(PRO. IN DEPARTMENT OF ENVIOROMENTAL COMMUNITY HEALTH, UNIVERSITY OF NIGERIA )
VOL.04 Issue 07
Viruses are probably the foremost common reason behind communicable diseases acquired within indoor environments and have a considerable impact on human health, ranging from severe life-threatening illnesses to relatively mild and self–limiting or asymptomatic diseases. Particularly, viruses causing gastrointestinal and respiratory diseases spread rapidly within the community and cause considerable morbidity. Increasing numbers of people who have impaired immunity, for whom the implications of infection are far more serious, are now cared for in ’out of hospital settings. there’s growing evidence that person–to–person transmission via the hands and contaminated fomites plays a key role within the spread of viral infections and there is a necessity for a wider understanding of the potential for contaminated surfaces to act as unidentified vectors of pathogens within the transmission cycle. Intervention studies have shown that improved standards of education, personal hygiene (particularly handwashing), and targeted environmental hygiene have a considerable impact on the control and prevention of infectious organisms.
Prevention, virus, life-threatening illnesses, communicable disease.
Nearly one thousand different kinds of viruses are known to infect humans and it’s estimated that they account for about 60% of all human infections (Horsfall 1965). Although many of the respiratory and gastrointestinal infections caused by viruses are going to be asymptomatic or relatively mild and self–limiting (coughs and colds, etc.), they still represent an enormous economic burden. Increasing numbers of people who have reduced immunity to infection, for whom the implications of infection are much more serious, are now cared for the reception. Otherwise healthy members of the family with asthma or allergies even have increased susceptibility to infection. within the united kingdom, it’s estimated that one in six people within the community belongs to an ’at risk‘ group (Bloomfield 2001).
World Health Organisation estimates suggest that, by 2025, there will be over 800 million people over 65 years old within the globe, two–thirds of them in developing countries (Anon. 1998). Viruses are probably the foremost common explanation for communicable diseases acquired within indoor environments. Viruses that cause tonsillitis, colds, croup, bronchiolitis, influenza, pneumonia, and other tract infections are also spread in aerosolized droplets. Aerosols produced by coughing, sneezing, and talking are inhaled directly by a susceptible host or may settle onto surfaces.
Infants are especially in danger of such infections because they often place objects, like toys, into their mouths. Transfer of viruses to food during handling and preparation via hands and food contact surfaces could be a vital route of spread of viral gastroenteritis
THE BURDEN OF viral infection gastrointestinal infections
In developed countries, it’s estimated that S0–40% of infectious gastroenteritis cases are because of viruses (Thompson 1994). Other data indicate that NLVs and rotavirus are the foremost typical pathogens causing outbreaks of gastroenteritis in homes for the elderly (Djuretic et al. 1996; Ryan et al. 1997; Dedman et al. 1998). Over the number 199S–96, a UK study involving some 460 000 participants was administrated to gauge rates of IID within the community and presenting to general practice which has given valuable insights into the epidemiology of viral infections within the community (Wheeler et al. 1999). The study indicated that as many together in five people within the final UK population develop IID annually with an estimated 9•4 million cases occurring annually. it’s long been recognized that, since cases and outbreaks related to viral agents are often unreported, the impact of viral intestinal infections is additionally much greater than national surveillance suggests.
Wheeler and associates estimated that for every one case of rotavirus and NLV reported to national surveillance a further S5 cases of rotavirus and 1562 cases of NLV occur within the community. UK surveillance covering 1995–96 showed NLV as a serious reason for epidemic gastroenteritis in community residential and nursing homes, accounting for 4S% of all reported general gastroenteritis outbreaks (Evans et al. 1998). the speed of reported NLV infection reaches a peak in children under 5 years and again within the elderly. Foodborne outbreaks can arise from contaminated raw food like shellfish and also through secondary contamination from food handlers carrying the virus. Rotavirus infections are highly seasonal, peaking within the winter months (Brandt et al. 1982; Ryan et al. 1996; Dedman et al. 1998). it has been suggested that low humidity and people spending longer indoors contribute to the spread of rotavirus infections (Anon. 1995).
