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PubMed1998

Microbial contamination of advanced life support (ALS) systems poses a moderate threat to the long-term stability of space-based bioregenerative systems.

Microbial contamination of terrestrial hydroponic plant-growing systems provides an effective analogue for studying microbial contamination issues for space-based advanced life support (ALS) systems. If aggressive root or foliar pathogens are introduced into ALS hydroponic systems, severe epidemics are probable. Greater than 80% of the reported outbreaks of root pathogens in terrestrial hydroponic systems describe epidemics caused by fungal species of Fusarium, Phytophthora, and Pythium. However, it is likely that a comprehensive sanitation and quarantine program for space-based ALS modules will prevent contamination by Phytophthora and Pythium spp. because these pathogens are general soilborne. However, Fusarium spp. are typically airborne, can grow saprophytically on diverse substrates, and have been common contaminants of American spacecraft. If comprehensive sanitation and quarantine programs are established for space-based ALS modules, then the threat of pathogen introductions into these systems will be significantly mitigated. Microbial contamination studies in spacecraft over the last 30 years indicate that a high diversity of bacteria, fungi, and actinomycetes are commonly carried on board probably via clothing, equipment, air currents during spacecraft handling and loading, food, and the astronauts themselves. Species of Alternaria, Aspergillus, Botrytis, Candida, Cephalosporium, Cladosporium, Fusarium, Mucor, Penicillium, Phoma, and Trichoderma were the most prevalent fungi recovered, and species of Bacillus, Escherichia, Klebsiella, Micrococcus, Pseudomonas, Staphylococcus, and Streptococcus were the most prevalent bacteria recovered from spacecraft. Most of these genera contain species that have been reported as plant pathogens. Strict quarantine procedures were not effective in preventing contamination of spacecraft during these missions. Research must be initiated to better understand how microorganisms interact with plants and animals in microgravity environments because microbial contamination of spacecraft and ALS modules cannot be avoided. An integrated pest management (IPM) program likely will be developed for managing plant disease outbreaks in space-based ALS systems.

Ecological Systems, Closed↗

PubMed2001

Malaria control: achievements, problems and strategies.

Even if history has not always been the Magistra vitae, Cicero expected it to be, it should provide, as Baas said, a mirror in which to observe and compare the past and present in order to draw therefrom well-grounded conclusions for the future. Based on this belief, this paper aims to provide an overview of the foundations and development of malaria control policies during the XX century. It presents an analysis of the conflicting tendencies which shaped the development of these policies and which appear to have oscillated between calls for frontal attack in an all-out campaign and calls for sustainable gains, even if slow. It discusses the various approaches to the control of malaria, their achievements and their limitations, not only to serve as a background to understand better the foundations of current policies, but also to prevent that simplistic generalisations may again lead to exaggerated expectations and disillusion. The first part of the paper is devoted to the development of malaria control during the first half of the century, characterised by the ups and downs in the reliance on mosquito control as the control measure applicable everywhere. The proliferation of "man-made-malaria", which accompanied the push for economic development in most of the endemic countries, spurred the need for control interventions and, while great successes were obtained in many specific projects, the general campaigns proposed by the enthusiasts of vector control faced increasing difficulties in their practical implementation in the field. Important events, which may be considered representative of this period are, on the campaign approach, the success of Gorgas in the Panama Canal, but also the failure of the Mian Mir project in India; while on the developmental approach, the Italian and Dutch schools of malariology, the Tennessee Valley and the development of malaria sanitation, included the so called species sanitation. The projection of these developments to a global scale was steered by the Malaria Commission of the League of Nations and greatly supported by the Rockefeller Foundation. Perhaps the most important contribution of this period was the development of malaria epidemiology, including the study of the genesis of epidemics and their possible forecasting and prevention. Although the great effectiveness of DDT was perhaps the main determinant for proposing the global eradication of the disease in the 1950s, it was the confidence in the epidemiological knowledge and the prestige of malariology, which gave credibility to the proposal at the political level. The second part deals with the global malaria eradication campaign of the 1950s and 1960s. It recognises the enormous impact of the eradication effort in the consolidation of the control successes of the first half of the century, as well as its influence in the development of planning of health programmes. Nevertheless, it also stresses the negative influence that the failure to achieve its utopian expectations had on the general disappointment and slow progress of malaria control, which characterised the last third of the century. The paper then analyses the evolution of malaria control funding, which often appears out of tune with political statements. The fourth part is devoted to the search for realistic approaches to malaria control, leading to the adoption of the global malaria control strategy in Amsterdam in 1992, and the challenge, at the end of the century, to rally forces commensurate with the magnitude of the problem, while aiming at realistic objectives. After discussing the conflicting views on the relations between malaria and socio-economic development and the desirable integration of malaria control into sustainable development, the paper ends with some considerations on the perspectives of malaria control, as seen by the author in early 1998, just before the launching of the current Roll Back Malaria initiative by WHO.

