001; 356:983-989) OF THESE 1415 PATHOGENS, THE MEANS OF SPREAD OF >200 ARE NOT KNOWN!!

538 BACTERIA (38%)

217 VIRUSES & PRIONS (15%) 287 HELMINTHS (20%)

BACTERIA & VIRUSES TOGETHER CONSTITUTE >50% OF KNOWN HUMAN PATHOGENS

66 PROTOZOA (5%)

307 FUNGI (22%)

SYED A. SATTAR, SIMMONS COLLEGE SYMPOSIUM, OCT., 2005

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HUMAN HEALTH IMPACT OF INFECTIOUS AGENTS



GLOBALLY, INFECTIONS DIRECT CAUSE OF >32% (18/56 MILLION) OF ALL DEATHS/YEAR; >45% IN DEVELOPING COUNTRIES
(WHO 2001)

b40 NEW PATHOGENS FOUND IN PAST 30 YEARS ALONE

(DESSELBERGER, J. INFECT. 2000; 40:3-15)

INFECTIONS & DELAYED OUTCOMES, E.G., POST-POLIO & GUILLAIN-BARR SYNDROMES

(WHO 2003)

VIRUSES (HBV, HCV, HPV) & BACTERIA (H. PYLORI) CAUSING CANCERS
(WHO 2003)
11

SYED A. SATTAR, SIMMONS COLLEGE SYMPOSIUM, OCT., 2005

HEALTH IMPACT (CONTD.)

  

CHRONIC CONDITIONS (ARTERIOSCLEROSIS, ARTHRITIS) EXACERBATION OF ASTHMA POLYMICROBIC DISEASES E.G., ~15% OF CASES OF ACUTE OTITIS MEDIA DUE TO A MIXTURE OF VIRUSES & BACTERIA
(HEIKKINEN & CHONMAITREE. CLIN. MICROBIOL. REV. 2003; 16:230-241.)

VIRUSES & OBESITY INFECTOBESITY (DHURANDHAR, J. NUTR.

2001; 131:2794S-2797S)

INFECTIONS & BEHAVIORAL CHANGES, E.G., TOXOPLASMA GONDII (BERDOY ET AL. PROC R SOC LOND. B BIOL. SCI. 2000; 267:1591-1594) LACK OF NEW VACCINES & DRUGS DECREASING RATES OF CHILDHOOD VACCINATIONS
SYED A. SATTAR, SIMMONS COLLEGE SYMPOSIUM, OCT., 2005 12

 

GLOBAL HEALTH IMPACT OF ROTAVIRAL INFECTIONS - 1986-2000

(PARASHAR ET AL. EMERG. INFECT. DIS. 2003; 9: 565-572)

EVENT (RISK) EPISODES OF DIARRHEA REQUIRING HOME CARE (1:1) VISITS TO CLINICS (1:5) HOSPITALIZATIONS (1:65) DEATHS IN CHILDREN <5 YEARS (1:293)
 

NUMBER/YEAR IN MILLIONS 111 25 2 ~0.5

SAFE & EFFECTIVE VACCINE STILL UNAVAILABLE PERSONAL & ENVIRONMENTAL HYGIENE EFFECTIVE IN PREVENTING SPREAD OF ROTAVIRAL INFECTIONS RELATIVE IMPORTANCE OF VARIOUS VEHICLES REMAINS UNCLEAR
SYED A. SATTAR, SIMMONS COLLEGE SYMPOSIUM, OCT., 2005 13

MODES & MEANS OF PATHOGEN SPREAD IN NATURE Infected host

HORIZONTAL V E R T I C A L HORIZONTAL SPREAD Infected host Infected host Direct (person-to-person) Indirect Suscepti le host Suscepti le host

Suscepti le host

Indirect spread is through vehicles such as water, food, air, fomites, insects, animals, soil, hands, environmental surfaces, medical devices & transplanted lood & tissues Suscepti le host
SYED A. SATTAR, SIMMONS COLLEGE SYMPOSIUM, OCT., 2005 14