Respiratory infections Infections caused by influenza viruses, rhinoviruses, coronaviruses, and respiratory syncytial viruses (RSV) are a significant health burden. Estimates suggest that adults suffer two to 5 colds p.a. and infants and preschool children have about four to eight colds each year (Sperber 1994). Although such infections are often thought to be trivial, taking into consideration lost days from work and faculty, hospital admissions, and mortality rates in infants and therefore the elderly, the health and economic costs are considerable. Although the cold is caused by several viruses, rhinoviruses and coronaviruses predominate. Rhinoviruses are answerable for outbreaks of communicable disease within the general community like schools, daycare centers, and hospitals (Denny et al. 1986; Krilov et al. 1986; Kellner et al. 1988).
Influenza affects all age groups, but it’s the elderly and persons with underlying health problems who are at particular risk from complications of influenza and are more likely to want hospitalization. syncytial virus infections occur everywhere the globe and outbreaks are common within the cold season in temperate climates and also the season in tropical climates. The respiratory syncytial virus may be a major explanation for respiratory disorder in young children, affecting about 90% of kids by the age of two years (Crowcroft et al. 1999; Simoes 1999). School-aged children often carry RSV to their homes and spread the infection to younger siblings. Attack rates within families are high, with about 40% of members of the family, including adults, becoming infected. In most family outbreaks although over 95% of infections are symptomatic they’re not usually severe (Berglund 1967; Hall et al. 1976a)
In adults RSV infection generally leads to a ’common cold‘ type illness although it can sometimes produce a ’flu–like‘ syndrome indistinguishable from influenza. Antibodies resulting from a babyhood RSV infection don’t prevent further RSV infections later in life. The respiratory syncytial virus is understood to cause a high incidence of pneumonia and death within the elderly. In England and Wales, it’s estimated that RSV causes 60–80% more deaths than influenza, causing about 2S 000 deaths each winter (Nicholson 1996). Gastrointestinal viruses Rotavirus. Rotavirus is shed in large numbers from an infected person, with feces often containing > 1012 particles per gram. Children and adults will be asymptomatic excretion of rotavirus (Ansari et al. 1991a) and rotavirus, In adults RSV infection generally leads to a ’common cold‘ type illness although it can sometimes produce a ’flu–like‘ syndrome indistinguishable from influenza. Antibodies resulting from a babyhood RSV infection don’t prevent further RSV infections later in life. The respiratory syncytial virus is understood to cause a high incidence of pneumonia and death within the elderly. In England and Wales, it’s estimated that RSV causes 60–80% more deaths than influenza, causing about 2S 000 deaths each winter (Nicholson 1996). Gastrointestinal viruses Rotavirus. Rotavirus is shed in large numbers from an infected person, with feces often containing > 1012 particles per gram. Children and adults will be asymptomatic excretion of rotavirus (Ansari et al. 1991a) and rotavirus excretion can persist for up to S4 d after diarrhea has stopped in symptomatic patients (Pickering et al. 1988). More recently, a hospital study showed that S0% of the immunocompetent children excreted rotavirus particles for quite 21 d and as long as 57 d after the onset of diarrhea (Richardson et al. 1998). Sattar et al. (199S) have shown that rhinoviruses can survive on environmental surfaces for several hours. Infectious viruses are recovered from naturally contaminated objects within the surroundings of persons with rhinovirus colds (Reed 1975). Clean hands can readily acquire the virus by touching or handling such objects (Ansari et al. 1991b). the maximum amount as 70% of infectious rhinovirus on contaminated hands has been shown to transfer to a recipient‘s fingers after contact of only 10 s (Gwaltney et al. 1978). After handling contaminated cup handles and other objects, over 50% of subjects developed an infection (Gwaltney and Hendley 1982). Hendley et al. (197S) and Reed (1975).