Animals↗

PubMed2002

A model for government-community partnership in building sewage systems for urban areas: the experiences of the Orangi Pilot Project--Research and Training Institute (OPP-RTI), Karachi.

Over 20 years the Orangi Pilot Project has been working to understand the problems of Orangi, a district of Karachi largely characterised by high-density informal settlement, and enable its residents to develop and implement solutions. Sanitation was identified as the major problem and a sewerage system was built. From this work was developed the "internal-external" concept for sanitation, which has 4 levels: sanitary latrines in houses; underground sewer in lane; neighbourhood collector sewer; and trunk sewer and treatment plant. The first three components are "internal" and can be undertaken by low-income communities; the "external" fourth component has to be funded and carried out by government or similar agency. Successful and unsuccessful attempts elsewhere to replicate this model have both confirmed the effectiveness and practicality of such community-based action and shown the - largely organisational pitfalls that must be avoided.

Cities↗

PubMed2002

State of the art and future perspectives of thermophilic anaerobic digestion.

The state of the art of thermophilic digestion is discussed. Thermophilic digestion is a well established technology in Europe for treatment of mixtures of waste in common large scale biogas plants or for treatment of the organic fraction of municipal solid waste. Due to a large number of failures over time with thermophilic digestion of sewage sludge this process has lost its appeal in the USA. New demands on sanitation of biosolids before land use will, however, bring the attention back to the use of elevated temperatures during sludge stabilization. In the paper we show how the use of a start-up strategy based on the actual activity of key microbes can be used to ensure proper and fast transfer of mesophilic digesters into thermophilic operation. Extreme thermophilic temperatures of 65 degrees C or more may be necessary in the future to meet the demands for full sanitation of the waste material before final disposal. We show data of anaerobic digestion at extreme thermophilic temperatures.

Bacteria, Anaerobic↗

PubMed1971

Bacterial contamination of confined, sealed space during long-term human occupation.

The long-term presence of human beings in a closed room of small volume is accompanied by the accumulation of a common and hemolytic microflora on their bodies, clothes, in the air, and on the room surfaces. A study was made of the dynamics of the spreading of such microflora in rooms measuring from 5-21 m3 when occupied by 1-3 persons for 5-30 days. With minimal sanitation the skin, after 30-40 days, is covered with several thousands of microbes per cm2, of which the hemolytic staphylococci amount to about 500 cells per cm2. Linen contained tens of thousands of bacteria per cm2, including up to 7000 hemolytic staphylococci per cm2. Generally, air contamination increases during the experiment. The rate of increase depends on many factors, and includes, in addition to common microbes, hemolytic staphylococci, streptococci, including pathogenic ones. The distribution of microbes in the air depends on human activity, and the total number is lowered by improved sanitation. While initial surface contamination depends on preliminary disinfection, there is a steady accumulation of micro-organisms on the chamber surfaces. No Escherichia coli could be found on chamber surfaces. Most bacteria were found on horizontal surfaces, working areas and floors (thousands of microbes per cm2), while ceilings and walls yielded from units to hundreds of cells per cm2.

Air Conditioning↗

PubMed2002

Reflections on a career in public health: evolving foodborne pathogens, environmental health, and food safety programs.

Events affecting environmental health and food safety policy, programs and organization and emerging or identified foodborne diseases are reviewed by decade. The review starts with the impact of the 1940s war years on environmental sanitation, as it was called, and disease control. It continues with the intensifying disease surveillance and improvements in sanitation of the 1950s and the improvements in foodborne-disease surveillance and the reorganization of environmental programs of the 1960s. Many previously unknown foodborne pathogens were identified, and more changes in environmental policy came about in the 1970s. Evaluation of foodborne-disease control measures were initiated. In the 1980s, evaluation of major foodborne-disease problems came to the forefront. In the 1990s, the media and consumer groups became aware of foodborne-disease problems and concerned with the environment. The first decade of the 21st century will be faced with continuing dilemmas posed by emerging diseases and will need to provide solutions through the balancing of science, education, and politics.