ENVIRONMENTAL SPREAD OF INFECTIOUS AGENTS

SOIL
(CLOSTRIDIUM TETANI)

MEDICAL DEVICES
(HEPATITIS B VIRUS)

ENVIRON. SURFACES
(HEPATITIS A VIRUS)

WATER
(CRYPTOSPORIDIUM)

FOOD (CAMPYLOBACTER)

AIR
(INFLUENZAVIRUS)

HUMAN HOST

INSECTS
(WEST NILE VIRUS)

HANDS
(ROTAVIRUS)

ANIMALS
(HANTAVIRUS)

SECONDARY HOSTS
(TOXOPLASMA GONDII)

WASTES
(ESCHERICHIA COLI O157:H7)

SYED A. SATTAR, SIMMONS COLLEGE SYMPOSIUM, OCT., 2005

15

SPREAD OF INFECTIONS IN NATURE

PATHOGEN SOURCE
INSECTS

ENVIRON. SURFACES

WATER

FOOD

HANDS AIR ANIMALS

SUSCEPTIBLE HOST
SYED A. SATTAR, SIMMONS COLLEGE SYMPOSIUM, OCT., 2005 16

BACTERIA, PARASITES & VIRUSES IN FOODBORNE DISEASE IN THE U.S. (FROM MEAD ET AL., 1999)
1. . 9.9

I H z
. 1.

.1

V
17

SYED A. SATTAR, SIMMONS COLLEGE SYMPOSIUM, OCT., 2005

FELINE CALICIVIRUS SURVIVAL ON FOODS AT 4C

120 % SU R VIVAL 100 80 0 0 20 0 0 1

5 TIME IN DA Y S
18

IDAWID ET AL. UNPUBLISHED DATA

SYED A. SATTAR, SIMMONS COLLEGE SYMPOSIUM, OCT., 2005

FELINE CALICIVIRUS SURVIVAL ON METAL DISKS AT 4C

10 0 90 0 0 0 50 0 0 20 10 0 1 2
BIDAWID ET AL. UNPUBLISHED DATA

5 T IM E IN D A

S
19

SYED A. SATTAR, SIMMONS COLLEGE SYMPOSIUM, OCT., 2005

SURVIVAL OF SELECTED ORGANISMS ON HANDS OF ADULTS AFTER ONE HOUR

90 80 70
% SURVIVA

2
NEA Y 45% OF FCV REMA RL INS DETECT BLE ON THE HA A NDS OF A DUL A TS FTER 20 MINUTES OF DR YING

60 50 40 30 20 10
V O 9E ) E U S A ) 14 5 E P .A (K -1

5 5 2 2

5
IC 2) 3 A L R (2 2 (W O U

2
F L U E N FL ZA A

0
P A E IN

D E N

IN

O TA

A U

O N

H N

IN

C O

FE L

A N

O R

P A

S .

R A

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SYED A. SATTAR, SIMMONS COLLEGE SYMPOSIUM, OCT., 2005

E .

IN

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GENERAL MEANS TO INTERRUPT SPREAD OF PATHOGENS

VACCINATION (POLIO) PASSIVE IMMUNIZATION (HEP. A) CHEMOTHERAPY (ANTIBIOTICS) VACCINATION OF ANIMALS (RABIES) DISEASE SURVEILLANCE (TB) QUARANTINE (RABIES) BARRIER PROTECTION (AIDS) SCREENING OF BLOOD & TISSUES (HEP. B) QUALITY CONTROL ON IMPORTS (CYCLOSPORA) EDUCATION (TOXOPLASMOSIS)
SYED A. SATTAR, SIMMONS COLLEGE SYMPOSIUM, OCT., 2005 21

ENVIRONMENTAL CONTROL MEASURES

WATER TREATMENT & DISTRIBUTION FOOD TREATMENT & PRESERVATION AIR FILTRATION & DISINFECTION LIQUID & SOLID WASTE COLLECTION, TREATMENT & DISPOSAL CONTROL OF ANIMALS & INSECTS CONTROL OF SECONDARY HOSTS STERILIZATION

