Germ book

Page 1



CONTENTS 1

Basics of Germs What are Germs? Different types of Germs What are Gram-Positive & Gram-Negative Bacteria? Enveloped & Non Enveloped Virus Transmission of Germs

2

Evolved Germs What are evolved Germs? Introduction & definition of Evolved Germs Which germs cause which infection?

3

Anti biotic resistant stains Entirely novel strains Germs causing novel Infections More virulent strains Zoonotic Origin Novel to region

4

Normal V/s Evolved Germs & Prevention Viral distinction – Normal vs. Evolved Bacterial distinction – Normal vs. Evolved

5

Role of Soap & Lifebuoy Prevention of germs through hand washing Lifebuoy Heritage Role of Lifebuoy The Saving Lives initiative - Impact of Lifebuoy Germs are fast evolving, how has Lifebuoy evolved to spin a fast one on the germs



Basics of

GERMS

1


What are

GERMS? Microbes that cause diseases are called germs They are tiny organisms – almost invisible without a microscope! And yet they are abundant on Earth.

They live in every nook and cranny in air, soil, rock, and water. Some survive happily in heat, while others thrive in freezing cold.


There are good germs and bad germs. The bad germs cause disease in humans, plants, and animals. Good germs are essential for a healthy life.

Since the 19th century, we have known that germs cause infectious diseases. Near the end of the 20th century, researchers began to learn that germs also contribute to many chronic diseases and illnesses.


Some scientific events and advances

Approximately 300 B.C. Aristotle, Greek philosopher and scientist, studied and wrote about living organisms.

1675 Antony van Leeuwenhoek discovered bacteria.

1796 Edward Jenner laid the foundation for developing vaccines.

1848 IgnĂĄc FĂźlĂśp Semmelweis discovered that simple hand washing could prevent passage of infection from one patient to another.


1857 Louis Pasteur introduced the germ theory of disease.

1867 Joseph Lister showed evidence that germs caused disease and pioneered the use of antiseptics during surgery to kill germs.

1876 Robert Koch, by studying anthrax, showed the role of bacteria in disease.

1928 Alexander Fleming was credited with discovering penicillin.

Different types of germs are as follows: Bacteria, Virus, Fungi, Protozoa


Different types of

Germs BACTERIA Bacteria are small. Made up of one cell, they look like tiny balls, rods or spirals under a microscope. They are essential as living on Earth would not be a possible without them. They are versatile and adaptable – surviving in both extreme heat and cold. Less than 1 percent of bacteria cause diseases in humans.

Doctor examining patients painful throat

Strep throat is a bacterial infection caused by streptococcal (strep) bacteria in the throat and the tonsils. The throat gets irritated and inflamed, causing a sudden, severe sore throat.


Good Bacteria

The helpful bacterial vaccines:

Harmless anaerobic bacteria, such as Lactobacilli acidophilus, live in our intestines, where they help digest food, destroy diseasecausing germs, fight cancer cells, and give the body needed vitamins. Healthy food products, such as yogurt, sauerkraut, and cheese, are made using bacteria.

In some cases bacteria can be helpful. Several vaccines that keep us from getting sick are made from bacterial toxins. For example, one type of pertussis vaccine, which protects infants and children from pertussis (whooping cough), contains toxins from Bordetella Pertussis bacteria. This vaccine is safe and effective and causes fewer reactions than other types of pertussis vaccines.

Bad Bacteria

Some bacteria, however, are harmful. They produce toxins which can make us sick. Botulism, a severe form of food poisoning, affects the nerves and is caused by toxins from Clostridium botulinum bacteria.

Bacterial infections/ diseases Diarrheal diseases, Meningitis, Pneumonia, Sinusitis, Skin

diseases, Strep throat, Tuberculosis, Urinary tract infection and Vaginal infection


VIRUS

Viruses are amongst the smallest germs, smaller than even bacteria!

Virus are not cells

Virus consist of one or more molecules of DNA or RNA, which contain the virus genes surrounded by a protein coat. They can be rod-shaped, sphere-shaped, or multisided and some look like tadpoles. Most viruses survive by taking over the machinery that makes a cell work. Once inside the cell, viral molecules such as DNA or RNA direct the cell to make new virus offspring and multiply as a result.


Viruses do cause diseases Unlike most bacteria, most viruses cause disease because they invade living, normal cells, such as those in your body. Once inside the cells, they multiply and produce other viruses like themselves. Each virus is very particular about which cell it attacks.

Various human viruses specifically attack particular cells in your body’s organs, systems, or tissues, such as the liver, respiratory system or blood.


The good and the bad viruses:

Many viral infections do not result in diseases. For example, by the time most people in the United States become adults, they have been infected by cytomegalovirus (CMV). Most people infected with CMV, however, do not develop CMV-disease symptoms. Other viral infections can result in deadly diseases such as AIDS or Ebola hemorrhagic fever.

A man with shingles rash on his neck. Shingles, or herpes zoster, is a painful infection caused by

Viruses can even “infect� bacteria: These viruses called bacteriophages, may help researchers develop alternatives to antibiotic medicines for preventing and treating bacterial infections.

varicella-zoster virus, a type of

Herpesvirus. This virus also causes Chickenpox.

Viral infections/ diseases

Common cold, Diarrheal diseases, Flu, Genital herpes, Meningitis,

Pneumonia, Shingles and Skin diseases


FUNGI

A fungus is actually a primitive plant and can be found in air, in soil, on plants, and in water. Millions of different types of fungi exist on Earth. Some live in the human body, usually without causing illness.

Did you know? Mushrooms, yeast, mold, and mildew are the most common types of Fungi.

Fungi have actually

made our lives better. Penicillin and other

antibiotics, which can kill harmful bacteria in our bodies, are made from

fungi. Other fungi, such

as certain yeasts, are also

helpful. For example, when a warm liquid, such as water, and a food source, such as

sugar, are added to certain

yeasts, the fungus ferments.