Disease Outbreaks↗

PubMed2002

[Water supply for civilian populations in crisis and post-war situations: example of Mitrovica city (Kosovo) in 1999-2000].

After reviewing the effects of water shortage on sanitation, the author describes minimum water requirement in terms of both quantity and quality during emergency situations and recovery periods. This article also gives general guidelines for water treatment to cover vital needs and provide adequate sanitation to the victimized community. To illustrate his point, the author cites the water management program implemented by the humanitarian action branch of an industrial group in Mitrovica, Kosovo in 1999 and 2000.

France↗

PubMed2002

[Minimally invasive technologies in the treatment of severe forms of acute pancreatitis at various periods of the disease].

The choice of the optimum technique of the sanitation procedure in treatment of acute necrotizing pancreatitis (ANP) is now one of the most disputable problems. Clinical estimation of the efficiency of various operative techniques of treatment of ANP at various stages of disease has been made. In the aseptic phase laparoscopic decompression of the pancreas is indicated when the patient has evident hemorrhagic parapancreatitis. In the phase of septic sequestration of ANP the optimum method of minimally invasive surgical intervention is considered to be minilaparotomy which is expedient for abscesses of small volume, lipid abscesses of any volume with the minimal content of necrotizing tissues as the first step of sanitation in critical patient. High quantity of the necrotizing tissues in the zone of the destructive focus requires traditional laparotomy of the abscess under conditions of preventive maintenance of the endotoxic shock.

Humans↗

PubMedDate not supplied

[Role of persisting opportunistic bacteria in the pathogenesis of the gastric and duodenum ulcer].

Dynamic study of the bacterial microflora of 122 patients with gastric and duodenal ulcer was carried out. Microflora examination of the bioptic samples of mucosa, obtained from the ulcerous zone of the patients, revealed that an open ulcer is like an infected wound needing sanitation. In the focus of lesion microorganisms of 32 genera and species, including Helicobacter pylori, fungi of the genus Candida, representatives of the genera Streptococcus, Staphylococcus, Corynebacterium, Bacteroides, etc., were detected. Opportunistic microorganisms were isolated in associations (up to 8 different cultures), possessing cytotoxic, hemolytic, antilysozyme, lecithinase, caseinolytic and RNAase activities. To inhibit the microflora, chitosan was used; 82-85% of the cultures of different bacteria under study proved to be sensitive to it. The inclusion of chitosan into the complex therapy suppressed the persistence of H. pylori, ensured the sanitation of mucosa affected by opportunistic bacteria and accelerated ulcers cicatrization.

Adolescent↗

PubMed2004

Common intestinal parasites.

Intestinal parasites cause significant morbidity and mortality. Diseases caused by Enterobius vermicularis, Giardia lamblia, Ancylostoma duodenale, Necator americanus, and Entamoeba histolytica occur in the United States. E. vermicularis, or pinworm, causes irritation and sleep disturbances. Diagnosis can be made using the "cellophane tape test." Treatment includes mebendazole and household sanitation. Giardia causes nausea, vomiting, malabsorption, diarrhea, and weight loss. Stool ova and parasite studies are diagnostic. Treatment includes metronidazole. Sewage treatment, proper handwashing, and consumption of bottled water can be preventive. A. duodenale and N. americanus are hookworms that cause blood loss, anemia, pica, and wasting. Finding eggs in the feces is diagnostic. Treatments include albendazole, mebendazole, pyrantel pamoate, iron supplementation, and blood transfusion. Preventive measures include wearing shoes and treating sewage. E. histolytica can cause intestinal ulcerations, bloody diarrhea, weight loss, fever, gastrointestinal obstruction, and peritonitis. Amebas can cause abscesses in the liver that may rupture into the pleural space, peritoneum, or pericardium. Stool and serologic assays, biopsy, barium studies, and liver imaging have diagnostic merit. Therapy includes luminal and tissue amebicides to attack both life-cycle stages. Metronidazole, chloroquine, and aspiration are treatments for liver abscess. Careful sanitation and use of peeled foods and bottled water are preventive.