HANDWASHING CLEANING/DISINFECTION
SYED A. SATTAR, SIMMONS COLLEGE SYMPOSIUM, OCT., 2005 22

ALCOHOL-BASED HAND RUBS AND FELINE CALICIVIRUS

(SATTAR ET AL., UNPUBLISHED DATA)

TREATMENT BASELINE 60% ETHANOL 70% ETHANOL 80% ETHANOL

MEAN VIRUS TITER 1.6 x 105 1.0 x 104 5.2 x 103 6.2 x 103

% REDUCTION 94.0 96.8 96.2

THE FINGERPAD METHOD (ASTM 1838) WAS USED. TEN L OF VIRUS IN SOIL LOAD WAS PLACED ON EACH FINGERPAD & DRIED. THE DRIED INOCULUM WAS EXPOSED TO CONTROL OR TEST SOLUTION FOR 30 SECONDS. THE FINGERPADS WERE ELUTED & ELUATES PLAQUE ASSAYED.
SYED A. SATTAR, SIMMONS COLLEGE SYMPOSIUM, OCT., 2005 23

AN ALCOHOL-BASED GEL AND CORONAVIRUS 229E

(SATTAR ET AL., UNPUBLISHED DATA)

TREATMENT BASELINE HARD WATER (200 PPM CaCO3) 75% (V/V) ETHANOL ALCOHOL (60%) GEL

MEAN s SD 1.32 X 104s 0.4 3.02 X 103 s 2.0 0 0

% REDUCTION 77.0 >99.99 >99.99

THE FINGERPAD METHOD (ASTM 1838) WAS USED. TEN L OF VIRUS IN SOIL LOAD WAS PLACED ON EACH FINGERPAD & DRIED. THE DRIED INOCULUM WAS EXPOSED TO CONTROL OR TEST SOLUTION FOR 30 SECONDS. THE FINGERPADS WERE ELUTED & ELUATES PLAQUE ASSAYED.
SYED A. SATTAR, SIMMONS COLLEGE SYMPOSIUM, OCT., 2005 24

CHEMICAL DISINFECTION TO INTERRUPT ROTAVIRUS SPREAD*

TREATMENT OF VIRUS NONE LYSOL DISINFECTANT SPRAY NO. INFECTED NO. TESTED 13/14 % INFECTED 93

0/14

Virus in fecal suspension was dried on plastic plates and volunteers asked to lick the surface with and without disinfection. Ward et al., J. Clin. Micro iol. 29: 1991-1996, 1991.
SYED A. SATTAR, SIMMONS COLLEGE SYMPOSIUM, OCT., 2005 25

EMERGING ISSUES


INCREASED SCRUTINY OF MICROBICIDES WITH MICROBICIDAL ACTIVITY AS ONLY ONE COMPONENT IN ACCEPTANCE & USE

     

FLAWED TEST METHODOLOGY PROSPECTS FOR REGIONAL/GLOBAL HARMONIZATION IMPROVED AWARENESS IN END-USERS TREATED ARTICLES MICROBICIDES & ANTIBIOTIC RESISTANCE (?) MICROBICIDE RESIDUES & ENHANCED BACTERIAL SPORULATION
(WILCOX & FAWLEY. LANCET 2000; 356; 1324.)
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SYED A. SATTAR, SIMMONS COLLEGE SYMPOSIUM, OCT., 2005

HAZARDS IN MICROBICIDE USE



SOME 300 CHEMICALS USED AS MICROBICIDES; MANY ARE NOW UNDER SCRUTINY MICROBICIDES ARE A DOUBLE-EDGED SWORD


NO CHEMICAL THAT CAN KILL PATHOGENS CAN BE TOTALLY SAFE FOR OTHER LIFE FORMS

    

DAMAGE TO THE ENVIRONMENT VOLATILE ORGANICS & AIR QUALITY DISRUPTION OF HORMONE FUNCTIONS CHANGES IN BIOFILM COMPOSITION COMBINED IMPACT OF CHEMICALS & PATHOGENS
SYED A. SATTAR, SIMMONS COLLEGE SYMPOSIUM, OCT., 2005 27