The process of fermentation is essential for making

healthy foods like some breads and cheeses.

A human nail infected by Onychomycosis fungus.

Mycoses Fungal diseases are called mycoses.

Mycoses can affect your skin, nails, body hair, internal organs such as

your lungs, and body systems such as your nervous system. Aspergillus fumigatus fungi, for example, can

cause Aspergillosis, a lung disease.

Fungal infections/ diseases

Athlete’s foot, Pneumonia, Sinusitis,

Skin diseases and Vaginal infection


PROTOZOA Protozoa are a group of microscopic one-celled animals. Protozoa can be parasites or predators. In humans, protozoa usually cause disease.

What diseases they cause?

Malaria is caused by a protozoan parasite. Another protozoan parasite, Toxoplasma gondii, causes toxoplasmosis, or toxo, in humans. This is an especially troublesome infection in pregnant women because of its effects on the fetus, and in people with HIV/AIDS or other disorders of the immune system.

Some protozoa, like plankton, serve as food for marine animals. Protozoa are found on land in decaying matter and in soil, but they must have a moist environment to survive. Termites wouldn’t be able to do such a good job of digesting wood without these micro organisms in their guts.

Infections/ diseases caused by protozoa Diarrheal diseases ,Skin diseases, Vaginal infection

Used cat’s litter may contain

Toxoplasma Gondii, a disease-causing parasite that can pass from a mother to her unborn child.


What are Gram-Positive & Gram-Negative bacteria? The nature of the cell wall determines the classification of bacteria as either Grampositive or Gram-negative, as determined by the Gram stain.


GRAM-POSITIVE BACTERIA

The cell wall of GramPositive bacteria is made up of two layers - Cell wall and Cytoplasmic membrane

The cell wall is a thick multi-layer of Peptidoglycan (a mixture of sugars and amino acids)

Lipoteichoic acids

Cell wall (Peptidoglycan) Cell membrane (Lipid bilayer)


Gram-Negative BACTERIA

The cell wall of Gram-Negative bacteria is made up of three layers - Outer membrane, Cell wall, and Cytoplasmic membrane

Outer membrane

Cell wall (Peptidoglycan) Cell membrane (Lipid bilayer)

The cell wall is thin and surrounded by an outer membrane (made up of Lipopolysaccharides and Lipoprotein)

Lipoprotein


Bacterial Classification Characteristics

Gram +ve bacteria

Gram -ve bacteria

Examples

S. aureus S. epidermidis C. xerosis

E. coli S. typhi P. aeruginosa K. pnemoniae

Found in

Environment & SoilGardens/Ground, Public places

Stagnant water, exposed foods

Antibiotic Sensitivity

More susceptible to antibiotics as compared to gram-negative Bacteria

Gram-negative bacteria are less susceptible to antibiotics

Infections

Skin Infections, Throat Infection Skin rashes, Prickly heat, Body odour

Typhoid, Pneumonia, Respiratory Infections, Stomach infection, Ear infections

Infections

Direct or indirect contact , Unclean hands

Contaminated food/ water, Unclean hands

transmitted by


ENVELOPED & NON-ENVELOPED

VIRUS These viruses can be classified basis the presence or absence of Lipid membrane

Protein/ Lipid coat Nucleic Acid

Non-Enveloped Virus This Virus consists of two basic components – Nucleic Acid (RNA or DNA) and a Protein/ Lipid coat, called the Capsid. (eg: Polio Virus, Adeno Virus, Rota Virus and Hepatitis B)

Polymerase

Enveloped Virus

Besides the two components of Non-Enveloped Virus, this virus has an additional layer surrounding the Caspid, called the envelope (eg: Herpes Simplex, HIV and Flu) Polymerase

Envelope


TRANSMISSION OF GERMS Transmission is the passing of a communicable disease from an infected host individual or group to a conspecific individual or group, regardless of whether the other individual was previously infected. How germs make us sick? Germs can transmit to a person through one or more of the following means :

Germs can travel through air

You can transmit germs to another person through the air by coughing or sneezing. These are common ways to get viruses

that cause colds or flu or the bacteria that cause tuberculosis (TB).

Close contact can pass germs to another person

Scientists have identified more than 500 types of bacteria that live in our mouths. One way you can transmit oral bacteria is by kissing. Germs such as HIV, Herpes

simplex virus type 2, which causes Genital

Herpes, and Neisseria gonorrhoeae bacteria, which causes Gonorrhea, are examples of

germs that you can pass to another person through sexual intercourse.


You can pick up and spread germs by touching infectious material

A common way for some germs to enter the body is through unintentionally

passing feces from hand to mouth. It also is possible to pick up cold viruses from

shaking someone’s hand or from touching

contaminated surfaces, such as a doorknob or computer keyboard.

A healthy person can carry germs and pass them to others A small number of people, called carriers, get better after having typhoid fever, but continue to be infected by Salmonella

typhi bacteria (bacteria causing typhoid).

You can get typhoid fever if you eat food or drink liquids that have been prepared by someone who has typhoid fever or who is infected with S. typhi.

Indirect transmission can also make you sick Transmission can also be indirect, via another organism, either

a vector (e.g. a mosquito) or an

intermediate host (e.g. tapeworm in pigs can be transmitted to humans who ingest improperly cooked pork).


EVOLVED

GERMS

2


What are EVOLVED

GERMS?

Evolved germs give rise to emerging and re emerging infections

Emerging infections can be caused by: Previously undetected or unknown infectious agents.

EMERGING INFECTION These are the disease which were previously unknown or known whose rate of infecting humans have significantly increased in the past two years.

Known agents that have spread to new geographic locations or new populations Previously known agents whose role in specific diseases has previously gone unrecognized.