All of the volunteers who licked rotavirus–contaminated plates became infected whereas, of these individuals touching the virus–contaminated plates with their fingers then their mouths, only about half became infected. Several studies in child daycare centers have shown that rotavirus will be widely disseminated when outbreaks occur. In one such center fecal contamination of hands. Respiratory viruses It is generally accepted that respiratory viruses, like those which cause communicable disease and flu, are spread from person to person by aerosol transmission thanks to sneezing and coughing. Nevertheless, there’s growing evidence that a big proportion of flu and particularly cold viruses are spread via hands and surfaces like handkerchiefs and tissues, tap and door handles, telephones, Sattar et al. (199S) have shown that rhinoviruses can survive on environmental surfaces for several hours. Infectious viruses are recovered from naturally contaminated objects within the surroundings of persons with rhinovirus colds (Reed 1975). Clean hands can readily acquire the virus by touching or handling such objects (Ansari et al. 1991b). the maximum amount as 70% of infectious rhinovirus on contaminated hands has been shown to transfer to a recipient‘s fingers after contact of only 10 s (Gwaltney et al. 1978). After handling contaminated cup handles and other objects, over 50% of subjects developed an infection (Gwaltney and Hendley 1982). Hendley et al. (197S) and Reed (1975) have demonstrated that rhinoviruses can survive for several hours on the hands and self–inoculation by rubbing the nasal mucosa or conjunctivae via virus-contaminated fingers can result in infection. Influenza virus will be shed before the onset of symptoms and for up to 7 d after onset and individuals with influenza are often infectious before they develop symptoms and for up to every week afterward. Both influenza A and B virus has been shown to survive on hard surfaces like stainless-steel and plastic for 24–48 hands-on absorbent surfaces like cloth, paper, and tissues for up to 12 h (Bean et al. 1982). it had been shown that influenza an endemic may be transferred from contaminated surfaces to hands for up to 24 h after the surface was inoculated. Epidemiological evidence supports the laboratory data because an influenza outbreak during a rest home suggested that the virus was spread by staff, through hands contaminated directly with body fluids.
EVIDENCE THAT HYGIENE CAN PLAY a component IN PREVENTING TRANSMISSION OF VIRAL INFECTIONS
Although studies about the survival characteristics of viruses represent a very important component in understanding the infection potential and also the preventive role of hygiene, much of our knowledge comes from reports of infection outbreaks where hygiene procedures are defective or from case-control studies. Fifteen such reports are examined during which viral contamination was directly implicated or that viral agents were likely to possess been the reason for the infections.
Although opportunities for cross-contamination and cross-infection may occur less frequently within the home it may be argued that, since the ratio of homes to daycare centres is incredibly large, the impact of those environments on the infection rates across a community might not be so dissimilar, although daycare centres bring more people together. None of the investigations cited relate specifically to the house but Fornasini et al. (1992) and Osterholm et al. (1992) report studies of disease transmission from daycare centres to the house where it’s transferred among members of the family. In a study disbursed during the cold and flu season at two daycare centres, fewer colds were reported within the test group of S–5–year–olds using proper and frequent handwashing techniques than within the control group. within the test centre, the proportion of colds remained fairly constant at 18•9% whilst in the control group the proportion of colds increased from 12•7% to 27•8% (Niffenegger 1997). Carter et al. (1980) demonstrated that families who used an iodine-based hand disinfectant, known to kill rhinoviruses, had lower rates of infection than families using an inactive handwash. within the intervention year, the infection rate among those attending the centres was significantly not up to within the previous S years, with an almost 50% decrease within the infection rate. Roberts et al. (2000a) administered a randomized controlled trial of the effect of infection control measures on the frequency of upper respiratory tract infection in childcare. The intervention measures were training of childcare staff about the transmission of infection, handwashing, and aseptic nose-wiping technique. the same study by these workers also examined the consequences of infection control measures on the frequency of diarrhoeal episodes in childcare employing a randomized controlled trial (Roberts et al. 2000b). They found that, for those centres during which children‘s compliance with handwashing was high, diarrhoeal episodes were reduced by 66%. In the US, a pestilence of aseptic meningitis because of echovirus S0 was reported amongst parents with children attending a childcare centre. it absolutely was found that more frequent handwashing among the teachers compared with the fogeys of young children was related to significantly lower rates of infection (Helfand et al. 1994). St. Sauver et al. (1998) studied hygienic practices and also the prevalence of respiratory disease in children attending daycare homes. Never or rarely washing hands by both children and carers was related to the next frequency of respiratory disease in both family and group daycare homes. sacs et al. (1991) reported a sevenfold reduction in the incidence of RSV during a hospital when patients and staff were educated about the importance of handwashing and infected babies were segregated. Before the intervention, 4•2% of youngsters under 2 years old developed nosocomial RSV, whilst after the intervention, only 0•6% developed an infection. Following the implementation of a hygiene intervention programme that included handwashing education, use of gloves, disposable nappy pads, and alcohol-based hand rinse the incidence of enteric illness was lowered