Adult↗

PubMedDate not supplied

Validation of microbial recovery from hydrogen peroxide-sterilized air.

The use of hydrogen peroxide as a sanitant in isolators and other barrier systems is well documented. To confirm that the isolator maintains a germ-free environment between decontamination cycles, microbiological air monitoring is performed after the sanitation and aeration cycles. In this study, we have shown that residual levels of hydrogen peroxide as low as 1 ppm can remain in the isolator and inhibit the growth of microorganisms after concentration on agar media. This lingering hydrogen peroxide can make accurate microbiological air monitoring difficult and can even cause false negative test results. To solve this issue, we have developed a new media that can mediate the effects of residual peroxide and prevent false negative test results. Initially, catalase was tested as a neutralizing agent but proved not to be efficient enough. Instead, 1% pyruvate was added, which was able to tolerate as much as 15 ppm Vaporous Hydrogen Peroxide (VHP) and ensured growth promotion of Staphylococcus aureus, Pseudomonas aeruginosa, Micrococcus luteus, Bacillus subtilis, Candida albicans and Aspergillus niger. The 1% pyruvate retained its neutralizing activity for Micrococcus luteus at up to 100 ppm VHP. Raising the pyruvate concentration to 5% pyruvate enabled neutralization of up to 300 ppm VHP, permitting subsequent growth of Micrococcus luteus on agar media.

Air Microbiology↗

PubMed2004

Prevalence of CagA and VacA genotype of Helicobacter pylori in Thai children.

UNLABELLED: Seroprevalence of Helicobacter pylori infection in children is variable according to geographical location and family sanitation. A previous study in Bangkok showed an incidence of 25.5% in 1998. The higher incidence in the urban and rural area is predicted in lower economic classes and poor sanitation. OBJECTIVE: To study the occurance of CagA and VacA genotype in Thai children using the Western blot technique. MATERIAL AND METHOD: Sera of 159 Thai native children aged 0-15 year without associated abdominal pain from different provinces in 4 parts of the Kingdom of Thailand were tested with the rapid screening test for H. pylori. The positive specimen was further tested with the Western blot technique for determination of Urea A (p37), CagA (p116) and VacA (p89). RESULT: Fiftyfive andfifty two (34.6%) were tested positive by the rapid test while 32.7% were positivefor the band of current infection marker (CIM). The 28 selected positive sera with complete history of housing and water supply were analysed. Thai children living in urban areas have a higher prevalence and the CagA+, VacA+ are found in 96.43% of infected patients. The transmission may be through the water supply. CONCLUSION: A high prevalence of Helicobacter pylori infection was found in childhood period in urban areas and may be associated with the local water supply.

Adolescent↗

PubMed2005

[Medicine in the concentration camps of the Third Reich].

Between 1942 and 1944 millions of prisoners were subjected to forced labor in concentration camps throughout the Third Reich, all the while being the victims of a systematic and "scientific" extermination policy. Though the policy was directed mainly against Jews, it was implemented against other "inferior races" as well. The prisoners, stripped of all rights, experienced constant humiliation, uncertain survival and terror. The harsh living condition, characterized by crowding, absent sanitation and poor personal hygiene led to considerable morbidity, mainly due to injuries, infectious diseases and famine, and to high mortality rates. Medical care in the camps was the responsibility of the S.S. Each camp had a chief S.S. physician accompanied by a number of assistants and orderlies. There was also a parallel system of "prisoner-physicians." There was a chief prisoner-physician in every camp, and each block was assigned a "block doctor" who was responsible for sanitation, the removal of corpses, setting up the sick- call and authorizing sick leave. Work teams were accompanied by "mobile doctors" (Streckenpfleger), who dispensed first aid for work injuries. Prisoner-physicians were also charged with disinfecting the blocks and maintaining hygienic conditions in the camp. Every camp had one or more blocks, called "Reviers", that were used for treatment and hospitalization. In the larger camps a number of blocks were designated to function as a sort of hospital (Krankenbau). At times one camp out of a group of camps would be set aside as quarantine, primarily for patients with infectious diseases. Officially, the "Revier" was the responsibility of an S.S. physicians', assisted by a chief prisoner-physician, his assistants and, at times, nurses. But in actuality the Reviers were managed by prisoners (Capos) who did not have medical training but were authorized to make decisions in medical matters such as operations and, on occasion, even performed them. The Reviers suffered from shortage of everything: beds, manpower, diagnostic and therapeutic means, sterile supplies and drugs for anaesthesia. Crowding was the rule, and each cot was occupied simultaneously by several patients regardless of their condition or the nature of their disease. Life-saving procedures could not be performed and surgery, if done, was usually without anaesthesia. Mortality was high, and the Revier was commonly perceived by the prisoners as a place of death, not of healing. Occasionally there were visits, or inspections, by the S.S. physicians. The main purpose of those visits was "selection". Patients with no chance of recovery were sent to their death and the others were returned to work in spite of their condition. The prisoner-physicians made every effort to prevent this "selection" in various ways. They were often punished or even executed for their efforts.