Re-emerging infections can be caused by:

RE-EMERGING INFECTION These are the disease which were previously unknown or known whose rate of infecting humans have significantly increased in the past two years.

Evolution of pathogens over time. Acquired resistance of pathogens to antimicrobial medications.


Emerging and Re-emerging infectious diseases 2004 2013

SARS - China

Novel MER Co V - Jordan, Qatar, UAE, France, Germany, Italy, Tunisia & UK

SARS - China

Meningitis epidemic – African cluster

2012 E.coli O157:H7 - USA Novel MER Co V – Saudi Arabia Cholera outbreak – Congo, Sierra Leone Ebola – Uganda

2011 Measles – US, Europe, Africa, Wild Polio Virus – Pakistan, China Meningococcal Disease – Chad E.coli O104 - Germany

Novel to humans

2010 Rift valley fever – South Africa Cholera – Haiti, Central Africa Polio – Central Asia, Russia, Congo


2005 S.Suis - China Avian Influenza (H5N1) – Europe, Africa, SEA Polio – Indonesia, Angola Meningococcal disease - India

2006 HFMD caused by Enterovirus 71 in China Meningococcal disease - India

2007 Cholera – Zimbabwe, Vietnam, Iraq Meningococcal disease - Sudan

2008 New virus Arenaviridae caused outbreaks in South Africa, Zambia

2009

Yellow fever – Brazil, Liberia, Paraguay

Measles – US, Europe, Africa, Wild Polio Virus – Pakistan, China Meningococcal Disease – Chad Pandemic Influenza A (H1N1) – world wide (H1N1 swine flu continues to cause infections worldwide every year)


Evolved germs-fast facts 1 75% is the percentage

of recently emerging infectious diseases affecting humans that are of animal origin

2 Evolved germs drug resistance is one of the most pressing health problems in the world

3

2 is the average number

of new species of human viruses reported every year

A Gram positive bacteria

is one of the most common causes of

hospital acquired infections. The threat is alarming due to increased spread to community settings.

4


A novel Corona virus, H7H9

5

has been reported in Saudi Arabia, Qatar, Jordan, and the United Kingdom. It

is known to causing bird flu and has

infected more than 100 people in China since April 2013

1 in 20

is the approximate number of people

6

contracting an infection related to hospital care

In Mumbai, in the year 2012

H1N1 influenza virus infected more people in the state than malaria and dengue

put together. In the city, the virus showed

7

a 60-fold jump in terms of the number

of people it affected as compared to 2011, but only five cases resulted in deaths

Mode of transmission

of newly discovered SARS like Corona

virus causing Middle Eastern respiratory syndrome (MERS) is unknown. (WHO) warned that the newly named MERS

Corona virus (MERS-CoV) is a “threat to the entire world�.

8


Evolved germs-fast facts

9

CRE - Carpabenam resistant enterobacteriace ( E.coli & K.pnuemoniae) are a growing threat in hospital settings with high probability of spreading to communities too.

CARBAPENEMS are considered as “last resort� antibiotics

10 Only 2 new antibacterial agents have been discovered during the past 4 years.


What are the signs of

germs evolving? Emergence of drug resistant strains:

Misuse of antibiotics, usage of antibiotics in the fields of Agriculture and Veterinary fields are major contributory factors of bacterial strains acquiring drug resistance.

There is an increased danger due to spread of drug resistant bacteria in community settings.

Drug resistance can develop against one or many types of antibiotics. Almost all common human pathogens like E.coli, K.pneumoniae, S.aureus, S.pneumoniae have acquired drug resistant genes system.

This is primarily a major concern in bacteria, but drug resistant H1N1 strains have also been discovered Infections caused by drug resistant bacteria are major cause of hospital acquired infections.


What are the signs of

germs evolving? The drug resistant germs – A global threat

Drug-resistant bacterial infections cause considerable mortality & morbidity. For instance, In 2005, almost 95000 people acquired methicillin-resistant Staphylococcus aureus (MRSA) infections in USA out of which 19000 people died due to the same.

According to the Centers for Disease Control and Prevention (CDCP), approximately 4% of hospitals in the nation have seen at least one case involving the super germ.


Drug resitant germsa global threat Antibiotic resistant bacteria

No. cases of infection

No. extra deaths

No. extra hospital days

171 200 (12%)

5400 (37%)

1 050 000 (16%)

18 100 (9%)

1500 (28%)

111 000 (22%)

32 500 (27%)

5100 (52%)

358 000 (27%)

18 900 (27%)

2900 (52%)

208 000 (27%)

141 900 (3%)

10 200 (7%)

809 000 (3%)

Antibiotic resistant bacteria Methicillin-resitant Staphylococcus aureus (MRSA) Vancomysin-resistant Enterococcus faecium

Antimicrobial-resitant Gram-negative bacteria 3rd generation cephalosporin -resistant Escherichia coli 3rd generation cephalosporin -resistant Klebsiella pneumoniae Carbapenem-resistant Pseudomonas aeruginosa


What are the signs of

germs evolving? New germs originating from non-human hosts

Avian Flu (H7N9, H5N1) & Swine Flu (H1N1, H3N2) are examples of infections where viruses have evolved to infect humans as new hosts.

With mutation at each stage, the virus/ bacteria can acquire capability to become contagious and spread from human to human. pathogen.

Types H7, H5 infections are entirely novel to humans. Novel MER Co V (Middle eastern SARS like Corona Virus) is believed to have originated from gene reservoirs of bats.

