Archive for the 'Infectious Diseases' category

A Look Back at the New Hampshire Hepatitis C Outbreak

May 16 2013 :: Published in Infectious Diseases

By Celia Hagan, Manager, HIV, Hepatitis, STD, TB Programs, APHL

A Look Back at the New Hampshire Hepatitis C Outbreak | www.aphlblog.org

People often associate hepatitis with intravenous drug use or getting tattoos or piercings at dirty parlors.  They think it’s something that can’t happen to them. However, recent health-care associated outbreaks in Oklahoma and New Hampshire show that hepatitis is something that we all need to be aware of.  The New Hampshire case, in particular, demonstrated how a rapid public health response can identify a hepatitis C outbreak and stop transmission.

In the spring of 2012, the New Hampshire Department of Health and Human Services, Division of Public Health Services began investigating a cluster of four people who were recently diagnosed with hepatitis C and who had been treated at the same hospital. The public health laboratory initially coordinated blood draws and performed hepatitis C virus (HCV) testing. Additionally, the public health lab performed DNA sequencing on the non-structure 5B region of the HCV genome to subtype the virus and sequenced the hypervariable region 1 of the HCV genome to determine if individuals who were infected were part of the same outbreak. When sequencing was performed on the initial cluster, the four individuals had matching HCV viral sequences indicating a common source of infection.

As the outbreak unfolded over the next few weeks, mounting evidence suggested that the mode of transmission was a drug diversion by a cardiac catheterization laboratory technologist at Exeter Hospital. The technician is accused of stealing Fentanyl syringes intended for patients, injecting his own arm, refilling the empty syringes with a saline solution, and returning the used syringes as if they were untouched. Those dirty needles were then used on patients.

Dr. Christine Bean, New Hampshire’s public health laboratory director, and Dr. Fengxiang Gao, New Hampshire’s public health laboratory virology and special testing program manager, said that in the initial phase of the investigation, where the primary concern was focused on testing patients who received care at the cardiac catheterization laboratory of Exeter Hospital, the laboratory tested 1,072 specimens. This was well over their normal testing volume of about 200 specimens per month. All testing was performed at the public health laboratory and positive specimens were sent to CDC for additional testing.  When the investigation expanded to other units in the hospital that the technician had access to, an additional 3,300 patients needed testing. Community testing centers were set up to assist with rapid blood draws. In addition to the routine testing done at the public health laboratory, the clinics offered rapid HCV testing on site and also trained sentinel laboratories on rapid testing to help with the volume. Ultimately, 32 patients were identified as part of the NH outbreak, in addition to the infected technician. As the outbreak investigation expanded to include other states where the technician had previously worked, additional cases were found.

The Molecular Diagnostics group at New Hampshire's Public Health Laboratory. This group did the hepatitis C (HCV) sequencing during the 2012 outbreak to determine the HCV subtype and HCV genetic relatedness. | www.aphlblog.com

The overall response to the outbreak from the laboratory was phenomenal.  Quick detection may have prevented additional infections. Dr. Bean emphasized that their success in responding to the outbreak depended on a strong public health laboratory system—the public health laboratory and epidemiologists working together and the public health laboratory’s capability and capacity to perform both serology and molecular tests for HCV.

In the May 10, 2013 issue of MMWR, CDC released Testing for HCV Infections: An Update for Guidance for Clinicians and Laboratorians. The updated guidelines emphasize identifying persons with current HCV infections as opposed to those who have had past infections that have been resolved and encourage laboratories to utilize newer testing technologies. The new recommended testing sequence includes an initial test with an FDA-approved test for HCV antibodies, followed by an FDA-approved nucleic acid test (NAT) intended for the detection of HCV RNA in serum or plasma if the initial serology assay is reactive.

May 19, 2013 marks the second National Hepatitis Testing Day during a month that is already dedicated to raising the awareness of viral hepatitis. The day is committed to testing people at risk for hepatitis and to educating providers and the public about chronic viral hepatitis and testing.