DEVELOPMENT OF EFFECTIVE HYGIENE POLICIES FOR PREVENTION OF VIRAL INFECTIONS
The data reviewed show how improved standards of education and integrated hygiene measures, including hand and environmental hygiene, could have a major impact in reducing infectious diseases within the community and residential environments. Traditionally, the general public has attended regard good hygiene as creating an environment free from germs. to plan a hygiene policy that has real public health benefits, it’s now accepted that a risk-based approach should even be adopted (Bloomfield and Scott 1997; Jones 1998; Scott 1999). A risk assessment approach to hygiene starts from the premise that homes and other settings always contain potentially harmful microbes (people, pets, food, etc.) which good hygiene isn’t about eradication but about targeting measures within the places and at the days that matter, to limit risks of exposure. For both the hands and for environmental surfaces hygiene is achieved by the physical removal of organisms from the surface. Alternatively, organisms may be inactivated on-site by a disinfection process or a mixture of both physical removal and disinfection. In many situations like the hands, and cooking and eating utensils, appropriate risk reduction will be achieved using detergent and predicament. However, since, during this situation, hygiene is achieved by removal of the microbes from the surface, if it’s to be effective it must be applied in conjunction with a radical rinsing process with clean water and must understand the strength of attachment of the microbes to the surface (Eginton et al. 1995)
Studies by Schurmann and Eggers (1985) showed that enteric viruses could also be more strongly certain to the skin surface which the inclusion of an abrasive substance, like sand or hydrated aluminium oxide, within the handwash preparation is advisable to realize effective virus removal. Recent studies of the transmission of viruses in a very household setting using bacteria– phage $X174 as a model showed that virus spread wasn’t prevented by the same old standards of hand hygiene as practiced in the household (Rheinbaben et al. 2000). Although these compounds will be used for disinfection of environmental surfaces they’re generally too toxic and irritant to be used on the skin. In achieving decontamination of hands, although hand rub and handwash products currently available may have good activity against bacterial pathogens, activity against viral contamination is variable and depends on the kind of virus. Rotter (1997) suggested that, although alcoholic hand rubs are effective against enveloped viruses like influenza, PIV, herpes, and RSV, activity against non–enveloped viruses like rotaviruses, rhinovirus, poliovirus, adenovirus, NLV, and hepatitis virus is proscribed unless extended contact times (up to 10 min) are used. Similarly, agents like triclosan and chlorhexidine have some activity against the enveloped virus but don’t seem to be considered effective against non– enveloped viruses.
It is well established that viruses are shed in large numbers and may survive for long periods on surfaces or fomites commonly found in many environments and this emphasizes the possible role of surfaces within the transmission of viruses. Faeces can contain up to 1012 virus particles per gram and spew to 107 per millilitre therefore the potential for hand and environmental contamination is considerable. Viral shedding may begin before the onset of symptoms and should continue for several days or perhaps weeks after the symptoms have ceased, Improved hand washing and surface hygiene procedures are shown to interrupt the transmission of viral infections via hands, surfaces, or fomites. Although the importance of hygiene and most particularly handwashing can not be overemphasized as a way of reducing infections it may be difficult to enforce even in healthcare facilities where staff should bear in mind the infection risks. The importance of hands within the transmission of the virus infections is well recognized and lots of the studies cited during this review relate specifically to handwashing interventions. Most particularly hand contact with contaminated surfaces is probably going to be the reason for such cross-contamination.
To motivate changes in attitude to hygiene it’ll be necessary to realize acceptance that homes and other community settings will always contain potentially harmful microbes which good hygiene isn’t about eradication but about targeting the right measures at the days that matter, to cut back infection risks. there’s a desire for a wider understanding of the potential for contaminated surfaces to act as unidentified vectors of pathogens, within the recontamination of hands, during the infection transmission cycle. The epidemiological evidence to this point shows that raising awareness about the importance of key procedures, like hand washing and surface hygiene (particularly hand and food contact surfaces), will have a substantial impact on the control and prevention of infectious organism
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