This phenomenon is not limited to viruses but also seen with bacteria strains. S.suis, E.coli O154 are examples where the bacteria commonly found in pigs/ cattle is now a human


Migratory water birds H 1-16 1

16

15

2

3 4

14 13

5

12

6 11

10

7

8

9

H 1-9 8

9

1 2

7 6

Domestic pig

3 5

4

Domestic birds


What are the signs of

germs evolving? Re-emergence of previously controlled infections/ Vaccine protected infections: Re emergence of Polio due to gaps in country vaccination programs/ infections by wild types not covered by vaccination

There have been several out breaks of mumps in vaccinated population in Europe and US. Countries with re-established virus transmission or reporting imported wild poliovirus Countries endemic for wild poliovirus

Polio infected countries for which WHO reccommends Polio Immunization or boosting to travellers

Outbreaks are believed to be caused by multiple factors: inadequate levels of vaccination, primary or secondary vaccine failure, antigenic differences between the outbreak and vaccine strains, increased risk of transmission associated with college campuses, inherent limitations in mumps protective immunity, and misdiagnosis of infection.


Anti biotic resistant

STAINS

3


What are EVOLVED

GERMS? 1

Anti biotic resistant stains – MRSA, E.coli ESBL, NDM-1 K. pneumoniae

2

Entirely novel strains - H7N9, H5N1, Enterovirus 71

3

Germs from Zoonotic origin - E.coli O104

4

Germs causing novel Infections - S. aureus Toxic shock syndrome

5

Germs Novel to region - Novel Corona virus in Middle east

6

More virulent strains of Germs E.coli 0157, V.cholerae 0139


Antimicrobial resistance Definition and mechanism What is Antimicrobial resistance? Antimicrobial resistance is the ability of germs to grow in the presence of a chemical (drug) that would normally kill it or limit its growth.

Gram-negative bacteria, such as E.coli, A.baumanni, P.aeruginosa, K.pneumonia, and Enterobacter sp., are dangerous group of disease causing germs because they are difficult to treat and have become increasingly resistant to currently available antimicrobial drugs.

In recent years, antimicrobial resistance has become an increasingly important health issue.


Definition and mechanism 1

Non-resistant bacteria exist

2

Bacteria multiply by the billions A few of these bacteria will mutate

MUTATION IN DNA

3 Some mutations make the bacterium drug resistant In the presence of drugs, only drug resistant bacteria survive

4

Drug resistant bacteria multiply and thrive


Examples of Antimicrobial resistance Micro organisms MRSA

Threat Causes minor infections of the skin to wound infections, bacteremia, and necrotizing pneumonia MRSA is highly endemic in hospitals with mean prevalence rates of >50% and as high as 70-80% Study has revealed that approx 50% of all S.aureus isolates are MRSA

MDR S.pneumoniae

This germ is the predominant pathogen involved in bacterial infections and remains the leading cause of community-acquired respiratory infections in children S. pneumoniae can result in bacteremia, meningitis, pericarditis, arthritis, and empyema; collectively these are referred to as invasive pneumococcal disease (IPD) [8] which can lead to severe illness, prolonged hospital stay and deaths

E.Coli ESBL producers

Such bacteria are associated with severe infections such as bacteraemias, intra-abdominal infection, urinary tract infections (particularly in the community setting) In China, the incidence of ESBL production from E. coli isolates ranged from 13%–15%

Carbepenem resistant

Klebsiella species and Escherichia coli (E. coli) are

Enterobacteriaceae

examples of Enterobacteriacea with KPC and NDM indicating resistance to almost all known antibiotics.


EUROPE

EU: ARB costs socirty Euro 1.5 bn/yr & 600 million days of lost productivity.

NORTH AMERICA

USA: ARB causes majority of 99,000 deaths/yr from infections acquired in hospitals. USA:: Health care costs of ARB are US$21-34 bn/yr.

Russia:: ARB a major concern with 83.6% of families imprudently use antibiotics at home.

GLOBAL IMPACT DUE TO INCREASE IN ARB Snapshot of the costs, impacts and burden of antibiotic-resistant bacteria (ARB) across the globe – World Economic Forum, Global Risks 2013 Burden due

SOUTH AMERICA

Peru, Bolivia: 51% of hospital infections caused by ARB. Brazil::Rates of ARB are up >60%.


ASIA

Thailand: >140,000 ARB infections/yr and >30,000/yr patients die; 2bn in productivity loseses/yr. Japan: :Extensive levels of ARB found in Tokyo’s urban watershed.

MIDDLE EAST & NORTH AFRICA Egypt: 38% ofblood infections contracted by young cancer patients are from ARB. Israel::ARB found fatal in ~50% cases when resistant toour strongest antibiotics.

SUB SAHARAN AFRICA

China: :Extreme over-prescription of antibiotics and rapid growth rate of ARB. India: :Within 4 yrs (02-06) ARB went from being resistant to 7, to 21 drugs. Vietnam: :Farming practices contributing to spread of ARB through environmental contamination Pakistan: :71% of infections in newborns are from ARB.

Tanzania: Death rate of ARB infected children are double that of malaria. Nigeria::Rapid spread of ARB that came to Africa from Asia

ANTARCTICA

ARB found in Antarctic animals and water samples .


Entirely new germs like SARS virus (originated in China in 2003), Bird Flu (originated in China in 2005), MERS CoV (Middle East respiratory syndrome, Saudi Arabia, 2012) have caused epidemics with high mortality rates.

Humans have naive immunity to these novel strains making the threat more pronounced.

Genetic re-assortment among avian, human and/or swine influenza virus gene segments has occurred in pigs and some novel reassortant swine viruses have been transmitted to humans(H5N1, H7N9 etc).

The responsible strains are novel due to re assortment of several viral strains or transfer from animal reservoirs with mutations to affect Humans.


TYpes of novel strains

AVIAN INFLUENZA A(H7N9) VIRUS A new avian influenza A (H7N9) virus was first reported in China by the World Health Organization on April 1, 2013. Most of the reported cases of human infection have resulted in severe respiratory illness.