To find a Hepatitis Testing Event near you or to register your event, click here.

 

 

 

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Unlocking My Unselfish Gene

Apr 25 2013 :: Published in Infectious Diseases, Workforce & Professional Development

By Sharon Master, Biological Sciences Bureau Chief, Scientific Laboratory Division, New Mexico Department of Health

If I were yanked off the street five years ago and informed that I would soon be working in public health I might have been aghast, to say the least.  I was exceptionally clueless as to what public health was or what a public health laboratory did even though our state lab was located two buildings away from where I worked on campus at the University of New Mexico.  Fortuitously for me that soon changed.

Sharon Master -- New Mexico Public Health Laboratory

I have always been the blatantly curious type and, having more of a penchant for matters scientific than artistic, I left my home in India for the US to pursue my Ph.D. in Microbiology in the hopes that I could pursue my ambitions of trying to find a cure for some insidious disease.  A couple years after graduating, I returned to India where I shot into the world of clinical testing and research, with a focus on tuberculosis. Having witnessed the ravages of tuberculosis around me, I decided to make this disease the focus of the cure I longed to discover. I then hopped back across the ocean to an academic setting in the US.  After a decade or so of research with no concrete remedy for tuberculosis in my crosshairs, dwindling will-power, my rude realization that I was not really cut out for the cutthroat competition of research, and feeling overwhelmingly unmotivated, I searched ravenously for new challenges.

Serendipitously, through my network of friends I learned of a managerial position at the New Mexico state laboratory.  I interviewed for the job and got it. A little over three years have passed and I am still here as ecstatic and motivated as I can be, certain that this is exactly where I am meant to be.

Fortunately for me, my transition from academia has been relatively free from trauma as I attempt to fit into this new, fascinating world of public health, dwelling in the midst of some of the pathogens I love, while learning of others I never knew existed.  I’ve encountered a plethora of fascinating events, most of them pathogen and outbreak related, such as a plague case or two, several food outbreak investigations, and an elephant with tuberculosis, to name a handful.  On the whole, my experience has been overwhelmingly mesmerizing.

I am constantly brought back to a feeling from my early days in public health that has lodged itself in my psyche and liberates me.  It was during my first year at the state lab that I was dispatched to a national tuberculosis conference in Atlanta.  This was my first non-academic conference and, to me, wide-eyed as I was, the difference in the mentality of the conferees was astronomical.  I did not witness the furtive, egotistical, and selfish I, me, mine mentality that I experienced in the academic world but in fact observed quite the opposite.  The overall unselfish generosity, warmth, and pervading helpful attitude of the citizens of public health that I constantly bump into renders me awestruck, for the most part, and is something I try to aim for frequently.  This mind-set can be neatly summarized through a quote from Mister Spock, science officer of the USS Enterprise, “the needs of the many far outweigh the needs of the few.” With a bit of luck, in a few years I shall reach that destination of completely unlocking my unselfish gene.

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Into the Wild: Lab Edition

Apr 24 2013 :: Published in Infectious Diseases, Workforce & Professional Development

By Samantha Case, APHL/CDC EID Training Fellow, Arctic Investigations Program, Centers for Disease Control and Prevention

It looks like a scene from one of the countless reality shows based in Alaska: the main character is bundled up, but still cold. She has just boarded a small five-person bush plane after arriving to the landing strip via snow machine. Then, she takes off on a flight flying east toward Anchorage from the southwest coastal area of Alaska. She’s looking at the land beneath her, noticing how it changes from vast tundra to an intricate network of rivers and streams to beautiful mountain ranges. She’s returning from a small village of Alaska Natives where she was assisting with a public health study, and had the opportunity to hear the Yup’ik Eskimo language and purchase native crafts. Sound like an adventure? Well, it is – only I’m the main character and this is just a small part of my experience as an APHL/CDC Emerging Infectious Diseases (EID) Training Fellow.

