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Infectious Disease Researcher Discusses The Spread, Treatment, Prevention Of Drug-resistant Salmonella

The spread of extensively drug-resistant Salmonella in Canada has prompted serious public health concern.

The outbreak, which has now spread across six provinces and infected at least 40 people, is being closely monitored by the Public Health Agency of Canada, according to an advisory.

Brian Coombes, chair of McMaster's department of Biochemistry and Biomedical Sciences and a member of the Michael G. DeGroote Institute for Infectious Disease Research, says that while Salmonella itself is a concerning pathogen, it is the drug-resistant nature of the current outbreak that is sounding alarms.

"This particular strain is extensively drug-resistant, which means it is resistant to almost all clinically used antibiotics," Coombes explains. "In a case like this, treatment options are really quite limited."

The Coombes Lab, which also supports initiatives at McMaster's Global Nexus School for Pandemic Prevention and Response, has a long history of studying Salmonella. In fact, his team is currently screening for chemical matter that could lead to new therapies for a drug-resistant strain of Salmonella associated with invasive bloodstream infections in Africa.

Here, Coombes gives a 101 on the ubiquitous, disease-causing bacteria and offers tips to keep you safe from infection.

What is Salmonella?

Salmonella is a genus of bacteria that typically infects the gastrointestinal tract of many different mammals, including humans. It is generally associated with food-borne illness, as it is very common in poultry and other animals used for food production.

How do people encounter Salmonella?

Handling raw food, especially meat products, is perhaps the greatest risk for Salmonella infection. These bacteria can live in animals that we raise for food production without causing significant signs of illness, so food producers often won't know their animals are sick.

As well, Salmonella can contaminate food at virtually any point during the food production process, so it's not necessarily sick animals that ultimately lead to human infection. For example, contamination could happen at a processing plant or during packaging processes.

Also, these bacteria can contaminate foods that we don't necessarily cook, like lettuce and vegetable products. That's why it's essential that care is taken when handling all food products.

Salmonella can also spread from person to person. Enteric bacteria, like Salmonella, often cause symptoms like diarrhea. And while diarrhea is a symptom of the infection, it is also a process that bacteria have evolved to induce in order to help them spread from one host to another.

So, by actively inducing inflammation in the gut, which leads to diarrhea, one person can expel millions of bacteria that can then contaminate bedding, clothing, door handles, and other items that other people might come into contact with. Because of this, Salmonella is very easily transmitted from person to person.

What are some common symptoms to watch for, and when should you see a doctor?

Salmonella typically causes gastrointestinal symptoms, including cramping, nausea, diarrhea, and vomiting. Generally, your body can handle the infection—you'll likely feel sick for about two or three days, but you'll often fully recover within a week or so without much medical intervention.

If symptoms persist beyond four days without signs of improvement, a doctor should be seen. They can prescribe antibiotics to help resolve severe illness.

Because regular symptoms include diarrhea and vomiting, Salmonella infection can lead to massive amounts of water loss. So, people whose symptoms are not resolving are at risk of dehydration, which can complicate things further.

What treatment options are available for Salmonella?

If you seek medical care for a suspected case of Salmonella, they will likely take either a stool sample or a swab and send it off to a clinical microbiology lab, where they can confirm what you're infected with. When the results come in, they can perform antimicrobial susceptibility testing to determine which antibiotic would be most effective against the particular strain that you're infected with. That process can take a long time, though, so oftentimes clinicians will prescribe a broad-spectrum antibiotic, which can help with recovery.

In some cases, however, the bacteria causing the infection is so extensively drug resistant that all but one or two classes of antibiotics will fail. And it's not always the case that those drugs that should work will be available or approved for use in Canada.

As such, prevention is really the best medicine for bacteria like Salmonella.

What can people do to protect themselves from Salmonella?

A lot of Salmonella prevention comes down to having good personal and food hygiene. This means strict handwashing and ensuring that you don't cross-contaminate utensils or other food-prep instruments. Handwashing during food preparation is particularly important, but you should also wash your hands when you return from public places or use the restroom.

Who is most at risk of Salmonella infection?

Salmonella can infect anybody, and mostly everybody who is infected will exhibit symptoms—it's very indiscriminate in that way.

That said, children under 5 years old are often associated with Salmonella outbreaks. This is for a few reasons. First, it's because kids are simply harder to keep clean—they don't wash their hands the same way or as often as adults do, they often have their hands in and around their mouths, and they crawl and play on the floor. They have a very heavy reliance on adults to look after their hygiene for them.

As well, young kids have immune systems that are not as well-trained as those of adults. Their immune systems just haven't seen as many things, so they can be hyper-reactive or in some cases slow to react to infections.

Finally, kids are just much smaller than adults and therefore don't have as much fluids as adults do, so infections that produce symptoms such as vomiting and diarrhea leave them more prone to dehydration.

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Airplanes May Not Be As Dirty As You Think

Fact checked by Nick Blackmer

Key Takeaways

Backseat pockets and high-touch areas like tray tables and toilet seats are likely the germiest spots on airplanes.

Most commercial airplanes have HEPA filters that remove bacteria, viruses, and fungi from the air. They also have sanitation protocols that require cleaning surfaces.

Experts say maintaining hand hygiene is more important than disinfecting surfaces.

Headlines about dirty plane seats and a "diarrhea incident" that turned into a biohazard on a Delta flight might make you think twice about flying this holiday season.

Although you can't do much about accidents that are out of your control, there are ways to avoid unwanted germs or viruses during your flight.

Infectious diseases are spread from close contact with a sick person or surfaces that are contaminated, according to Stacey Rubin Rose, MD, an associate professor of internal medicine and infectious diseases at Baylor College of Medicine in Houston.