Symptoms High fever & cough Pneumonia Respiratory failure septic shock Multi-organ failure leading to death

FACTS

A total of 40 people in Saudi Arabia, Qatar, Jordan, the United Kingdom (UK), the United Arab Emirates, and France were confirmed to have respiratory illness caused by a novel (new) coronavirus. (From September 2012 to date) 44 out of 135 people died (12th Aug) .


Evolution of H7N9 virus NA HA PB2 PB1 PA HA NP NA M NS

M2

H7

PB2 PB1 PA NP M

H9N2

H7N9

PB2 PB1 PA

H7N9

NP M

Sequence similar to frm wild duck and bird H2N9/H11N9 viruses from Eurasian flyway

NA

N9


Novel virus threats Infections caused by novel viruses are alarming due to unknown genetic make up, mode of transmission, clinical manifestations which can be only detected over time.

Bird Flu H5N1 virus First breakout in China

Atypical

442

262 Pneumonia/

SARS

H1N1 spread at alarming rates due to its ability to pass from one human host to another vs. H5N1 & H7N9 where no human – human transmission has been reported Total cases

Swine Flu H1N1 virus 414945

First breakout in China 8006

5850

Threat of novel viruses reaching pandemic status is determined by human – human transmission capability.

774

Total deaths

Padndemic H1N1 (2009)


Zoonotic diseases

*Zoonoses are infections or diseases that can be transmitted directly or indirectly between animals and humans, for instance by consuming contaminated foodstuffs or through contact with infected animals.

The severity of these diseases in humans varies from mild symptoms to life-threatening conditions

SEVERITY METER

Mild

Life threatening


Zoonoses infections examples Swine Flu (H5N1) Directly from birds Influenza viruses transmits from animals to humans. They can transmit through any of the following mediums

B

Virus-contaminated Directly from environments

birds

Virus-contaminated

Through an intermediate environments host, such as a pig

Through an intermediate host, such as a pig

Influenza A (animal source virus), Influenza B (human source virus) and swine influenza viruses can infect pigs. In the infected pigs, the genes of these viruses mixes and create a new virus which can infect humans.

A


Zoonoses infections examples Swine Flu (H5N1)

A virulent, rare strain of E.coli known as O104:H4 was identified as the source of the infections outbreak that struck Germany and France in the spring and summer of 2011.

The main reservoir hosts of these starins are the ruminants, including cattle, sheep, goats, and cervids. In many cases, human infection occurs via consumption of vegetal and animal foodstuffs contaminated by the faeces of ruminants (mainly cattle)

E.coli O104:H4 transmits into humans through either consuming or handling contaminated food or water or through contact with infected animals


Germs nOvel to region

Sometimes evolved germs cause an outbreak in a certain geographic location

That geographic location might have not seen the novel germs earlier. These germ can cause mild to life threatening illnesses.

Immunity Humans have naive immunity to these novel germs making the threat more pronounced.

Low

Local cases

Middle Eastern

Imported cases

Respiratory

Germany

Syndrome (MERS-CoV)

Tunisia Qatar UAE

UK

France Italy

Saudi Arabia Jordon


Novel (New) Corona Virus

The Middle East respiratory syndrome Corona Virus (MERS-CoV) is a novel Corona Virus first reported on 24 September, 2012 in Saudi Arabia

Symptoms Fever Cough Shortness of breath

24/9/12

A total of 138 people in Saudi Arabia, Qatar, Jordan, the United Kingdom (UK), the United Arab Emirates, and France were confirmed to have respiratory illness caused by a novel (new) Corona Virus (From September 2012 to date). 60 out of 138 people died (~50% mortality rate, 14th Oct., 2013).

MERS CoV is beta Corona Virus, and is different to other corona viruses affecting humans (this is most similar to Corona Viruses found in bats)


Germs causing NOvel infections Newly identified diseases caused by a previously known germs:

Helicobacter pylori was recognized to be associated with chronic gastritis and gastric ulcers (contradicting the conventional thinking that no bacterium can live in the human stomach due to extensive amounts of strong acids it produces)

These germs which were known to be harmless, can invade into body causing life threatening diseases.

Few strains of Klebsiella pneumoniae can cause urinary tract infection

Blood infection may lead to bacteraemia and meningitis, and without treatment on time, it can be fatal

Most strains of E.Coli are harmless, but few can cause mild to life-threatening illnesses such as Pneumonia.


Germs causing NOvel infections Toxic Shock Syndrome (TSS): TSS is a good example of a condition discovered only in 1999.

Although the symptoms lead to the discovery and definition of TSS as a new infection, the micro organisms causing this are S.aureus & S.pyogenes.

These bacteria invade the body’s bloodstream and release poisonous toxins.

These toxins cause a sudden high fever and a massive drop in blood pressure (shock), resulting in dizziness and confusion.The toxins also damage tissue, including skin and organs, and can disturb many vital organ functions.

TSS is a rare but lifethreatening bacterial infection. If it is left untreated, the combination of shock and organ damage can result in death.


More virulent strains of

Germs These strains have a large number of dangerous genes, resulting in production of Shiga toxins in human hosts.

Common disease causing germs can transform to acquire genes that leads to increased virulence to human hosts. These strains are strong enough to cause diseases in human beings. Examples: Escherichia coli O157:H7, Escherichia coli O104:H4.

Shiga toxins kills RBCs causing Hemolytic Uremic Syndrome leading to kidney failure and related complications.

Europe outbreak (2011)

(above) Schistocytes as seen in a person with hemolyticuremic syndrome.


Normal vs Evolved Germs &

Prevention

4


(Viral Distinction) Respiratory illnessRegular Corona Virus vs. MERS Co V Middle Eastern Respiratory Syndrome (MER Co V) Evolved Germ

Regular flu (Corona Virus) Normal Germ

Viral strains

1 Causes significant percentage of all common colds. MERS CO V is beta Corona Virus, and is different to other corona viruses affecting humans (this is most similar to Corona viruses found in bats).