Samantha Case -- APHL/CDC EID Training Fellow

As a microbiology major in college, I was fascinated with infectious diseases. It wasn’t until I traveled to Lima, Peru during my junior year of college that I discovered public health. I worked with a group of student volunteers to deliver mobile health clinics to impoverished communities. While others were interested in medicine or dentistry, I wanted to know more about big picture solutions that would improve health on a community level. The following year, I was able to combine my interests of microbiology and public health during a semester-long internship at the Vermont Department of Health Laboratory learning techniques in microbiology and how a public health laboratory functions. I was hooked! I wanted to learn even more so I applied to the EID fellowship program. I was ecstatic when I was accepted the following summer!

After narrowing down potential host laboratories for my year-long fellowship, I chose CDC’s Arctic Investigations Program (AIP) in Alaska because of the unique opportunity it would provide. AIP focuses on vaccine-preventable diseases and emerging infections, particularly ones that disproportionately affect the Alaska Native people. From networking with international partners for circumpolar surveillance to collaborating with local agencies here in Anchorage, AIP is certainly fundamental in enhancing public health in the state of Alaska and the arctic.

My fellowship has been incredibly diverse and has exceeded my expectations.  In addition to village trips, I have trained in traditional microbiology and molecular diagnostics within AIP. My main project involves looking at the population structure of Streptococcus pneumoniae (bacteria that cause invasive diseases, including meningitis and bacteremia), using a type of DNA sequencing called multilocus sequence typing (MLST). I have also been active outside of AIP: I rotated through the Alaska State Public Health Laboratory for two weeks, and I am currently assisting on a cellular immunity project with Alaska Native Tribal Health Consortium. I will also be training at the Alaska State Virology Laboratory in June.

When I told others I picked AIP as my host lab, I received many strange looks. People couldn’t believe I was moving all the way to Alaska from the east coast! However, I couldn’t be happier with my decision. My goal was to make the most out of my fellowship opportunity – to learn as much as possible, and to get hands-on experience in many different areas – and I have certainly done that. Each day, I work with an amazing group of people who are truly dedicated to their work, and they inspire me to continue on my path in public health.

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World TB Day: What’s in a name?

Mar 24 2013 :: Published in Infectious Diseases

By Will Murtaugh, Specialist, Infectious Diseases, TB Programs, APHL

Robert KochWorld TV Day, you say?!  Sorry, unfortunately not. But since you’re here – let’s talk about World TB Day!  So hit pause on Contagion (you know you’ve already seen it umpteen times), take a look at this guy, and read on.

This German man with the enviable uber-beard once gave an uber-exciting lecture titled “Über Tuberkulose” describing how he discovered the bacilli that causes tuberculosis (TB). He eventually won a Nobel Prize for his discovery, and now, on World TB Day, we’re supposed to celebrate!

Not yet convinced to throw on that party hat? OK, so he’s no Jude Law and maybe this wasn’t the blockbuster climax you were looking for – but the story of “Über Tuberkulose” is far from over…

Imagine that you were this shrewd-looking man surrounded by people who still believed they lived in a “miasma” filled world that caused 1 in 7 people to die with a combination of symptoms including fever, weight loss, and a prolonged productive and bloody cough.  What if this was happening to 7,000,000 people worldwide every year?  What if it was believed incurable and treatment involved being sent away in isolation to a “sanatorium” with a prescription of more fresh air?  You’d surely say,

“…my words have been unheeded. It was still too early, and because of this they still could not meet with full understanding. It shared the fate of so many similar cases in medicine, where a long time has also been necessary before old prejudices were overcome and the new facts were acknowledged to be correct….”

Or something like that – right?

This was the reality of 131 years ago.  But you can thank your lucky pipettes for a “19th Century scientist giving a speech about discovering germs in a laboratory” that the miasma fog has lifted and exposed the road to TB elimination we continue down today; one in which we can demand, “Stop TB in my lifetime”.  Specifically, you can thank Dr. Robert Koch for revealing to the world on March 24, 1882, in an oft romanticized speech, still considered one of the greatest in medical history, that TB was caused by an identifiable infectious agent, Mycobacterium tuberculosis.