Concentration Camps↗

PubMed2005

Hand hygiene behavior in a pediatric emergency department and a pediatric intensive care unit: comparison of use of 2 dispenser systems.

BACKGROUND: Adherence to hand hygiene standards is poor. Approaches and systems to improve hand hygiene practices warrant testing. OBJECTIVE: To compare the frequency of use of manually operated and touch-free dispensers of sanitizer for hand hygiene. METHODS: Manual and touch-free dispensers of alcohol sanitizer were placed in the emergency department and an intensive care unit of a large pediatric hospital for two 2-month periods for each type of dispenser. Counting devices installed in each dispenser and direct observations were used to determine actual frequency of and indications for hand hygiene. RESULTS: The touch-free dispensers were used significantly more often than were the manual dispensers. The means for the number of episodes of hand hygiene per hour were 4.42 for the touch-free dispensers and 3.33 for the manual dispensers (P=.04); the means for the number of episodes per patient per hour were 2.22 and 1.79, respectively (P=.004); and the means for the number of uses of the dispenser per day were 41.2 and 25.6, respectively (P=.02). However, the overall compliance rate was 38.4% (2136 episodes of hand hygiene per 5568 indications for hand hygiene). CONCLUSIONS: The type of dispensing system influenced hand hygiene behavior. Nevertheless, overall hand hygiene compliance remained low. In order for interventions to have a major effect on hand hygiene, multiple factors must be considered.

Education, Continuing↗

PubMed2005

Protecting human and ecological health under viral threats in Asia.

Severe acute respiratory syndrome (SARS) outbroke in 2003, and the avian influenza A (H5N1) also outbroke in 2003 and continued to 2004. These pandemic viral diseases originated in South East Asia. Many human and animal lives were lost. Economic damages due to the pandemics were also very large. The question arises of why did the pandemics originate from South East Asian areas. Human influenza A consists of many sub-types of coronaviruses including the SARS virus and the avian influenza (H5N1) that are all variants of RNA of avian coronavirus. Variants are formed during infection of a coronavirus through not only birds but also mammals, including human beings. There are hot spots where viral infection rates are accelerated among birds, mammals and human beings. Suspicious areas are in South East Asia, where living conditions of birds, mammals and human beings are so close that there are always risks of viral infection. When we see the living conditions of farmers in southern China, northern Vietnam, Laos and northern Myanmar, they commonly raise ducks/chickens with pigs sharing ponds into which they discharge household wastewater, including human excreta, and pig excreta that are significant carriers of viruses. Bird faeces are also key carriers of the viruses. In the ponds, they raise ducks and conduct fish culture. Other important players are migrating birds from North Asia, which are principal vectors of avian influenza viruses. There is an urgent necessity of improving human and ecological health in South East Asia to control viral infection among birds, mammals and human beings. We can hinder the vicious cycle of virus infection through water contamination in ponds by providing good human, pig and chicken sanitation. It is easy to provide good sanitation practices for human, pigs and chickens, introducing collection and treatment of excreta. Our modern water technology can find good solutions for the problem.

Agriculture↗

PubMed2005

Effect of water resource development and management on lymphatic filariasis, and estimates of populations at risk.