Transmission By inhalation of aerosols, personto-person and indirectly through contaminated fomites. Not established yet, speculated to spread through large droplets. Close contact with another person can lead to the spread of MERS-CoV virus

2


Symptoms/ infections Running nose, cough, sore throat and

3

fever, mild to moderate upper-respiratory tract illnesses Severe acute respiratory illness with symptoms of fever, cough and shortness of breath. Very high mortality rates, with 60% deaths

High risk groups

4

Common infections People in contact with infected poultry or contaminated environments.

5

Treatment There is no specific treatments for illnesses caused by human corona viruses, people recover on their own. No specific treatment. Medical care is supportive and to help relieve symptoms.


7 Immunity Populations may have innate immunity to regular corona viruses. Novel virus - No innate immunity.

Current status Infection is common throughout the world.

55 cases reported, 32 deaths since Oct 2012. First discovered in KSA. Spread to UAE, Jordon, Qatar, Tunisia France, Italy, UK reported.

8


FLU- Regular Flu vs. H1N1 (Swine Flu) Regular flu Normal Germ

H1N1 (Swine Flu) Evolved Germ

Viral strains

1

H1N2

H3N2 H1N1

B

Influenza A, B, C causes regular flu. The known strains that cause swine flu include subtypes of influenza A

A

known as H1N1, H1N2, and H3N2.

C

Transmission Human-to-human, Contaminated droplet transmission. Human-to-human, Contaminated droplet transmission.

It is caused by a family of viruses that is endemic to pigs.

2


Symptoms/ infections

3

Fever, chills, muscle pain, weakness, fatigue, sore throat, headache and discomfort. Fever, chills, muscle pain, weakness, fatigue, sore throat, headache and discomfort. Can lead to more severe Pneumonia and respiratory failure.

High risk groups Common infections.

4

Children, people with medical conditions associated with high risk complications, elderly, pregnant women.

5

Treatment No specific treatment given, symptoms subside in 3-5 days. Oseltamivir (Tamiflu).


Immunity

6

Populations may have innate immunity to regular flu viruses. Human population has naive immunity to H1N1 (2009), hence, a cause for pandemic.

Current status

Common infection. H1N1(Swine Flu) has reached post pandemic status. Now a seasonal flu strains.

7


FLU- Regular Flu vs. H5N1/ H7N9 (Bird Flu) Regular Flu – Normal Germ

Bird Flu Evolved Germ

Viral strains Influenza A, B, C causes regular flu.

1

Completely new viruses, Novel strain- H7N9, Highly Pathogenic Avian Influenza A -H5N1.

Transmission Human-to-human, Contaminated droplet transmission. Most cases in people have been linked to contact with infected poultry. No Human-to-human transmission cases yet.

2


Symptoms/ infections

3

Fever, chills, muscle pain, weakness, fatigue, sore throat, headache and discomfort. High fever and cough, more serious complications including pneumonia and respiratory failure, septic shock and multi-organ failure leading to death.

4

High risk groups Common infections People in contact with infected poultry or contaminated environments.

5

Treatment No specific treatment given, symptoms subside in 3-5 days. Oseltamivir (Tamiflu) and Zanamivir (Relenza). In few cases H7N9 is resistant to Tamiflu.


Immunity

6

Populations may have innate immunity to regular flu viruses. Novel virus - No innate immunity.

Current status Infections are common throughout the world. As of April 30th, 126 cases of H7N9 with 20% deaths. 350 deaths due H5N1 with a total of 600 cases reported in 15 countries

7


Hand Foot and Mouth Disease (HFMD) Common vs. Severe Regular HFMD Normal Germ

Severe HFMD Evolved Germ

Viral strains

1

Coxsackievirus A16 Enterovirus 71

Transmission

Human-to-human contact. Human-to-human contact.

2


3

Symptoms/ infections Fever, ulcers in the oral cavity, and rashes with blisters that appear on the palm and sole. Symptoms are usually mild. Fever, ulcers in the oral cavity, and rashes with blisters that appear on the palm and sole. Aseptic meningitis and more serious diseases, such as encephalitis or poliomyelitis-like

High risk groups

4

Children below 10years/ young adults. Children below 10years/

Under 10 yrs

young adults.

5

Treatment Patients normally recover without requiring any special medical attention There is no antiviral treatment or vaccine for Enterovirus 71. Only supportive treatment is possible in case of severe complications.


6

Immunity Populations may have innate immunity to regular flu viruses. Human populations may have naive immunity.

Current status

Infections are common throughout the world. SEA, China, recently reported cases in Australia.

7


(Bacterial Distinction) Stomach InfectionRegular vs. Antibiotic resistant Regular E.coli – Normal Germ

E.coli ESBL Producers Evolved Germ

1

Viral strains

Escherichia coli E.Coli O157:H7, O104:H4 - Shiga toxin producers – highly virulent.

Transmission Fecal-oral route. Fecal-Oral route, Very low exposure levels (100 CFU), Can cause infection.

2


3

Symptoms/ infections Diarrhea, stomach pain, fever. Bloody diarrhea, stomach pain, fever RBCs get destroyed leading to acute kidney failure – termed at HUS/ Hemolytic Uremic Syndrome.

High risk groups

4

Children. Children.

5

Treatment Non-specific supportive therapy, including hydration, people recover from E. coli infections in 5 to 10 days. Blood transfusions and kidney dialysis.


7

Immunity Populations may get acquired immunity after infections. Innate immunity as first line of defense.

Current status Common infection, worldwide distribution. Out breaks are increasing globally.

8


Respiratory Infection Regular vs. Antibiotic resistant Regular K.Pnemoniae – Normal Germ

1

Super Bug NDM 1 Evolved Germ

Viral strains

Klebsiella pneumoniae. NDM 1 K pneumoniae.

Transmission

Person-to-person contact. Person-to-person contact.