So, what’s in a name?

In the case of M. tuberculosis, an infectious bacilli likely as old as mankind itself, a lot. So don’t throw on your party hats just yet.  Part of observing World TB Day is that we recognize we are still a long way from TB elimination. In 2013, we face a different set of challenges than those of 1882:

  • An increasingly mobile global community in which one-third of its population are believed to be carriers of M. tuberculosis.
  • The emergence of Multi-Drug Resistant (MDR-TB) and Extensively Drug Resistant (XDR-TB) strains of M. tuberculosis induced by improper use as a result of an expensive and long-term treatment program.
  • Systemic societal issues, including marginalized high-risk populations such as persons co-infected with HIV, foreign-born persons, the homeless and those in America’s prison system.

We recognize the progress of science, medicine and public health that has contributed to the global reduction of TB and remember Dr. Koch’s fundamental contribution in naming M. tuberculosis. Specifically here at APHL, we recognize its impact on the development of TB diagnostics used in our public health laboratories today.  Koch contributed to the development of a widely used test for detecting TB infection, the tuberculin skin test (TST, also known as PPD or Mantoux test).  Additionally, he successfully developed a method to both grow and visualize M. tuberculosis that was so valuable similar methods are still used by our public health laboratories to aid in the diagnosis of TB.  As our Mycobacteriology laboratories progress forward, detecting M. tuberculosis with faster, and more advanced technologies, they evaluate many of these tests against the methods pioneered by Koch.  Furthermore, laboratories are developing the capability to “name” M. tuberculosis in greater detail, revealing important information such as the strain responsible for an outbreak and the presence of MDR and XDR-TB.  The value of these laboratory capabilities is becoming increasingly apparent as we overcome the evolving and often overlapping challenges. Important instances of the laboratories’ continued relevance in TB control in the United Stated can be found in still ongoing events such as the outbreak in a largely homeless population in Los Angeles’s Skid Row and the detainment of a Nepalese man in McAllen, TX diagnosed with XDR-TB.

So not to worry, Dr. Koch, with the help of those funny lenses of yours, our public health laboratories see the way forward.  Party hats on!

To learn more about public health laboratories and TB, check out APHL’s TB page.  Additional information and resources for World TB Day and related events can be found at CDC’s dedicated website.

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The Newest SuperBug: CRE

Mar 21 2013 :: Published in Infectious Diseases

By Laura Iwig, Senior Specialist, Infectious Disease Program, APHL

What is this new antibiotic-resistant superbug that is flooding the news streams these days?  Nightmare bacteria?  Triple threat?  What is this monster?

On March 5, 2013, CDC’s Vital Signs featured a report describing the newest superbug circulating health care facilities around the world: Carbapenem Resistant Enterobacteriaceae (CRE). It has targeted patients in health care facilities receiving care that requires devices such as ventilators, urinary catheters, or intravenous catheters.  People receiving these treatments are immunocompromised and more susceptible to other infections.  Symptoms can include gastrointestinal illness, pneumonia, or, in serious cases, infections of the bloodstream or other organs.

Hospital bed

CRE is unlike other antimicrobial resistant bacteria.  As Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention, stated “They’re resistant to nearly all antibiotics. They have high mortality rates, killing half of people with serious infections. And they can spread their resistance to other bacteria.”

Most health departments are only beginning to look for CRE.  Many report health care-associated infections only when there is an outbreak.  As indicated in the MMWR article, only six states require facilities to report CRE infections!  This means that the true impact of CRE is not known.

What are public health laboratories doing in response?