Lymphatic filariasis (LF) is a debilitating disease overwhelmingly caused by Wuchereria bancrofti, which is transmitted by various mosquito species. Here, we present a systematic literature review with the following objectives: (i) to establish global and regional estimates of populations at risk of LF with particular consideration of water resource development projects, and (ii) to assess the effects of water resource development and management on the frequency and transmission dynamics of the disease. We estimate that globally, 2 billion people are at risk of LF. Among them, there are 394.5 million urban dwellers without access to improved sanitation and 213 million rural dwellers living in close proximity to irrigation. Environmental changes due to water resource development and management consistently led to a shift in vector species composition and generally to a strong proliferation of vector populations. For example, in World Health Organization (WHO) subregions 1 and 2, mosquito densities of the Anopheles gambiae complex and Anopheles funestus were up to 25-fold higher in irrigated areas when compared with irrigation-free sites. Although the infection prevalence of LF often increased after the implementation of a water project, there was no clear association with clinical symptoms. Concluding, there is a need to assess and quantify changes of LF transmission parameters and clinical manifestations over the entire course of water resource developments. Where resources allow, integrated vector management should complement mass drug administration, and broad-based monitoring and surveillance of the disease should become an integral part of large-scale waste management and sanitation programs, whose basic rationale lies in a systemic approach to city, district, and regional level health services and disease prevention.

Elephantiasis, Filarial↗

PubMedDate not supplied

Outbreak of community-acquired methicillin-resistant Staphylococcus aureus skin infections among a collegiate football team.

CONTEXT: Methicillin-resistant Staphylococcus aureus (MRSA) was once primarily a hospital-acquired organism, but now community-acquired MRSA (CA-MRSA) is causing outbreaks among otherwise healthy sport participants. OBJECTIVE: To investigate MRSA skin and soft tissue outbreaks within a collegiate football team and the effect of infection control measures over 3 years. DESIGN: Retrospective analysis. SETTING: College. PATIENTS OR OTHER PARTICIPANTS: Collegiate football team. INTERVENTION(S): Infection control measures included education, following Centers for Disease Control and Prevention recommendations, nasal cultures, hexachlorophene 3% soap, disposable towels, and hand sanitizers. MAIN OUTCOME MEASURE(S): Number of MRSA infections and hospitalizations. RESULTS: Complicated skin and soft tissue infections (those requiring surgical debridement and/or hospitalization) were diagnosed in 2 (1.8%) of 107 players in 2002, 17 (15.8%) of 107 players in 2003, and 1 (0.96%) of 104 players in 2004. CONCLUSIONS: Outbreaks of CA-MRSA in sports teams are very serious, and recognition is crucial. Treatment includes incision for proper drainage, bacterial culture and sensitivity, and appropriate antibiotic therapy. Infection control measures include educating athletes and staff, following Centers for Disease Control and Prevention recommendations, identifying CA-MRSA carriers with nasal cultures, introducing hexachlorophene 3% soap intermittently in the showers, making alcohol-based hand sanitizers available on the field, disinfecting weight training and rehabilitation equipment, and using disposable towels on the field during practices and games.

Journal Article↗

PubMed1991

[The hygienic situation of the central drinking water supply in the former East Germany--an evaluation of the annual reports on water hygiene from 1984 to 1989].

In the former GDR an annual report on the situation in the field of communal hygiene had to be elaborated and submitted to the minister of public health. One part of this was the report on the hygienic situation in water supply, worked out by the Reference Laboratory for Water Hygiene in Bad Elster. After the political changes in autumn 1989 it became possible to analyse these reports as a whole. In this paper the reports from 1984 to 1989 are interpreted. The results of the laboratory measurements and field controls by the State Sanitary Inspectorates are shown in 17 graphics and compared to the bacteriological and chemical limits in drinking water standards. Special issue is drawn on the estimation of the number of inhabitants concerned by reduced drinking-water quality or any hazardous situations. The special problems of the different districts are compared in some graphics. The hygienic safety of the central drinking-water supply units is assessed basing on the results of the field controls by the State Sanitary Inspectorate. The Sanitation of the central drinking-water supply facilities in the new federal countries of the FRG is connected with the solution of a variety of technological problems, particularly the improvement of the water treatment techniques and the restoration of the pipe systems. The use of surface waters from extremely polluted rivers generates a high hygienic risk and requires the sanitation of the rivers. The high number of existing protection zones in the catchment areas for drinking-water is a valuable precondition to ensure the hygienic safety of the drinking-water supply in the new federal countries.

Fresh Water↗