2


Symptoms/ infections

3

High fever, chills and cough. High fever, cough and difficulty in breathing, blood infection may lead to bacteraemia and meningitis. paralysis can lead to fatality.

High risk groups

4 Chemotherapy

Children, elderly. Immuno compromised individuals such as people undergoing chemotherapy, transplant patients, the very young and the very old.

5

Treatment Antibiotics such as aminoglycosides and cephalosporins. Colistin, which is infrequently used because of its toxicity, is often the only antibiotic to which NDM-1-producing bacteria are susceptible.


6 Immunity Populations may get acquired immunity after infections . Innate immunity as first line of defense.

7 Current status

Common infection, worldwide distribution. Prevalence is increasing worldwide.


Staph Infection Regular vs. Antibiotic resistant Regular S.Aureus Normal Germ

MRSA Evolved Germ

1

Viral strains

Staphylococcus aureus. Methicillin-Resistant Staphylococcus Aureus (MRSA).

Transmission Skin-to-skin contact. Skin-to-skin contact or through infected surfaces.

2


3 Symptoms/ infections Skin infections (superficial skin lesions such as boils, styes and furuncules). Food poisoning, septic shock syndrome. More severe or potentially lifethreatening infections such as pneumonia, mastitis, phlebitis, meningitis, and urinary tract infections.

4

High risk groups People with weak immune system. Elderly people, newborn babies and people with a long-term health condition, such as type 2 diabetes.

5 Treatment Penicillinase-resistant penicillins (flucloxacillin, dicloxacillin). Bactrim and vancomycin ,clindamycin, minocycline, Tygacil, Cubicin, Zyvox, and Synercid.


7

Immunity Populations may get acquired immunity after infections. Innate immunity as first line of defense.

Current status Common infection, worldwide distribution. MRSA is one of the leading causes of hospital and community acquired infections worldwide.

8


ROLE OF LIFEBUOY

5


Significance of Hand washing Prevention of germs through hand washing Reduced incidence of diseases: Hand washing with soap can help reduce many commonly occurring problems like skin infections, eye infections, Intestinal worms, Swine flu, Pandemic flu, SARS, Avian Flu, Trachoma, Parisitic worm infections, Neonatal mortality, school absenteeism, sickness in AIDS patients and chronic malnutrition.

Importance of Hand washing: Germs are the main cause of various diseases. As they are everywhere, they are difficult to avoid. Hand washing with soap has been sited as the simplest and the most cost effective interventions to prevent spread of diseases

Simple solution to stay protected:

Hand washing and child mortality rate

There is consistent evidence that hand washing with soap at critical times including before eating or preparing food and after using the toilet can reduce diarrheal risk by about 45%

Hand washing with soap has been cited as one of the most effective interventions to reduce child mortality and morbidity with its subsequent impact on overall health and school attendance. This simple act can play a crucial role in reducing diarrheal related deaths and diseases.


Practice of Hand Washing Hand washing rates for different occasions

Despite the Evidence:

19%

After cleaning child stools

The practice of hand washing with soap is low. An 11 country review of hand washing behavior shows that on an average only 17% of the mothers wash their hands with soap after having used the toilet, and 45% wash their hands without soap (water only)

13% Before handling food

This is despite universal presence of soap in households


Lifebuoy's Heritage About Lifebuoy

To bring safety, security and health to five billion people around the world, through the active promotion of hand washing with soap.

Started and invented by William Lever, Saving Lives in 1894

“To make cleanliness common place; to lessen work for women; to foster health and contribute to personal attractiveness, that life may be more enjoyable and rewarding, for the people who use our products�

Affordable Hygiene Against Cholera Outbreak in Victorian England


LAUNCHED IN THE UK IN 1894, Lifebuoy is one of Unilever’s oldest brands, and has championed a message of health through hygiene for more than a century One of Unilever’s founders, William Lever, launched the Lifebuoy brand to help bring affordable hygiene to Victorian England at a time when epidemics of typhoid, smallpox, cholera and diphtheria were a constant threat. Today Lifebuoy products are sold in more than 34 countries in Asia and Africa, and every second 91 families buy a Lifebuoy product, trusting the Lifebuoy brand for their family’s health.

No. 1

The Lifebuoy Clinical Trial in 2007/8 demonstrated that by following the Lifebuoy Way (washing hands at 5 key occasions during the day), episodes of diarrhoea in target children reduced by 25% and target children had 40% less days off school due to illness, compared with the control group.

Lifebuoy was the world’s first health soap when it was launched in 1894, and it is still the world’s no.1 selling germ protection soap today*.


Role of Lifebuoy Child Disease burden & potential of hand washing with soap

Many of these deaths can be averted by the simple act of hand washing with soap.

Mortality Rates

Each year, more than 2.1 million of our million of our world’s children don’t live to celebrate their fifth birthday because of diarrhea and pneumonia. Diarrhea kills more children each year than AIDS, malaria and measles combined.

Washing with the soap reduced the incidence of the presence of any type of faecal bacteria on peoples hands from 44% to 8%, whereas hand washing with only water reduced the incidence to only 23%. Hand washing with soap at scale will result in the reduction of the world’s two biggest causes of child mortality – acute respiratory infections and diarrhea.

Hands are the principal carriers of disease causing germs. Water alone is not enough to wash hands as shown by studies.