Depending on the presence of CRE in their state, public health laboratories are either working to respond or preparing for an influx of testing orders.  The Colorado public health laboratory, for example, has collaborated with state epidemiologists to implement CDC screening procedures for CRE in response to an outbreak at a Colorado hospital.  To date, the lab has screened a total of 126 swab samples for the presence of CRE, and validated and implemented detection of two CRE genes to support identification of the nightmare bacteria.

At the same time, APHL is assisting public health labs to build CRE testing capability.  In August 2012, the association, in collaboration with CDC, selected the Indiana State Public Health Laboratory and Michigan Public Health Laboratory to develop non-automated antimicrobial susceptibility testing capability for CRE to provide confirmatory testing for clinical laboratories.  These critical projects are well underway; it is in the public’s interest to ensure that they are sustained.

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No Haven From Norovirus in Paradise

Mar 07 2013 :: Published in Infectious Diseases

By Nichole Nirei, Intern, Hawaii Department of Health, State Laboratories Division

Aloha – I am Nichole Nirei, a Microbiology student at the University of Hawaii at Manoa (soon to be a graduate joining the masses to search for a job) and an intern at the Hawaii state public health laboratory.  Although microbiology is integral to child development (vaccinations, dairy products, breads, strep throat, etc.), I had little idea that it even existed. But once I was introduced to the discipline, I became fascinated with disease and infections. Fast-forward to 2013, and now I’m trying to use my fascination to better understand infections and hopefully to help prevent disease.

What is norovirus?

2011Amanda Mills Did you know that the very simple activity of frequent hand washing has the potential to save millions of lives globally each year?Recent increases in norovirus infections and the emergence of a new strain of this short-lived, but gruesome infection have caught the media’s attention.  Noroviruses are single-stranded, non-enveloped RNA viruses that can cause pain and torment to anyone who cross their path. Characterized by nausea, vomiting, watery diarrhea and abdominal pain, these microscopic terrors are the leading cause of viral gastroenteritis, affecting everyone from babies to the elderly. In fact, noroviruses can be especially dangerous in infants and the elderly. Not only do they have spectacular symptoms, they can survive in hosts for at least two weeks after the infection and for over a year in contaminated still-water!

There are different genotypes; those that affect humans are genotypes I, II and IV.  Strains are typically named after the location where they first emerged.  For the last couple of years, norovirus outbreaks have been caused predominantly by GII.4 New Orleans but, in recent months, circulation has shifted to a novel strain, GII.4 Sydney.  This is of significance because new emerging strains often lead to increased outbreaks, more hospitalizations and more deaths. Hawaii’s state public health lab, a member of the Centers for Disease Control and Prevention’s CaliciNet, a network that uses a national database to monitor norovirus outbreaks and trends, has already documented the shift here in the Aloha State.  It will be very interesting to see which strains are dominating worldwide this season. The virus is constantly and rapidly evolving, and we need to keep track if we want to reduce infections.

Most of us have likely have had an encounter with this well-established warrior. Noroviruses are a relentless pathogen and, although no protection or immunity is guaranteed once you’ve had one, newer strains hit populations harder than those that have been circulating for a while.

To help battle this foe, we must wash, wash, wash!  Washing hands for 20 seconds with soap and water, cleaning and disinfecting contaminated surfaces with bleach-based cleaners, and thoroughly washing contaminated clothing makes a big difference.  Washing our hands is our best weapon for preventing outbreaks of Norovirus, and interrupting the transmission of many infectious diseases.  A Hui Hou!

 

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Syphilis: An Old Disease That Keeps on Giving

Feb 12 2013 :: Published in Infectious Diseases, Workforce & Professional Development

By Kelly E. Wroblewski, MPH, MT (ASCP), Director of Infectious Disease Programs, APHL

Syphilis public health campaign poster

Looking for that perfect Valentine’s Day gift that keeps on giving? How about syphilis? This Valentine’s Day, APHL and ASCLS are hosting a webinar, VD (Valentine’s Day) and Syphilis: An Old Disease Still with Us, on new testing methods for the detection of a very old disease. As is the case with many long-lasting-loves, being old does not make you irrelevant on Valentine’s Day.