High-touch surfaces, including toilet seats, doorknobs, and tray tables, are probably the germiest surfaces on airplanes, Rose said, although this hasn't been extensively studied.

"Theoretically, if you touch a contaminated surface, and then touch your own mouth or nose, you could ingest and become infected with germs from these surfaces," Rose told Verywell in an email.

According to Brenda Orelus, a flight attendant who goes by @flightbae.B on TikTok, seatback pockets are the dirtiest surface on a plane because they're never cleaned unless someone vomited.

Still, the odds of getting sick during a flight are relatively low.

Certain germs can live on surfaces for hours or days, and you might have seen people wiping down tray tables with a disinfectant wipe as a precaution, but it may not be necessary.

"My sense is it's overkill. The airlines take pretty good care of planes when you land, and they sanitize everything," said Victor DiRita, PhD, chair of the department of microbiology & molecular genetics at Michigan State University.

DiRita said to focus on hand hygiene instead of cleaning the surfaces yourself. If you're stuck in the middle seat and can't use the bathroom, hand sanitizer is also a good option.

"I wash my hands a lot when I'm in airports and when I'm traveling," DiRita said.

What About Face Masks?

Air travelers aren't required to wear masks on U.S. Flights anymore, but you can protect yourself and others from respiratory infections by wearing a high-quality mask in crowded, high-trafficked areas, including airports.

"Airports are big mixing bowls, people are coming from all over the world. So, I don't think that's a horrible approach to travel if that's how you feel most safe," DiRita said.

Most commercial planes have HEPA (High-Efficiency Particulate Air) filters to remove a majority of germs from the cabin. These filters are more than 99.9% effective at removing bacteria, viruses, and fungi from the air, according to the International Air Transport Association.

However, most planes don't turn on high-performance ventilation before takeoff. Respiratory diseases, like the flu and COVID-19, can spread in enclosed areas with poor ventilation.

"To avoid germs that are spread through 'droplets' or through the air, wearing a mask can be helpful. This is especially important if you have an underlying immune deficiency," Rose said.

Related: Is It Really Time to Take Off Your Mask on Public Transit?

Flying Is Low Risk Compared to Other Parts of Your Travel

Most experts say the risk of getting sick on an airplane is not that high.

"I do not think people need to be overly concerned, though individuals with underlying medical problems or immune deficiencies may want to discuss their travel plans with a healthcare professional," Rose said.

It might be better to think about reducing your health risk when you get to your destination. Foodborne illness is more rampant during the holiday season.

Turkey and roast beef, for instance, are linked to the bacteria Clostridium perfringens, and foodborne outbreaks related to these foods typically peak during November and December, according to the CDC.

"We're handling turkeys and turkeys carry pathogens. So I'd be more concerned about that risk than almost any other risk that we've talked about," DiRita said.

Read Next: 11 Ways to Avoid Travel Constipation

What This Means For You

Experts say that flying does not pose a serious risk for infections, especially if you are vaccinated and practice good hand hygiene. Consider talking to a trusted healthcare provider if you are concerned about your own risks.

Read the original article on Verywell Health.

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Infectious Diseases Quickly Spreading Through Gaza, Group Says

Smoke rises following Israeli airstrikes on Gaza City.

The World Health Organization warned that the risk of disease is growing in Gaza as health facilities, water and sanitation systems have become disrupted.

The warning comes as international groups have urged the Israel Defense Forces and Hamas to engage in a cease-fire, which the United States has opposed.

The WHO says 1.5 million people have been displaced in Gaza, many of whom are living in "severely overcrowded" shelters.

"Lack of fuel has led to the shutting down of desalination plants, significantly increasing the risk of bacterial infections like diarrhea spreading as people consume contaminated water," the WHO said. "Lack of fuel has also disrupted all solid waste collection, creating an environment conducive to the rapid and widespread proliferation of insects, rodents that can carry and transmit diseases."

The WHO says there has been a significant increase in cases of diarrhea, especially among children. Reports of lice, scabies, chicken pox and upper respiratory infections have also spiked in recent weeks, the organization said.

"WHO calls for urgent, accelerated access for humanitarian aid – including fuel, water, food, and medical supplies – into and throughout the Gaza Strip," the WHO said. "All parties to the conflict must abide by their obligations under international humanitarian law to protect civilians and civilian infrastructure, including health care. WHO calls for the unconditional release of all hostages and a humanitarian ceasefire to prevent further death and suffering."

SEE MORE: Lawsuits accuse US government of failing Palestinian Americans in Gaza

Although U.S. Officials say they won't back a cease-fire, they said they are open to a "humanitarian pause."

"When we talk about a cease-fire, when you use that term — when that term is implied, a general cease-fire — it connotes a cessation of hostilities for an indefinite period with the purpose of finding an end to the conflict," said National Security Council spokesperson John Kirby. "Usually, when you get into a cease-fire, it's when you think you're at the endgame and it's time to negotiate: Go to the table and brass tacks here, how are we going to end this war? And we don't support that at this time."

On Tuesday, Dr. Hussam Abu Safiya, the head of pediatrics at the Kamal Adwan Hospital in Gaza, told Scripps News his hospital is on the verge of running out of fuel — meaning many children currently hooked up to ventilators might instantly die.

"He's asking that the U.N. Come and make sure that his hospital is not used for any other means, but they need fuel," said Dr. Zaher Sahloul, the president of international nonprofit MedGlobal, who helped with translation.

The humanitarian crisis has been exacerbated by hostilities in the region after Hamas terrorists launched an attack in Israel that targeted civilians on Oct. 7. Israel responded by bombing targets in Gaza as Israel told Gaza residents to flee.

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