Small actions. Big difference Every 15 seconds, one child dies from diarrhea and pneumonia. That’s 2 million children every year. Many of these deaths have been averted by the simple act of hand washing with soap Lifebuoy has committed to help 1 billion people improve their hygiene habits by 2015 To date we have reached 130 million people

We have demonstrated that when children wash their hands with Lifebuoy, diarrhoea is reduced by 25%, acute respiratory infections by 19% and school absence by 40%


A simple act of hand washing can save lives Over 40% of under 5 deaths occur during the neonatal period i.e. first 28 days after birth 3.1 million neonatal deaths occur every year The simple act of hand washing with soap can reduce this figure by upto 70% Despite this, only 17% of mothers wash their hands with soap after the toilet; this figure drops to 2% among mothers with children under one year Lifebuoy runs a neonatal program which explains the link between newborn survival and hand washing with soap which includes-

• • • •

Post defecation (mother) Post – contact with the baby faeces Before touching the umbilical cord After couching / sneezing on hands


Lifebuoy is spearheading a hand washing movement to help every child around the world reach 5


Our Saving Lives initiative Impact of Lifebuoy

1

Incidence of Diarrhea has gone down by 14% amongst kids (0-5 years)

24% 10%

37% more mothers have started washing their hands before meals

28%

65%

2


Our Saving Lives initiative Impact of Lifebuoy

3

31% of mothers have started washing their hands before feeding their babies

33%

64%

11% more kids have started washing their hands with soap after this program

82%

93%

4


Germs are fast evolving, how has Lifebuoy evolved to spin a fast one on the germs Germs are evolving at an alarming rate and are increasingly becoming immune to medicines Evolved germs can be defined as germs that qualify to one or more of the below criterion:

1) Anti biotic resistant strains – MRSA, E.coli ESBL, NDM-1 K. pneumoniae 2) Entirely novel strains - H7N9, H5N1, Enterovirus 71 Germs from Zoonotic origin - E.coli O104 3) Germs causing novel Infections - S. aureus Toxic shock syndrome 4) Germs Novel to region - Novel Corona virus in Middle east 5) More virulent strains of Germs - E.coli 0157, V.cholerae 0139


Lifebuoy's Innovation to avert this crisis To enhance prevention of such diseases Lifebuoy has developed a unique patented technology to avert these diseases

Developed with Activ Naturol Shield, a unique combination of pine and thyme along with the best of skin cleansing ingredients it provides complete germ protection than other germ protection soaps

Provides unmatched mild cleansing and 10X more germ protection in a realistic contact time of 10-30 seconds


Lifebuoy Clinic- care The science behind the MagiK Lifebuoy Clini-care bar is formulated with high levels of polyols to provide skin care benefits, in terms of providing skin moisturization. The milder formulation results in lower degradation of skin proteins and lipids and better moisturization.

The superior germ protection is delivered through a patent pending Unilever technology (WO 2010/046238 A1) which employs a unique combination of two nature identical molecules Terpineol and Thymol, along with the known antibacterial agent, TCN

CH3

OH

OH

H3C

CH3


More effective * against germs

Log reduction of germs 10

causing infection like Diarrhoea, Enteric Fever, Dysentery, Pneumonia

Germs associated with Stomach Infection, Diarrhoea

Enteric/

Dysentery

Respiratory Infection,

Typhoid Fever

Food poisoning

Pneumonia

Lifebuoy CliniCare 10 Competition Bar 1 Competition Bar 2


Longer lasting protection *

Residual germs on skin

against re-growth of germs on skin

No. of hours after wash Prewash

0

(hours) Lifebuoy CliniCare 10 Competition Bar 1

4

8

10


Superior germ removal (in use hand washing test)

Initial Germ

Residual Germ

Count

Count

Lifebuoy CliniCare 10 Competition Bar 1


Proven Superior Germ Removal in Real life Hand washing studies Tested and Proven to reduce the levels of different types of infection causing germs

After washing with Competition Bar 1

Versus

After washing with Lifebuoy CliniCare 10

Initial Germ Count

Lifebuoy CliniCare 10 Residual Germ

Competition Bar 1

Count

Lifebuoy Clini-care 10 soap is significantly superior compared to leading international competitor soap bar in removing germs from hands after a single wash.


More Skin care than other Bar Soaps Higher Levels of Skin moisturizers and emollients: Lifebuoy Clinic-care 10 is formulated with high levels of polyols to provide skin care benefits. This helps keep the skin moisturized, supple and healthy. Healthy skin prevents re-entry of germs and decreases episodes of infection, thus providing more complete protection. With 10X powerful humectants and skin emollients proven to moisturize and condition the skin

Better Retention of Skin Barriers with Lifebuoy: Milder/ more skin care than other bars: (determined in vitro using Zein scores)

Condition of Skin Product

Water

Ultra Mild

Healthy

Mild

Harsh

Damaged

Detergent Soap

Lifebuoy CliniCare 10 Competition Bar 1 Competition Bar 2 Competition Bar 3


Faster and Effective Reduction against Wide range of Germs Tested and proven to reduce the levels of different types of infection causing germs

Germ

Infection

Efficacy

Escherichia coli

Stomach infection, Diarrhea

Yes

Pseudomonas aeruginosa

Ear Infection

Yes

Staphylococcus aureus

Skin infection, Rashes , Boils, Blisters, Food

Yes

Bacteria

Poisoning, Ear Infection Shigella sonnei

Dysentery, Food poisoning

Yes

Kiebsiella pneumonia

Upper respiratory tract infection,

Yes

Kiebsiella pneumonia Salmonella typhimurium

Enteric or typhoid fever

Yes

Straphiococcus epidermidis

Pimples, body odour

Yes

Bacillus cereus

Diarrhea, Nausea, Vomitting

Yes

Shigella flexneri

Dysentry

Yes

H1N1

Flu

Yes

Rotavirus

Diarrhea among infants

Yes

Adenovirus

ARI, Pink eye (viral conjunctivitis)

Yes

RSV

Lower respiratory tract infection,

Yes

Viruses

common cold FCV

FCV is similar to norovirus which causes

Yes

gastroenteritis in humans NDM 1

Upper respiratory tract infection ,

Yes

Kiebsiella pneumonia MRSA

Skin infection, rashesh, boils, blisters, food poisoning, ear infection

Yes


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