What is syphilis?

Syphilis is a sexually transmitted disease that has been plaguing the globe for more than 500 years with the first documented cases occurring in 15th century Europe.  Evolutionary biologists point to syphilis as the first truly global epidemic, with multiple studies showing that the then deadly disease originated in the New World and was introduced to Europe by Christopher Columbus (who later died of the deadly disease) and his crew and quickly spread to Africa and Asia. It was not the souvenir they were hoping for. “Christopher Columbus explored the world and all I got was this deadly disease!”

Syphilis was very common throughout history until the introduction of penicillin in the 1940s.  With the introduction of this effective treatment came the United States’ first widespread public health campaign that openly promoted use of condoms, testing and treatment as a means to control the spread of syphilis and gonorrhea.  Aimed primarily at members of the U.S. military, World War II era public health campaigns focused on “responsible masculinity” and patriotism in efforts to de-stigmatize the disease.

Although case rates have remained relatively stable since the mid-1990s, there are still certain populations and geographic areas where syphilis remains a significant public health problem and public health measures to control the disease must remain constant.

Recent syphilis outbreaks in the news:

  • In September 2012 Houston, TX reported a 97% uptick in reported cases. Officials linked the outbreak to increased use of social media to find sexual partners.
  • A recent public health investigation of an outbreak in rural Kansas prompted the identification of a pregnant woman infected with the disease preventing transmission to her unborn baby. In infants, syphilis can cause blindness, deafness, and, in up to half of the cases, still birth.

Avoiding risky sexual behavior and using condoms is the best way to prevent syphilis transmission.  Testing and treatment in the early stages of infection remain the best way to control its spread. For more information on signs, symptoms and treatment for syphilis, see the CDC fact sheet.

Our advice: your special someone will appreciate chocolate and roses this Valentine’s Day rather than syphilis. Trust us on that.

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What We’re Reading: Flu Edition

Jan 17 2013 :: Published in Infectious Diseases, What We're Reading

By Stephanie Chester, MS, Senior Specialist, Influenza Programs, APHL

Flu cartoon -- Cross-country hitchhiker

Many of you have seen or heard the recent headlines: “Flu reaches epidemic level,” “Flu season strikes early,” and “Death increases, misery mounts”.  There’s no doubt that this season started earlier and stronger than the past few seasons, but it’s important to remember that every influenza season is unique. Listed below are the articles and websites we have been reading this week.

If you can only read one: This article has great information covering a lot of different issues.  It addresses common concerns and myths about flu and the vaccine; it also responds to reasons people often give for not getting the vaccine like “I never get the flu!”

What’s going on right now?

Debunking Common Myths about Influenza and the Flu Vaccine

  • Flu Shot Causes Flu? Nonsense – 4 Flu Vaccine Myths Busted: The flu vaccine is a great way to protect yourself from season influenza. Learn about the most common myths and misgivings about the vaccine — like it doesn’t cause flu!
  • Flu Season 2013: What You Need to Know: There are a lot of respiratory viruses floating around right now. So how do we know if we actually have flu and what to do if we get it? This article also has a great slideshow correcting many myths around influenza in general.

Vaccine Supply

Wash Your Hands!

We’ll leave you with one last thought for the day. While getting the flu vaccine is the best way to avoid getting the flu, washing your hands is the second best way.  Wash those hands frequently and stay healthy!  Check out this fun video to really understand why hand washing is so important: Toothbrush Prank

 

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On World AIDS Day, Do Your Part: Get Tested!

Nov 30 2012 :: Published in General, Infectious Diseases

Since the first case of what came to be known as “Acquired Immune Deficiency Syndrome” (AIDS) was reported in 1981, the disease has spread across the world in a pandemic that has killed 30 million people and infected 34 million more. World AIDS Day recognizes the strides made in the fight against the HIV virus, and the work still to be done to address gaps in access to testing, treatment and care.