HOUSEHOLD MICROBICIDES & CHILDREN

(M. SPANN ET AL., AM. J. PUB. HLTH. 2000;90:971-973)


 

ANNUALLY ABOUT 800,000 CHILDREN (<6 YEARS IN AGE) IN THE U.S. INGEST HOUSEHOLD PESTICIDES MEDICAL ATTENTION NEEDED IN 10% OF THE CASES MICROBICIDES INVOLVED IN >90% OF SEVERE CASES

WORKING YOUTH & DISINFECTANTS

(BREVARD ET AL., ENVIRON HLTH PERSPECT. 2003;111:1654-1659)


 

ACUTE OCCUPATIONAL EXPOSURE TO DISINFECTANTS IN WORKING YOUTH (15-17 YEARS OF AGE) IN THE U.S. ANALYSIS OF 300 CASES IN A 5-YEAR PERIOD (1993-1998) THE RATE OF EXPOSURES 4-FOLD HIGHER IN THE YOUTH AS COMPARED TO THAT IN 24-44 YEAR OLDS. 45% OF CASES OF ILLNESS INVOLVED SOD. HYPOCHLORITE

NEED BETTER EDUCATION OF PARENTS

SYED A. SATTAR, SIMMONS COLLEGE SYMPOSIUM, OCT., 2005 28

REASONS FOR DESPAIR

      

UNABATED POPULATION INCREASE LEVELS OF POVERTY RISING AIR & WATER POLLUTION STILL TOO HIGH CLIMATE CHANGE WILL IMPACT DISEASE SPREAD INCREASING ANTIBIOTIC RESISTANCE AIDS CONTINUES ITS ONSLAUGHT VACCINATION RATES IN CHILDREN DROPPING


RECENT (OCT. 2005) CASES OF POLIO IN THE U.S.

REDUCED EMPHASIS ON PREVENTIVE STRATEGIES

SYED A. SATTAR, SIMMONS COLLEGE SYMPOSIUM, OCT., 2005 29

REASONS FOR HOPE

 

RENEWED EMPHASIS ON BETTER NUTRITION ELIMINATION/ERADICATION OF MANY CHILDHOOD DISEASES



OVER 90% OF CHILDREN IN CANADA AND THE U.S. IMMUNIZED AGAINST COMMON CHILDHOOD DISEASES

UN TREATY ON RIGHTS OF CHILDREN



AN INTERNATIONAL TREATY THAT RECOGNIZES THE HUMAN RIGHTS OF CHILDREN AS OF NOV. 2003, TREATY RATIFIED BY 192 COUNTRIES, MORE THAN ANY HUMAN RIGHTS TREATY IN HISTORY SOMALIA UNABLE TO RATIFY AS IT HAS NO RECOGNIZED GOVERNMENT IN THE U.S., THE REVIEW TO RATIFY MAY TAKE SEVERAL YEARS
SYED A. SATTAR, SIMMONS COLLEGE SYMPOSIUM, OCT., 2005 30

CONCLUDING REMARKS


PROTECTION OF CHILDREN FROM INFECTIONS IN GENERAL REQUIRES SPECIAL CONSIDERATION EVEN IN DEVELOPED COUNTRIES


WIDE VARIATIONS & GAPS IN STANDARDS OF HYGIENE EDUCATION & PARENTAL AWARENESS SAFE & EFFECTIVE ENVIRONMENTAL CONTROL MEASURES LACKING USE OF MICROBICIDES IN HAND ANTISEPSIS & DISINFECTION OF ENVIRONMENTAL SURFACES REQUIRES REVIEW.

REVIVAL OF EMPHASIS ON PREVENTION NEEDED

SYED A. SATTAR, SIMMONS COLLEGE SYMPOSIUM, OCT., 2005 31

ACKNOWLEDGMENTS


DR. LIZ SCOTT & OTHERS AT THE CENTER FOR HYGIENE & HEALTH IN HOME & COMMUNITY, SIMMONS COLLEGE

SYED A. SATTAR, SIMMONS COLLEGE SYMPOSIUM, OCT., 2005

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