Here in the US, the Centers for Disease Control and Prevention (CDC) estimates that approximately 1,000,000 people are living with HIV, with approximately 50,000 more added each year.  Sadly, over one-quarter (26%) of the new infections are in young people between the ages of 13 and 24.  Most of these adolescents and young adults (60%) are not aware of their infection status, according to CDC’s recent Vital Signs report.

What can you do to curb the pandemic, and also protect yourself and those you love? Get tested!  CDC recommends that everyone should be screened who does not know his or her HIV status.

Yes, it’s daunting to confront disease of any type, much less AIDS, but knowledge is your best protection. Early treatment of HIV infection prolongs life and prevents transmission, and for the vast majority who are not infected, testing brings peace of mind.

What’s more, it’s never been easier to get tested. Clinics offer rapid tests that provide preliminary results on-site. Over-the-counter tests, approved by the Federal Drug Administration in July, are now available at pharmacies for at-home testing. To ensure the accuracy of these tests, initial positive results are confirmed at public health, clinical and commercial laboratories.

Do you know your HIV status? If not, do your part on this World AIDS Day, and get tested. You can find the closest testing center by entering your zip code at CDC’s testing resources site.

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Beware of the Nose Pickers

Oct 16 2012 :: Published in Food Safety, Infectious Diseases

By Kara MacKeil, BA, Senior Technician, Public Health Preparedness and Response, APHL

Let’s all stop and think for a moment about why you, personally, should wash your hands.  We all agree that washing your hands is a good thing; according to the US Agency for International Aid, good hand washing can reduce death from diarrheal disease by almost half.  But you may notice that “I know I should wash my hands” often does not equal “I DO wash my hands.” (Feel free to read this if you don’t believe me.)  So in the interests of public health, I’m going to do my best to scare you all into picking up the soap.

Nose Picker

Picture the handle on the front door of your workplace (if yours doesn’t have one, skip ahead to the elevator buttons).  Who might have used this handle before you arrived this morning?  What have they all been touching before they came to work? Many have small children at home; conceivably they changed a diaper or dealt with an accident before they left the house.  Almost certainly they used the bathroom themselves.  There are numerous pet-owners, perhaps they did the morning walk or scooped a litter box. It’s cold season, so quite a few have been coughing and sneezing, and just as many have spent the last hour sitting in traffic with their index fingers shoved firmly up their nostrils.  They might have hit the sink, they might have used hand sanitizer, but they all touched that handle before you did.

Go inside and walk to your desk.  Notice that the cleaning crew has thoughtfully dusted underneath your various pencil holders, convention toys, and other objects.  How nice!  I’m sure they washed their hands before they picked up the mouse you’re about to spend all day holding. The rest of the day passes as usual.  You touch buttons on the copy machine and objects on your desk.  You pick up a pen, and wonder idly how you came to own it, since you didn’t attend the convention it advertises.  Someone must have left it on your desk.  Wonder what they touched?

Lunchtime hits, and you eat with your co-workers.  Hopefully everyone washed their hands, especially the one passing out cookies.  After lunch it’s more buttons, more objects, more mystery pens.  Someone coughs in the background, jolting you from your post-lunch stupor, and you hit the candy jar for a boost.  Just be sure to get to it before the cougher does.

You use the bathroom.  Uh-oh, there’s another door handle.  Are you sure you heard the sink when the last person finished?

Work is done, so it’s time for errands, or maybe the gym. Whatever you do, you’ll be touching things. More door handles, more objects, more nose pickers. On the way home, you realize your EZ pass isn’t in the car, and you’ll have to use cash.  Amazing how long a coin lasts, I bet THOUSANDS of people have touched that!

Here’s your front door, safe at last!  It’s late, so crawl into bed, maybe read a few pages of that great book you snagged from the secondhand bookstore.  As you drift off, try not to think about how many things you have touched today, and all the hands that touched them first. Pay no mind to all those times you touched your face.

Wash your hands!

 

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